podcasts

Keesha:
It really does, because my own personal story is I was diagnosed with rheumatoid arthritis when I was 30, and I’m 56 now. And within six months, I was able to reverse it without the methotrexate prescription I was given or the non-steroidal anti-inflammatory drugs or steroids, because one of the things that I started doing was looking for root cause immediately. Instead of just saying, oh, you have to take these drugs and then come back. And this is what the rheumatologist said, “When you get worse, we’ll change your meds.” Not if, and no, when I asked the question, I’m really disciplined, is there anything else I can do? No, diet doesn’t have anything to do with this, and no. And so it was, it’s genetic, your grandfather had it, you just told me that. So of course, and that was it, and that was true, my grandfather did have it and was wheelchair bound and died at the age that I am now with RA. So the idea that ‘this autoimmune issue is going to be something that is incurable, and we just need to manage it with meds, and come back when you’re worse and we’ll look at whatever medication cocktail we can come up with that might manage your symptoms leaves a lot of despair in our patient populations.

 

And so functional medicine comes at this from a completely different place, as it does with everything, and says, well let’s look at why your immune system is going after you. I always say, like a system that’s at war with itself, there’s no winner, right? And so if autoimmune means I am attacking my own self, then there has to be something here that we can unpack that will halt that process. And the way that I think about it is, from a genetic standpoint, for sure, but also the gut health and toxic burden and load, which can include chemicals and it can include viruses and bacterial infections. And it can include all of our environmental pollutants, but also our own toxic load of our thought processes, which leads to what I call this, the four corners of the puzzle is what I kind of think about this as we’re solving each individual person’s puzzle. There’s not a cookbook here. And the fourth corner piece of that puzzle is trauma and past stress. And the thing about this one, I call it the missing piece of the puzzle, is that if we have past childhood trauma, and everyone has had trauma of some kind, and we can take me and I’ll unpack that a little bit and differentiate between capital T trauma and lowercase T trauma. But trauma science tells us it will affect how we express our genetics, affect our gut microbiome, affect that toxic burden, because if our gut microbiome and gut intestinal mucosa lining isn’t healthy, then we’re more likely to hold onto that toxic load and toxic burden, cause we have a bigger burden on the liver, a bit bigger burden on all of our organs of detoxification, so then we get imbalanced. So it’s a matter of taking a look at what can, if we think about, I always tell my patients, it’s a matter of critical mass. There’s not one thing that created an autoimmune disorder. And so with that being said, we have to think about how many things on the scale finally tipped and capsize that boat, and then how many things, if the feather’s the thing, or the straw that breaks the camel’s back, so to speak, we can’t just take the straw off or the feather at that point, we have to actually take a bunch of load off to finally get that to come back into a balance again.

And so I talk about autoimmune disease reversal, not cure, because your genetics are still your genetics, whether you’re expressing them in a way that signals autoimmune disease or not, and your patterns of thought and behavior until they’re changed, you’re going to keep them, so if I were to go back to a lot of the ways that I live my life in terms of my lifestyle choices, then I could get RA back I think within six months pretty easily, it’s in my genetic code, I have that there. And so I think I could trigger that easily. So that’s the thing to remember is functional medicine approaches it from this place of, so what are those antecedents and triggers and mediators, and what are the lifestyle choices, and what was happening six months, a year, five years on the timeline before this diagnosis occurred? Cause none of it is… My patients will always say, all of a sudden I was sick, and that is definitely how I experienced it too. I was running marathons, raising four children, very, very, very active, type A personality, pushed myself to the limit. And just overnight, one morning I woke up, I had 10 pounds of extra puffiness and redness around my joints, and it was like someone had taken the batteries out of the Energizer bunny. I was flattened. And so it did feel like it was all of a sudden, but if you look at my timeline, it was not all of a sudden. We know that from science now that it takes us anywhere from 10 to 30 years to develop a full-blown ICD 10 code autoimmune illness, to move from imbalance to disease. So it’s really interesting, because functional medicine allows us to investigate that 10 to 20 to 30-year period to find those clues.

Kalea:
I think you’ve so beautifully summarized so many of the tools that we use in the functional medicine model. When we think about body systems in particular, you just mentioned several body systems and how they’re all interconnected and working together to kind of direct our health trajectory into the future. And then also what we call the mental, emotional, spiritual considerations that I think really touch on the trauma aspect. And then, of course, those modifiable lifestyle factors, which we know is what’s really going on behind the scenes in those 20, 30 years before an autoimmune disease is diagnosed. So, I mean, that was the perfect description of how the functional medicine model is really set up to treat autoimmune patients comprehensively.

Keesha:
Right. We’re not just tracking a high sensitivity C-reactive protein, right? We’re not looking at a sed rate and saying, okay, is the medication making that come down? Which is how the standard

Western model works. And it’s very frustrating. It’s frustrating for the doctors too, for all the providers who are in that model, which is why there’s standing room only now at functional medicine training, because everybody wants to be able to say, oh, we can see why, and we can go back and we can fix that from underneath it, not from above it.

Kalea:
Exactly. When I’m trying to describe what the functional medicine model means to my patients, I usually tell them it gives me a framework to map out really complex cases, and humans are complex, full of complexities, and so this helps us to organize that a little bit, which I think is really important in autoimmunity when there’s all of these contributing factors.

Keesha:
Right.

Kalea:
I want to zone in on the trauma piece a little bit, because you mentioned the big T trauma, little T trauma. I think this is a really fascinating concept. Will you just give us a brief description of what you mean by that?

Keesha:
Sure. There is a study that’s quite famous now at this point that we talk a lot about from stages, it’s the adverse childhood experiences study, or ACEs study, and it’s the largest one that’s been done of its kind. And a lot of times now when people hear the word trauma, they’re putting in those ACEs. So back between 1995 and 1997, Kaiser Permanente and the Centers for Disease Control conducted this large study and said, before the age of 18, did you experience any of these things? And that included domestic violence that you witnessed with your mom, against your mom, parents that were or caregivers addicted to a substance or mentally ill or absent or neglectful or incarcerated or dead? Physical, psychological, emotional abuse, abandonment, these great big things that we think of as capital T trauma. And the outcomes from that, that they are, they’re still being unpacked, you know? Oh, the higher that score, the higher the numbers of ‘yes, I had that, yes, I had that,’ then the higher your risks for all of the chronic illnesses we see in our society today, including autoimmunity. And also behavioral issues.

The one that I find the most compelling is the higher the ACEs score, the less willing the person is to engage in self-care. And when I say self-care, self-neglect can include not exercising and moving every day according to what your body’s needs are, not eating according to what your body’s needs are, not engaging in a lifestyle regimen that includes supplementation and nutrients consistently. So a lot of people with high ACEs score will say, I’m good and then I self-sabotage. I’m good and then I’m not, right? And they use the word good. So that is where I will come in and take a look at that. And I described, yes, that is the capital T trauma. That’s the stuff that we usually think about when we hear stories. And I have that in my history, that was one of my ACEs is sexual abuse when I was 10. So people will hear that story and say, oh, well, I didn’t have any trauma. But the thing of it is, is we also have this lower-case T trauma, and the way our brains are is, biologically, we’re wired to understand that if we are put outside the firelight circle, in tribal days, the saber-toothed tiger can eat us. And so any experience of rejection or betrayal or not feeling good enough or smart enough or fast enough or beautiful enough, or any of the things, that is also considered traumatic, lowercase T trauma.

There was a study that was done that looked at, and I found this one really interesting, when I was in my doctoral work, I did a study called the healing unresolved trauma (HURT) study. And I found a group that had just given a perceived stress index questionnaire to the participants in the study and then they did brain imaging. And they found that people that said that they were perpetually overwhelmed and stressed had the same exact brain changes as what show up with somebody that has post-traumatic stress disorder. So it doesn’t matter if it’s capital T trauma. If you perceive yourself as a zebra being chased by a lion, then you are also making the same brain architectural changes of shrinkage in the prefrontal cortex, the adult brain and growth, especially in the right side of the amygdala, that’s looking for, am I safe? Am I okay? Am I going to be respected? Am I loved? Am I right? Am I seen? Am I valued? Am I respected? Am I, over and over again, right? On a loop. Am I okay? That is doing the same thing as somebody that has those triggers that are created from a capital T trauma. And so the ACEs study, when all the findings came out and had been, they’re still being published and applied, has been such groundbreaking and important work. But I think there’s a little bit of a hiccup there where now providers are screening for ACEs, but they’re missing the cultural overtone of the tyranny of productivity that our culture has as the whip that makes us all go, right? Achievement, productivity, making sure we’re busy, and people, I mean, when I read that study, I thought, I don’t have a patient that doesn’t identify as overwhelmed all the time or over-scheduled. That just doesn’t happen. And so this was an important piece of really understanding there’s this, everybody has trauma.

Kalea:
I think it’s so helpful how you talk about this, because I’m sure you hear this from patients all the time, of I have patients who come in and they’re overburdened and they’re overworked and they’re overstressed, but there’s almost this theme of my trauma isn’t traumatizing enough. It’s almost like imposter syndrome, but with your trauma. So being able to describe what you just did about, it’s your perception, how you’re interfacing with your world, if that’s traumatic, it is what it is.

Keesha:
When you have to think about it, when you think about it critically, you can leave aside like all the studies and all the science, which I know we don’t like to do at IFM, but just for a second, just to really critically think this through and go back to really basic AMP, then you go, okay, so actually it’s really not about dopamine and serotonin and PEA and GABA and all the neurotransmitters, or it’s not about cortisol, and it’s not about pregnenolone steal, and it’s not about the gut microbiome, that’s again, coming at it from above. It’s about what we perceive, it’s about the mind. It’s about how we are.

We’re talking a lot now in our culture about biases. And I think that’s great. That’s a conversation that’s been long overdue, that we’re being able to witness that, oh, we all have our own biases, but those biases or those perceptions, we can even take the word bias out, the perceptions that we have were how, what those filters are.

I’m a photographer, so if you stick a filter in a camera, it’s going to change. So the filter you stick there is built when you’re a child. It doesn’t matter if it was in the face of capital T trauma or lowercase T trauma, it’s just like, here’s the nurture versus nature discussion again. And it’s nurture and nature. And we know that now. And so whatever it is that we filter, experience our life through, is coloring what then happens, which neurotransmitters get sent to tell the body what to do next and whether or not the adrenals get tagged and saying, oh, we need to run. We’re in danger. And what happens to the brain architecture It’s the mind. And the emphasis on training the mind, in my opinion, this is my bias, over lots and lots of years now, like I said, I’m 56, and I’ve had to learn this myself. It feels like that’s being left behind in the very beginning.

I teach some very basic, like establishing a calm, safe place within that roots us and grounds us so that if your impulse is to be a caretaker or a caregiver, then you do it from a place of groundedness first, so you’re not leaving yourself and self-forgetting and self-neglecting. So you can be a parent, a really good one, that’s caring and compassionate, and you can take care of people in your world, but you’re keeping yourself anchored, and it’s not coming from a place of having to have that feed your self-worth. If it feeds your self-worth and you are doing it because you want it to be worthwhile, and you bring yourself out, and you leave yourself

in order to do that, then you’re going to wind up in one of our offices, very probably with some sort of stress-related illness. And they’re all stress-related when we boil them all down. Because now your biology and your chemistry are fried, right? Your buckets of everything have been tipped over as your body madly scrambles to rob Peter to pay Paul, and now it’s all empty.

And now you’re sitting in my office and I’m saying, it’d be really good if in order to get that cortisol to come down that we’re seeing on this test that goes up at night, if you were to take a bath with some Epsom salts and maybe some lavender oil and give yourself a good massage just before you go to sleep. And somebody that I’m saying that to bursts into tears and says, do you know my schedule? There’s no possible way I could fit that in. And then saying, well, that is why you’re here, is because of that. And then tracing that back to, it’s that constant overwhelm, that perfectionism, that whatever it is in the mind that drives you to eat a pack of Oreos every night before you go to bed or staying up on your computer to work with your Hong Kong clients at 3:00 am and then having five cups of coffee before noon so you can get through. Like, all of those things are motivated by something in your perceptual field about your worth and your job on this planet being more important than whatever it is that you are, the gift on the planet is.

Kalea:
Well, I think we can directly connect this to what you mentioned in the beginning of our episode, is autoimmunity isn’t just getting the diagnosis and doing the treatment. It’s all this stuff, the iceberg beneath. And I think these are the types of things that it’s not common practice to think about, oh, well, how is your trauma and your type A personality, how is that contributing to your disease process? And so it’s so important to have these conversations.

I want to start to build some bridges to our body systems. We’ve talked a little bit about a body systems approach in functional medicine, and you talked about the adverse childhood events. These can be a really significant source of stress into adulthood for many. We’ve been talking about how psychological changes that stem from those stresses might ultimately affect our gut microbiome. So building a bridge to our gut health, our ability to assimilate and utilize our nutrients. What are some implications of trauma in gut-related illness? And is that somewhere that you explore when you have a patient who seems to have a stress-related illness?

Keesha:
Yes. And we know we have three brains, right? You could say, or nervous systems, that we have an enteric nervous system that innervates our entire gut. And then we just talked about, like, before you’re 26 years old, between 24 and 26 years old, this prefrontal cortex finally is online and fully grown and developed. We don’t have that in childhood. So whatever it is that we go through in our early development, in whether it’s capital T trauma or lowercase T trauma, we’re going to make up a meaning that goes with that. That’s what my HURT study kind of tracked, like, how does this all come to pass? And so we have this initial hurt or some experience that’s, you could say naive, it’s new, we’ve never had it before. And then we have some sort of emotion or feeling that will go with it.

So I use mine to track, so you could say sexual abuse. Okay? In fifth grade, vice principal of the elementary school, I’d be sitting in my fifth grade classroom and the intercom would go off, right? The speaker would crackle to life and it could be for us to all stand up and say the pledge of allegiance to the flag, right? And then the secretary to make announcements and very, very, very infrequently, it was to call me to the office. So every time, just like Pavlov’s dog, that thing crackled to life, I went into a complete panic inside, right? So everything that has to do with sympathetic nervous system arousal, where my hands would get cold and clammy, and my heart would be like a panicked rabbit, and I would just be sitting there completely in shock and frozen. And till that thing was quiet, and then I would slowly start to recover.

So a child is going to make up a meaning that makes sense to them in that place. So for me, all of that stuff was going on, right? Nervous system activation, complete and total zebra being chased by a lion. So in that process, cortisol’s racing into my system. We know that that’s really good if there really is something dangerous that you need to get away from. Children usually are not, they’re not autonomous and they’re not powerful, so when we talk about fight, flight, freeze, or faint, it’s usually freeze in a danger kind of zone, right? Because we’re little kids. So in that freeze moment, there’s a lot happening under the surface where in perpetuity, cortisol continuing to release is going to start breaking down that gut wall. And then there’s going to be a lot of acidity with the holding of breath, carbon dioxide probably building up, there’s probably a lot of respiratory acidosis going on in there, as everything went so tight. And that was happening every single day.

So using just me as example A, then you’re going to be able to see that on top of that antibiotic use for strep throat, that was happening all the time. Well, is that a chicken or an egg, right? Our immune system begins to break down with lots of cortisol being released over and over and over again, so then you become more susceptible. So oftentimes in the literature, you’ll see with RA that there’s a bacterial infection correlation, which makes a lot of sense, but then you have to ask, so was there trauma in that person’s background where there was a lot of cortisol being released? And if that’s the case, then it’s not just going to be about the bacterial infection, it’s also going to be about that entire ecosystem of the microbiome, which of course was a hot mess when I came into adulthood. So in adolescence, I wound up having my tonsils out, and then I started having acne, terrible acne. So what happened? Accutane and antibiotics. And so, you can just see on my timeline that this trauma piece had a huge part of the story, but also what it did is it created weaknesses in my system where bacterial and viral illnesses were then treated with antibiotics, which continued to break things down. And with non-steroidal anti-inflammatory drugs and Tylenol to get fevers down, and all of this stuff just keeps rolling, right? And so it creates these systemic imbalances as you’re going. And until finally, like I said, there’s nothing left to borrow from, to create, to keep that homeostasis, and then there’s a giant capsize of your health. And in my case, there’s going to be a weakness in your genetics, so RA was there and then there it is.

Kalea:
And again, I think when I’m listening to all of these moving parts, it keeps coming up for me of, this is why it’s so important that we’re thinking about all of these systems and how they’re working together or we’re going to miss a big part of this if we’re not considering how the trauma is, well just our nervous system activation is potentially changing how our gut bacteria are behaving, which then can make us more susceptible to a whole slew of things.

Keesha:
So if all we do is a SIBO breath test, because someone comes in with bloating and we do a SIBO breath test and we go oh, wow, we have all these methane-producing bacteria in your small intestine, we need to do a protocol for it, which is great. It’s better than doing some other things, than just giving you anti-gas medication or whatever, a proton pump inhibitor. That’s great to get to the actual microbial imbalance, but if you’re not thinking about the terrain that the microbes are living in, and realizing that, oh, that terrain, there’s a reason it looks like a bombed war zone. And we’re a microcosm of the macrocosm of the universe. I love that saying. It comes from Ayurvedic medicine, which is a 10,000-year-old sister science of yoga. And one of the things that they say is we’re not all the same and that autoimmune disease is undigested anger. I love that, because it gets you to start thinking about, oh, the way that we think about it in the scientific Western model is, we’ll say, so we have this vagus nerve that responds to our perceived threat, right? The enteric nervous system, we have to really pay attention to that, and that’s great. But you can get a patient there in two seconds by saying undigested anger, right? It’s like, oh, you haven’t digested this. And what happens if you don’t digest the apple that you ate this morning? What happens then? You can take them through that process, you get constipated. And what happens if they get constipated? Well, if you’re not taking out your kitchen trash, then you’re gonna have a whole bunch of vermin, and so that’s what you’ve got right now, is a bunch of vermin. But the reason that vermin started living there is because you weren’t taking out your trash. So let’s get to that. Why is it that you’re not dumping your trash out every day? And let’s look there too in addition to getting rid of the vermin.

Kalea:
That just really expanded the way that my mind is thinking about our, in functional medicine we talk about the assimilation node or how we’re breaking down and utilizing foods, but you just put a whole new spin on it for me that it’s not just assimilating our foods, it’s assimilating our experiences and our feelings, all of these other things that even I, even wasn’t at the front of my mind. And then also you talked about taking out the trash. And usually we’re thinking about that from a gastrointestinal perspective, but really this is all kinds of things that we’re processing, our history, our everything.

Keesha:
If you, you can see people do this. I’m a huge Lord of the Rings fanatic. I read those books from childhood until now like 15 times. I read them to all my kids, you know? And so a lot of imagery will come up from whatever you spend a lot of time with. And I think about, like, sometimes people that have had a lot of trauma will hold it like Gollum and the ring, it’s precious to them because it gives them a, a sense of, this is why I am the way I am or I have this to blame. It’s like blamestorming instead of brainstorming. And so a lot of the work that I do in my practice is to help them, like, put the ring in Mount Doom and let it melt. Like that, yes, it explains, and then what? And so it’s this opportunity.

I did this Ted Talk just before the pandemic on the hero’s journey of disease and moving up the developmental scale. Susanne Cook-Greuter has this really beautiful adult ego development model of going from black and white thinking, where it has to be this way or this way, and into a more, oh, you could think of it as Erikson’s generativity, but I am generating everything that is my story. And so then I’m more willing and able when I’m in that place to take responsibility at that point, and you’ll see that happen with people that reverse their autoimmunity or are able to cure their cancer. I usually don’t use the word cure for that either, but move through one level of cancer.

And they have a lot that they learned in the process, and it’s usually this kind of stuff, like, oh, I actually, in my HURT study, forgiveness was a huge interventional piece that I used, and it works. But it’s not the forgiveness of the church pulpit where you say, oh, I forgive you. It’s the forgiveness that’s a whole process of saying, so what is the character trait that drove that person to do whatever they did and how do I have that same trait and do it? And it’s not gonna look the same way. Like I always use my vice-principal, my perpetrator, and if I were to say, so what are the character traits that I see in him that drove him to take the actions that he did, abuse a child? Then it’s cruelty, misuse of power, he also called me white trash. I was in an all black school and so bigotry. And so then I can go, okay, so how do I do those three things? I’m not going to sexually abuse children, but all humans have the exact same character traits, we just do them differently.

And so in order to throw the ring away, that I was harmed, and so therefore this is my self-righteous space that I’m going to stay in of victimization, then you start doing that work with, like, okay, so how do I misuse power? And this is fairly amusing if you’re a parent, because I have four children, and I can go, oh yeah, I’m a parent, I’ve misused power a thousand times or more. You know, like okay. Yep. I’ve guilted my kids before. And then how, how have I been cruel? Oh, well again, I’m a parent. I’m sure any of the times that I’ve said, no, you have to do your chores before you can go do X, Y, or Z, they’ve considered me cruel. Okay, there’s that. And then the third one was really difficult for me at first, bigotry, because I’m a Navy brat, lived all over, and I would have never considered myself a bigot. And then I started realizing, I’m really intolerant to people that are intolerant. I’m very intolerant to people that are intolerant. I’m a bigot. And so in that moment, I can now see the humanity. Okay. So I don’t forgive the behavior, but I can go, oh, all humans, we all have these ways that we are perpetrators and victims. And so, okay, and then I can say, I forgive you, and then I can go ask forgiveness, which I did for my children, of the times that I’ve been a perpetrator.

That right there, if you just even consider that, it relaxes your enteric nervous system, it opens up your chest wall, it takes your jaw and softens it. It drops your shoulders and allows you to breathe with your diaphragm. It opens up everything in your head so it’s not so clenched, and you can feel everything relax. Well, what does that then do biochemically? All good things. And so the outcomes were, wow, this is amazing. So this is the stuff that’s free. You don’t have to take a bunch of supplements for that. This is the training the mind part that I was talking about earlier. And because our gut is a microcosm of the larger macrocosm, how we are in our environment and how we perceive, you can feel your gut microbiome doing the same thing, relaxing.

Kalea:
Yeah. Wow. I feel like I just have to acknowledge everything that you just described to do that work and to challenge those belief systems and to go to those potentially dark places to do this healing work. It might not cost anything, but it’s not easy.

Keesha:
It’s not easy.

Kalea:
It’s hard work.

Keesha:
It’s not, and I never said that.

Kalea:
Oh no, absolutely not.

Keesha:
This is the hardest work of an entire life, but this is where wisdom comes from. Wisdom doesn’t come easily. And it doesn’t come from the happy cruising places of our life. It comes from the darker, grittier, right? That’s why we have all these, like, Rumi saying, if you’re irritated by every rub, how will your mirror ever be polished? Or it’s the grain of sand in the oyster that makes the pearl. Like we have all kinds of different societies and cultures in time and space saying that this is the work, like, this is it right here. And so plugging that into our functional medicine model is very important.

Kalea:
Yeah. And I think that it also speaks to our therapeutic partnership, that that’s so much part of our philosophy that we cultivate that safe space, that it’s, like, okay, you can go here and I can help you because we have this rapport that’s very important to me as the clinician. And so I think that really

speaks to just the value of maintaining a therapeutic partnership, because it gives you that freedom to do that hard work.

Keesha:
Absolutely. It’s not a patriarchal, you can’t hand that down from on high to somebody. This is a place where you are in compassionate collaboration with them and curious about their experience. Not what you have that’s the answer to their problem. And that requires a lot of humility, and a willingness to, I always say reversing autoimmunity is learning to develop compassionate curiosity for what your body’s been trying to say to you for perhaps decades, right? And instead of saying, why aren’t you acting this way? Saying, oh, I hear you. You’ve been trying to give me some information here, and really with compassion and curiosity, going into that inquiry. And that’s exactly how we, as clinicians need to be with our clients. Like, I’m never going to say, oh, you’re Gollum and the ring, you need to throw that ring away. That’s just for the sake of this as a visual, it’s no, it’s coming to that with this collaborative curiosity that’s infused with compassion.

Kalea:
I love this term, compassionate curiosity. That’s how I go into patient visits myself, but it’s just occurred to me as we’re speaking that that’s, you also have to hold that compassionate curiosity when you are exploring your own history and your own timeline and have that compassion for your own story.

Keesha:
You can’t do this for another person if you haven’t walked this walk yourself. And there’s a really beautiful Chinese proverb that says, if you really want to know where you’re going, then ask the people that have already been there and are on their way back. So that’s, you have to do your own work. And that, that’s it right there.

Kalea:
Yeah. Beautifully said. And as we get close to the end of our episode, there’s something that I want to touch on that I think is really important. We’ve talked ACEs and how we know that when we start accumulating these adverse events in our childhood, well, maybe that makes us more predisposed to different conditions into adulthood. I always want to frame that, and I think you’ve done this already, of this is not necessarily your destiny, but it’s just something that we want to be aware of. How do you talk to patients about that? I can imagine if I was looking at this list of all these things in my history and then feeling like, well, I’m just bound to be sick now… How do you empower folks to really get to and understand their own story, but then turn the ship around to some extent?

Keesha:
Right, well to the whole extent, that’s what we’re after. We don’t want the car to go over the cliff. We’re turning that baby around, right? And it’s a beautifully phrased question, and it’s the most important question. Like, okay, so, in my book “Solving the Autoimmune Puzzle,” I have the ACEs quiz, and I say at the end, so, okay, you have this number now, and this number, the implications from research are this, and that doesn’t need to be your outcome. If you change your compass needle by just even one degree, it changes where you’re going. And so if you keep doing what you’re doing, because I assume if you’re reading this book, that’s because there’s something going on, then you can assume this is where you’re going to go. But because, so in the HURT model, I show them the model that was created out of my study. There’s this initial hurt, which I told you about, you make up a meaning, you have a belief, and then you have an adaptive behavior response that came from the mind of the child, right? Without the prefrontal cortex fully on board. And that made sense to that child.

So an example of that is, I worked with a man in my area who works for one of the great big software companies. And he had to get up as a software engineer and deliver his findings to great big groups of people, and he would get hyperhidrosis, it would just like sweat out his shirts. And he had a social anxiety, so he’d turn red and he’d sweat, and he just said, I can’t remember any of the figures or the numbers and the formulas when I’m in that space. And he had been to doctor after doctor after doctor, been on beta blockers, Botox in his armpits, the gamut, anti-anxiety meds. And he had heard about me and he said, I don’t know, like, what the route would be.

We started talking and I gave him a series of questions and it got him to this place in middle school where he’d been in the cafeteria and he’d been walking along with this tray and tripped, and those, everything went, right? And so it was, he fell flat on his face, food everywhere. And of course, like the popular kids and the girl that he had a crush on were right there and laughing, the entire cafeteria erupted in laughter. So in that moment, that’s not a capital T trauma, according to an ACE score, right? That’s nothing, that’s just a kid tripping in the cafeteria. But the meaning he made up about that was, I am an idiot and a klutz and I can’t be trusted to be in front of people. And the behavior he used as an adaptation to that was to hide. And so he had never been in a cafeteria to that day, and he was in his 40s. He started eating in the library. He went to an Ivy league school because he got really good grades because of this. And he ate in the library there. And he ate at his desk at his work and he hid. So now he’s being asked for his job to get up in front of people, and here’s this trauma that hasn’t been digested yet. It’s coming out and he’s in his 11-year-old body again.

And so what the HURT model says is you’ll have that whole thing set up and then it bifurcates, and you have over here, if you keep doing what you’ve been doing, I call it the maladaptive memory processing loop, where you have automatic negative thoughts, you ruminate on them, they create the same biological changes, physiological changes, that you had in the initial hurt, and that leads to disease. And in the middle of that circle, it says unwilling to self-confront. You just keep doing it. Over here on the right-hand side, in the center of the circle, it says adaptive memory processing, and it says willingness to self-confront, to engage in that self-inquiry. Like, okay, so every time things go right, I’m present, I must be part of this. So what is it that’s happening here that I’m responsible for. And that can be, like, you have to do some trauma therapy, you need to undo these loops. And it’s working on what those meanings and beliefs were and shifting them and changing them. Forgiveness comes after that. It’s not, you can’t move to forgiveness until you’ve done this other piece. And then that leads to wellness and well-being. And we know that well-being is the term and in our literature these days of how we’re measuring how we’re doing, indexes of well-being. And so it’s the ability and the willingness to self-confront that’s the big thing. Can you engage with curious compassion and looking at self?

Kalea:
Wow, this is, there’s so much to think about in everything that you’re saying, there’s just so much to chew on here, and I’ll do my best to kind of, my takeaway at the end of this is that focusing on healing our trauma and helping our patients to do that really helps us to regain control over our health. And as a clinician, I think taking away that compassionate curiosity piece is so helpful, but just as a human also knowing that there’s all these things that we can uncover, and then we actually have the power to make a shift and to change our trajectory, I think just as a human and a patient myself, that’s what is so important and reassuring to hear from you. So thank you so much for taking this time, and sharing your experience and your knowledge. And I just am so grateful to be able to talk today.

Keesha:
Thank you.

Kalea:
To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit ifm.org.

To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit ifm.org.