UNFUCK YOUR BODY: Using Science to Eat, Sleep, Breathe, Move, and Feel Better

Part of the 5 Minute Therapy Series

© Dr. Faith Harper, 2021

First edition © Microcosm Publishing, May 25, 2021

eBook ISBN 9781621061434

This is Microcosm #235

Edited by Elly Blue

Designed by Joe Biel

For a catalog, write or visit:

Microcosm Publishing

2752 N Williams Ave.

Portland, OR 97227

www.Microcosm.Pub

Did you know that you can buy our books directly from us at sliding scale rates? Support a small, independent publisher and pay less than Amazon’s price at www.Microcosm.Pub

The “Sleep” chapter was originally published as Unfuck Your Sleep.

Microcosm Publishing is Portland’s most diversified publishing house and distributor with a focus on the colorful, authentic, and empowering. Our books and zines have put your power in your hands since 1996, equipping readers to make positive changes in their lives and in the world around them. Microcosm emphasizes skill-building, showing hidden histories, and fostering creativity through challenging conventional publishing wisdom with books and bookettes about DIY skills, food, bicycling, gender, self-care, and social justice. What was once a distro and record label was started by Joe Biel in his bedroom and has become among the oldest independent publishing houses in Portland, OR. We are a politically moderate, centrist publisher in a world that has inched to the right for the past 80 years.

Global labor conditions are bad, and our roots in industrial Cleveland in the 70s and 80s made us appreciate the need to treat workers right. Therefore, our books are MADE IN THE USA.

Contents

Introduction

Context and Deeper Inquiry

How the Body and Brain Communicate

Is the Vagus Nerve a New Idea?

How Does the Vagal System Work?

Recognizing Your Personal Vagal Responses

• Window of Tolerance

• Fight / Flight

• Freeze / Collapse

How Do Bodies Get Fucked Up and What Does Mental Health Have to Do With It?

Trauma

• How Trauma Shows Up in the Body (and Mind)

Inflammation

• How Inflammation Affects Our Mental Health

• Inflammation and Chronic Pain

• Some Signs of Chronic Inflammation

Toxic Environment

• Physical Symptoms of Toxic Overload

Stress

• What is Stress?

• How Does Stress Work?

• Consequences of Chronic Stress

• When Chronic Stress Becomes Worse

Unfuck Your Body

Unfuck Your Vagal System

• How to Stimulate the Vagus Nerve Directly

• The Felt Sense

• Positive Thinking

• Aromatherapy

• Pain and the Mind

Unfuck Your Stress

• Embracing Stress Through Mindset Training

• But the Key Thing About Stress....

Breathwork

This is Your Brain on Breathing

• Breathwork and Trauma Responses

• Breathing Exercises

Mindfulness and Meditation

• This is Your Brain on Mindfulness and Meditation

• Trauma Sensitive Practice

• How to do Mindfulness and Meditation

Unfuck Your Movement

• How Does Movement Help?

• The Science of Movement

• Some Movement to Try

Unfuck Your Sleep

• What Sleep Is and How It Works

• Why We Sleep

• Are You Getting Enough Sleep?

• How to Sleep Better

Unfuck Your Food

• Skinny Doesn’t Equal Healthy

• Our Food System is Bullshit

• So What’s the Perfect Diet?

• Shop Like a Lawyer

• Cost Savings Through Being Local, In-Season, and Waste-Free

• I Hate Okra and You Can’t Make Me Eat It

Supplements and Medications

• What Are Supplements

• Do I Need Supplements?

• How Do I Know What Supplements To Take?

• Supplement Safety

• The Obligatory Disclaimer About Supplements

• Some Supplements to Consider

Conclusion

Further Reading

References

More by Dr. Faith

Introduction

Where do we even start with talking about how bodies get fucked up?

We get sick or injured. Trauma takes root, directly affecting our physical body as much as our brain. Stress seizes us up. Our toxic environments and food systems poison us. We experience pain. Our immune systems freak out and we don’t know why. We have kids, or don’t. We get busy and stop exercising. Years of insomnia catch up with us. We have surgery or take medication that changes our bodies. Or, most common of all, our personal meat puppet gets older and less tolerant of our bullshit.

We can’t talk about bodies without talking about our brains, and vice versa—because our bodies and minds influence each other in every area of our physical and emotional lives.

This book is about how the body and mind communicate with each other using the vagus nerve, and the enormous role trauma, inflammation, toxicity, and stress plays in that communication and our overall health. And most of all, it’s about how we can feel better, by improving our body-brain awareness, developing habits that support the brain and body, and accessing treatments that serve our physical and mental health.

When my first book, Unfuck Your Brain, came out, there was so much about the mind body connection that I wanted to include that there just wasn’t physically the room to include. I swore that this book would follow up where that one left off.

Unfuck Your Brain is about trauma. So is this book. Trauma is a physical event, an injury to the nervous system. In that book, I did talk a little about the impact of trauma on the body (like with the physical symptoms of PTSD, anxiety, depression, and anger) and in some cases recommended physical treatments. I focused mainly on mental and emotional sources of trauma, as well as ways of working with those issues to promote healing.

But so much of trauma is a bodily experience that it merits a deeper dive and its own book. Stuff that we have known is incredibly helpful to mental health (like yoga, breathwork, somatics, and dietary changes without the BMI body shaming bullshit) as practice-based evidence is now collecting more and more data to back it up as evidence-based practice. And we are gaining ground at light speed at answering the “but why” questions of the body-mind connection. So much so, that I have to dial it down a bit and not write the 12 volume Encyclopedia of Body Unfuckening that will then be sold in late night commercials by Time Life Books (and if you are old enough to get that joke, you are as middle aged as I am).

There was some concern that if I wrote this book it would get shelved as another “change your body, change your life” diet-and-exercise regime book with tips like gargle with lavender essential oil, sleep upside down like a bat, and live on a diet of bee pollen and kale. Or whatever idea is fresh at this moment. But one thing that has happened in the five years since Unfuck Your Brain came out, is a bigger cultural awareness of the mind-body connection and how we support whole health by recognizing both. This means it isn’t weird and woo-woo for us to recognize our gut as being our second brain. Or that polyvagal theory explains so much about how our bodily reactions fuel our thoughts and feelings. Stuff that nutritionists and other complementary practitioners have been yammering on about for a century or more are now entering the mainstream with enough energy that I can tell this story with hella research and without the presumption that I am trying to sell you on a fad regime that includes wasp stings, protein powder, and astral projection.

So here is the goal. To dive into the science of the mind-body connection. To really look at how and why the body impacts (ok, actually is in charge of) our mental health. To separate fact from fiction on body-based treatments and holistic care (with the best research we have at the time of this writing) as ways of supporting/enhancing other traditional treatment options. To help us all consider what wellness looks like beyond fads and beyond bullshit cultural norms and standards. To create space to personalize a wellness plan that suits you.

We’ll also talk about a lot of practical things you can do to unfuck your body, including coping skills, food, meds, movement, sleep, breathing, and mindfulness techniques. I’m all about the practical. I also busted my booty to approach each topic without all the shame and blame crap we’re all used to getting served to us. I know these are loaded topics, but we’re going to make them all as un-loaded as possible. And you can skip whatever chapters you aren’t up for dealing with right now. There isn’t an order you need to do things, it’s all about finding what works for you.

A note about my expertise and its limits: Much of what you’ll find in this book falls into the category of “complementary medicine.” Complementary means just that: adding to, shoring up, augmenting, and helping us heal. As well as being a licensed professional counselor, I fall into the nutritionist/complementary practitioner category. I have a post doctoral certification in clinical nutrition. I’ve also trained in yoga (including trauma informed yoga), meditation, mindfulness, breathwork, and a lot of the other stuff I talk about in this book. So I recommend them with a solid understanding of what I am recommending and an understanding that they are not intended to diagnose, treat, cure, or prevent any disease. When I talk about supplements, it’s knowing that this information is based on available research and my own training coursework, not statements that have been evaluated by the Food and Drug Administration. I expect that most of you have a doctor who is an MD. I am not an MD and am not looking to replace MDs or discourage you from going to one. Your MD is doing the diagnosing and treating, I’m providing ideas that can help support your body’s capacity to heal. In my own practice, it’s just as much a part of being a trauma therapist as the talking part. Ultimately, anything in this book you try should be done in concert with a trusted medical provider and your own inner voice telling you what most nourishes you.

CONTEXT AND DEEPER INQUIRY

Much of what I write about in this book has deep cultural and spiritual roots. Western medical and psychiatric practitioners (and philosophers) have argued for over a century about how minds and bodies are connected. Historically there was no separation, meaning treatment protocols were as much about the soul or our place in society as they were the mind and body. These are roots that modern scientists keep trying to appropriate and distance themselves from at the same time, rather than appreciate and embrace.

Take this example from a peer-reviewed journal:

The psychophysiological coherence model draws on dynamical systems theory. We use the terms cardiac coherence and physiological coherence interchangeably to describe the measurement of the order, stability, and harmony in the oscillatory outputs of the regulatory systems during any period of time.

Any idea what they are talking about? They’re talking breathwork. Specifically about nadi shodhana pranayama (which already had a perfectly usable English translation, alternate nostril breathing). Oscillatory means breathing in and out. Regulatory systems? Your heart and lungs. The fuck, right?

One of my clinical nutrition professors jokingly told us that the word “herbs” chokes scientists up so badly they had to change it to “polyphenols” in order to stomach studying them. And polyvagal theory may only have existed for a few decades, except that it also exists within 10,000 years of Traditional Chinese Medicine, in forms still used today.

Dr. Candace Pert once said that scientists would rather use each other’s toothbrushes than each other’s words. But in this case it goes even deeper than branding. As I mentioned above, there is a distancing from the cultural roots of these earlier modes of healing. The bestseller The Relaxation Response, first published by Herbert Benson in 1975, intentionally decoupled spirituality from transcendental meditation in order to encourage non-Buddhist individuals to use it for its health benefits, essentially cherry picking from a religious practice.

But here’s the thing—you don’t have to ascribe to a belief system to have a deeper experience (and appreciation) of a practice. I worked hard to acknowledge these roots throughout the book, but reviewing 10,000 years of Traditional Chinese Medicine isn’t practical. I tried, my editor said “girl, no.” And honestly, that work has already been written way better than I could have written it.

So here is my invitation and encouragement to explore deeper. If you already have practices that you engage in, or if you find some in this book that you connect with, you will gain more from the practice by recognizing how it developed in context. For example, I would encourage my yoga people to read books like Embracing Yoga’s Roots and The Myths of the Asanas. At the very least, we will have a lot fewer people ending class with “namaste,” which is actually a term used in greeting.

There isn’t much new under the sun, and we can always benefit from learning about the practices that have provided so much healing across so many generations, right? Respecting what inspires us and heals us is never wasted time.

How the Body and

Brain Communicate

Our bodies and brains really are not separate things, even though they are typically treated thusly. We tend to think of the body as the meat sack the brain is in charge of hauling around, when in fact they are as dynamic and interrelliant a duo as Grace and Frankie.

One of the major pathways of brain-body communication is the tenth cranial nerve, otherwise known as the vagus nerve, (historically referred to in Traditional Chinese Medicine as the du channel) which serves as the foundation of polyvagal theory. All methods of body-brain intercommunication appear to organize through this channel.

The vagus nerve is the part of us that most of this book rests on. It’s the nerve that physically creates the mind-body connection, linking your brain and your gut and the rest of you. It’s the body’s communication system. It’s how information, inflammation, and relaxation spread. And because our whole body is involved in our emotional health, understanding the vagus nerve helps us understand both our physical health and our emotions, and how they are connected. In the next part of the book, we’ll look at trauma, inflammation, stress, and toxicity and how the vagus nerve mediates them all.

The vagus nerve’s information flow is designed to help us stay alive and stay safe. But like every other safety process, it is designed to err on the side of caution by embedding memories of past threats and overcorrecting juuuuuuust in case something might be dangerous. Hence, the prevalence of trauma-informed responses and fuckery galore.

In this chapter, we’re going to take some extremely fancy science and boil it down into something a normal-but-nerdy-enough-to-be-reading-this human can understand. If you can understand these ideas, then you’ll have the key to understand so much about how our bodies and brains work, how they get fucked up, and how they can heal.

IS THE VAGUS NERVE A NEW IDEA?

First, a little bit of history. Because vagus theory is seen as cutting edge in the scientific community right now, but it goes back thousands of years.

We’ve known forever that there is a governing mechanism that delivers information throughout the body to include the brain. The oldest records we have of a singular, governing bodily system are from the Mawangdui (206 BC – 9 AD) and Zhangjiashan (196–186 BC) tombs of the Han-era Changsha Kingdom. These texts describe 11 pathways that carry the same names as the acupuncture meridians described in later works. The idea that these meridians are pathways through the body in which our vital energy (Qi) circulates. They are still widely used today in Traditional Chinese Medicine to treat a wide array of ailments, physical and mental.

The idea of a singular, governing system within the body wasn’t missing from Western culture, either. In 1543, Flemish anatomist and physician Andreas Vesalius, the “father of modern physiology,” wrote and illustrated a seven-book series called On the Fabric of the Human Body that included amazingly detailed drawings of the nervous system showing a mind-body connection similar to what Chinese physicians had long been aware of.

Back in 1872, Darwin wrote specifically about the expression of emotions, noting the bi-directional neural relationship between the brain and the heart. But the founders of modern psychology and mental health treatment must not have read this, or done the thing scientists have been doing since the beginning of sciencing—ignoring anything that didn’t fit their paradigm.

The work that did fit this new, modern research paradigm? The work of British physiologist John Newport Langley, who wrote the “definitive” guide to human physiology in 1921 (still in the middle of the emerging field of psychology) which shifted the whole focus of physiology away from the idea that our brains and bodies are in constant communication back and forth with each other. Modern medicine was the future, therefore studying how X pill affects Y organ became the standard practice.

It wasn’t until the 1990s that a research scientist named Stephen Porges started studying the autonomic regulation of preterm infants, which led to a serious reexamining of how our bodies affect our brains and vice versa throughout our lifespan through the central organizational structure of the brain-body connection.

HOW DOES THE VAGAL SYSTEM WORK?

The vagus nerve is the information highway between the emotional-cognitive centers of the brain and the body, including our intestinal functions.

Right off the bat, one of the most important things to know about the vagus nerve is that it swings both ways (heh): It carries information and activates response both from the brain to the body and from the body to the brain. We like to think of the brain as being in charge, but we have four times more messages going up to the brain rather than down from the brain—80% of are body-to-brain (afferent messaging), and only 20% is brain to body (efferent messaging).

Junior high science flashback: Nerves are cells that have special communication functions. Like telephone lines that run all over your body, they communicate throughout the body as bioelectrical signals. Like, what happens if you touch a hot thing? The nerves in your hand send a message of “FUCKING OW!” to your brain, which then sends a message back saying: “WELL PUT IT THE FUCK DOWN THEN! THAT’S THE LITERAL MEANING OF DROP IT LIKE ITS HOT!!!”

Nerves exist throughout our body and serve to transmit electrical impulses for intra-body communication. Our sensory and motor functions in the body are specifically tasked to 12 cranial nerves. Some of these cranial nerves are super specific. Like the olfactory nerve, unsurprisingly transmits information about what we smell to our brain. But number 10 of 12, the vagus nerve, is the longest, weirdest, and most complex of the twelve pairs of cranial nerves. The name itself (vagus) comes from the Latin word for “wandering” because this nerve wanders all around the damn body, sending information to organs and tissues. It wouldn’t be irrational to say that this particular nerve is an information superhighway.

This? The Fancy Fucking Diagram of the Vagus Nerve. So You Can See How the Brain Communicates with Every Major Organ in Your Body. No Pressure to Remain Calm Then, Right?

Nerve cells don’t just bop around aimlessly like your useless ex. They are organized into systems. Nervous systems are the networks of the nerve cells and fibers that transmit messages. These systems make the messages transmit more efficiently. So that you will, indeed, drop it like it’s hot when need be.

Now while the vagus nerve is the messanger for an entire nervous system, it is only one of several nervous systems that create the entire human nervous system. So, the human nervous system can be broken up into the central nervous system (brain and spine) and the peripheral nervous system which connects the brain and spine to the rest of the body. The peripheral nervous system can be split again into two parts:

- The somatic nervous system, which we have voluntary control over

- The autonomic nervous system which is the part that we do not have voluntary control over, which regulates all of our organs and endeavours to maintain bodily homeostasis

Bodies. So complex and so dumb at the same time. Am I right?

The autonomic system is the one we are focusing on in this book. All autonomic means is self-governing. These nerves work involuntarily and are not under conscious control. So you are not allowed at any time to decide whether or not you are going to drop the hot thing. That’s the kind of shit that will get you killed. Your body is not interested in negotiation, shit’s just getting dropped. You’re starting to feel me on why this is important info, yeah?

The autonomic nervous system has three components: the sympathetic, parasympathetic, and enteric nervous systems. And the vagus nerve is their communication pathway. It’s important to understand how they work in relation to each other.

The sympathetic nervous system governs our fight-flight-freeze instinct, which is critical to our survival. It is activated in the face of a threat or perceived threat, whether it be to our actual, physical safety, the individuals we love and care for, our possessions, or our needs, wants, desires, well-being, and belief systems. Essentially, anything that challenges the core of who and what we are and who or what belongs to us invokes a protective response. It has nothing to do with how mentally or physically strong we are or how much we love the person or people that we are with. That ability to be engaged and connected goes offline.

If we perceive aggression as a means of escape, we will fight. If our instincts tell us we can’t fight effectively but we can escape, we will flee. If neither of these responses are likely going to be effective, we will freeze.

All of these strategies, even fighting, are purely defensive ones. The intent is not to win against or overwhelm the threat, but to survive. The body’s job is to size up the situation and figure out the best means of staying alive. It chooses a strategy based on the information it is receiving and past understanding of the threat. We may move back and forth between strategies as we take in information and gauge our effectiveness at managing the perceived imminent threat. All three responses are part of our defensive, survival instincts.

I’m focusing so much on the freeze response (official science-y term: dorsal-vagal response) because it’s talked about the least. And it’s the one that most human beings are embarrassed about, although it makes just as much sense as a protective strategy as fight and flight do. It’s also the most physically dangerous: the freeze response can actually kill you if it goes on too intensely, too long.

So why does the body do something so dangerous? Peter Levine (until Porges, he was one of the few theorists to talk about the body’s survival mechanism and trauma) states that there are four potential evolutionary survival benefits to the freeze response:

• Most predatory animals won’t eat an animal they believe is already dead unless they are really hungry. Most animals have encoded information that meat that is already dead may be spoiled and therefore is a risk to eat.

• It is more difficult for predators to detect prey that is not moving. Immobilization shuts down all movement responses. Even if we are trying to be still and quiet it is difficult to do so unless we have become biochemically immobilized.

• When one animal collapses in a group, this distracts the predator from the rest of the group, allowing their escape.

• The freeze response releases a numbing agent in the body that makes the pain of attack more bearable.

Now obviously, it makes sense that the sympathetic nervous system should not be in charge all the time. It would make us fall apart at the seams pretty quickly (and this is why people who don’t have conscious ways to cope with chronic stress do fall apart at the seams pretty quickly).

Our second nervous system, the parasympathetic nervous system, is the one associated with social relationships and bonding. We’re pack animals. We need to connect to other human beings for long-term survival, not just for mating season, and be able to navigate the world without feeling batshit crazy and threatened by our surroundings all the time. Being relaxed and alert is how we best engage with the world around us. This means that when the parasympathetic system is in charge, we are able to connect and communicate and form social relationships because we feel safe to do so.

The foundation of Porges’ research on the vagal system is the finding that our nervous systems work in ranked order (a hierarchy). Safety and connection and relationships—the functions governed by the autonomic nervous systems— rank highest on the hierarchy. But because these processes are managed outside of conscious thought, our ability to remain calm and engaged and relational is the first thing we lose when our bodies perceive threat. In order to be our best selves, to live and work in cooperation and build relationships, our bodies have to perceive us as being safe.

But when something challenges our sense of safety at a bodily level, the parasympathetic system goes offline. This works because the sympathetic nervous system is myelinated, while the parasympathetic nervous system is not. I know, I know with the science textbook words, but this is actually an important point. Myelination provides insulation, which speeds up the sending of the messages. So the nervous system that is in charge of our stress response works faster than the one that is in charge of our chill response.

Both systems operate involuntarily. And the sympathetic nervous system has to be turned off for the parasympathetic nervous system to work, meaning it has to determine that there is no stress or threat and that you are allowed to go about your day. But even when it’s not running the show, the sympathetic nervous system is still humming in the background, watching for danger. And it works faster than the chill system, so it will shut shit down on a moment’s notice.

Any of us with unresolved trauma histories are far more likely to have our parasympathetic systems go offline, putting us into survival mode. We’ll get more into this in the trauma chapter coming up next.

The stomach is called the second brain for a reason. The third part of the autonomic nervous system is the enteric nervous system, which resides in the gastrointestinal tract and is the largest of the three autonomic nervous systems and has its own unique microcircuits. It receives feedback from the other two systems but is also able to operate independently of them. There are people out there with severed vagus nerves and their enteric nervous systems work just fine. This is some zombie science shit.

Because many neurotransmitters, signalling pathways, and anatomical properties are common to the enteric nervous system and the central nervous system, it’s safe to say that the vagus nerve is actually messaging our “gut feelings” to the brain.

And those gut feelings are loud. Our internal bodily state is communicating continuously with the brain far more than the brain is communicating back with the body (4 to 1, remember?). The brain is dependent on the physiology of the body to manage our breathing, our heart rate, whether or not we are hungry or full, and the nervous system activity related to our emotional states. This isn’t something we think about (pun intended), which is why Dr. Candace Pert, the neuroscientist who first became known as the person who discovered the opiate receptor in the brain as a freakin’ undergrad, stated that the entirety of the human body operates as the unconscious mind.

If the vagal system is the body’s information superhighway, how exactly does that relate to stuff like being scared, activated, or experiencing a trauma trigger? We know that memories of past events are stored in the amygdala, but how exactly is that memory file being pulled up? Is it just within the brain or is it also in the body?

Dr. Pert’s research described and explained how human moods, feelings and emotions are mediated and experienced through peptides. Peptides are made up of amino-acids (the organic compounds that combine to form proteins in the body) but can be best thought of as information substances because their common function in any form is to distribute information throughout the body.

Yes, there is a high concentration of peptide receptors in the amygdala. But there are also high concentrations of them at the back of the spinal cord (vagus!) and any place in the body where information about the five senses enter the body (vagus vagus vagus!). Peptides are what activate the vagal system in order to send and receive messaging. Our body-mind is using peptide cues to choose or discard both emotions and behaviors. And the vagal system is the mechanism for how the information travels.

This is how, as Dr. Pert put it, traumatic emotional events put down deep roots in the body, not just as episodic-autobiographical memories. She noted that “while we may not remember something consciously, the psychosomatic network in the body does.”

And that, smart cookie, is exactly why we’re talking about this in so much scientific depth. Your feelings are real. It’s not a made-up discomfort, it’s biochemical and bioelectrical messaging happening between your body and mind on a constant basis. And the system is wired to err on the side of caution to keep you safe. So if you have been through some deep shit, your whole body becomes wired with a hair-trigger invader detection system. That doesn’t mean healing is impossible. It’s completely fucking possible and I see people do it every day, which is why I love my job so much. But we have to understand what healing entails for the entirety of the body, how to change our relationship with past events in our lives, and how to move forward as healing survivors.

RECOGNIZING YOUR PERSONAL VAGAL RESPONSES

Ok, so there was a lot of blahblahblah about scienceblahscience. We’re about to get into a whole lot of the ways your vagal system can get fucked up, but before we do that let’s start putting this knowledge into practice so you can recognize what’s going on in your own body.

You’re going to see the lolwut-inducing term vagal tone quite often throughout this book. So just to let you know now, that really just refers to the activity of the vagus nerve. It’s ability to communicate quickly and effectively. The better it’s ability to communicate, the healthier we are both physically and mentally. The word tone comes from how the effectiveness of vagal communication is measured in terms of heart rate variability, which is interesting (to me) and super-techy and not important to this discussion (for everyone else).

Our body’s vagal response has an array of “options.” Visualize a series of light switches, with “safe” in the middle and “too low” on one end and “too high” on the other, and a couple of switches in between for when you’re moving down or up.

Remember how I said fight, flight, and freeze all of these responses are survival instincts, and your body is going to read the room and choose the physiological response that makes the most sense? Porges’s work visualizes the response options as existing on a ladder, which presumes that we enter and exit certain states in a certain order. I’ve found this personally confusing and instead use the visualization as a series of flip-switch options rather than a spectrum.

Depending on the level of threat detected and previous experiences, the body will flip one switch rather than another which is why you can go from fight/flight to complete collapse so quickly. The body has to make snap decisions. I have worked with people who only freeze up, others who only fight, and people who run the gamut. Remember how I mentioned earlier it’s about what the body recognizes is its best bet for survival or pain management?

On the “too low” end of the spectrum, you have the freeze/collapse response switch, scientifically known as the Dorsal Vagal response. On either end is the sympathetic nervous system switch. On the “too high” end, you’ve got your fight and flight responses, or as we call it “SNS Engaged”. In the safe center, you have your window of tolerance switch, where your vagus nerve sees no threat and your parasympathetic nervous system is engaged. That’s your baby bear just right switch. Like any spectrum, there are shades in between—you can be activated down into dorsal vagal or moving up into SNS and notice that and bring yourself back into your window of tolerance if you need to. That’s what we’ll be working on here.

Our goal is to stay within our window of tolerance, and learn to expand our window of tolerance as much as possible. In a perfect world, we would become activated enough to deal with potentially threatening situations, but we wouldn’t become SNS Engaged or Dorsal Vagal unless we were under a real attack, right? But a trauma response trains our bodies to presume attack based on the traumas we experienced. So it may not be real in an external world sense, but is very real to our internal world.

Window of Tolerance

In our our window of tolerance state (ventral vagal), our muscles are relaxed, our breathing is easy, our heart rate is resting, our blood pressure is normal, our skin is our “normal” rosy hue (which is obvs different for everyone, but there is blood flow to the skin enough to give us some color), our pupils are normal sized, our eyelids are relaxed, and our digestion is functioning. Our eyes and mouth are moist and our skin is dry. We can differentiate individual sounds from background noise (the muscles of our middle ear have tone). Emotionally we are calm. We can feel love and pleasure. More complex emotions are bearable (e.g, we can be sad or frustrated but process through the experience with a sense of it being manageable). Our prefrontal cortex (thinking brain) is engaged. We are able to connect with self and others, and feel integrated within our own bodies. Our parasympathetic nervous system is in charge and it’s doing a great job.

Think about:

• What signs tell you that you are in your window of tolerance?

• What activities, coping skills, and behaviors help you remain in your window of tolerance? Which can you do for yourself? Which do you need support from others to do? Who are your go-to support people?

Fight / Flight

As we start getting into the the danger zone heading toward fight or flight (with our sympathetic nervous system activated), our muscles become more tense, our breathing gets faster and comes more from our upper chest (hyperventilation), our heart rate and blood pressure go up, our skin gets paler (under whatever level of melenation we have) because blood is rushing to our muscles away from the skin, our pupils become dilated, our eyelids get tense, and our digestion halts (this is why the dorsal vagal is called fight/flight and ventral vagal is referred to as rest/digest). Our eyes and mouth start to become dry while our skin starts to get sweaty (though it may be a cold sweat). Sounds become overwhelming, and it becomes harder to pick out individual voices (we lose tone in the muscles in our middle ear to make it easier to pick out low frequency predator sounds). Emotionally, we start to feel angry or fearful and our ability to connect with others becomes increasingly limited and eventually not likely. Concomitantly, our thinking brain goes increasingly offline and we find it more and more difficult to connect to our own bodies.

Think about:

• What signs tell you that you are in fight or flight mode?

• What helps you move out of this response and back into your window of tolerance? Which can you do for yourself? Which do you need support from others to do? Who are your go-to support people?

Freeze / Collapse

As we move into the shutdown state of freeze mode (dorsal vagal activated), our muscles become rigid instead of tense, and we will move from hyperventilation (getting too much oxygen) into hypoventilation. Our breathing and heart rate can bottom out to very slow (bradycardiac). Our blood pressure will also get very high and then bottom out. Our skin will often become even paler, our pupils get very small, our eyelids will start to move from very tense to either completely closed or stuck open. Our eyes and mouth will get very dry and our skin may go from extremes of hot to cold, though will eventually become very cold if we continue in this state. All auditory stimuli can become loud and overwhelming and you may shut all sound out completely because of it. Emotionally, we may feel terror or complete dissociation. Our thinking brain moves into being inaccessible, and connection with others and our own bodies moves to being impossible.

NOTE: Once you are in hypofreeze (bradycardia) this is now a medical emergency, and emergency medical care is required. You’ve probably heard about seeking medical attention if someone is “in shock” and that’s exactly what’s going on here.

Think about:

• What signs tell you that you are in freeze mode?

• What helps you move out of this response and back into your window of tolerance? Which can you do for yourself? Which do you need support from others to do? Who are your go-to support people?

In the second half of this book, we’ll have a ton of exercises aimed at recognizing that your body is reaching for a particular switch, when it’s been flipped and how to work with that state, and how to expand our personal windows of tolerance. But first, let’s go into some of the reasons our vagal system regularly goes wonky to begin with.

How Do Bodies Get Fucked Up and What Does Mental Health Have to Do With It?

I think everyone feels that their body is enemy territory. We feel a sense of frustration and even failure at our inability to “be healthy,” by whatever health standard has been established in that regard. And while there is a lot of information out there on how to “be healthy” so much of it is contradictory and extreme and unhelpful. And it rarely takes into account how much our bodies are taking in that is really out of our control.

The reason I carry such a big purse all the time is that I have a multitude of soapboxes I insist on dragging along with me. One of the biggest of the boxes involves all the systemic ways humans struggle with physical and mental health issues that have little or anything to do with their personal choices.

Yes, I know. Mainstream media will insist otherwise. As will a lot of medical and health practitioners. Or programs trying to sell you a new smoothie as a quick fix. When reality is so fucking complicated that everything I am about to cover is only the tip of the iceberg.

But first things first. I want you to take a couple of pieces of scrap paper and write “because fat” one one and “because lazy” on another. Now crumple them up and throw them away. Or stomp them. Or set them on fire (but safely, of course).

Because bullshit.

While dietary changes and movement can help us combat the systemic problems I’m about to throw down about, oversimplification and victim blaming have no place here. I am so over that bullshit and I hope you’re with me.

Now, we all know our food system is crap. And the crappier it is, the more it is subsidized. The Standard American Diet is SAD for a reason. And if you are poor? You are so truly, deeply fucked within the current system, I don’t have a purse or a soapbox big enough to even begin to get started. But this is stuff we all know, and I want to go even deeper than “genetically modified soybeans, amiright?” because it’s bigger than all that and the solution-generating depends on understanding it.

But before we start getting granular with doable solutions, let’s get into the physical mechanisms that are causing body fuckery to begin with. The biggest culprits? Trauma (surprise!), inflammation, environmental toxicity, and our relationship with stress.

TRAUMA

Short answer: It’s trauma. It’s always the fucking trauma. Trauma is something I write about a lot—it’s the whole point of these books.

When we talk about our five senses, we talk about how we use them to organize information from the outside world, but rarely do we use them to register what is going on inside of us. In reality, we are receiving internal sensory information on a constant basis but are rarely connected to that experience simply because that’s how bodies are supposed to act. All of it. Walking, talking, breathing, avoiding a crack in the concrete that we could trip over, recognizing that the milk is spoiled as soon as we open the container and not drinking it. It would take too much of our physical and mental effort to do all of these things consciously and continuously. These behaviors have to be automatic for our survival.

But what if the correction process has become trauma informed?

Sometimes the wiring goes wonky. You know. Our body and mind are over-eager and over-protective and start sending haywire messages that are overanalyzing current experiences and anticipating dangerous and damaging future experiences based on our past experiences.

That’s the very definition of a trauma response.

Any living animal will respond to changes in light and shadow. From amoebas to Homo sapiens, we perceive threat and duck. The difference between us and amoebas is that we can (at least on a good day), become aware of our instincts and challenge the efficacy of our ducking patterns. This means being more aware of the interplay between our external and internal sense messages. And learning to tolerate our duck response without needing to always duck.

We need this duck response to survive. But sometimes it gets stuck on. And when it sticks around for the long term, we call it PTSD, which is a fear response that gets switched on but never gets switched off.

PTSD can come from one specific terrible event, which is what the psychological establishment defines it as, but it also can come from a ton of bad things adding up.

Trauma and PTSD are widely recognized as a major factor in our mental health. But they are very much bodily reactions, which is why this book exists.

Of course, trauma affects our health at all stages of life, but childhood trauma is more likely to change our epigenetic structure, according to a 2014 Yale University study. The world is unsafe from the get-go, and when things happen to us as kids—either one big event or a lot of bad things—our stress response gets set to high alert, which can persist through our adult life if left untreated.

One term being thrown around on the regular now to account for the impact of childhood trauma on our bodies is “ACEs.” An ACE is an “adverse childhood event” which is a fancy way of saying childhood trauma. The Center for Disease Control and Kaiser Permanente conducted one of the largest research studies on the impact of ACEs on health and well-being over the lifespan, and developed a questionnaire which is widely used for determining how much childhood trauma might be a part of your life now.

The ACE questions are looking for information about your life prior to your 18th birthday, specifically regarding, abuse, neglect, and what are termed household challenges. Abuse questions ask about physical, emotional, and sexual abuse. Neglect questions focus on physical and emotional neglect. And the household challenges include having family members with a mental illness and/or substance dependence, having family members incarcerated, witnessing interpersonal violence, or witnessing separation and/or divorce.[1]

Researchers have linked ACEs to the onset of chronic conditions and early death in adulthood. The more ACEs that occur, the more an individual is at risk for negative health outcomes. If you experienced an ACE (just one!), you are twice as likely to suffer depression. And also twice as likely to suffer cancer, heart disease, and diabetes.

Studies have also shown that ACEs mean you are far more likely to suffer with migraines and irritable bowel disease, as well. Women who’d faced three types of childhood adversity had a sixty percent greater risk of being hospitalized with an autoimmune disease as an adult. Suffering six categories of early life stress shortened one’s lifespan by twenty years. ACEs are also tied to the adoption of health-risk behaviors (smoking, not exercising, eating gummi worms instead of broccoli, etc.).

So the CDC looked at the data and came up with a fancy explanation for the data. They created a graphic[2] that endeavored to explain the relationship of ACEs to the physical and mental health issues that we see co-occurring with them. It shows a pyramid with ACEs at the base, and then several levels building on each other, starting with social, emotional, and cognitive impairment, leading to the adoption of health-risk behaviors, which produce disease, disability, and social problems, all culminating in early death.

I call bullshit.

This model leans heavily on the trope that trauma fucks us up so we don’t take care of ourselves. The implication is that we are fat and lazy (and whatever else), which is making us sick. Because of trauma, sure, but it is still very victim-blaming.

This graphic refers to research gaps that seem to show that science doesn’t know how ACEs lead to impairment or how that leads to risky behaviors. This is bullshit too. By the time the CDC published this graphic in 2014, there were already plenty of studies to explain what was going on and there are even more studies backing up the understanding that trauma alters the immune system and metabolic system and these changes persist over time, increasing our chances of developing disease. Everything that we have discussed in terms of upregulated inflammation and vagus system messaging can also be ACE-activated.

The body does not differentiate how it responds to physical and emotional trauma. We already recognize that if we are in a car accident, and our chest hits the steering wheel, that causes pain and inflammation, and that injury can lead to more health problems down the road. And now it is time to recognize that growing up in a household where you didn’t feel safe and loved and secure causes the same pain and inflammation.

That’s a little heavy, I know. When I teach this class, people generally need a minute to breathe.

What we also need to know, though, is that just like we can treat physical injuries and recover from them, emotional injuries aren’t our destiny either.

How Trauma Shows Up in the Body (and Mind)

How do you know you’re dealing with trauma?

Once you start operating from a trauma-informed experience (whether full blown PTSD or not), you can see signs of the following in your life as the brain’s way of managing your trauma with adaptive strategies. Which is just a grad school way of saying we create great ways to avoid our trauma responses so we don’t have to deal with them. But it’s a foundation that was built on unsteady ground. Cracks start to develop.

• Arousal – The amygdala is always wearing its crazy pants and you find yourself freaked out when you shouldn’t be or don’t want to be. You may or may not know why. Your heart is racing, your breathing gets weird, your muscles get tense—you are shifting out of your zone of tolerance.

• Avoidance – You find yourself avoiding things that trigger arousal. Grocery store was bad? I can order my groceries online. Really don’t need to leave the house for groceries, right?

• Intrusion – Thoughts, images, and memories related to the trauma experience start shoving their way up. The things that your brain was protecting you from don’t actually go away. And they start bubbling to the surface without your consent or willingness. This isn’t the same as rumination, where you worry over a bad memory intentionally; instead, stuff shows up when least expected. And you can’t manage everything that is bubbling up.

• Negative Thoughts and Feelings – With all this other stuff going on is it any wonder that you never feel good? Or even just okay?

These are the essential four horsemen of the PTSD apocalypse. It’s how we diagnose full-blown PTSD. When they’re present, it means that at some level you are reliving your trauma in your head at any given moment.

Not everyone having a trauma response has full-blown PTSD. A PTSD diagnosis is a checklist in the end. And someone who is giving a diagnosis is asking if you have X number of these symptoms or not. Some people meet some of the criteria for PTSD but not enough to warrant a diagnosis. But not meeting criteria for PTSD does not put you in the all-clear or make you magically feel any better, right? You are clearly not okay now and there is a pretty damn good chance that it is gonna get worse.

Ok, then. What kinds of symptoms do we need to watch out for? Good question, smart cookie! The list is a pretty long one.

Reliving the Trauma Symptoms:

• Feeling like you are reliving the trauma even though it’s behind you and you are physically safe. Not just thinking about it, but your body is reacting as if it is happening in the present.

• Dreaming that you are back in the traumatic event (or maybe a similar event).

• Having a huge emotional response when something or someone reminds you about the trauma. Like freaking the fuck out, even though you are currently safe and/or having lots of physical symptoms (sweating, heart racing, fainting, breathing problems, headaches, etc.)

Avoiding the Memories of the Trauma Symptoms:

• Doing things to distract from thoughts or feelings about the trauma, and/or avoiding talking about it when it comes up.

• Avoiding things associated with the trauma, like people, places, and activities. And a lot of times these areas of avoidance get bigger and bigger. Like avoiding a certain street that an accident happened on. Then the whole neighborhood, then driving in a car at all.

• Needing to feel in control in all circumstances, like sitting in places that feel safest in public places, not having close physical proximity with other people, avoiding crowds.

• Having a hard time remembering important aspects of the trauma (blocking shit out).

• Feeling totally numbed out or detached from everything or just about everything.

• Not being interested in regular activities and fun stuff. Not being able to enjoy shit, even if it should be enjoyable shit.

• Not being connected to your feelings and moods in general. Feeling just . . . blank.

• Not seeing a future for yourself, like just more of the same versus things getting better.

Other Medical or Emotional Symptoms:

• Stomach upset, trouble eating, only craving foods that are sugary (therefore more comforting to a stressed out body)

• Continuously stressed out, and unregulated and out of your zone of tolerance for most of the time or all of the time.

• Trouble falling asleep or staying asleep. Or sleeping a lot but for shit. Either way, feeling fucking exhausted all the time. Having intrusive traumatic dreams even in your sleep.

• Not having enough fucks in your pocket to take care of yourself in important ways (exercising, eating healthy foods, getting regular health care, safer sex with chosen partners).

• Soothing symptoms away with substances (e.g., drugs, alcohol, nicotine use, food) or behaviors (e.g., gambling, shopping, or dumb endorphin-producing shit like playing chicken with trains).

• Getting sick more frequently, or noticing that chronic physical health issues are getting worse.

• Anxiety, depression, guilt, edginess, irritability, and/or anger. (A huge number of mental health diagnoses are really just a trauma response that is not being properly treated, sadly.)

Is it any wonder that we get all confused about what is a trauma response versus some other diagnosis? So the easy diagnosis is PTSD. But trauma responses, like I mentioned above, can wear a Halloween mask of other stuff. Depression and anxiety are two big ones. Autoimmune diseases and chronic pain are also really common. Heart disease and high blood pressure can also have emotional trauma roots.

There is nothing wrong with any of these other diagnoses in and of themselves. These are all serious diagnoses that need to be treated appropriately. And these diagnoses can absolutely exist on their own, without a trauma trigger. But the problem with getting real help is when trauma is one of the root causes.

And that is how we set ourselves up for failure. Trauma-related diagnoses are actually more successfully treated than many other mental health issues, and can be an integral part of treating chronic medical issues as well if we understand what the symptoms are in response to and handle them in that context.

Unfuckening is a completely possible thing.

INFLAMMATION

Inflammation is another one of those buzzwords that you hear all the time and to be fair, nutritionists looooove to blame inflammation for everything, sorry about that. We have this idea that inflammation is inherently bad and is to be avoided. In reality, inflammation is just as important and life saving as our fight/flight/freeze responses. Inflammation is the result of our bodies fighting off infection and external invaders like viruses and bacteria. This fighting-off battle is mediated substantially by chemicals in our body called cytokines that signal our white blood cell count to rise and the like. And? That inflammatory reflex response in the body? Is mediated by the vagus nerve.

As with the vagal system, the body remembers past threats and can stay upregulated long past when you need to fend off attackers. Cytokine production can get stuck on, resulting in chronic inflammation. Chronic inflammation leads to tissue damage, disease susceptibility, and autoimmune issues. The World Health Organization recognizes that chronic inflammatory diseases are the most significant cause of death in the world.

Inflammation can result not just from physical injury, but psychological injury—like trauma. And chronic inflammation leads to this higher risk of diseases. High rates of inflammation are found not just in individuals with heart disease and cancer and autoimmune disorders, they are found in individuals with diagnoses of PTSD, OCD, depression, and anxiety disorders. According to a 2012 study in Biology, biomarkers for inflammation are higher in individuals who have experienced adverse events.

So, I’m gonna say this again because this is one of those “thesis statement” ideas that I want to stick with you even if you don’t remember fuck-all about the rest of this book. The body responds to physical trauma with inflammation, right? If you smash your thumb with a hammer (by accident, not a suggested experiment or anything) it hurts like a motherfucker and it becomes inflamed to protect the area while it is healing. The body also responds to emotional trauma with inflammation. The body doesn’t differentiate where the injury is coming from or the type of injury it is. Inflammation is part of the body’s healing mechanism and it responds to physical and emotional injuries in the same way. We need this response in order to be able to rest and recover after an injury.

Another important thing to know is that this response majorly slows us down. If the body recognizes itself as injured—physically or psychologically—its first line of defense to ensure healing is to conserve energy for the healing process. In order to make sure that that energy is available, it reduces our natural drive to perform other tasks, even simple stuff like taking a shower and brushing our teeth, because task performance takes energy.

In fact a study from Emory University found that inflammation doesn’t just make us tired and sore, it directly reduces the dopaminergic signaling system in the brain, which assists us with a multitude of tasks including spatial working memory, cognition in general, motor function and other shit humans need... and is a necessary part of having the energy and motivation to do shit. Fancy terminology? The body engages in an immune-mediated disruption of the dopamine pathways using inflammation as a mechanism to decrease dopamine production.

How would the world be different if we recognized that inflammation is stripping away our ability to “function normally?”

Our microbiome (that’s our bodies’ internal soup of bacteria, fungi, and viruses, both helpful and harmful) changes constantly throughout life based on our exposures. These exposures include toxins (that’s the next chapter), foods (which can operate like toxins), and our stress hormone cascade (which is a whole complicated process in and of itself therefore has its own upcoming chapter, exciting right?).

Inflammation problems often start in the gut and/or are reinforced in the gut, allowing them to to run rampant through the body. It’s like having a wound on the inside and every time we eat or drink (and we kinda have to in order to do the staying alive thing) we are poking at the wound.

Our gut is full of organisms. Most of them are not trying to kill us, but live with us happily, keeping us healthy. The mechanism in play here, is that the chronic activation of our stress response (traumatic events, adverse childhood events, fucked up shit happening on the regular, call it what you will) is fucking up the balance of these bacteria (as is toxins, don’t forget the toxins!). More and more research is focusing on the gut microbiome of individuals with childhood trauma (the ACEs again) or PTSD and finding that they have significantly lower levels of Actinobacteria, Lentisphaerae and Verrucomicrobia. Coprococcus and Dialister (all good bugs for the tummy) have been found to be consistently depleted in individuals struggling with depression, whether or not they were undergoing treatment.

Imbalances in our gut bacteria can lead to damage of the lining of the gut. The fancy term for this process is leaky gut (Finally! An easy one to remember!) because gut lining damage means that toxins, bacteria, food particles, etc, can leak through the intestinal walls into the bloodstream. Then the body says “Wait, what? Invader!” and launches an attack (immune system response) which perpetuates the cycle of inflammation.

Inflammation spreads like wildfire once the on switch becomes stuck (the molecular switch for chronic inflammation is a cluster of immune proteins called the NLRP3 inflammasome that was just isolated in a laboratory in 2020 by scientists), and it lights up through multiple pathways in the body, using the vagus nerve as its superhighway.

More and more research is demonstrating that inflammation is a trigger for many mental health and physical health diagnoses. When we recognize that, we can perceive healing in a different light. Integrative medicine expert Dr. Mark Hyman views disease as having processes, not causes. When I wrote Unfuck Your Brain, the whole point was to explain “if this is how our brain is wired to process, we need to change how we approach healing in order to be effective.” And we need to approach the body-mind in the same way.

How Inflammation Affects Our Mental Health

So how does inflammation affect our emotions? We already talked about how our enteric nervous system comes into play, and how our gut bacteria can give us feelings. But a lot of mental health problems start in the body before they end up tearing up shit in our brains.

The brain and spinal column have their own, unique immune system (the neurimmune system). Until recently, researchers assumed that inflammation of the brain (neuroinflammation) was pretty rare, because there’s a wall of cells, called the blood-brain barrier, between the neurimmune system and the rest of the body’s immune system.

But we are now finding increasing evidence that neuroinflammation may be as common as cornbread (that’s not a real expression, I just made it up, pass it on). When inflammation stays upregulated (turned on for long periods of time) and crosses the blood-brain barrier, we can get a ton of mental health problems including, it’s starting to look like, depression.

Let’s back up and look at how the neurimmune system works. It’s managed by these tiny brain cells called microglia. Microglia make up about 10% of the brain and serve various protective functions that vary depending on the part of the nervous system they are in. One of the things they do to protect our brain is secrete cytokines (inflammatory chemicals) when they detect a threat. The swelling caused by the cytokines serves as a buffer while the microglia attack and destroy whatever crossed the blood-brain barrier.

Scientists are now finding increasing evidence that microglia can remain upregulated even when the original invader is no longer present (just like the inflammation process in the rest of the body)...and, at that point, are no longer serving their reparative function. For example, researchers have found that individuals who engaged in binge drinking as teenagers, had upregulated microglia far into adulthood even when they were no longer binge drinking. In another recent study, researchers found that many individuals who suffered an ACL tear (a pretty horrific tear of a ligament in the knee that is caused by a torquing motion, which is why you see it in athletes a lot) also suffered neuroinflammation afterword. And those with that higher level of upregulated microglia after the tear, had slower bodily recovery and were more likely to reinjure their ACL again.

Does this mean every injury can cause a neuroimmune response? And if you are klutzy as I am, are you entirely fucked for time eternal? Scientists don’t know enough to answer that question with precision. But it happens often enough that we need to be aware that it is a possibility that could be impacting our continued physical health as well as our mental health.

One of the most studied impacts of inflammation on our mental health (and how complicated it can be) is depression.

The brain is the least understood organ in the body, which means that we have a lot of theories about depression and a good number of the puzzle pieces, but we haven’t fit everything together yet. For a half a century, the idea was (and depending on who you ask, sometimes still is) that low serotonin causes depression. This is what antidepressants were created to address, and why their effectiveness varies wildly. Research that endeavors to monitor the influence of serotonin typically leaves us with more questions. When the metabolization of serotonin was studied in human spinal fluid back in the 70s, there was no difference in the levels between depressed and non-depressed individuals. And just in 2019, scientists removed the stuff in the brains of mice that produce serotonin, thinking they would exhibit signs of depression when they did so, but they continued micing along as normal.

Does serotonin play some role in depression? Of course it does. In my book This Is Your Brain On Depression, I wrote about how serotonin transmits messages between nerve cells, and therefore has a role in the coordinated function of the nervous system. When you’re depressed, something gets janky in that process, but we don’t really know what. Low serotonin may create depression, or depression may be creating low serotonin. Either way, inflammation seems to be a likely stakeholder in the process.

While lower levels of serotonin are correlated with depression, researchers are realizing that the causality is not cut and dry. Serotonin is a chemical that is found throughout the body. In fact most of it is found in the gastrointestinal tract, ninety percent of it, in fact, produced by the enterochromaffin (EC) cells that line the digestive tract. Some research shows that taking an

antidepressant creates more serotonin in the stomach, not in the brain directly. Which isn’t necessarily bad. A study done on mice found that when the gut-brain connection is severed (this is the vagus nerve), the antidepressants also stopped working, leading to the theory that serotonin is gut-produced and the vagus nerve is the mechanism of travel up to the brain.

To get a different perspective on how depression digs its claws into us, let’s start with where inflammation itself starts, in the body. Those same EC cells that make serotonin in the lining of the gut also relay information to the rest of the body and brain about our diet, our microbes, and possible inflammatory factors. Like, “dumbass is eating hot cheetos again even though we’ve warned her a thousand times, release the kraken!” These EC cells serve to activate responses within the gut-brain axis and they influence a batrillion important parts of our physiology: cognition, metabolism, you name it.

There was a great scientific journal article published a couple of years ago called “The Bowel and Beyond” (I knoooooooow, this is what I read for y’all!) in which the authors stated something that many of us have intuited for a very long time; that if we recognize that the gut-brain connection has a significant impact on keeping us healthy, it also must have a significant impact on how and why we become ill. This begs the question: the “social, emotional, and cognitive impairment” that the CDC likes to remind us is a result of childhood trauma—that sounds a lot like depression, doesn’t it? And that loss of energy to complete tasks? Is depression a product of inflammation? Is depression actually a body illness rather than a mind illness? And is the body’s way of trying to protect us from further pain by slowing us down?

This is deep mind-body connection shit that we are just beginning to wrap our science brains around. But we know that inflammation causes “sickness behavior” in that it slows us down to create opportunity for healing. And we know that neuroinflammation increases the chances of nerve cells dying and not regenerating. And we can see a decrease in the effectiveness of the brain’s ability to communicate (which happens in part through serotonin, which is a neurotransmitter).

There is far too much data out there to stick with the classic model of “take an SSRI and the magic happens,” especially when research shows that antidepressant medications are not effective for many, many people. This isn’t me dissing antidepressants. I know they have been life-saving for many people, and if you are one of them then that’s awesome. But because they aren’t helpful for everyone, we need to step up our treatment strategy game, right? We want to keep everyone on Team Alive and Happy. And adding immuno-psychiatry (to borrow Oxford psychiatrist Edward Bullmore’s term) to our range of treatment options increases our chances of finding effective treatment strategies for people, especially the people who haven’t benefited from traditional antidepressants.

Inflammation and Chronic Pain

According to an NIH study in 2012, 11% of U.S. Americans (over 25 million people) reported having some form of pain every day for at least three months in a row. That’s a lot of people suffering all the fucking time because we are struggling to find treatment options that bring relief. These numbers are also super relevant to everything I wrote about the mind-body connection. We know that pain and depression share the same neurophysiology, meaning the parts of the brain that are involved in perceiving pain also affect mood. So while being in constant pain is reason enough to experience depression, it’s more insidious than that, they actually end up together more often than not, like peanut butter and jelly.

There are two types of pain that we’re going to be talking about here, nociceptive and neuropathic.

Nociceptive pain requires a physical interaction or a physical stressor, like a sports injury, a papercut, or chronic muscle tension due to how we sit at work. This is the sort of pain that shows your body is working correctly, giving you information about an injury. But if you’ve been following along, you’ll notice that a lot of the body’s signals can get stuck on.

Neuropathic pain doesn’t always have a physical component. This could be when the nervous system keeps sending pain signals to the brain after the physical injury has healed, or as a result of conditions that don’t have an external physical injury component (like diabetes, cancer, multiple sclerosis). Lots of things can set off a neuropathic pain response, like being reminded of your injury, being inactive, your immune system being activated, or even changes in temperature.

While there are numerous neuropathic chronic pain conditions, the one that is finally being taken more seriously and studied more intensively is is myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), which is characterized by extreme fatigue, joint pain, dizziness, and difficulty with memory and focus, among other symptoms that go on for months and months. I’m going to talk specifically about ME here, because research in this area has led to huge breakthroughs on where it comes from and new ideas on how to treat all types of chronic pain.

So where do ME and other neuropathic diseases come from? The Mayo Clinic defines ME as “a complicated disorder that can’t be explained by any underlying medical condition.” First of all, um, thanks? This lack of definitional clarity (and the presumption that it’s all psychosomatic) is a big contributor to the reason that while there are an estimated two million U.S. Americans with ME, 90% of them have not been diagnosed.

ME affects twice as many women as men.[3] It’s most common among people over the age of 40 and doesn’t seem to favor individuals of certain races or socioeconomic status. Because of the physical and psychological distress associated with ME, there are much higher rates of unemployment among people with the diagnosis, meaning that this disease alone is causing an economic loss of 9 billion dollars per year in productivity. Not that our human worth has anything to do with our productivity but damn you’d think this would make treatment a higher priority for the overlords of capitalism.

ME was originally termed chronic fatigue syndrome, but the disease isn’t just being “really tired.” The CDC recommends ruling out other conditions first, plus finding a significant drop in regular activity levels due to severe fatigue that has lasted more than 6 months, a spike in symptoms when you engage in physical or mental activity, and trouble falling or staying asleep. There also needs to be either impairment of short term memory or dizziness, faintness, or weakness when standing or sitting upright.

There are also physical, measurable pathologies associated with ME (meaning we can diagnose it with more accuracy). They include:

• Altered gut microbiome with less colony diversity

• Hypermetabolic response to stress (presumed to be the result of mitochondrial dysfunction)

• High level of immune cells (especially NK cells)

• Chronic or reactivated infection with a virus such as Epstein-Barr

• Elevated levels of oxidative stress, especially after physical activity

• Bacterial infections such as a Mycoplasma species or Borrelia burgdorferi

• Lyme disease, FM, or postural orthostatic tachycardia syndrome (POTS)

Why are we talking about chronic pain syndromes in the middle of all this shit about inflammation and the vagus nerve? Once again, it’s the vagus nerve. The vagus nerve is the nervous system’s conduit of information throughout the body as it connects all of our major organs. And all of our organs have likely at one time or another harbored the herpesviruses (not just the STD, but also HHV6, HHV-5 [cytomegalovirus], and HHV-4 [Epstein-Barr virus])[4] which have been thought to be associated with ME/CFS for decades.

If any of these viruses lying dormant in the body wake up, then they start replicating in different organs in the body and using the vagal system to reach the brain. The brain’s first line of defense is to combat them with glial cells. The glial cells are the scaffolding for the vagus nerve, and they also assist in regulating nervous system messaging. So the presence of infection causes them to release cytokines, free radicals, and glutamate, causing system wide inflammation. Constant production of these chemicals is what tells the body we are injured, making chronic pain likely. This can add up to the otherwise unexplainable joint aches of ME, and if it remains untreated can become something termed allodynia, meaning any touch, no matter how slight, will cause the nervous system to react with pain signaling.

When dealing with treatment-resistant depression and pain, we are moving more and more in the direction of treating chronic inflammation in the brain and body. Strategies for this include antiinflammatories, glial cell inhibitors, and vagus nerve stimulation. A series of journal articles by medical doctor and researcher Sota Omoigui posits a unifying theory of pain which states that all pain (whether acute, chronic, peripheral, central, nociceptive or neuropathic) originates with inflammation and our bodies’ response to inflammation. Inflammation is mediated by all the stuff we’ve been talking about thus far (cytokines, neuropeptides, and neurotransmitters) creating our own unique inflammatory profile, which varies person to person and even varies within the same person over time. If we can understand our inflammatory profile, Dr. Omoigui states, we can treat our pain effectively.

Tl;dr: Our inflammatory response is not designed for modern society. It’s very likely that many of our “modern” ailments, including mental illness and chronic pain, are the result of inflammation running rampant and we should be focusing on treatments that mitigate these issues at their source.

Some Signs of Chronic Inflammation

Acute inflammation is pretty obvious, right? Pain, swelling, redness, heat, and complete loss of function. Chronic inflammation is more subtle.

Stuff you might notice

• Fatigue

• Sore joints

• Chest pain

• Lower back pain

• Mouth sores

• Rashes (Livedo Reticularis, a purple marble-y rash is especially common)

• Insulin resistance (which you will notice either through checking your blood sugar or recognizing it in your body when it’s unstable)

• Muscle weakness (myositis)

• Bowel inflammation (abdominal pain, diarrhea, cramping, constipation)

• Dry eye

• Mental fog

• Memory issues

Stuff your doctor might notice

• Hardening of the arteries (arteriosclerosis)

• Excessive blood clotting (hypercoagulation)

• Insulin resistance noted in bloodwork (high fasting glucose, high fasting triglycerides, high A1Cs (amount of red blood cells that have sugar coated hemoglobin)

• Increase in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and plasma viscosity (PV) in your blood work (they demonstrate elevated protein, which is related to higher levels of inflammation)[5]

If you think chronic inflammation might be something that is up with you, find treatment providers who specialize in this area. If your regular doctor has blown you off, look for people who specialize in pain management who aren’t just medication pushers. Ask online and join groups of individuals with similar diagnoses to hear about new treatment options. You aren’t doomed to live a life in bed, we are getting better and better at treating chronic pain.

TOXIC ENVIRONMENT

Toxins are antigenic substances. Antigenic means anything that produces antibodies in the body as part of our immune response. That is, toxins are poison. They fuck up the internal workings of our bodies, even when present at low concentrations. Even when they are not producing a specific disease (though that happens quite regularly too) they are pinging our immune system and upregulating our inflammation levels on the regular.

Toxins can be a lot of things, but for our purposes, I am not referring to unique poisonous events like snakebites or the cinnamon challenge, but instead the various chemical compounds that have entered our everyday environment and our bodies in the last 200 years (but especially post World War II) as a byproduct of pesticides, industrial waste, burning fuel, and other crap modern technologies create. We are barraged by toxins every day in the air we breathe, the water we drink, the food we eat, and the products we use.

Avoiding toxins is something you might hear people talk about or read about in magazines—but it’s not as simple as a personal choice to buy organic or use an expensive stainless steel water bottle. Some of our exposure is within our control—like broccoli being a better meal choice than gummi worms. But even the broccoli we are eating today is often sprayed with pesticides. And even the fancy organic kind doesn’t have the same micronutrients that it used to have. The earth’s atmosphere is a closed system, the soil is slowly being depleted, and the toxins are recycling into our food supply (among other places).

Even though chemical pollutants have been accumulating on the planet at accelerating rates in the last 75 years, we have only begun to start monitoring how it is affecting the environment, animals, and us. We may bump into an article in our daily scroll that demonstrates how air pollution is destroying the gut microbiome and cardiac cellular structure of individuals as young as three years old in Copenhagen (this is a real thing, not a made up example) and think that’s pretty fucked up. We may read up on how many of these chemicals are not just toxic in general, but either mimic or block the work of certain hormones in our body (endocrine-disrupting chemicals, also a real thing, not a made up example). Just in 2020, scientists discovered that there are traces of microplastics in human organs and traces of nanoplastics in human tissue. But it’s difficult to fully grasp the impact of how toxins are fully affecting our body-mind since most of the research has been done on animals. Additionally, there is tremendous variability between people and how they react to certain chemicals.

We know that we all have a bioburden of these chemicals and there is likely an additive effect of their existence in our systems that builds up over time and is impacting our physical and emotional health. We won’t know the extent of it until we start monitoring this data on a significantly larger scale. It’s important to recognize that our body burdens are not short term. For instance, if we paint our bathroom, the chemicals we inhale can be found in our system for a couple of weeks after. Many of us hold these chemicals for indeterminate amounts of time.

The most in-your-fact example of this issue is among the Inughuit peoples of the Arctic who still eat an Indigenous diet of foods they fish and hunt. Quebec epidemiologist Dr. Éric Dewailly was studying the effect of toxic exposure on breastmilk. He decided to use Inughuit women as his control sample, presuming them to be a “clean” standard to compare to other women because of their Indigenous diet. So he took their blood, expecting it to be free of toxins. He was shocked at what he discovered: that Inughuit women have an incredibly high level of toxic compounds in their bloodstream—in fact, they’re significantly higher than those of women in industrialized settings.

The Inughuit are not the only Inuit peoples with these high levels of toxic compounds. Because the industrial emissions, pesticides, and chemicals from the rest of the world are unable to break down and weather patterns allow them to eventually travel into the polar ecosystem where they are absorbed into the animals that are eaten by the peoples who subsist off of them. As a result, nearly all Indigenous individuals living in Greenland and northern Canada have mercury and PCB levels that exceed international health guidelines. Their bodies contain the highest human concentrations of industrial waste found anywhere on earth—so much so that Inuit women have been told not to breastfeed their children. Their breastmilk and their tissue could be classified as toxic waste. The exposure of babies in the womb alone is affecting their immune systems and brain development. Dewailly’s studies were done in 1987, and many of the babies he was studying decades ago are now mothers themselves.

But that doesn’t mean people south of the Arctic Circle are living toxin-free lives. Bill Moyers submitted a sample of his blood as part of his investigative piece Trade Secrets: A Moyers Report, a 2001 investigation into the chemical revolution and the companies that drove it. His blood sample was returned from the Mount Sinai School of Medicine with the information that there were 84 distinct toxic chemicals found in his body. These 84 chemicals make up his personal “chemical body burden.” Some of the chemicals found in his blood were ones that have been banned for several decades and some were so obscure that there was no information even on what they were.

And 84 really wasn’t that bad. According to the Environmental Working Group (EWG), the average newborn baby has 287 known toxins in their umbilical cord blood. Eighty thousand toxic chemicals have been released into our environment since the dawn of the industrial revolution. We are each exposed to just over 2.5 billion pounds of toxic chemicals and 6 million pounds of mercury alone each year.

Now we add to that the common toxins humans experience in their lifetime. Not all of these toxins are human-made chemicals—there are certain naturally occuring substances like mold, fungus, or tick bite transmitted bacteria that operate as biotoxins for the human body. And some toxins we welcome into our bodies as treatment for something more insidious—like cancer treatments—but they are still toxic. And then there’s your everyday stuff. Toilet cleaner in a spray bottle, pesticides on food, car exhaust, off gassing from new furniture, those plug-in air fresheners, the plastic in your face lotion....

These toxins cause, you guessed it, inflammation. And all the issues that can come along with it, including mental and physical illnesses, chronic pain, and even trauma.

Take all of these together, add our own unique genetic make up to the mix and we get varying degrees of total load. Total load is the total amount of stressors (which includes toxins) to your system at any given time. There is only so much we can handle without overflow and illness. And some of us have gene patterns that make us more susceptible to overload. About 25% of people have the specific gene pattern that means their bodies don’t have adequate mechanisms to deal with these toxins, which makes them more likely to be susceptible to chronic inflammation and increased likelihood of illness.

A lot of people with a high toxin load may have normal labs, or may show signs of candida, bacterial overgrowth, or a parasite infection. They get treated but then it keeps coming back. The aforementioned mercury numbers? People without the GSTM1 gene which is critical for mercury detoxification are far more susceptible to that total load tipping point. The people who are genetically more susceptible or have more exposure (such as individuals who work with harsh chemicals or live in especially toxic environments like the Inughuit women) are the same ones that are more susceptible to Chronic Inflammatory Response Syndrome (CIRS) because their bodies can’t naturally shed all of the toxins they are taking in.

Physical Symptoms of Toxic Overload

Some signs that you might be dealing with a greater toxic load than your body can handle include:

• Fatigue

• Concentration difficulties

• Muscle aches

• Headaches

• Joint pain

• Sinus problems (congestion and/or postnasal drip)

• Gas, bloating, water retention, constipation, diarrhea, or extra stinky poops[6]

• Heartburn

• Sleep problems

• Food cravings (quick carbs usually because blood sugar is wonky)

• Trouble losing weight, toning up, or increasing energy (you’re doing the right things but your body isn’t feeling any better)

• Skin problems (rashes, eczema, psoriasis, acne, canker sores)

• Halitosis

• Puffy, dark circles under the eyes

• Premenstrual syndrome or other menstrual disorders

If you have a suspicion this might be a major issue for you (especially if you’ve had identifiable exposures, like living in a major agricultural area or growing up in a moldy house or a war zone), working with a clinician that specializes in shedding a toxic load can be hugely beneficial. There are treatments (medications, supplements, and specialty diets) that help you significantly lessen your toxin load. As does doing everything in your power to control your toxin exposure as much as possible by whatever means are available. When it comes to detox, everything within this book applies. Movement and eating strategies, treating inflammation, and the like can help you better mitigate the things you can’t control so they don’t affect you nearly as much.

STRESS

Like inflammation, stress is an example of something that isn’t inherently bad for the human body but becomes problematic because of modern life. We talk about stress and being stressed probably more regularly than we discuss any other aspect of our health and wellness. However, it has become so big and so vague that we lose sight of the fact that stress isn’t external events. And we have far more control over our stress response than we do over our toxin exposure.

Stress is how our body responds to life events with the appropriate output of resources. Stress is heavily influenced by our life events (stressors), the chronic nature of them, and even our perceptions of them. And understanding all of this isn’t as complicated as most research papers would have you believe and is a very important part of anyone’s personal wellness plan.

What Is Stress?

Stress affects us all differently. Some people thrive on it and use that energy to get shit done. Others feel overwhelmed and check out. Maybe you get energized and motivated. Maybe your shoulders get tight. Maybe your whole body gets tight. Maybe you yell at people or drive recklessly. Maybe you space out. We all respond differently based on our previous experiences.

Physiologist Walter Cannon first proposed the idea of the “acute stress response” in 1915. He also termed it the “fight or flight response”—which is going to sound familiar; remember, the fight or flight response (which is, yes, also called the SNS vagal response) is what becomes trauma if it gets stuck. His use of the term “stress” comes from the engineering field. Stress, in the context of engineering, refers to the pressure or tension imposed upon material objects. Because (no shit) we are also material objects and experience pressure or tension on our state of being.

In the 1930s, a physiologist named Hans Selye’s inability to do basic lab draws led to our first understanding of the effects of stress on the body. He was trying to study the effects of ovarian extracts on rats but sucked horribly at the injections. He kept dropping the rats and ended up chasing them around the laboratory for hours on end. Fortunately, he was far better physiologist than rat handler, and he noticed that his ineptness was causing enlarged adrenal glands, fucked up immune systems, and ulcers in all of the rats that were fried by his continuous bullshit.

Our bodies are quite able to manage occasional stressors and have a nice orderly way of doing so. But as Selye discovered through his dumbass behavior, our bodies are not designed to respond to stress all the fucking time. When that happens our bodies get overloaded and we get sick. Selye referred to this overload as general adaptation syndrome, which today is called “adrenal fatigue.”

But in a clinical sense, stress is a more neutral term that refers to any event that requires an output of resources.

Stress can be good (output of resources to create art, run a race, or finish school) or it can be bad (coping with a car accident, an illness, or being terminated from a job). Kelly McGonigal, in her book The Upside of Stress defines stress in terms of meaning. Things are stressful to us because they fucking matter to us.

Whether the situation is good or bad, we can hit a point where we run out of the resources that we need to cope with the situation. And that is what distress is. The point of resource depletion. The point where we need support. It isn’t something you can do on your own. It isn’t a term that identifies someone as tragically fucked up. It’s a clinical term that we understand to mean this person needs some help.

If you have tipped into distress, maybe it’s because life has been throwing you too many curveballs and then you also just spilled your coffee and it was the last fucking straw. Or maybe it’s a lot of great stuff happening, like you’re on a fun trip and you hit exhaustion/sensory overload and the ziplining event reduces you to tears even though you were the one who planned it. They are both distress, not because they’re equivalently upsetting but because they’re overloading your system.

And it’s distress that researchers are talking about when they say that our “stress” numbers are through the roof, worldwide, according to the data collected within Gallup’s 2018 Negative Experience Index. The index tracks the human experience of stress, anger, pain, sadness, and worry throughout the world. In 2017, the global index score hit a new high score of 30. All of the markers of negative experiences went up in 2017 except anger (yeah, I dunno why not either). And stress and worry numbers went up the most, with almost 4 out of every ten people reporting stress and worry.

How Does Stress Work?

Stress—or distress—is regulated by something called our “HPA axis”, short for Hypothalymic-Pituitary-Adrenal Axis, which is basically our central nervous system as it is intertwined with our endocrine system—which produces our hormones.

The HPA axis is designed to keep our body balanced (or as scientists put it, in homeostasis). This means, weirdly enough, helping us react appropriately to stress. In order to stay on an even keel, we are meant to deal with problems quickly and efficiently so we can go back to point chill. Two of the main hormones that the HPA axis deploys to deal with stress, however, cause problems when they are activated regularly and run rampant. They are cortisol and adrenaline.

Adrenaline

When our body determines an event to be stressful, a cascade of events is set off. The amygdala—the emotional center of the brain—starts the process, sending a signal to the hypothalamus in the brain stem region, which has the task of releasing hormones to help us level up to respond to the stressor. The hypothalamus flips the switch for the sympathetic nervous system to get ready to engage and tells the vagus nerve to shoot a message down to the adrenal glands that they need to pop the tab on an energy drink.

The adrenal glands say “bet” and release adrenaline into the bloodstream. Adrenaline (also called epinephrine) ups our heart rate and our blood pressure, expands our ability to take more air in our lungs, makes our pupils expand so we can take in more visually, and redistributes blood to our muscles. It gets us ready for action. Adrenaline is our first line of defense. It’s such an immediate response that it happens pre-awareness. Whatever we are looking at, hearing, or smelling, we haven’t even processed the information in the prefrontal cortex—the thinking brain—but the body is already chugging Red Bull. Because it happens so quickly, it also wears off really quickly. It’s that flush of energy you get when you have a really bad scare. Then when you feel kinda nauseous 20 minutes or so later, that’s the adrenaline wearing off.

Cortisol

After the adrenaline kicks in, if the amygdala says “nah, not done yet, need more juice” we end up with cortisol production.[7] Cortisol is also a flip-switch for the sympathetic nervous system, causing rapid heart rate and and breathing and all the same energy drink feelings, but even more sustained.

Cortisol is slower-acting in the system than adrenaline, since it’s the second line of defense and is designed to keep our nervous system on the gas to deal with a longer-lasting situation. It takes more time to build up in the body, and takes longer to dissipate back out. When we are trying to test someone’s chronic stress levels, we look at cortisol. Cortisol levels going up are also correlated with vagal tone going down (as measured by heart rate variability), meaning we are far less likely to remain in our window of tolerance.

You’ve probably heard about how cortisol causes belly fat and heart attacks? That’s because it changes the body’s metabolism by altering our blood glucose when it is in our system all the damn time. Cortisol also increases amygdala activation and brakes hippocampal activity (which keeps the hippocampus from going in and telling the amygdala to calm its tits), which leads to more cortisol production (Thanks, brain!).

Continuous cortisol build up makes our thinking brain (the prefrontal cortex) far less effective. Just like trauma, chronic stress changes the blood flow in the brain because the blood flow is going to the muscles of the body to prepare us for an attack. Decreased blood flow means decreased brain activity which creates “holes” in our prefrontal cortex.[8] It fucks with our ability to think clearly and remember things that aren’t related to stressful situations. Which is why you feel like you can’t think straight when you are really stressed out, because you can’t think straight when you are really stressed out.

Cortisol is a total asshole, BTW, if it’s something we have in our system on the regular. This whole response of the body makes evolutionary sense. It protected us from predators, right? But that’s not modern life and we are not suited to having this chronic chemical cascade going all the time in the face of everyday stressors.

It’s like driving a car and you get stuck in 5th gear. You may still technically be the one driving, but the actual amount of control you have over the car is pretty low. You’re kinda just looking for a pile of hay to crash into to avoid as much damage as possible, right? (Hi, yes, I grew up on The Dukes of Hazzard, why do you ask?)

The Consequences of Chronic Stress

The question, then, is how exactly does a normal, protective stress response lead to chronic, unhealthy distress? There is no one, singular answer because we are talking about really complex fucking systems. But Western medicine has been catching up in the past decade to what Eastern medical professionals have been saying for about three thousand years and functional medicine practitioners have been saying for over a hundred years—that there is quite likely a huge role being played by inflammation.

So we know inflammation is how the body responds to perceived threats through the production of cytokines activated by the stress response. And we know that the cytokines can stay upregulated when stress is chronic creating the perfect human body soup in which to cook up some physical and mental health issues.

Stress is hell on our guts. That chronic production of cortisol is telling the body to get ready to fight, right? And the opposite of the fight/flight response is the rest/digest response. We can see how the body not having time to do the resting/digesting part affects the gut’s ability to protect us from other illnesses. The gut does this through an immunoglobulin called secretory IgA. Once that system starts going down, pathogens in the gut start running amuck.

Additionally, all that cortisol starts eating the glutamine, which is an essential amino acid, in our gut lining, which strips away another layer of protection. Then we get gut permeability (meaning pathogens get through the gut lining into the rest of the body). This breaks down our gut lining (and other tissue in our body, such as our muscles) and we are now more likely to have food sensitivities, less able to handle toxin exposures, and have more trouble absorbing nutrients in general.

All of this (waves arms around wildly) is modulated by the vagus nerve—both the emotional component and the inflammation component.

Pretty much everything that can go wrong with us, in terms of physical or mental health, has a stress connection. Naming them all and detailing the connection would be a multiple volume book series. WebMD (everyone’s favorite internet diagnostic tool) will tell you that chronic stress causes (to name just a couple) heart disease and asthma. And on the “mental” health side, depression and anxiety are strongly correlated with chronic stress.

Physical Symptoms of Chronic Stress

• Cardiovascular issues like abnormal heart rhythms, high blood pressure, heart disease, heart attacks, and strokes

• Disordered eating patterns and and weird weight fluctuations due to jacked up hunger signals from cortisol

• Menstrual problems

• Loss of sexual desire, sexual dysfunction, impotence, and premature ejaculation

• Problems with hair and skin (hair falling out, skin problems like rashes, eczema, acne, etc.)

• Gut upset (IBS, gastritis, ulcers, nausea, GERD, etc.)

• Low energy

• Headaches, other aches and pains (chronic or acute), and tenseness throughout the body

• Upset stomach, including diarrhea, constipation, and nausea

• Racing heart and rapid breathing

• Other nervous behaviors (fidgeting, picking at cuticles, etc)

• Changes in sleep

• Changes in appetite

• Getting sick more easily than usual (colds, flus, infections)

Emotional/Mental Stuff

• Mental health problems, such as depression, anxiety, PTSD, and thought disorders

• Feelings of agitation and frustration

• Uncontrolled mood swings, racing thoughts

• Thinking you are losing control, being out of control

• Low level depression, hopelessness, helplessness, worthlessness

• Unable to relax or enjoy things you usually enjoy

• Avoiding people and situations you generally enjoyed in the past

• Inability to focus, feeling disorganized and forgetful

• Incessant worry

• Making bad choices and judgements

• Always framing things through a negative lens

• Struggling to stay organized and/or focus your attention

• Procrastinating and avoiding responsibilities

• Increased use of substances to manage mood (drugs, alcohol, nicotine, caffeine)

So for those of us with all kinds of continued stress-response upregulation of the HPA axis and its hormonal compadres, we start seeing the effects in our lives. It can also be complicated, because many of the symptoms of stress can be symptoms of other things. Is it stress or is it immediate death butt-cancer?

Saying it again for the people in the back who are worried about going all woo-woo and ignoring other serious medical issues: We always need to rule out other medical stuff that might be going on. And even if it isn’t immediate death butt-cancer, it’s still serious. Your body is trying to get your attention. Because early stress symptoms turn into chronic problems within the body which can lead to serious illness (and yes, more on that later).

Additionally, you may already have already had some of these issues and then they get exacerbated by stress. Everyone with a chronic physical or mental illness is totally nodding their head right now. When you look back at all of the chemicals associated with the stress response and look at how they operate within the body, this list starts to make tons of sense.

Stress affects everyone differently, and clearly, the more chronic the stress, the more likely it is to cause a cascade of issues. Which brings us to...

When Chronic Stress Becomes Worse

When chronic stress starts to cause more severe issues, we have what’s long been referred to as adrenal fatigue. Except you won’t find that diagnosis on your medical records anywhere. The problem is although it sounds clinical as fuck, adrenal fatigue still isn’t an accepted medical diagnosis. Adrenal insufficiency is something that can be measured on lab work, while adrenal fatigue cannot.

Whether we call it adrenal fatigue, general adaptation syndrome, or hypoadrenia, there is no real diagnostic criteria to determine it exists. It’s a catchall term for a set of symptoms like body aches, fatigue, nervousness, sleep disturbances and digestive problems. It’s hard to define what we can’t measure. And the medical establishment understandably worries that there is another medical illness causing those symptoms that are being left untreated, like major depression, Addison’s Disease, or even ME.

And that’s entirely fucking fair. Other serious medical issues should always be ruled out first. But if we do rule out other stuff and are still feeling low-level shitty all the time, we are doing ourselves a disservice by not considering that we might be experiencing a physiological maladaptation to stress causing a chronic dysregulation of the HPA axis.

Our bodies are not designed for being in a constant state of stress. Modern living and anticipatory distress have made it far more likely that we remain in this state of disequilibrium on an ongoing basis. And with more and more research linking patterns of adrenal hormone output to other chronic illnesses, I think that we are doing ourselves a disservice to dismiss that the cascade of events caused by the stress response, if activated constantly, causes dysregulation of the HPA axis. One term I’ve seen more recently in response to this idea is HPA-D (HPA-Dysregulation) as a replacement term for adrenal fatigue.

So rather than looking just at adrenal output as a measure of disease, we are looking at the entire system becoming hypo-activated. That is, slowing down from overuse.[9] It’s the body’s ways of adapting, physiologically, to the constant influx of stress hormones—by decreasing production of those same stress hormones. Just like the whole HPA axis activation is a complicated process, so is the adaptation of the process to chronic stress which appears as HPA dysregulation. And when we slow down on producing stress hormones, our body is less able to effectively respond to stress (which remains a legitimate need), which causes more stress, and begins the cycle again. This can lead to more complex physical and mental health issues, like...

While we can’t measure issues within the adrenal glands until they are shutting down (which then gives us a possible diagnosis of a disease like Addisons, Cushings, etc), we can measure for patterns of elevated cortisol with a fairly simple saliva test. We can also measure an individual’s Cortisol Awakening Response and their Cortisol-to-DHEA ratio.

Even easier than that? Another common symptom of HPA dysregulation is orthostatic postural hypotension. Meaning, a drop in blood pressure when you stand up. If I suspect HPA-D, I will have someone lie down on the floor and take their blood pressure after resting there a few minutes (the floor in my office is clean, though, it’s cool). Then I will have them stand up and take it again. Normally, someone’s blood pressure should go up when standing up, but if it drops (especially by 10 or more points) that’s a sign of HPA-D. The bigger the drop, likely the bigger the problem. I know this sounds a little redonkulous, but a recent study of patients in Poland found orthostatic hypertension in all of the study participants who had both adrenal insufficiency and adrenal crisis.

How We Think HPA-D Continues to Self-Reinforce

Long story short, there are usable testing techniques that we can employ to recognize a body overloaded by stress before we develop an even more complex and chronic mental health issue. I see it akin to treating chronic allergies before it becomes a bronchial infection or pneumonia. We can also look at good old clusters of symptoms in our lives.

The symptoms associated with HPA-D may feel super vague to you, but they are still a good starting point. And when we see certain patterns in symptoms we can get a better idea of what’s going on. Symptoms of HPA-D due to chronic stress can look somewhat different from stress symptomatology. Here’s what we look for:

• Difficulty getting up in the morning

• High levels of fatigue each day

• Inability to handle stress (small things get really big, really fast)

• Cravings for salty foods

• Higher energy levels in the evenings (and not just because you are finally away from your stupid job or school day)

• Overuse of stimulants like caffeine (I feel attacked)

• A weak immune system (every bug that makes the rounds, you get)

If this sounds super familiar to you, it’s another case where it’s good to find a doctor who takes this stuff seriously. Not one who says “Hahaha, just relax, it’s not that bad!” Plus, everything we talk about later in this book about supporting a healthy body, was written with stress hormones in mind, not just vagal response (cuz it’s a system that self-references constantly, right?). Making lifestyle changes is hard work, but you’re already doing the hard work of living with an exhausted body, so this will be a cakewalk in comparison!

Unfuck Your Body

The first part of this book was about how our bodies (or rather, or body-minds) can get fucked up. You made it through some hella science, gold star!

The second part is about the fixing. Yesssss, fixable! Or at least, pretty damn manageable! Yaaay for hope! If we change how we view the creation of those issues, we can change how we approach supporting the body’s ability to heal, right?

We’re going to start with working on the vagus nerve itself, and directly addressing the stress, inflammation, and toxicity that throws us for such a loop.

Then, we have chapters that cover various aspects of bodily unfucking, so we can go right to where we are feeling it the most: eating, movement, and sleep. And we’re also going to talk about meditation and breathing.

UNFUCK YOUR VAGAL SYSTEM

Okay, so if the vagus nerve is the body fuckery superhighway, we should start our healing journey there, right?

It turns out that we can influence our vagal tone directly, which can go a long way into getting us back into that window of tolerance we talked about in part one—a state where our nervous system isn’t primed to respond to immediate threats and we are able to be relaxed, social, creative, and curious instead of just preparing for attack. Learning to recognize your body’s responses to various situations and work toward managing them is foundational to body-mind healing. And here you thought I was going to tell you to eat more kale and go breathe in a salt cave!

If you have spent a lot of time being dissociated from your body, even recognizing how your body is responding can be really difficult. So it definitely needs to be said—it’s okay if you aren’t aware of your body responses right now and/or don’t have good coping mechanisms to deal with them. Cuz the next couple of chapters are going to teach you some. This is designed to help you start recognizing your body’s responses in a conscious way and figure out what may already be in your toolkit and what tools you need if yours is currently empty.

How to Stimulate the Vagus Nerve Directly

All of the other chapters in this book relate in one way or another to healing the body-brain connection, and much of that relates to the vagus nerve (even when we are focusing on physical inflammation in the body, that is still largely affected by vagal tone).

One of the best, most direct ways to regulate the vagus nerve is through breathwork. There is a whole chapter about this coming up. I’ve studied breathwork pretty intensively, so I kinda geeked out and there was no way it would all fit here, so feel free to skip ahead if you want to get right into working on that. But there are other mechanisms for vagus stimulation that don’t require a dissertation that you can start experimenting with right away.

Directly calming the vagus nerve is becoming a more common (and drug free) treatment option. The FDA approved a vagus nerve stimulation (VNS) device in 2005 as a treatment for severe, treatment-resistant unipolar and bipolar depression. The device gets surgically implanted underneath the skin near the collar bone and stimulates the vagus nerve much in the way a pacemaker stimulates the heart muscle. So impacting the vagus directly is obviously hugely beneficial. And we can make that happen without going half-Borg in the process.

Ear Stuff

The most direct way to improve your vagal tone is through stimulating the auricular branch of the vagus nerve (ABVN) which runs through the skin of the outer ear canal and parts of the ear. I know this seems like a weird place to be able to access the vagus nerve directly through the body, but that’s because it’s actually a remnant of our embryonic nerve, which supplied the first branchial arch.

It is also known as Alderman’s nerve, a century’s old historic reference to London politicians who would activate the ABVN with rosewater to encourage digestion. Besides helping with indigestion, stimulating the ABVN has shown to help with migraines, panic attacks, and our stress response. Stimulating the ABVN is being investigated as a medical intervention for chronic heart failure, so it’s the real deal. This impacts the vagus nerve directly, telling the body to activate the parasympathetic response system again, which puts us back in our window of tolerance.

If you are looking at an ear, and consider the ear canal 12 o’clock, the ABVN runs 1 to 3 o’clock from it. You can feel the cartilage from the ABVN which leads down to the ear canal if you are poking your finger around in there, looking like a weirdo in the middle of the grocery store.

Pressing on that area or wearing an ear seed (an acupressure ball that you stick onto your skin) are both ways of stimulating the ABVN. I also know several people who have had that area pierced and found it hugely beneficial for their anxiety and migraine headaches. I’m not recommending ABVN piercing necessarily (an ear seed is way less invasive), but if you were kind of wanting to get one anyway it may have benefits beyond the aesthetic.

Tongue Stuff

The tongue is so weird, y’all. The deeper we get into this, the weirder the body seems to be. The tongue is part of the autonomic nervous system and part of what is called the somatic nervous system, which is a whole entire nervous system devoted to the parts of our body that are under conscious control. So the tongue is activated both consciously and unconsciously. And it is thought to be part of all three components of the autonomic nervous system. Not just the sympathetic and parasympathetic, but also the enteric—which makes sense, because our tongues are an essential part of our eating and digestive process. The tongue represents the gateway to the enteric system, due to the presence of specialized ganglia on the anterior and posterior area of the tongue; it would act as a chemical “spy,” letting the stomach know what fuckery we have put in our mouths.

And remember when I talked about the difference between afferent and efferent information?

Meaning brain-to-body and body-to-brain communication? The tongue becomes a crossroads of efferent and afferent information.

Because the tongue operates involuntarily and voluntarily, this is another place we can activate vagal tone. One of the simplest ways is tongue positioning. When we push our tongue up against the roof of our mouth (even if we do it subconsciously) we are activating the sympathetic nervous system, moving us into fight/flight. Moving our tongue out of that position activates us going back into our ventral vagal window of tolerance. If your tongue tends to get stuck and clenchy when activated, take a sip of water and hold it in your mouth, letting your tongue “float” in the water. Or stick your tongue in a glass of water to help detach your it from your hard palate.

The Felt Sense

Another important way of working with our body-brain connection is to deepen our recognition of how our bodies react to stimuli. We started with some physiology basics in the first part of the book, like about how our heart rate and skin color respond to different vagal states. Now we are going to get a little more nuanced.

The felt sense refers to the inner feelings of the body. It’s also termed interoception. It includes things like noticing when your chest is tight or your stomach is rumbly.

The idea originates with Eugene Gendlin, who was a couples therapist in the 1950s who was trying to find the common thread in why some of his couples were able to achieve their goals and heal their relationships, and others ended up getting divorced. He couldn’t find an obvious thread regarding the type of problem that brought them to counseling, so he started going through hundreds of hours of tapes of therapy sessions and had an aha moment after some time. The people who “got better” were the ones who were able to go quiet and still and listen to bodies rather than just stay in their brains and listen to their thoughts. He termed this the felt sense, and thought, “Well what if we teach people to do this?”

So he created a technique called Focusing and published a book by the same name in 1978. He has a six-part system, but has always maintained that anything that helps you get to the felt sense is totally awesome, which means that many tricks and tips have been formulated over the past decades. And as the connection between polyvagal theory and interoception become clearer more recently, felt sense work has become more common.

Interoception Exercise

This exercise helps us feel into our bodies in a deliberate way, which can be helpful when we are either hypervigilant to external information or dissociating and shutting down. Learning to connect to our felt sense helps us develop a better working relationship with our vagus nerve, so we can recognize when we are out of our zone of tolerance and work to get back into it.

I use this exercise (adapted from Peter Levine’s book In An Unspoken Voice) all the time with clients as a skill for managing trauma reactivity, internal overwhelm, and dissociation. Want to get an idea of where I’m going with this?

• Hold out one of your hands. It doesn’t matter which one, but take note of your choice.

• Hold it in the air, without letting it rest against another surface (like a table top or your leg) for support. If you cannot comfortably do so, then absolutely use a surface for support.

• Open up the palm of that hand, facing back toward your body, and use your eyes to observe it.

• Slowly make a fist with that hand, watching the whole time. Take note when your hand feels completely closed into a fist.

• Without breaking eye contact, open your hand back up.

Now close your eyes if it feels safe for you to do so. If not, try softening your gaze so you aren’t looking at anything in particular (instead of focusing on your hand) and repeat this exercise.

Feel what having your hand open feels like from the inside, then the act of closing your hand into a fist, then reopening. Pay attention to all that you notice in your body that wasn’t present when you were focusing on your external sight messages.

How did your awareness of the experience change once you were entirely dependent on your internal sense messages? Was it disconcerting at any point? Comforting? Did anything shift or feel different in how you connect with yourself?

I have also had clients use their feet with the exercise, but making sure to keep them connected to the floor for grounding. Try flexing and wiggling your toes with and without visual stimulus and see if the experience changes for you any.

P.A.T.H.

This is another interoception exercise, with the goal of connecting to the felt sense and recognizing your body’s messaging. It adds some parameters to the sensory data you are paying attention to, which is helpful if your senses feel overwhelmed. This exercise is less for calming yourself when things are crap, and more for gaining more clarity over how your body communicates in all kinds of situations.

Turn your attention inward instead of the environment around you. Part of you will continue to pay attention to the environment to keep you safe, while you relax your body and soften your gaze but leave your eyes open.

Now, ask yourself the following four things about your body right now.

P. Where can I feel pressure?

A. Where can I feel the air around me on my body?

T. Where is there tension?

H. Where can I feel heat?

Finding the Words

As you feel more comfortable in working with your felt sense you can expand your awareness of the sensations you are experiencing. Just like emotions, sensations are intended to give us information not to last forever.

Here is some sensory vocabulary:

Burning/Hot/Cold/Warm/Chilly/Icy/Cool/Clammy/Chilly/Sweaty/Gentle

Sharp/Dull/Rough/Smooth

Shaky/Trembly/Tingly/Twitchy/Butterflies/Jittery/Jumbled/Jangly/Itchy/Jumpy

Weird/Off-Kilter/Off-Center/Edgy/Tearful/Owie

Hard/Soft

Stuck/Weak

Strong/Tough

Small/Large

Sour/Sweet/Bitter/Salty/Pungent

Relaxed/Calm/Peaceful/Flowing/Spreading/Silky/Still/Tranquil/Comfortable

Undisturbed/Chill/Still/Quiet/Peaceful Empty/Full Fast/Slow/Still

Tight/Tense/Pressure/Vibrating/ Dizzy/Fuzzy/Blurry/Woozy/Faint/Light-Headed

Numb/Prickly/Tickly/Goose-Bumpy/Uncomfortable

Light/Heavy

Open/Closed/Loose/Tight

Some of the body sense words that may help you define your experience include:

Pressure, Air Current, Pain, Tingling, Itching, Temperature, Size, Weight, Shape, Motion, Speed, Texture, Earth Element, Color, Smell, Taste, Sound, Lack of Sensation

Because this is a pretty big list it may feel like writing a thesis on your body. Start by just noticing a couple of things. Maybe start with two or three opposite possibilities and decide which fits best. For example, does it feel tight or loose? Heavy or light?

Self-Holding

The goal of this exercise is to remember that our body is a container for our sensations and feelings. Dissociation sometimes leads to us not even realizing we have edges. A holding exercise helps us recognize our container, connect to it, and ground within it. It helps us “settle” even when experiencing uncomfortable emotions and sensations.

There are several ways to do this exercise, here is a basic version, but keep in mind it can be done laying down, sitting up, or some kind of in-between reclining.

Self-hug: Place one hand under the arm on the opposite side of your body, and the other hand over the upper part of the other arm. Give yourself a hug. The light squeezing can soothe the nervous system the same as getting under a heavy blanket. Now just pay attention to your body. Don’t try to force any reactions but see what shifts within you.

Positive Thinking

Positive thinking sounds cheesy, but it works. This is different from being pollyanna-ish and pretending things are just fine when they are a shit-show. By contrast, positive thinking frames our experience around whatever control we do have in any given situation, who helps us activate our own ability to not just survive but thrive.

One proven method you can use to shift your thinking is journaling. There is so much research out there on journaling and how it affects mental health. Probably because it’s a cheap thing to study. But also because it is an activity humans have engaged in since we developed the ability to read and write, which way predates the field of psychology.

Journaling has been found to be helpful with specific struggles with anxiety (trait anxiety) as well as with low-key continuous anxiety (state anxiety). It helps us manage stress and maintain a positive mood (read: window of tolerance).

One specific journal exercise designed to build a positive mindset has been shown to have a direct impact on vagal tone:

Each day for three days in a row, reflect on a positive experience in your life, and imagine yourself back in that experience. Think about your emotions and how you felt in your body when it happened. Write about the experience in as much detail as possible, especially focusing on the thoughts, feelings, and sensations that went along with it.

Even better news? You only have to journal for three days to see results. Not thirty. Just three. We can all handle that. And if you are the student who is always going for extra credit, you can absolutely continue past day three.

Aromatherapy

Working with scents really is a whole other entire book, or at least zine, especially when we get into essential oils and all that weird misinformation out there co-mingled with valid scientific data. Suffice it to say that there is valid scientific data that shows that aromatherapy directly affects the body-brain connection. So much so, that certain therapeutic interventions use scents as part of trauma recovery work.

We now know that scents are recognized midbrain (in the amygdala), enhancing our sympathetic response—which is why we can respond so strongly to smells without our thinking brains even realizing what is happening. Researchers have also found that smells directly impact gastric vagal nerve activity. So we can use them to physically activate a feeling of safety and calm.

Certain scents have been studied for their impact on the vagal system more than others. Lavender likely has the most research behind its effectiveness at calming the nervous system, with citrus scents following right behind. The gastric vagal nerve activity study was conducted with grapefruit essential oil, FWIW. And we don’t have to engage specifically with essential oils, obviously. Smelling plants in a garden, making a fragrant tea, and using a nice scented bubble bath are all aromatherapy. Essential oils are strong and portable, so that’s what you will see used in studies, but the hot tea I make for people in my office is just as scent-soothing as the oils I keep for people to use if they so desire.

Even though there are certain oils that have been shown to be efficacious for calming the vagus nerve, we all have our own unique history with particular smells. It can be helpful to go to a store that has samplers, so you can test out different scents and see which ones are best for your window of tolerance.

The easiest way to use essential oils is to put a drop on the palm of one of your (clean) hands and cup your hands around your nose and mouth, breathing deeply to inhale.[10] If you feel calmer, that scent works for you.

Once you’ve identified a soothing scent, start using it when you feel calm to connect it to your window of tolerance. Then move on to using it when you are activated, to help you get back into your window of tolerance. A couple of drops on a cotton ball that you store in a ziplock bag and carry in your pocket makes it portable without bringing the whole bottle with you. A low-tech version of a diffuser is to drop a little on the lightbulb of whatever lamp you’re using. You can get fancier and high tech from there, but aromatherapy can get expensive so I always suggest (like with everything) experimenting before investing!

Purchasing quality essential oils and avoiding pyramid schemes, scams, and crappy products is a book in and of itself. Start with companies that are well reviewed online, are selling therapeutic grade oils, and that you can just...buy from. If they try to get you to sell the oils, buy a bunch of weird crap to go with them, drag ten of your friends over to your house for an oil party, or whatever, walk away. We’re just looking at helping you find tools to manage your body-brain connection, not looking to start a home business that requires thousands of dollars of investment in some kit.

Pain and the Mind

First of all, it’s important for me to say and resay x1000 that pain isn’t all in your head. Pain is a very concrete, physical reality for many people. So when I talk about mental health approaches to pain management, I’m not saying, “Don’t be crazy, the pain doesn’t physically exist,” I’m saying, “The human mind has great capacity for self-healing when we recognize the validity of our experience and focus on our own self-care.” And research is backing this approach up.

One of the best known names in pain research is Dr. Sean Mackey, who runs the Division of Pain Medicine at Stanford. Some of his findings include the benefits of using cognitive behavior therapy—he found that 30% of people with fibromyalgia report a reduction in pain after using CBT. He has also studied the effects of mindfulness meditation—study participants reported a 40% reduction in pain intensity when using this technique (there’s an entire chapter on this coming up). Another strategy he looked at was conscious distraction—study participants reported a 44% percent reduction in pain intensity when focusing on an external soothing cue.

Remember when we talked about nociceptive vs neuropathic pain? Mental and emotional techniques can help us with the management of nociceptive pain that comes from immediate injury, and they can help heal us long term from neuropathic pain, by helping us convince our brains that the threat has passed. So I’m including two pain-specific techniques here, and the techniques in the breathing and meditation chapters were written with pain management in mind, not just trauma.

ACT for Pain

The two big mental components that help with pain are 1) recognizing the influence of thinking patterns on our pain and 2) being mindful of our bodies in the present. Acceptance and Commitment Therapy (ACT) combines both these strategies in a way that has gained a lot of traction in the last decade.

ACT was been described by its founder, Russ Harris, as “a type of therapy that aims to help patients accept what is out of their control, and commit instead to actions that enrichen their lives.” I have peppered my previous books with ACT exercises. And there are plenty of people out there incorporating ACT interventions in their lives without going to an ACT therapist by focusing on the six mechanisms for creating more psychological flexibility in your life and seeing how they are influenced by chronic pain.

Acceptance: This includes recognizing the thoughts and behaviors that are associated with either trying to control or avoid the pain that are not the healthiest long-term solutions for pain management. I spent years trying to control my pain by ignoring it. INstead of avoiding pain by doing nothing, I pretended it didn’t exist at all, constantly overdoing it and making it worse. In my practice I would say this is just as common (if not more common) pain response than trying to control it into submission with medications.

Cognitive Defusion: Activities that help disconnect feelings and thoughts that surround our experience of pain from the pain itself, in order to decrease its influence on our lives. (There is an exercise for this in the Mindfulness chapter.)

Being Present: Mindfulness of your immediate environment rather than being hooked into the pain preoccupations.

Self as Context: A perspective about your life in general with pain as only part of it.

Values: Identifying what matters to you that you want to prioritize above the pain. This helps you recognize how your pain-adaptive behaviors have gotten in the way of your goals.

Committed Action: The determination to achieve certain things based on your values while experiencing pain.

Investigating Our Relationship with Pain

One of the first things we can do is pay attention to our relationship with pain. I know, as someone who has lived with chronic pain for decades, that it gets very easy to just live in it, rather than try to engage with it in new ways. When I’ve engaged differently, I’ve seen huge changes in my ability to manage it on a day to day basis, and been able to tolerate spikes with self-compassion and consideration. While having no pain would be lovely, I don’t have that expectation. I just want to be able to continue to live a full and active life, and recognizing that pain is a part of my human experience helps me do that.

Ask yourself the following questions:

• How have you put your life on hold because of pain?

• Is it the pain or the fight with the pain that is getting in your way?

• What are some pain controlling thoughts or strategies you engage in?

• What are some pain avoiding thoughts or strategies you engage in?

• What are some alternatives that you are willing to try that allow you to honor your pain but still be engaged in your life?

UNFUCK YOUR STRESS

While we all know a few stress divas who seem to have a homing beacon for inviting stress in, most of us don’t choose stress, we just have to deal with it. Whether it’s everyday stress, life events stress, or disintegration of society stress, this is the shitshow we’ve been handed. And research shows the more we try to avoid stress, the worse it gets. So what does help?

There’s good news, I swear there is good news. Research supports that we have far more control over our experience of stress and how it affects our bodies than you’d think. Not by chucking everything and living in a van down by the river, but by changing your perception of stress.

Remember how we talked earlier about how stress is just your body perceiving that something is important and upping its resource game? Some smart people compared the National Health Interview Survey data to mortality data in the US. Guess what they found? Stress alone isn’t so bad for you. But if you think that stress is bad for your health and you perceive yourself as having a lot of stress, you have way worse physical and mental health outcomes. The increased risk of premature death for those folks was 43%. So if you think about stress in a negative way you are far more likely to die of a stress related disease.

There are tons of studies of this nature, if you start digging. In 1998, 30,000 adults in the US were asked about the levels of stress in their life and whether or not they felt that stress was harmful to their health. Eight years later, researchers scoured public records to see which of the 30,000 had died. While high levels of stress increased their risk of dying by 41% it was only true if these same people believed that stress was harmful to their health. Stress plus the belief that stress is harmful is what makes stress the 15th leading cause of death in the US. Our belief system has more impact on our longevity than quitting smoking or taking up exercise: while exercising and smoking cessation are consistently shown to add 4 years to our lives, having a positive outlook on aging adds 8, according to a Yale study.

And several of the studies show that there is a cascade effect on our behaviors, not just our health. For example, one study of Crohn’s patients found that a patient’s perception of their illness had a direct effect on their stress levels and their stress levels had a direct impact on the types of coping skills they used. That is, the more stressed they were, the more likely they were to use coping skills that were more harmful and costly in the long run, such as disordered eating, dissociating via overuse of social media and the internet, and abuse of drugs and alcohol.

Consider your own history with stress:

• What kinds of avoidant coping skills have you used in the past?

• What other kinds of coping skills have you used that aren’t avoidant of the stressor but are ultimately unhealthy for you?

• What opportunities have you missed in an attempt to avoid the stress that would come along with them?

• How might you be limiting your future?

Embracing challenges and facing the problems in our lives proactively increases our likelihood of remaining in their ventral vagal zone of tolerance. The opposite of fight/flight is known as rest/digest in its passive state, but is also known as tend/befriend in its active state. Meaning we are engaged in connection with others toward the betterment of all. People who have suffered the most in life are also the people who jump in to care for others. Stress can actually increase our courage, our capacity for caregiving, and strengthen our social relationships. Changing our individuals lives, as well as the world around us, requires us to have a mindful relationship with our stress response.

Embracing Stress Through Mindset Training

The author of the book The Upside of Stress, Kelly McGonigal, (whose research is the starting point for a lot of what I write about here) states: “Embracing stress is a radical act of self trust.”

We’ve been told not to though, haven’t we? We’re told to avoid stress, to calm down, that it isn’t good for us. Harvard Business School professor Alison Wood Brooks asked hundreds of people the same question: If you are anxious about a big presentation, what’s a better way of handling it? Feeling excited or trying to calm down?

91% of people said “try to calm down.”

But, as mentioned eleventy times above, the stress isn’t in and of itself bad—it’s not necessarily a problem you need to solve or get away from. This is borne out by multiple studies, including the one mentioned above, where the researchers found that just saying “I’m excited” out loud can reappraise stress as excitement. Despite what most of us have been told, it’s easier for the brain to jump from anxious feelings to excited ones rather than calm ones. Cortisol is going to be activated because something matters to you. But you can consciously label it as excited instead of stressed, which changes how you interpret and experience your own body.

The practice of reframing our thoughts from those of overwhelm to those of empowerment is known as mindset training. This doesn’t mean bullshitting ourselves, but recognizing that we do have the capacity to handle tough situations, or at least the capacity to give it our all and try our best. The term mindset is one of those words we associate with those performance coach guru types. Tony Robbins isn’t wrong, though. Mindsets are really nothing more than the beliefs we have about ourselves and the world that shape our realities. This isn’t negating the fact that we may be dealing with really fucked up situations, but is about taking back whatever power we have in our own responses when dealing with shitshow scenerios.

Mindset training has a direct impact on our stress response. One study found that a stronger physical stress response was associated with higher test scores in school situations, but only for people who have had mindset training. Another study demonstrated that just by telling people “You’re the kind of person whose performance improves under pressure” increases their task performance by 33%. One of the biggest predictors of stress overwhelming us is our perception of not being up to the task, so focusing on the fact that we are, indeed, up to it shifts our thinking.

And yes, individuals with anxiety can absolutely benefit from mindset training. Since stress is one of the biggest anxiety triggers, researchers have demonstrated that the stress response (at least the beginnings of it) is the same for people who have anxiety and those who do not. It’s our perception of what it means that differs. So a disruption of that stress response can end up circumventing anxiety and panic attacks.

Psychology researcher Salvatore Maddi termed this mindset-building a form of hardiness, meaning the courage to grow from stress. This is how someone can be “good at stress.” It doesn’t mean that difficulties don’t get to us and stress doesn’t bother us, but rather that we value growth, accomplishment, and being an active participant in our own lives enough that we befriend our stress response when we can and learn from it when it overwhelms.

Any stressful situation can become an opportunity to practice a mindset shift. When you notice your stress response activating, you can remind yourself that your body is reacting to something because it’s important to you. Then, use that energy to help carry you through the situation. Whether you are getting through a stressful interview or fighting facism, being alert, engaged, and present is vital to success.

Mindset training seems awkward at first, but once you build that neural pathway it becomes more natural and more likely to be your automatic response. As you practice, you won’t have to work so hard at it over time. Your stress mindset will also change how you react to others’ stress. Mindset leads to resilience. And emotional resilience is one of the first lines of defense against mental illnesses like depression and learning what behaviors build that up could clue physicians in on how to treat those illnesses.

Having a GOOD Mindset

You can practice mindset training as part of your daily self-care routine. I like the GOOD acronym of mindset training since it doesn’t involve any kind of fake hype about shitty situations, it really just is about being grounded in your own self-efficacy. And clearly you are a fucking survivor—you’re reading this right now, which means your survival rate thus far is 100%, right? This is one of those internal work exercises that might be easier to make external by journaling through it, especially at first while you get used to the process. But I am, for once, not insisting you write everything down if you really hate that shit!

Gratitude: Focusing on gratitude is a really good part of our mental health in general and can create a perspective shift in our day. This doesn’t mean discounting what’s problematic, but focusing more on what’s good in your life.

Openness to Possibilities: If we are gratitude focused, we are far more likely to be aware of solutions, support, and opportunities around us. In a negative mindset, we are more likely to dismiss things that are available to us (or not notice them at all) because we are overwhelmed and frustrated with life in general.

Opportunities in this Experience: No matter what experience we are having, we can focus on the opportunities that exist to help us grow. We can learn more about different situations and ourselves even if we don’t achieve the success we were hoping for. As someone who does a lot of political advocacy work, I can tell you that every lost battle taught me a new strategy of approach for next time.

Determine: Visualize yourself successfully embracing the challenges ahead. This is hardiness in action. If you mentally set yourself up for success, you are in the right frame of mind to tackle the project. And no, you aren’t more frustrated if things don’t go perfectly. I’ve found that even when I don’t succeed, I’m still proud of myself for going in prepared and positive because I feel like I really gave it my all.

But the Key Thing About Stress...

It’s super important that you don’t beat yourself up for not doing stress well. The entire engine of modern society operates on the psychic energy of people not doing stress well. The whole game is designed to work that way. If you are exhausted, burned out, depleted, experiencing adrenal fatigue, and the like, just changing your mindset isn’t going to resolve all that.

It took years if not decades to get you to the point of exhaustion you are sitting at right now, right? You can’t unfuck this level of attack on a human body by chanting “I’m not stressed, I’m excited!” Caring for yourself is going to be a constant (D) all of the above situation.

Befriending your stress response is way easier with a non-exhausted body, right? You need to treat yourself as you would with any other illness, giving your body the time and ingredients for recovery. Everything else in this book is designed to help treat the chronic inflammation, chronic toxic stress, and the mindbody experience of trauma.

BREATHWORK

We’re diving straight into what might be the most powerful tool we have to regulate our vagal system, expel toxins, heal from trauma, manage inflammation, and control stress: our breath. I know, that’s some gross-ass hippie shit. I’m sorry. But it’s true. And bonus points that it’s free. You’re doing it anyway, so doing it somewhat differently can end up being world changing for you.

Breath (pranayama), along with the topics of the next two chapters which are meditation (dhyana) and movement (the asanas), just happen to be three of the eight limbs of yoga. Now, I super pinky-swear I am not trying to trick you into doing yoga if that’s not your jam, but when I was framing out this book it became pretty obvious pretty quickly that Patanjali figured out in the 2nd Century BCE, way before “modern” science did, that these are good ways to keep your body and mind healthy and connected to each other.

Some of these exercises come with contraindications. Just like something being a whole food supplement or herb doesn’t make it a good choice for your body and circumstances, some breathing techniques may also be a bad idea. But hey, other than that? Breathing is free and you are already doing it anyway, so might as well get a little fancy.

This Is Your Brain on Breathing

Breathing is one of those things that we control with both our conscious and unconscious brain.

The unconscious part is managed by the brainstem, which is the keeping-the-body-alive part of the brain. It’s often called the reptilian brain, though it’s more complicated than that in reality.

An example is how the neural circuit in the brainstem affects the connection between breathing and brain control. That neural circuit is actually our “breathing pacemaker” because it adjusts itself based alterations of our breathing rhythms.

If something activates our fight or flight response (like a big dog chasing us) our breathing will become faster and more erratic. Our heart rate goes up, our neural activity goes all kinds of wonky, and we have a strong emotional response, like anxiety, panic, fear, or anger. We all know that part, right? We’ve all lived that and some of us live it every day because of anxiety disorders that create imaginary big dogs on the regular. But here is the cool part; there is a bidirectional flow happening in this process.

Our experiences change our breathing, which changes our entire physiology. If we consciously change our breathing, we can also directly influence our physiology. Mindfully slowing our breathing increases our baroreflex sensitivity, which measures the amount of control over our own heart rate.

A recent study directly showed that changing our breathing can also change our emotions. If we control our breathing by counting breaths, we are influencing neuronal oscillations (super fancy way of saying brain waves if you are at a MENSA convention or looking to bore your Tinder date to death) throughout the brain, especially in the mid-brain regions that are related to the regulation of emotion. And according to a study in the journal of Cognition and Emotion, our breathing accounts for up to 40% of our emotional responses.

Controlling our breathing changes our vagal tone, triggering the parasympathetic nervous system which is the counterbalance of the “fight, flight, freeze” sympathetic nervous system response to stress (either real or perceived) which goes on to influence the entirety of our body and our long-term physical health (including activating the lymph nodes to better expel toxins), not just our short-term stress response.

Breathwork and Trauma Responses

Like any other intervention, those of us with trauma histories may need to take an extra special approach to breathwork.

I have over a decade of formal meditation practice and a pretty intense amount of clinical training in both breathwork and mindfulness. It can be (it is) still really difficult. I know. I know. Conscious alteration of your breathing when you are triggered or activated may feel completely undoable. Someone telling you how to do it feels even worse. So if you have had an awful experience in a meditation class or a yoga class, with a therapist, or listening to an app, you aren’t the least bit crazy, that’s really common. So I want to talk a little about why that is and how to plan for it.

Trauma changes our breathing. When we are out of our zone of tolerance, our breathing becomes shallow (to change oxygen movement throughout the body to prepare for the perceived attack). And trauma survivors often hold their breath regularly without realizing it. And that creates tension and more body dysregulation that we are often even aware of.

We can learn from yoga practitioners who have been developing trauma-informed practices that can help you use mindful movement and breathing for trauma recovery, without being retraumatized or triggered by it. David Emerson’s trauma-informed yoga is an evidence-based practice for trauma recovery, and there are several unique aspects to how he cues yoga that I use as a teacher and clinician.

One of the biggest differences in his approach is that he doesn’t tell practitioners when to breathe in and out. He only suggests noticing it. If you have taken a more traditional yoga class, you’ll remember being told when to breathe in and breathe out constantly. That’s why the first breathwork exercise in this chapter is designed to help you just notice your breath, with no plan of altering it. Trauma survivors regularly struggle to notice their breathing at all, so beginning to do so is a really big deal. And it helps us notice when we are holding our breath as well. While an anxiety or panic response can include very rapid, shallow breathing, a trauma response may invoke a locked jaw, breath suppression, and abdominal inhibition.

Another really amazing resource is David Treleaven’s book Trauma-Sensitive Mindfulness. If you are a trauma survivor or an individual who works with trauma survivors, this book is invaluable. He offers suggestions for managing trauma triggers and activation during mindful meditation practice, which can also be applied to breathwork to help maintain that polyvagal window of tolerance.

• Recognize your internal go and stop signals (thoughts, feelings, body sensations) as markers of how you respond to different breathing techniques. Which are most helpful? Which are activating?

• Take breaks when you need to or alter how you are holding your body. Move into a more comfortable position or wiggle in place a little.

• Open your eyes, if they have been closed.

• Change to slow, mindful breathing if you were trying one of the more complicated pranayama techniques.

• Focus on an external object that is in your line of vision.

• Shorten your breathwork practice period or otherwise adjust the practice itself (for example, the 4-7-8 breathing pattern can be altered to shorter breaths).

Learn and practice breathwork when you are in a relaxed state, rather than trying to do it when you are already activated. The more you practice when your body isn’t under siege, the more likely you are at being successful with it when your body is under siege.

Breathing Exercises

We’re gonna start with the classic breathwork techniques, then move into some more specific

pranayama techniques, focusing on the ones that my clients have reported to be the most helpful over the years. I’m not just including pranayama because I’m a yoga dork. The impact of different pranayama techniques on physical and emotional health has been studied extensively in recent years.

Pranayama is the combination of three Sanskrit words: prana is our life force energy, ayama refers to lengthening and extending, and yama refers to containing or restricting.

This kind of breathwork is part of yoga, even though it doesn’t fit what most of us see when we hear that word. When we think of yoga, we think of the bendy shit. But the poses and forms, which are known in sanskrit as the asanas are in fact only one of the eight limbs of yoga and pranayama is another one of the eight. Many yoga practitioners will attest to the fact that pranayama is foundational to the asanas and the dhyana (meditation).

Pranayama is how we clear and cleanse our bodies, and the asanas and dhyana are how we test the efficacy of our breathing practice. And this is why the mindfulness and the bendy shit can be so difficult if you haven’t gotten a handle on the breathing part.

A precaution about all of these techniques: If you have nose or throat irritation or congestion, it may not be a great breathwork day for you. If you have a strong negative response to any of the techniques, stop doing them immediately. Any specific contraindications for any technique will be listed with the technique itself.

Noticing the Breath

Settle your body into a comfortable position. You can close your eyes if you feel comfortable doing so, or settle into a soft gaze instead.

Bring your awareness to your breathing. Notice as you breathe in, and follow through as you breathe out. When your thoughts wander, just notice them, maybe label them as thinking, and bring your attention back to the breath. You can use Thich Naht Hahn’s breathing mindfulness technique to help center your focus on being mindful in the moment:

Breathing in, I know I am breathing in…

Breathing out, I know I am breathing out.

Breathing in… I know I am breathing in…

Breathing out… I know I am breathing out…

Notice the rhythm of your breathing, notice how it changes. Notice the sensations in the rest of your body and how they change. Don’t do anything to alter your breathing or to “breathe better,” just pay attention to where you are now.

No specific contraindications.

Three-part Breathing

We’ve all done a big inhale before starting a new task, right? The inhale is our sympathetic nervous system becoming activated, which gives us an energy boost to act. Someone in distress is breathing so rapidly they are constantly inhaling, building up an energy flow that tells the brain to become anxious or panic.

The exhale is the parasympathetic response, which lowers our heart rate and calms our energy.

The retention (the space between inhale and exhale) is the space where we connect with our body and what’s going on inside it (interoception). So the 4-7-8 breathing pattern is designed to manage a stress response by lengthening out our periods of interoception and parasympathetic engagement.

• Breathe in for a count of 4

• Hold for a count of 7

• And out for a count of 8

You may feel a little light headed at first, and it’s totally okay to sit or lie down. Another option is to use the same ratio, but shorten it:

• Breathe in for a count of 2

• Hold for a count of 3.5

• And out for a count of 4

No specific contraindications.

The Complete Breath (Dirgha Pranayama)

Dirgha is a good daily practice to help manage breathing errors that we have collected over time. While you don’t (and really can’t) breathe like this 24/7, practicing with it daily will help you naturally lengthen and deepen and relax your “regular” breathing naturally.

• Get in a comfortable position—seated is best for this practice. Hold your spine as straight as you are comfortably able to, and let your abdomen soften.

• Place your hands on your abdomen or bring awareness to that area. Gradually start to lengthen and deepen your breathing. Work to expand your belly like a balloon with each inhale, and deflate it back out upon exhale. This is abdominal (or belly breathing).

• Now shift your attention to your ribcage. If you are able to place your hands on the side of your ribcage, do so and focus your breathing into that space. Feel the flexibility of your ribs as you expand them on inhale and relax them on exhale.

• Now shift your attention to your upper chest. If you are able to, place the tips of your fingers on the front of your chest right below the collar bone. Focus breathing into this area, bringing awareness to your chest lifting slightly upon inhale, and softening back into your body on exhale.

• Try combining all three parts. Exhale fully, then focus on inhaling into the belly, up through ribcage, and then through the upper lungs. Gradually release the breath, noticing how the upper lungs, rib cage, and belly deflate as you do so.

Don’t do Dirgha if you’ve had recent abdominal surgery, or if you have throat or sinus irritation or a respiratory infection.

Alternate Nostril Exercise (Nadi Shodhana Pranayama)

This technique is great for balancing the left and right hemispheres of the brain and balancing the vagal system. Studies of pranayama have demonstrated that alternate nostril breathing was the only type of breath work that was found to have a positive effect on the cardiovascular system (heart rate, respiratory rate, and blood pressure).

This breathing exercise involves breathing from alternate nostrils. This exercise cleans nostrils and sinuses. It is also helpful in the activation left and right side of the brain simultaneously.

• Get your body comfortable, sitting if possible.

• Place your left hand on your left knee, and lift your right hand up to your nose.

• Tuck your middle three fingers into the palm of your hand, leaving your pinky and thumb extended (the universal sign for “call me!”)

• Complete an exhale, then use your right thumb to close your right nostril. Inhale through your left nostril.

• Use your pinky to close your left nostril while opening your right nostril and exhaling through the right nostril.

• That is one complete breath cycle. Continue for up to five minutes, making sure that you always finish your practice by finishing with an exhale on the left side.

Don’t do alternate breathing if you have hypertension, an active migraine, or an active sinus or chest infection. Also generally be aware of discomfort if you have a full stomach.

Bee Breath (Bhramari Pranayama)

This technique has been shown to reduce stress and anger, help with sleep induction, and helps strengthen the muscles of the throat.

• Get comfortable, sitting upright if possible.

• Take a full inhalation

• Hold for three seconds,

• Close your ears using your index fingers

• Make a soft humming sound on exhale (like the sound of a buzzing honeybee).

• Repeat 5-6 times if possible.

As an alternative to closing your ears, you can place your thumb on the cartilage between your cheeks and your ears, so you feel the vibration but aren’t blocking off your hearing.

Don’t do bee breath if you are actively suffering a migraine. Also generally be aware of discomfort if you have a full stomach.

Ocean Sounding Breath (Ujjaji Breathing)

This technique is fantastic for centering and focusing concentration without the nervous system activation that usually comes along with increasing our attention.

• Sit comfortably, upright if possible.

• Relax your jaw and keep your lips closed.

• Start with some deep breathing to bring your body’s focus back to breathwork.

• Now softly contract the back of your throat so you are making a “hhhhhhhh” sound upon inhale and exhale. Think of how you would use your throat to fog up a mirror. It can also be helpful to hold your cupped hands in front of your mouth and breathe into them so it sounds like holding a seashell up to your ear.

If it’s hard to hear yourself, some people do well using headphones to block out other noise so they can hear the sound from inside their head. It’s much easier to create the ocean sounding breath on exhale than inhale, so focus on exhale first if you are practicing this technique and it’s taking you awhile to get it down.

No specific contraindications.

MINDFULNESS AND MEDITATION

Mindfulness is the basic human ability to be aware and fully present in our own lives, to bear witness to the workings of our body and mind as well as what is going on around us. John Kabat-Zinn, likely the best known mindfulness instructor in the Western world, states that mindfulness is just awareness. It is the natural state of the human body, especially when we are young, but it is something we become trained out of when we developmentally get to the place where we realize we can escape our present reality and be somewhere else. In fact, we do that so often researchers have found that at least half of our waking hours are spent with wandering minds.

Mindfulness does not require meditation. Mindfulness is essentially the best path we have figured out for accepting the is-ness of our lives. This isn’t to say that we should take shit lying down, it’s about recognizing the reality of the current moment rather than getting so wrapped up into how we want it to be/how it should be that we get stuck. When we get stuck in how things should be we get stuck in unceasing judgement, which is not a place systemic change comes from.

Meditation, by contrast, is a formal process of focused attention and does not have to include mindfulness. Transcendental Meditation (TM) is probably the best known form of meditation that is not mindfulness-based. TM uses a monosyllabic sound as a mantra to help the mind get out of the loop of spinning thoughts (more on this in a bit). This seems like a nit-picky difference, but a mantra meditation is creating a new present moment with a specific repeated sound while mindfulness meditation is just about being in the present moment.

Mindfulness meditation is where the two meet. This is where that process of awareness is brought into the formal practice of focused attention. This doesn’t mean perfect attention, but it is a process of recognizing when the mind wanders and refocusing awareness back to the present when it does, usually with some kind of anchor (the breath is the most common).

There is not a “correct” form of mindfulness, meditation, or mindfulness meditation. They all have the same goal of helping achieve a peaceful mind and manage stress so I am including a wide variety of practices for you to experiment with in this chapter.

You might have some beef with the idea of mindfulness and meditation. Which makes sense, because a lot of the breathless writing you’ve probably run across about it is about some kind of escape from reality into an ethereal higher consciousness. You might get the idea that you are supposed to go into meditating (or come out of it) empty-mind and completely calm. That it has to be done in a certain exact way every time which involves some weird pretzel contortion position. And probably shaving your head and wearing saffron robes. Or whatever. And none of that is true. None of this is about changing yourself. It’s the opposite: meditation and mindfulness are about meeting yourself, finding yourself, and connecting to yourself exactly as you are in the present.

Will mindfulness and/or meditation change your life? Yes. But maybe not in the ways you expect it to or hope it to. Over a decade into practice, I still don’t have a calm brain. But I do have space between my brain’s chatter and my reactivity. I have a different level of awareness of how I’m reacting to myself and the world. I see different choices and different paths. You may think “that’s it?” but as a person with a loud-ass brain, I can tell you it’s still life-changing.

You know why mindfulness-based therapy is so brave? Because even when we are told that we will reach down and discover our innate goodness, we are still so fearful that isn’t the case. What if we are the exception? What if we are the one person too broken inside to be worthy? What if the real truth is that I am that one person who is not ok?

Bravery is telling that voice to fuck off. Bravery is digging deeper still, past that voice, to listen through all the chatter. And to trust the goodness is there. And you (yep, even you with your broken, hurting, scarred, and fragile insides) are still innately, beautifully, and so deeply good.

You will find that space. Keep looking.

This Is Your Brain on Mindfulness and Meditation

Mindfulness has been so well researched at this point, the research backed benefits would be an encyclopedia in and of itself. But here are a few of the big ones that are most relevant to what we’re focusing on in this book.

Mindfulness has been found to:

• Positively impact overall human functioning (cognitions, emotions, physiology, and behavior)

• Improve attention and focus

• Provide greater empathy and compassion, positively impacting interpersonal behavior

• Reduce proactive interference (when old stuff we know gets in the way of new stuff we are trying to learn

• Help manage caregiver burnout

• Help manage chronic pain (showing just as much benefit as CBT)

• Help overcome insomnia

• Help with the management of mental health issues, including depression, anxiety, and PTSD

• Increase the body’s immune response

A lot of studies have been done specifically about meditation, and the results are fascinating. We have literally thousands of years of mindfulness and meditation practice documented in human history that include reported benefits of the practices. With the advent of fMRI (functional magnetic resonance imaging), we can actually see how mindfulness and meditation affects the functioning and even the neuroplasticity of the brain, which is the brain’s ability to grow, learn, and heal damage.

When scientists have looked at people’s brains while they meditate, they find that within a few minutes of beginning meditation, the ventromedial prefrontal cortex lights up, meaning that this part of the brain is electrically firing. This is the thinking brain, the “monkey mind”—the part of the brain that tries to connect every thought to our “me-ness” and plans for the worst all the time. This is why the first few minutes of meditation feel so grunge and funky.

If you stick with it past those first uncomfortable minutes, the lateral prefrontal cortex lights up instead. This is the part of the brain that has more equilibrium. Our thoughts become less chatty and me-focused, less obsessed with potential catastrophes and more accepting of what is actually happening.

If we meditate daily (or at least really regularly) for two to three months, then our dorsomedial prefrontal cortex starts to get activated during meditation. This is the part of the brain that is related to empathy. We become more compassionate in our daily lives to ourselves and others.

Over time, meditation increases grey matter in the prefrontal cortex, which is brilliant for emotional regulation, focus, and ability to problem solve. It also thickens the hippocampus and decreases the amygdala response, which helps us stay anchored in the present (read: less likely to have our fight-flight-freeze response activated). The brains of meditators also show an increase in alpha wave activity (something people pay good money to induce with neurofeedback, hypnotherapy, and alpha stims). Meditation keeps neural connections strong and prevents atrophy. Essentially, the brain of a meditating middle-aged person is comparable to the brain of a 20 year old.

Meditation also changes the chemical structure of our body. It increases the chemicals that help us maintain calm homeostasis. GABA (gamma-aminobutyric acid), serotonin, and BDNF (brain-derived neurotrophic factor) are all chemicals that are of benefit to mood stabilization and all are increased with meditation. Additionally, the hormones associated with stress (cortisol and adrenaline) seem to be mitigated by meditation.

This gets us back to the idea of a vagal window of tolerance. More and more research is demonstrating that meditation not only helps in the moment, but helps us remain in our window of tolerance in general, not just when we are meditating, by creating positive alternations in the neural activity and connectivity of the default mode networks of the brain (the storytelling brain). This means meditation is teaching the brain to learn process-specific states of calm (all the time regulation) instead of state-specific calm (we’re calm when we meditate).

If you’re looking for the benefits of mindfulness and meditation, but are uncomfortable with it being tied to a particular religious or spiritual practice, you can find therapeutic programs that utilize these techniques without being tied to “something bigger.” Mindfulness and meditation practices have long been used in clinical settings like therapy, and there is a huge and growing amount of research backing this up.

The two that have been around the longest and studied the most are Mindfulness-Based Stress Reduction (MBSR) which was developed by John Kabat-Zinn and his colleagues at the University of Massachusetts Medical Center and Mindfulness-Based Cognitive Therapy (MBCT), developed by Dan Siegal and his colleagues at the UCLA School of Medicine. MBSR has a more generic application and is applied to stress arising from a variety of life events including physical or mental illness. MBCT is a spin-off of MBSR, and tends to target specific conditions and vulnerabilities. It adds cognitive behavior therapy (generally considered the therapy gold standard) to MBSR in order to add focus to shifting patterns of thoughts, emotions, and behaviors that do not serve your emotional health. Other common modalities, most notably Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT), are not mindfulness-based, but rely on mindfulness as a core skill.

Trauma Sensitive Practice

While mindfulness and meditation can be of huge benefit to a large number of people, it isn’t magic for everyone, and may require trauma-sensitive modifications, just like any body-oriented practice. If you have a trauma history and try to sit down to meditate following any standard instructions, it’s possible that it will fuck you up.

Things you may notice that are signs of dorsal and ventral vagal responses (either fight and flight activation, or freezing up) can include:

• Prolonged, uncontrollable crying

• Shortness of breath

• Trembling

• Clenched fists

• Getting very pale or very flushed

• Excessive sweating

• Depersonalization

• Derealization

• Fear

• Panic

Having a trauma history, or having a trauma response while meditating, doesn’t mean you can’t meditate or practice mindfulness. But those of us with intense trauma histories need to have space for choice. This means choice in working through a trauma history in our own time and in our own way, instead of having memories flood our present moment and disrupt our lives. Traditional meditation practices encourage us to go back to the breath and to treat any triggers or activation as thinking that detracts from the present moment. Instead, a trauma informed practice helps us lean into uncomfortable feelings without losing our zone of tolerance.

If trauma is an issue for you, here are some tips, many of them inspired by David Treleaven’s book Trauma-Sensitive Mindfulness. This may be familiar from the Breath chapter.

1) Recognize your internal go and stop signals (thoughts, feelings, body sensations). You don’t have to sit and stew in emotional pain. Some discomfort can help us grow, but retraumatizing ourselves fixes fucking nothing. Notice what practices are helpful and which are activating. Get up and take a break when you need to, but next time stay seated just a little longer.

2) You don’t have to sit in physical pain either. Take breaks when you need to or alter how you are holding your body. Move into a more comfortable position or wiggle in place a little. While meditation (specifically mindfulness meditation) has been shown in research to be incredibly helpful to pain management, it’s not supposed to be torture. Support your body in whatever ways you need to to be as comfortable as possible.

3) Meditation exercises often suggest closing your eyes. This is totally optional. If you don’t feel comfortable with your eyes closed in the environment you’re in, leave them open. Or start with a soft gaze as a step towards closing your eyes.

4) If your practice involves attending a class, talk to the teacher. If there is any hands-on component (like if your practice involves yoga or tai chi), you can tell them not to provide physical adjustments (meaning, not to touch you).

Just like with everything else in this book, listen to your body more than you listen to me. Don’t do things that are awful and upsetting for you. Meditation is a chance to work through crap without being overactivated. So if you are overactivated by something, it may not for you, at least not right now.

How to do Mindfulness and Meditation

The rest of this chapter is devoted to giving you a taste of some of the variety of practices to see which resonate best with you. There is meditation without mindfulness, mindfulness without meditation, and practices that incorporate both.

The fact that there are such a wide variety of practices out there that have demonstrated effectiveness is really good news. If you have had bad experience with any practice in the past, it means there are a variety of other methods you can experiment with.

Let’s try some new stuff, yeah?

Basic Mindfulness Meditation Instructions

This is the classic, go-to mindfulness based meditation that uses breath as the anchor to the present moment.

• Settle in a comfortable position. Sitting with an aligned back is the classic method (either on a cushion or in a straight backed chair) but if that isn’t a position you can get into or maintain, no worries—settle your body to be as presence-focused as possible.

• Bring your awareness to the physical sensations of your body. Where do you feel the pressure of your body making contact with your chair, bed, or floor? What other sensations (like air, temperature, texture) do you notice? Spend a minute or two noticing those sensations.

• Now bring your awareness to your lower abdomen, recognizing the sensations of your breath moving in and out of your body. You can place a hand on your abdomen to help you feel the sensation if you are struggling to make that connection if that’s helpful. Notice your abdominal wall stretching and inflating with each in-breath and gently deflating with each out breath.

• Continue to follow the breath in and out, giving yourself permission to just be in the experience of your breath.

• Eventually (probably sooner rather than later) you will notice that your mind is wandering. You start daydreaming, planning, getting consumed with other thoughts. My brain likes to sing songs and make shopping lists, personally. This is what brains do. It doesn’t make you a mindful meditation failure. Just when you notice that you’re doing it, label it “thinking” and focus back on the breath.

• Bring curiosity and patience to your wanderings, rather than frustration. Notice what was going on and return to the breath.

Most research demonstrates that 15 minutes of practice is the amount of time it takes to gain the benefits of mindfulness meditation. If you can’t tolerate it for that long, that’s also okay. Practice working up to it. If you find that it’s helpful and want to extend time out further that’s also great, but not required.

Mindfully Eating a Raisin

This mindful eating practice is a classic MBSR (mindfulness-based stress reduction) technique. It gives you a different element to focus on, other than your breath.

• Place a few raisins in your hand. And no you don’t have to use raisins, any food will do. I’ve found that even people who don’t like raisins are not bothered by them in this exercise. But if they really gross you out, grab something else.

• Pretend this is your first day on the planet. This is a new food that you have never seen before, and you are an alien explorer that is going to make scientific study of raisins and raisin-ness. Use all five of your senses to explore it. Turn it around with your fingers, notice the color, the tactical sensations. How does it fold or reflect light? What does it smell like when you hold it up to your nose? Does it make any sound if you apply pressure?

• You will start having thoughts of the “Why am I doing this? This is fucking weird” variety. Totally normal. Just recognize them as a thought you are having and bring yourself back to the activity.

• Bring the object slowly to your mouth. Notice how automatic it is for your hand to bring nourishment up to your mouth. Notice whatever anticipation you are experiencing. Is your mouth watering? Gently place the raisin on your tongue without biting down. Explore the sensation of the raisin in your mouth.

• When you are ready, bite down. Notice the taste that is released when doing so. Notice how you habitually move it to one side of your mouth over another. Slowly chew the raisin. Notice how it changes in texture, and flavor as you chew. When you feel ready to swallow, notice your conscious intention to do so. Pay attention to the sensation of it moving down your throat, to your esophagus.

How did the experience of eating differ when you did so mindfully? What did you notice? What did you enjoy? What was uncomfortable?

Metta Meditation

Metta loosely translates loving-kindness. In essence, it’s a focus of general goodwill, friendliness, and open-heartedness. It’s a way of engaging in the world without all shields up, feeling defensive and ill at ease.

A metta meditation involves focusing not just on the breath, but on a series of healing statements about yourself, another person or group of people, or the world.

The original texts from the Buddha on metta (as translated from The Discourse on Loving-Kindness) is:

Wishing: In gladness and in safety, may all beings be at ease.

Whatever living beings there may be, omitting none

Let none deceive another, or despise any being in any state

Let none through anger or ill will wish harm upon another.

These statements have an archaic language (and don’t worry, we’re gonna use a more modern format), but speak to universal human struggles across time. Specifically, the harm we experience just by being a human living in an imperfect world, and the continued harm (suffering) that we impose on ourselves in the process. Metta meditation allows us to work with the feelings we avoid the most, like aversion and despair. The Buddha stated that by working with uncomfortable emotions, we can transform them into something that serves us better.

When we don’t like someone, doing a metta meditation on their behalf feels gross. My meditation instructor encourages focusing on the easiest people first, the people or living things we love and adore (yes, it can absolutely be your pup or your favorite tree in the park if you aren’t feeling particularly people-y). After that, we can move to the people who are a little more sketch, and finally to the people we consider the most difficult as we build tools to release what about them creates toxic emotions within us.

Also, we should offer metta to ourselves. Self-hatred is far more common than hatred of others. Buddhist meditation instructor Sharon Salzberg discusses how this is a super common in Western culture as an offset of systemic oppression (defined by bell hooks as “imperialist white supremacist capitalist patriarchy”). Because no matter what set of circumstances or privileges we have accessed, no one measures up to these standards. We all struggle with not-enoughness and feel a continuous need to earn our space in the world, rather than recognizing that we deserve by the sheer fact that we are human.

Here are some more modernized metta meditation statements that you can use in your own practice, that are used more often now than the Buddha’s originals. You can say these out loud or think them in your head, timed with your breath. Where there is a blank you insert “I” or “my” for doing metta for yourself, “you” or the name of the person you are focusing on, or “all” meaning the entirety of sentient beings.

• May _____ be protected and safe from harm from others

• May______be protected and safe from self-inflicted harm

• May _____ be happy

• May _____ body support the practice of loving awareness

• May _____ be free from anxiety

• May _____ be free from anger

• May______be free from fear

• May______love themself/themselves exact as they are

• May _____ be free from suffering

• May _____ find peace in the world

• May _____ find balance between attachment and apathy

Mantra Meditation

Using a mantra to meditate is the best known form of meditation that isn’t mindfulness based. In Sanskrit, man translates to “mind,” and tra means “to free from.” Mantras are used as a tool to free the mind (or to be freed from the mind). They help break the cycle of spinning thoughts that lead to anxiety, self-doubt and the like. Transcendental Meditation, which relies on mantras, got really big when Maharishi Mahesh Yogi brought the ancient technique to the US.

As with other practices that have spiritual roots, researchers in the US were interested in how the techniques themselves, outside a cultural context, can alter physical and mentals states. Since the 1970s, Herbert Benson, professor of medicine at Harvard Medical School and founder of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, has studied what creates that meditative state, which he termed “the relaxation response” (with a bestselling book by the same name).

Benson has experimented with subjects repeating Sanskrit mantras as well as nonreligious words, such as “one.” He’s found that regardless of what the practitioner repeats, the word or phrase has nearly the same effects: relaxation and the ability to better cope with life’s unexpected stressors. Mantras actually soothe the default mode of the brain,

keeping it from going into storytelling mode creating anxious thoughts.

Sanskrit chanting is often part of many practices, including different branches of yoga. The sanskrit often has complex meanings beyond the literal translations. I’ve found that learning the relevance and meaning behind mantras like om mani padme hum lends depth to my practice. But, mantras in any language have the same effect. You can chant any contemplative expression from your faith system (like “Hail Mary, full of grace”) or something more generally spiritual (like “I am Divine Love”), or any secular humanist phrase, and gain the same default mode benefit. Or maybe there is a certain mantra about your path of healing that you want to use.

Once you’ve decided on a mantra, find your comfy place and set a timer for yourself. Start with a few deep breaths and then start changing your mantra (in your head is fine, outloud voice is also fine). If you catch your thoughts wandering, bring them back to the mantra.

Meditation in Motion

What we often refer to as “walking meditation” is really just “meditation in motion.” Whatever device you may use for mobility will become part of the process.

• Find an unobstructed space in which you can move back and forth in a reasonably straight line for about ten feet (yes, you can also do a greater distance). If you are walking and are able to do so barefoot (and it’s an area that is safe for you to be barefoot), you may find it helpful to gain more awareness of how your body creates balance for movement.

• If you are walking, bring your attention to your feet, shifting your weight from side to side and front to back, as far as you are able to do so comfortably. Lift your head and chest so you are facing forward, let your shoulders drop away from your ears. You can clasp your hands behind your back, hold them in front of you, or let them hang loosely at your side.

• Lift up one of your legs. It doesn’t matter which, but take notice. Pay attention to how your weight shifts in your body when you do so. What does the other side of your body need to do to hold your full weight. Move your lifted foot forward, then place your heel on the ground and roll the rest of your foot down, ending with your toes. Pay attention to how your other foot begins to lift and move forward as well. Bring that foot forward and repeat.

• If you use a device for mobility, focus your attention on the sensations of movement. Connect the sensation of using your hands to connect to the mobility support and guide you forward. Feel the sensation of moving forward and your connection of being embodied and supported in that experience. If you are using a chair that relies on voice, facial expression identification, or the like, focus on how you engage your body and connect to the chair to create movement. What shifts do you feel physically and energetically?

• No matter how you create movement, your mind will wander as minds like to do. As your attention wanders off, you can bring yourself back to present practice with the thought of “attention engagement forward” or an anchoring reminder of your choice.

• When you come to the end of your path (unless it was a circle to begin with), turn fully around, face the direction from which you came, and start over. If you are moving in a circular shape, simply notice that you have completed one full round.

Meditation on the Soles of the Feet

This particular practice has been shown to be really beneficial for the management of aggression and anger.

• If you are standing, stand in whatever relaxed posture is most natural for you.

• If you are sitting, sit comfortably with the soles of your feet flat on the floor or another surface.

• Breathe normally. You don’t have to do deep belly breaths or anything outside of how you regularly breathe.

• Now, think back on an incident that made you very angry. Stay with that anger. Let the angry thoughts flow through your mind without trying to stop them. You may notice your heart rate or breathing go up as you remember that anger.

• Now, shift all your attention to the soles of your feet.

• Slowly, move your toes, feel your shoes covering your feet, feel the texture of your socks or hose, the curve of your arch, and the heels of your feet against the back of your shoes. If you do not have shoes on, feel the floor or carpet with the soles of your feet.

• Keep breathing naturally and focus on the soles of your feet until you feel calm and the physical signs of anger dissipate, this will take probably 10 to 15 minutes.

• Slowly come out of your meditation, sit quietly for a few moments, and then resume your daily activities.

Cognitive Defusion

Remember earlier when I talked about how we can practice mindfulness without doing so in the form of meditation? And how some forms of therapy aren’t mindfulness-based but still center mindfulness as a core skill? Cognitive defusion is a technique from Acceptance and Commitment Therapy (ACT) that focuses on mindfulness in managing being overwhelmed without having to sit on a cushion with it. As with the other practices listed here, this is one I use with clients regularly.

This skill is designed to help manage thoughts that are painful, overwhelming, unkind, or unhelpful. We tend to over identify (fuse with) with our thoughts, so thinking something like “I’m terrible” or “I don’t deserve love” can become the truths we operate within unless we approach them with mindfulness.

• Start by identifying a hurtful self-criticism that you want to work with. If you can shorten it into a phrase or single sentence, it’s easier to work with than a rambling paragraph of self-recrimination (which is my personal speciality).

• Let yourself engage with the thought rather than try to push it away. You can repeat it to yourself mentally or verbalize it out loud.

• Now add this modifier in front of it: “I’m having the thought that…” so “I don’t deserve love” becomes “I’m having the thought that I don’t deserve love.”

• Now take another step away from it by adding “I notice…” so we are now at “I notice I’m having the thought that I don’t deserve love.”

• It may be wordy and complex at first, but with some practice you may be able to shorten it into a sentence that really gets at the heart of the issue.

• Now reflect on whatever mental shifts you notice as you defused the thought by recognizing it as an experience your brain was having instead of your life operating instructions. What did you notice?

Mindfulness and Pain Management

Mindfulness for pain, whether acute or chronic, doesn’t mean learning to ignore the pain so we can go about our day (let’s be real, we are already way too good at that). Trying to escape pain just gets us more ensnared in the long run. When we feel what’s real in the present rather than trying to hide from it, we are more awake and alive to reality. It’s how we bear witness to reality, to be curious and compassionate rather than shaming and blaming or prickly and protective.

Earlier, I wrote about how pain works in the brain. You can use mindfulness to specifically train your brain to cope with pain by recognizing its existence rather than trying to avoid it completely or get swallowed whole by it.

When we hurt, our breathing tends to get shallow, in an attempt to avoid the pain. We can breathe into and through the pain as a form of mindful recognition, allowing the pain to speak to us and pass through.

Mindfulness can also include “conscious distraction” which seems like a contradictory statement, but if we start with attention, we can then make a decision to feel into our pain or to let ourselves carve out a break from it which is far different from “ignore ignore ignore.”

We can also breathe into the places that are not in pain, focusing on whatever areas of our body are not experiencing pain at this moment, even if it’s just the middle toe of your left foot.

If the pain is wildfire, you can even choose a focal point outside the body and declare it your no-pain zone to focus on while breathing deeply. This gives the nervous system some relief from its constant messaging. I had a college professor that started each class with a candle and a vase of flowers as our focal point in the middle of the room. Nowadays, I have a tattoo on my right wrist that serves as my focal point/anchor/reminder to be present.

Humming for Migraines

Tony Bateson, a chronic migraine sufferer, recognized that his migraines dissipated when ranted and raved out loud. So he started studying, first of all, how that could possibly be, and second of all, if he could gain the same effect without the yelly part. He found a good deal of literature on sound healing and came up with the hypothesis that humming at a particular frequency was the part that disrupted the headaches. He began to play with the technique, particularly with mantra meditation, and came up with something that has helped others.

Others have since studied what he came up with and stated that it makes sense. Pain takes control of our brain oscillations (brain waves) and if we use an acoustic that creates an oscillation of the opposite frequencing as the pain oscillation, it would neutralize. Acoustic frequencies, like mantras, have been shown to change the brain. So electrophysiologists think it may help with other pain as well.

The frequency Bateson found most effective to hum is 140 hz, which is essentially a low C sharp. My Buddhist-y and yoga-y readers will recognize this as the same tone as the chanted OM (which is also known as the sound of creation). If you are trying to find that frequency, look for a YouTube video so you don’t have to invest in a pitch pipe to get it right. You are going to hum with your upper and lower jaw held together, teeth touching, but not a clenched jaw. Try to keep the hum as regular a rhythm as possible.

• Hum for 10 seconds

• Take a deep breath in through the nose

• On the exhale, hum again for 10 seconds

• Repeat for 9 more cycles (ten cycles total of hums)

• Rest for two minutes

• Repeat the sequence (ten cycles and two minutes of rest)

• Then rest for 10 minutes before going about your day

UNFUCK YOUR MOVEMENT

This chapter is about exercise. Wait, tho! Don’t skip it! I swear there is not going to be any exercise shaming or body shaming! Quite the opposite, give me a chance??

The idea of exercise often has a punitive connotation. Even the most benign definition of exercise I could find (“a subset of physical activity used for the specific purpose of promoting fitness and overall health”) still reads as a chore to be completed, like: get your teeth cleaned, bring the dog to the groomer, and jump on the treadmill. Even if you like the results, the task itself being a chore is exactly the problem.

I’d like to change that. I’d like to reclaim moving our bodies because our bodies like to move. I want the process to be as joyful as the end result.

I grew up in probably the last unruly-gang-of-kids generation. As a Gen Xer, we ran in packs of bikes and Big Wheels and didn’t come home until the street lights came on. If you got thirsty, you drank from the hose. In short? We played.

And I want to bring that sense of play back, in whatever way that makes sense to you. I happen to adore hiking, swimming, and yoga. And when I say yoga, I don’t mean the sweaty kind that smells like feet and butts, but gentle practices. You may not like any of those things but maybe you adore basketball. Or gardening. Or maybe you are one of those people who digs running even when no one is chasing them with an axe. Or you used to. I want to encourage you to find that joy again. Or if you never had it, I hope that you can in some way find it.

This chapter is all about the positive effects of movement on our bodies. I’m including it all because it’s extra motivation and I’m a research nerd. And if it motivates you to try something new or pick up something you used to adore then I did my job. But my hope is that you continue playing just because you love it.

How Does Movement Help?

Physical exercise is good for us, and not because of burning calories, or how it might make our bodies look.

We know this not just from people who took surveys that said they felt better after a boxing class. There is evidence of a biochemical effect of exercise on our mental health. Any kind of physical exercise is positively correlated with an increase in serotonin, the brain chemical that makes us feel good. You will read tons of stuff that says “exercise increases serotonin” and while that may be true, the exact mechanism of how it actually does so.

Some research shows that body movement increases the plasma level of certain branched chain amino acids (BCAAs) in the brain, which increases tryptophan absorption (which then bio-converts to serotonin). Another benefit: physical activity increases the protective cells and hormones (like endorphins) that mitigate our immune response, meaning the body releases fewer pro-inflammatory signals, which also ties in to better mental health.

Exercise has shown, time and again, to be of greater benefit than medications in managing dysthymia and milder forms of depression. Medications have a risk-benefit ratio that moving our bodies does not have. So much so that in the United Kingdom, the National Institute for Health and Clinical Excellence supports exercise as the first treatment option for these (again, milder cases). A study published in the Journal of Clinical Psychiatry in 2011 found that individuals who were being treated for depression and had sedentary lifestyles found symptom relief after a few months of a regular walking routine. Again, we’re not talking about athletics, just whatever amount of movement feels good to your body.

Bonus points if exercise happens outdoors, where light exposure is also shown to be beneficial to mitigating symptoms of depression because you get the added effect of the vitamin D. I live in South Texas where it’s winter right now but still sunny, bright, and will get into the low 70s. Not everyone has that option. People who live in places where there is less access to natural light are starting to invest in sun lamps to mimic the effect.

Other research demonstrates that exercise helps us build resilience to both physical and psychological stressors. Because only a complicated term will do, we call it the cross-stressor adaptation hypothesis. The idea is that physical exertion (not extreme but engaged in regularly) creates positive adaptations to both the HPA Axis and the sympathetic nervous system, making both of them less likely to become over-activated. This increased zone of tolerance may be a function of self-regulation. That is, exercise builds mindfulness of our autonomic state, helping us stay in that window of tolerance.

For individuals with chronic pain, movement can be very healing with some careful caveats. You have probably heard that exercise is incredibly helpful for managing chronic pain. This is absolutely true. But you have probably also experienced a significant worsening of your pain when you tried to exercise, which is absolutely real. Science backs you up. For normies, working out actually decreases the experience of pain. Things hurt less because endorphins are kicking in.

But the same wonkiness that causes chronic pain to begin with gets turned up even more when you first work out, which is why most of us end up avoiding exercise. It fucking hurts because the same mechanisms in your body that upregulated your pain response to begin with, get activated when you work out, especially if it’s aerobic excercise and you haven’t done anything in awhile. The release of endorphins that actually help pain exists for normies, but not us.

So if it’s true that exercise is making things worse, then why is all this data saying that it helps? There’s a couple of things that we really have to consider when looking at movement for pain management. The first is the healing effect that builds over time. And that we need to focus on exercise that isn’t aerobic in nature, and work with the duration and intensity that is manageable for our pain levels. This may mean swimming, where joints are supported by water. Or restorative yoga which is slower in movement and the forms are supported with pillows and props. There is a balance to be found between movement causing more pain and movement helping pain that is more razor-edge for individuals with chronic pain disorders.[11] But please don’t give up. And don’t think that gentle movement is a cop out. There are still huge benefits to be gained in making exercise part of your treatment plan, even if your legs up the wall in yoga just feels like a nice nap in the moment!

It teaches us, body to brain, that our body is not our enemy. And we all need more of that. Whether we struggle with chronic pain or not.

When clients ask me what forms of exercise I think they should engage in, my first answer is: anything you like or are interested in trying. If there isn’t anything, try things that amplify that self-regulation process, such as yoga and qi-gong. That’s not just because I like yoga—let me talk about why in a little more depth.

The Science of Movement

The human body is biochemical at one level, but at a deeper level it is electromagnetic. Everything contained in the human body is vacuum packed in between layers of connective tissue called fascia. Fascia connects organs to muscle, to spine, to nerves. The primary ingredient of fascia is collagen. Collagen is more than just strong – it’s full of crystals, specifically, hydroxyapatite crystals, which are composed of calcium and phosphates therefore conduct electricity. Fascia creates impermeable compartments throughout the body. If you look at the main fascia structures throughout the body (you perv you), you see that they match up not only with the vagus nerve but the smaller pathways mapped by doctors of Traditional Chinese Medicine—the multitude of points used in acupressure and acupuncture.

This means that when we move our body, it causes an electrical charge in the crystalline material throughout our body. The connective fabric of our bodies creates a living electrical web.

So not only does our chemical body demonstrate a direct impact on our mental health, so does our electromagnetic body, communicating through an electromagnetic field. The intentional use of our body’s electromagnetics (any kind of movement, and probably especially mindful movement) encourages interoception (our connection to the internal working of our bodies—our felt sense) and energetic discharge (a release of emotional tension from the body).

This is why movement is so effective as trauma therapy. When we exercise, we aren’t just building serotonin, decreasing inflammation, and making our hearts healthier. We are reaching into where our emotions start and influencing their movement in the body. That is, we are teaching our body safety. And that is the foundation of trauma therapy: calibrating ourselves back to that physiological zone of safety.

Some Movement to Try

If you’re new to exercise, coming back to it after a long time, recovering from an injury or illness, or have a history with exercise that’s stressful or traumatic, I recommend starting with gentle movements. While there are very few times where I wouldn’t suggest any kind of movement (being in traction in a hospital being the big one), I am big on the idea of “just move, whatever floats your boat.” But there are a couple things I will specifically recommend to people in certain cases that I want to review real quick before we all take a taco break.

It needs to be said that in any cases where exercise is being used as part of a mental health treatment, jumping into it without any kind of clinical support can be dangerous. Activating sensations, thoughts, and emotions will come to the service and you will need a space to process them out. Trauma informed exercise trainers and instructors are incredibly helpful, but also talk to your therapist, your sponsor, or whomever you are working with on your mental health as well.

Movement, just like working on sleeping, eating, medications, and supplements, is a process. Tracking what you do and what results you see is how you will develop a “best self” plan. So give it a whirl and track it like you’re tracking any other changes you’re making.

Gentle Movement

Some of the gentler forms of movement include yoga, tai chi, qi gong, or just plain walking at a pace and a distance that isn’t painful for you. These are good ways of moving your body without causing strain or pain, plus they are the types of exercise that have been shown to have benefit to trauma recovery. When I started doing yoga in the 90s, it was not yet a ubiquitous practice (at least in Texas). Nowadays it’s far easier to find gentle movement type classes, either online (live feed or videos) or in person. If you are looking to incorporate this work for trauma recovery, ask your therapist (if you are seeing someone) about specific teachers they recommend. Otherwise, start looking around. Some teachers are trained in trauma-informed yoga and other practices. Private studios may be out of your price range, but community centers may have free or donation based classes. The local “alternative” papers will usually have listings, as may your local library.

Functional Training and Corrective Exercise

If you have a history of physical injury or immobility that doesn’t require physical therapy, but has still slowed you down, I recommend a personal trainer who specializes in functional training or corrective exercise.

Functional training is a workout with the purpose of improving certain activities in your life with more ease, less pain, and less chance of injury: like lifting heavy boxes at work or picking up heavy kiddos at home. Functional training is sort of between personal training and physical therapy, with the idea that resistance coupled with flexibility produces mobility. Instead of focusing on isolation training (targeting specific muscles in ways that don’t necessarily support natural actions of the human body), functional training combines weight-bearing activities that build core muscle strength as well as compound movement exercises that focus on joint strength.

Corrective exercise works similarly, but focuses on fixing issues caused by imbalances and movement compensations as well as improving your functional mobility. For instance, if you have a condition that causes you to favor one side of your body, or weakness in an area due to a past injury or surgery.

These types of exercise aren’t as fun and playful on the surface as something you inherently enjoy, but a good trainer can help you work in a way that helps you stay engaged while watching yourself progress. Even exercise that is fairly prescriptive shouldn’t feel bad, painful, or shameful. If it does, talk to your trainer or find a new one.

Strength and Muscle Building Exercises

Some people really enjoy a level of exercise that builds on getting strong, working up a sweat, and wearing themselves out enough that they feel a sense of having released negativity from their system. For them, gentle exercise isn’t always the most therapeutic, and this isn’t a one size fits all book, right? Weightlifting or another physical activity that requires a concomitant strength and muscle building program, like boxing, swimming, parkour, or circuit training programs like Crossfit or BodyPump may be more your speed.

While none of this is my personal cup of tea, there are a couple of situations where I highly recommend strength and muscle building. The first, is for individuals whose trauma history has left them feeling physically weak and overpowered. Feeling strong and capable in one’s body can be an incredibly healing experience. The second, is for individuals recovering from eating and dieting disorders. When someone is engaged in an eating disorder, exercise is generally used as a means of influencing weight or shape. But that is exercise designed to burn calories (like running or aerobics). To be successful, strength and muscle building requires healthy energy consumption in the form of nutrient dense foods. The focus becomes on gainz instead of losses.

UNFUCK YOUR SLEEP

I have people ask me how I get so much done in a day. I don’t think I’m Superwoman by any means, in fact I think I’m pretty spoiled in that I really enjoy all the different things that I do. But it is a fair point, that I am juggling a lot of stuff that requires mental exertion and relational presence. And my answer to that question is a pretty simple one.

I get sleep.

Seriously, I prioritize and protect my sleep like it is absolutely necessary for my survival because honestly? It is.

When clients are presenting a big bundle of symptoms related to depression, anxiety, stress, stomach issues, chronic pain, chronic fatigue, and all those other things that therapists hear about, the first thing I ask is, “How’s your sleep?”

And I usually get a double-take “WTF?” reaction. As in: “I just told you that running away from everything and living in a cave with the sasquatches in the Pacific Northwest seems like a good idea and you told me to have a juicebox and a nap?” And it’s a fair question on the surface. What does sleep have to do with anxiety, depression, heart health, and inflammation? Probably a hell of a lot more than you realize.

What Sleep Is and How It Works

If you have read anything else I have written ever, you have copped to the fact that I like functional definitions that set the tone for what we’re talking about. So here’s one for sleep.

Sleep is the brain’s own meditative state that happens about 8 hours out of every 24 (if we are doing it right) in accord with our circadian rhythm. During sleep, some parts of the brain become way less active and other parts of the brain become way more active.

When I say circadian rhythm, I’m referring to the natural cycle that defines a day for us. Circadian just means “around day,” after all. Every species on the planet (barring those that only live a very few days) has a circadian rhythm. It’s generated by our internal time clock but informed by the earth’s rotation. For my fellow science nerds, our internal time clock is an actual existing thing in the middle of the brain, called the suprachiasmatic nucleus.

Sleep occurs in four different stages that we cycle through during our time asleep. There are three stages of Non Rapid Eye Movement (NREM) sleep, moving from lighter to heavier and then there is Rapid Eye Movement (REM) sleep which is the time period where most of our dreaming occurs.

The cycling through REM and NREM stages is weird AF. There is no symmetry to how it happens, except we do know that the NREM sleep is more dominant early and the REM sleep is more dominant later (and closer to the time we wake up). So if we stay up too late we lose more NREM sleep, and if we have to get up too early we lose more REM sleep. Both are important. Equally so. Let’s get on with why that’s the case, eh?

Why We Sleep

Understanding why we sleep has actually been one of the final frontiers of how-the-body-works science. And only in recent years do we have a better idea of what’s actually going on.

When we are awake we are taking in all kinds of new information, right? NREM and REM sleep have different functions in terms of what our brains do with that information.

The brain is busy during the day, attending to all of our ongoing shenanigans. Sorting through those shenanigans takes time and energy we don’t have when we are active. NREM sleep is our time to store this new info, strengthen some connections, and prune away the unnecessary bullshit. It reinforces remembering what we need to remember and forgetting what we need to forget.

REM sleep is the time where we integrate all the info we brought in with the stuff we already knew to be true about the world. REM sleep is essentially our emotional processing time. It helps us recognize patterns and fuels our creativity. This is the likely purpose of the dreaming we do in this stage. It helps us make more intelligent and thoughtful decisions in future days. The brain is figuring out what things are important to remember and what things can be let go of. For those of us working through our old crap and creating new, healthier associations and coping skills, sleep is an important part of all of that happening.

The latest research shows that essentially, sleep time is housekeeping time. Research published by Dr Maiken Nedergaard in 2013 found that the brain’s toxin flushing system (the glymphatic system) is ten times more active when we are asleep than when we are awake. If the brain is a city, the glymphatic system DR334 is our sewer system (pleasant image, right?). During sleep, our neuroglial cells (the cells that support our neuron functioning; the word “glia” means “glue” in Greek) shrink up, allowing our sewer system to flush out. The toxins are pulled out of the brain and into the bloodstream so the liver and kidneys can process the waste out.

It takes a fuck ton of energy to propel this process, and the brain doesn’t have the energy to spare when it’s busy processing information during our waking hours. Toxins build up continuously in our brains and bodies as the side effect of being alive on the planet. That’s not a cause for concern, as long as the body is equipped to do the cleaning outing part. For the brain, this process happens continuously as we move through different cycles of sleep.

You might be wondering what this has to do with the stuff we talked about in part one. Much of the toxins being flushed are neurodegenerative molecules so there is clean space between brain cells, allowing better intra-brain communication.

Additionally, adenosine, a chemical that exists throughout every cell in the body and is one of the neurotransmitters (chemical messengers) in the brain. Adenosine has an important proactive role in the body—it’s a nervous system depressant, meaning it suppresses arousal so we don’t have panic attacks 24/7. It builds up during our waking hours and plays a big role in our feeling sleepy at the end of the day. One of the things caffeine does is block the adenosine effect, which is why it makes us so jittery. Adenosine also builds up in areas of inflammation, trying to keep our inflammation responses from killing us. And we are now aware that inflammation occurs from emotional trauma, not just physical trauma and that neuroinflammation is wayyyy more common than scientists previously realized. So sleep is imperative in managing our body’s response to inflammation.

Every single one of these processes relate to trauma recovery. Dumping old ways of relating to the world and interacting in new and healthy ways? Reducing chronic inflammation and body toxicity? Flushing the built up crud that blocks the brain messaging correctly, and tamping down neuroinflammation so you can start the next day with a clean slate? Enhancing decision-making ability and creativity? Get some sleep!

Are You Getting Enough Sleep?

Don’t fucking lie to me, now. You aren’t, are you? And you aren’t alone. Authors of a National Sleep Foundation report noted that two-thirds of all adults in the US do not get the minimum recommended amount of sleep (7 hours) at least on weeknights, and generally not at all. And it’s not like everyone is coming close but getting 6.5 hours or something. Most people are clocking way, way less on a regular basis. This isn’t just a US problem, however. The two-thirds number is exactly the same in Japan and nearly that in the UK. Other countries vary in their number count but it’s still way, way too high. Even in Germany, where it’s “only” 30% of the population who is sleep deprived.

Seven to nine hours: that’s what adults are supposed to get. I happen to be a nine-hour person, but seven is the minimum to ward off all the ills I’m going to discuss below. This isn’t a Dr. Faith number, this is a World Health Organization number.

“Bah!” a lot of people say. “I’m one of those people who don’t need much sleep.”

“Bah!” I say in return. Bullshit, alas. The number of people who actually are able to gain all the benefits discussed above on less sleep is minute. Like a fraction of 1%. And it seems to be related to a variant of a specific gene known as BHLHE41.

So why do so many people think they are just fucking fine? Several reasons, I’m guessing. The first is the cultural norm of sleep deprivation. We think we are supposed to push through things and be all tough and shit. Sleeping a full 7 hours is a cultural sign of weakness. Another reason is that it’s the norm for us personally. We don’t realize that this isn’t our optimal self. It’s just how it’s been for so long. Finally, research demonstrates that we greatly underestimate our level of impairment from sleep deprivation. The rate of mistakes we make when sleep deprived has been tested and quantified in studies, but ask us to estimate our level of impairment? We think we’ve got it under control.

Because sleep is inextricably tied to pretty much every function of the human body, it is not a shock that not enough sleep (or disruption of quality sleep) is associated with a multitude of problems.

Here’s a fun list of things we are far more likely to develop if we are sleep deprived:

• Reduced immune system function and immune deficiency

• Reduced motor function

• Cancer and the spread of cancer

• Diabetes

• Infertility

• Alzheimer’s

• Depletion of our gut microbiome

• Cardiovascular disease

• High blood pressure

• Higher susceptibility to infections

• Stroke

• Congestive heart failure

• Depression

• Anxiety

• Bipolar disorder

• Schizophrenia

• PTSD

• Suicidality

• Shorter life span

• Vehicle crashes and traffic deaths. Drowsy driving accounts for more of these than drugs and alcohol combined.

Now some of these things are causal. Accident rates due to drowsy driving? We make mistakes when impaired. Period. But it isn’t always a cause and effect situation. No one is saying (that I’m aware of) that sleep deprivation causes PTSD or any other emotional or physical illness. Correlation is not causality. But treating sleep can greatly reduce the symptoms of these other issues and help promote healing and recovery.

How to Sleep Better

Okay, first of all, if you have the ability to get enough sleep (as in you can fall asleep just fucking fine) but you don’t let yourself get enough sleep (as in, you are binging on Netflix or some dumb shit instead of putting yourself to bed): stop that shit right now and get enough sleep.

There, easy fix.

Now, for the rest of you who are trying to get enough sleep but have trouble doing so and have for some time? Like you don’t sleep well for several nights a week for months on end? Or maybe you’re getting crappy sleep quality.

It’s possible you have a sleep disorder you’ll need to get medical intervention for. Talk to your medical doctor if you think this might be the case. But insomnia generally stems from worry, rumination, anxiety, and other types of emotional distress. It’s common. 1 out of 9 people meet the criteria for insomnia at any given moment. The rest of this section is for you. Let’s unfuck your sleep.

Set Yourself Up to Succeed

First, make sure you have appropriate sleep opportunity time. You need to give yourself a good 30 minutes to fall asleep. So if you need 7 hours, put yourself to bed 7.5 hours before wakey-uppy time. Have a regular going to bed and getting up time, even on your days off.

I know. The advice “have a bedtime routine” makes you want to throw up in your mouth every time you read it. But have a bedtime routine. If you didn’t fall asleep during your 30-minute opportunity window, don’t perseverate over it. Don’t look at the clock. Don’t toss and turn. Get up and go do something. Don’t turn on the Xbox or anything super stimulating, and nothing with blue lights in general (read: anything with a screen). Read something dry and boring like a Dr. Faith book. Do a load of laundry, empty the dishwasher, something like that. When you feel sleepy again, go back to bed.

Don’t take late naps. Naps in the early afternoon tend to be beneficial to us. Naps later in the afternoon or evening (I know a lot of after-work nappers) can disrupt your nighttime sleep.

Weighted blankets are superb for supporting individuals who live with anxiety, ADHD, ASD, and other issues. They have also been shown to support sleep. Weighted blankets provide deep touch pressure, which raises serotonin levels in the body, which as we know from above, promotes the generation and release of melatonin in the body. Weighted blankets used to be prohibitively expensive, but now can be found for under 100 dollars with some research. For adults, you generally want to get a weight that is 5-10% of your healthy body weight[12]. For kiddos, the general number is 10% of their body weight plus a pound of two.

Other weighting options can include “Korean mink” blankets (which I’ve seen available for up to 10 pounds for about 30 dollars, and no they are not actually real mink) or just piling on whatever blankets you have in the house. If you do the pile on trick, you will probably have to drop the temperature in the house some more because it will be significantly warmer. Weighted blankets use plastic pellets for the weight, therefore aren’t as hot to have over the body.

Create a Good Environment for Sleep

Bedrooms are for two things and watching TV isn’t one of them. It’s bad for your partnership if you have one and it’s really fucking bad for your sleep. A poll taken by a TV manufacturer (LG to be precise) found that 61% of people fall asleep with the TV on. Besides the blue light disruption, the cacophonous noise in the background is going to disrupt your sleep quality.

If you do better with noise at night, try a noise machine. Many of them offer different settings from white noise, like rain or heartbeats. A lot of people also use a fan or air purifier. Both make white noise while helping with air circulation and cleaning toxins out of your space.

Try to get natural sun exposure during the day and limit your blue light exposure in the evenings. Charles Czeisler of Harvard Medical School found that individuals who used electronic reading devices (like Kindles) before bedtime had a harder time falling asleep, had reduced levels of melatonin in the body, and were groggier the next morning. Like a 50% reduction in melatonin levels. That’s a big deal.

It’s the blue light coming from our screens, y’all. Whether it’s an e-reader, our phones, or the TV, our constant exposure to the blue light confuses our brain into thinking it’s daytime for longer than it actually is.

And if you’re thinking “Fuck off, Dr. Faith, watching Netflix in bed is my low key reason for living, I’m not giving that up”? Studies have demonstrated that people who used blue light devices and wore blue blocker glasses for three hours before bedtime produced just as much melatonin as people who were not exposed to blue lights. And the glasses are super inexpensive. A pair that is obviously yellow and looks like what Bono wears is about ten bucks. If you want a pair that does the trick without being so overtly weird, you can get them for twenty or so bucks. They are still yellow tinted to block the blue light but it isn’t obvious up close. You can also get them in different reading glass strengths. I think they’re actually kinda cute.

Another option is to download a program like f.lux on your computers. It will change your computer display’s light settings to match what the sun is doing outside. I’m currently typing on my laptop at 8PM and the light is a dimmer pink so I don’t need to wear my blue blockers of sassiness.

Temperature can help or hinder sleep. Your body temp needs to drop 2-3 degrees Fahrenheit (1 degree Celsius for anyone on the planet not in the US) in order to be able to sleep. Sleeping with a colder room can really help. Optimally, the room should be about 65 degrees. Most people keep their rooms warmer than that so 65 may be a big change. Try dropping the thermometer a couple of degrees from where you usually keep it and see if that helps. You can also take a hot bath since you will have a temperature drop when you get out of the warm water into the cooler air. And while exercise is helpful to sleep in general, exercising close to bedtime will raise your core body temperature and may disrupt your sleep.

Track Your Sleep

For about five minutes, everyone and their dog was wearing a FitBit, smartwatch, or other tracking device. If you still do so, use it to track your sleep! If you don’t have one (or, like me, don’t want the continuous shaming about your level of inactivity) you can use a sleep tracking app instead. I’ve been using the SleepCycle app for about two years now and it’s been really helpful. It uses the mic on my phone to track my stages of sleep and quality of sleep. It also listens for distressed breathing and will record a small clip if you are snoring or if you’ve always wondered what you say when you talk in your sleep. It’s caught me having an asthma attack in the middle of the night, which was very helpful information. If you notice chronic breathing problems, you could have sleep apnea and you need to get a sleep study to find out. Even if you pay for the premium version, an app like this is waaaay cheaper than another tracking device.

You can also keep a notebook by your bed and jot down notes about sleep time and quality.

Maintain Your General Health

A lot of sleep disruption is due to stomach upset, needing to use the bathroom more, and breathing issues. Using other sleep hacks without treating the root causes may help a bit, but in the long term is more like changing deck chairs on the Titanic than anything else. For example, if you have blood sugar stress, you will likely be up peeing in the middle of the night a lot more than you would otherwise. I’m gonna tattle on Mr. Dr. Faith by pointing out how much better he sleeps after he got his blood sugar under control.

Remember the hierarchy of interventions? First, try looking at dietary changes, lifestyle changes, and supplements that can help manage underlying issues. For example, food sensitivities might be impacting your health and your sleep, so try an elimination diet to figure out what those are. Or maybe you sleep better when you’ve gotten a certain amount of exercise. Or meditating right before bed could clear out the anxiety that keeps you up. Anytime we can give our body what it needs to heal itself instead of treating symptoms, the better everything works.

Prescription Medicine

If sleeping pills induced a natural sleep—meaning, appropriate cycling through NREM and REM sleep—that would be awesome. But they don’t. According to studies, sleeping pills (Ambien, Lunesta, and the like) only demonstrate a small improvement in the time it takes to fall asleep and they don’t create the brainwaves that we see in real sleep. And they have a fuck ton of side effects. You’ve probably heard about people doing crazy zombie shit on sleeping pills. There’s also the grogginess and forgetfulness that happens the next day. They are also associated with higher rates of infection and higher rates of cancer. Also? Higher rates of death. All the things that are more likely to happen because of lack of sleep also happen on sleep induced by prescription sleep meds.

But that’s not to say that allopathic medicine can’t help with sleep. Some drugs can treat the underlying conditions that disrupt our sleep, like blood sugar and anxiety. Night terrors are something people with PTSD are often (understandably) seeking to medicate away, but even though sleep medications can lessen the night terrors, they also end up disrupting REM sleep and you also lose all the things REM sleep gives the body, so it’s not a good trade-off in the long run. There is a prescription option that may work better. Many individuals with PTSD have higher levels of norepinephrine (noradrenaline) released by the nervous systems. Meaning that the hormone/neurotransmitter that the body uses to engage the fight or flight response is swimming around in their heads, promoting alertness, even when they are supposed to be sleeping. Essentially, people with night terrors are trying to sleep through an activated sympathetic nervous system, they aren’t able to maintain a zone of tolerance even when they are conked out. So some docs are using a high blood pressure drug called Prazosin, which has the side benefit of suppressing the noradrenaline without suppressing REM sleep. Chat with your prescriber about it if this is something you struggle with.

Supplements

Supplements can be an effective alternative, but we should always take into consideration possible side effects and interactions with other meds. As we will see in the last chapter when discussing aspirin and acetaminophen and the like, over the counter doesn’t equate to totally safe. Please read the Supplements chapter of this book and talk with your doctor before experimenting with supplements.

Melatonin is one supplement a lot of people find useful, especially those who have trouble falling asleep to begin with. Our body produces the hormone melatonin in the pineal gland. We generally have enough of it unless we are deficient in some way (as caused by the blue light usage, for example, which is everyone and their dog at this point). Melatonin works best if you take it 2-3 hours before you go to bed since it helps amp up the body’s own natural melatonin kicking in as part of your circadian cycle. If you take it like you would a sleeping pill (swallow pill and lie down) you’ll not get near the same effect.

For every person I’ve met who has tried melatonin and thought it was brilliant, I’ve talked to someone else who said it did nothing for them. There’s a good reason for that. Even if you are taking it exactly when you are supposed to, you may notice that you fall asleep pretty well but the staying asleep portion of the program is still problematic. You’re not the only one. Most melatonin supplements are fast-acting instead of continued release, so you get your little burst but then it wears off.

Melatonin is contraindicated with individuals with seizure disorders and with high blood pressure. It also shouldn’t be taken with a prescription sleep medicine. Like everything else, check with your doc and be safe.[13]

One of the other supplements I often suggest (and I talk about it more in the Supplements chapter) is L-Tryptophan (yes, the stuff in turkey). It is one of the essential amino acids that the body doesn’t produce on its own (unlike melatonin). We have to get it from our foods or in supplementation. L-Tryptophan is used by the body to make niacin. Niacin makes, among other things, serotonin. And serotonin is instrumental in our melatonin production.

Now I know you’re thinking, wait, what? Serotonin? Does that make L-Tryptophan an antidepressant? Some research shows that L-Tryptophan does demonstrate some relief of depression-related symptoms. If you are able to add it in, you may be able to talk to your prescriber about reducing or discontinuing other medications you have been taking for depression. But let them in on what you’re doing before you start futzing with your dosages, mmmkay?

If you add L-Tryptophan, you may still use a little melatonin to help the falling asleep part but you won’t need nearly the dose because the L-Tryptophan will keep it producing throughout the night like a champ. And, yes, there are multiple studies that demonstrate that L-Tryptophan supplementation works like a boss for promoting sleep. And as I mentioned in a previous chapter, L-Tryptophan is contraindicated for people with eosinophilia myalgia syndrome and may have some level of interaction with other antidepressants since it is also involved in serotonin production. So all together now: Check with your physician!

Valerian root and the kava plant have both been used for their sedative effect for thousands of years and can therefore be beneficial for sleep. While I’m a fan of both, I am more cautious about the brands being used than I am with melatonin and L-Tryptophan. Both of these supplements are more expensive to produce, making it more likely that you end up buying something with a non-efficacious dose because the manufacturer is trying to amp their bottom line. I prefer the Mediherb brand because the quality is above and beyond and the manufacturing is so transparent. Annnnnnd because they water-extract their kava in order to eliminate many of the side effects associated with other extraction processes. If you’ve heard about kava being unsafe, you were reading about kava lactone toxicity. Essentially, some extraction methods used on the kava plant also extract glutathione, which can damage the liver. Clearly no bueno. Mediherb products are only available through professional treatment providers (as is another brand on my short list, Galen’s Way). For over the counter brands that are good quality, I lean toward Gaia Herbs and Mountain Rose Herbs. You may also find an herbalist in your area that makes their own extractions so you can see their process up close and personal.

Finally, here are a couple of teas to try sipping before bed. Grandma was right to give you chamomile. It’s generally really safe, per the FDA. Though if you have a ragweed allergy, you may react to chamomile—they are from the same family. You do need to make sure you brew it properly to get the sleepy-sleepy effect. Use two to three tea bags and put a cover over the pot or your cup so all of the good oils don’t escape in the steam.

Banana peels are not just brilliant in your compost pile (or fed directly to your rose bushes), you can make an amazing tea out of them—and bananas also contain L-Tryptophan. Cut off the stems and use them fresh, baggy them and freeze them to use frozen, or dehydrate them out to use later. One fresh peel is equal to about 2 tablespoons of dried peel, all of which is equal to one cup of tea. Boil water, throw in the peel, then cover and reduce heat to let it simmer for about ten minutes. You can add cinnamon and vanilla if you dig, as well. Bananas (including the peels) are a good source of magnesium and potassium, which are both things bodies need anyway and something many people tend to not have enough of.

Substances to Avoid

Alcohol can help you pass out, but it’s not going to give you the sleep you need. A study just published in the medical journal The Lancet determined that any health benefits of alcohol (like the classic “red wine is good for your heart!”) are far outweighed by the risks. Essentially, the study authors found, there is no such thing as a safe amount of alcohol and it is the leading risk factor for death-and-disability-adjusted life years for those of us ages 15 to 49.

It also doesn’t help that drinking makes you have to get up and pee more (because alcohol is a diuretic). It over-relaxes your muscles, even in your throat, making it more likely that you will snore. It disrupts your circadian rhythm, it amps up your alpha brain waves which then compete with your delta brain waves making the restorative sleep less effective, and it blocks REM sleep like a motherfucker.

So seriously. No drankin’. Or at least reduce your amount of alcohol way down. You’re tracking your sleep now, so look at the differences on drinking and non-drinking nights. Even better, give it up for a month and track your sleep. If you aren’t sure if there is an improvement, add it back in and notice the difference, just like you would a food detox.

Also, avoid caffeine and nicotine before bedtime. Both are stimulants, right? We all have different rates of metabolism for these substances so pay attention to when you use either and how it affects your sleep. Some people can have coffee after dinner and be fine, while others of us need to cut out caffeine mid-afternoon or earlier.

Cannabis and kratom are two more substances that people often use to help them sleep, but that can have counterproductive effects. The research on both is limited, I realize. Most cannabis and sleep research comes from the 70s, though with it being legal in more states, we will see better studies and confirmatory studies over the next few years, I hope. Kratom (the tropical tree leaf that has stimulant and opioid properties) is legal in most states but new to the US in general so also has limited studies to back it up.

I know that a lot of people use cannabis (CBD or THC) or kratom to help them manage their symptoms of anxiety, depression, PTSD, and chronic pain. However, the research that is out there does show that both disrupt sleep quality, specifically reducing REM sleep (which we now know is kinda sorta really fucking important). Sleep problems on kratom are an oft-reported side effect. With cannabis, it’s slightly more complicated. Deep sleep is enhanced with initial use, but the cannabis-helping-you-sleep effect fades away pretty quickly the more often you use it. The “why” part of that is still unknown.

Because all of these fun herbs can disrupt REM sleep, it also lessens night terrors, and is used by folks with PTSD and the like. But then you also lose all the things REM sleep gives the human body, so not a good trade-off. There is a prescription option that may work better.

For those of you who are using cannabis and/or kratom to help you manage other symptoms, I feel you. I know many people consider them an absolute lifesaver. The lesser the dose, the less impact it has on your sleep. Monitor your dosing along with monitoring your sleep and work to figure out your sweet spot for the amount you take and time(s) of day you take it.

And if you smoke your THC? Consider using another method of ingestion. Smoking increases your risk of breathing issues (asthma, COPSD), which will also fuck with your sleep.

Cognitive Behavior Therapy for Insomnia (CBT-I)

Therapy, or at least some forms of it, can also help you sleep. The Chronic Insomnia Task Force of the American Academy of Sleep Medicine has recommended CBT-I as the first professional intervention that someone should undertake for insomnia (assuming apnea, restless leg syndrome, and other medical conditions have been ruled out). CBT-I is a short-term therapy (4-8 sessions, generally) that pairs the principles of cognitive behavior therapy with specific sleep hygiene protocols and relaxation techniques to assist people in untethering the emotional distress that is the general root cause of insomnia.

If you are disrupted consistently by nightmares and night terrors, that means your brain is working hard to make sense of some traumatic shit you have dealt with in the past. CBT-I may be enough to help you through the process, or you may have to do some trauma-informed therapy to work through whatever it is that your brain is trying to figure out. All of the exercises that help you increase vagal tone and widen your window of tolerance will also absolutely help your sleep.

UNFUCK YOUR FOOD

Food and eating have a deep relationship with trauma, inflammation, toxicity, and stress so I would be remiss for not discussing them. However, issues surrounding food and eating can be incredibly emotionally expensive for just about everyone. Eating and dieting disorders exist in people of all shapes, sizes, and genders. Not looking like the media idea of someone with an eating disorder doesn’t mean you don’t have one. Nor does it mean you are safer from the associated negative health outcomes (eating disorders are the second deadliest mental health disorder, only opioid addiction is higher).

If this is an area in which you are struggling and your inner voice tells you to skip over this chapter, listen to it.

It’ll always be here later if you are looking at making some considered food choices from a more stable place. You may find that the chapter on supplements and meds will help in terms of looking at ways of getting some missing nutrients in your body when food is a battleground. And exercise isn’t off the table, even if you have used it as a purging mechanism in the past. If you are getting treatment right now, talk to your therapist or group about how strength and muscle building exercise (rather than calorie burning exercise) may be a helpful part of your recovery and get their feedback.

If you are still deciding, please know that this chapter is not at all about weight loss or fitspo or food choice shaming in any way, shape, or form. It’s actually pretty political. Shocker coming from me, I know. It’s about problems within the food system that are creating problems for our health and the kinds of changes we can make in order to combat these problems. If that’s your cup of tea, carry on!

Skinny Doesn’t Equal Healthy

One of the most troubling things about food for most of us is its relationship with body weight. We have this cultural myth that fat is unhealthy and skinny is healthy. It’s so pervasive, it’s everywhere. And it’s not true. (Say it out loud for the people in the baaaaaack) So most people from medical professionals to social media “experts” skip treating real problems and focus on shaming people for the size of their thighs. And we really got to fucking stop.

Fatphobia Is Racist

Centuries ago in Europe, being full figured was synonymous with being healthy and strong (look at Renaissance art work if you want to see the ideal). This carried over to the early days of colonization of Turtle Island (now North and South America).

Because of availability of enough food, American colonists weren’t just heartier, they were much taller than their families back in Europe. By the mid 1800s, there was an eight centimeter high discrepancy between Americans and Europeans. Bigger bodies were considered more beautiful. It was fashionable for women to drink down “weight gain” tonics if they were too skinny to catch a good husband.

The widespread trade of enslaved people was happening at the same time, and this presented a problem. In order to mentally justify the ownership of some bodies by other bodies, there had to be a mechanism for deciding superiority and inferiority. This was easy at first because of skin tone. But the continued rape by slave owners and interbreeding with enslaved Indigenous peoples (yes that happened, too) meant that future generations had lighter and lighter skin. So the comparison of body types, frame size, and where fat settles on the body became the mechanism for deciding who is superior (see Sabrina Strings’s amazing book Fearing the Black Body). White women of a certain class were able to differentiate themselves from enslaved women and poor white women by showing that they didn’t have to be solid and strong to get through a day, they could center thinness as an ideal.

A Presbyterian minister by the name of Sylvester Graham (yes, the graham cracker guy) promoted an extremely restrictive lifestyle and diet (the original graham crackers were not yummy, trust). He died in 1851, but his followers remained active through the 1880s.

Tonics meant to put on weight were replaced with ones meant to melt it away.

Lulu Hunt Peters, a young woman who had struggled with “baby fat” into adulthood, earned her MD and translated nutrition research to the public in what became a bestselling book. Diet and Health: With Key to the Calories was released in 1918 and included an extensive list of “100 calorie snacks.” Dietary restrictions became the rage. But then the question became, how do we decide what determines an acceptable amount of thin?

The BMI Is Racist, Sexist, and Transphobic as Fuck

The Body Mass Index (BMI) is the defining metric modern medicine uses to determine BMI is a measure that uses your height and weight to determine if your weight is healthy. Okay, then. As the queen of the “but why” questions, I wanted to know where this came from. The BMI was actually invented 200 years ago. The dude who created it, Adolphe Quetelet, was not a physician, but actually an academic who was super fired up on astronomy, sociology, math, and statistics. A Belgian in the 1800s, he was part of the boom in racist “science”—he is also credited with founding the field of anthropometry, which includes all that phrenology bullshit. He was looking for ways to identify the characteristics of “the average man”, thinking that represented the social ideal of manliness.

He believed that someone whose physiology fit the mathematical mean of all people (which for him meant European people, but okay) would be the human ideal, which is bullshit. Based on the measurements of French and Scottish men, he came up with a formula known as Quetelet’s Index (now known as the BMI), which ranked peoples’ body size on a curve based on his available study subjects. It was intended as a social tool; he never meant it as a measure of body fat, build, or individual health. By the early 1900s, this index became the mechanism for determining if someone was fit to parent, and as a justification for forced sterilization, or eugenics. And not just against people of color, but also poor people, people with disabilities, and neurodiverse people.

But then, capitalism. US Life Insurance companies began compiling tables of height and weight to determine what to charge policy holders. The tables were based on the weight and height of the people who could actually afford to purchase life insurance and had the legal means to do so. And the numbers were self-reported. Most tables did not include frame size or factor in age. And all this information was put together by sales agents and actuaries, not medical professionals.

Physicians began using these unscientific tables as a means of evaluating a patient’s weight as an indicator of their health. This went on through the 1950s and 60s, until medical science decided to find a more effective measure in the 70s. A research team led by Ancel Keys conducted a study of 7,500 men (yes, only men) from five (yes, only five) different countries, trying to find the most effective measure of body fat that would be easy and cost effective because it could be easily calculated during a regular doctor’s office visit. They compared it to the use of skin calipers and water displacement and found that all were weak but the BMI sucked the least.

In this study, Keys found that the BMI diagnosed “obesity”[14] accurately about 50% of the time. Meaning, that half the time individuals are carrying extra weight on their frames, and the other half of the time they just have bigger frames or a lot of dense muscle tissue. This level of “accuracy” has continued to hold at 50%. A 2011 study in the Journal of Obstetrics and Gynecology stated that, yup, it was right half the time. No matter. In 1985, the National Institutes of Health (NIH) redefined obesity in terms of BMI. And that made it literal public policy.

The NIH wasn’t done with us though. In 1998, they changed the definitions of both “obese” and “overweight,” lowering the threshold of what is medically considered fat. All of a sudden, millions of people became medically (and legally) fat without gaining a pound. And now we can have a good old fashioned public health crisis over our so-called obesity epidemic and blame someone’s weight for all of their medical issues.

So now we have a systemic problem that disproportionately affects women, individuals of color, and trans people. There are sex based differences that are not accounted for in the BMI—which was developed measuring only men, remember? But any woman who has ever been heavy at some point in their life has a story of being told by a doctor that their chief complaint will be resolved through weight loss. Many trans individuals are denied surgical gender confirmation interventions until they lose weight, even though an 18 year longitudinal study of post-op complications shows this is not the case. And according to the World Health Organization (WHO), the BMI overestimates fatness and health risks for Black people while underestimating the health risks for Asian communities.

People are being dismissed, other real illnesses are not being diagnosed and treated, and denied life saving treatments and surgeries based on a two hundred year old tool designed to legitimize ethnic cleansing and cultural genocide.

And I don’t think the irony is lost on any of us right now.

A Low BMI Isn’t Necessarily Healthy

You can have a low BMI and not be at all healthy. Not just if you have an illness or an eating disorder—some people seem to have these insane metabolisms that keep them slim yet they are not any healthier, or are even far less healthy, than their thicker counterparts. And being actually underweight (BMI less than 18.5) is associated with early death more often with being overweight. As determined in over 50 studies.[15] A friend of mine was bluntly told by her doctor when approaching 40, “Yes, you are tall and slim, but that doesn’t mean you aren’t rotting on the inside. You gotta take better care of yourself.”

The official term for someone with a “normal” or “underweight” BMI is metabolically unhealthy non-obese (MUHNO). Just like in the early days of the US when being scrawny was considered problematic, it still is. MUHNO individuals may be eating like crap and not moving their body and can therefore still be insulin resistant and have high triglycerides, high blood pressure, cardiac issues, and high inflammation markers (an indicator we keep returning to again and again). Their body fat patterns are just different, not better. Extreme bodybuilding can also lead to metabolic shut down. I’m not dissing bodybuilding (my son is a weightlifter and it’s a huge part of his wellness routine), but all extremes put pressure on our bodies that they aren’t equipped to handle, no matter how much we would like to hack the process and live forever. Bodies are all weird and different and each one has its own operating instructions. We can’t do a little height and weight algebra equation to know if someone is healthy or not.

But one thing we do know? The greatest indicator of life span is not your mass, it’s your class. If I wanted a good test of whether or not you are in good health and will live a long life, I would not look at your BMI, but at your socioeconomic status. This is true for virtually every disease in every industrialized country. And the greater the level of inequality in a country, the greater the health disparities. Your access to care changes, the respect you are given when you do access care changes, and your access to a healthy environment and nutritious food changes. It brings us back to stress, trauma, a toxic environment, and chronically upregulated inflammation once again. If you are interested in reading more about the science of individual weight set-points and the influence of socioeconomic status, read Body Respect by Linda Bacon.

And while suggesting government overthrow just gets NSA agents showing up at my office and scaring my clients, I can suggest potential changes we can make individually to combat the systemic issues we are all dealing with. And fuck if that isn’t the narrative arcs of all of my books, right?

Our Food System Is Bullshit

So now that we got the “this isn’t a chapter about dieting” stuff out of the way, let’s talk about our actual diets. Cuz not the same thing, right? And since our diets are not just of the things we like to eat, but are greatly influenced by what’s affordable and available, let’s talk about why that system is utter trash.

If you have purchased groceries even once in the history of ever, you know that broccoli is way more expensive than a loaf of bread. And if you have ever been on a tight budget, you know that you can get a fast food value meal far cheaper than a healthy meal.

US Federal government data states that our primary sources of calories are sweets and simple carbs (stuff like ice cream, pasta, pizza, bread, and sugary drinks). You know what all of these foods have in common besides their carb load? They are produced primarily from the crops and farm foods that are heavily subsidized by the federal government: corn, soybeans, wheat, rice, sorghum, milk, and meat.

Between 1995 and 2010, the government allocated $170 billion in agricultural subsidies to finance the production of these foods. The farm bill is renewed by Congress every five years; the version approved in 2014 called for $956 billion in spending. The farm bill in progress as I write this in 2021 is projected by the Congressional Budget Office (CBO) to total out at $428 billion over the 5-year period 2019-23.

Of course, none of these foods are inherently unhealthy. The problem is not that these foods exist in the world, but only a tiny percent of them are being eaten as is. Most are being converted to additives and cheap products like corn sweeteners, industrially produced oils, refined carbohydrates, and processed meats. They become the building blocks for the ultra processed foods I am going to talk about later in this chapter.

The subsidies program was started with good intentions, as many of our most ridiculous government initiatives are. The idea was to support struggling farmers and strengthen America’s food supply. But instead of supporting the small farmers who grow veggies and fruits and nuts and the like (which are formally categorized as “speciality crops” by the government), the money goes to these aforementioned “commodity crops.” Ironically, “specialty” farms account for 75% of our farmland in the US but only receive 14% of crop subsidies. And whatever the intentions of the bill, small farmers are not getting the money. Huge industrial agri-business farm-factories are getting half of the subsidies while only representing 7% of US cropland. Some versions of the farm bill even stipulated that you could not grow anything other than commodity foods. Until 2014, you would literally be penalized for growing broccoli. Thanks to advocacy, now a whole 15% of your crop can be “specialty foods” if you receive subsidy funding.

So there are very real reasons that crap foods seem so cheap—but actually, they aren’t. You are paying for them out of your tax dollars. But since they are essentially our pre-paid foods, they are the ones that are easiest to access and afford. And they are the ones that even our own government has found to be most likely to cause metabolic distress and chronic inflammation.

Measurable improvements can be made in many health issues by changing how we eat by promoting better well-being, lower health care costs, greater sustainability, reduced disparities among population groups, improved economic competitiveness and greater national security. This means not just changing what we individually put in our mouths every day, but improving how nutrition is supported by the medical establishment and government. And supporting better nutrition is actually cost saving. For example, one program found that a home delivered medically tailored meal program actually saved $9,000 a year for patient health care costs because patients had less health care issues that required medications and other treatments.

What Are “Processed” Foods?

In trying to eat better, you probably keep hearing that we should avoid processed food. But most of our food (no matter what type of diet we ascribe to) is processed in some way, and this isn’t necessarily a bad thing. The idea of processed food is super vague. Technically, once we chew our food in order to swallow it without choking, we’ve processed it. Even putting aside that fact, the US dietary guidelines use a very broad definition of “processed”:

Any raw agricultural commodity [product] that has been subject to processing, such as canning, cooking, freezing, dehydration, or milling. Processing certain foods can make them last longer by killing organisms in the food or slowing their growth.

True all of this: processing foods allowed us to carry harvest through multiple seasons, especially before refrigeration became a widespread thing. Canning, drying, fermenting foods kept us alive after the harvest. Processing can also make foods safer (cooked versus raw chicken, anyone?) and could also create better bioavailability of the nutrition contained within (like the nixtamalization[16] of corn into hominy or the sprouting of grains).

Just in the past few years, a team from the Center for Epidemiological Studies in Health and Nutrition at the University of São Paulo in Brazil took on the tasking of defining food processing as a spectrum. They came up with a scale that helps us determine when we are veering into an unhealthy territory. It was published as part of “The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing” and you can find the whole thing online, if that’s your kink. But here are their basic classifications:

Unprocessed or Minimally Processed Foods: This includes the edible parts of any foods (plant or animal based) after they have been harvested from their natural source. Minimal processing may include removing parts that are inedible, roasting or broiling, drying, freezing, fermenting without alcohol, or squeezing (like getting juice from fruit).

Processed Culinary Ingredients: This is essentially our oils, fats, salts, and sugars. Like honey removed from a honeycomb, maple syrup extracted from a tree, sugar processed from sugar cane or sugar beets, salt harvested from the sea, or oils extracted from a plant (like olive oil extracted from olives). These ingredients are created by pressing, grinding, crushing, pulverizing, and refining.

Processed Foods: These are foods that are a combination of the first two groups, such as a naturally or minimally processed food that has a processed culinary ingredient added to it. Still not bad, right? Salt cured lemons would be processed while simply dried lemons would not. Me toasting a mix of nuts in a little bit of olive oil with salt and spices would be a processed food, while eating them raw or merely sprouting them or toasting them would not. So even at this level, we are seeing that processing isn’t bad. This is how we make things taste good.

Ultra-Processed Foods: This is where we get into ingredients that you couldn’t replicate at home (think hydrogenated oils, hydrolyzed proteins, soy protein isolate, maltodextrin, invert sugar, high fructose corn syrup, dyes, stabilizers, and emulsifiers). These industrialized formulas were synthesized in laboratory settings. They have little (if anything) to do with the first category of foods. Think candy bars, cake mixes, breakfast cereal, instant noodles, and most pre-packaged frozen foods. They taste yummy because they were frankensteined to do so but they aren’t food.

So when we are talking about processed foods being a problem, we are talking about these ultra-processed foods. These are the foods that have been correlated with higher risks of cancer, metabolic syndrome, and death from any cause. In the United States, 61% of an adult’s total diet comes from ultra-processed foods. We aren’t alone though: the proportion in Canada is 62% and in the UK its 63%.

Awareness makes a huge difference in lessening our ultra-processed food consumption. For example, Finland in the 1980s had the highest rate of cardiovascular disease fatalities. Scientists attributed the high rate to the added sodium in food.

The salt we add to our food to make it taste delicious is composed of sodium and chloride. We generally aren’t getting too much salt, but we are often getting too much sodium. Sodium added to food as a preservative includes sodium benzoate, sodium citrate, and sodium sorbate, which is not the same thing as the salt you sprinkled on your tomatoes. Sodium is used to enhance color and give things a firmer texture. More than 75% of the salt in our diet is coming from sodium added to ultra-processed foods as a preservative. When you see “no salt added” on your can of beans, that’s the one you want to buy, because it means no added sodium-whatevers. You can salt it to your taste level with real, normal salt when you’re cooking at home.

So that’s what the Finnish government did. Anything with a high sodium content got a big honking “Don’t Buy This Shit” label on it.

Okay, not really. It got a label that said “High Salt Content”—meaning high sodium, but since they get used interchangeably people got the message. So by 2007, sodium consumption had dropped 30% in Finland and that led to a 75% decrease in deaths from strokes and heart disease.

Ultra-processed foods have far more inflammatory potential than their whole-food counterparts. For example, one common food additive, tert-Butylhydroquinone, which has been studied fairly extensively at this point, has been demonstrated to hamper the body’s immune response. The body treats the buildup of these substances as a toxin, and we develop an inflammatory response.

Ultra-processed foods are also correlated with mental health issues. The journal PLOS ONE published a randomized controlled trial finding that depression, anxiety, and stress symptoms decreased from the “moderate” range to the “normal” range after only three weeks of eating a diet that significantly reduced ultra-processed food consumption. It wasn’t a special fancy diet, just a general “Mediterranean-style pattern” according to the study, meaning food instead of crap. The control group continued to eat refined carbs, sugary foods and beverages, and other ultra-processed meals and showed no decrease in their depression scores.

Why do we eat this stuff if it’s so bad for us? First of all, it tastes good. Food scientists figured out the ideal level of salt to fat, the right amount of crunch or creaminess, and the general mouthfeel to not only make things taste good, but hijack our brain’s ability to signal satiety. Instead of getting the “we’re full” we get a “carry on” message. Also? They’re cheaper. Cheaper in money and cheaper in labor and time. The processed packaged food industry is extraordinarily efficient at using cheap ingredients to create “meals” to sell. They have also benefited from government subsidies in a way that broccoli farmers have not.

Which makes it make sense that the people most likely to eat ultra-processed foods are young people, poor people, and people who live alone. We all get targeted, but these are the people who are the biggest markets of the industry.

You don’t have to go completely off the grid, or give up all of your favorite treats forever to make big changes. Remember how a 30% reduction in sodium intake alone caused a 75% reduction in cardiovascular death? Start by reading labels. Get the no salt (sodium!) added canned beans and veggies, get the no sugar added fruits. Swap out flour tortillas for corn at the taco stand. If you aren’t ready to give up the fast food french fries and chicken nuggets, you can still switch out the soda for an iced tea in your combo meal. If you enjoy cooking (or at least don’t absolutely hate it), you’ll likely find you really enjoy getting creative with healthier meals. It’s not meant to be a punitive plate of steamed broccoli and sadness, right? While it is more expensive to buy quality ingredients than crappy ones, you start to learn how to be clever and budget conscious pretty quickly. Using eggs for protein more than steak etc, which local farmers you can purchase from directly, etc. It is also 100% true that you will save money in the long run because you absolutely feel better.

Antibiotic Overload

Our systems are overloaded with antibiotics and I don’t mean just the ones you are taking for a sinus infection. We’ve all seen the news articles saying that we overtake antibiotics and we are causing antibiotic resistance because we are whiney babies who demand them from our doctors when all we have is a common cold. But it turns out that’s not the full story. We are ingesting most of our antibiotics from our food.

Antibiotics are used to increase the size of animals raised for meat (including cows and chickens). In Vandana Shiva’s book Stolen Harvest: The Hijacking of the Global Food Supply, she mentions the use of sulfa drugs (an inexpensive, common antibiotic) in the meat they use at the McDonald’s restaurants in India. Sulfa drugs are also commonly fed to conventionally raised animals in the US. The FDA tested sulfa levels and found them at three times the rate allowed by law in the cattle being sold for food. One particular dairy farmer had a cow with 323 times the legal limit. It turns out that 40% of the antibiotics produced in this country go to feedlots, not people. And from there they make their way into our bloodstream. Fairly conservative sources are noting the huge problems with this, from veterinarian programs at the University of Idaho to our own National Institutes for Health.

Our body responds to these drugs as a toxin, once again leading to chronic inflammation. Residual drugs have been tied to allergic reactions in the people that consume meat, dairy, and eggs. It’s also been tied to increasing instances of cancer in humans. If we eat conventionally-farmed meat, we are at increased risk of developing antibiotic resistance even if we are not taking antibiotics in pill form, and we are also at risk of negative effects if we have an antibiotic allergy, especially to sulfa. The articles about all of this are in my reference section if you want to read along and also throw up a bit in your mouth the way I did.

So what do we do about this? Going organic is more expensive that a lot of us can afford. Fortunately, finding meat that has not been treated with antibiotics is a more cost-effective middle ground. And then we can choose to eat less of it. I’m the queen of making a huge pot of chili with only one pound of actual beef and a ton of lentils to bulk it up. And even though antibiotic-free eggs are more expensive than conventional ones, they are still one of the cheapest non-plant proteins available. All the essential amino acids your body needs are in an egg yolk, which is why a lot of people who follow a plant-based diet will also include eggs (from chickens who never had a husband, as Ellen Degeneres describes her own diet).

Food Allergies

Food allergies are becoming a larger and larger public health burden. When our body has an immune response to a specific food, like peanuts, we produce antibodies called immunoglobulin E (IgE). These antibodies cause symptoms like swelling, itching, tingling, rashes, wheezing, dizziness, and/or lightheadedness. This happens when a specific food, like peanuts, causes us to

Allergic reactions to food itself is actually considered the “second wave” of the allergy epidemic. The recent increase in asthma is thought to be the result of our immune responses to food (not just air quality issues). It’s hard to know the exact numbers due to the conflation of allergies with food intolerances (which I’ll get into next). Additionally, most sensitized individuals are able to tolerate a food they are allergic to without reaction, which is brilliant for keeping someone from going into anaphylactic shock because someone next to them ate peanut butter, but it makes it harder to test accurately.

Best guess is that one in ten adults have a food allergy (and more than a quarter of them stated that they weren’t allergic to foods as children). The rate of food allergies among kids has doubled over the past two decades, and today one in 13 children has a food allergy. If that doesn’t seem like a lot, think of it as two kids per classroom in any given K-12 class.

And while allergy rates have increased, so has the range of foods that people are allergic to. Methods of production likely pay a role, but so does ancestry. Researchers found that children of African or East Asian descent who were born in a Western environment are at higher risk for food allergies than Caucasian children born in the same environment, which lends support to the idea that there is a genome-environment interaction with food.

There have been several theories that are plausible, but the one that is our current best guess (and fits with many of the other issues described in this book) is the “old friends” theory posited by Graham Rook, an emeritus professor of medical microbiology at the the University College of London. Our personal microbiota (the microorganisms within our personal bodies) are changing in ways that don’t support our bodies capacity to defend itself. Our homes are built of plasterboard and biocide-treated lumber. We’re exposed to lots more antibiotics which kill off a portion of everything, not just the bad germs. We’re more likely to be born by c-section, and not just for reasons of health and safety of the parent and child. In a multitude of ways we have fewer of the microbes that help our immune system respond to foreign substances (food and other potential allergens). Our struggling microbe is quite likely the reason that our immune response fails far more often than it used to, leading to a multitude of problems, including an increase in allergic reactions.

Food Sensitivities and Autoimmune Trigger Foods

Another common food problem we’re facing more and more is food sensitivities. The American Academy of Allergy, Asthma & and Immunology (yes, that’s AAAAI, I agree that rebranding would help) defines a food intolerance or a food sensitivity as what occurs when a person has difficulty digesting a particular food, leading to pain, gas, bloating, and/or diarrhea. Unlike allergies, food sensitivities don’t cause rashes and restricted airways, but they do cause issues in our gut, leading to leaky gut and chronic inflammation once again.

Figuring out what is an allergy and what is a sensitivity can be difficult. Dairy is the most common food allergy in human beings, and it is also a very common intolerance (most people’s bodies turn off the ability to digest the sugars in lactose after age three), leading to chronic inflammation and discomfort.

Some autoimmune diseases, like celiac, are an immune reaction to certain foods. Other autoimmune diseases (there are 150 and still counting) are exacerbated by certain foods. The casein found in milk is a common one and gluten is another. If a person who is sensitive to the food eats it, the resulting inflammation can trigger a nasty flare of Hashimoto’s or one of a number of diseases that occur when the body attacks itself, thinking it’s an outside invader. So the milk itself isn’t a problem, it creates that whole cascade effect of longer term problems in the body.

Going gluten-free has been popular for a minute now, to the point where it’s hard to believe it’s a real sensitivity and not the latest diet fad, but there is merit to the idea that a good number of people struggle to digest gluten properly, even if they don’t have celiac. The official term for those people is Non-Celiac Wheat/Gluten Sensitivity (NCWS). There are now a ton of studies where NCWS was tested in people through double-blind methods (meaning the doctors and patients didn’t know what had gluten in it and what didn’t). And researchers were able to see measurable levels of immune activity in the gut, and irritable bowel symptoms. It’s just as measurable as someone with a real allergy (like I will absolutely get a rash if something has cream cheese in it even if I didn’t know it was there). Three out of four people who had been diagnosed with NCWS ate gluten-free at the beginning of a long term study, and had stayed gluten free ten years later. It wasn’t a fad for them. And the people in the 75% category had almost total relief from IBS and upregulated inflammation. While the other 25% (unsurprisingly) were still symptomatic. This is all to say that if going gluten free gives you relief, stay gluten free. You aren’t alone and it isn’t just hype.

Scientists are still trying to figure out the why part with gluten sensitivities, but there are a few good guesses as to what the actual problem is. Partly it’s because the variants of wheat we grow in those subsidized giant farms aren’t as wholesome as what our recent ancestors ate. The pesticides used to grow in that quantity don’t help either. Which means some people can eat bread baked with organically produced Einkorn wheat, for example, while others have to avoid wheat all together.

Nightshades are another food sensitivity category for a lot of people that we look at when trying to mitigate inflammation, especially with chronic pain sufferers. Nightshades are a group of plants (think tomatoes, peppers, eggplants, certain spices like paprika and cayenne—everything delicious) that contain alkaloids. Alkaloids are the plant’s way of fending off insects trying to eat them, and for some people with inflammatory conditions like diabetes and arthritis they are disruptive to the body and can create digestive issues.

Taking the time to figure out how your body best functions in regards to food can go a long way to helping your physical and mental health. The standard way to figure out if you have an allergy or sensitivity is through an elimination diet like Whole30 or a low FODMAP diet. If you think a particular type of food might be causing you problems, you can try eliminating the suspect alone but it can be more than one thing and/or a cascade effect. Elimination diets aren’t meant to be long term. You generally only need to follow a very restricted diet for a month or so, to give your body a chance to get rid of all traces of the possible offenders. Then after a time you add one food back in every couple of days to see how your body responds and which ones end up getting shown the door with the message “and stay out!”

If you think you might have a bunch of food sensitivities, or if you’re dealing with chronic pain, another thing to try is the autoimmune protocol diet (AIP). Some people will just dump out gluten, nightshades, maybe some other common trigger foods like dairy, and feel great. Some people will need to go further and try a complete AIP diet (such as the Wahls Protocol or the Autoimmune Solution). A strict AIP diet isn’t a forever thing for most people. After at least a month (and if you are healing gut issues, I would give it a full six months), you can start introducing tomatoes and the like back in and testing your body’s reaction. If you aren’t chronically inflamed, you will likely not have a spikey reaction to most of these foods.

So What’s the Perfect Diet?

The two big universals that we should all do, depending on our financial situation and food availability situation, are to decrease animal-based proteins that come from animals that were treated with antibiotics and to decrease ultra-processed foods.

But beyond that, there is no right diet for everyone.

This truth is backed up by science. A large scale study comparing different weight-loss diets based on different ratios of the three principal dietary macronutrients (fats, carbs, proteins) was sponsored by the NIH and conducted at Brigham and Women’s Hospital over a two year period. And they found that everyone is different and there is no one magic diet.

But there are so many options out there and there is always a new diet fad to check out. As a Gen Xer, I came of age in the era of SlimFast and fat-free everything. I remember taking out boxes of Snackwell’s cookies with my college roomie while binging on Twin Peaks and wondering why I had horrible sugar headaches. Wasn’t this the thing that we were supposed to do? My body needs fat for fuel and was getting none, and it didn’t need the amount of ultra processed shelf-stable cookies I was shoving into it.

As you try to figure out the foods that work best for you, one thing to consider is where our ancestors are from and that their bodies evolved while eating the foods that were available in those places. For example, the Tsimané of Bolivia eat far more carbohydrates than the average American (never mind an American on a paleo diet) but researchers found no coronary artery calcium (a significant risk factor for heart disease) among them.

A more ancestral based diet might make far more sense than Slimfast and Snackwells (though both of these brands are still in business), if only for the basic reason that you are eating real foods (which means don’t load up on nutrition bars and shakes that are keto and paleo just because they fit your new diet profile) and you are eating the things your body evolved to eat.

But the question is...which ancestors? The ancestors of the person who wrote the diet book? Or yours? And why does that matter?

This is the big debate around plant based diets isn’t it? People who have a strong value system around eating plant based foods, like His Holiness the Dalai Lama, are being told by their doctors to include some animal based protein back in their diets. Why are some people able to be incredibly healthy on a vegan diet and not others? Although you can get protein from a plant based diet, our ability to convert amino acids is different from person to person. In the book Traditional Foods Are Your Best Medicine (a book that has been around a few decades but was recently republished as Primal Nutrition: Paleolithic and Ancestral Diets for Optimal Health to capitalize on the paleo diet craze), Ronald F. Schmid discusses evidence that shows some people are able to properly convert plant aminos into the essential aminos that the body needs to maintain optimal health. And many people simply can’t. So why is that?

The gut microbiome is best conceived as a holobiont, meaning organisms from different species working and managing challenges together in a way that a singular organism (our human body) cannot do alone. Our gut microbiota range from 100 trillion to 1 quadrillion organisms (best guess) and are a collection of archaea, eukarya, and bacteria that co-evolved with us over time. If you were going to compare the amount of microbiota we have versus the number of human cells we have, the microbiota outnumber our human-ness 10 to 1. Our ancestry determines what bacteria we co-evolved with, which plays a big role in what foods our bodies work best with.

While the idea of consuming beneficial bacteria (for example, in the form of fermented foods) isn’t new in human history, the Western medicine study of the human microbiome is very new. The term microbiome itself was coined in 2001, and the Human Microbiome project (an NIH funded initiative) wasn’t established until 2007. So there is a ton more in the what we don’t know category than in the what we know category. But there are a few things that are important.

Half of our current microbiome is shit we have zero control over. For example, our genetics account for about 12% of our microbiome. Then there are factors like how we were born or whether or not we were breastfed and the toxins we were exposed to growing up that we can’t control.

The other half of our microbiome is the part we have more control over. We can actively build a good microbiome by reducing antibiotic intake (which will be mostly as consumed in food) and finding the foods that our bodies operate best on. Which brings us back to the idea of food intolerances and doing a time-limited elimination diet to see what you respond poorly to. Your body is always your best intolerance test.

For long-term dietary choices, being super strict about what you eat or avoid almost never makes you healthier. If you are on a medical keto diet to manage seizures, then being super careful with your diet makes sense. But in general? Even for people who are eating a specific diet to manage other health issues like the Auto-Immune Protocol or the Gut and Psychology Syndrome diet, it shouldn’t be miserable and all consuming. And as for more conventional diets, counting calories and macros isn’t a sustainable or pleasurable way to live. Calories are not created equal (100 calories of soda won’t affect your body in all the same way as 100 calories of almond butter). Ultimately, any diet that you’re supposed to stick to indefinitely with strict religious zeal for general health or weight loss is a red flag without an underlying medical reason.

Instead, eat real foods. If you are hungry between meals, try adding more fat, like a dollop of coconut oil in your morning smoothie, or a dollop of almond butter with your banana to get you through to lunch without gnawing on the furniture. If you are working to add muscle, add more protein, like a couple of hard boiled eggs (but not in your smoothie cuz gross). If you don’t feel full right after a meal, bulk up on non-starchy veggies like salad greens or carrot sticks. If you are working on healing an inflamed gut, you can add more fiber (like apples or avocados, yum) and anti inflammatory foods like nuts, or fatty fish and herbs like turmeric, green tea, and rosemary.

Shop Like a Lawyer

My motto when I’m reading a food package label is to think like a lawyer.

When buying organic beef recently, I found a package of sausage sitting next to it. Finding sausage that is organic and both pork and dairy-free is a blue moon thing. I was super excited. Then I noticed that while the beef said “Antibiotic Free!” the sausage said “No added antibiotics!”

:::squinty look:::

I put the sausage back. Because no added antibiotics since when? Since they left the farm? All the way through the feedlot? Sorry Charlie, I don’t trust your semantics.

If you find yourself reading labels and you spot a loophole in the verbiage, cut and run. Gatrillions of dollars are spent on figuring out how to make things look healthy without them actually being healthy. People who produce legitimately clean food are proud of the fact and say that in straightforward ways.

Farm fresh? All-natural? Mean absolutely nothing. They are advertising buzzwords[17].

No hormones? Important when it comes to cattle. But doesn’t mean anything when it comes to poultry. Poultry isn’t treated with hormones in the US anyway, so you may pay more for BS.

Grass fed? Not the same as grass finished. A lot of livestock is started on grass but moved to feedlot corn pretty early, and for most of their lives. But if they ever ate grass at any point, the package is allowed to say “grass fed.”

Cage free or free range? Required by law to have some access to the outside. It may be a tiny door at the end of a very long building. Not necessarily animals that are bopping around in the sunlight scratching in the dirt and eating bugs. Lots of egg cartons will promote that the hens are fed a “vegetarian diet” like that’s a good thing, but it just means they feed their chickens corn and soy.

Look instead for labels that say antibiotic-free, non-GMO, certified humane, or organic. Though it should be noted that a lot of local farmers use very clean processes that we would consider organic but they haven’t gone through the expensive process of organic certification. I always opt for purchasing from someone local without the fancy label who treats their land and the living beings on it with care.

Run across some weird word that you don’t know what to do with? Check out the Lexicon of Sustainability website (lexiconofsustainability.com) who has done a lot of the lawyer-type thinking for us!

Cost Savings Through Being Local, In-Season, and Waste-Free

Does it cost more to eat fresh and local produce? It can. It’s really not bad when you shop in season. But health generally does cost more. Because as we talked about, broccoli isn’t subsidized by the government. But as someone who was already raised to respect my food, I’ve noticed that I am even more cognizant of the importance of that respect when I pay for good quality and know where and who it is coming from.

In 2001, when living in the Houston area, I read a book by Barbara Kingsolver called Small Wonder. In this book (which predates Animal, Vegetable, Miracle—another book I highly recommend) she suggests that we spend $20 a month of our grocery budget towards local ingredients. I contacted my local agriculture extension office and was informed by a very nice man that there were no farmer’s markets in the Houston area (something that is no longer true). He gave me a list of you-pick farms and I hit up the local blueberry farm and picked berries and bought local honey. I stopped at the local farm stands whenever I saw them. I picked the blackberries in my own backyard. And I generally had a hard time even finding $20 worth of local foods to buy.

Now the majority of my grocery budget each week goes to local goods: meats, cheeses, eggs, and produce. This food comes from sources like local food delivery services, community supported agriculture (CSA) subscriptions, and local farmer’s markets. When shopping at my local produce markets or the grocery store (whether the huge and fancy one or the local, tiny urban farm stand), I look for items marked as local and buy whatever they have, even if just to encourage them to continue to carry local produce. Most local of all, I also have a garden with a pecan tree, citrus trees, lots of herbs, and a few veggies if I think I will be home enough to tend to them. And I also am known to forage things that grow wild in my area. When I was in Houston, I had blackberry brambles on the edge of my property. Here in San Antonio, I can collect cactus fruit and other goodies.

I can and freeze stuff when it is fresh and abundant and inexpensive so I can have delicious things all year. A chest freezer is a healthy-delicious food person’s bestest buddy. The strawberries you can buy in the store in November may not taste good, but the ones you buy in May and process and store are going to taste amazing in comparison.

A loaf of bread from the farmer’s market will be eaten with dinner and the leftovers will be turned into croutons for next week’s salad. Knowing the man who stayed up all night baking those loaves makes me want to respect the work that he did. Besides knowing where my food comes from, and knowing exactly what I’m putting in my body, I’m also directly supporting my local economy instead of a faceless conglomerate.

Looking to buy local? Look for food co-ops, farmer’s markets and farms that sell to the public, or CSAs (community supported agriculture—essentially buying a share in a farm’s harvests for the season).

Eat Wild (eatwild.com) includes lists of farmers and other purveyors who work to provide foods that have the quality nutrition of the foods that were abundant before we fucked with the system so much. Evidence is growing on an almost daily basis that these wholesome foods give us more of the nutrients we need to fight disease and enjoy optimum health. Additionally, the Eat Well Guide (eatwellguide.org) has information on all kinds of local, sustainable resources including restaurants and stores, not just farms and markets.

I Hate Okra and You Can’t Make Me Eat It!

So maybe you are trying to up your inclusion of gut-healing foods. But the foods that have been recommended to you gross you out.

First of all, I totally have tricked a ton of people over the years into eating things like kale, okra, and nopales by tossing them in a big pot of soup. It’s rare that I hate a particular ingredient to the point of full melt-down, though getting there took some work. I used to have a serious fight-face about a lot of different things, but challenged myself to look past regular ways of preparing things and trying new ways. So now I’m not a fan of beets, unless you roast them for me. You might surprise yourself or the people you cook for by getting them eating things they would throw down about in the past.

I have a “courtesy bite” rule in my house. My family knows I won’t force eggplant down their gullets if they really can’t stand it. But they have to try it with an open mind. And they, in turn, are excellent about saying “okay, that’s delicious, I’ll eat it.” If you are cooking for kids, it’s also helpful to cook with kids. My kids would eat anything they helped cook when they were young. They were the chef, of course they were proud of the meal!

But I also know that everyone is far more likely to eat healthy once they figure out what foods they already like and intentionally eat more off them. If I tell you okra is amazing for you but you hate okra, that isn’t going to get us very far. Once you have a good idea of what food components you are looking for (selenium to promote testosterone production, for example) you can check out the World’s Healthiest Foods website (whfoods.com) and do a search. For some reason, the site doesn’t include nuts and seeds, but you can Google search most anything with “health properties of XYZ” to get a good idea. Try it with whatever foods you love best and see what pops up.

And this is where whole food supplements and herbal supplements can come in handy. Spanish black radish is a fantastic detox but it’s hard to find and doesn’t taste fabulous (and I generally LIKE roasted radishes). So I take it as a whole food supplement. And that handily leads us to our next chapter. Go take a stretch break, drink a nice glass of water, and meet me over there in a few, ok?

SUPPLEMENTS AND MEDICATIONS

Medications, supplements, vitamins—there are a lot of pills and doses out there that can have a pretty profound impact on how our bodies function (or don’t). I’m going to focus in this chapter on supplements that we can use to support our overall health, because they are widely available, often much cheaper than drugs, and there isn’t a lot of good information about them out there.

I am not anti-medication. Not even a little bit. I am, however, anti over-medication. For one thing, we have a toxic history with using medications as mechanisms of chemical restraint (disproportionately so within institutional settings and child-serving systems like foster care, and disproportionately of individuals of color within these settings and systems) which many of y’all who are reading this may have been subjected to.

But even for the rest of us, medications are often the first and only line of defense. And they are typically not considered within the context of other treatment interventions. One of my clinical nutrition professors offered this hierarchy as the ideal alternative to over-medication and I’m all for it. When there’s a problem, we should start at the top of this list and work our way down (just the way we have in the structure of this book):

Hierarchy of Interventions

1. Lifestyle

2. Food

3. Supplements

4. Drugs

5. Surgery

See how far down that list supplements and drugs come? I worry about the fact that those of us in the US are on a lot of medications. 50% of U.S. American adults take at least one prescription drug every month, and one in four of us are taking three or more. 73.9% of doctors visits end with a prescription being written and 80.4% of hospital visits end with a prescription being written. From 2008 to 2018 the use of opioids went up 22%, but antidepressants went up 97% anti-anxiety and anti-epilepsy meds went up 661% (Not a typo. Six hundred. And sixty-one.). Medication being the first thing we go to is a really worrisome habit.

And the medicines we’re given generally do not work as universally as we are led to believe. Nor are they typically designed for longer term use. Pain medications are a good example. The two medications we use most for chronic pain are opioids (and the opioid crisis is something we all know about) and over the counter NSAIDs (nonsteroidal anti-inflammatory drugs). These include aspirin, ibuprofen, and naproxen. Opioids do block pain, but only for about a month, then your body reacts by increasing the number of receptors to allow the pain signal to get through again. Additionally, they reduce the body’s ability to release endorphins, letting us manage pain independently. And opioid use reduces gut motility and interferes with the secretion of digestive enzymes from the gallbladder and pancreas resulting in impaired nutrient absorption.

But over the counter (OTC) pain medications aren’t a real, long term pain solution either. NSAIDs (like ibuprofen) account for 3200 deaths per year, and 32,000 hospitalizations. An OTC drug doesn’t mean it’s a benign drug, and these can cause hypertension, heart disease, kidney damage, and gastrointestinal bleeding. Even more common is that NSAIDs inflame the intestinal tract, which can lead to leaky gut. The intestinal lining is repaired and replaced every 3-5 days, and NSAIDs interrupt and block that process. Intestinal permeability occurs within 24 hours for 60-80% of the people who take an NSAID With long term use, 50-70% of people develop chronic intestinal inflammation. NSAIDs reduce pain but prevent healing.

Almost all analgesics (Tylenol as well as the NSAIDs) cause hypersensitization to our pain receptors, just like opioids. We end up with increased pain over time by using them. A study of people with episodic migraines who took NSAIDs 10-15 times a month found that many of them ended up having chronic daily headaches. Our own pain relief system (endorphins) shuts down when we take pain medicine, and it takes time to get that system to kick back in.

I have had significant success helping clients avoid needing prescription medications or minimize the number of prescriptions they need to use (under their prescriber’s watchful eye—I always work in conjunction with the prescriber!). I’ve also had clients increase their prescription medication usage, just like I did in 2020, to better manage their symptoms during an unprecedented crisis. Doing so isn’t a sign of failure or an over-reliance, so long as it is done thoughtfully and with an eye to the other mechanisms of supporting a healthy body.

I’m saying all this because I am passionate about finding alternative methods to support health beyond the current medical model. Whether we are talking about penicillin or lavender oil, anything we use should be done thoughtfully and holistically (using the true sense of the word). And if you do take allopathic drugs, they’ll be most effective when supported with everything else further up the hierarchy.

All that being said, let’s talk about how using supplements to support your health might benefit you.

What Are Supplements?

A supplement is something that completes or enhances something else when added to it. The idea is that there is something missing from our bodies and we are trying to complete or enhance our intake of food and prescription medications with other nutrients and bodily support.

According to the World Health Organization, 80% of the medications taken world-wide are naturally derived formulations rather than things grown in a lab. Our history of medication is based on the natural world. Animal, mineral, and herbal products have been used for over 5000 years. As late as the 1890s, 59% of the products in the US Pharmacopoeia were based on herbs or herbal combinations. The WHO reports that in the United States, a third of people are taking some form of supplements. And interestingly, the higher someone’s level of education, the more likely they are to use a supplement. (And that one-third number doesn’t include individuals taking something like Lovaza, which is a prescription formulary of fish oil).

A lot of times you will see the word “vitamins,” which I tend to shy away from since most vitamin products on the market are synthetic isolates and that’s exactly the thing we are trying to avoid. Instead, I recommend in my practice (and use in my personal life) a variety of whole food supplements and good quality herbs.

Whole food supplements are literally just food. Or rather, they’re pills, but pills that are condensed versions of food, like vitamin C where the C comes from constituted buckwheat juice, not ascorbic acid. You’re piling on the nutrition you need for healing. My motto is, you have to either eat it or take it. And honestly, getting enough of the nutrients we need through diet alone is nearly impossible. For example, depleted soil means we may not be getting enough trace minerals in our diet from the veggies we eat, even if they are local and organically raised. And there’s less and less biodiversity available in supermarket produce. So we supplement. While I already cook with garlic, I still add a whole food garlic supplement to support my immune system during flu season. And since finding spanish black radish in a grocery store is pretty impossible, I take them as a whole food supplement to help support my digestion as well. Whole food supplements can help bridge that gap without the side effects of the synthetic isolates found in allopathic meds and most over-the-counter vitamins.

Herbal supplements work far more like medications do, but also more like whole food supplements than you would first guess. Instead of treating a symptom, they are also operating to promote the body’s own healing and ability to balance itself. That’s why so many of the herbal remedies that are most effective for mood disorders are adaptogenic ones, meaning that instead of being just an upper or downer, they function as all-arounders. They’re like the thermostat on the wall that is going to kick in heat when it’s cold or the a/c when it’s hot as balls. They work by promoting the stabilization of physiological processes.

Do I Need Supplements?

Maybe you don’t need to supplement your diet. If you are getting all you need through your food—especially if you are getting organically grown veggies, eggs and meat from pasture raised chickens, beef from grass-fed and grass-finished cattle, on land that has been tended carefully for generations.

I’m not saying all this to be snarky or up-sell you on nutritional support but to point out that almost everyone in this day and age are dealing with numerous barriers to getting adequate nutrition from the foods they eat.

And speaking of that toxic environment? I know, we already did because I am such a joyful person to hang out with. But we have been absorbing way more crap into our systems since WWII. We come into contact with products and byproducts every day that are inflammatory, cancer-causing and the like.

And if we are taking prescription medications? There are side effects to those. Medications can disrupt our nutrient absorption in a multitude of ways. A 2018 study published in the Journal of The American Medical Association found that one-third of U.S. Americans are taking a prescription medication that can cause a mood disorder, stating there are over 200 different prescription medications that can have this effect, including super common medications like proton pump inhibitors that treat acid reflux and beta-blockers that treat hypertension. Anything we put in our body affects the whole system, something that helps our blood pressure may decrease absorption of other nutrients which cause a biochemical issue that presents as depression, anxiety, and the like. And the more of them we are taking, the higher our risk: going from one medication to three more than doubles our risk of developing clinical depression.

This is true of physical health as well—our prescription meds can cause a multitude of long term issues. For example, someone on corticosteroids for rheumatoid arthritis will need calcium supplementation to manage the decrease in calcium absorption. And an individual on angiotensin converting enzyme (ACE) inhibitors for more than 3 months will likely need zinc supplementation.

How Do I Know What Supplements to Take?

So how do we figure out what supplements would benefit us most? Lab work is ideal, so we can look at what your white blood cell count and the like are actually doing, and also look for patterns of issues. You may not be completely out of range by lab standards, but have decreased levels in a few areas that bear looking at. Alternatively, looking at clusters of the symptoms you are experiencing can help find patterns of bodily responses. Nutritionists and functional medicine docs will ask about all the weird symptoms you might be experiencing (not just the ones you came in with) with some kind of questionnaire, and many more traditional MDs are starting to do the same. I do love the smell of a good paradigm shift in the morning, don’t you?

If you are on prescription medications, look at what you are taking, check out the pharmacy fact sheet on side effects (or if you are like me and throw those away pretty quickly, log onto drugs.com) and see if any of your current health complaints overlap with the side effects listed. There is tons of information online about which medications and classes of medications can cause issues.

Watch carefully with new meds. Doctors and pharmacists are way overworked in our healthcare system, but they do give a shit and do know these are issues to watch out for so request a consult with them. It is also really helpful to do a “brown-bag” yearly update on your medications. Bring in everything you are taking to your annual check up to review with your doctor or their clinic staff. I have clients who keep spreadsheets of what they are on, what they have been on and when they stopped, etc. It’s a ton of work on their part but it makes it way easier to review and go “Oh! This might be the problem!”

Another way to figure out what supplements might help is to keep track of your health and habits daily. If you are trying to figure out how your body responds to all of the input it receives, a health journal is your best tool. Now that there is an app for everything, you can make this as easy and digitized as possible if that is your preference. If you are old school, you can just jot down the following every day:

• The meds you are taking, the dosage, and the time (both prescription and OTC).

• Same for any supplements.

• What you ate.

• What you drank.

• Other substances ingested (ahem).

• Vaccines received.

• Exercise/movement engaged in.

• Any physical ailments and whatever you used to manage them (asthma attack, back pain).

• Any accidents or injuries.

A lot of docs love if your health journal includes your medical history and your family history as well, so if you are sharing it with them you have it all in one place.

There are a lot of benefits to keeping a health journal. You’ll be more organized and streamlined for doctor’s appointments and your own personal tracking. You’ll save money because you can see your history treatment at a glance. For example, you can go “oh yeah tried that two years ago and it gave me a horrible headache, no thanks.” You’ll be more likely to figure out food triggers. You’ll notice how stressors (lack of sleep, crappy work schedule, people around you being all people-y) are influencing symptoms. And you’ll be more likely to figure out what meds/supplements are helping or hindering.

Supplement Safety

You may have heard something along the lines of “supplements don’t work,” or “supplements are dangerous.” It’s true that a lot of them are crap.

Part of the reason that dietary supplements get a bad rap is because many of the ones on the market are just bullshit in a bottle. The New York Attorney General tested and sent a multitude of cease and desist letters to herbal supplement companies based on the fact that much of what they tested had no active ingredient. University of Guelph in Canada studied a bunch of supplements and found many unlisted ingredients within them, including things that could encourage an allergic response in someone taking them. And synthetic versions of the product, rather than the actual extracted herb or whole food, are generally going to have more side effects because the human body struggles to recognize them for what they are.

So we read about the amazingness of using St. John’s Wort for depression, then we feel stupid and/or ripped off when it doesn’t work for us. I had that experience with a cheap kava I tried years ago. It made me seriously irritable and more than a little batshit. I was afraid to try kava again until I learned more about finding and using quality products. I was great about educating myself on prescription meds, but it somehow never occurred to me that I should treat supplements just as seriously.

Additionally, supplements aren’t magical fixes anymore than an allopathic medication is. Nothing is a magical remedy, but you can’t convince social media of that. While I was writing this chapter, I saw a well-known herbal store post wild claims about bay leaf. Claims that included if you have bay leaf (which they sell!) you have no need for a pharmacy. That a bay leaf added to your meat will convert triglycerides to monounsaturated fats and allows the body to produce insulin (among many other magical things).

This particular meme has been going around since 2019 and it easily fact checked. But this company didn’t bother to do so. While I am the queen of ignoring stupidity on the internet because it’s bad for my mental health, this is the kind of thing that gets my nutritionist knickers riled up. So I did the research and found out that bay leaf impacts circulating blood lipids, metabolism, and glucose by the same mechanisms that certain forms of cinnamon do. Meaning both are helpful in promoting managing metabolic stability. One leaf added to your pot of beans doesn’t do anything but flavor the beans. But in supplement form (which this company did not sell), it works great. Fresh bay leaf can be encapsulated to about 500mg per capsule. Two to six of those (3mg) taken daily for thirty days has been shown to reduce blood glucose by 20%. And yes, that is phenomenal. Especially considering that there would be no accompanying side effects (unless you are allergic). This could be used in conjunction with other treatments and lifestyle changes to help manage blood sugar. And maybe help minimize the amount of insulin or metformin someone needs to take. But telling people adding a leaf to their food means they can throw away their meds? Those are the types of “alternative facts” that kill people.

A new supplement also has to be the right thing for your specific circumstances. I have colleagues message me on the regular because they have a client who wants to try supplementation for their depression and what should they take? I’m not being snarky when I say I have no idea. I don’t know their history, their other medications, all their symptoms, I haven’t seen their lab work etc. An ethical nutritionist is going to be as careful and considered as an ethical allopathic doc. If you tell an MD buddy you’ve been moody lately, and ask what would be helpful, they aren’t gonna say “Abilify, LMAO, bet,” they are gonna tell you to go get a workup. (At least they should. Run like the wind if they throw pills at you like confetti.)

So, takeaway? There is no magical plant to chew on, research matters as much as anything else you are putting in your body. If the claims seem over the top they probably are.

(And the particular company I argued with on the internet gets props for taking down the post rather than just blocking the angry nutritionist who called them out. And here’s hoping they won’t share dumb shit in the future.)

If you are using supplements (either herbal or whole food), research as much as you can. ConsumerLab.com is a third party lab that rates for purity and truth for labeling. Look for brands that go through third party testing (NSF International, NSF GMP, US Pharmacopeia (USP), TGA, IFOS & IKOS, Consumer Lab...my favorite brand is TGA tested and approved) or if it’s a cottage industry maker, ask them about how they source, process, store, and the like. You’re looking for them having mechanisms in place to make sure you are getting quality product in the dosage amount it claims on the bottle.

If you can afford to, work with a provider who knows their shit, like an herbalist, Chinese medicine practitioner, or clinical nutrition professional. Most of those who do work with supplements professionally are brand-loyal based on experiences, but will also discuss different brand options with you. I always give people a couple of brand recommendations and discuss what to look for if they are exploring other brands (e.g., you want a kava that has been water extracted and you want a fish oil that hasn’t been sitting on a pallet in an unheated storage facility behind a club warehouse).

But most important? Trust your body more than you trust me. A whole food supplement or herb will likely have fewer side effects for you than a prescription medication (and research continues to back this up). If your body recognizes something as food, it will metabolize it differently. But not all bodies respond the same way to food, right? Even healthy foods.

Every body is different and your body will be the best tell of whether or not something is helpful. If you start a new supplement, and have a poor reaction to it, believe your reaction. Stop taking it for a few days then try again. Same reaction? That’s a nope from the judges. If you notice any weird “new” problem after a period of time, take a “supplement holiday” and see how you feel. Gradually add them back in one at a time and see what happens. FWIW, this can also be a good idea for some prescription medications, but those can come with serious side effects from withdrawal, so only do so with your doc knowing what’s going on.

The Obligatory Disclaimer About Supplements

I am about to talk about some specific supplements. But please don’t just go out and try them on your own. It is super important to discuss these things with your treatment provider before embarking on any of them. I have a postdoc in clinical nutrition, but if I have a client on prescription meds I always talk to their prescriber before adding anything else. Interactions are no joke and it’s important to be careful. Anything you take can also be of concern if you are pregnant, if you are drinking, or if you are using drugs or even over the counter medications. A prime example? I went to a tea making class last year and the person teaching it, a very skilled herbalist, discussed a calming blend that contained St. John’s Wort. She failed to mention that St John’s Wort can interact badly with antidepressant medications and HIV medications.

You also need to consider the following statement to hold true to everything I’m discussing in terms of supplemental treatments:

“This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

The FDA does not review claims related to structure and function of supplements, which is what we are discussing here. I’m going to discuss the structure of different supplements and what research is out there regarding how they function in the human body to help the human body gain equilibrium. And that’s not the same as a treatment, right? We are all smart cookies and we got that. I’ve cited my ass off in terms of the studies related to structure and function but also encourage you to do your own reading and thinking and talking to your treatment peeps before you start mixing the red and blue pills.

Some Supplements to Consider

Ok, I know I just spent pages flapping around saying don’t pop supplements like they’re Pez because you will kill youself dead. While that’s overall true, there are some generally safe things that are helpful for most people. So here is my top 5 for most-everybody list (though keep in mind that if your tummy doesn’t like it, your tummy is in charge).

And, as always, a supplement is not intended (nor FDA approved to) diagnose, treat, cure or prevent any disease. Supplements are designed to support your body’s best health and functioning. Even with the most generally safe stuff, your doc may have concerns about what you’re taking and at what dosage you are taking. Consult the nice person who is trying to keep you healthy, yeah?

Probiotics

Our chronic exposure to toxins and our overexposure to antibiotics has done a lot of damage to our gut microbiome. There is a lot of promising research out there that probiotics can help heal gut lining damage and rebalance that biome.

Probiotics are just beneficial bacterial cultures that research demonstrates reduces the severity and the incidence of gut infections (both chronic and acute) thereby reducing inflammation in the body. Other research has found them to be of benefit to managing cancer and allergies as well.

We don’t know the magical cocktail to use (and indeed, how it would vary from person to person), so you may need to experiment with different formulations and brands. A brand with a higher count of strains is generally a good bet.

Something it might be helpful to take along with probiotics is prebiotics, which are a type of indigestible fiber that operates as food for the probiotics. Their job is to keep the good bacteria active in your system. And then, you may also find it helpful to add digestive enzymes which are the proteins that speed up the chemical soup reaction in our body allowing our food to be broken into substances that our digestive tract can absorb. I say all this within the probiotics section because you can get probiotic supplements that also have prebiotics and digestive enzymes in the same compound.

There aren’t any contraindications for probiotics. You might get a little gassy from them, but that is about the extent of side effects.

Omega 3s

Omega 3s are on the list of supplements everyone should take because of how efficiently they decrease inflammation and oxidation that is associated with so much disease, from heart disease to depression.

Omega 3 fatty acids consist of alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Most fatty acids are produced within the body. ALA is not, so we must get it from food or food-based supplements. ALA combines with enzymes to create EPA and DHA.

You can get Omega 3s from foods like fatty fish, flax seed, chia seed, and walnuts. Or you can take them in supplement form as fish oil, plant-based blue-green algae, or ahiflower oil. I take cod liver oil because it also has vitamins D and A. Fun fact, cod liver oil was given to children regularly to fight rickets and obviously had a lot of other health benefits we weren’t aware of. I know there’s a lot of info out there about Omega 6 and Omega 3 ratios. We don’t know what is optimal, but all the research shows that focusing on raising Omega 3s is plenty beneficial rather than worrying about lowering Omega 6s or monitoring them in accordance with each other.

Omega 3s can be contraindicated with a host of bowel conditions, as well as liver conditions, appendicitis, and schizophrenia. Check with your doctor first if any of these issues apply to you.

L-Tryptophan

You read about this one in the Sleep chapter. L-Tryptophan is the sole precursor of serotonin, and experimental research has shown that L-Tryptophan’s role in brain serotonin synthesis is an important factor involved in mood, behavior, and cognition. Tryptophan also increases serum melatonin levels and decreases cytokine production. It’s kinda a 20 dollar wonder drug. While L-Tryptophan is in food, we don’t absorb it as well because of amino acid competition in the transport system, so taking it as a pill will get you more benefit than eating a lot of turkey will. If quality sleep is an ongoing issue, take it at night as one larger dose instead of throughout the day.

L-Tryptophan is contraindicated with eosinophilia myalgia syndrome. It’s also something to discuss with your doctor if you are taking an antidepressant. While there is less interaction between antidepressants and L-Tryptophan versus a strong nervine herb like St John’s Wort, there can still be an issue if you are taking a prescription antidepressant.

Magnesium

Odds are literally even that you are magnesium deficient. 50% of Americans (and up to 80% of older Americans) are. Magnesium is the fourth most abundant mineral and the second most abundant positively charged ion in a human cell. It’s fundamental to human wellness for a multitude of reasons, including being responsible for cellular function (the importance of which we talked about earlier in the book), and been shown to directly impact depression in human beings (with demonstrable difference in symptoms in as quickly as one week).

Fun fact? Because magnesium is so good at preventing lactic acid build up, I like to suggest taking it before and after a workout or a massage (it also increases the available glucose to energize your muscles)!

Contraindications for magnesium include renal disease (big one!) but you should also check with your doctor if you have heart disease, intestinal issues, or diabetes.

Zinc

One-third of the population worldwide is zinc deficient (and deficiency rates are even higher in low- and lower-middle-income countries). Zinc is an essential nutrient for humans. It is extensively involved in pretty much every groovy thing the body does and is therefore considered an antioxidant. Its ability to alleviate depression is related to many mechanisms in the body (supporting immunity, decreasing inflammation, helping manage oxidative/nitrosative stress, mitigating the stress response, supporting recovery from neurotrophic deficits, and regulating transcriptional/epigenetic neutral networks).

The body needs to take in zinc regularly, since it doesn’t have a way to store zinc “for later.” It’s found in multiple food groups, like shellfish, legumes, seeds, and nuts, so malnutrition can lead to decreased zinc intake. Zinc deficiency can also be inherited—some people just don’t absorb it well.

Zinc deficiency is identified through lab work, though research shows that a zinc assay test (which you can purchase online for like fifteen bucks) is about 70% accurate if you are looking for a cheaper option.

Zinc may be contraindicated if you have a disorder that leaves you with an inadequate amount of copper in your system.

Conclusion

Was this book as hard to read as it was to write? If my editorial team is any indication, it was. So first of all, so many gold stars for tackling something really complex. Between you and me? Mind-body science is so complicated that it still isn’t being taught in graduate programs for therapists, at least where I live. It is also a topic that can veer quite easily in depression-inducing overwhelm. I mean, if shit is this fucked then why bother?

Okay, it is fucked. I get that. I agree. But not hopelessly. I don’t believe in doomwriting, handwringing, and hopelessness. I do believe we have enormous capacity to heal, both our bodies and the world they reside in. I’ve been in this field a super long time now, and see over and over the astonishing capacity we all have for healing, even when we know what the fuck we are actually up against.

I’ve had many people tell me over the years that my book Unfuck Your Brain gave them a different perspective on how to approach their healing. And to not beat themselves up for doing something really fucking dififcult. And I hope this book did the same thing for your relationship with your body. And many of the books that I most love that explore these topics in even more depth are listed in the further reading section of this book for your next steps forward.

You don’t need me telling you how strong and capable you are, do you? You know. You’re already doing it. Here’s to more support on the journey.

Further Reading

Polyvagal Theory

The stuff written by Stephen Porges on polyvagal theory is very dense and scientific, but interesting.

The books (and posters and flipcharts) by Deb Dana on the application of polyvagal theory to mental health are generally designed for mental health practitioners but could also def be used by anyone.

Somatic Trauma

Waking the Tiger: Healing and Trauma by Peter A. Levine

In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness by Peter A. Levine

Molecules of Emotion: The Science Behind Mind-Body Medicine by Candace Pert

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van de Kolk

My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies by Resmaa Menakem

Focusing by Eugene Gendlin

Focusing in Clinical Practice: The Essence of Change by Ann Weiser Cornell

Inflammation

The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First by Dr. Mark Hyman

The Inflamed Mind: A Radical New Approach to Depression by Edward Bullmore

Stress

The Upside of Stress: Why Stress is Good for You, and how to Get Good at it by Kelly McGonigal

Burnout: The Secret to Unlocking the Stress Cycle by Amelia and Emily Nagoski

Breathing

Breath: The New Science of a Lost Art by James Nestor

Mindfulness and Meditation

Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing by David Treleaven

Don’t Just Do Something, Sit There: A Mindfulness Retreat with Sylvia Boorstein by Sylvia Boorstein

Movement

Overcoming Trauma through Yoga: Reclaiming Your Body by David Emerson

Yoga for Depression: A Compassionate Guide to Relieve Suffering Through Yoga by Amy Weintraub

The Joy of Movement: How Exercise Helps Us Find Happiness, Hope, Connection, and Courage by Kelly McGonigal

Embracing Yoga’s Roots: Courageous Ways to Deepen Your Practice by Susanna Barkataki

The Myths of the Asanas: The Stories at the Heart of the Yoga Tradition by Alanna Kaivalya and Arjuna van der Kooij

Invisible Rainbow: A Physicist’s Introduction to the Science Behind Classical Chinese Medicine by Changlin Zhang

The Body Electric: Electromagnetism and the Foundation of Life by Robert O. Becker

Sleep

Why We Sleep: The New Science of Sleep and Dreams by Matthew Walker

The Sleep Revolution: Transforming Your Life, One Night at a Time by Arianna Huffington

Food

Fearing the Black Body: The Racial Origins of Fat Phobia Sabrina Strings

Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight by Linda Bacon and Lisa Aphramor

Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health by William Davis

Eat In Peace To Live in Peace: Your Handbook for Vitality by Charlotte Kikel

Stolen Harvest: The Hijacking of the Global Food Supply by Vandana Shiva

Primal Nutrition: Paleolithic and Ancestral Diets for Optimal Health by Ron Schmid

Small Wonder by Barbara Kingsolver

Animal, Vegetable, Miracle by Barbara Kingsolver

Supplements

The Emperor’s New Drugs by Irving Kirsch

Drug Muggers: Which Medications Are Robbing Your Body of Essential Nutrients---And Natural Ways to Restore Them by Suzy Cohen

References

Introduction

Chan, C., Gan, R., Shah, N. P., & Corke, H. (2018). Polyphenols from selected dietary spices and medicinal herbs differentially affect common food-borne pathogenic bacteria and lactic acid bacteria. Food Control, 92, 437-443. doi:10.1016/j.foodcont.2018.05.032

Mccraty, R., & Zayas, M. A. (2014). Cardiac coherence, self-regulation, autonomic stability, and psychosocial well-being. Frontiers in Psychology, 5. doi:10.3389/fpsyg.2014.01090

Breathing

4-7-8 breathing: How it works, benefits, and uses. (n.d.). Retrieved September 16, 2020, from https://www.medicalnewstoday.com/articles/324417

Benson, H. (1976). The relaxation response. New York: William Morrow.

Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW, et al. (2017) Correction: Relaxation Response Induces Temporal Transcriptome Changes in Energy Metabolism, Insulin Secretion and Inflammatory Pathways. PLOS ONE 12(2): e0172873. https://doi.org/10.1371/journal.pone.0172873

Bhasin, Manoj K., et al. “Relaxation Response Induces Temporal Transcriptome Changes in Energy Metabolism, Insulin Secretion and Inflammatory Pathways.” PLoS ONE, vol. 8, no. 5, 2013, doi:10.1371/journal.pone.0062817.

Brulé, D. (2020). Just breathe: Mastering breathwork. New York: Atria/Enliven Books.

Cebolla, A. M., &amp; Cheron, G. (2019). Understanding Neural Oscillations in the Human Brain: From Movement to Consciousness and Vice Versa. Frontiers in Psychology, 10. doi:10.3389/fpsyg.2019.01930

Cronkleton, E. (2018, July 09). Alternate Nostril Breathing: Benefits, How To, and More. Retrieved September 18, 2020, from https://www.healthline.com/health/alternate-nostril-breathing

Cope, S. (2001). Yoga and the quest for the true self. New York: Random House International.

Emerson, D. and Hopper , E, (2011). Overcoming trauma through yoga: reclaiming your body. California: North Atlantic Books.

Harrold, E. (2017). Life with breath: IQ + EQ = new you. Draper, UT: Go BE Great.

Herrero JL, Khuvis S, Yeagle E, Cerf M, Mehta AD. Breathing above the brain stem: volitional control and attentional modulation in humans. J Neurophysiol. 2018;119(1):145-159. doi:10.1152/jn.00551.2017

Joseph, Chacko N., et al. “Slow Breathing Improves Arterial Baroreflex Sensitivity and Decreases Blood Pressure in Essential Hypertension.” Hypertension, vol. 46, no. 4, 2005, pp. 714–718., doi:10.1161/01.hyp.0000179581.68566.7d.

Jovanov, E. “On Spectral Analysis of Heart Rate Variability during Very Slow Yogic Breathing,” 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference, Shanghai, 2005, pp. 2467-2470, doi: 10.1109/IEMBS.2005.1616968.

Lee, A. (2019, August 28). 5 Pranayamas (breathing exercises) to do every morning. Retrieved September 16, 2020, from https://thriveglobal.com/stories/5-pranayamasbreathing-exercises-to-do-every-morning/

Levine, J. (2015, June 17). 4 Research-Backed Benefits of Mindful Breathing. Retrieved September 16, 2020, from https://www.yogajournal.com/yoga-101/4-reasons-breathe-right

(n.d.). Retrieved September 16, 2020, from https://www.datasci.com/solutions/cardiovascular/baroreceptor-sensitivity-(brs)

Levine, P. A., &amp; Frederick, A. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. Berkeley, CA: North Atlantic Books.

Saoji, A. A., Raghavendra, B., &amp; Manjunath, N. (2019). Effects of yogic breath regulation: A narrative review of scientific evidence. Journal of Ayurveda and Integrative Medicine, 10(1), 50-58. doi:10.1016/j.jaim.2017.07.008

Simpkins, C. A., & Simpkins, A. M. (2014). Yoga and mindfulness therapy workbook for Clinicians & Clients. Eau Claire, WI: Pesi Publishing & Media.

Treleaven, D. (2018). Trauma-sensitive mindfulness: practices for safe and transformative healing. New York, NY: W. W. Norton and Company, Inc.

Trí, Q. (2013, April 19). Main menu. Retrieved September 17, 2020, from https://buddhajourney.net/a-short-teaching-on-mindfulness-of-breathing/

van der Kolk, B. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. New York, NY: Penguin Books.

Yackle, Kevin, et al. “Breathing Control Center Neurons That Promote Arousal in Mice.” Science, vol. 355, no. 6332, 2017, pp. 1411–1415., doi:10.1126/science.aai7984.

Pain

Abdo, Hind, et al. “Specialized Cutaneous Schwann Cells Initiate Pain Sensation.” Science, vol. 365, no. 6454, 2019, pp. 695–699., doi:10.1126/science.aax6452.

Act for Pain: Defusing the Threats of Languate by Integrative Pain Science. (2019, September 03). Retrieved October 09, 2020, from https://www.integrativepainscienceinstitute.com/defusing-the-threats-of-language/

Coleman, M. (2019, July/August). Working Mindfully With Physical Pain. Spirituality and Health, 20-22.

Darnall, B. D., Mackey, S. C., Lorig, K., Kao, M.-C., Mardian, A., Stieg, R., Porter, J., DeBruyne, K., Murphy, J., Perez, L., Okvat, H., Tian, L., Flood, P., McGovern, M., Colloca, L., King, H., Van Dorsten, B., Pun, T., & Cheung, M. (2020). Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol. Pain Medicine (Malden, Mass.), 21(8), 1523–1531. https://doi.org/10.1093/pm/pnz285

Davies, N. (2018, February/March). Acceptance and Commitment Therapy for Pain. Pain-Free Living.

Dinsmoor, R. S. (2018, February/March). Qi Gong. Pain-Free Living.

Dolan, L. C., Matulka, R. A., & Burdock, G. A. (2010). Naturally occurring food toxins. Toxins, 2(9), 2289–2332. https://doi.org/10.3390/toxins2092289

Evans, J. (2020, May). How I heal...migraine. What Doctors Don’t Tell You., 68-71.

Geneen, L., Smith, B., Clarke, C., Martin, D., Colvin, L. A., &amp; Moore, R. A. (2014). Physical activity and exercise for chronic pain in adults: An overview of Cochrane reviews. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd011279

Gibson, E. M., Nagaraja, S., Ocampo, A., Tam, L. T., Wood, L. S., Pallegar, P. N., . . . Monje, M. (2019). Methotrexate Chemotherapy Induces Persistent Tri-glial Dysregulation that Underlies Chemotherapy-Related Cognitive Impairment. Cell, 176(1-2). doi:10.1016/j.cell.2018.10.049

Kremer, J. (2018, October/November). Rethinking Pain Management: Diet and Lifestyle. Paleo Magazine, 54-56.

Gilam, G., Gross, J. J., Wager, T. D., Keefe, F. J., & Mackey, S. C. (2020). What Is the Relationship between Pain and Emotion? Bridging Constructs and Communities. Neuron, 107(1), 17–21. https://doi.org/10.1016/j.neuron.2020.05.024

Harris, R. (2011). Embracing your demons: An overview of Acceptance and Commitment Therapy. Psychotherapy. Retrieved from https://www.psychotherapy.net/article/Acceptance-and-Commitment-Therapy-ACT#section-the-goal-of-act

Harris, R. (2013). Acceptance and commitment therapy training. Retrieved from https://www.actmindfully.com.au/acceptance_&_commitment_therapy

Jahnke, R., Larkey, L., Rogers, C., Etnier, J., & Lin, F. (2010). A comprehensive review of health benefits of qigong and tai chi. American journal of health promotion : AJHP, 24(6), e1–e25. https://doi.org/10.4278/ajhp.081013-LIT-248

Kay, E. (2018, October/November). Chronic Inflammatory Response Syndrome. Paleo Magazine, 42-45.

Klein, P. J., Baumgarden, J., & Schneider, R. (2019). Qigong and Tai Chi as Therapeutic Exercise: Survey of Systematic Reviews and Meta-Analyses Addressing Physical Health Conditions. Alternative therapies in health and medicine, 25(5), 48–53.

Levine, H. (n.d.). Can Your Medications Cause Depression? Retrieved July 28, 2020, from https

Lima, L. V., Abner, T., & Sluka, K. A. (2017). Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena. The Journal of physiology, 595(13), 4141–4150. https

Markus, M. A., & Morris, B. J. (2008). Resveratrol in prevention and treatment of common clinical conditions of aging. Clinical interventions in aging, 3(2), 331–339.

McManus DE. Reiki Is Better Than Placebo and Has Broad Potential as a Complementary Health Therapy. J Evid Based Complementary Altern Med. 2017;22(4):1051-1057. doi:10.1177/2156587217728644

Natri, H., Garcia, A. R., Buetow, K. H., Trumble, B. C., & Wilson, M. A. (2019). The Pregnancy Pickle: Evolved Immune Compensation Due to Pregnancy Underlies Sex Differences in Human Diseases. Trends in Genetics, 35(7), 478-488. doi:10.1016/j.tig.2019.04.008

Omoigui, S. (2007). The biochemical origin of pain – Proposing a new law of pain: The origin of all pain is inflammation and the inflammatory response. Part 1 of 3 – A unifying law of pain. Medical Hypotheses, 69(1), 70-82. doi:10.1016/j.mehy.2006.11.028

Omoigui S. (2007). The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3 - inflammatory profile of pain syndromes. Medical hypotheses, 69(6), 1169–1178. https://doi.org/10.1016/j.mehy.2007.06.033

Omoigui S. The Interleukin-6 inflammation pathway from cholesterol to aging--role of statins, bisphosphonates and plant polyphenols in aging and age-related diseases. Immun Ageing. 2007 Mar 20;4:1. doi: 10.1186/1742-4933-4-1. PMID: 17374166; PMCID: PMC1845171.

One Theory To Explain Them All? The Vagus Nerve Infection Hypothesis for Chronic Fatigue Syndrome. (2019, March 13). Retrieved July 28, 2020, from http://simmaronresearch.com/2013/12/one-theory-explain-vagus-nerve-infection-chronic-fatigue-syndrome/

Shockley, S., &amp; Siegel, B. S. (2018). The pain companion: Everyday wisdom for living with and moving beyond chronic pain. Novato, CA: New World Library.

Schweder, M. (2018, July/August). Mother Earth Living, 44-49.

Vowles, K. E., Fink, B. C., & Cohen, L. L. (2014). Acceptance and Commitment Therapy for chronic pain: A diary study of treatment process in relation to reliable change in disability. Journal of contextual behavioral science, 3(2), 74–80. https://doi.org/10.1016/j.jcbs.2014.04.003

Vowles, K. E., Witkiewitz, K., Levell, J., Sowden, G., & Ashworth, J. (2017). Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain. Journal of consulting and clinical psychology, 85(2), 87–98. https://doi.org/10.1037/ccp0000159

Vowles, K. E., Witkiewitz, K., Sowden, G., & Ashworth, J. (2014). Acceptance and commitment therapy for chronic pain: evidence of mediation and clinically significant change following an abbreviated interdisciplinary program of rehabilitation. The journal of pain : official journal of the American Pain Society, 15(1), 101–113. https://doi.org/10.1016/j.jpain.2013.10.002

WHITESIDE, A. (2004). Exercise lowers pain threshold in chronic fatigue syndrome. Pain, 109(3), 497-499. doi:10.1016/s0304-3959(04)00121-6

Sleep

Admin. “Understanding CBD: The Calming and Sleep Promoting Benefits of Cannabidiol.” Your Guide to Better Sleep, Your Guide to Better Sleep, 29 Jan. 2018, www.thesleepdoctor.com/2017/08/10/understanding-cbd

Alison, et al. “How To Make Banana Tea For Restful Sleep.” Mommypotamus, 30 July 2018, www.mommypotamus.com/banana-tea-for-sleep/.

Bloomberg.com, Bloomberg, www.bloomberg.com/news/articles/2018-08-23/no-amount-of-alcohol-use-is-safe-analysis-of-studies-finds.

Burkhart, K, and J R Phelps. “Amber Lenses to Block Blue Light and Improve Sleep: a Randomized Trial.” Advances in Pediatrics., U.S. National Library of Medicine, Dec. 2009, www.ncbi.nlm.nih.gov/pubmed/20030543.

Buysse DJ. Sleep health: can we define it? Does it matter? SLEEP 2014;37(1):9-17.

“Cannabis and Sleep.” Psychology Today, Sussex Publishers, www.psychologytoday.com/us/blog/sleepless-in-america/201211/cannabis-and-sleep.

“Cannabis as a Sleep Aid: Here’s What You Need to Know.” Healthline, Healthline Media, www.healthline.com/health/medical-marijuana/cannabis-for-sleeping#precautions.

“Circadian Rhythm.” Psychology Today, Sussex Publishers, www.psychologytoday.com/us/basics/circadian-rhythm.

Czeisler, Charles A. “Perspective: Casting Light on Sleep Deficiency.” Nature News, Nature Publishing Group, 22 May 2013, www.nature.com/articles/497S13a.

Davis, Jeanie Lerche. “Sleep Supplements: Melatonin, Valerian, and More.” WebMD, WebMD, www.webmd.com/diet/features/natural-good-sleep-tips-on-melatonin-valerian#1.

Figueiro, M G, et al. “The Impact of Light from Computer Monitors on Melatonin Levels in College Students.” Advances in Pediatrics., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/21552190.

Gallagher, James. “Sleep Cleans the Brain of Toxins - BBC News.” BBC, BBC, 17 Oct. 2013, www.bbc.co.uk/news/health-24567412.

Ghosh, Pallab. “Why Do We Sleep?” BBC News, BBC, 15 May 2015, www.bbc.com/news/science-environment-32606341.

Gillette, M U, and S A Tischkau. “Suprachiasmatic Nucleus: the Brain’s Circadian Clock.” Advances in Pediatrics., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/10548871.

Gooley, Joshua J., et al. Advances in Pediatrics., U.S. National Library of Medicine, Mar. 2011, www.ncbi.nlm.nih.gov/pmc/articles/PMC3047226/.

Hartmann, E. “Effects of L-Tryptophan on Sleepiness and on Sleep.” Advances in Pediatrics., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/6764927/.

“How Alcohol Affects the Quality-And Quantity-Of Sleep.” National Sleep Foundation, sleepfoundation.org/sleep-topics/how-alcohol-affects-sleep.

“How Blocking Blue Light at Night Can Transform Your Sleep.” Healthline, Healthline Media, www.healthline.com/nutrition/block-blue-light-to-sleep-better#section2.

“Kava Lactones and the Kava-Kava Controversy.” Egyptian Journal of Medical Human Genetics, Elsevier, 29 Aug. 2003, www.sciencedirect.com/science/article/abs/pii/S0031942203003819.

“Kratom: Is It Safe?” Healthline, Healthline Media, www.healthline.com/health/food-nutrition/is-kratom-safe#side-effects.

Mandal, Ananya. “What Is Adenosine?” News-Medical.net, News-Medical.net, 23 Aug. 2018, www.news-medical.net/health/What-is-Adenosine.aspx.

“Melatonin: How It Affects Sleep - Watch WebMD Video.” WebMD, WebMD, www.webmd.com/sleep-disorders/video/melatonin-sleep.

Peters, Brandon. “How Does Adenosine Help You Get a Good Night’s Sleep?” Verywell Health, Verywellhealth, www.verywellhealth.com/adenosine-and-sleep-3015337.

Purves, Dale. “Neuroglial Cells.” Advances in Pediatrics., U.S. National Library of Medicine, 1 Jan. 1970, www.ncbi.nlm.nih.gov/books/NBK10869/.

Shaw, K, et al. “Tryptophan and 5-Hydroxytryptophan for Depression.” Advances in Pediatrics., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/11869656.

Singh, D, et al. “Severity of Pain and Sleep Problems during Kratom (Mitragyna Speciosa Korth.) Cessation among Regular Kratom Users.” Advances in Pediatrics., U.S. National Library of Medicine, www.ncbi.nlm.nih.gov/pubmed/29558272/.

“Touch for Socioemotional and Physical Well-Being: A Review.” Egyptian Journal of Medical Human Genetics, Elsevier, 25 Feb. 2011, www.sciencedirect.com/science/article/pii/S0273229711000025.

Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner, an Imprint of Simon & Schuster, Inc., 2018.

“What Falling Asleep With the TV On Is Really Doing to Your Health.” Health.com, www.health.com/sleep/falling-asleep-tv-on.

“What Is Sleep? Why Is It Needed? - American Sleep Association.” American Sleep Assoc, American Sleep Association, www.sleepassociation.org/about-sleep/what-is-sleep/.

“Why Do We Sleep, Anyway?” Sleep and Memory | Need Sleep, healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/why-do-we-sleep.

Inflammation and Toxins

Abbott NJ and Yusof SR (2010). Structure and function of the blood-brain barrier. Front. Pharmacol. Conference Abstract: Pharmacology and Toxicology of the Blood-Brain Barrier: State of the Art, Needs for Future Research and Expected Benefits for the EU. doi: 10.3389/conf.fphar.2010.02.00002

Albert, P. R., & Benkelfat, C. (2013). The neurobiology of depression--revisiting the serotonin hypothesis. II. Genetic, epigenetic and clinical studies. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 368(1615), 20120535. https://doi.org/10.1098/rstb.2012.0535

Alpert, M., Friedhoff, A. J.: Receptor sensitivity modification in the treatment of tardive dyskinesia. Clin. Pharmacol. Ther. 19, 103–104 (1976)

“Ancestral Diet Gone Toxic.” Los Angeles Times, Los Angeles Times, 13 Jan. 2004, www.latimes.com/archives/la-xpm-2004-jan-13-me-inuit13-story.html.

Augusto-Oliveira, M., Arrifano, G. P., Lopes-Araújo, A., Santos-Sacramento, L., Takeda, P. Y., Anthony, D. C., Malva, J. O., & Crespo-Lopez, M. E. (2019). What Do Microglia Really Do in a Healthy Adult Brain?. Cells, 8(10), 1293. https://doi.org/10.3390/cells8101293

Bone I. The increasing importance of inflammation in neurological disease. Curr Opin Neurol. 2007;20(3):331-333. doi:10.1097/WCO.0b013e32813a3658

Bullmore, Edward T. The Inflamed Mind: a Radical New Approach to Depression. Short Books, 2019.

Calkins, Beverly M. “A Meta-Analysis of the Role of Smoking in Inflammatory Bowel Disease.” Digestive Diseases and Sciences, vol. 34, no. 12, 1989, pp. 1841–1854., doi:10.1007/bf01536701.

Callaghan BL, Fields A, Gee DG, et al. Mind and gut: Associations between mood and gastrointestinal distress in children exposed to adversity. Dev Psychopathol. 2020;32(1):309-328. doi:10.1017/S0954579419000087

Carrington, D. (2020). Microplastic particles now discoverable in human organs. Retrieved October 29, 2020, from https://amp.theguardian.com/environment/2020/aug/17/microplastic-particles-discovered-in-human-organs

Carrington, Damian, and Matthew Taylor. “Air Pollution Is the ‘New Tobacco’, Warns WHO Head.” The Guardian, Guardian News and Media, 27 Oct. 2018, www.theguardian.com/environment/2018/oct/27/air-pollution-is-the-new-tobacco-warns-who-head

Cowen, P. J., & Browning, M. (2015). What has serotonin to do with depression?. World psychiatry : official journal of the World Psychiatric Association (WPA), 14(2), 158–160. https://doi.org/10.1002/wps.20229

Davies N, Thwaites G. Infections of the nervous system. Pract Neurol. 2011;11(2):121-131. doi:10.1136/jnnp.2011.242214

Duman, R. S., & Li, N. (2012). A neurotrophic hypothesis of depression: role of synaptogenesis in the actions of NMDA receptor antagonists. Philosophical Transactions of the Royal Society B: Biological Sciences, 367(1601), 2475–2484. doi:10.1098/rstb.2011.0357

“Endocrine-Disrupting Chemicals EDCs.” Hormone Health Network, www.hormone.org/your-health-and-hormones/endocrine-disrupting-chemicals-edcs.

Feighner, J. P., Boyer, W. F., Merideth, C. H., & Hendrickson, G. G. (1989). A double-blind comparison of fluoxetine, imipramine and placebo in outpatients with major depression. International Clinical Psychopharmacology, 4(2), 127–134. https://www.ncbi.nlm.nih.gov/pubmed/2663975

Fung,Thomas C., Helen E. Vuong, Cristopher D. G. Luna, Geoffrey N. Pronovost, Antoniya A. Aleksandrova, Noah G. Riley, Anastasia Vavilina, Julianne McGinn, Tomiko Rendon, Lucy R. Forrest, Elaine Y. Hsiao. Intestinal serotonin and fluoxetine exposure modulate bacterial colonization in the gut. Nature Microbiology, 2019; DOI: 10.1038/s41564-019-0540-4

Gennings, C., Ellis, R., & Ritter, J. K. (2012). Linking empirical estimates of body burden of environmental chemicals and wellness using NHANES data. Environment international, 39(1), 56–65. https://doi.org/10.1016/j.envint.2011.09.002

“Greenland: Love in a Very Cold Climate.” The Independent, Independent Digital News and Media, 20 Oct. 2011, www.independent.co.uk/environment/greenland-love-in-a-very-cold-climate-525188.html.

“How Dirty Air Could Be Affecting Our Gut Health.” BBC Future, BBC, www.bbc.com/future/article/20190128-how-dirty-air-could-be-affecting-our-gut-health.

Hemmings, S., Malan-Müller, S., van den Heuvel, L. L., Demmitt, B. A., Stanislawski, M. A., Smith, D. G., Bohr, A. D., Stamper, C. E., Hyde, E. R., Morton, J. T., Marotz, C. A., Siebler, P. H., Braspenning, M., Van Criekinge, W., Hoisington, A. J., Brenner, L. A., Postolache, T. T.,

Hillhouse, T. M., & Porter, J. H. (2015). A brief history of the development of antidepressant drugs: From monoamines to glutamate. Experimental and Clinical Psychopharmacology, 23(1), 1–21. doi:10.1037/a0038550

“Introduction to EDCs.” Endocrine Society, www.endocrine.org/topics/edc/introduction-to-edcs.

McQueen, M. B., Krauter, K. S., Knight, R., … Lowry, C. A. (2017). The Microbiome in Posttraumatic Stress Disorder and Trauma-Exposed Controls: An Exploratory Study. Psychosomatic medicine, 79(8), 936–946. https://doi.org/10.1097/PSY.0000000000000512

Hyman, Mark. The Ultramind Solution: Fix Your Broken Brain by Healing Your Body First. Simon & Schuster, 2010.

Kaplan GG, Tanyingoh D, Dixon E, et al. Ambient ozone concentrations and the risk of perforated and nonperforated appendicitis: a multicity case-crossover study. Environ Health Perspect. 2013;121(8):939-943. doi:10.1289/ehp.1206085

Kim, Doe-Young, and Michael Camilleri. “Serotonin: a Mediator of the Brain-Gut Connection.” The American Journal of Gastroenterology, vol. 95, no. 10, 2000, pp. 2698–2709., doi:10.1111/j.1572-0241.2000.03177.x.

Kirsh, Irving. The Emperor’s New Drugs: Exploding the Antidepressant Myth. Bodley Head, 2009.

Kish, Lisa, et al. “Environmental Particulate Matter Induces Murine Intestinal Inflammatory Responses and Alters the Gut Microbiome.” PLoS ONE, vol. 8, no. 4, 2013, doi:10.1371/journal.pone.0062220.

Li, N., Lee, B., Liu, R.-J., Banasr, M., Dwyer, J. M., Iwata, M., … Duman, R. S. (2010). mTOR-Dependent Synapse Formation Underlies the Rapid Antidepressant Effects of NMDA Antagonists. Science, 329(5994), 959–964. doi:10.1126/science.1190287

López-Muñoz, F., Alamo, C., Juckel, G., & Assion, H.-J. (2007). Half a century of antidepressant drugs: on the clinical introduction of monoamine oxidase inhibitors, tricyclics, and tetracyclics. Part I: monoamine oxidase inhibitors. Journal of Clinical Psychopharmacology, 27(6), 555–559. doi:10.1097/jcp.0b013e3181bb617

Ma Q. (2013). Role of nrf2 in oxidative stress and toxicity. Annual review of pharmacology and toxicology, 53, 401–426. https://doi.org/10.1146/annurev-pharmtox-011112-140320

Malan-Muller S, Valles-Colomer M, Raes J, Lowry CA, Seedat S, Hemmings SMJ. The Gut Microbiome and Mental Health: Implications for Anxiety- and Trauma-Related Disorders. OMICS. 2018;22(2):90-107. doi:10.1089/omi.2017.0077

Ming He, Hou-Hsien Chiang, Hanzhi Luo, Zhifang Zheng, Qi Qiao, Li Wang, Mingdian Tan, Rika Ohkubo, Wei-Chieh Mu, Shimin Zhao, Hao Wu, Danica Chen. An Acetylation Switch of the NLRP3 Inflammasome Regulates Aging-Associated Chronic Inflammation and Insulin Resistance. Cell Metabolism, 2020; DOI: 10.1016/j.cmet.2020.01.009

Moore, A. (2012, July 04). Childhood Trauma Can Result in Chronic Inflammation. Retrieved August 04, 2020, from https://www.medicaldaily.com/childhood-trauma-can-result-chronic-inflammation-241114

Mu, Q., Kirby, J., Reilly, C. M., & Luo, X. M. (2017). Leaky Gut As a Danger Signal for Autoimmune Diseases. Frontiers in Immunology, 8. doi:10.3389/fimmu.2017.00598

Nakazawa, D. (2020, January 10). Childhood trauma leads to lifelong chronic illness - so why isn’t the medical community helping patients? Retrieved August 04, 2020, from https://acestoohigh.com/2016/08/10/childhood-trauma-leads-to-lifelong-chronic-illness-so-why-isnt-the-medical-community-helping-patients/

Nguyen, T., Nioi, P., & Pickett, C. B. (2009). The Nrf2-antioxidant response element signaling pathway and its activation by oxidative stress. The Journal of biological chemistry, 284(20), 13291–13295. https://doi.org/10.1074/jbc.R900010200

Pahwa R, Goyal A, Bansal P, et al. Chronic Inflammation. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493173/

Prozac. (2005). Chemical & Engineering News, 83(25). Retrieved from https://pubs.acs.org/cen/coverstory/83/8325/8325prozac.html

Salomon, R. M., Miller, H. L., Krystal, J. H., Heninger, G. R., & Charney, D. S. (1997). Lack of behavioral effects of monoamine depletion in healthy subjects. Biological Psychiatry, 41(1), 58–64. doi:10.1016/0006-3223(95)00670-2

Schmaal, L., Hibar, D. P., Sämann, P. G., Hall, G. B., Baune, B. T., Jahanshad, N., … Veltman, D. J. (2017). Cortical abnormalities in adults and adolescents with major depression based on brain scans from 20 cohorts worldwide in the ENIGMA Major Depressive Disorder Working Group. Molecular Psychiatry, 22(6), 900–909. doi:10.1038/mp.2016.60

Schmaal, L., Veltman, D. J., van Erp, T. G. M., Sämann, P. G., Frodl, T., Jahanshad, N., … Hibar, D. P. (2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular Psychiatry, 21(6), 806–812. doi:10.1038/mp.2015.69

Silent Spring Institute (n.d.). How are we exposed to toxic chemicals? Retrieved August 01, 2020, from https://silentspring.org/our-science/how-are-we-exposed-toxic-chemicals

Udenfriend, S., Weissbach, H., & Bogdanski, D. F. (1957). Biochemical Findings Relating to the Action of Serotonin. Annals of the New York Academy of Sciences, 66(3), 602–608. doi:10.1111/j.1749-6632.1957.tb40750.x

Wong, D. T., Perry, K. W., & Bymaster, F. P. (2005). The Discovery of Fluoxetine Hydrochloride (Prozac). Nature Reviews Drug Discovery, 4(9), 764–774. doi:10.1038/nrd1821

Takahiro Masuda, Roman Sankowski, Ori Staszewski, Chotima Böttcher, Lukas Amann, Christian Scheiwe, Stefan Nessler, Patrik Kunz, Geert van Loo, Volker Arnd Coenen, Peter Christoph Reinacher, Anna Michel, Ulrich Sure, Ralf Gold, Josef Priller, Christine Stadelmann, Marco Prinz. Spatial and temporal heterogeneity of mouse and human microglia at single-cell resolution. Nature, 2019; DOI: 10.1038/s41586-019-0924-x

Tian L, Ma L, Kaarela T, Li Z. Neuroimmune crosstalk in the central nervous system and its significance for neurological diseases. J Neuroinflammation. 2012;9:155. Published 2012 Jul 2. doi:10.1186/1742-2094-9-155

Trade Secrets : Chemical Body Burden. (n.d.). Retrieved August 01, 2020, from http://www.pbs.org/tradesecrets/problem/bodyburden.html

Weder N, Zhang H, Jensen K, et al. Child abuse, depression, and methylation in genes involved with stress, neural plasticity, and brain circuitry. J Am Acad Child Adolesc Psychiatry. 2014;53(4):417-24.e5. doi:10.1016/j.jaac.2013.12.025

Yano, J. M., Yu, K., Donaldson, G. P., Shastri, G. G., Ann, P., Ma, L., Nagler, C. R., Ismagilov, R. F., Mazmanian, S. K., & Hsiao, E. Y. (2015). Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis. Cell, 161(2), 264–276. https://doi.org/10.1016/j.cell.2015.02.047

Young S. N. (2007). How to increase serotonin in the human brain without drugs. Journal of psychiatry & neuroscience : JPN, 32(6), 394–399.

Zhang, J. M., & An, J. (2007). Cytokines, inflammation, and pain. International anesthesiology clinics, 45(2), 27–37. https://doi.org/10.1097/AIA.0b013e318034194e

Eat

Adams, J., White, M. Characterisation of UK diets according to degree of food processing and associations with socio-demographics and obesity: cross-sectional analysis of UK National Diet and Nutrition Survey (2008–12). Int J Behav Nutr Phys Act 12, 160 (2015). https://doi.org/10.1186/s12966-015-0317-y

AHA Healthy for Good | 22 Jul 2014. (n.d.). Are salt and sodium the same? Retrieved October 01, 2020, from https://sodiumbreakup.heart.org/salt-vs-sodium

Bacon, L., & Aphramor, L. (2014). Body respect: What conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas, TX: BenBella Books.

Bailey, L.R. (1966). “Indian Slave Trade in the Southwest”. Los Angeles, CA: Westernlore Press.

Benjamin W. Bellet, Payton J. Jones, Richard J. McNally, Trigger warning: Empirical evidence ahead, Journal of Behavior Therapy and Experimental Psychiatry, Volume 61, 2018, Pages 134-141, https://doi.org/10.1016/j.jbtep.2018.07.002.

Beth B. (2011). Collection of milk samples from known tissue residue violators questions and answers. Retrieved from http://www.nmpf.org/sites/default/files/FDA%20Milk%20Sampling%20QA%27s_122110.pdf

Bjork, C. (2020, April/May). How important is it to count calories and macros? I hate tracking everything I heat or drink. Is it really necessary to meet my goals? Paleo Magazine.

Campbell, P. C. T., Campbell, C. T., Campbell, T. M., Trainor, T., Robbins, J., & Lyman, H. B. (2006). The china study: The most comprehensive study of nutrition ever conducted and the startling implications for diet, weight loss and long-term health. Dallas, TX, USA: Benabella Books.

Carroccio A, D’Alcamo A, Iacono G, Soresi M, Iacobucci R, Arini A, Geraci G, Fayer F, Cavataio F, La Blasca F, Florena AM, Mansueto P. Persistence of Nonceliac Wheat Sensitivity, Based on Long-term Follow-up. Gastroenterology. 2017 Jul;153(1):56-58.e3. doi: 10.1053/j.gastro.2017.03.034. Epub 2017 Mar 30. PMID: 28365444.

Cerulli, T. (2013). The mindful Carnivore: A vegetarian’s hunt for sustenance. United States: Pegasus Books.

Cheng E, Um CY, Prizment A, Lazovich D, Bostick RM. Associations of evolutionary-concordance diet, Mediterranean diet and evolutionary-concordance lifestyle pattern scores with all-cause and cause-specific mortality. Br J Nutr. 2018 Dec 18:1-10. doi: 10.1017/S0007114518003483. Epub ahead of print. PMID: 30560736; PMCID: PMC6581641.

Choi HR, Kim J, Lim H, Park YK. Two-Week Exclusive Supplementation of Modified Ketogenic Nutrition Drink Reserves Lean Body Mass and Improves Blood Lipid Profile in Obese Adults: A Randomized Clinical Trial. Nutrients. 2018 Dec 3;10(12):1895. doi: 10.3390/nu10121895. PMID: 30513970; PMCID: PMC6316485.

Christensen, J. (2016, January 7). New dietary guidelines limit sugar, rethink cholesterol - CNN.com. Retrieved from http://www.cnn.com/2016/01/07/health/2015-dietary-guidelines/

Colbin, A. (1986). Food and healing. United States: Random House Publishing Group.

Davis, W. (2014). Wheat belly total health: The ultimate grain-free health and weight-loss life plan. United States: Rodale Press.

Davis, W., Davis, M. d. W., & Philpott, W. H. (2013). Wheat belly: Lose the wheat, lose the weight, and find your path back to health. United States: Rodale Books.

Durant, J. (2014). Paleo manifesto: Ancient wisdom for lifelong health. United States: Harmony Books.

Eating Disorder Statistics. General &amp; Diversity Stats: ANAD. (2020, November 16). Retrieved November 24, 2020, from https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/

Emery, P. (2003). PROTEIN | Digestion and Absorption of Protein and Nitrogen Balance. Encyclopedia of Food Sciences and Nutrition, 4854-4858. doi:10.1016/b0-12-227055-x/00985-8

Farm Bill Spending. (n.d.). Retrieved December 03, 2020, from https://www.ers.usda.gov/topics/farm-economy/farm-commodity-policy/farm-bill-spending/

Farooqi IS, O’Rahilly S. The Genetics of Obesity in Humans. [Updated 2017 Dec 23]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279064/

Friend, Y. (2019, October 18). The Bizarre and Racist History of the BMI. Retrieved November 27, 2020, from https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb

Gómez-Ambrosi, J., Silva, C., Galofré, J. C., Escalada, J., Santos, S., Gil, M. J., Valentí, V., Rotellar, F., Ramírez, B., Salvador, J., & Frühbeck, G. (2011). Body adiposity and type 2 diabetes: increased risk with a high body fat percentage even having a normal BMI. Obesity (Silver Spring, Md.), 19(7), 1439–1444. https://doi.org/10.1038/oby.2011.36

Finlay, B. B., & Finlay, J. M. (2019). The whole-body microbiome: How to harness microbes--inside and out--for lifelong health. Madeira Park, British Columbia: Douglas and McIntyre.

Food Allergies. 8 June 2020, www.cdc.gov/healthyschools/foodallergies/index.htm.

Francis, H. M., Stevenson, R. J., Chambers, J. R., Gupta, D., Newey, B., & Lim, C. K. (2019). A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. Plos One, 14(10). doi:10.1371/journal.pone.0222768

Fuel Your Gut With Prebiotics. (2019, Fall). Nutrition Health Review, (124), 9.

Glickman, Dan, and Dariush Mozaffarian. “Our Food Is Killing Too Many of Us.” The New York Times, The New York Times, 26 Aug. 2019, www.nytimes.com/2019/08/26/opinion/food-nutrition-health-care.html.

Health Benefits of Fermented Foods. (2019, Fall). Nutrition Health Review, (124), 9.

“Introduction.” Nutrition and Health Are Closely Related - 2015-2020 Dietary Guidelines, health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/introduction/nutrition-and-health-are-closely-related/.

Ives, G. C., Fein, L. A., Finch, L., Sluiter, E. C., Lane, M., Kuzon, W. M., & Salgado, C. J. (2019). Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty. Plastic and reconstructive surgery. Global open, 7(3), e2097. https://doi.org/10.1097/GOX.0000000000002097

Jackson, A., Stanforth, P., Gagnon, J. et al. The effect of sex, age and race on estimating percentage body fat from body mass index: The Heritage Family Study. Int J Obes 26, 789–796 (2002). https://doi.org/10.1038/sj.ijo.0802006

Kaplan, Hillard, et al. “Coronary Atherosclerosis in Indigenous South American Tsimane: a Cross-Sectional Cohort Study.” The Lancet, vol. 389, no. 10080, 2017, pp. 1730–1739., doi:10.1016/s0140-6736(17)30752-3.

Kolata, G. (2016, December 12). One Weight-Loss Approach Fits All? No, Not Even Close. Retrieved December 02, 2020, from https://www.nytimes.com/2016/12/12/health/weight-loss-obesity.html

Korn, Leslie. “The Brainbow Blueprint for Mental Health.” Spirituality & Health - The Soul | Body Connection, spiritualityhealth.com/articles/2020/04/14/the-brainbow-blueprint-for-mental-health.

Loh, W., & Tang, M. (2018). The Epidemiology of Food Allergy in the Global Context. International journal of environmental research and public health, 15(9), 2043. https://doi.org/10.3390/ijerph15092043

Moss, M. (2013, February 20). The Extraordinary Science of Addictive Junk Food. Retrieved October 01, 2020, from https://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html

Mozaffarian D, Mande J, Micha R. Food Is Medicine—The Promise and Challenges of Integrating Food and Nutrition Into Health Care. JAMA Intern Med. 2019;179(6):793–795. doi:10.1001/jamainternmed.2019.0184

Negative Affect, Intrusive Thoughts, and Avoidance. Clinical Psychological Science, 7(4), 778–793. https://doi.org/10.1177/2167702619827018

Nova groups for food processing. (n.d.). Retrieved September 30, 2020, from https://world.openfoodfacts.org/nova

O’connor, A. (2016, July 19). How the Government Supports Your Junk Food Habit. Retrieved December 02, 2020, from https://well.blogs.nytimes.com/2016/07/19/how-the-government-supports-your-junk-food-habit/

Pace, T. W., Negi, L. T., Adame, D. D., Cole, S. P., Sivilli, T. I., Brown, T. D., Issa, M. J., & Raison, C. L. (2009). Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology, 34(1), 87–98. https://doi.org/10.1016/j.psyneuen.2008.08.011

Processed Foods. What they are, how they affect our bodies, and how to avoid them.. (2019, Spring). Nutrition Health Review, (124), 7-9.

“Public Impact Initiative: Food Is Medicine.” Public Impact Initiative: Food Is Medicine | Friedman School of Nutrition Science and Policy, nutrition.tufts.edu/about/public-impact-initiative-friedman-school/food-is-medicine.

Susan B Racette, Susan S Deusinger, Robert H Deusinger, Obesity: Overview of Prevalence, Etiology, and Treatment, Physical Therapy, Volume 83, Issue 3, 1 March 2003, Pages 276–288, https://doi.org/10.1093/ptj/83.3.276

Rahman, M., & Berenson, A. B. (2010). Accuracy of current body mass index obesity classification for white, black, and Hispanic reproductive-age women. Obstetrics and gynecology, 115(5), 982–988. https://doi.org/10.1097/AOG.0b013e3181da9423

Reducing Chronic Inflammation. (Jan-Feb, 2020). Nutrition Health Review, (126), 15-17.

Rosenheck, J. (2014, April). Doctor’s Review: Medicine on the Move. Retrieved November 27, 2020, from http://www.doctorsreview.com/history/queen-calories/

Sacks, F. M., Bray, G. A., Carey, V. J., Smith, S. R., Ryan, D. H., Anton, S. D., . . . Williamson, D. A. (2009). Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. New England Journal of Medicine, 360(9), 859-873. doi:10.1056/nejmoa0804748

Sisson, M. (2014, May 13). Does Skinny Equal Healthy? Retrieved December 02, 2020, from https://www.marksdailyapple.com/does-skinny-equal-healthy/

Sisson, M. (2019, April/May). The Evolution of Protein Recommendations: And Where I Land Today. Paleo Magazine, 60-62.

Strings, S. (2019). Fearing the Black Body. New York University Press.

The Endocrine Society. (2009, June 22). Widely Used Body Fat Measurements Overestimate Fatness In African-Americans, Study Finds. ScienceDaily. Retrieved November 22, 2020 from www.sciencedaily.com/releases/2009/06/090611142407.htm

The Gut Microbiota-Obesity Connection. (2019, Fall). Nutrition Health Review, (127), 6-8.

The Gut Microbiota-Obesity Connection. (2019, Fall). Nutrition Health Review, (124), 9.

The Role of Nutrition in Brain Health. (2020, March-APril). Nutrition Health Review, (124), 9.

Water: How much should you drink every day? (2017, September 06). Retrieved October 05, 2020, from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256

Why food allergies are on the rise. (n.d.). Retrieved December 03, 2020, from https://www.bbc.com/future/article/20201023-food-allergies-why-nut-dairy-and-food-allergy-are-rising

We’re in the money. (2020, May). What Doctor’s Don’t Tell You.

WebMd (2016, May 2) What Are Trans Fats? Food Sources, Decoding Labels. Retrieved July 3, 2016, frrom http://www.m.webmd.com/diet/guide/understanding-trans-fats

Whole30 Downloads | The Whole30® Program. (2016). Retrieved June 26, 2016, from http://whole30.com/pdf-downloads/

Wood, R., Pitchford, P., & Markel, P. (1999). The new whole foods encyclopedia: A comprehensive resource for healthy eating. New York, NY: Penguin/Arkana.

Why Processed Food Is Cheaper Than Healthier Options. (2013, March 01). Retrieved October 01, 2020, from https://www.npr.org/2013/03/01/173217143/why-process-food-is-cheaper-than-healthier-options

Willett WC, Koplan JP, Nugent R, et al. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 44. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11795/ Co-published by Oxford University Press, New York.

Gunnars, K. (2013, August 12). 6 Reasons Why Vegetable Oils Can be Harmful. Retrieved July 3, 2016, from Nutrition, https://authoritynutrition.com/6-reasons-why-vegetable-oils-are-toxic/

Hartwig, D., & Hartwig, M. (2014). It starts with food: Discover the whole 30 and change your life in unexpected ways. United States: Victory Belt Publishing.

Jensen, B., & Anderson, M. (2000). Empty harvest: Understanding the link between our food, our immunity and our planet. United States: Avery Publishing Group Inc.,U.S.

Johnston, A. (2000). Eating in the light of the moon: How women can transform their relationship with food through myths, metaphors and storytelling. United States: Gurze Books.

Konie, R. (2015, February 18). The Ugly Truth: Vegetable Oils Are Bad. Retrieved July 3, 2016, from Real Food, http://www.thankyourbody.com/vegetable-oils/

Levin, P., & Lee, J. (2002). Perfect bones: A Six-Point plan for healthy bones. United States: Celestial Arts.

Medford, L., & C.N, E. C. (1999). Why can’t I lose weight? United States: L D N Publishing.

Moss, M., & Professor of History Michael Moss (2013). Salt, sugar, fat: How the food giants hooked us. New York: Random House Publishing Group.

Möller, G. (2006). 1 animal drug residues in food. Retrieved from http://www.webpages.uidaho.edu/foodtox/lectures/lecture22/L22-Animal%20Drug%20Residues%20in%20Food.pdf

National Research Council (1999). The use of drugs in food animals. Retrieved July 2, 2016, from http://www.nap.edu/read/5137/chapter/7

NCBI Bookshelf (1980). Antibiotics in Animal Feeds - The Effects on Human Health of Subtherapeutic Use of Antimicrobials in Animal Feeds. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK216502/

News, F. S. (2010, April 1). How Sulfa-Loaded Beef Gets To Market | Food Safety NewsFood Safety News. Retrieved July 2, 2016, from Government Agencies, http://www.foodsafetynews.com/2010/04/how-sulfa-loaded-beef-gets-to-market/

Paul, G. (2014). Eat yourself calm. United States: Hamlyn (UK).

Philpott, T. (2014, April 23). Monsanto GM Soy Is Scarier Than You Think | Mother Jones. Retrieved July 2, 2016, from http://m.motherjones.com/tom-philpott/2014/04/superweeds-arent-only-trouble-gmo-soy

Quillin, P. (2010). Wisdom and healing power of whole foods: The ultimate handbook for using whole foods and lifestyle changes to bolster your body’s ability to repair and regulate itself. United States: Leader Company, Incorporated, The.

Read “the use of drugs in food animals: Benefits and risks” at NAP.edu (1999). . Retrieved from http://www.nap.edu/read/5137/chapter/7

n for vibrant health and maximum weight loss. United States: William Morrow Paperbacks.

Schimke, D., Grumdahl, D. M., Staff, E. L., Olson, K., Wachter, H., Terry, B., … Anthony, M. (2004, March ). Big Fat Controversy · Experience Life. Retrieved July 3, 2016, from https://experiencelife.com/article/big-fat-controversy/

Schmidt, R. (1987). Traditional foods are your best medicine. (1st ed.). New York: Ballantine.

Somer, E. (1995). Food and mood. New York: Holt.

Steinman, D., & Marcus, W. (2006). Diet for a poisoned planet: How to choose safe foods for you and your family - the Twenty-first century edition (21st ed.). United States: Running Press.

Stitt, B. R. (1997). Food & behavior. Natural Press.

The National Academies Press (1999). 5 Drug Residues and Microbial Contamination in Food | The Use of Drugs in Food Animals: Benefits and Risks. Retrieved from http://www.nap.edu/read/5137/chapter/7

Move

Benias, P.C., Wells, R.G., Sackey-Aboagye, B. et al. Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Sci Rep 8, 4947 (2018). https://doi.org/10.1038/s41598-018-23062-6

Borghouts, L. B., &amp; Keizer, H. A. (2000). Exercise and Insulin Sensitivity: A Review. International Journal of Sports Medicine, 21(1), 1-12. doi:10.1055/s-2000-8847

Muehsam, D., Lutgendorf, S., Mills, P. J., Rickhi, B., Chevalier, G., Bat, N., et al. (2017). The embodied mind: a review on functional genomic and neurological correlates of mind-body therapies. Neurosci. Biobehav. Rev. 73, 165–181. doi: 10.1016/j.neubiorev.2016.12.027

Craig, A.D.. (2003). Interoception: The Sense of the Physiological Condition of the Body. Current opinion in neurobiology. 13. 500-5. 10.1016/S0959-4388(03)00090-4.

Edwards, D. (2020, April/May). The Essence of Functional Training. Paleo Magazine.

Healthy Ways To Deal With Stress. (2020). Nutrition Health Review, (129), 4-7.

Mond, J. M., Hay, P. J., Rodgers, B., & Owen, C. (2006). An update on the definition of “excessive exercise” in eating disorders research. International Journal of Eating Disorders, 39(2), 147-153. doi:10.1002/eat.20214

Reducing Chronic Inflammation. (Jan-Feb, 2020). Nutrition Health Review, (126), 15-17.

Sullivan, Marlysa B., et al. “Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience.” Frontiers in Human Neuroscience, vol. 12, 2018, doi:10.3389/fnhum.2018.00067.

Taylor, A. G., Goehler, L. E., Galper, D. I., Innes, K. E., and Bourguignon, C. (2010). Top-down and Bottom-up mechanisms in mind-body medicine: development of an integrative framework for psychophysiological research. Explore 6, 29–41. doi: 10.1016/j.explore.2009.10.004

Trivedi, M. H., Greer, T. L., Church, T. S., Carmody, T. J., Grannemann, B. D., Galper, D. I., . . . Blair, S. N. (2011). Exercise as an Augmentation Treatment for Nonremitted Major Depressive Disorder. The Journal of Clinical Psychiatry, 72(05), 677-684. doi:10.4088/jcp.10m06743

Young SN. How to increase serotonin in the human brain without drugs. J Psychiatry Neurosci. 2007;32(6):394-399.

Stress

“Adrenaline and Noradrenaline.” Encyclopedia of Life Sciences, www.els.net/WileyCDA/ElsArticle/refId-a0001401.html

“Are We in an Anxiety Epidemic? Dr. Rachel Abrams Says Yes - 1440 Multiversity Blog.” 1440 Multiversity - 800 Bethany Drive, CA 95066, https://www.1440.org/blog/are-we-in-an-anxiety-eBupidemic-dr-rachel-abrams-says-yes

Asbert, M. (1976). Serotonin depression: A biochemical subgroup with the affective disorders? Science,191, 478-80; Asberg, M., (1976). 5-HIAA in the cerebrospinal fluid. Archives of General Psychiatry, 33, 1193-97.

Asbert, M. (1976). Serotonin depression: A biochemical subgroup with the affective disorders? Science,191, 478-80; Asberg, M., (1976). 5-HIAA in the cerebrospinal fluid. Archives of General Psychiatry, 33, 1193-97.

Bellono NW, Bayrer JR, Leitch DB, et al. Enterochromaffin Cells Are Gut Chemosensors that Couple to Sensory Neural Pathways. Cell. 2017;170(1):185-198.e16. doi:10.1016/j.cell.2017.05.034

Berk, M., Kapczinski, F., Andreazza, A. C., Dean, O. M., Giorlando, F., Maes, M., ... & Magalhães, P. V. S. (2011). Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neuroscience & biobehavioral reviews, 35(3), 804-817.

Bouchez, C. (2011, October 12). Serotonin and Depression: 9 Questions and Answers. Retrieved July 28, 2020, from https://www.webmd.com/depression/features/serotonin

Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Frontiers in psychiatry, 9, 44. https://doi.org/10.3389/fpsyt.2018.00044

Bullmore, Edward T. The Inflamed Mind: a Radical New Approach to Depression. Short Books, 2019.

Butts KA, Weinberg J, Young AH, & Phillips AG (2011). Glucocorticoid receptors in the prefrontal cortex regulate stress-evoked dopamine efflux and aspects of executive function. Proceedings of the National Academy of Sciences of the United States of America, 108 (45), 18459-64 PMID: 22032926

Callaghan, B. L., Fields, A., Gee, D. G., Gabard-Durnam, L., Caldera, C., Humphreys, K. L., ... & Tottenham, N. (2019). Mind and gut: Associations between mood and gastrointestinal distress in children exposed to adversity. Development and psychopathology, 1-20.

Chang, T. T., Yen, Y-C., (2010). Cytokines and Major Psychiatric Disorders. Taiwanese Journal of Psychiatry (Taipei) Vol. 24 No. 4, 257-268.

Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet.

2014 Jun 21;383(9935):2152-67.

Crawford LE, Knouse LE, Kent M, et al. Enriched environment exposure accelerates rodent driving skills. Behav Brain Res. 2020;378:112309. doi:10.1016/j.bbr.2019.112309

Cytokine Function, https://www.sinobiological.com/cytokine-rerview-receptor-source-targets-main-function-disease-association-a-1310.html.

Dietrich J, Han R, Yang Y, Mayer-Pröschel M, Noble M. CNS progenitor cells and oligodendrocytes are targets of chemotherapeutic agents in vitro and in vivo. J Biol. 2006;5(7):22. doi:10.1186/jbiol50

Dobbin, J. P., Harth, M., McCain, G. A., Martin, R. A., & Cousin, K. (1991). Cytokine production and lymphocyte transformation during stress. Brain, behavior, and immunity, 5(4), 339-348.

“Demystifying Depression.” Demystifying Depression - Wikibooks, Open Books for an Open World, https://en.wikibooks.org/wiki/Demystifying_Depression.

Field, Tiffany, et al. “Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy.” The International Journal of Neuroscience, U.S. National Library of Medicine, Oct. 2005, https://www.ncbi.nlm.nih.gov/pubmed/16162447/.

Foster, J. A., Rinaman, L., & Cryan, J. F. (2017). Stress & the gut-brain axis: regulation by the microbiome. Neurobiology of stress, 7, 124-136.

Gallup, Inc. “Gallup 2018 Global Emotions Report.” Gallup.com, www.gallup.com/analytics/241961/gallup-global-emotions-report-2018.aspx?utm_source=link_newsv9&utm_campaign=item_242117&utm_medium=copy.

Gershon, M. D. (1999). The enteric nervous system: a second brain. Hospital Practice, 34(7), 31-52

Gibson, E. M., Nagaraja, S., Ocampo, A., Tam, L. T., Wood, L. S., Pallegar, P. N., . . . Monje, M. (2019). Methotrexate Chemotherapy Induces Persistent Tri-glial Dysregulation that Underlies Chemotherapy-Related Cognitive Impairment. Cell, 176(1-2). doi:10.1016/j.cell.2018.10.049

Griffin, R. Morgan. “10 Health Problems Related to Stress That You Can Fix.” WebMD, WebMD, www.webmd.com/balance/stress-management/features/10-fixable-stress-related-health-problems#1.

Guilliams , Thomas G. The Role of Stress and the HPA Axis in Chronic Disease Management Principles and Protocols for Healthcare Professionals. Point Institute.

Haas, Robert, et al. “Lactate Regulates Metabolic and Pro-Inflammatory Circuits in Control of T Cell Migration and Effector Functions.” PLOS Biology, vol. 13, no. 7, 2015, doi:10.1371/journal.pbio.1002202.

Haroon, E., Raison, C. L., & Miller, A. H. (2012). Psychoneuroimmunology meets neuropsychopharmacology: translational implications of the impact of inflammation on behavior. Neuropsychopharmacology, 37(1), 137.

He, Ming, et al. “An Acetylation Switch of the NLRP3 Inflammasome Regulates Aging-Associated Chronic Inflammation and Insulin Resistance.” Cell Metabolism, vol. 31, no. 3, 2020, doi:10.1016/j.cmet.2020.01.009.

Hemmings, S. M., Malan-Muller, S., van den Heuvel, L. L., Demmitt, B. A., Stanislawski, M. A., Smith, D. G., ... & Marotz, C. A. (2017). The microbiome in posttraumatic stress disorder and trauma-exposed controls: an exploratory study. Psychosomatic medicine, 79(8), 936.

Hong-Ji, Kim. “South Koreans Lock Themselves up to Escape Prison of Daily Life.” Reuters, Thomson Reuters, https://widerimage.reuters.com/story/south-koreans-lock-themselves-up-to-escape-prison-of-daily-life.

Hyman, Mark. The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First: the Simple Way to Defeat Depression, Overcome Anxiety, and Sharpen Your Mind. Scribner, 2010.

“Is Stress Good or Bad? It’s Actually Both.” BBC Worklife, BBC, www.bbc.com/worklife/article/20191212-is-stress-good-or-bad-its-both.

Keller, Abiola, et al. Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Sept. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3374921/#R21.

Kirsch, Irving. The Emperor’s New Drugs: Exploding the Antidepressant Myth. Basic Books, 2011.

Koopman, F. A., Chavan, S. S., Miljko, S., Grazio, S., Sokolovic, S., Schuurman, P. R., . . . Tak, P. P. (2016). Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proceedings of the National Academy of Sciences, 113(29), 8284-8289. doi:10.1073/pnas.1605635113

Lacasse, JR & Leo, J. (2005). Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. PLOS Medicine. DOI: 10.1371/journal.pmed.0020392

LaMotte, Sandee. “Stress Might Lead to Memory Loss and Brain Shrinkage, Study Says.” CNN, Cable News Network, 25 Oct. 2018, https://www.cnn.com/2018/10/24/health/stress-memory-loss-under-50-study/index.html.

Larochelle, C. (2020, February 04). More than a knee injury: ACL tears cause harmful changes in our brain structure. Retrieved July 28, 2020, from https://news.umich.edu/more-than-a-knee-injury-acl-tears-cause-harmful-changes-in-our-brain-structure/

Martin, C. R., Osadchiy, V., Kalani, A., & Mayer, E. A. (2018). The Brain-Gut-Microbiome Axis. Cellular and Molecular Gastroenterology and Hepatology, 6(2), 133-148.

Michopoulos, V., Powers, A., Gillespie, C. F., Ressler, K. J., & Jovanovic, T. (2017). Inflammation in fear-and anxiety-based disorders: PTSD, GAD, and beyond. Neuropsychopharmacology, 42(1), 254.

Milaniak, I., & Jaffee, S. R. (2019). Childhood socioeconomic status and inflammation: A systematic review and meta-analysis. Brain, behavior, and immunity.

Monje, M. L. (2003). Inflammatory Blockade Restores Adult Hippocampal Neurogenesis. Science, 302(5651), 1760-1765. doi:10.1126/science.1088417

Nauert PhD, R. (2019). Mice Study Suggests Lack of Serotonin Not Behind Depression. Psych Central. Retrieved on July 28, 2020, from https://psychcentral.com/news/2014/08/28/mice-study-suggests-lack-of-serotonin-not-behind-depression/74206.html

Papierska, L., & Rabijewski, M. (2013). Delay in diagnosis of adrenal insufficiency is a frequent cause of adrenal crisis. International journal of endocrinology, 2013, 482370. https://doi.org/10.1155/2013/482370

Pennisi, E., Feb. 4, 2019, et al. “Evidence Mounts That Gut Bacteria Can Influence Mood, Prevent Depression.” Science, 4 Feb. 2019, www.sciencemag.org/news/2019/02/evidence-mounts-gut-bacteria-can-influence-mood-prevent-depression.

Ray, Julie. “World Took a Negative Turn in 2017.” Gallup.com, Gallup, 18 Dec. 2018, https://news.gallup.com/poll/242117/world-took-negative-turn-2017

Renna, M. E., O’toole, M. S., Spaeth, P. E., Lekander, M., & Mennin, D. S. (2018). The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic review and meta-analysis. Depression and anxiety, 35(11), 1081-1094.

Schipani, Denise, et al. “Everyday Health: The Link Between Stress and Inflammation.” EverydayHealth.com, https://www.everydayhealth.com/wellness/united-states-of-stress/link-between-stress-inflammation/.

Serotonin: Facts, uses, SSRIs, and sources. (n.d.). Retrieved July 28, 2020, from https://www.medicalnewstoday.com/articles/232248

Smith S. R. (1997). Immunological Evidence Supporting The Immune-Cytokine Model of Depression. Cytokines and Depression.

Smith, Sean M., and Wylie W. Vale. Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Dec. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC3181830/.

Stanley, et al. “Stressed out and Not Thinking Straight? Blame Dopamine Release in Your Prefrontal Cortex.” Neurotic Physiology, 14 Sept. 2017, http://scicurious.scientopia.org/2012/12/05/stressed-out-and-not-thinking-straight-blame-the-dopamine-in-your-prefrontal-cortex/.

“Stress Symptoms.” WebMD, WebMD, www.webmd.com/balance/stress-management/stress-symptoms-effects_of-stress-on-the-body#1.

Sylvia, K. E., & Demas, G. E. (2018). A gut feeling: microbiome-brain-immune interactions modulate social and affective behaviors. Hormones and behavior, 99, 41-49.

Tattersall RB. Hypoadrenia or “a bit of Addison’s disease”. Med Hist.

1999 Oct;43(4):450-67.

Toft, H., Bramness, J. G., Lien, L., Abebe, D. S., Wampold, B. E., Tilden, T., ... & Neupane, S. P. (2018). PTsD patients show increasing cytokine levels during treatment despite reduced psychological distress. Neuropsychiatric disease and treatment, 14, 2367.

Werbner, M., Barsheshet, Y., Werbner, N., Zigdon, M., Averbuch, I., Ziv, O., ... & Koren, O. (2019). Social-Stress-Responsive Microbiota Induces Stimulation of Self-Reactive Effector T Helper Cells. mSystems, 4(4), e00292-18.

Valles-Colomer, Mireia, et al. “The Neuroactive Potential of the Human Gut Microbiota in Quality of Life and Depression.” Nature Microbiology, vol. 4, no. 4, 2019, pp. 623–632., doi:10.1038/s41564-018-0337-x.

Valles-Colomer, M., Falony, G., Darzi, Y. et al. The neuroactive potential of the human gut microbiota in quality of life and depression. Nat Microbiol 4, 623–632 (2019). https://doi.org/10.1038/s41564-018-0337-x

Taylor, Alan. “A Weekend in a Prison Cell to Escape Modern Life.” The Atlantic, Atlantic Media Company, 26 Nov. 2018, www.theatlantic.com/photo/2018/11/weekend-in-a-prison-cell-to-escape-modern-life/576652/.

The link between stress and depression ... and the 10 simple words that could help. (2019, October 13). Retrieved August 01, 2020, from https://www.theguardian.com/society/2019/oct/13/the-link-between-stress-and-depression-and-the-10-simple-words-that-could-help

Treadway, M. T., Cooper, J. A., & Miller, A. H. (2019). Can’t or Won’t? Immunometabolic Constraints on Dopaminergic Drive. Trends in Cognitive Sciences, 23(5), 435-448. doi:10.1016/j.tics.2019.03.003

Weintraub, Karen. “‘Stress Hormone’ Cortisol Linked to Early Toll on Thinking Ability.” Scientific American, 25 Oct. 2018, https://www.scientificamerican.com/article/ldquo-stress-hormone-rdquo-cortisol-linked-to-early-toll-on-thinking-ability/?utm_source=join1440&utm_medium=email&utm_placement=itkst.

Whitaker, R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America. Crown Publishing.

Viena TD, Banks JB, Barbu IM, Schulman AH, Tartar JL. Differential effects of mild chronic stress on cortisol and S-IgA responses to an acute stressor. Biol Psychol. 2012;91(2):307-311. doi:10.1016/j.biopsycho.2012.08.003

Yano, J., Yu, K., Donaldson, G., Shastri, G., Ann, P., Ma, L., . . . Hsiao, E. (2015). Indigenous Bacteria from the Gut Microbiota Regulate Host Serotonin Biosynthesis. Cell, 161(2), 264-276. doi:10.1016/j.cell.2015.02.047

You and Your Hormones, www.yourhormones.info/hormones/adrenaline/.

Zhang, Maochen, et al. “Illness Perceptions and Stress: Mediators between Disease Severity and | PPA.” Journal of Pain Research, Dove Press, 23 Nov. 2016, www.dovepress.com/illness-perceptions-and-stress-mediators-between-disease-severity-and--peer-reviewed-article-PPA.

Supplements Citations

Abdelmalek, Mark Dr., Adhikari, B., Koch, S., Diaz, J., and Weinraub, C. “New Studies Shows U.S. Government Fails to Oversee Treatment of Foster Children With MindAltering Drugs.” November 30, 2011. http://abcnews.go.com/US/study-shows-fosterchildren-high-rates-prescription-psychiatric/story?id=15058380;

Adhikari, Brinda, Martelli, J., and Koch, S. “Doctors Put Foster Care Children at Risk With Mind-Altering Drugs.” December 1, 2011. http://abcnews.go.com/Health/doctors-put-foster-childrenrisk-mind-altering-drugs/story?id=15064560;

Anna, A. (2019, August 17). 10 Benefits of Keeping a Daily Health Journal (Health Diary). Retrieved July 28, 2020, from https://www.healthyhabitsreset.com/10-benefits-of-keeping-a-health-journal/

Are probiotics right for you?. (2019, Fall). Nutrition Health Review, (124), 9.

Chaparro, C. M., & Dewey, K. G. (2010). Use of lipid-based nutrient supplements (LNS) to improve the nutrient adequacy of general food distribution rations for vulnerable sub-groups in emergency settings. Maternal & child nutrition, 6 Suppl 1(Suppl 1), 1–69. https://doi.org/10.1111/j.1740-8709.2009.00224.x

Cortese, M., Riise, T., Bjørnevik, K., Holmøy, T., Kampman, M. T., Magalhaes, S., Pugliatti, M., Wolfson, C., & Myhr, K. M. (2015). Timing of use of cod liver oil, a vitamin D source, and multiple sclerosis risk: The EnvIMS study. Multiple sclerosis (Houndmills, Basingstoke, England), 21(14), 1856–1864. https://doi.org/10.1177/1352458515578770

DeDea, Larissa PharmD, BCPS, PA-C When to take statins; Lovaza versus OTC fish oil supplements, Journal of the American Academy of PAs: May 2011 - Volume 24 - Issue 5 - p 23

DiNicolantonio JJ, O’Keefe JH, Wilson WSubclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisisOpen Heart 2018;5:e000668. doi: 10.1136/openhrt-2017-000668

Doleyres, Y. and Lacroix, C. (2005) Technologies with free and immobilised cells for probiotic bifidobacteria production and protection. Int Dairy J 15, 973–988.

D’Souza, A.L., Rajkumar, C., Cooke, J. and Bulpitt, C.J. (2002) Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ 324, 1361–1366.

Eseceli, H. (2020). Pro-/Anti-Inflammatory Food Supplements: Probiotics and Prebiotics. In Günşen, U., & Atan, R. M. (Eds.), Role of Nutrition in Providing Pro-/Anti-Inflammatory Balance: Emerging Research and Opportunities (pp. 142-168). IGI Global. http://doi:10.4018/978-1-7998-3594-3.ch006

Fast foods make flu shot even less effective. (2019, April 7). Experimental Biology Annual Meeting.

“Foster Kids Prescribed Psychotropic Drugs.” December 2, 2011. http://abcnews.go.com/2020/video/foster-kids-prescribedpsychotropic-drugs-heavy-duty-drug-treatments-neglect-2020-15077792 9 The U.S. and state governments have written national and state reports,

Fuller, R. (1989) Probiotics in man and animals. J Appl Bacteriol 66, 365–378.

Gill, H.S. and Guarner, F. (2004) Probiotics and human health: a clinical perspective. Postgrad Med J 80, 516–526.

Go “fish”. (2019, November). Women’s Health.

Gordon, D. (2019, May/June). 10 Concerns About Supplements. Spirituality and Health.

Gruner, T., & Arthur, R. (2012). The accuracy of the Zinc Taste Test method. Journal of alternative and complementary medicine (New York, N.Y.), 18(6), 541–550. https://doi.org/10.1089/acm.2011.0298

Ito M. K. (2015). A Comparative Overview of Prescription Omega-3 Fatty Acid Products. P & T : a peer-reviewed journal for formulary management, 40(12), 826–857.

Khan, A., Zaman, G., & Anderson, R. A. (2009). Bay leaves improve glucose and lipid profile of people with type 2 diabetes. Journal of clinical biochemistry and nutrition, 44(1), 52–56. https://doi.org/10.3164/jcbn.08-188

Karadima V, Kraniotou C, Bellos G, Tsangaris GT. Drug-micronutrient interactions: Food for thought and thought for action. EPMA J. 2016;7:10.

LaValle JB. Hidden disruptions in metabolic syndrome: drug-induced nutrient depletion as a pathway to accelerated pathophysiology of metabolic syndrome. Altern Ther Health Med. 2006;12(2):26-31.

Levine, H. (n.d.). Can Your Medications Cause Depression? Retrieved July 28, 2020, from https://www.consumerreports.org/drugs/can-medications-cause-depression/

Swardfager, W., Herrmann, N., McIntyre, R. S., Mazereeuw, G., Goldberger, K., Cha, D. S., Schwartz, Y., & Lanctôt, K. L. (2013). Potential roles of zinc in the pathophysiology and treatment of major depressive disorder. Neuroscience and biobehavioral reviews, 37(5), 911–929. https://doi.org/10.1016/j.neubiorev.2013.03.018

Markowitz JS, Donovan JL, DeVane CL, et al. Effect of St John’s wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA. 2003;290:1500-1504.

Maret W, Sandstead HH. Zinc requirements and the risks and benefits of zinc supplementation. J Trace Elem Med Biol 2006;20:3-18.

Maxfield L, Crane JS. Zinc Deficiency. [Updated 2020 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493231/

Mehta, N. M., & Duggan, C. P. (2009). Nutritional deficiencies during critical illness. Pediatric clinics of North America, 56(5), 1143–1160. https://doi.org/10.1016/j.pcl.2009.06.007

Mohn, E. S., Kern, H. J., Saltzman, E., Mitmesser, S. H., & McKay, D. L. (2018). Evidence of Drug-Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics, 10(1), 36. https://doi.org/10.3390/pharmaceutics10010036

Paredes, S. D., Marchena, A. M., Bejarano, I., Espino, J., Barriga, C., Rial, R. V., Reiter, R. J., & Rodríguez, A. B. (2009). Melatonin and tryptophan affect the activity-rest rhythm, core and peripheral temperatures, and interleukin levels in the ringdove: changes with age. The journals of gerontology. Series A, Biological sciences and medical sciences, 64(3), 340–350. https://doi.org/10.1093/gerona/gln054

Prasad AS, Beck FW, Grabowski SM, Kaplan J, Mathog RH. Zinc deficiency: changes in cytokine production and T-cell subpopulations in patients with head and neck cancer and in noncancer subjects. Proc Assoc Am Physicians 1997;109:68-77.

Rashrash, M., Schommer, J. C., & Brown, L. M. (2017). Prevalence and Predictors of Herbal Medicine Use Among Adults in the United States. Journal of patient experience, 4(3), 108–113. https://doi.org/10.1177/2374373517706612

Reducing Chronic Inflammation. (Jan-Feb, 2020). Nutrition Health Review, (126), 15-17.

Richard, D. M., Dawes, M. A., Mathias, C. W., Acheson, A., Hill-Kapturczak, N., & Dougherty, D. M. (2009). L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications. International journal of tryptophan research : IJTR, 2, 45–60. https://doi.org/10.4137/ijtr.s2129

Romani A. M. (2011). Cellular magnesium homeostasis. Archives of biochemistry and biophysics, 512(1), 1–23. https://doi.org/10.1016/j.abb.2011.05.010

Sandstead HH. Understanding zinc: recent observations and interpretations. J Lab Clin Med 1994;124:322-7.

Singh, V., Mohammad, S., & Singh, N. (2012). Herbs and surgery. National journal of maxillofacial surgery, 3(1), 101–106. https://doi.org/10.4103/0975-5950.102180

Temple University. “Novel Protein In St. John’s Wort Found To Suppress HIV-1 Gene Expression.” ScienceDaily. ScienceDaily, 25 October 2005. <www.sciencedaily.com/releases/2005/10/051025074707.htm>.

The Truth About Antibiotics. (2016, December). Family Circle.

Van Zyl M. The effects of drugs on nutrition. S Afr J Clin Nutr. 2011;24(3):S38-S41.

Vitamin D and Magnesium for Managing Depression. (2012, March-April). Nutrition Health Review, (127), 6-8.

Young SN. How to increase serotonin in the human brain without drugs. J Psychiatry Neurosci. 2007;32(6):394-399.

Vagal System Citations

Bargas, J., & Pérez-Ortega, J. (2017). Microcircuits neuroscience to understand pathophysiology. Oncotarget, 8(5), 7226–7227. https://doi.org/10.18632/oncotarget.14792

Bracha H. S. (2004). Freeze, flight, fight, fright, faint: adaptationist perspectives on the acute stress response spectrum. CNS spectrums, 9(9), 679–685. https://doi.org/10.1017/s1092852900001954

Bordoni, B., Morabito, B., Mitrano, R., Simonelli, M., & Toccafondi, A. (2018). The Anatomical Relationships of the Tongue with the Body System. Cureus, 10(12), e3695. https://doi.org/10.7759/cureus.3695

Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Frontiers in psychiatry, 9, 44. https://doi.org/10.3389/fpsyt.2018.00044

Burton, C. M., &amp; King, L. A. (2004). The health benefits of writing about intensely positive experiences. Journal of Research in Personality, 38(2), 150-163. doi:10.1016/s0092-6566(03)00058-8

Csikszentmihalyi, Mark. (2006). Readings in Han Chinese Thought. Indianapolis and Cambridge: Hackett Publishing Company, Inc. ISBN 0-87220-710-2.

Craig A. D. (2002). How do you feel? Interoception: the sense of the physiological condition of the body. Nature reviews. Neuroscience, 3(8), 655–666. https://doi.org/10.1038/nrn894

Critchley, Hugo D., and Neil A. Harrison. “Visceral Influences on Brain and Behavior.” Neuron, vol. 77, no. 4, 2013, pp. 624–638., doi:10.1016/j.neuron.2013.02.008.

Dana, D., & Porges, S. W. (2020). Polyvagal exercises for safety and connection: 50 client-centered practices. New York: W.W. Norton & Company.

Dana, D., & Porges, S. W. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. New York: W.W. Norton & Company

Porges, S. W., & Dana, D. (2018). Clinical applications of the polyvagal theory: The emergence of polyvagal-informed therapies. New York (N.Y.): W.W. Norton & Company.

Darwin C. The Expression of Emotions in Man and Animals. D Appleton; New York, NY: 1872.

Kandel, E. R., Dudai, Y., & Mayford, M. R. (2014). The molecular and systems biology of memory. Cell, 157(1), 163–186. https://doi.org/10.1016/j.cell.2014.03.001

Koopman, F. A., Chavan, S. S., Miljko, S., Grazio, S., Sokolovic, S., Schuurman, P. R., . . . Tak, P. P. (2016). Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proceedings of the National Academy of Sciences, 113(29), 8284-8289. doi:10.1073/pnas.1605635113

Kok, B. E., Coffey, K. A., Cohn, M. A., Catalino, L. I., Vacharkulksemsuk, T., Algoe, S. B., . Fredrickson, B. L. (2013). How Positive Emotions Build Physical Health. Psychological Science, 24(7), 1123-1132. doi:10.1177/0956797612470827

Karen-Anne McVey Neufeld, John Bienenstock, Aadil Bharwani, Kevin Champagne-Jorgensen, YuKang Mao, Christine West, Yunpeng Liu, Michael G. Surette, Wolfgang Kunze & Paul Forsythe. “Oral Selective Serotonin Reuptake Inhibitors Activate Vagus Nerve Dependent Gut-Brain Signalling.” Scientific Reports (First published: October 3, 2019) DOI: 10.1038/s41598-019-50807-8

Laborde, S., Mosley, E., & Thayer, J. F. (2017). Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Frontiers in psychology, 8, 213. https://doi.org/10.3389/fpsyg.2017.00213

Levine, P. A. (2010). In an unspoken voice: How the baby releases trauma and restores goodness. Barkeley, CA: North Atlantic Books.

Levine, P. A., & Frederick, A. (1997). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. Berkeley, CA: North Atlantic Books.

Maehle A. H. (2004). “Receptive substances”: John Newport Langley (1852-1925) and his path to a receptor theory of drug action. Medical history, 48(2), 153–174. https://doi.org/10.1017/s0025727300000090

MikeS, R. (2020, September 03). Oldest Surviving Anatomy Atlas Discovered in Mawangdui Tomb Details Physical Pathways Predating Acupuncture Meridians. Retrieved October 27, 2020, from https://stillmindmartialarts.com/oldest-surviving-anatomy-atlas-discovered-in-mawangdui-tomb-details-physical-pathways-predating-acupuncture-meridians/

Murray, A. R., Atkinson, L., Mahadi, M. K., Deuchars, S. A., &amp; Deuchars, J. (2016). The strange case of the ear and the heart: The auricular vagus nerve and its influence on cardiac control. Autonomic Neuroscience, 199, 48-53. doi:10.1016/j.autneu.2016.06.004

NEWS PROFILE: Candace Pert: `God is a neuropeptide’. (1997, January 02). Retrieved October 27, 2020, from https://religionnews.com/1997/01/01/news-profile-candace-pert-god-is-a-neuropeptide/

Novella, Steven (25 January 2012). “What Is Traditional Chinese Medicine?”. sciencebasedmedicine.org. Society for Science-Based Medicine. Retrieved 13 May 2015.

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: Norton.

Porges S. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic journal of medicine, 76 Suppl 2(Suppl 2), S86–S90. https://doi.org/10.3949/ccjm.76.s2.17

Porges S. W. (2007). The polyvagal perspective. Biological psychology, 74(2), 116–143. https://doi.org/10.1016/j.biopsycho.2006.06.009

Porges S. W. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 42(2), 123–146. https://doi.org/10.1016/s0167-8760(01)00162-3

Price, C. J., & Hooven, C. (2018). Interoceptive Awareness Skills for Emotion Regulation: Theory and Approach of Mindful Awareness in Body-Oriented Therapy (MABT). Frontiers in psychology, 9, 798. https://doi.org/10.3389/fpsyg.2018.00798

Rao, M., Gershon, M. The bowel and beyond: the enteric nervous system in neurological disorders. Nat Rev Gastroenterol Hepatol 13, 517–528 (2016). https://doi.org/10.1038/nrgastro.2016.107

Schmidt, J. E., Carlson, C. R., Usery, A. R., & Quevedo, A. S. (2009). Effects of tongue position on mandibular muscle activity and heart rate function. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics, 108(6), 881–888. https://doi.org/10.1016/j.tripleo.2009.06.029

Squires, S. (1985, August 21). Molecules of Emotion. Retrieved October 27, 2020, from https://www.washingtonpost.com/archive/lifestyle/wellness/1985/08/21/molecules-of-emotion/b9357aaa-a702-425c-a832-0dd3a182b2c3/

Tanida, M., Niijima, A., Shen, J., Nakamura, T., & Nagai, K. (2005). Olfactory stimulation with scent of essential oil of grapefruit affects autonomic neurotransmission and blood pressure. Brain research, 1058(1-2), 44–55. https://doi.org/10.1016/j.brainres.2005.07.048

Trampe D, Quoidbach J, Taquet M (2015) Emotions in Everyday Life. PLoS ONE 10(12): e0145450. https

1 The ACEs assessment is easily found online, and free to use (just not free to republish in a book so I didn’t). The original assessment uses more gendered language (did you witness your dad beat up your mom), so I prefer the state of California ACEs Aware version, which uses more general terminology about parents, guardians, and partners. Additionally, their website has free training you can enroll in, which actually does go into epigenetic changes, how emotional trauma impacts the physical body and the like. It’s the only ACE materials that I have seen discussing that information (besides my own), team science!

2 Since it’s a government graph it’s public domain so I can reproduce it just to yell about it. Woohoo!

3 Women account for 80% of the autoimmune diseases in the US overall. It turns out that there is an inflammation reason for that as well. Individuals with wombs, predominately cis women, have bodies anticipating the existence of a placenta, leading to the pregancy-compensation hypothesis. Pregnancy requires downregulation so the body doesn’t consider the placenta and embryo an invader to be attacked. Therefore when the body is not pregnant, the immune system gets spikey to protect from germs. Since we don’t have near the number of pregnancies than we did in the past (thanks birth control!) the spikey levels stay higher for longer causing more inflammation and autoimmune disruptions.

4 Most humans carry several of these herpesviruses in latent form unless some stressor or biological event allows them to become reactivated.

5 This is easier to find than artery plaque build up and the like. I always suggest to clients to find out how much blood work is covered under their well care if they have a large deductible and get as much as possible. Generally only a basic panel is requested unless your doc is doing diagnostic labs, but get a full panel and differentials if they will prescribe it (and if it doesn’t cost you thousands out of pocket). As a nutritionist, I look for patterns of elevation in lab work, not just numbers being completely out of range, as a clue to inflammatory fuckery taking hold.

6 I mean, all poop stinks. It’s poop. But if it’s that chronic “something crawled up my ass and died” smell then that may mean toxins your body is working to dispel.

7 This is where we really see the complexity of the whole system. Cortisol doesn’t release on its own. The continued threat signals the hypothalamus to release corticotropin-releasing hormone (CRH), which travels to the pituitary gland (there’s the P part of HPA!), triggering the release of adrenocorticotropic hormone (ACTH). Then the ACTH runs to the adrenal glands, prompting them to release cortisol. I refrained from putting this in the main text of the book because ugh it’s a lot of science.

8 As determined by measuring blood flow and electric activity in the brain through SPECT imaging (Single Photon Emission Computed Tomography, if you’re nasty).

9 I have a middle aged body and I resemble this.

10 Look up contraindications for any essential oil you are thinking about using. Some of them shouldn’t be used while pregnant or if you have certain medical conditions. Some shouldn’t be applied directly to the skin. While the palm of the hand isn’t particularly sensitive skin for most people, you can blend any oil with a carrier oil before applying it to your skin, particularly if you haven’t done a patch test on that particular oil or blend yet.

11 Sciency stuff? Essentially, working out once, especially when it’s something that is super bouncy-aroundy makes pain spiky if you have a chronic pain disorder because it increases phosphorylation of NMDA (N-methyl-d-aspartate) receptors in the RVM (rostral ventromedial medulla). But gentler and more regular movement reduces NMDA receptor phosphorylation, meaning it helps teach the body to be less pain activated over time. Then, over further time, it increases serotonin levels and our naturally occurring opioids in the body (including in the RVM which is what was initially causing the increase in pain). Your body eventually learns to use exercise to feel better the way it does for normies.

12 This isn’t by BMI standards because, as we are going to establish in the next chapter, that’s garbage. But the weight your body is healthiest at. If you are under or over that right now, adjusting the weight of your blanket accordingly probably won’t be helpful, and will likely not feel right.

13 I know, I am saying this a batrillion times, but I have had a doctor not give a fuck about my supplement schedule and wouldn’t even document it. Fortunately, I knew because of my training to watch for certain interactions but his lack of interest was dangerous. I changed doctors. My current doctor doesn’t just document what I take, she is super fascinated with it all and takes notes for herself because she wants to learn more about other avenues of treatment. This is totally the kind of doc to look for, if you have any decision making power in the process.

14 According to the modern scale, if a BMI is less than 18.5, it falls within the underweight range, 18.5 to <25, is “normal,” 25.0 to <30 is overweight, 30.0 or higher is obese, and 40.0 or higher is morbidly obese.

15 I hit the underweight mark some years ago when my iron levels crashed out. I was sick, I felt awful and was shaking with cold all the time, but the number of people who told me “OMG you are so tiny! You look amazing! You are so cute!” was freakishly high. When I got treatment and was back at my healthy weight and people commented on that I loved saying “Right? Thank Buddha, I feel so much better now!”

16 This is when corn is soaked and cooked in an alkaline solution (usually limewater), washed, and hulled to make the body better able to absorb the nutrients within it.

17 I fell for this again in the middle of editing this book. My husband bought some salmon that was labeled as “Atlantic Salmon” so I thought it was wild salmon, not farmed. Nope. “Atlantic Salmon” was the name of the company and it was farmed and dyed for color. I could tell it was grody after one bite and looked more carefully at the label. The fuckers.

More by Dr. Faith

Books

The Autism Relationships Handbook (with Joe Biel)

Coping Skills

How to Be Accountable (with Joe Biel)

This Is Your Brain on Depression

Unfuck Your Adulting

Unfuck Your Anger

Unfuck Your Anxiety

Unfuck Your Blow Jobs

Unfuck Your Body

Unfuck Your Boundaries

Unfuck Your Brain

Unfuck Your Cunnilingus

Unfuck Your Friendships

Unfuck Your Intimacy

Unfuck Your Worth

Unfuck Your Writing (with Joe Biel)

Woke Parenting (with Bonnie Scott)

Workbooks

Achieve Your Goals

The Autism Relationships Workbook (with Joe Biel)

How to Be Accountable Workbook (with Joe Biel)

Unfuck Your Anger Workbook

Unfuck Your Anxiety Workbook

Unfuck Your Body Workbook

Unfuck Your Boundaries Workbook

Unfuck Your Intimacy Workbook

Unfuck Your Worth Workbook

Unfuck Your Year

Zines

The Autism Handbook (with Joe Biel)

The Autism Partner Handbook (with Joe Biel)

BDSM FAQ

Dating

Defriending

Detox Your Masculinity (with Aaron Sapp)

Emotional Freedom Technique

Getting Over It

How to Find a Therapist

How to Say No

Indigenous Noms

Relationshipping

The Revolution Won’t Forget the Holidays

Self-Compassion

Sex Tools

Sexing Yourself

STI FAQ (with Aaron Sapp)

Surviving

This Is Your Brain on Addiction

This Is Your Brain on Grief

This Is Your Brain on PTSD

Unfuck Your Consent

Unfuck Your Forgiveness

Unfuck Your Mental Health Paradigm

Unfuck Your Sleep

Unfuck Your Work

Vision Boarding

Woke Parenting #1-6 (with Bonnie Scott)

Other

Boundaries Conversation Deck

How Do You Feel Today? (poster)

More for becoming your best self at www.Microcosm.Pub

SUBSCRIBE!

For as little as $15/month, you can support a small, independent publisher and get every book that we publish—delivered to your doorstep!

www.Microcosm.Pub/BFF

More Dr Faith Harper from www.Microcosm.Pub

Table of Contents

UNFUCK YOUR BODY

INTRODUCTION

Context and Deeper Inquiry

HOW THE BODY AND BRAIN COMMUNICATE

Is the Vagus Nerve a New Idea?

How Does the Vagal System Work?

Recognizing Your Personal Vagal Responses

HOW DO BODIES GET FUCKED UP AND WHAT DOES MENTAL HEALTH HAVE TO DO WITH IT?

Trauma

Inflammation

Toxic Environment

Stress

UNFUCK YOUR BODY

Unfuck Your Vagal System

Unfuck Your Stress

Breathwork

Mindfulness and Meditation

Unfuck Your Movement

Unfuck Your Sleep

Unfuck Your Food

Supplements and Medications

CONCLUSION

FURTHER READING

REFERENCES

FOOTNOTES

MORE BY DR. FAITH!