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Katie: Hi there, 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 very advanced, distinctive strategy to coping with musculoskeletal ache and orthopedic ache. And he talks at the 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 obtained 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 via 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 loads on ache on this one, however he has experience in plenty of completely different areas. I believe you’ll be taught loads. So, let’s be part of Dr. Josh. Dr. Josh, welcome. Thanks for being right here.

Josh: It’s a actual deal with to be right here. Thanks for having me.

Katie: Nicely, 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 at present in the course of a tropical storm, which is the one time we have now good waves in our space. So after this podcast, I can be taking a few of my children to log on in a hurricane. However I’ve a notice that for those who have been gonna give a TED speak, you’ll speak about how browsing imitates life. So, I do know this could possibly be a subject of its personal, however are you able to simply give us a pair excessive factors there, to begin off?

Josh: Yeah, completely. Nicely, keep protected on the market, and, sure, hurricane waves are the most effective waves. I do know it sounds loopy to folks, when everybody else is desirous 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, sooner or later, I’ll most likely sort of develop a complete speak round this topic, browsing imitating life. Oh, my gosh, there’s a lot to say, proper? In all probability one of the frequent issues that comes up in my scientific observe is about steadiness, and browsing and surfers, I believe, are sort of just like the individuals who could be accused of getting actually good steadiness, proper? It’s a balance-intensive train, and so, you recognize, we speak loads about steadiness. And I’m certain, you recognize, it’s a topic that comes up, work-life steadiness, marital steadiness, you recognize, all these kinds of issues in steadiness and well being and wellness and conserving your self collectively.

And so, you recognize, a surfer looks as if a very good particular person to speak to about that, proper? Nicely, 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? Browsing is that this, like, ever motion, ever-fluid exercise that requires fixed kind of evaluation of what’s occurring 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 absolutely not true. As an alternative of being good at balancing, what surfers are good at is the efficient administration of imbalance, and I believe 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’d argue that in life, this concept, there’s a pursuit that lots of people are on the lookout for, “I wanna discover steadiness in my marriage, steadiness in my parenting, steadiness in my work, steadiness in my life.” And I sort of wanna inform those who, 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 a lot better off, in order that’s sort of like simply one of many bullet factors of my browsing imitates life speak. And, sure, we might go on and on.

Katie: I really like that. I hope you truly do this as a chat sooner or later. 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: Completely.

Katie: And in addition I wanna be sure that we have now plenty of time to delve into your space of experience, as a result of I believe 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 nicely. However, to begin broad and sort of perceive how you bought right here, I’ve a notice that you simply went to UCLA on a pre-med observe, and then you definitely pivoted. So, are you able to stroll us via what triggered 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 believe there’s only a few individuals who don’t find out about that, and who’ve an expertise in some kind or one other. Yeah. I used to be a kind of children 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 nice fortune to kind of, like, grow to be pleasant with, due to parental relationships, with plenty of medical doctors 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. Lots of them have truly come to move now, regarding insurance coverage corporations and large pharma and all that kind of stuff. Life as a health care provider, as they used to comprehend it, wasn’t nearly as good, and they also have been saying, you recognize, “I don’t know for those who wanna do that. You understand, it’s gonna simply worsen.”

So I took that recommendation and took off, for a yr. That is sort of what lots of people name a spot yr. After I completed UCLA, as an alternative of happening to a graduate medical training, I simply took off for a yr, and this was me hair rising, you recognize, hitchhiking and touring all over the world with a backpack, sleeping in youth hostels, sleeping on seashores, all that kind 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 mountain climbing round, and heading to Europe, Switzerland, actually, and I had a blister on the again of my foot simply from, you recognize, plenty of strolling in sandals and never nice hygiene, I’ve to confess, on the time. Anyway, that blister obtained contaminated, and I knew sufficient to know that this was one thing critical. As I’m flying on this airplane, my leg is pink. I’m getting a fever. It’s creeping up my leg. I had cellulitis, which is a really critical medical drawback. And so, I had the nice fortune to have the ability to name in my folks again residence. I obtained a prescription for antibiotics, referred to 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 at the moment in lots of European pharmacies and locations all over the world, all these different medicines, proper? Along with 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 sort of, like, you recognize, in a febrile, hallucinating state or one thing, however this was actually, actually eye-opening to me. It’s like, wow, there’s this complete 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 sort of humorous to consider it this manner. I’m, like, the naturopathic physician who obtained his begin in a pharmacy the place I used to be selecting up a prescription for antibiotics, you recognize, which I’m very grateful for, nevertheless it opened my eyes to a complete world of medication 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 positively have a tendency towards the pure facet 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 nicely. I believe that’s an vital caveat to recollect on this dialog. So, what sort of sufferers are you seeing now in your workplace if you’re working with folks?

Josh: I’m glad that you simply 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 pleased about issues which have saved our lives, saved our limbs, however there’s additionally loads to be realized from the pitfalls in Western medication. And so, I believe the kind of affected person that I see, that’s sort of like a elementary query right here. So, for me, to begin 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 plenty of instances of it. I’ve by no means seen most cancers or thyroid illness. It’s at all times been, up to now at the moment, 20-plus years and counting, an individual with arthritis, an individual with coronary heart illness, an individual with most cancers, which I believe is a very 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 an enormous 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 instances, in my world, individuals who have ache. So, plenty of my observe was dedicated to the care of individuals with musculoskeletal ache, however actually not solely. After which one other kind of philosophical level there’s 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 critical thumb drawback who went to see, not only a hand physician, however somebody who focuses on thumbs, which is sort of wonderful you probably have a thumb drawback, nevertheless 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 observe, though I had a reasonably vital concentrate on orthopedics and musculoskeletal ache, was a observe that was just like the anti-specialty, or is a observe, it’s just like the anti-specialty. No matter you bought, you’re a human. I understand how to deal with people, let’s go. And if we have to sort of transfer on down the road to higher specialization, then that’s superb. However largely folks with musculoskeletal ache, and all the pieces else, too, is my reply to that one.

Katie: I really like that reply as a result of, having been a affected person that I felt like was only a analysis 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 relation to ache as nicely, as a result of I really feel like as practical and naturopathic medication have gotten extra well-known, individuals are wanting into extra root trigger approaches now. So, as an example, by the top of my journey, I wasn’t only a thyroid affected person anymore. The general public I used to be working with understood the intestine connection, understood how the physique works as a complete. However it looks as if with ache, particularly with joints, there’s nonetheless possibly, such as you mentioned, some blinders there, that whereas we will take a look at the whole-body strategy in different areas, it’s usually a temptation to go, “Oh, you’ve a knee drawback,” and never take a look at the entire remainder of the physique, or not take a look at ache as being the entire remainder of the physique. And I’d 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 sort of orthopedic situation?

Josh: Yeah. And that’s a terrific query. I imply, you’ll be able to completely relate. Sufferers with thyroid problems are kind of generally kind of simply siloed into endocrinology. And, yeah, ache is a very tough one, loads to say right here. I imply, actually, if somebody twists their knee and tears their ACL snowboarding, they do, they’ve a knee drawback, proper? That’s fairly clear. However in addition they have ache, this mysterious sensation that we have now. I’d wish to kind 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 most likely earlier than, it’s intriguing, referred to as phantom limb ache. That is in an individual who’s an amputee, who doesn’t have a limb. Perhaps they misplaced it in an accident or harm or regardless of the case could also be, and so they nonetheless have ache in that limb, or itching or different sorts of sensations. Actually tough to handle.

However it offers you this very fascinating perspective if 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 isn’t within the foot, proper? It could actually’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. Nicely, they’ve a knee. It’s simply sort of broken proper now, and so they have this ache, not in contrast to the ache that the phantom limb affected person has. Is the ache within the knee? Nicely, it actually was generated by buildings 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. After which the mind grabs a maintain of those indicators 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 pressure and fibrosis, and we will speak all about that, in and round an space infiltrated with blood and cells to assist heal. And there’s this complete 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? Once more, it goes again to that elementary philosophical standpoint. It’s an individual, proper? We have now to know what tales they’ve round that ache, what it means to them, what they’re afraid of. Loads of occasions, there’s concern wrapped up in there. After which we have now to know diet, biomechanics, biochemistry, environmental medication, together with toxicity and all the kinds of issues that practical and naturopathic medical doctors 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 believe 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 harm or trauma deserves, proper? And I believe there’s a lot room for serving to and therapeutic folks in that house, 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, until a affected person wants surgical procedure. However it appears like from what you’re saying, there’s plenty of issues that could possibly be finished otherwise and on completely different ranges that will actually change outcomes. So, let’s go deeper on that, and the way that could possibly be finished otherwise.

Josh: Yeah, completely. And also you’re proper. I imply, ache is taken into account now a significant signal, and, you recognize, that was sort of an concept that wound up sort of being an enormous 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 kind of stuff. When the truth is the ache is a sign, proper? Ache is a sensation that we expertise, that our physique is telling us to alter our conduct. Essentially the most sort 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 essential transfer your hand away from the hearth, proper? That’s nice. And that works very well. You probably 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 sort of response. And but, like, there’s all these tales that get wrapped up in it, and in addition, it will get enhanced or elevated by all of those underlying baseline elements like diet and whatnot.

So, the brief story of how…the genesis of any sort of ache syndrome, I like to consider, like, you get up in the course of the night time to go use the lavatory or one thing and smash your toe towards the facet 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 recognize, there’s harm to the world. And it hurts. After which 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 sort of obtained sense…has sensors for these sort of chemical substances which are telling you that you simply’ve been traumatized ultimately. And that kicks off this superior, extraordinarily advanced cascade of interactions involving cytokines and leukotrienes, prostaglandins, and issues which are all these chemical indicators that inform your immune system, primarily, your white blood cells and all these cleanup cells, to say, “Hey, there’s one thing happening in that toe. Get on down there and begin to clear up the mess.”

So, that’s what occurs. The white blood cells infiltrate the world, and the cleanup crew begins. The purpose right here is that this inflammatory response, and we’ll get into irritation possibly even in additional element as we go alongside, is a needed a part of a therapeutic response. You’ve got a, I consider a matrix of occasions that occurs, tissue harm, after which some ache, after which irritation, after which muscular pressure 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 sort of cascade, is a serious goal, the place we see extreme response based mostly on the extent of the harm, proper? So, many individuals who don’t eat nicely, who’re uncovered to environmental toxins, and many others., will smash that very same toe towards the top desk and see a higher inflammatory response. And so, the extent of ache, the extent of irritation in response to an harm is straight 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 harm 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: Completely. It doesn’t matter if it’s a mosquito chunk or if it’s an ACL tear in a snowboarding harm. An individual who’s more healthy will reply in a more healthy approach, with lowered ranges of irritation, a speedier therapeutic time, and many others. And that applies irrespective 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 harm like a trauma.

Katie: And also you additionally mentioned, like, that inflammatory response I’d 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, similar to there’s an inflammatory response post-exercise, that results in muscle development. So that is…usually, irritation isn’t categorically a foul factor, however you’re speaking about when we have now this systemically continual irritation that then makes all of those responses worse?

Josh: Completely. It’s both systemically continual or extreme in response to trauma or an infection or harm. And the best way I like to consider it…and, sure, you’re proper. The inflammatory response is a elementary a part of kind of human immunological reactions. If we didn’t have it, it might be lights out. It’s completely needed. And I believe, you recognize, that is actually fascinating. Maybe you recognize 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. Irritation is called after fireplace. And really very like fireplace, I imply, it’s a really aptly named course of. Hearth is… Nicely, right here we’re, you recognize, at a time when the world is burning up, particularly in California, you recognize, these wildfires are so harmful. Hearth is a large human development and elementary 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.

However fireplace can also be extraordinarily harmful, maybe one 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 an enormous drawback, proper? So, irritation is called after fireplace, and correctly so. It’s needed. It’s elementary. It’s truly essential to our survival, however an excessive amount of is a foul deal. And an excessive amount of could be, like, a low-lying continual burn occurring on a regular basis, such as you talked about, a continual 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 harm, a mosquito chunk, it flames up like that. And so, yeah, irritation is nice, however an excessive amount of isn’t good.

Katie: After which it looks as if plenty of the primary line of strategy to, like an harm particularly, or to ache, is a few sort of anti-inflammatory ache treatment. However I’d guess since this isn’t addressing the basis explanation for the opposite irritation, and there are uncomfortable side effects to plenty of these medication, that may, in the long run, have a detrimental impact, I’d guess?

Josh: Completely. I imply, yeah, the thought of suppressing irritation, you recognize, sort of an excellent achievement by way of medication, but in addition not with out threat, proper? This can be a elementary organic course of. I imply, you and I can each relate to this. You probably have any organic course of that’s kind of been…that’s a part of sort 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’ll be able to’t simply get away with that endlessly. And, sure, in fact, irrespective of which approach you determine to suppress irritation, whether or not or not it’s from prednisone or steroids like that, or from the extra frequent courses of over-the-counter drugs, non-steroidal anti-inflammatory medication, NSAIDs we name them, yeah, there’s gonna be a value to pay for that. So NSAIDs are, you recognize, loaded with a complete host of uncomfortable side effects, and steroids are much more highly effective anti-inflammatories which have much more highly effective uncomfortable side effects.

So, the best way that naturopathic medical doctors like to consider that is to help the inflammatory course of, proper, slightly than suppress it. And, I believe, that’s a very enormous distinction between the best way I observe medication and sort of practical integrative medical doctors’ practices, help versus suppress. After all, there’s a time for suppression. When an individual’s life is in danger or limbs are in danger, you recognize, suppression could be needed. But when we take into consideration this as a hierarchical sort of strategy, if there are methods to help a degenerative sort of joint ache sort of syndrome, slightly 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 could possibly be very counterproductive in the long run. And in my notes, you speak about a ache matrix, and sort of another strategy to dealing with this, which I’m beginning to sort of be capable of 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 continual ache like this that they’re making an attempt to work via?

Josh: Yeah, completely. And I believe that is kind of elementary to the strategy. It’s one thing that developed for me over time, sort 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’ve joints that harm. It is perhaps their neck or their shoulders or their again or their elbows, wrists, you recognize, hips, knees, wherever the case could also be. They get lumped into this class referred to as arthritis, and once we look rigorously at these folks, there’s a kind of a sample that emerges over years of caring for them on this kind of naturopathic sort of approach. First is, there’s one thing fallacious, proper? There’s one thing fallacious with the joint. It is perhaps that the cartilage is thinned out. It is perhaps that there’s bone spurring within the space. It is perhaps {that a} disc within the cervical or lumbar backbone is thinner than it’s imagined to be or is bulging out in a single place or one other.

So there’s some structural integrity. Most often of people that have these sorts of issues, there’s one thing that’s structurally compromised. Fairly often, 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 medical doctors will inform the affected person is fallacious, proper? “Oh, we see this structural compromise. We see this bone spur. We see this disc factor. We see this joint house narrowing. There’s your drawback,” proper? So, I’m right here to let you know that that’s not at all times true. In actual fact, 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 complete matrix, this cascade of occasions that happens. The primary, and one we began to simply scratch the floor on a little bit bit, is when there’s structural issues, what does the physique do? Inflammatory response. Identical to 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 when an individual has these underlying elements, the inflammatory response is perhaps extreme. In order that’s the primary a part of the ache matrix after the structural drawback.

Structural drawback results in an inflammatory response, which could possibly be wholesome and well-controlled, or it could possibly be uncontrolled like a wildfire. After which from there, that irritation is a set off for ache. It’s, you recognize, sort of an excellent system. You’ve got a traumatized or structurally compromised space, you’ve some irritation, you get a sign that it hurts. So that you begin limping, otherwise you begin doing different sort of conduct change…postural modifications, fairly often involving muscle pressure. 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 pressure 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 sort of maintain on to it. Like, you don’t wanna transfer it extra, and it’s a really clever physique response, proper? And when one thing’s torn or broken, you maintain on to it tighter.

Nicely, similar to irritation, there are circumstances that may lead folks to carry tighter and maintain longer than they need to with that muscular pressure, and if that muscular pressure persists, you wind up having muscular pressure 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 pressure within the muscle tissues throughout that disc, and now issues are actually beginning to harm, proper? After which, this persists, and right here we go, the final section of the matrix, is when this persists lengthy sufficient, the muscle pressure cuts off blood provide, and as that blood provide is lower off, the tissue turns into, oh, gosh, extra gristly, like, much less tender. You understand, for those who consider a bit of meat, for those who eat meat, you recognize, there’s tender, and we sort of normally like that. After which there’s, like, powerful, 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 underneath pressure, since you’re guarding them and holding for such a very long time, they’ll grow to be powerful, 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 pressure to fibrosis, that bundle is what hurts. And fairly often, if you deal with all of these different accent issues, particularly the irritation, muscle pressure, and fibrosis, the structural drawback, it doesn’t matter a lot anymore. It’s not as large of a deal.

Katie: That is smart. And you may right 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 nicely. Like, as an example, I’ve heard of instances, folks having a bulging disc or ruptured disc and never experiencing any ache. Whereas conversely, they’ve a minor situation and be experiencing an amazing quantity of ache.

Josh: You’re 100% proper. It’s simply wonderful to me, Katie, that extra medical doctors don’t perceive this, or don’t even ask themselves that quite simple query that you simply simply raised. Take a living proof. Right here’s an individual. I simply had a case like this final week. He has again ache. You understand, it didn’t go away. He went to a health care provider. He obtained an MRI. And the MRI confirmed that he had a bulging disc, disc herniation in between L5 and S1 in his case. After which, he did some stuff. He did some PT. You understand, possibly he took some treatment, no matter it was. It’s irrelevant. He did some stuff for just a few weeks, and he obtained 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 recognize, he simply doesn’t have the ache anymore. And that is extraordinarily frequent. So, this has been nicely 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 house narrowing, disc bulges, degenerative modifications of any type, don’t correlate with a stage of ache. There’s a lot of folks on the market who’ve all types of badness and yucky-looking stuff on MRIs, and so they really feel superb. And there’s all types 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 explanation 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 imagined to be a disc herniation. However, if there’s extreme irritation, muscle pressure, fibrosis in and round that space, that’s the distinction between that disc herniation hurting and never hurting. And that’s probably the most progressive ache management sort 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 sort of a whole-person strategy, versus simply that acute trauma of the ache?

Josh: Yeah. So, and I believe speaking concerning the continual stuff is extra related. And I’ll begin truly by going again to one thing that we mentioned earlier than, which was concerning the expertise of the ache itself and the tales that we inform ourselves. You understand, we have been simply speaking about how poorly imaging findings, X-rays and MRIs, correlate with ache, proper? However there are tons and much of people that get instructed by their radiologist or their orthopedist, and even proven these photographs, proper? They are saying, “Hey, look right here. You’ll be able to see. See the way it’s bulging out proper there. That’s an issue. See how that is asymmetrical, and there’s a narrowing over right 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 recognize, an authority determine, telling them that they’re damaged. That’s what that story actually is telling them.

In actual fact, the affected person I simply instructed 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 damaged, that my again is degenerated, that I’m a multitude,” proper? “I’m falling aside.” And that may 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 damaged. There’s tons of people that have disc herniations like that, and so they really feel completely superb. In actual fact, you’re gonna really feel completely superb in only a couple weeks, and also you’re nonetheless gonna have that disc herniation. So, you’re not damaged. You’re simply hurting. So let’s begin there,” proper? And that comes, you recognize, as a terrific aid to lots of people who actually really feel now that they’re damaged, in order that they need to be cautious, they’ll’t run anymore, they’ll’t bike anymore, they’ll’t carry up their children or one thing like that, for concern that their damaged again is gonna actually grow to be, you recognize, an even bigger drawback. I believe Western medication, mainstream medication does an enormous disservice to sufferers sort of unintentionally, by telling them or implying that they’re broken, and it’s unlucky that that occurs. So, we begin there, attempt to, you recognize, reverse that story, to alter the channel, so to talk.

After which, there’s this complete 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, help the well being of the broken connective tissues. So, these are issues that you recognize about, Katie. These are issues that, like, are collagen, you recognize, plenty of these connective tissues like cartilage have collagen at their base, and are fashioned of compounds that you simply’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 help that integrity. In order that’s primary.

Quantity two is we attempt to help that inflammatory course of, lower the quantity of extreme irritation, with out suppressing irritation, however simply supporting it. So which means dietary modifications. We are able to get deeper on that if we…you recognize, there’s a lot. It’s principally all the pieces, 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. After which if there’s muscle pressure concerned, I wish to work on that as nicely. 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 finished, a lot of them with my very own fingers. After which relying on the chronicity, like how lengthy the issue has been happening, and whether or not or not there’s proof of this scarification, you recognize, particularly in outdated accidents, we attempt to do what we will to interrupt up that fibrosis that’s sort of the scar tissue, that toughness in a muscle or delicate tissues round an affected joint. And that’s the bundle.

Katie: And, yeah, it looks as if a way more complete strategy that will have constructive 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 facet right here being addressing all of these elements, even for those who’re simply motivated initially by this acute ache, is gonna have such constructive 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 relation to ache, I’m seeing lots of people utilizing various kinds of biohacking and stepping into a few of these, like, extra obscure, or simply sort of fringe concepts that I believe… 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 believe 80% of it’s the belongings you’re doing every day, small habits, issues which are free, your sleep, your stress, your meals, your motion. However I do additionally assume there is usually a time and a spot for these. However I’m curious your tackle that, as a result of plenty of these do appear to line up with musculoskeletal or bodily efficiency. So, do you employ any of these therapies, and in that case, how?

Josh: Yeah. I admire this query, and it’s a terrific one. And it’s nearly controversial a little bit bit. I do know that world very nicely, like, the well being and wellness world, you recognize, and the attraction to the brand new…you employ the phrase fringe. You understand, the “progressive” is perhaps…you recognize, we love shiny new objects on this nation, and that’s actually no completely different on the planet of orthopedics and musculoskeletal ache. We additionally need to do not forget that ache is a large motivator. Like, folks hate ache. They don’t wanna be in ache, and so they’ll do something. They’ll spend some huge cash, they’ll do all types of loopy stuff to attempt to get out of ache. I believe it’s true that…you employ the phrase “biohacker,” which is type of a complete 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 utterly agree with you. I imply, I consider…and I’m gonna use a little bit allegory right here for a minute. If there’s a fly buzzing round in our kitchen, there’s plenty of completely different choices that we have now for that. And me, and I think you is perhaps comparable, I wish to attempt to, like, open up the window and see if I can get him out. You understand, 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 generally works. There’s some dangers to it. It is perhaps a little bit tougher. After which, 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 most likely wouldn’t, only for the sake of my metaphor right here, to, like, a chemical spray, like Raid or one thing. You possibly can spray that across the kitchen and kill it. After which, if it’s nonetheless not going away, we might pull out, like, a flamethrower, proper?

And the thought right here is that, like, there’s rising ranges of pressure that could possibly be used to deal with an issue, on this case, the fly drawback. I just like the least pressure. That’s the best way I love to do it. And if that doesn’t work, we step it up. And with every rising stage of pressure, there’s rising ranges of toxicity or trauma to the kitchen, proper? Like, you pull out the flamethrower, there’s gonna be an enormous 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 recent fancy stuff. And people could be nice, however they’re sort 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. After which we go up from there. And, yeah, there is perhaps a time the place we’d like 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. After which that developed, and lots of people now are doing PRP, platelet-rich plasma injections, the place we extract the platelets, which have development elements in there, sort of a one-up to the outdated prolotherapy. After which 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 also you requested am I into that. Yeah. I’m into all of that. I believe that stuff is wonderful, and it’s superior, particularly if it comes earlier than the subsequent big-ticket intervention, like, for instance, a joint alternative. However for those who’re asking am I into that, like, proper out the gates? Completely not. I share your ideas. I wanna work with the open the door for the fly strategy first, dietary, natural, dietary, and sort 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 in addition protected to their pocketbook… I believe there’s some huge cash to be made in plenty of these fancy interventions, too. So, “protected,” I’d use the time period very broadly. But when it’s cheap intervention, and it’s protected for the particular person, and is perhaps efficient earlier than pulling out the flamethrower, then yeah, let’s go, you recognize. In order that’s the place I’m at with biohacking and novel progressive therapies.

Katie: Yeah. It looks as if an vital sort 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 instructor, to your level. And so, I’d 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 alter, and also you’re capable of then educate about all the methods by which they’ll do this, that even when they find yourself needing sooner or later a kind of extra superior issues like surgical procedure, hopefully not, however their physique is gonna most likely be in a a lot better state to deal with surgical procedure, or deal with no matter they want sooner or later, than if they’d not addressed these issues. As a result of as you have been speaking about this, I’m imagining, you recognize, if somebody’s having…we’ve talked concerning the inflammatory connection right here and all of the layers of this. If somebody is in that state, going via surgical procedure is one other stress on the physique, is creating extra irritation and tissue harm within the physique, so their restoration from that is also fairly tough in the event that they haven’t addressed these different elements.

Josh: Yeah, completely. It was so eloquent the best way you simply described that, Katie. It’s so true. That’s the place individuals are, proper? That’s the precipice that they’re on, “This drawback that I’ve is now not acceptable to me.” They usually’re keen to do one thing about it, proper? And I believe the purpose of the doctor, I imply, actually, it’s not a approach I’ve ever actually considered my job, however it’s, to kind of assess, like, “All proper. Like, how problematic is that this? What are you keen to do? What modifications are you keen to make?” It’s actually 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 instances, how a lot do you want that working that you simply do, that’s simply messing up your knee? And I’ve had numerous those who I’ve needed to say, you recognize, “I believe it is perhaps time to change to a bicycle.” And it’s brutal. It’s a brutal actuality verify for them to need to assess, like, “Yeah. I’m on a precipice proper right here. I can not cope with this hip scenario anymore. I’ve to make a change.”

And, yeah, for some folks, which means I’m able to have a surgeon lower me open and take my outdated hip out and put a brand new one in. However there’s many…I’d say not…I don’t know if I wanna say most. In my observe, I’d say, you recognize, a major 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 might a profession be, to have the ability to assist folks keep away from these sort of costly, scary interventions, and as an alternative use pure therapies? And, yeah, it’s unlucky that we have now to… It’s. It’s very exhausting to get folks to alter till there’s some purpose that just about forces them. And, yeah, truly, in plenty of methods, makes my job simpler, proper? Right here they’re. They’re able to go, you recognize. So I simply assist usher them alongside that path.

Katie: And I’m certain it’s refreshing for them to work with somebody who isn’t making an attempt to push them into the high-ticket, costly, and considerably drastic choices, but in addition deal with these root causes first. And I additionally assume, if we will shift…since you talked about the mindset a few occasions. I believe if we shift our mindset, we will have excessive gratitude when there’s ache, as a result of it’s an unimaginable instructor, and it will get our consideration, and we will be taught a lesson, and hopefully, we do, in a approach that has constructive results. Going ahead, I do know for me, I’ll, like, get susceptible for a second. Just a few months in the past, I ended up, via a mix of unusual and strange elements, getting rhabdo. Which isn’t a factor that will usually have occurred to me, however I had had blood loss after which a collection of issues that sort of compounded, and I obtained rhabdo. And the ache of that was sufficient to get my consideration. And positively, I used to be capable of deal with some issues via that have and be taught classes about not pushing myself too exhausting in sure areas, which have been vital to be taught.

However I believe if we reframe it, like, any sort of ache, even emotional ache, there’s plenty of metaphors there, turns into a terrific instructor if we let it. And if we don’t resist it, if we let it educate 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’d guess, additionally enhance our resilience if we’re injured or if we encounter ache, as a result of if we deal with all these items beforehand, it might appear to be we will deal with these issues higher in the event that they happen. Is that your expertise as nicely?

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 superb. So I hope that’s true. Yeah. The expertise of ache is a superb instructor certainly, and I believe that we stay in a world, society, actually within the healthcare universe, the place we wanna simply suppress it. We would like nothing to do with it, proper? We wanna keep forward of it so to talk, medicate it away, and we’re dropping loads once we do this. Now, in fact, the ache is uncomfortable, proper? It’s uncomfortable for a purpose, and when an individual is ready to kind of take a pair deep breaths and sort of go lean into that ache, that is what plenty of the mindfulness work spearheaded by Jon Kabat-Zinn and so many others, you recognize, about utilizing cognitive conduct remedy and mindfulness as pertains to ache, could be wonderful, highly effective instruments that don’t contain any change, you recognize, in diet, however have radical impression on the biochemistry and the entire kind of neurochemistry of ache.

And completely, I believe, we have to take it for what it’s value. You understand, completely, if it’s disabling or incapacitating, there’s instruments that we have now and we must always be pleased about to assist handle that. However, sure, it’s certainly a lesson, a instructor, and there’s at all times, and I’d 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 recognize, your life historical past tells a sure story, and then you definitely come up towards some sort 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 believe that as a part of a complete kind of naturopathic administration to a ache syndrome, whether or not it’s a continual drawback or an acute drawback, is that the evaluation of that story, and making an attempt to assist folks discover methods to reframe it in a approach that makes it a constructive expertise for them finally.

Katie: I really 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 numerous books which have had a profound impression in your life, and in that case, what they’re and why?

Josh: Yeah. I do know your model with this query, and I really like this query. And my reply is a e book referred to as “Ferdinand the Bull.” And that may 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 obtained stung by a bee. Discuss 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 most important, fiercest bull. He will get stung by a bee. He jumps up, he runs round loopy, and so they say, “Oh, we discovered our bull.” They usually carry Ferdinand the bull to go battle within the bullfights in Madrid, and all he ever needs to do is simply sit down in the course of the ring like he at all times did out within the pasture, and odor the flowers. He’s a peaceable, type bull. He doesn’t wanna battle. And that’s at all times been my favourite e book, and it stays my favourite e book to this present day. 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 really 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 if you’re taking new sufferers?

Josh: Thanks. Yeah. So, my observe, and proper now my observe is…I’m a busy particular person, so my observe is full to new sufferers in the mean time. That may at all times change, relying on all kinds of various skilled and private life issues. My observe is right here in Hamden, Connecticut, and we have now 5 different medical doctors there as nicely. That’s a observe referred to as Complete Well being in Hamden, Connecticut. And the web site for our observe is You’ll see me there. I’m nonetheless there. I simply am at this precise second not accepting new sufferers proper now. I additionally am the medical director of an organization referred to as UpWellness, which is discovered at,, UpWellness. And the emblem of UpWellness is a wave. I instructed you firstly I’m a surfer, and upwelling… That is an fascinating little facet notice for you. UpWellness is the identify of our firm, and our tagline is named “Nutrient-Wealthy Residing.”

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. However it’s additionally a nutrient-rich infusion, so therefore the identify of our firm, UpWellness, “Nutrient-Wealthy Residing,” 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 really like that. I’ll put that hyperlink as nicely. I had a few of your merchandise in my espresso this morning. It was scrumptious.

Josh: Nice.

Katie: I’ll be sure that folks can discover these. And any parting recommendation to depart with the viewers at the moment?

Josh: Oh, gosh, you recognize, we’re…I believe, sort of my tagline that I educate to my children that I attempt to, you recognize, most likely educate to myself as a lot as anyone, is simply to be type to one another. We’re in a very difficult time, you recognize, and I don’t wanna get into it, all of the division that’s on the market. However I believe that there’s just a few elementary guidelines, and kindness might be on the high of that checklist that would assist plenty of us, you recognize, get alongside higher and resolve among 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’d encourage folks to search for methods to search out awe, A-W-E, you recognize, 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.

However superior is one thing that, you recognize, 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 constructive feelings, and it seems that awe is an anti-inflammatory. In the event you expertise awe, it reduces ranges of IL-6 within the bloodstream greater than different constructive feelings, together with issues like pleasure and contentment and different constructive feelings. Awe is probably the most highly effective constructive emotion by way of anti-inflammatory results. So, be type, and be superior.

Katie: I really like that tidbit. That’s actually nice to find out about awe, and I’d guess others like gratitude and pleasure are nonetheless helpful. However that’s actually cool that they’ve truly studied that.

Josh: Yeah. They’ve. They studied that at Berkeley. Yeah. They usually’re all helpful, for certain, like gratitude, love, pleasure, all clearly helpful, however if you take a look at IL-6 ranges, that is what they determined to evaluate, awe works the most effective. So go discover one thing superior.

Katie: And that brings us full circle to our start line with browsing, and I positively realized loads at the moment. I’m grateful for the work that you simply do. I do know we didn’t even get to essentially delve into your merchandise that a lot, however I’ll put a hyperlink within the present notes. I’m an enormous fan, so I’ll put a hyperlink, folks can discover these. Every part we talked about can be at And Dr. Josh, thanks a lot on your time at the moment.

Josh: It was an actual pleasure, Katie. Thanks.

Katie: And thanks as at all times to you guys for listening and sharing your Most worthy assets, your time, vitality, and a focus with us at the moment. We’re each so grateful that you simply did, and I hope that you’ll be part of me once more on the subsequent episode of the “Wellness Mama Podcast.”

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

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