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Katie: Hello, and welcome to the “Wellness Mama Podcast.” I’m Katie from and That’s wellness with an E on the top. And this podcast is all about actual options for orthopedic and musculoskeletal ache. And I’m right here with Dr. Josh Levitt, who attracts on the science of each typical and pure medication, he’s a naturopathic physician that has a extremely complicated, distinctive strategy to coping with musculoskeletal ache and orthopedic ache. And he talks right this moment about his wide-ranging strategy to this and why it’s rather more than simply addressing the acute ache. And he talks about how he bought began as a naturopathic physician, the sufferers he works with and his strategy to care, the basis causes of ache, the mind-body connection that we will perceive by understanding issues like phantom limb ache, understanding irritation and the way it pertains to ache, and a lot extra. He’s additionally the founding father of, which is a brand new firm. I’ve been utilizing a few of their merchandise and actually having fun with them. And we contact so much on ache on this one, however he has experience in a number of completely different areas. I feel you’ll be taught so much. So, let’s be a part of Dr. Josh. Dr. Josh, welcome. Thanks for being right here.

Josh: It is an actual deal with to be right here. Thank you for having me.

Katie: Well, I’m tremendous excited to delve into your space of experience, however earlier than we get there, I’ve a notice in my present notes that you’re a surfer. And I’m presently in the midst of a tropical storm, which is the one time we have now good waves in our space. So after this podcast, I shall be taking a few of my youngsters to go online in a hurricane. But I’ve a notice that in case you have been gonna give a TED discuss, you’d speak about how browsing imitates life. So, I do know this may very well be a subject of its personal, however are you able to simply give us a pair excessive factors there, to start out off?

Josh: Yeah, completely. Well, keep protected on the market, and, sure, hurricane waves are one of the best waves. I do know it sounds loopy to folks, when everybody else is eager to hunker down, surfers seize their boards and head outdoors. I can completely relate to that. So have enjoyable and keep protected on the market. Yeah, completely. I imply, at some point, I’ll in all probability type of develop a complete discuss round this topic, browsing imitating life. Oh, my gosh, there’s a lot to say, proper? Probably some of the frequent issues that comes up in my scientific follow is about steadiness, and browsing and surfers, I feel, are type of just like the individuals who could be accused of getting actually good steadiness, proper? It’s a balance-intensive train, and so, you understand, we discuss so much about steadiness. And I’m positive, you understand, it’s a topic that comes up, work-life steadiness, marital steadiness, you understand, all these kinds of issues in steadiness and well being and wellness and preserving your self collectively.

And so, you understand, a surfer looks as if particular person to speak to about that, proper? Well, it seems that in browsing, and I suppose it’s additionally true in life, there’s probably not something…there’s no static fastened level of steadiness, proper? Surfing is that this, like, ever motion, ever-fluid exercise that requires fixed form of evaluation of what’s taking place with the wave, together with your board, together with your physique, with the currents, and whatnot, after which readjusting. And so, the concept a surfer is at any level balanced is actually not true. Instead of being good at balancing, what surfers are good at is the efficient administration of imbalance, and I feel that these are two actually various things, proper?

So, when an individual’s browsing on a wave, the wave pitches, and you progress, after which it pitches the opposite approach, and you progress the opposite approach. And I might argue that in life, this concept, there’s a pursuit that lots of people are on the lookout for, “I wanna find balance in my marriage, balance in my parenting, balance in my work, balance in my life.” And I type of wanna inform folks that, like, take it from a surfer. There’s no such factor. There’s no fastened level. It’s not like one thing balancing on one thing. It’s not static. We’re speaking a couple of fluid factor right here that’s life and work and relationships. And so, take it from a surfer, simply discover ways to successfully handle the imbalance, and also you’ll be significantly better off, in order that’s type of like simply one of many bullet factors of my browsing imitates life discuss. And, sure, we may go on and on.

Katie: I like that. I hope you truly try this as a chat at some point. And I agree with you. I’ve written about that too, that, like, steadiness is a shifting goal, and flexibility is rather more vital than discovering that fastened level usually.

Josh: Totally.

Katie: And additionally I wanna ensure that we have now a number of time to delve into your space of experience, as a result of I feel that is one thing that impacts lots of people listening to some extent, and from what I’m seeing, it’s one thing that’s on the rise as effectively. But, to start out broad and type of perceive how you bought right here, I’ve a notice that you just went to UCLA on a pre-med monitor, and then you definately pivoted. So, are you able to stroll us by what brought about that change for you?

Josh: Yeah, completely. And, sure, we’ll spend the vast majority of our time on our content material, as a result of ache, I feel there’s only a few individuals who don’t learn about that, and who’ve an expertise in some type or one other. Yeah. I used to be a type of youngsters who simply at all times wished to be a health care provider. So, it simply made sense. I studied neurophysiology at UCLA, and I had the great fortune to form of, like, grow to be pleasant with, due to parental relationships, with a number of docs at UCLA on the time, a lot of whom, now, we’re speaking 25-plus years in the past, a lot of whom discouraged me from medication, profession in medication that’s. They have been seeing the modifications afoot. Many of them have truly come to move now, regarding insurance coverage firms and massive pharma and all that form of stuff. Life as a health care provider, as they used to understand it, wasn’t pretty much as good, and they also have been saying, you understand, “I don’t know if you wanna do this. You know, it’s gonna just get worse.”

So I took that recommendation and took off, for a yr. This is type of what lots of people name a spot yr. After I completed UCLA, as an alternative of occurring to a graduate medical training, I simply took off for a yr, and this was me hair rising, you understand, hitchhiking and touring all over the world with a backpack, sleeping in youth hostels, sleeping on seashores, all that form of stuff. Anyway, the origin story, if you’ll, was, on this fateful flight, I used to be leaving from Israel, truly, the place I had been, and climbing round, and heading to Europe, Switzerland, in truth, and I had a blister on the again of my foot simply from, you understand, a number of strolling in sandals and never nice hygiene, I’ve to confess, on the time. Anyway, that blister bought contaminated, and I knew sufficient to know that this was one thing severe. As I’m flying on this airplane, my leg is crimson. I’m getting a fever. It’s creeping up my leg. I had cellulitis, which is a really severe medical drawback. And so, I had the great fortune to have the ability to name in my folks again residence. I bought a prescription for antibiotics, known as right into a pharmacy in Zurich, Switzerland, and I hobbled my approach in there in a feverish state, and took antibiotics, which saved my life, or at very least, saved my leg.

And in that pharmacy, I noticed, like you’ll nonetheless see right this moment in lots of European pharmacies and locations all over the world, all these different medicines, proper? In addition to the antibiotics that I so desperately wanted on the time, I additionally noticed homeopathic medicines. I noticed natural teas, all this dietary stuff, nutritional vitamins, minerals, natural extracts and issues. And this was simply…possibly it’s as a result of I used to be type of, like, you understand, in a febrile, hallucinating state or one thing, however this was actually, actually eye-opening to me. It’s like, wow, there’s this entire medication that’s not antibiotics and surgical procedure and all of the stuff that I knew of, and that was the start. Like, right here I’m now. It’s type of humorous to consider it this manner. I’m, like, the naturopathic physician who bought his begin in a pharmacy the place I used to be selecting up a prescription for antibiotics, you understand, which I’m very grateful for, however it opened my eyes to a complete world of drugs that I didn’t know existed, and has since grow to be my ardour, my profession, my life.

Katie: What a cool story. And I’ve an identical factor, like, I undoubtedly have a tendency towards the pure aspect of issues most frequently, however I additionally very firmly imagine there’s a time and a spot for Western medication. And I’ve been very grateful for the few occasions that it’s saved my life as effectively. I feel that’s an vital caveat to recollect on this dialog. So, what sort of sufferers are you seeing now in your workplace whenever you’re working with folks?

Josh: I’m glad that you just phrased it that approach, what sort of sufferers, as a result of I at all times like to consider this. Even in distinction to the mainstream or typical medication that we’re speaking about, sure, we will be glad about issues which have saved our lives, saved our limbs, however there’s additionally so much to be realized from the pitfalls in Western medication. And so, I feel the kind of affected person that I see, that’s type of like a basic query right here. So, for me, to start with, and most significantly, my sufferers are folks first, proper? I’ve by no means seen arthritis come strolling in my workplace, though I’ve seen a number of circumstances of it. I’ve by no means seen most cancers or thyroid illness. It’s at all times been, thus far right this moment, 20-plus years and counting, an individual with arthritis, an individual with coronary heart illness, an individual with most cancers, which I feel is a extremely vital distinction, and sadly usually will get misplaced in Western medication.

We’re gonna speak about orthopedics and musculoskeletal ache, and it’s so frequent. I imply, anyone who’s been in a giant factory-like orthopedic workplace can know the sensation of, like, you’re “the knee in room six,” otherwise you’re the “hip in room seven.” And that’s actually irritating to folks as a result of they really feel like they’re simply their physique half, simply their illness, simply their gland, simply their sickness. And so, yeah, the primary a part of that reply is that they’re people. They’re sufferers. They’re individuals who have issues, in lots of circumstances, in my world, individuals who have ache. So, a number of my follow was dedicated to the care of individuals with musculoskeletal ache, however definitely not completely. And then one other form of philosophical level there may be that if a health care provider like myself treats folks, then I deal with the issues that these folks have, which is, once more, very completely different than Western medical specialties. I stay in Connecticut, proper down the highway from Yale. And at Yale, there’s hyper, hyper-focus on specialization, proper?

So, I’ve had, and I child you not, a affected person who had a really severe thumb drawback who went to see, not only a hand physician, however somebody who focuses on thumbs, which is type of wonderful you probably have a thumb drawback, however it’s fairly straightforward to really feel like that’s, the blinders are on, and all you’re being handled for is that drawback. So, my follow, though I had a reasonably important give attention to orthopedics and musculoskeletal ache, was a follow that was just like the anti-specialty, or is a follow, it’s just like the anti-specialty. Whatever you bought, you’re a human. I understand how to deal with people, let’s go. And if we have to type of transfer on down the road to higher specialization, then that’s high-quality. But largely folks with musculoskeletal ache, and every little thing else, too, is my reply to that one.

Katie: I like that reply as a result of, having been a affected person that I felt like was only a prognosis when it got here to thyroid illness for a very long time, it’s actually superior to listen to a practitioner clarify it from that perspective. And it’s fascinating in terms of ache as effectively, as a result of I really feel like as purposeful and naturopathic medication have gotten extra well-known, persons are trying into extra root trigger approaches now. So, for example, by the top of my journey, I wasn’t only a thyroid affected person anymore. Most of the folks I used to be working with understood the intestine connection, understood how the physique works as a complete. But it looks as if with ache, particularly with joints, there’s nonetheless possibly, such as you mentioned, some blinders there, that whereas we will have a look at the whole-body strategy in different areas, it’s usually a temptation to go, “Oh, you have a knee problem,” and never have a look at the entire remainder of the physique, or not have a look at ache as being the entire remainder of the physique. And I might guess that there’s nonetheless, in fact, going to be whole-body connections there. So, how do you strategy somebody who is available in with a fancy case that possibly additionally has this musculoskeletal ache, or some type of orthopedic problem?

Josh: Yeah. And that’s a terrific query. I imply, you may completely relate. Patients with thyroid problems are form of generally form of simply siloed into endocrinology. And, yeah, ache is a extremely difficult one, so much to say right here. I imply, definitely, if somebody twists their knee and tears their ACL snowboarding, they do, they’ve a knee drawback, proper? That’s fairly clear. But in addition they have ache, this mysterious sensation that we have now. I’d prefer to form of share one thing that everyone can relate to, and I can relate to this, not personally, however professionally, having had sufferers who’ve suffered with this. There’s this drawback that we’ve all heard of in all probability earlier than, it’s intriguing, known as phantom limb ache. This is in an individual who’s an amputee, who doesn’t have a limb. Maybe they misplaced it in an accident or damage or regardless of the case could also be, they usually nonetheless have ache in that limb, or itching or different forms of sensations. Really tough to handle.

But it offers you this very fascinating perspective whenever you simply give it some thought, proper? If an individual doesn’t have a foot, and their foot that they don’t have hurts, it’s fairly clear that the ache just isn’t within the foot, proper? It can’t be, as a result of there is no such thing as a foot, proper? So, right here we have now our skier that we simply talked about, who tore their ACL. Well, they’ve a knee. It’s simply type of broken proper now, they usually have this ache, not in contrast to the ache that the phantom limb affected person has. Is the ache within the knee? Well, it definitely was generated by constructions within the knee, however the ache is perceived within the mind, proper? It’s actually a mind drawback, and, yeah, it has its origins in a trauma within the knee. And then the mind grabs a maintain of those alerts which are coming from a traumatized space, after which tells the particular person a narrative about it, after which there’s all these biochemical issues that occur, like irritation and muscle stress and fibrosis, and we will discuss all about that, in and round an space infiltrated with blood and cells to assist heal. And there’s this entire story, an emotional half.

So, ache, gosh, it’s actually one thing. And so, your query was how do I strategy a fancy affected person with a ache dysfunction? Again, it goes again to that basic philosophical standpoint. It’s an individual, proper? We have to know what tales they’ve round that ache, what it means to them, what they’re afraid of. A whole lot of occasions, there’s worry wrapped up in there. And then we have now to know diet, biomechanics, biochemistry, environmental medication, together with toxicity and all the types of issues that purposeful and naturopathic docs speak about, occult infections, and all the opposite issues that would make one thing that’s traumatized or injured and in any other case painful much more painful. And I feel that’s truly the important thing to debate right here is there’s so many individuals who’ve exaggerated reactions, be it irritation, or ache itself, past what their damage or trauma deserves, proper? And I feel there’s a lot room for serving to and therapeutic folks in that area, in that delta.

Katie: Yeah. So, let’s go deeper on that, as a result of having had just a few joint accidents all through my life, it looks as if the mainstream mannequin of care is simply ache aid and let it get higher, except a affected person wants surgical procedure. But it appears like from what you’re saying, there’s a number of issues that may very well be achieved in a different way and on completely different ranges that will actually change outcomes. So, let’s go deeper on that, and the way that may very well be achieved in a different way.

Josh: Yeah, completely. And you’re proper. I imply, ache is taken into account now a significant signal, and, you understand, that was type of an concept that wound up type of being a giant drawback, as a result of it initiated or was a part of the initiation of the opioid disaster that we have now now, treating ache, managing ache, staying forward of ache, all that form of stuff. When the truth is the ache is a sign, proper? Pain is a sensation that we expertise, that our physique is telling us to vary our conduct. The most type of primitive instance I can consider of that’s, like, in case your hand begins feeling actually, actually scorching as a result of it’s near a fireplace, the ache tells you that there’s one thing that should change, and that one thing is that it’s good to transfer your hand away from the fireplace, proper? That’s nice. And that works very well. If you could have a thorn in your foot, you’ll limp to not press extra on that thorn, these kinds of issues. It’s a really primitive type of response. And but, like, there’s all these tales that get wrapped up in it, and likewise, it will get enhanced or elevated by all of those underlying baseline components like diet and whatnot.

So, the brief story of how…the genesis of any type of ache syndrome, I like to think about, like, you get up in the midst of the evening to go use the toilet or one thing and smash your toe in opposition to the aspect of the top desk there, toe will get crushed, proper? Some tissue will get broken within the space. Hopefully, you didn’t break a bone, however, you understand, there’s harm to the world. And it hurts. And then a complete bunch of issues begins to occur. Blood vessels opened up. Some tissue was broken. That tissue that was broken launched some chemical mediators from contained in the cells into the native bloodstream, after which the native bloodstream type of bought sense…has sensors for these type of chemical compounds which are telling you that you just’ve been traumatized ultimately. And that kicks off this superior, extraordinarily complicated cascade of interactions involving cytokines and leukotrienes, prostaglandins, and issues which are all these chemical alerts that inform your immune system, basically, your white blood cells and all these cleanup cells, to say, “Hey, there’s something going on in that toe. Get on down there and start to clean up the mess.”

So, that’s what occurs. The white blood cells infiltrate the world, and the cleanup crew begins. The level right here is that this inflammatory response, and we’ll get into irritation possibly even in additional element as we go alongside, is a vital a part of a therapeutic response. You have a, I consider a matrix of occasions that occurs, tissue damage, after which some ache, after which irritation, after which muscular stress across the space, some quantity of guarding, after which the therapeutic response. And irritation, which is a serious, main a part of the ache generator type of cascade, is a serious goal, the place we see extreme response based mostly on the extent of the damage, proper? So, many individuals who don’t eat effectively, who’re uncovered to environmental toxins, and many others., will smash that very same toe in opposition to the top desk and see a higher inflammatory response. And so, the extent of ache, the extent of irritation in response to an damage is immediately correlated with the underlying biochemical well being of the person. So, that’s how I take into consideration these musculoskeletal pains, whether or not they come from trauma, acute damage like a ski accident, or from an autoimmune illness or a degenerative course of like arthritis, it’s all the identical.

Katie: That is smart. So, somebody with already the next diploma of irritation within the physique would have a heightened response to that acute irritation.

Josh: Absolutely. It doesn’t matter if it’s a mosquito chunk or if it’s an ACL tear in a snowboarding damage. An individual who’s more healthy will reply in a more healthy approach, with diminished ranges of irritation, a speedier therapeutic time, and many others. And that applies regardless of the trauma, whether or not it’s a degenerative arthropathy, whether or not it’s an autoimmune illness, or whether or not it’s an acute damage like a trauma.

Katie: And you additionally mentioned, like, that inflammatory response I might guess truly serves a vital objective within the physique, in an acute sense, as a result of it’s releasing all of these signaling mechanisms, identical to there’s an inflammatory response post-exercise, that results in muscle progress. So that is…normally, irritation isn’t categorically a foul factor, however you’re speaking about when we have now this systemically power irritation that then makes all of those responses worse?

Josh: Absolutely. It’s both systemically power or extreme in response to trauma or an infection or damage. And the way in which I like to consider it…and, sure, you’re proper. The inflammatory response is a basic a part of form of human immunological reactions. If we didn’t have it, it might be lights out. It’s completely vital. And I feel, you understand, that is actually fascinating. Perhaps you understand this, or possibly not, that irritation, it has a Latin root phrase, like so many medical phrases. Inflammo means to set ablaze. It means fireplace. Inflammation is known as after fireplace. And very very similar to fireplace, I imply, it’s a really aptly named course of. Fire is… Well, right here we’re, you understand, at a time when the world is burning up, particularly in California, you understand, these wildfires are so harmful. Fire is a large human development and basic to our survival, proper? We use it to cook dinner. We use it to remain heat. Harnessing fireplace was one of many best achievements of humankind.

But fireplace can also be extraordinarily harmful, maybe some of the harmful forces on the planet, and so irritation may be very a lot the identical. Like, we love a candlelit dinner, but when the candle catches the curtains on fireplace, we have now a giant drawback, proper? So, irritation is known as after fireplace, and correctly so. It’s vital. It’s basic. It’s truly important to our survival, however an excessive amount of is a foul deal. And an excessive amount of may be, like, a low-lying power burn taking place on a regular basis, such as you talked about, a power inflammatory state, or it may be that the comb is so dry, there’s simply a lot tinder on the market, that when one thing occurs, a trauma, an damage, a mosquito chunk, it flames up like that. And so, yeah, irritation is nice, however an excessive amount of just isn’t good.

Katie: And then it looks as if a number of the primary line of strategy to, like an damage particularly, or to ache, is a few kind of anti-inflammatory ache treatment. But I might guess since this isn’t addressing the basis explanation for the opposite irritation, and there are unwanted side effects to a number of these medicine, that may, in the long run, have a detrimental impact, I might guess?

Josh: Absolutely. I imply, yeah, the thought of suppressing irritation, you understand, type of an excellent achievement by way of medication, but additionally not with out danger, proper? This is a basic organic course of. I imply, you and I can each relate to this. If you could have any organic course of that’s form of been…that’s a part of type of our system and who we’re, and also you simply willy-nilly suppress that system, there’s gonna be penalties to that, proper? You can’t simply get away with that eternally. And, sure, in fact, regardless of which approach you determine to suppress irritation, whether or not it’s from prednisone or steroids like that, or from the extra frequent lessons of over-the-counter medicines, non-steroidal anti-inflammatory medicine, NSAIDs we name them, yeah, there’s gonna be a value to pay for that. So NSAIDs are, you understand, loaded with a complete host of unwanted side effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective unwanted side effects.

So, the way in which that naturopathic docs like to consider that is to assist the inflammatory course of, proper, quite than suppress it. And, I feel, that’s a extremely large distinction between the way in which I follow medication and type of purposeful integrative docs’ practices, assist versus suppress. Of course, there’s a time for suppression. When an individual’s life is in danger or limbs are in danger, you understand, suppression may be vital. But if we take into consideration this as a hierarchical type of strategy, if there are methods to assist a degenerative type of joint ache kind of syndrome, quite than simply suppress, suppress, suppress irritation, the sufferers will nearly at all times be higher off in the long term.

Katie: That is smart. And if ache is a messenger that’s telling us one thing in our mind, versus simply an acute response in a spot within the physique, it is smart that simply suppressing that with out determining the basis of it may very well be very counterproductive in the long run. And in my notes, you speak about a ache matrix, and type of an alternate strategy to dealing with this, which I’m beginning to type of have the ability to pull some items based mostly on what you’ve mentioned, however can we go into element on this, particularly for anybody who has, like, a power ache like this that they’re attempting to work by?

Josh: Yeah, completely. And I feel that is form of basic to the strategy. It’s one thing that developed for me over time, type of like a circulate chart or a course of, or perhaps a sample recognition, for me, within the workplace watching individuals who endure, a lot of them…and simply as a broad class, we’ll name it arthritis, proper? They have joints that harm. It could be their neck or their shoulders or their again or their elbows, wrists, you understand, hips, knees, wherever the case could also be. They get lumped into this class known as arthritis, and after we look fastidiously at these folks, there’s a form of a sample that emerges over years of caring for them on this form of naturopathic type of approach. First is, there’s one thing fallacious, proper? There’s one thing fallacious with the joint. It could be that the cartilage is thinned out. It could be that there’s bone spurring within the space. It could be {that a} disc within the cervical or lumbar backbone is thinner than it’s purported to be or is bulging out in a single place or one other.

So there’s some structural integrity. In most circumstances of people that have these sorts of issues, there’s one thing that’s structurally compromised. Very usually, and I’d like to get into this extra later, that structural compromise is seen on X-ray or on MRI, and may be very usually the one factor that the docs will inform the affected person is fallacious, proper? “Oh, we see this structural compromise. We see this bone spur. We see this disc thing. We see this joint space narrowing. There’s your problem,” proper? So, I’m right here to inform you that that isn’t at all times true. In truth, fairly often, it isn’t true. Structural drawback is simply part of the story, as a result of, from that structural drawback is that this entire matrix, this cascade of occasions that happens. The first, and one we began to simply scratch the floor on slightly bit, is when there may be structural issues, what does the physique do? Inflammatory response. Just like we described earlier than, this inflow of white blood cells, and there’s an inflammatory response. A wholesome inflammatory response, it’ll be graded based on the extent of structural trauma or structural integrity issues. But if an individual has these underlying components, the inflammatory response could be extreme. So that’s the primary a part of the ache matrix after the structural drawback.

Structural drawback results in an inflammatory response, which may very well be wholesome and well-controlled, or it may very well be uncontrolled like a wildfire. And then from there, that irritation is a set off for ache. It’s, you understand, type of an excellent system. You have a traumatized or structurally compromised space, you could have some irritation, you get a sign that it hurts. So you begin limping, otherwise you begin doing different type of conduct change…postural modifications, fairly often involving muscle stress. So, within the muscle tissues adjoining to the disc, or within the muscle tissues adjoining to the shoulder the place the rotator cuff is torn, or the knee or the hip or wherever the case could also be, it’s extraordinarily frequent for folks to have extreme quantities of muscular stress within the space the place there’s a structural drawback and a few irritation. We name this splinting or guarding. We’ve all skilled it earlier than. When one thing hurts, you type of maintain on to it. Like, you don’t wanna transfer it extra, and it’s a really smart physique response, proper? And when one thing’s torn or broken, you maintain on to it tighter.

Well, identical to irritation, there are circumstances that can lead folks to carry tighter and maintain longer than they need to with that muscular stress, and if that muscular stress persists, you wind up having muscular stress as a brand new ache generator, proper? So, right here we have now a structurally compromised disc, some irritation within the space of the disc, now muscle stress within the muscle tissues throughout that disc, and now issues are actually beginning to harm, proper? And then, this persists, and right here we go, the final section of the matrix, is when this persists lengthy sufficient, the muscle stress cuts off blood provide, and as that blood provide is reduce off, the tissue turns into, oh, gosh, extra gristly, like, much less tender. You know, in case you consider a chunk of meat, in case you eat meat, you understand, there’s tender, and we type of normally like that. And then there’s, like, robust, and we don’t like that an excessive amount of, not less than most individuals don’t.

And in case your muscle tissues are contracted and below stress, since you’re guarding them and holding for such a very long time, they’ll grow to be robust, and that toughness is the results of the buildup of fibrin, like a scar tissue within the space, that makes the musculature much less tender, much less juicy, if you’ll. And so, that, that I simply described, from structural compromise to irritation to muscle stress to fibrosis, that package deal is what hurts. And fairly often, whenever you deal with all of these different accent issues, particularly the irritation, muscle stress, and fibrosis, the structural drawback, it doesn’t matter a lot anymore. It’s not as huge of a deal.

Katie: That is smart. And you may appropriate me if I’m fallacious on this, however I’ve heard that the structural factor doesn’t at all times essentially line up with the ache response in somebody who’s in any other case wholesome as effectively. Like, for example, I’ve heard of circumstances, folks having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor problem and be experiencing an incredible quantity of ache.

Josh: You’re 100% proper. It’s simply wonderful to me, Katie, that extra docs don’t perceive this, or don’t even ask themselves that quite simple query that you just simply raised. Take a working example. Here’s an individual. I simply had a case like this final week. He has again ache. You know, it didn’t go away. He went to a health care provider. He bought an MRI. And the MRI confirmed that he had a bulging disc, disc herniation in between L5 and S1 in his case. And then, he did some stuff. He did some PT. You know, possibly he took some treatment, no matter it was. It’s irrelevant. He did some stuff for just a few weeks, and he bought higher. So now his again doesn’t harm anymore. So, if…we’ll do a theoretical right here…we have been to shoot the MRI once more, he nonetheless has a disc herniation. So, you understand, he simply doesn’t have the ache anymore. And that is extraordinarily frequent. So, this has been effectively studied. Your level is well-taken, and also you’re completely spot-on on this one.

The presence of imaging abnormalities, like arthritic modifications, joint area narrowing, disc bulges, degenerative modifications of any type, don’t correlate with a degree of ache. There’s plenty of folks on the market who’ve every kind of badness and yucky-looking stuff on MRIs, they usually really feel high-quality. And there’s every kind of people that have horrible ache whose MRIs and X-rays look regular. So we can not correlate imaging findings, X-ray, MRI, CT scan, to a scientific syndrome. It simply doesn’t work, and the rationale why is the ache matrix that I simply described. It’s not at all times…I don’t wanna say that the structural factor is irrelevant, as a result of it’s there. It’s an actual factor. There’s not purported to be a disc herniation. But, if there’s extreme irritation, muscle stress, fibrosis in and round that space, that’s the distinction between that disc herniation hurting and never hurting. And that’s essentially the most progressive ache management type of protocol on the market proper now, is to disregard the imaging findings. They don’t matter as a lot as most individuals assume they do.

Katie: So, with that extra complete understanding of ache, what’s your strategy to treating that in a type of a whole-person strategy, versus simply that acute trauma of the ache?

Josh: Yeah. So, and I feel speaking in regards to the power stuff is extra related. And I’ll begin truly by going again to one thing that we mentioned earlier than, which was in regards to the expertise of the ache itself and the tales that we inform ourselves. You know, we have been simply speaking about how poorly imaging findings, X-rays and MRIs, correlate with ache, proper? But there are tons and much of people that get advised by their radiologist or their orthopedist, and even proven these pictures, proper? They say, “Hey, look here. You can see. See how it’s bulging out right there. That’s a problem. See how this is asymmetrical, and there’s a narrowing over here.” And sufferers fairly often have this picture. They’re not radiologists, they don’t know what they’re taking a look at, however they’ve a picture seared into their mind by a health care provider, you understand, an authority determine, telling them that they’re damaged. That’s what that story actually is telling them.

In truth, the affected person I simply advised you about was proven an image of an MRI with a bulging disc, and in his thoughts, he’s listening to this story from a radiologist, “Oh, your disc is bulging.” What he’s listening to and internalizing is that, “I’m broken, that my back is degenerated, that I’m a mess,” proper? “I’m falling apart.” And that could be a very unlucky casualty of that dialog. So, one of many first issues that I begin with is by telling folks, “Look, you’re not broken. There’s lots of people who have disc herniations like that, and they feel perfectly fine. In fact, you’re gonna feel perfectly fine in just a couple weeks, and you’re still gonna have that disc herniation. So, you’re not broken. You’re just hurting. So let’s start there,” proper? And that comes, you understand, as a terrific aid to lots of people who actually really feel now that they’re damaged, so that they need to be cautious, they’ll’t run anymore, they’ll’t bike anymore, they’ll’t elevate up their youngsters or one thing like that, for worry that their damaged again is gonna actually grow to be, you understand, an even bigger drawback. I feel Western medication, mainstream medication does an enormous disservice to sufferers type of by accident, by telling them or implying that they’re broken, and it’s unlucky that that occurs. So, we begin there, attempt to, you understand, reverse that story, to vary the channel, so to talk.

And then, there’s this entire world of choices that grow to be accessible to folks, relying on the uniquenesses and the specifics of their very own case, that may, one, assist the well being of the broken connective tissues. So, these are issues that you understand about, Katie. These are issues that, like, are collagen, you understand, a number of these connective tissues like cartilage have collagen at their base, and are fashioned of compounds that you just’ve heard of earlier than, like glucosamine sulfate and chondroitin sulfate and methylsulfonylmethane, all these sulfur-containing amino acids which are a part of the matrix, the fairly literal matrix of what we’re constructed out of. So, we use issues within the pure medication world or within the dietary world to assist enhance the integrity of connective tissue, as a result of nearly at all times, whether or not it’s a disc or a bone or a muscle or a ligament or a tendon with connective tissue integrity issues, we attempt to assist that integrity. So that’s primary.

Number two is we attempt to assist that inflammatory course of, lower the quantity of extreme irritation, with out suppressing irritation, however simply supporting it. So which means dietary modifications. We can get deeper on that if we…you understand, there’s a lot. It’s mainly every little thing, actually, diet and life-style, that’s the distinction between a wholesome inflammatory response and an extreme one. So we go down that highway with diet and dietary modifications, and natural medicines as applicable. And then if there may be muscle stress concerned, I prefer to work on that as effectively. And that may be labored on additionally nutritionally and biomechanically, postural re-education, bodily remedy, energy, stretching, strengthening, set off level launch work, all these handbook issues that may be achieved, a lot of them with my very own fingers. And then relying on the chronicity, like how lengthy the issue has been occurring, and whether or not or not there’s proof of this scarification, you understand, particularly in outdated accidents, we attempt to do what we will to interrupt up that fibrosis that’s type of the scar tissue, that toughness in a muscle or mushy tissues round an affected joint. And that’s the package deal.

Katie: And, yeah, it looks as if a way more complete strategy that will have optimistic ripples. I imply, the thought of irritation and out-of-control irritation being a root of many issues has come up on this podcast fairly a bit. It makes full sense that it might have a tie-over into ache, and the plus aspect right here being addressing all of these components, even in case you’re simply motivated initially by this acute ache, is gonna have such optimistic spillover into so many different areas of life. Like, I really feel like altering that inflammatory response and getting it in a wholesome vary is gonna assist sleep, it’s gonna assist stress, it’s gonna assist digestion. Like, in fact, we all know the entire physique is linked.

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There’s lots of people on the market, particularly in terms of ache, I’m seeing lots of people utilizing various kinds of biohacking and stepping into a few of these, like, extra obscure, or simply type of fringe concepts that I feel… My take is at all times there’s a time and a spot for lots of these issues, however I at all times like to inform folks, too, I feel 80% of it’s the belongings you’re doing each day, small habits, issues which are free, your sleep, your stress, your meals, your motion. But I do additionally assume there could be a time and a spot for these. But I’m curious your tackle that, as a result of a number of these do appear to line up with musculoskeletal or bodily efficiency. So, do you employ any of these therapies, and if that’s the case, how?

Josh: Yeah. I admire this query, and it’s a terrific one. And it’s nearly controversial slightly bit. I do know that world very effectively, like, the well being and wellness world, you understand, and the attraction to the brand new…you employ the phrase fringe. You know, the “progressive” could be…you understand, we love shiny new objects on this nation, and that’s definitely no completely different on the planet of orthopedics and musculoskeletal ache. We additionally need to keep in mind that ache is a big motivator. Like, folks hate ache. They don’t wanna be in ache, they usually’ll do something. They’ll spend some huge cash, they’ll do every kind of loopy stuff to attempt to get out of ache. I feel it’s true that…you employ the phrase “biohacker,” which is type of an entire neighborhood, a complete universe, actually, progressive medical stuff, may be very seductive, as a result of it makes these wild guarantees about this new science of injecting this or that.

And I fully agree with you. I imply, I consider…and I’m gonna use slightly allegory right here for a minute. If there’s a fly buzzing round in our kitchen, there’s a number of completely different choices that we have now for that. And me, and I think you could be related, I prefer to attempt to, like, open up the window and see if I can get him out. You know, I don’t just like the fly being in there. It’s an issue that I’ve, however I’m gonna attempt to use, like, a peaceable resolution. And it typically works. There’s some dangers to it. It could be slightly more durable. And then, I’d step it as much as, like, the rolled-up newspaper or the fly swatter, after which I’d step it up, though I in all probability wouldn’t, only for the sake of my metaphor right here, to, like, a chemical spray, like Raid or one thing. You may spray that across the kitchen and kill it. And then, if it’s nonetheless not going away, we may pull out, like, a flamethrower, proper?

And the thought right here is that, like, there’s rising ranges of pressure that may very well be used to deal with an issue, on this case, the fly drawback. I just like the least pressure. That’s the way in which I love to do it. And if that doesn’t work, we step it up. And with every rising degree of pressure, there may be rising ranges of toxicity or trauma to the kitchen, proper? Like, you pull out the flamethrower, there’s gonna be a giant mess. You’ll kill the fly actually successfully. And in orthopedics, we have now this on a regular basis, proper? We love surgical procedure. We love injections. We love prolotherapy, PRP, Lipogems, all of latest fancy stuff. And these may be nice, however they’re type of up in that larger class, nearer to a flamethrower. So, if the case permits for it, there’s time, it’s not that extreme, then we begin with the mild stuff, the dietary modifications, the approach to life modifications, posture, biomechanics, therapeutic massage, dietary remedy, natural remedy. That’s the opening the door or the window. And then we go up from there. And, yeah, there could be a time the place we want treatment or an injection of some type, and that is the place that biohacking universe begins up.

We had prolotherapy was one of many early introductions, which was the injection of sugar molecules to assist spur or improve the expansion of cartilage cells. And then that developed, and lots of people now are doing PRP, platelet-rich plasma injections, the place we extract the platelets, which have progress components in there, type of a one-up to the outdated prolotherapy. And then up from there, we have now a bunch of fancy new peptides which are accessible, or the extraction of fats, and injecting that into joints.

And you requested am I into that. Yeah. I’m into all of that. I feel that stuff is wonderful, and it’s superior, particularly if it comes earlier than the following big-ticket intervention, like, for instance, a joint substitute. But in case you’re asking am I into that, like, proper out the gates? Absolutely not. I share your ideas. I wanna work with the open the door for the fly strategy first, dietary, natural, dietary, and type of work my approach up that ladder, up that hierarchy. And so long as therapies are protected, and protected is each protected to the affected person, in fact, and likewise protected to their pocketbook… I feel there’s some huge cash to be made in a number of these fancy interventions, too. So, “safe,” I’d use the time period very broadly. But if it’s cheap intervention, and it’s protected for the particular person, and could be efficient earlier than pulling out the flamethrower, then yeah, let’s go, you understand. So that’s the place I’m at with biohacking and novel progressive therapies.

Katie: Yeah. It looks as if an vital type of development of the depth of therapies there. That was a terrific analogy. And I’ve at all times heard it mentioned that individuals solely change when the ache of staying the identical turns into higher than the ache of adjusting, and on this case, speaking about precise ache, it’s an exquisite trainer, to your level. And so, I might guess for lots of people, you get to see them in an fascinating level the place they’re hitting that threshold of it’s now extra painful to remain the identical, they’re keen to vary, and also you’re in a position to then educate about all the methods through which they’ll try this, that even when they find yourself needing at some point a type of extra superior issues like surgical procedure, hopefully not, however their physique is gonna in all probability be in a significantly better state to deal with surgical procedure, or deal with no matter they want at some point, than if that they had not addressed these issues. Because as you have been speaking about this, I’m imagining, you understand, if somebody’s having…we’ve talked in regards to the inflammatory connection right here and all of the layers of this. If somebody is in that state, going by surgical procedure is one other stress on the physique, is creating extra irritation and tissue harm within the physique, so their restoration from that may be fairly tough in the event that they haven’t addressed these different components.

Josh: Yeah, completely. It was so eloquent the way in which you simply described that, Katie. It’s so true. That’s the place persons are, proper? That’s the precipice that they’re on, “This problem that I have is no longer acceptable to me.” And they’re keen to do one thing about it, proper? And I feel the objective of the doctor, I imply, definitely, it’s not a approach I’ve ever actually thought of my job, however it’s, to form of assess, like, “All right. Like, how problematic is this? What are you willing to do? What changes are you willing to make?” It’s definitely a dialogue that we at all times have, like, how a lot do you want your present food regimen? How a lot do you want your present inactive life-style? Or, in some circumstances, how a lot do you want that operating that you just do, that’s simply messing up your knee? And I’ve had numerous folks that I’ve needed to say, you understand, “I think it might be time to switch to a bicycle.” And it’s brutal. It’s a brutal actuality examine for them to need to assess, like, “Yeah. I’m on a precipice right here. I cannot deal with this hip situation anymore. I have to make a change.”

And, yeah, for some folks, which means I’m able to have a surgeon reduce me open and take my outdated hip out and put a brand new one in. But there’s many…I might say not…I don’t know if I wanna say most. In my follow, I’d say, you understand, a big majority of individuals can enhance their ache state, musculoskeletal ache, fairly dramatically with out resorting to the flamethrowers of the world. And that’s been…gosh, I imply, how rather more gratifying may a profession be, to have the ability to assist folks keep away from these type of costly, scary interventions, and as an alternative use pure therapies? And, yeah, it’s unlucky that we have now to… It is. It’s very exhausting to get folks to vary till there’s some purpose that just about forces them. And, yeah, truly, in a number of methods, makes my job simpler, proper? Here they’re. They’re able to go, you understand. So I simply assist usher them alongside that path.

Katie: And I’m positive it’s refreshing for them to work with somebody who just isn’t attempting to push them into the high-ticket, costly, and considerably drastic choices, but additionally tackle these root causes first. And I additionally assume, if we will shift…since you talked about the mindset a few occasions. I feel if we shift our mindset, we will have excessive gratitude when there’s ache, as a result of it’s an unimaginable trainer, and it will get our consideration, and we will be taught a lesson, and hopefully, we do, in a approach that has optimistic results. Going ahead, I do know for me, I’ll, like, get weak for a second. A number of months in the past, I ended up, by a mixture of unusual and weird components, getting rhabdo. Which just isn’t a factor that will usually have occurred to me, however I had had blood loss after which a sequence of issues that type of compounded, and I bought rhabdo. And the ache of that was sufficient to get my consideration. And undoubtedly, I used to be in a position to tackle some issues by that have and be taught classes about not pushing myself too exhausting in sure areas, which have been vital to be taught.

But I feel if we reframe it, like, any type of ache, even emotional ache, there’s a number of metaphors there, turns into a terrific trainer if we let it. And if we don’t resist it, if we let it train us, after which combine these habits and transfer ahead, and even for somebody who possibly doesn’t have a bulging disc or an ACL tear, and isn’t in acute ache, all of those belongings you’ve talked about, I might guess, additionally enhance our resilience if we’re injured or if we encounter ache, as a result of if we tackle all this stuff beforehand, it might seem to be we will deal with these issues higher in the event that they happen. Is that your expertise as effectively?

Josh: Yeah, completely. I imply, first, to your factor, and we received’t spend any extra time on it apart from me to say I hope it was a speedy and full restoration for you. It looks as if you’re doing simply high-quality. So I hope that’s true. Yeah. The expertise of ache is a good trainer certainly, and I feel that we stay in a world, society, definitely within the healthcare universe, the place we wanna simply suppress it. We need nothing to do with it, proper? We wanna keep forward of it so to talk, medicate it away, and we’re shedding so much after we try this. Now, in fact, the ache is uncomfortable, proper? It’s uncomfortable for a purpose, and when an individual is ready to form of take a pair deep breaths and type of go lean into that ache, that is what a number of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, you understand, about utilizing cognitive conduct remedy and mindfulness as pertains to ache, may be wonderful, highly effective instruments that don’t contain any change, you understand, in diet, however have radical impression on the biochemistry and the entire form of neurochemistry of ache.

And completely, I feel, we have to take it for what it’s price. You know, completely, if it’s disabling or incapacitating, there’s instruments that we have now and we must always be glad about to assist handle that. But, sure, it’s certainly a lesson, a trainer, and there’s at all times, and I might say at all times, I imply, we don’t get to say that too usually in medication, tales that we have now which are borne of our personal experiences, that inform what our expertise is of that ache. And so, if, you understand, your life historical past tells a sure story, and then you definately come up in opposition to some type of ache, you’ll take that ache expertise, and it’ll grow to be a part of your story. And which may make it harm kind of, relying on what your background is and what tales you’re telling your self about it. And so, I feel that as a part of a complete form of naturopathic administration to a ache syndrome, whether or not it’s a power drawback or an acute drawback, is that the evaluation of that story, and attempting to assist folks discover methods to reframe it in a approach that makes it a optimistic expertise for them finally.

Katie: I like that. And as we get near the top of our time, just a few questions I like to ask, the primary being if there’s a e-book or quite a lot of books which have had a profound impression in your life, and if that’s the case, what they’re and why?

Josh: Yeah. I do know your fashion with this query, and I like this query. And my reply is a e-book known as “Ferdinand the Bull.” And that could be a child’s e-book that I’ve just a few copies of. It was my favourite e-book as a toddler, and it stays my favourite e-book as an grownup. It’s the story of Ferdinand the bull, who bought stung by a bee. Talk about ache. And it was proper at a time when all of the bullfight crew was coming in from Madrid to evaluate the bulls within the pasture, who was the largest, fiercest bull. He will get stung by a bee. He jumps up, he runs round loopy, they usually say, “Oh, we found our bull.” And they convey Ferdinand the bull to go combat within the bullfights in Madrid, and all he ever needs to do is simply sit down in the midst of the ring like he at all times did out within the pasture, and scent the flowers. He’s a peaceable, type bull. He doesn’t wanna combat. And that’s at all times been my favourite e-book, and it stays my favourite e-book to at the present time. It’s nearly, I don’t know, peace, smelling flowers, and non-violence. I simply love “Ferdinand the Bull.” So I admire the query and the reminiscences it evokes.

Katie: I like that. That’s a brand new advice. I’ll put a hyperlink within the present notes for anybody who isn’t acquainted. And the place can folks discover you to continue to learn about your strategy and/or work with you in case you are taking new sufferers?

Josh: Thank you. Yeah. So, my follow, and proper now my follow is…I’m a busy particular person, so my follow is full to new sufferers in the mean time. That can at all times change, relying on all kinds of various skilled and private life issues. My follow is right here in Hamden, Connecticut, and we have now 5 different docs there as effectively. That’s a follow known as Whole Health in Hamden, Connecticut. And the web site for our follow is You’ll see me there. I’m nonetheless there. I simply am at this actual second not accepting new sufferers proper now. I additionally am the medical director of an organization known as UpWellness, which is discovered at,, UpWellness. And the brand of UpWellness is a wave. I advised you originally I’m a surfer, and upwelling… This is an fascinating little aspect notice for you. UpWellness is the identify of our firm, and our tagline is named “Nutrient-Rich Living.”

So, any surfer can relate to this, or anybody who’s swum within the ocean or a big physique of water. There’s this phenomena the place you hit a chilly patch, and a chilly patch is an upwelling, the place there’s this upwelling of chilly, nutrient-dense water from beneath, that replaces the nutrient-depleted water above, the place all of the organic exercise is, from the solar and the fish and whatnot. And so, that higher layer of water will get depleted, after which currents and whatnot will trigger this infusion from beneath of chilly water, and we expertise that as a chilly patch. But it’s additionally a nutrient-rich infusion, so therefore the identify of our firm, UpWellness, “Nutrient-Rich Living,” and is the place folks will discover all of the merchandise that we create that assist folks with musculoskeletal ache and all method of different completely different issues, natural, dietary merchandise that me and my spouse Amanda Levitt, who’s additionally a naturopathic physician, formulated ourselves. So, that’s at

Katie: I like that. I’ll put that hyperlink as effectively. I had a few of your merchandise in my espresso this morning. It was scrumptious.

Josh: Great.

Katie: I’ll ensure that folks can discover these. And any parting recommendation to depart with the viewers right this moment?

Josh: Oh, gosh, you understand, we’re…I feel, type of my tagline that I train to my youngsters that I attempt to, you understand, in all probability train to myself as a lot as anyone, is simply to be type to one another. We are in a extremely difficult time, you understand, and I don’t wanna get into it, all of the division that’s on the market. But I feel that there’s just a few basic guidelines, and kindness might be on the prime of that checklist that would assist a number of us, you understand, get alongside higher and clear up a number of the nice world issues if we simply saved kindness on the entrance of our minds. And past that, there’s one different factor, and I’ll share this with you, too, is that I might encourage folks to search for methods to search out awe, A-W-E, you understand, once more, a surfer phrase. We use the phrase superior, proper, after which surfers possibly co-opted that phrase to explain waves, or maneuvers on waves.

But superior is one thing that, you understand, makes us really feel small, makes us really feel humble, makes us notice that the world is that this greater place that we’re part of. It’s the oneness. And it seems, closing notes right here, that scientists have studied all these completely different optimistic feelings, and it seems that awe is an anti-inflammatory. If you expertise awe, it reduces ranges of IL-6 within the bloodstream greater than different optimistic feelings, together with issues like pleasure and contentment and different optimistic feelings. Awe is essentially the most highly effective optimistic emotion by way of anti-inflammatory results. So, be type, and be superior.

Katie: I like that tidbit. That’s actually nice to learn about awe, and I might guess others like gratitude and pleasure are nonetheless useful. But that’s actually cool that they’ve truly studied that.

Josh: Yeah. They have. They studied that at Berkeley. Yeah. And they’re all useful, for positive, like gratitude, love, pleasure, all clearly useful, however whenever you have a look at IL-6 ranges, that is what they determined to evaluate, awe works one of the best. So go discover one thing superior.

Katie: And that brings us full circle to our start line with browsing, and I undoubtedly realized so much right this moment. I’m grateful for the work that you just do. I do know we didn’t even get to actually delve into your merchandise that a lot, however I’ll put a hyperlink within the present notes. I’m a giant fan, so I’ll put a hyperlink, folks can discover these. Everything we talked about shall be at And Dr. Josh, thanks a lot in your time right this moment.

Josh: It was an actual pleasure, Katie. Thank you.

Katie: And thanks as at all times to you guys for listening and sharing your most beneficial assets, your time, power, and a spotlight with us right this moment. We’re each so grateful that you just did, and I hope that you’ll be a part of me once more on the following episode of the “Wellness Mama Podcast.”

If you’re having fun with these interviews, would you please take two minutes to depart a score or assessment on iTunes for me? Doing this helps extra folks to search out the podcast, which implies much more mothers and households may benefit from the data. I actually admire your time, and thanks as at all times for listening.

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