Speaker 1  0:01  
Welcome to all things Vegas, nourishing self care for the helping professional. During our time together, we will explore a wide variety of topics relating to self care, all especially geared to the helping professional. Our guests are all thought leaders and cutting edge providers in their respective fields of endeavor. They will offer not only helpful insights, but practical skills that you can begin

Unknown Speaker  0:25  
to use immediately.

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Dr Christine White is

Speaker 1  0:29  
a seasoned naturopathic doctor who's been practicing in Montana since 2002 with a background in family medicine from the National University of natural medicine. Dr white brings a wealth of experience in complex case management, including chronic infections, gastrointestinal issues, hormone balancing and long covid treatment. Dr Smith received his medical training from the National University of natural medicine

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in Portland, Oregon. Before that,

Speaker 1  0:57  
he completed a master's degree in New York City, where his research focused on epigenetics and neuroscience. Dr Smith provides comprehensive naturopathic care for individuals of all ages, focusing on neurological mental health, gastrointestinal hormone and respiratory conditions.

Unknown Speaker  1:15  
He is passionate about supporting

Speaker 1  1:17  
the health and wellness of patients across the lifespan and throughout generations. Well, Christine and Michael, thank you so much for joining us. We're wrapping up our I guess we could call it a series on sleep. We've been talking about how to sleep, but the topic, I think today, is more like why we don't So, Christine, you want to kick us off? Sure, I think

Speaker 2  1:40  
it's, it's a blending of things. So I think, you know, sleep sometimes gets talked about as if it's, it's its own central thing. And if we just understood sleep, we would, we would all sleep better. And I think the reasons that we don't sleep are really important to understand, because when we understand why we don't sleep, then we can begin to think about the things that we can use to facilitate sleep by understanding the mechanisms of action of all the various things we can use to support sleep, whether it's in that mind body, kind of nervous system realm, whether it's herbs that you use or medications, whatever it is when we understand why we don't sleep, We can actually pick the proper tool.

Speaker 1  2:21  
That's a brilliant way of putting it, because I think it's a lot more complex than we like to think.

Speaker 2  2:28  
Perhaps, yeah, it's probably one of the toughest things I treat as a naturopathic physician, is it really and people are like, Why are you asking me all these questions? I'm like, because I can't just, I'm not going to just write you a prescription, something that's just going to knock you out. I'm not going to use a hammer when we need a whole toolbox.

Speaker 3  2:46  
And I also think to add to that, it hearkens the idea that in medicine and healthcare, there are so many things that we can consciously control. We can control when we eat and what we eat. We can control how we move our bodies, whether that's formal exercise, going to gym, going on a lock, whatever, but it's it's sometimes is very hard to consciously control our sleep, as we talked with with Dagny in the past couple episodes, there's a lot of things that we can do to create invite optimal conditions for sleep. We can work on regulating our blood sugar. We can do all the other things, making sure cortisol and stress is everything ideal. But ultimately we it's sleep is not something we can just force, like, we can force us going to the gym and hopping on a treadmill. We have to, like, really understand these nuances. And I think in doing that, it allows us to give ourselves a little grace, because the responsibility is not always conscious, and so we recognize these unconscious elements that I think we'll dive into, these neurotransmitters, these hormones, these chemicals in our body, that it's not like we can say, hey, melatonin, can you just turn up a little bit please. Right now, that would be really helpful. On a conscious level. We can do that with maybe some other things. We can think stressful thoughts and our blood pressure goes up, but we can't really control that with sleep stuff.

Speaker 1  4:12  
When we're talking about all of this nuance, and I think that's a really good way of putting it, because, you know, kind of like Christine, what you were saying it's like, you know, we're not gonna take a hammer to this, right? Because there are so many different mechanisms. Yeah. So what's the most common thing that you see? I guess, I think I

Speaker 2  4:30  
would say there are two things that are probably equally common in what I hear from people, and one of them is that people can easily fall asleep, but they're waking up somewhere between two and four hours later, and their mind is racing. So the question is, okay, so that you know that's the question is, is it your mind that is keeping you awake? So that is a, I think that's a big piece for people. And there are many different mechanisms by which our systems can sort of become stimulated that our brains turn on. The other one I hear a lot from people is pain. So. People will often discount, you know, you ask them three or four questions, like, well, actually, I mean, I hurt every time I wake up. I'm waking up because I hurt. It's like, okay, this isn't a sleep problem. This is a pain issue. So I think it's, it's the minds that won't quit chattering and actually

Speaker 1  5:19  
being in pain. So you differentiate those two points, so that you kind of know what, what are we actually working with here? Then we

Speaker 2  5:26  
sort of walk down all those pathways of, well, how much caffeine are you drinking? Well, I don't drink coffee, but, you know, I have a caffeinated soda drink. You know, all afternoon, it's like sorting out the caffeine. I talked with someone yesterday who does not consume caffeine in any other way, except they're taking, I think, nine pain relievers a day, each one of which has 65 milligrams of caffeine. I was like, okay, here is a mechanism of action. A, you hurt and B, we have to treat the pain. And I've taken change subjects are a little bit but then we have to, we have that because we have to bring down the caffeine load in your body. It's all those questions about, do you are you having? Are you waking up with your heart racing? Or do you wake up and your mind starts to run and then your pulse, or your blood pressure goes up? Are you waking up hot? Are you? Are you rolling over because you hurt? It's just like sort of going through these really detailed questions that often people just are not thinking about. Sometimes it's it's restless legs. There's certain populations where we might expect to hear a restless leg sort of a symptom picture, and there are other places where it's really out of the blue and not really typical. It's a it's a younger person, it's an active person. It's somebody who doesn't have a bunch of underlying health issues. Well, they've got something going on. It's got their legs twitching all night long. So, you know, we start there, getting to the

Speaker 1  6:48  
nuance of that person, the individual picture for that individual person, which kind of speaks to we're not going to do a hammer with this.

Speaker 2  6:59  
The reason we're asking those questions as we're trying to also find the proper tools. Okay, you wake up and your mind is really active. Is it because you have an acutely stressful situation going on? Or do you have a chronically stressful situation going on? Are you waking up, you know, worried about a conversation you had today at work? Or are you waking up concerned about your elder parent whose funds are running out, and you have to figure out where they're going to live in six months. And those different sorts of stresses will use different sorts of tools. Is understanding is there, is there a level of depression in here? Do you have daytime anxiety that might be feeding into this? You know, waking up hungry is a very common thing. You know, oftentimes it's talking to people about what you're eating and how you're eating in the in the work that that Dr Smith and I do, you know, people are spending a lot of time paying attention to their diet. And some people get their sometimes people get their diet so dialed into a particular direction that they're now unknowingly waking up with low blood sugar every night. You know, one of the most amazing tools I sometimes use with people to sort out sleep is a continuous glucose monitor. I mean, the cool thing about those is they're over the counter. Now you don't need a doctor to be between you and a continuous glucose monitor that you, you know, attach to your upper arm, pair it with your phone, and all of a sudden you can recognize, wow, look what my blood sugar is doing in the middle of the night. No wonder I'm waking up with my heart racing and feeling like I'm stressed. And so there that's an important clue, because, yes, I can use herbs with certain mechanisms of action that will calm the nervous system. But if your system is ramped up because your blood sugar's low, can't get very far with calming nervous system herbs. If the issue is, is that you, for whatever the reason is, don't have great glucose control overnight,

Speaker 1  8:57  
it's the kind of stuff I think that people may not understand that might be a mechanism of action that would give someone who is who's trying to help them sort this out information that you wouldn't be able to access

Speaker 2  9:11  
other way, right? And it's also, I guess, a little bit of getting at the things that are a little bit more hidden, a little bit less obvious. You know, we can also get into anything in the hormonal realm, whether we're talking stress hormones, or we're talking menstrual cycle hormones, or we're talking menopausal hormone levels, those are things that are a little bit less obvious. If you're sorting this out on your own, it's like, ask yourself these questions. It's like, can I come up with the obvious answer that sort of Dr Smith was talking about a little bit earlier? Can I come up with a little bit less obvious answer, or it's like, I don't know, man, there's something going on in the middle of the night, and there are tools that any of us can use to help us figure that out.

Speaker 3  9:51  
The thing that comes to mind, in addition to what Dr Mike was saying, is the idea of or. Limbic system, I felt like in our I don't know if it's just right now, in our clinic, we are seeing a lot of patients whose limbic system is on overdrive, such that one little change in anything creates this massive response in their body, and they're not able to effectively deal with it. Once we able to calm that down, there's a whole bunch of limbic system retraining programs and so forth, and I think you probably hit on lots of those throughout your episodes in one way or another, we can calm the body down so that when we're trying to introduce some of these little things to help support sleep. The body's not going to freak out and go into this over anxious state that would then impair sleep

Unknown Speaker  10:47  
further when we get

Speaker 1  10:48  
so I'm going to say over stimulated when, when our nervous system gets

Unknown Speaker  10:52  
so upregulated, it

Speaker 1  10:55  
doesn't it possibly doesn't really matter if the change is a helpful one or a not helpful one. It's just the fact that there is change Exactly.

Speaker 3  11:05  
So the analogy that I like to use that we borrow from another author, I think it's Annie Hopper, that mentions this one, is the is that we have a nice house with a little guard shack in front, and there's a security guard that makes sure that everyone who's coming in and out is, you know, accounted for the Amazon UPS delivery truck is bringing some packages like, okay, great, come on, deliver it. Move on your way. And that's, and that's kind of a normal functioning when the limbic system is is not working, right? We have the UPS delivery person come to bring a package, but then in but the body responds such that there's a whole army unit, SWAT team that shows up with arm with guns drawn, to say there's a change. And be it's a good change. We want. We want that package delivered because we ordered on the internet. We're expecting it to come. But our body is overreacting. Our nervous system is way overreacting to this one little change. I've seen it so many times with even just recent patients. One I was working on a lot of gut stuff for and I just saw her this last week. She was so much better than we were able to start actually working on her gut, because we actually worked on all of these nervous system things first, and this, it's for some patients, it's it's like a prerequisite before I can even touch what they're coming in for. We need to calm that down. I think that really applies to sleep, with all of the things that we're talking about, if we're wanting to address melatonin or introduce herbs that are good for certain neurotransmitters. These are good changes. We consciously want them, but sometimes that change itself can be triggered as a negative change.

Speaker 2  12:54  
I think the other interesting layer that comes into this, that people can really do for themselves and sorting this out is also really paying attention to, okay, I'm focused on sleep. I'm going to try something, and it's either going to on a really high level work or not work or be neutral. It's really interesting to me. In conversations with people, I'll say, well, they'll say, Oh, I tried melatonin. It didn't work. What does that mean? What do you mean? It didn't work digging into the store. Did it give you crazy dreams? Did it leave you waking up feeling hungover? Did you fall asleep and have rebound awakening? It's like when something doesn't work, and in this context of sleep, you know, if you're really working on it, I'd encourage you to pull out a journal and write down I drank this tea, and this is what happened. So it doesn't mean that all and it didn't help, or it was had a negative effect. It doesn't mean that whatever that combination is you got from wherever is bad. It means there's an ingredient in there that doesn't resonate with you. And that also comes down to not only is there this limbic system layer, then there's also genetics layer, particularly when it comes to the GABA receptors in our brains. And that pathway, GABA is a calming neurotransmitter, but we can have genetic variations that actually result when those receptors get triggered, that it ends up being stimulating, not calming. It's not because whatever it is you tried is bad. It's like, okay, if you took this and you had this sort of paradoxical reaction, keep track of that, because somewhere along the line, you'll either begin to find your own answers, or you'll talk to someone who will ask you these questions, and then it will become very it's like, oh, that mechanism of action is not going to work for you. So we'll put that mechanism of action aside, and we're going to go in a different direction. We're very used to, oh, it just didn't work. Throw the whole thing out. And I think that also partly comes in this realm of sort of self help, and in this realm of non conventional op. Questions, because many of the providers that people work with don't understand the nuance layer of this integrative approach. We, you know, we often it's the proverbial throwing the baby out with the bathwater. Well, then all herbs are bad. Well, no, maybe you can't handle valerian, maybe you can't handle chamomile, maybe you can't handle Kava. Kava doesn't mean that all herbs are bad. It means we've got something going on that doesn't resonate with you physiologically, and so we skip it and we move forward.

Speaker 1  15:28  
If your threat detection system in your brain is like saying, this is a change. Change is not good. If that's the problem, then any of these things that might at some point when that calms down, they might be helpful. Are just not right now, correct?

Speaker 2  15:45  
I also use this line a lot with people. Is just because it didn't work for you in the past, or we even tried it together and it didn't work, doesn't mean I'm not going to consider trying it again when we sort out a different layer. You know, it's just, it's again, it's just coming back to understanding the, why are you not sleeping, or what, what was the thing you tried that upset the system, or just plain didn't work? Maybe it will forever be off the table. But maybe, as Dr Smith was talking about, if we, if we calm down your cell danger response, we calm down the limbic system all of a sudden, something that felt like it was overly stimulating provides you with the best night's sleep you've had in years.

Speaker 1  16:29  
When we're talking about these things that people can do, I mean, there are some things that are kind of out there, pretty easily obtainable. What do you see that

Speaker 2  16:40  
people have tried? Probably the most common thing I've seen people try is some varying dose of melatonin, and melatonin, physiologically is in very, very tiny amounts. Most of the melatonin products on the market are magnitudes higher than what our body would make on its own. When we go from using, when someone goes from using, sort of a what we would, I would refer to as a physiologic dose, it matches sort of what your body would normally do to what I would call a pharmacologic dose. Let's use melatonin, for example, like a drug, like a sleep drug. Then you can have this whole array of experiences underneath. So people will come in and say, I tried that. It didn't work. I mean, that is so it's like, Okay, what does it didn't work? Mean, outline that for me. Oh, well, I wake up feeling super, super hungover, like I can't handle it, but I sleep really well. Okay, well, maybe you were taking a timed release version and maybe that was wrong. Or maybe we get you to dose something earlier in the evening, so it wears off by the time you wake up. You know, melatonin can have rebound effects for people. So there's just all sorts of reasons. And then the other piece, just getting at the why people don't sleep, is that melatonin is the end, sort of the end product of the production of serotonin. So we go from L, tryptophan, an amino acid to five HTP, five hydroxy tryptophan, which is a neurotransmitter that gets converted down to serotonin that ultimately becomes melatonin. So sometimes what people actually need is their whole serotonin pathway supported. You don't need melatonin the end product. You need more of something higher up. Or for some people, if you sort of genetically can't get from point A to point B, if you can't get your tryptophan to five HTP, well then let's not use tryptophan. Let's move on to the next one down. And it's not a common one that I use because to me, melatonin is often a hammer, when what we need is, you know, a small set of jewelers screwdrivers.

Speaker 3  18:40  
And if we do use it, if we can use it in very small doses and get a really big bang for the buck in that context, it doesn't need to be a big dose. And so I would say

Speaker 2  18:51  
to people, you know, if you're if you feel like in some way, melatonin is helpful for you, but you don't like the side effects, change the dose, like anyone can do that. You know, in this country, melatonin is over the over the counter. There are some places in the world where melatonin is actually a prescription drug, but here in the States, you can go get yourself a different formulation.

Speaker 1  19:13  
The idea being that if you have an experience, it might be not the thing as much as it is, when were you using it? How much were you, know, that kind of which is all under our control as individuals, right?

Speaker 2  19:30  
Just like if you use an herbal tea and it doesn't work, keep a hold of the box, save the label. Go find yourself a different blend,

Speaker 1  19:41  
outside of melatonin, which I think most people are pretty aware of. What else do you see that people have tried, that they might come to you and say, Ah, this doesn't work.

Speaker 3  19:53  
There's this whole world of herbal medicine the people have tried. There's the sleepy time tea, there's the chamomile. Whatever. There's all there's so many herbs. And as I was preparing for this, it was amazing just to remind myself how these sleep. There's just 10 or so herbs that we've been thinking about for sleep, how they do so many different things in the body. It's not just one mechanism. It's not just the GABA receptor. It's not just serotonin. There's things that modulate thyroid and blood vessel opening and cortisol and so many other things. This brema of herbal medicine is so complex, and I think that's where the challenge comes with patients that come to us, they've they've tried these, they've done, you know, tried different teas or different supplements they heard about on social media or whatever, and they're getting mixed results. But that's when we really need to step back and say, Okay, what? What really is going on here? And we can use what they've tried, or what we can give them in between visits and so forth as kind of a therapeutic trial, what's worked, what hasn't worked, and what clues can we get from that? As Dr Wright was saying earlier, that gives us hints about what is their body doing. Do they have mutations in the genes that regulate C, O, m, t or Mao or MTHFR, or all these other genes that affect how our body processes hormones. Do we need to adjust those very, very finitely with herbs or with targeted supplements? We can use that information the trial of these things, as helpful diagnostic information.

Speaker 4  21:41  
So is

Speaker 1  21:57  
it possible you can have a pharmaceutical drug interaction?

Speaker 2  22:01  
You can have interactions between herbs and nutrients and pharmaceuticals, sort of in any combination. There it's also this, you know, people kind of recognize this idea of polypharmacy, people who end up on so many pharmaceuticals. You take one thing, you take two things for two things, but now you have three things for those side effects, and then you come up with some other some now you have an, okay, we can do the same thing with supplements, with herbs and nutrients. And, you know, I say to people all the time, I don't want to give you seven things for seven things, I want to create a plan for you that involves three things that treat all seven of those things. And that's some of the beauty. And the nuance that Dr Smith was just talking about is is just like, to some degree, we understand how certain pharmaceuticals you would pick, you would pick one pharmaceutical over another, because there is this other thing going on. I mean, that that kind of nuance does go on with conventional prescribing, but that very much becomes part of the nuance when we're getting into trying to use sort of non pharmaceutical approaches. But yes, that the handfuls of things that people end up taking, and sometimes those end up being really appropriate lists. And sometimes it's either redundancies or it's this, we get into this really mechanistic mindset of, here are my six things. So I want to go get six things for those six things, or sometimes we just end up treating the wrong thing. I mean, you know, the, you know, menopausal women will come in because they're not sleeping, I don't treat sleep. I'm going to treat the rest of the hormone imbalance that's setting off the rest of the system. And so that is also sometimes, what happens when, when folks just end up taking so many supplements and along with their pharmaceuticals, is it's it's got to step back and go, what are we actually treating here? And is your symptom now an interaction between one thing and another? Are you taking, for example, something herbally that is impacted your liver's rate at which they are metabolizing a certain pharmaceutical you're on and now you are more anxious, or your blood pressure is up. Well, it's because these herbs you're doing over here have influenced your liver and your pharmaceuticals aren't lasting as long. Or are we treating an innate symptom, which is our body simply telling us that something is not right? Or are we treating a drug or supplement side effect. Mean, that's the other thing, is, I also don't want to sort of malign side effects, like sometimes you have to take things that do cause something over here. I don't live in this perfect world where I think that never happens, but let's at least just acknowledge what we have going on here. Sometimes we just get afraid, I think, to either ask those questions or afraid to weave it all together.

Speaker 3  24:43  
And I think it really goes back to what is the root cause, and I think that's what you said, without saying it like what is really going on here? And as we try to figure out what combination of pharmaceuticals, either they're already someone's already taking, or we. Want to think about or all these supplements or herbs, there are these interactions. And one of the cool things about seeing a naturopathic doctor, at least myself, is that I have access to databases that we can plug in lists of all of these things, drugs and nutrients and supplements and herbs. And it does all this cross interaction that a regular, conventional provider is not necessarily going to have access to the same way I do, and I'm able to, like, okay, these are affecting these particular liver enzymes. We need to just be mindful of dosages or things like that. Or maybe, let's, maybe these are okay, but let's, let's be careful. Or, no, they don't work. Or maybe everything's fine, but just being aware of the presence of interactions is important in any aspect, and it's something that's that's top of mind, at least for me. And I think you say the same thing, I

Speaker 2  25:54  
think the other thing I would say there too, when we're thinking about, you know, how do people? There's just so much information available for people in there, you know people, whether it's some AI model or whatever it is you're doing, like if you want to ask a question, there are a whole bunch of answers you can get, because you can ask anything and get the answer that you want. You can go out in your own echo chamber and get exactly the answer that you're looking for. So when it comes to understanding nutrients and herbs. You know, if you're thinking about something and you're doing some research and you and you find this set of answers, well, then go out and sort of, can you ask that question a little bit differently? Can you find a different source if you're looking for something in the realm of herbalism, and all you're doing is looking at PubMed research, you're going to get a biased answer. I'm not saying that the answer is necessarily wrong, but there's a bias. Just like if the only place you're looking is herbal websites, you're going to get a bias in that direction. If something doesn't seem quite right, it probably isn't, but I just that research element is so hard. I mean, we had this conversation a couple different times, even just yesterday, of people sort of calling in saying, oh my gosh, I am taking this you have me taking this thing, and I've just gone and found all this information that says I shouldn't be doing this. It's like, okay, so I this is not an easy, quick fix, so I need you to come in so we can sit down and talk about, what is the question you're asking. What is the information that you're getting? Does that really even make any sense? Melatonin has been in the news recently because there was a single pre publication abstract that was released that basically was taken to say using melatonin causes heart failure. It is a unpublished, pre reviewed piece of research. It talked about a correlation, not a causation, and when you dug into the details, really, really murky, and that is actually not what it said. But I can't tell you how many times in the last several months I've had to speak to this particular topic. So I just want to throw that one out there in the context of this conversation, is that, and that's another one where you sort of think about like, if I think about it, I'm not saying it's completely impossible, but I can't come up with a mechanism of action whereby melatonin is going to cause congestive heart failure like I can't, I can't go back to the basic chemistry of the body and come up with that one. And there's some

Speaker 3  28:30  
nuances with that, of like, was it prescription? Like in in other countries where melatonin is truly a prescription, or whether it was it over the counter, and I think this study was being prescribed. And if someone is prescribed melatonin for a health condition, what else is going on that's causing them to lose their sleep? And if they have sleep apnea, that's not that's making their sleep difficult, that, in and of itself, is a significant risk factor for cardiovascular disease. We look at the mechanisms of melatonin, what it's doing. It's an end. It's it has anti inflammatory properties. It has antioxidant properties. It does so many other things in cleaning up and helping calm the brain down, if anything, the research that I know about melatonin is it's actually going to be beneficial for preventing heart disease, not causing it. In context of all this information, we need to make sure we're getting the right information from the right source in the right context. And if you need interpretation, go to someone who's well versed in that information to dissect it the conversation yesterday, don't go don't ask a nephrologist which supplements you should be taking or not, because they're not trained in supplements in herbal medicine.

Speaker 1  29:50  
What are some other common things that you see people taking?

Speaker 2  29:55  
There are some very common ones that are super effective. Chamomile is a super effective it's got. At a number of different properties that are calming and soothing to the brain. Lavender. Lavender is useful in whether you're taking it as a tea, whether you're using it as a as an essential oil that you're smelling. I mean, the research shows lavender goes straight to the limbic system, like it really, truly calms people down. Ashwagandha is one of those also very, very useful herbs. It helps, sort of modulate the cortisol response in the body. I would probably also say something called oat straw, another super calming to the nervous system. There is a lot of things out there that can be super helpful. Catnip, for example, that's one of my favorite ones. And catnip is actually in the mint family. It is bit of a digestive aid, and it's also calming to the nervous system. A cup of catnip tea sweetened with a little bit of glycine, which is an amino acid that is also calming to the brain, can be a wonderful sleeping so people, there are lots of things out there that people can get that work really, really well. And again, the importance just to kind of harp on this is, if it didn't work, then try something different. Or I sometimes will say to people, if you really are, if you're really had a really rough day and you're really stressed out and you've you want to use herbs in a tea to help you sleep better, maybe use two tea bags instead of one steep. It a little bit longer, like if you're trying to use herbs as a little bit medicinally. Then the cup of tea you might brew yourself at three o'clock in the afternoon, where the tea bag was in the water for a minute, is probably not the ideal steeping amount of time, if what you're really trying to do is use that tea bag to get you you enough medicinal herb to fall asleep.

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