214 Dr Dani Gordon | Medical Cannabis, CBD and Resilience (stimulating forms of breath work)

9:20AM Jan 27, 2023

Speakers:

Angela Foster

Dr Dani Gordon

Keywords:

people

brain

resilience

cannabis

dmt

patients

endocannabinoid system

stress

thc

cbd

important

called

ayahuasca

medical cannabis

depression

find

morning routine

ashwagandha

uk

substances

For some people who have really bad insomnia, they they try to take hemp CBD before they go to bed. It doesn't work as a sleep aid directly. Sometimes it can actually make people more wakeful. It can actually wake up some of the parts of the brain in that are involved with keeping us awake and alert.

Hi friends. In this week's episode, we're gonna be diving into the world of CBD and medicinal cannabis. I'm chatting to Dr. Danny Gordon, who is a London based double board certified doctor and world's leading expert in CBD cannabis medicine and integrative medicine. She has an incredible book called the CBD Bible, which will give you everything you need to know about CBD that she published in 2020. And she has a second book coming out later this year called the resilience blueprint. She in addition to being dual certified by the UK and American boards in integrative medicine, she's also studied mind body medicine at Harvard, yoga, meditation, and herbal medicine extensively throughout India and Southeast Asia. She was also the founder of an EEG Neurofeedback Wellness Centre in Bali that was specialising in burnout and stress resilience, and she has been using mindfulness and Mind Body techniques with patients for over a decade. You're going to hear about some of these practices in this week's episode. And you'll also be hearing about when is the right time to use more stimulating forms of breath work like Wim Hof breathing? For example, when should you be using cold water therapy and sauna? And when aren't these things appropriate? When are they actually a bit too much stress for the system depending on where that person is, in terms of their their level of fatigue, or burnout, and Dr. Downey explains this very fluently for us today. I think it'll give you some really good insights and how you can begin to optimise your own practices. So without further delay, let me introduce you now to the lovely and highly knowledgeable Dr. Danny Gordon. So Dr. Danny, it's so good to have you here. I'm really, really excited to talk about integrative medicine resiliency, I think, you know, there couldn't be a better time really, when we look at the way the world is now coming, you know, the back of sort of two years of the pandemic, post pandemic. And now everything all over the news is all about the economy. And I think just globally, we've been under this, this volume of stress University for such a long time. So I'm really thrilled to have you on the show. So very well, Mark.

Thank you really excited to be here.

Yes. Can you look up with tonnes and tonnes of questions for you? So I guess, I think probably a really good place to start is resilience is a term, you know, I talk about a lot and lots of people are using. But isn't that well understood? So why don't we start there by describing what it what does it mean to be a resilient human?

Yeah, it's a great question. So researchers, of course, are still arguing about the definition of what is resilience. It's kind of a nebulous term. But what I mean when I talk about resilience is really about health and well being resilience. And for me, there's some core factors that play into that. So the first thing is how well we can bounce back after we've had a setback, or a challenge or some kind of adversity, because everyone faces these things. And I always I like that phrase of bouncing forward. So not only have you my patients who are really sick, we're trying to get them to bounce back. But my patients were really well ready, we want to make them bounce forward. So they can use these challenges that they face as a building block for even more resilience. Because the thing about the how the brain works, is you actually need to have setbacks and challenges to build resilience. So this is great news. For everyone who's ever been under stress, we actually need some stress to get more resilient. The other thing for me that resilience is about is really about four different aspects of mental well being so our energy levels, how much energy we have, how energetic we feel, how energised our our cells are mitochondria, and then we have stress and anxiety levels. So how ramped up our nervous system is, are we able to return to that calm baseline easily. And then we have mood, which of course is our ability to interact with the world and putting our brain into that approach behaviour and not getting stuck in the the lows and in really like the the really down loops that the brain gets stuck in. And then the last sector of resilience for me as a doctor is mental function, cognitive function, including how clear headed we feel, you know, getting rid of brain fog, how well we can think and how we can execute on our life's vision. So for me, that is really what resilience is about.

Yeah, great. I love that. It's pretty broad, isn't it? I mean, do you as part of that? Do you also factor in when you're looking at you mentioned there like the resiliency of the mitochondria and your energy? Do you also look at heart rate variability, because I find that's a really good indicator of looking at Adaptive reserve, right? When it's going down, you know that you just don't have that much available at this point in time, you need to kind of double down on that record. Do you also integrate that?

Yes. So I think we're talking about this a little bit offline with, you know, I used to have in a Neurofeedback brain Wellness Centre in Bali in Indonesia, before we moved back to London, and we use a lot of HRV alongside brain biofeedback. So HRV is really nice tool. It doesn't work well, for everyone, I have to say over the years, I have found that some people respond really well to HRV training, some people don't. So it's it's finding what works for the person. But I do like HRV training, I do like that a lot of the smartwatches. And things are starting to integrate that so you don't have to use kind of the more old school equipment. It is a nice, it's a nice home practice. That's not very expensive that people can kind of get into.

Yeah, it's really interesting. And when you were talking there about challenges, this is this is something you never know, when I'm coaching clients, we always try to focus on is what are the learning experiences from this? And how can we translate that into potential for future growth? Because it's a little bit isn't it? Like going to the gym, and breaking down the muscle? You've got to do that to actually make yourself stronger. But there's a fine balance, I guess, between someone overreaching, so far that they can't bounce back, as you say. What have you found is that kind of tension ratio between for someone who's looking really to perform at their highest level between kind of pushing themselves enough? I don't know what the research is here. Because when we look at something like flow states, for example, to get into, we think that that challenge skill ratio is about 10%. Outside, right? But what about the kind of resiliency? How much do we need to sort of stress ourselves to get those adaptations without actually burning ourselves out?

Well, it really comes down to something that you just touched on was how much our brain for you is feeling the stress. So we can turn bad stress, which is becomes toxic, and creates free radical damage in our cells and creates toxic patterns in the mind into good stress, depending on a number of factors, including what our baseline level of resilience is. And that fluctuates all the time. So for example, if you're going through a really stressful time in your life, or a really stressful month, your resilience is probably going to be a bit lower, it ebbs and flows all the time. So those are the times were checking in with yourself doing a simple practice, like mindfulness, for example, journaling, whatever it is for you. And lowering the stress burden is important to make sure that we don't push over into that toxic stress world. And it's this this is kind of related back to the Yerkes Dodson law, which is this, these two scientists that that 100 years ago, they, they found that in order for people to experience growth, and they started off in animal models, actually, in order for, for animals to to perform at their best, they had to have some level of stress, but too much stress, as you said, to people over into dysfunction. So everyone has their own set point for how much stress they can handle before it becomes toxic stress. And actually, through a process of increasing our resilience over time, we can actually shift that setpoint to a certain extent. But there'll be some people who always struggle with one particular domain or another. So some people really, for probably genetic reasons, epigenetic reasons, their mitochondria are just not as resilient, meaning they are more prone to getting sick, getting colds, flus, and probably to fatigue. Then there's other people who are more prone to to getting low mood or their mood is not as resilient. But they might be have loads of energy. So it's really kind of knowing what I call your resilience. makeup. I actually just wrote a book about this, that's coming out in April, because I think this is part of the key is if you don't know your resilience, type your resilience makeup, then it's really hard to know where that that that balance point is for you. Because we're also different. So what someone else is doing, might be completely different than what you need.

Yeah, you noticed that with work, don't you? And I think as well, like that level of kind of intrinsic motivation around what you're doing plays a huge part, right in terms of your energy levels, because if you're doing something you enjoy, you naturally feel more energetic. So it's very interesting what you say there about the epigenetic, because we look at sometimes, you know, if you look at something like the comt gene, which affects dopamine, and the way people process that, and how, how stressed they might feel, by certain events, and some people for example, I find where they're more of this sort of warrior type and by worry, I mean within a REIT, so they're a little bit more maybe gung ho about things they can take on a a lot more strain. But those people, those individuals, I'm within that category, you almost do need a deadline and a pressure to get things done. So there's always a doubt and upside and downside, right? Yeah, look at that. But very interesting what you're saying about mood there, because that isn't something that I'd automatically seen as a factor, if you'd like for resiliency, but just drawing on my own experience with depression, that actually makes so much sense. Because once I experienced that it was it then sort of filters into everything in your life, doesn't it

go? It does, because, you know, depression is a final common endpoint, as you know, if you've suffered from it, and one person's depression, I treat a lot of depression in the clinic. And one person's depression is not the same as the next person's depression. Sometimes you can have more of an inflammatory depression, you can have depression, from chronic pain, you can have depression from burnout. And what happens when when it gets down the line is the brain goes into withdrawal and protect mode, because that's what it's trying to do is trying to do less trying to say, You know what, it's not safe out there, I'm going to come back and do less, and retreat and withdraw, to protect the brain, because when we were cavemen, that was the best thing to do. So you didn't get eaten. Because if you were feeling depressed, and you were wandering outside very slowly, if you weren't paying attention to your environment, you might get eaten. So this is still what our brain does. So it's, I think it's such an overlooked part of resilience.

So it's so important what you're saying there as well, because I certainly found that I just wanted to hide away. And that actually then compounds the problem because you become very, very isolated in that situation. people experience it, but it was that natural feeling of I just want to retreat, I need to kind of defend, but then I think what I was unprepared for was just actually how much it affects the immune system once you are depressed.

Yeah, yeah, the the neuro immune access is so linked to with depression to our immune function. Because what happens is even we can get changes in the microbiome. And then sometimes it microbiome changes what starts the depression, I have patients who get an infection, for example, like a vector borne illness like Lyme disease, or some other kind of infection, and that kind of starts the process probably in the gut first, and then something kind of tipped over the brain, maybe with a stressor at work, maybe it was losing their job. So it's for every person, it's quite different. But that interplay between the immune system and the mood balancing system is very real, and it's very, very under recognised in conventional medicine pretty much unrecognised.

Yeah, I would definitely agree with that. I remember being told about it when I was having treatment at the priory that you know, but it was more along the lines of You need medication, because this could affect your immune system. There wasn't anything down in and around the immune system to sort of boost it if you'd like. It's very interesting, because everyone's got kind of really into CBD and things but you use medicinal cannabis that you prescribe. This is not an area that I must say that I'm very familiar with, which I love when someone comes on the on the show, and I don't have much knowledge because it means that I can learn a lot and I know that the listeners will be really keen to learn. Can you first describe the endocannabinoid system how this works it kind of brief overview on what we need to know because I know it affects mood effects, pain effects, things like that, but I don't know a whole lot more about it.

Yeah, of course. So the endocannabinoid system is very long word for saying that we have as human beings, a system in our brains and our bodies naturally, that can use plant chemicals from the cannabis plant but we actually make our own version of these cannabinoid these these chemicals to help the brain and body balance itself. So this endocannabinoid system is actually the most important, overall overarching brain and body balancing system. It deals with everything from our mood balance, as we've mentioned, to sleep, to our eating behaviours or appetite, to our response to trauma and pain, which is very important if you have chronic pain, or if you've experienced PTSD, for example. It also it contacts our immune system, and it regulates things like inflammation, immune responses, it's involved, the system becomes dysregulated in a variety, actually, most chronic diseases have some dysregulation we know now in the endocannabinoid system, even in our womb, we have receptors for cannabinoids in our womb. So the endocannabinoid system is involved in our reproductive health as well. And even in our bone marrow, so it's it's a far reaching global system of health in balance it homeostasis really. And we we actually did learn about this in medical school when I went to medical school. Less than 20 years ago, we were not learning about this and actually still now many medical schools don't teach it. So we're, we're to we're finally catching up to the fact we're waking up to this whole system we've been missing treatment for in medicine. And that's why plant cannabinoids from the cannabis plant seem to work so well for a variety of these symptom clusters that are not well treated by a pill for every ill approach.

super interesting. When you talk there about the womb, so could the mother's endocannabinoid system and how that's interacting affect the growing foetus, for example, and what that child is then going to go on to experience

it's very possible we are really at the beginning of our understanding of what happens with the, the you know, the, the prenatal kind of development, the pregnancy phase in the endocannabinoid system and how that might affect the foetus. For that reason, of course, we don't tend to prescribe cannabis based medicines in pregnancy. Because that system is so involved with the developing foetus. There's actually no major research saying that there's there is causing it causes mal malformations or anything like that. But there's some conflicting evidence based on population level data that women who use a lot of cannabis recreationally for example, in their pregnancy, which is of course, quite different than medical cannabis, but still the same compounds that there are babies might be at higher risk for being low birth weight, for example. And then there's a few studies again, it's conflicting, the evidence is conflicting, whether this is the case. But there's some studies that do point to a potential subtle, neurocognitive changes in the children when they're a little bit older. So potentially changes in their behaviour, that sort of thing. For mothers who were exposed to really high THC, recreational cannabis, lots of it when they were pregnant. There's been other studies that show that there is no correlation between those those behavioural changes. But because it's an area of huge unknowns, we tend to avoid it in pregnancy.

And with the low kind of pathway is that after discounting for the fact, for example, that often cannabis recreationally is taken with tobacco smoking, and we know that smoking reduces birth weight, is it kind of independent of that? Well,

they have ways of, you know, getting rid of these confounding factors as much as possible, but there are statistical ways of doing that. So they're not perfect. So it's, we don't know for sure is the answer. And then there's the other factor with even if it was just cannabis that they were smoking, is it the smoking, that is the issue for the low birth weight, because we know smoking, anything, burning anything in the lungs is bad. And that might be the cause of the low birth weight. So there's a lot of unknown still, of course, because we can't test these things in pregnant women, we have to rely on, you know, population level observational datasets, which, you know, have their their drawbacks.

And so before we go into medicinal cannabis, because a lot of people are taking CBD. And when I was kind of doing some research into that some time ago and sort of experimenting with it, you can get kind of hemp extract, and then you can also get full spectrum. And then you can get broad spectrum, I believe. And so I think I think broad spectrum is kind of the middle ground is it and full spectrum oil, it may be the other way around. But one of them contains all of the elements, if you like of the plant, but with very, very minimal THC, which I think when I tried it actually was shipped to me from an American company, because I'm not sure it's even available here in the UK. And I remember it actually being quite powerful. I didn't mean like the heaviness of it under the tongue. But it was pretty powerful in terms of sleep. With CBD. Can you just explain the subtle differences for people and what's available and also the kind of levels it's it's quite an expensive thing, I think as well to start taking if you get good quality.

Exactly, yeah, the good quality stuff is expensive. And unfortunately, there's a lot of bad quality that's very well branded and marketed. That's the same price as the good quality good stuff. So it's hard to tell, but I'll try to kind of break it down for people who might be looking for something that they can buy over the counter so all the over the counter CBD you can get without a prescription is from hemp. Hemp is the subtype of the cannabis plant that has very very little THC to begin with. So that's the legal thing that they can sell you know on the high street shops sort of thing. So using a full spectrum extract you're exactly correct. It is considered the best because it has not it doesn't really have much THC but it has a trace THC and it has all the some of the other minor cannabinoids, other plant chemicals that work together and what's known as herbal synergy or in cannabis world. It's called the entourage effect. And why this is important is because the endocannabinoid system doesn't just respond to just CBD or just THC. It's all the other plant chemicals are also biologically active. A lot of them Probably over 100 that we know about so far. So that contributes to the medicinal effect. Much like I'm also trained to botanical medicine as well as you know, being a conventional medical doctor. Much like when I use botanical medicines alongside drugs, a lot of times I'm looking for these the synergy effect with some of these botanicals in cannabis is kind of the same way but in the same in its own plant in the same plant. So full spectrum CBD is harder to come by in the UK, because of a regulation called novel foods. It's a long story basically, it's harder to get now broad spectrum supposedly does have some of them that I might have plant chemicals that no THC at all. However, most broad spectrum extracts if you look at the breakdown on the certificate of analysis, they're basically almost CBD isolate which is just pure CBD. Pure CBD CBD isolate can work, okay for some people, but for a lot of people, they don't really notice much change or they have to have such high doses that they might get a side effect or something like this. So generally, for something you can buy on your own for kind of milder issues like milder stress issues, a full spectrum, good quality product that comes with what's called a COA from a good reputable company is the way to go.

So it Yeah, Okay, interesting. And in terms of the best time of day to take it is that in the evening,

it really depends with CBD. So in my medical clinic, for example, we treat a lot of insomnia. And as some people may know, you know, the integrative medicine view of insomnia is actually it's a 24 hour disorder of arousal in the nervous system. It's not just when we go to sleep, that's just when we notice it because we're trying to sleep. So from that perspective, even hemp CBD if you take it throughout the day, and it lowers the cortisol levels, lowers the stress hormone levels throughout the day, that can help the natural sleep hormone at night to have kind of come back online at the right time. And avoid avoid the the melatonin blunting the sleep hormone blunting and potentially reduce the cortisol flipping that you get in chronic stress overload. There's not a lot of research on it, but clinically, that's what we find. But some people who have really bad insomnia, they they try to take hemp CBD before they go to bed. It doesn't work as a sleep aid directly. Sometimes it can actually make people more wakeful. It can actually wake up some of the parts of the brain in that are involved with keeping us awake and alert. So for treatment resistant insomnia in the clinic, we use actually THC, an oil of THC and a full spectrum. plant oil like a prescription oil with THC in a very, very tiny dose, like starting at one or two milligrammes before bedtime, just to give people a reference. If you smoked half of the joint, you might get seven, if you smoked a whole joint, you might get 100 to 150 milligrammes of THC in about five minutes. I'm talking about one to two milligrammes of THC over a long acting period of a few hours. So it's very, very different than

kind of micro dosing, it's not gonna get the munchies on that.

No, you're not gonna get the munchies and then slowly titrating up until you get a no sleep effect without feeling hungover or any side effects.

What have you found that you need to go? I mean, it obviously varies with patient to patient, right? But when you're when you're titrating up and you're going from that very low dose, comparing that to what you would have, for example, someone smoking a joint, how high do you need to go to actually get those effects,

usually not very high. But everyone as you said, is different because everyone's endocannabinoid system is different. And especially when the endocannabinoid system becomes dysregulated like it does in mood disorders, for example, chronic fatigue syndrome, any any chronic pain condition Fibromyalgia really have a lot of and reproductive dysfunction, fibromyalgia, then it's all bets are off, you just have to really tailor it to the person and sometimes it's not just the amount of THC and CBD, it's the cultivar that you're using. So you switch to a different strain and the effects change. So it's so individualise and of course, I use cannabis alongside other botanicals, sometimes along with alongside other medications, of course, and what we find is that the optimal dose for each person can be quite different, so I can have one person taking two or three milligrammes long term of THC, and that can be working great, I could have another person taking 20 milligrammes of THC at nighttime, and for them that doesn't make them feel groggy or funny in the morning at all, and that's how much they need. That's probably someone who's we've weaned down off of opioids for really terrible chronic pain, they might have Restless Leg Syndrome, they might have a neurological condition. So the the person at the lower end might just be suffering from kind of mild to moderate anxiety, insomnia and depression.

Interesting Do you see any kind of dependency with with cannabis.

So with medical cannabis, I've never seen it become a problem. And I've treated 1000s of patients over many years. And I teach I do a lot of teaching with other doctors who now prescribe. That being said, if you smoked huge amounts of high THC, black market cannabis and joints every single day for years and years and years, there's some literature that says this probably around eight to 9% chance of having a cannabis use disorder, kind of coming from that. That being said, alcohol is about 20% If you did the same thing. So it's lower risk than a lot of other substances. In the medical context, the risk is probably below 1%. It's very, very small. But you know, when it's not used properly, I mean, we have to remember this is like I tell my patients and doctors I teach, this is a power plant to power plants, we have to treat them with respect, THC, this is in this this power plant kind of arena. And when they're misused, just like anything else, they can become hurting the resilience system rather than helping it.

And these are what about in terms of young people like some of the when you look at countries that have looked, for example at legalising it, one of those issues is around how it might affect the developing brain. What are your thoughts around that?

So this is another point I teach on quite a bit. So there's a few things there. So there is quite robust evidence that first of all, legalising cannabis for adult use does not increase the amount of teens and young people using cannabis. It seems that that youth will use substances recreationally, whether or not as legalised it doesn't seem from the very actually good level of robust data we have that makes that worse that makes a beaut abuse of cannabis by young people worse. However, in some cases where children are suffering from illnesses that have not responded well to other medications like epilepsy, children who are autistic who are on terrible amounts of medication like antipsychotics and, you know, kind of basically neuro neuro depressants to kind of manage the behavioural symptoms of autism. Actually, medical cannabis can be used very effectively in those children to improve their quality of life and improve their symptom control. So it can be a medicine in children. But we're not talking about normal children. We're talking about children who have medical problems, obviously, in children who are completely healthy and normal. I would say definitely avoid cannabis. Because there's some research that under the age of 25, very high THC smoked recreational use cannabis. Cannabis is not very good for the developing brain, because the frontal lobe is still developing until the age of 25. So especially under a teens who are healthy and normal, we would want them to avoid recreational use as well of cannabis. But that's quite different than treating some of the paediatric cases we see with medical cannabis because there's a high clinical need and it's actually less risky than the other drugs they're already taking for the Braves and

taking drugs anyway. So yeah, correct sense. And you mentioned as well, when we're looking at like pain and resiliency, earlier there around mitochondria. And the health of mitochondria. We know these kind of energy powerhouses. Is medicinal cannabis affecting the mitochondria?

Probably the answer is yes, we have some preclinical evidence. We don't have robust huge data sets yet in humans, but we have some evidence that CBD and THC probably are mitochondrial protective. But again, very early days, clinically, what I found over many years of doing this with many patients, I treat a lot of chronic fatigue spectrum illness, and more recently long COVID. And I do find that medical cannabis is a very helpful tool for the fatigue. And again, it's it's really helpful to get people that quick weigh in that they need that relief from the fatigue, because it's really hard to get someone on a recovery programme that's quite complex, looking at you know, their gut microbiome, revamping their diet, doing complicated supplements, doing functional medicine, testing, all that stuff. If they're so fatigued, they can't even focus on brushing their teeth, it's just too much. So what we do with medical cannabis is we get them feeling better, we can help relieve their fatigue with the medical cannabis usually quite effectively. And then we start the longer term process of recovery and helping the mitochondria you know, regain as normal function as possible. Of course, some people's mitochondria just don't work as well as other people's, it might always be the case, but we can get people to a point where they feel normal again most of the time.

How interesting so it's kind of like a first step effectively. It's the one thing I guess I was like to isolate them thing that then has that domino effect of making everything else is

That's right, that's exactly it. It's, I like to call it it's relief, recovery and resilience and relief. We use a lot of these novel that The scents and cannabis is really number one. Yeah.

And you mentioned as well that using other botanicals, well, what other kinds of things are you utilising?

So I use a lot of different botanicals for different things for burnout and chronic stress. You know, there's, there's the adaptogen herbs that I really like. And every person will have a different mix of adaptogens depending on the makeup of that person. So for example, if someone is tired, but wired, you don't want to give them Panax ginseng, because it's going to ramp them up more. You want to use more of a kind of a calming adaptogen herb or a neutral adaptogen. Something like eleutherococcus combined with maybe some Ashwagandha is it for women's health, for example. So I do really tailor to the patient, but there's some there's some kind of general buckets there, the adaptogen herbs that basically help our body adapted to chronic stress. So I use a lot of those. So those are things like Siberian Ginseng ashwagandha. who ask stragglers, there's what else do we have? We have American

Ginseng. And right yeah,

she's Sandra rhodiola, all of those. And then we have the medicinal mushrooms. And there we have ratios in our core to set for to love them. Right. And they're not,

they just make you feel amazing. Like Zen balance. Yeah, I feel like I I feel like if I could ever become a Buddhist monk, it would be through.

Yeah, so we use I use a lot of mushrooms as well. And I'm quite picky about what companies I use, I'm not affiliated with any companies, but with the mushrooms specifically is very, very important. What the source is because it's the fruiting bodies and the, the you know, the the fruit talaga saccharides. And the the, the the composition of the the powder or the extract that's so important. And then in patients who really need high dose therapy, there's even liquid extracts we can get from mushrooms now that are really, really, really high strength. So yeah, I use a lot of that stuff. And then I use a lot of nutraceuticals as well. So PQ, Q A lot of kind of brain hacker ingredients that people would probably recognise. And sometimes that's in combination tablets from, you know, supplement companies who make really good stuff. And then sometimes it's me piecing it together, depending on the person.

Amazing. I want to go into the brain hacking in just a moment, but I just had something I wanted to touch on there was ashwagandha because I think people, I think it's a tricky one, isn't it because of the way it can interact with thyroid? And I'm just curious what you found. Because sometimes like, it's difficult when you're kind of wading through the research to see in some cases, obviously, for people who have a hyperactive thyroid, so something like graves, it seems contra indicated. But then people have an underactive thyroid presumes in some people that can actually be helpful but may interact with our medication. In other people it may not be and I'm curious what you found or under this is just very individual, again,

it's really individual, there's no good studies giving us a clear answer. So we have to go on basically, clinical wisdom, really, in what I found with ashwagandha. I've been using it for well over a decade. And sometimes I still get an occasional surprise with ashwagandha. Usually, I'm pretty good at knowing who's gonna respond well and who's not. But I had a, I had a surprise, about six months ago, I thought I chose this woman, I thought she was gonna be perfect for ashwagandha. And it made her really fatigued. So it's also just listening to your patients. Sometimes, like, as soon as I hear that, I'm like, Okay, this is not the right botanical for you, let's change it. And then we found something that really did work well. And for her, it was less around the botanicals for her it was more about focusing on the microbiome and the mitochondrial support. So it's it's just I think it's just a lot of it is is clinical wisdom. And then of course, just keeping training and studying all the time.

Oh, I love that. And on the brain hacking, right, let's go there. Because I think this is going to be interesting for everyone listening. It's a real passion of mine, because I'm always trying to, you know, upgrade my brain. I think it's someone who's really passionate about with what they do. I always want to kind of give my full list. And that obviously means and we were talking there in the beginning of this interview, we're talking about having a degree of stress because it helps enhance resiliency, and it helps you make progress, right? But you don't want to push yourself too hard. The idea behind all these botanicals and everything you're using and cannabis is presumably not to say, oh, that's fine. You can just go instead of going 100 miles an hour, no, you can go 1000 miles an hour and not burn, you know, that isn't possible. So for somebody who is you know, wanting to perform at their best, and really have good levels of concentration, but coupled with that kind of creativity and below, which I think is really important to have that balance. What have you So how can we how can we hack our brains?

Well, I think the simplest way is to decrease the bad stress. So something as simple as doing a simple mind body practice, I teach my patients who have never meditated before the breath one. So it's just inhale through the nose and longer exhale through the mouth with a ha seed sound. It's so simple. But if you just do that five times, sorry, five minutes, a few times a day, or even one minute, I like to call them resilience reset. So I say to people do a resilience reset for one minute, even three times a day and then once before you go to bed, so that's a total of four minutes a day. That can help kind of with the stress build up that we get that turns off our hippocampus, our learning centres, it makes our brain shut down. It makes us less creative. So that's a really easy one. Then you get into brain hacking with supplements. There's lots you can do there. We've touched on that a little bit. And then there's there's other things like Neurofeedback for example. So, I still use Neurofeedback myself. There's something called SMR neurofeedback, which is very, very simple Neurofeedback protocol. It's very, very old. It just uses two electrodes on the head, and it basically stabilises the brain rhythm that is really good for kind of calm focus. And it also helps us become more resilient to stress I've used so I've used a lot of neurofeedback, I also find that doing something creative, I dance, that's my creative outlet. And I find that the way that I feel after I dance after I go to a dance class I do contemporary dance is similar to the way I feel after I've done a Neurofeedback session. So it's finding, what is the best way for you to tap into your flow state really, because SMR is actually similar to the flow state. So there's there's high tech ways of hacking it. There's low tech ways of hacking it. You just have to find what works for you really?

An SMR is a brainwave frequency.

Yeah, it's called the sensory motor rhythm.

Quite. It's quite fast, isn't it?

It's quite, it's actually slow beta. It's low beta, basically. Yeah. So it's in between the alpha state and the beta state?

Yeah. Yeah, I think because I've, I was speaking to Dr. Patrick Porter, about that. When I'm playing with my brain tap. There's some sessions on there, too, for SMR training. Yeah. Yeah. And so So doing that if you regularly do SMR training, so it's kind of like it's crossing that line, right? Where beta? For people listening, a beta brainwave state, it's kind of like we are now right, where you're concentrating, you're interacting. But if you go too fast into beta, it can be very high stress. Anxious. Yeah, alpha. Yeah. And alpha is kind of dropping more into that creativity. So here was sort of straddling, almost between the two. So is that going to achieve that focus with creativity that will,

creativity possibly, but it's more of the kind of calm focus is kind of the where the calm focus state. So the the ability to tolerate more stress, that sort of thing, getting down into the alpha, the low alpha frequency, you might get a bit more creative, but then you're going to be quite kind of, almost kind of in an altered state of awareness at that point. But it's not just getting into the state, what we find the most flexible brain see the more most resilient brains, they're actually good at not getting stuck. So you can get stuck in alpha people who have depression can be idling too much. People who have anxiety can have too much high beta. So it's actually the ability to to flexibly change states is so important. Personally, for me, that's I think, why dance is so good, because it's a brain workout, but also it's a body workout. And then once you're doing the choreography in your in your flow, you're you're switching brain states quite a bit. So anything, any activity like that, that people find that they enjoy, can potentially do a similar thing. And neurofeedback is great, but of course, it's very expensive, and it's very fiddly. So these other ways that we can kind of access those. Those brain skills are really valuable.

Yeah, interesting. And do you what about do you do you use other forms of breathwork or things like cold exposure, for example, in relation to this and other Wim Hof style breathing? What are your thoughts around that?

Yeah, so I do I do all of that stuff, depending on the person. It depends on how much they can handle some of my patients. When they've had a patient who came to me they were already doing Wim Hof. But for them, they were too depleted. That was Wim Hof is what I call a building practice. It's a wonderful building practice. But if you're in the depleted state, it's not the time to do those building practices. So you really have to match the practice not just to the person but to the phase of their journey that they're in I find so for example, co therapy can be really, really useful for people with forms of chronic pain that involve what we call a central sensitization, which is the nervous system as an out of out of proportion response. adds to the biological pain signal. But too much too soon can basically traumatise the nervous system and make them more people more fatigued. So, you know, before we do ice baths, we do cold bath, or you get a little bit of your body into the bath, or you do a cold shower. So the hot and cold can be really beneficial if it's tailored to the person I thought.

So you build up slowly and start doing like, effectively a cold bath or a warm one, then reducing to cold then but not in the same same session, presumably exposing themselves to either increasing amounts of cold or increasing the length of call duration. Correct.

Correct. And so same with sauna so I recommend sauna a lot of times as well. But again, it's it too much stress, any type of too much stress can create DNA damage and free radical damage. So it's whether it's cold stress, heat stress. So again, it's finding the right level of that stress. And there's also a people like why do people like doing a small sauna session? It's harder, it's the hard sell is always the cold water. But it's an easier sell. Sometimes when I have people with treatment, resistant chronic pain, and they're trying a lot of other things in cold water therapy, it's free. So you know before we go to something like ketamine therapy, which is where we do an IV infusion of ketamine, which is a medication used to induce an altered state of consciousness in this case, and as a pain reliever. It's a novel medicine, another novel medicine we use now, but it's very effective, but it's very expensive. We could do something like hot water therapy as the medical cannabis. And a lot of times that gets them to where they need to be.

So when you're using ketamine, they are talking about it and using that altered state. For what purpose are you then going to engage in some kind of therapy session with the individual?

Yes, not myself personally, but we have trained psychotherapist. So So ketamine psychotherapy is is a treatment we can do now in the UK for treatment resistant chronic pain, and for treatment resistant depression. So there's a biological component. So even if you did, so the the most the famous and experienced ketamine doctor is a professor at Oxford. And he actually in his clinic, they don't use any therapy, they just use the biological method of of treating patients with depression with ketamine. And it's actually quite effective. But it's more effective when you add the psychotherapy component. Because what happens when you're in the session, and you have this altered state experience where you have a dissociation at these higher doses is then you you can have some insights sometimes and those integrating those insights and kind of unpacking the boxes in the brain, so to speak, and looking in them and kind of integrating those boxes is very beneficial. So ideally, it's both together.

So it's sort of helping you create that observer effect.

Is that what you're saying? That's right. That's right. Yeah.

Which is actually quite hard. I remember when I was going through my own journey, that psychotherapy actually developing that sense of being the observer really took practice, it take it takes, exactly accelerates it.

It accelerated and there's a biological antidepressant effect and ATP in effect right away as well. Yeah, hello,

just while you're having that infusion, or does it last after the event,

it laughs But every person is different. So for chronic pain, for example, you might have to talk people up every two or three weeks, or maybe every two or three months. And same with depression. Some people can get months and months out of after they've had a few sessions, and they're stable, they can get longer and longer periods of time of remission of their depression symptoms, but sometimes you need to top up. So it's not a permanent cure. But as you said, it's more quick antidepressant effect. It lasts for a while, and then alongside of the observer effect and learning to live alongside the depression rather than having it consume your whole person

was really interesting, because as soon as you teach stuff like that, right, you can't unlearn things. That's why I think it's so useful. Now you have that in your toolbox. Are there any side effects?

When you choose the patients? Well, they're actually very well tolerated. But of course, you have to make patients comfortable, they have to be comfortable with some, you know, that altered state experience. So it's done in obviously in a medical setting, which is very safe and very reassuring for the patient. So when it's done that way, there's there's very little side effects. But you know, obviously with any medication, you have to choose the patient's carefully and, of course, that they're only experts.

You find the right person. What about do you use any kind of psychedelics at all?

So ketamine is considered a form of psychedelic assisted psychotherapy. It's the only one that we can you legally use now in the UK, but of course there are many others. So many of my patients have have gone through psychedelic assisted psychotherapy in various forms outside of the UK where it is legal, and it can be incredibly transformative. Are people so and that's one of my areas of research interest is psilocybin, which is a magic mushroom extract. And also things like ayahuasca, which is the main, one of the main ingredients is DMT, from the vine in the Amazon, and there's also some, some others as well. So there's a lot of ongoing studies here in the UK using psilocybin and DMT derived plants for things like PTSD, eating disorders, anxiety, depression, with some promising initial results. But of course,

what you can produce naturally through breathwork if you're if you're doing correctly,

yeah, there's no big studies on that. But there's, you know, there's, there's some, you know, potential there, we think we're producing natural DMT that is something that we've produced, we produce naturally as well, you're exactly right. So it's, it's, you know, using these substances in a safe way, in a really responsible way, it's also really important because I've also, you know, I'm involved in the healing community for many years. So of course, I've also seen it go wrong, where people use this like, go on a psychedelic journey, and it just has gone wrong for multiple reasons. And sometimes it can make people more traumatised. So it has to be done in such a safely held container. And of course, here in the UK, it has to be just ketamine, we can't use those other substances yet. But some of my patients have gone to the Netherlands to do personal growth retreats with psilocybin, or gone to the Caribbean, where they can do those retreats now, or Costa Rica, where you can do Ayahuasca retreats, or the Amazon. So I do have a lot of experience working with people and helping them with the integration of those experiences, and they can be really life changing. But of course, you got to do the integration work. Otherwise, it's just the peak experience. And it's just fleeting. And holding the set, and the setting in a really safe container is just really important.

And also that reintegration. From what I've heard, I haven't been out to the Netherlands and done it myself. I've thought about it. But I know that people I've spoken to said actually, it's almost then very difficult coming into what we perceive as sort of the rat race here. That's right, it can be difficult making that transition

back, it can be really difficult making that transition back, you're absolutely right. And the integration is is what's really lacking in a lot of these kind of, you know, settings. Some people do it really well, this guy than the other one, do it really, really well. But you know, there's other settings, especially one of the underground settings, where it's a huge group of people who are doing it in an underground setting, there's not a lot of oversight, they're not medically trained, they're not psychotherapist, they're trying to do the best they can, but they might be doing huge amounts of people in a group and then just sending them away at the end of a weekend. You know, without that integration work, and it can, it can really leave people in a really tricky spot at the best of the worst that can lead people quite distressed. So I think it is really, really important. And you can also have things unexpected things happen when you when you you know have these altered state experiences that you don't expect or things that feel very real, but they're they're not real. And it's having someone who is trained like a psychotherapist, who's trained to kind of help you unpack all of that, not just once, but on a period of time going forward at intervals. That's so healing help you

and with, like ayahuasca, for example, I don't know whether it's because I just seen things like this on social media, where it just and it was it Cambo that a lot of people were using where we put this kind of poison into the arm and there's so much purging people just like, you know, basically throwing up and it doesn't actually look particularly pleasant. Is that normal? Is that in these extreme doses? No, it's

I was good. So cannabis, very different. Cambo is actually more of an opioid like compound. It's not a psychedelic. We know a lot less about Cumbo. Actually, it has a lot less research, but I was good, you know, the DMT kind of analogue from what has lots of other plant compounds as well, anyone who's an Ayahuasca fiskardo It's going to be like, it's not just DMT Yeah, that's true. It's not, but when it you know, the content that we study, primarily is DMT from it. But the basically, when we when you use the substance, like ayahuasca, it's not going to be a recreational experience. So these are not drugs that are abused because with Ayahuasca, for example, yeah, there's a lot of throwing up and vomiting that most people experience when they do an Ayahuasca ceremony. It's in the traditional use in a lot of the traditional tribes who have used this in the Amazon Basin, for example, and throughout Central America, they consider that part of the, the the journey that someone goes on when they when they take one of these sacred plants, but it's certainly not a pleasant experience for a lot of people. It can be very transformative, but I haven't met many people who said, Oh, yeah, you know, I Had a great time going to the Ayahuasca retreat, it is a big party. It's not that kind of plant medicine.

And what about when it's being used in a medical setting? Or you micro dosing you still expecting to have that, like, is that a necessary part of it and what's causing that former thing effectively, the purging of memories and things and experiences or is actually just, it is physiologically making you feel nauseous?

Well, when the DMT is being studied in different analogue forms, not Ayahuasca brew, because you can't really make Ayahuasca brew into a medicine that standardised because there's so many things in there, and every tribe makes their Ayahuasca brew differently, actually, depending on the native vines and plants that are in that local ecosystem. So when you're studying DMT, you can give people DMT, through intravenous, for example, just pure DMT. No, usually you don't get the vomiting just from pure DMT. But it's a very profound, it's almost instant altered state experience. And people have very altered states with DMT. In a medical setting. There's a great book by a University of Arizona professor called Rick Strauss. And it's called the Spirit DMT, the spirit molecule, and it's basically chronically has researched with DMT. And it's, if anyone's interested, it's fascinating read. And, you know, people can have on DMT, they've had all kinds of interesting experiences of thinking that they've contacted other entities. And there's all I mean, you know, I'm a scientist. So I'm just, we don't know exactly what these things mean. But people can have very altered state experiences and very similar kinds of experiences on the same substance, substance. It's the same with masculine derived compounds. Like in traditional use cultures, for example, you see a lot of the same types of visions coming from pod as you can get sometimes with the San Pedro even though it's completely different culture, because mescaline is the one of the main psychoactive ingredients in both of those cacti.

Interesting, yeah. And honourable kind of not not actually saying. Let's say more legal, no, shall we say? What are your thoughts around methylene blue for enhancing energy and concentration and mitochondrial health?

I've never used it. And I can't say I know much about it. But I am not aware that there's any good big research on it. Okay, interesting.

Before you go, one of the last thing, we talked there about your son or symptom relief, your three r's and relief, your recovery. And then the last one is, is the resiliency part of this is an integration of practices. But you mentioned offline, that gut health is also really an important part of this. What have you found there? It is interesting, like with mood disorders, with anxiety, we're just learning more and more about the microbiome and how it's affecting things.

Yeah, so I would say most of my patients who we go on to do functional medicine testing for the gut, that's one of my I only do functional medicine testing, when I think it's going to change what I do for someone because it gets really expensive. But I do comprehensive stool analysis panels a lot in my practice. And what we find some of the most common things we find are leaky gut. So leaky gut is the scientific term is intestinal permeability. And when you have altered intestinal permeability, you have proteins getting in where they shouldn't, you have undigested proteins, if there's not enough stomach acid, for example, not even getting broken down, and then the whole protein is going through, you can have bugs you can have toxins going through. And that creates a lot of disturbance in the immune system. So a lot of times people suffering from a mood disorder or obviously chronic fatigue, fibromyalgia, long COVID You see a lot of disturbance in the in the gut, the access, and when you start to improve and reduce the intestinal permeability, reduce the leaky gut, get rid of the baddies, as I say, the small bowel intestinal overgrowth is a lot of SIBO that we find a lot of kind of dysregulated microbiome, lack of short chain fatty acids, then people start to improve their symptoms to improve. So working with the gut is pretty central to a lot of these chronic conditions, in my opinion.

Really important, right? I'm sure learning Yeah. Do you have any affiliate link to where people can find you? I know you have a new book coming out. Do you have a particular morning routine that you use to keep your brain and your health? You've kept yourself really, really healthy that you use your focus or concentration and particularly nootropics anything exciting that you want to share?

Well, I have to say I had a more impressive one before I had a two year olds. Now I've already

the morning routine goes out the window, right?

You have a baby. So that was a full time working person with a two year old. My morning routine is a lot different So now I've just basically gone back to the bare basics. So I have a really healthy breakfast. I have wheat free whole grain sourdough bread, I have organic coffee, I have a bunch of flax. And that's like a good morning breakfast to me and usually some some yoghurt and fruit. So good morning breakfast, that's key, I usually take a few minutes when I'm waking up to do a short Mind Body practice before I kind of get out of bed if my toddler allows me to. And then a lot of my morning routine, and that's it's just basically that now and then just is getting my toddler and to be honest, it just mindfully enjoying him before I get them off to preschool. That's what I have found is is a joy for me at this point in my life. So I've just decided, You know what, I don't have time for a big morning routine anymore. I'm just going to embrace these beautiful little moments with my little guy. And for me, that actually brings me a lot of joy in the morning. So by lunchtime, I have a feeling frazzled, I find that I do. Because after he's off, I do take a few minutes and go for a walk in the woods and do a breathing exercise for about 510 minutes. And that is basically shifted with some of my morning routine to my lunch routine.

As it does but it's you know, what is what you're saying? Now I just love because it's so important to enjoy the magic, right? It's just beautiful and and it goes too quickly. Right having had like three of my own and then growing up now my youngest is 10 and a half. Like it's so magical. Why would you try and resist that right? I just such a massive fan of going with the flow, right? And as you say, as she gives you that mindfulness because you can a toddler two year old is so present. That's the thing. There's so Presents Amazing. They teach.

They do they do and that's it. It's just going with the flow. And I've learned, you know, I was so upset about my morning routine at first, you know, getting into the routine of being a new mom. And then I just thought this is it's never going to be the way that it is changed. It's just part of life. So I did have to change what my morning routine what I think a good morning routine looks like now.

And just adapt. Yeah, amazing. Well, when is your book out? Tell us when is your book? Where can people find you?

Yeah. So the book is as an April, the second book, my current book is the CBD Bible and the cannabis, the cannabis book that is out currently. And that could be found pretty much any major bookstore on Amazon. The new one is on April. I don't know what date yet. But people can find me and the links to the book and so forth at resilience dot clinic. There's also linked to the medical practice for people who want to get in touch about being a patient or people who are already well and don't need me for that. There's just free resources and resilience tips and stuff like that.

Amazing. We'll link to all of that in the show notes. Thank you so much. I've really really enjoyed this conversation. I've learned so much. I think it's gonna be one I'm gonna go back and listen to myself. Oh,

thank you. It's been so nice, Angela.

Amazing. Thank you. Thank you for listening to today's show and for your interest in health optimization for high performance. If you're new to my podcast, you may be interested to know that you can get a free health score and report complete with personalised recommendations on how to optimise your sleep, nutrition fitness and resilience in the top link in the show notes below. I hope you enjoyed this episode. Links to everything we talked about are also in the show notes and if you enjoyed today's show, please subscribe for more