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BEEP!

Hi, I'm Miami-Alic. I'm Jonathan Cohen. And welcome to our breakdown. Welcome, in particular, to part two of our conversation with someone who is a specialist in the biology of trauma. We're talking to Dr. Amy Apigen, and we hope that you will check out part one of the episode where we discussed so many aspects of trauma, the cellular mechanisms underlying trauma, the different states of shutdown that our body will engage in when it doesn't feel safe, all about caffeine, alcohol, how your body is fighting to stay alive and what we're doing that's countering that. That was all in part one. And we cover how when we're shut down on a biological level, our body stops producing the energy we need to be excited for life to feel happy, to use our intuition and to be productive. Also shout out to anyone who's interested in microglia, a whole conversation about those supportive neurons in episode one. Episode two, which we are here to talk about right now, goes into how trauma informs depression and anxiety. We're also going to talk about what is the biological mechanism behind intuition? Is there a way to explain a gut feeling? Also, we go deep into autoimmune disorders, why women are disproportionately affected, and Dr. Amy believes that you can absolutely reverse an autoimmune condition, which shocked me and I'm very interested in this. We also talk about emotional patterns of disease, what kind of personalities are more likely to get sick, what kind of different personalities lead to different kinds of sickness? And what is the impact of trauma on parrymenopause and menopausal symptoms? There is so much in this second episode, we cannot wait to share it with you. Make sure to also go over to Substack. Learn about Substack. Go to subsac.com. Myambiolks breakdown has more on this and so many other topics. So please check that out. And without further ado, let's welcome back double board certified physician and preventive and addiction medicine, Dr. Amy Apigen. You've mentioned brain fog. You've mentioned lethargy. You've mentioned sleep problems and you, you kind of, you vaguely mentioned chronic pain But I wonder when you talk about these things and the other ones that you have spoken about, surprising physical symptoms of unresolved trauma, brain fog, lethargy, sleep problems, chronic pain, you also talk about migraines and you talk about irritable bowel syndrome. And I don't have irritable bowel syndrome. I have been given that diagnosis for a lot of fascinating reasons, which we don't need to get into. But for people who have IBS, for people who have migraines, for people who have chronic pain, or sleep problems, or lethargy, or brain fog, we've already been told by the medical establishment, what's wrong with us? We have migraines. We have IBS. We have chronic pain. And here are the medications you take. And here, if you're lucky, are some of the lifestyle changes you should make, right? With migraines like, oh, caffeine, chocolate. Check out your hormones, maybe, if you've been a woman in the last five years. before years before then it was like we don't know. But when people are given these diagnoses, what you're suggesting is that under these things is a long running cascade of biological processes and a shutdown, a shutdown state that has been induced because of increased and prolonged stress, which led at some point to trauma. How do we start to make an in-road into arenas of the medical field that we've been told are handled? Don't worry about it. We got you. Here's the medication. Maybe try and, you know, not drink caffeine in the three hours before you go to sleep. You're suggesting there's a completely different approach to some of literally the most common complaints that I would argue most Americans are experiencing. I don't mean to, you know, hold your feet to the fire, but please help us understand how do we reframe

how we think about some of the most common things ailing people? The way that I've come to see it is that everything in the body is driven by the nervous system because the nervous system decides our inner state. We have three different operating modes or inner states. we are in one or the other at all times.

And knowing that the nervous system is changing that is what gave me the insight to realize that when I could help my patients learn to shift their interstate in the moment, I was doing them more good than writing the prescription for any medication, supplement, or diet. Wow. Can you talk about those three states and talk about what are some of the ways that, that again, that we can frame some of these common ailments? Talk about IBS. That's one that I was like, I don't know. It seems like it's a genetic thing and it runs in families,

right? And like, you get it and, you know, people used to be told like, it's all in your head. And then we finally started to understand, oh, well, I guess my stomach gets upset when I'm nervous. Maybe IBS is just a more exaggerated version of that. What do we know in particular about something like IBS? We actually know a lot about IVS and its relationship to the nervous system, and this information

has been in the medical literature for decades now, and there's... We actually know a lot about IVS and its relationship to the nervous system.

And this information has been in the medical literature for decades now and they're still

not listening.

Not that that's going to be a surprise to anyone here.

But it's not that we don't have the science.

I think that where we run into is that we have it known what to do about it.

I remember talking with Dr. Vincent Fletti and he's saying, look, just asking them, what happened to you? Improved patient outcomes. But yet when he told his colleagues this, they looked at him and they were like, but what do I do with that information? And he was like, You don't have to do anything. That's the whole point you just ask. It's the asking that changes the outcomes, not the doing something, but we as practitioners are so programmed to do something. We do something. We prescribe something. We solve problems. And so what do you mean? I don't I don't do something. And a lot of times, honestly, it's we don't want to we don't want to hear because in some way it's going to resonate with something we've been through and we haven't resulted ourselves yet. So this idea then that there is so much nervous system regulation behind every physical health symptom, condition, and diagnosis. And especially IBS I get really excited about because we have some specific data that will blow your mind. Here's what we know. IBS is a result of early childhood experiences where our nervous system would have fluctuated very quickly between the two survival states, the two survival states being stressed and the shutdown or trauma. And it's the fluctuation between those two that created the baseline for IBS to develop. And not everyone who's fluctuating between those will develop IBS. Some people will develop other fun things. That will depend on what genetic imprint you are bringing that will depend on epigenetics. It will depend on also environment, a variety of things that can pull all of these levers. It will also depend on diet. It will depend on and this is not a political statement. It will depend on vaccine status. It will depend on, and this is not a political statement.

It will depend on vaccine status. It will depend on access to health care. It'll depend on what

kind of dairy you're eating and what hormones you're eating, like everything matters, right?

And this is why this is the exactly the concept of the biology of trauma. All of those things,

at the end of the day, create an internal biology that is either one of safety or one of fear. And those things your diet, your environment, toxins, vaccines, they're all cues of safety or danger to your nervous system. And it's the cumulative effect. Can you talk a little bit about depression? You know, depression and anxiety, I don't have the stats in front of me. But this is one of, I'd say, the most common complaints, you know, things that people present with. And what's becoming even more and more common is, you know, internal medicine doctors basically just writing prescriptions for antidepressants. Well, look, I mean, I get mean, I get it. So many people are coming in with symptoms of depression and of anxiety. I mean, this is a, it is an epidemic in this country, right? And even before clinical depression, you have exhaustion, you have hopelessness, you have people who are considered the quote unquote languishing generation who they just don't have a passion, they feel lost, they their aimless, they don't know what they want. In what ways is depression protective? You've talked about some sort of protective mechanisms potentially of depression and anxiety, but is there a way to get to the root of those besides antidepressants besides talk therapy? Why are those things not necessarily going to work? And the evidence on SSRIs versus many other interesting modalities is actually not looking so good for SSRIs. What's going on with this epidemic of depression and anxiety and where does an understanding of trauma inform the way we possibly start to try and actually get people help.

Oh, I love this conversation because it really again kind of highlights the nature of the nervous system and what it does and what that looks like. When we are in a stress response biology, we are anxious. The sympathetic nervous system generates adrenaline. Adrenaline causes anxiety. It's supposed to. It's intended to. So the anxiety isn't bad. It's just, well, what are we doing with it? What we are designed to do with it is to take action, to move. We discharge all that adrenaline through the movement of our muscles. This is why even when we're completing a stress response, or maybe're watching an animal complete a response because they do a much better job at this than we as humans do, they will tremble. Trimbling is these fine motor fisculations and the fine motor fisculations are discharging adrenaline. It's so powerful because we got to get that adrenaline out of our system to get out of the anxiety. But as I mentioned before, we can get to the point where there's so much adrenaline. Our panic reaches a high point that it just causes the paralysis. And we reached that point where we don't see how we could take action. We don't see how we could do anything to make this stop. We don't see how we could make a difference by doing anything. And this enters depression. Depression is just that. I don't see how anything that I could do could make a difference. So what's the point? What's the point of trying? What's the point of going out? What's the point? What's the point? And when we're in that trauma biology because of the effect on our mitochondria, we don't have the energy. And so there's all this going at play. However, it's really important to bring in the neurochemistry into the equation. And the serotonin and the dopamine, the acetylcholine, the GABA, these are all neurochemicals intended to generate the different sensations and responses that we want to have in order to be in our best self aligned with our bodies rhythms and

inflammation is going to disrupt the levels of these neurochemicals

80 more than 80% of our serotonin is made in our gut. Well, what if you have IBS?

Oh, no, and this is where we get to this idea that trauma

Only be gets more trauma. It's one of the saddest things in life. You didn't just get hit once. You're going to keep getting hit because now the inflammation that the trauma created is going to feed back and change your neurochemicals. They're going to create oxidative stress. going to do all of these other changes that further promote more and more trauma responses. And in many cases, the emotional response will mirror that as we are seeking high risk behaviors, we are seeking out partners that maybe cause some sort of turmoil, but don't really give us a sense of peace or safety or we feel alive in a state of crisis, right? We keep creating drama in relationships. We create breakups. We create fights. We have these kind of dramatic interactions, even with friends. Those are ways that the emotional response is echoing the cellular response. Absolutely. And we look at this idea of, you know, the body is ultimately seeking safety. It's what we're seeking safety and if we're always in danger, we're seeking relief from that danger. We're seeking safety and what is it that actually makes a person feel safe? According to neuroscience, it is familiarity. Well, what if what is familiar to you is the danger that you're seeking safety? neuroscience, it is familiarity. Well, what if what is familiar to you? Is the drama? Is the chaos? Is the stress? Well, then that's where you will feel safe. You won't like it because you're always anxious and you're always stressed. But if you were to actually go to a yoga retreat where you just meditate and there's no drama, you would be so uncomfortable, you'd crawl out of your skin, you'd be so bored, because that's not what's safe. What is safe to a person is what they know. It's the unknown that is unsafe. And so even a person who has felt depressed, they may actually have a part of them that doesn't feel safe to be more alive, because what if I were actually more alive? What if I actually had more energy? Well, more might be expected from me. I might actually be expected to take that higher position in the office and manage other people, and I don't want that. I may be expected to be seen and be more on the stage or take on these other responsibilities. It's safer for me to stay depressed, safer for me to stay small, not be seen. Even though I will express that I don't like it, it's ultimately what feels safer than this other way of living where I'm actually more alive. This episode is sponsored by Wondering Jews and Open Door Media Brand. If you've ever found yourself feeling like you have more questions than answers, you're in good company. The Jewish people have been like that for thousands of years. Wondering Jews with Michal and Noam is a podcast where two of today's most dynamic Jewish voices, Michal Beton and Noam Weissmann dig into the biggest questions about life through a Jewish lens. It's the kind of conversation where you'll laugh, learn something new, and probably shout and disagreement at least once. Michal and Noam tackled the tough topics, like anti-Semitism in America, what happens after we die, and the future of religion with guests like Brett Stevens, Michael Rappeport, and Sarah Herwitz. And this past month, in honor of Jewish American Heritage Month, they've been celebrating some of the Jewish lives and institutions that have shaped American life, from food to music and comedy, thoughtful, joyful, and always honest. That's wondering Jews with Michal and Noam a production of Unpacked.

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