Epigenetics of low back pain: inflammation, stress and sleep

So epigenetics kind of speaks to that. It's the various things that turn genes on or off the genes that you already have. So your hard coding is your genetics and your genetics doesn't necessarily determine who and what you're going to be as much as the things that you decide to do with your life and expose yourself to that turns those genes on or off. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales. Hey guys, this is Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast.

Thanks for joining the Movement Movement. Today I'm going to have on a guest. This is Philip Snow. He's been on one time before and you heard a little snippet of what we're going to talk about or stuff we're going to talk about. Now, again, full disclosure, just as in the other episode, Philip, as well as Ben Ramos and I, are part of an online continuing education platform that we formulated ourselves to scratch our own itch because we want online continuing education to be game-changing. And this is going to be game-changing, as you're going to tell by this interview here. So I'm going to have Philip kind of figure out and categorize and talk about some of the, all, all the stuff that is new in regards to spines that we, a lot of times as, as clinicians do not have time to go ahead and learn because he's digging through the research for us. If this is your first time on the podcast, thank you so much for joining me. There are a ton of things in the archives if you're interested. And I, my personal experience through podcasting so far is that I can tell you that I practice very differently now than what I did when I started the podcast. And, uh, as I learned from each person is there's many different ways to attack the same problem, some a little bit more fruitful than others. And it's really dependent upon what the person accepts and what the person will tolerate.

But if you find the right dosage and the right thing, they resolve very quickly. And by that, I mean, sometimes within under five minutes or so, and they can control their own symptoms, which then we, um, we, we can empower the patient better. So patients, if you're listening to this, uh, this podcast, the intention is actually to blend the line between medical and, uh, lay public. So you guys can understand some of the more complex topics that we really want you to understand because we think that you deserve to know, but also too, it helps unveil the curtain, uh, the mystery that is how to get over some of these conditions that you get, that you have. And this one, we're going to go over mainly back related stuff. Now, again, full disclosure, we do have that course and the, over the next few weeks, I'm going to be interviewing the presenters that are in the course. We pay these presenters to be, uh, to submit content to the course. All right. These presenters are legit. Okay. Completely legit. And we're going to have, there's a lot more of the people that the people who are writing books, the people who are putting on, uh, uh, uh, workshops and so on. Like those are the kind of people we're targeting to get in here, as well as the hidden gems that you probably have not heard of. But when you hear them, you're going to think, damn, why aren't they actually having workshops and books? It's because they haven't done it yet. So, um, I think that the course is a complete game changer when it comes to practice. Cause again, it's, uh, as I, as I think about my entire journey through this podcast, I, I see that my practice style has changed and I'm starting to realize the things that I didn't know even existed and they're very helpful. I plug them in when needed. So, um, as you go through that pot, as you go through the CE course, you're going to find some of those as well. There's a ton of clinical gold nuggets in there. You do get 12 CEs for it, but I'm telling you, don't think the CEs think about how this is going to game change. This is going to literally change the game about how you practice. And it's, it's, it's like the blinders came off. Okay. So as we go into Phillips interview today, um, just know that, uh, there is more of him. There's four hours of him actually in the course. Cause I think he was a big game changer. And as, um, my past intern, Jeremy Dinkins would probably say that that doing that course literally changed the way he's going to practice as well as, uh, I, I did, uh, I did a little website consult with, uh, with another doc up in Portland and he said he took his course as well, the fix your own back course. And he said it, it changed the game form as well. And if you want to have some raving fans in regards to back and disc conditions, Phillips is the one to learn it from. So he's very good at what he does and he breaks it down in a very simple way. So the fix your own back is the workshop and I've personally been twice. It's been a game changer. So, uh, before we go into the interview, let me share a little bit about myself because I do believe that you should know your hosts and hopefully you should like your house. So, um, by the way, on a personal note, I've been really attempting to slow down. Like, I think you get the best information from me when I'm a little bit more loose lipped and I can, and I can do some little, little bit profanity, but I'm trying to calm it. So, um, hopefully you hear that from me over the next few months. And I do believe that as I'm listening to all these other experts and even comedians and presenters and stuff, if they're engaging, they don't always need to cuss. And sometimes I, I tend to get a little loose lipped on that. So I'm trying to improve that for everybody. So hopefully I'm doing a good job. Let's get to the story. And then the interview, you know, one story I actually forgot about for a very long time was, so when I was a kid, so I'm about 36 now. And if you're around my age, there was a time in life where you actually, if you went to McDonald's, there was 29 cent hamburgers on certain days or 39 cent cheeseburgers on another day. And there was a fish filet and a Friday, I think. And they're all like, there are certain prices, like obviously like they were 89 cents, 99 cents, something like that typically. So when I was back growing up, like I didn't have a ton of money, like my family wasn't poor or anything.

We didn't live in the sticks or anything, but we'd go over there from school and we'd try to get ourselves a cheeseburger or a hamburger or something. So you go on that certain day, you're like, you know what? Like I'm going to get myself a cheeseburger. But the thing was that, so I'm lactose intolerant, if you guys know me. So I can either choose to take a lactate pill or just simply not eat cheese. Not a big deal, right? So I pull up to the window there and I'm like, hey, can I get a cheeseburger with no cheese? Because it was 39 cent cheeseburger day. And they're like, no, no, no, you can't do that. I said, why not?

They said, cause that's a hamburger and hamburgers cost 89 cents today. I said, I know, but can I just get a cheeseburger with no cheese? And they're like, no, no, you can't do that. I'm like, I'm like, what's the difference? You just take the cheese off. They're like, well, we can't do that. We have to ring it up as a hamburger. I said, okay, fine. Can you give me a couple of cheeseburgers? So I took the cheese and took it off. And obviously that cheese is like plastic now anyways. So by the way, I don't eat McDonald's anymore. I think it's been a very long time. Um, gosh, probably been like 10 years, 15 years since I had a cheeseburger from McDonald's. But anyway, it's probably why I forgot it for so long. But yeah, cheeseburger, no cheese. Apparently can't do that because it's a different price. It's a different item. Damn it. You can't just put that double cheese on someone else, you know, like someone else can be really happy with that other piece of cheese. So it makes me kind of think maybe they didn't make it to order, you know, because it was already done. They didn't want to take the cheese off anyways. They go cheeseburger, no cheese. Let's get into the content and the revolution. Yeah. I would, uh, put together these little old man rap, uh, songs about, um, about the dog and his, uh, adventures in, uh, revolutionary war times. And, um, um, among those would be a fife and drum corps, uh, fife and drum, uh, uh, uh, like a parade. So general Pfeiffer's won, or sorry, general, uh, uh, Chester Puppers won many a battles and, uh, was saluted by a Pfeiffer, Pfeiffer, uh, 21 Pfeiffle salute.

F-I-F-E. God damn it. Get it right, man. Hang on. I'll, uh, put her out. All right. Let's go. So I took the liberty of actually recording part of, of general Pfeiffer's or general Chester Puppers story in case you want me to keep that. Uh, that's fine with me. I don't care. Uh, they just, so everyone knows we're human interest. That's right. Um, he, I bet all of your passwords are something about Chester and general and Puppers and that was Phillip's old puppy. No, a lot of my, uh, my, uh, second stage security questions are there. Oh, right, right. Along with your, your car being your first car's color. Yeah, exactly.

All the stuff you can really find on online anyway. So, um, okay, well, yeah, so I took the liberty to start it, I guess. Uh, so we'll just, this is an atypical starting point, but that was good. I liked that. Everyone likes to know the person behind the mic. Right on. Um, so this is Phillip Snell, Dr. Phillip Snell. You've been on before and, uh, I introduced you as being a partner of me and Ben's in the pro chiropractic online CE course. And you are number two of the series of interviewing the presenters. Uh, so I thought you can go into a little bit about, uh, we'll, we'll, we'll go through a quick about who you are and how you got into thinking the way that you do really.

All right. Simple. By the way, I don't, I don't intend us ever interviewing me and Ben about ethics. Yeah, no doubt. No doubt. We can go, we go some, uh, interesting places there. Uh, well, I, as you said, I am a chiropractor, uh, in clinical practice in Portland, Oregon. My focus is on, um, sports med injuries and rehab. Um, my practice, like many people's, it's been, um, guided not only by my education, but also by my experience. Um, a major, uh, thing that happened to me that kind of put me on the trajectory that I'm on, uh, today happened, uh, close to 20 years ago when I had a herniated disc in my back, um, in my first year in clinical practice. And, um, it was in the process of trying to figure out how, uh, one, uh, learning that the things that I had learned in chiropractic school, um, at a very good science-based school, um, University of Western States, uh, that time Western States Chiropractic College, uh, really did not prepare me to be able to deal with that particular type of injury. And I, um, struggled with it for a good long time. And like many people that have that kind of injury was amazed at the level of pain, um, that I could feel and amazed at how it, um, uh, kind of really seemed to erode the base of my security systems. Uh, you start to wonder, you know, whether or not you're going to be able to make a living, take care of your family, provide for your child, uh, et cetera, et cetera. And, um, in my process of trying to figure out what the heck to do about all of that, um, I came across the research, Stuart McGill, and then that kind of put me on more of a movement and, uh, exercise-based rehab, uh, model instead of a passive care model.

And that's where my practice has gone over the years and it's taken me into other online exploits. Um, more specifically about the thing that is, the, the bit of that or the aspect of that that's being represented on the Prochiro online site in this first module that we're releasing is, uh, two hour, um, two hours of deep diving, uh, the epigenetic influences, uh, uh, that, um, can, and, uh, uh, the epigenetic aspects of chronic pain and specifically, uh, discogenic chronic pain. So, uh, yeah. So, uh, go ahead. So epigenetics then, um, actually I was curious, did you, before you ran into McGill's, did you find McKenzie's? Uh, I found, really got into McKenzie's stuff a little bit after McGill, but it was, you know, at that point, McGill was kind of given a hat tip towards McKenzie's stuff. So what did you find that was even, what, would, did anything work until you hit that point or what were you trying? Not, uh, not only temporarily, only very temporarily, like, you know, 20 minutes of relief from manipulation of your back and that it was a coin toss as to whether or not with manipulation, I was going to get remarkably worse or remarkably better. Um, but never really knowing, uh, what was going on was a problem as well, as you know, with working with your patients. It's that not knowing, um, space that the brain starts to fill in all of that gray area with the what ifs. And that's where we start to get into all of our, uh, lovely pain neuroscience dialogues too, about how we probably should do a better job of making sure that in those areas of gray, we give patients some coloring tools to be able to, uh, uh, highlight those appropriately with non-noticevic, um, messages and, and ideas about what, uh, might be going on with their back.

So, um, sometimes that thing is an actual frank structural injury that needs to be addressed and triage that such dealt with as an inflammatory problem. Uh, explain that in a simple way that you say to patients to fill in the gray areas. Uh, well, uh, that, that would of course depend on the, the presenting patient what was, uh, driving their particular issue. But if, if that particular patient say, um, to go with the last thing I was talking about there, if my exam suggested that they had, um, an ongoing nociceptive driver say at, uh, potentially at a lumbar disc, um, then I would, uh, tell them that that's what I think is going on. Um, but I would hasten to add very quickly that the process can heal once you understand the mechanism of injury and you stop doing that for a while.

And then going forward, it's about, uh, developing, uh, muscular control of that particular area and getting stronger overall and being active consistently throughout a life. And as we'll talk, uh, in more depth about the epigenetic influence that, uh, those other things that can be done that may actually be even more important, uh, have to do with, uh, things like sleep, uh, things like diet, uh, things like exercise and other lifestyle things like, uh, smoking, alcohol consumption and such. Yeah. I'm just kind of curious actually, cause, uh, I mean, I've been to your course a couple of times and the, I know I've gotten this when people have come in to see me sometimes, uh, they look at you and what you do and they're like, is this, is, this isn't chiropractic. What is this? Like, what are you doing? Like, um, what's the response of patients that you get that, um, kind of follow the methodology that you're, that you're using, you know, you use McKinsey stuff and, uh, McGill stuff and, um, pain science and some DNS, right? And sure. So what's their, go ahead. Yeah. People, um, I, I consider myself, you know, fair, much, uh, a mixed bag in the type of work that I do, but that's also something of a product of the state that I practice in as well.

And the school within that state, I mean, the scope of practice, um, for chiropractic, uh, is the broadest in state of Oregon, um, uh, the broadest in the U S. Um, and, uh, you know, we do everything in our training from minor surgery to, um, gynecology, um, obstetrics, uh, proctology, uh, proctology. And, um, a lot of people, even, you know, local folks that leave here in Oregon that aren't aware of that are quite surprised to hear that that's part of the training, uh, and some docs that want to move into Oregon from other states, uh, are also quite surprised to find that because they have to pass those board exams and it becomes sort of a backend regulatory way of, um, uh, managing who practices chiro in this particular state. But the, the patients, I, I will say, uh, over the years, the majority of my referral system has been built through, uh, local, um, MDs, clinical, uh, internists and family practice docs. And a lot of those patients, uh, I've, I've had some patients that I've treated two, three, four times and they still don't know I'm a chiropractor and I'm cool with that. Um, it might be, I treat someone two, three, four times and don't find that manipulation is the, the thing that, uh, I need to be leading with right now, or I'm getting very good effects from other things. And I don't necessarily hold, uh, a, a, um, a belief system around, uh, chiropractic that suggests that joints have to be manipulated, mobilized, um, by another individual in order to maintain health there. Uh, I think we can teach people how to move it themselves. As I say, uh, as I say to patients all the time, a joint to be healthy, it's gotta be moved and I can move it or you can move it, but I come with a price.

So, um, tell me about epigenetics because I know that's what you're, uh, that you're just, you just nod at the bit. Probably the, probably the, uh, the easiest way for most of us to conceptualize it based on the, the physiology and pathology courses that we took in school is, uh, you've got, you remember genotype and phenotype and, uh, that genotype is what, you know, your genetics are and phenotype is what, uh, is sort of that, uh, um, uh, exposure to whatever life, lifestyle, diet, exercise things, um, will cause those genetics to express themselves or not. Um, so epigenetics kind of speaks to that.

It's the various things that turn genes on or off the genes that you already have. So your hard, your hard coding is your genetics and your genetics doesn't necessarily determine who and what you're going to be, um, as much as the things that you decide to do with your life and expose yourself to that turns those genes on or off. And, uh, some of those genes can be, um, bigger in genes and some of them can be smaller in genes. Um, they can typically bigger in genes and smaller in genes have a, uh, relationship to each other in the way that, uh, different signals are received by cells that turn on or off those genes. So, uh, the, the epigenetic part is, uh, I think probably in the next few years, we're going to hear enough about all of this. We're probably all going to start calling it a fad. Uh, cause that seems to be the way things go, isn't it? Yeah. The science first comes out, everybody gets really interested. And then when everybody starts talking about it, then it's kind of like your favorite band when you were in college, you know, and you knew them when they were cool. Wait, so what was your favorite band in college anyways? I don't know. R.E.M. was up there. I really liked R.E.M. Oh, R.E.M. The, uh, um, that, what is it? What did R.E.M. mean? I know it was an acronym. Well, rapid eye movement. Um, but I don't know what, what, what the, uh, the Athens, Georgia band had. I liked Athens, Georgia. I liked the B-52s and the R.E.M. The B-52s? Did they have anything beyond those couple? Oh, Jesus, man. Oh, God. There's, there. You gotta hip yourself. I, I really hip myself. I think there's, there's a couple songs just in existence that I wish I would never hear again. And Rock Lobster is one of them. Um, and, uh, there was the other one. What is the, uh, they, they did another one, which is, it was just too much trouble. It just, it set me over the edge.

It, it, it was my trigger for my epigenetics episode. Yeah, there you go. So, um, what kind of things can I, so actually question, once you turn on a gene or turn on an expression, can you turn it off? Absolutely. Okay. Uh, what are, what are the common triggers? And then, um, how would you then decrease the expression? Well, um, let's take an example more specifically for, um, back pain and maybe even more specifically for discogenic back pain. Um, the genetics that have been most robustly associated with pain, um, are genes that control the, the inflammatory process. And of the inflammatory cytokines that tend to express around an injured disc, the one that is thought to be, um, one of the first, if not the first and the most important one that kind of kicks off the inflammatory cascade is tumor necrosis factor alpha. That's TNF alpha. And the, that inflammatory cascade, um, locally and systemically, um, TNF alpha then stimulates release of three other cytokines, interleukin eight, uh, interleukin six and interleukin one beta. And all of those, um, you can envision this as your salt, pepper, garlic powder, and onion powder for your stew of the hot mess that an injured disc is. And you're going to see those, those flavoring adjuncts, um, in that particular stew, uh, when a person is hurting. Now, um, doesn't necessarily mean that a person who has an injury to those particular structures is going to be inundated in those stews. Some people have more, continue our analogy, salt, pepper, garlic powder, and onion powder in their cupboard and the, uh, and they don't have the shaker, um, uh, uh, calibrated part, part, uh, yeah, the shaker part on the top. The, uh, they just have the pouring part on the top. So when they try to put a little bit of those things in, they get a whole lot of that stuff instead of a little bit and they aren't able to meet it out.

Common restaurant joke in Portland, I'm sure. Yep. Well, I'm, I'm, I'm literally right now. I've got a, uh, uh, beef brisket on my Traeger and, um, I'm watching my clock cause I've got to get down there when it hits 170 degrees and pull it and wrap that sucker for the last, uh, five hours of cooking. But, uh, anyway, I digress. Uh, everyone gets more excited about Traegers and stuff and smoking than really anything else we talk about. Yeah, this is true. This is, this is true. You know, if there are comments on this conversation, wherever it is, I guarantee the majority of them will be about my dog and probably, you know, as, as I go through, like, so I look at the audio on the other side when I'm just checking things out and, uh, I try to pull a nice snippet that I know is like a good intro. And so usually you can tell where someone gets excited because there's spikes in the audio, right? I guarantee you all those spikes are going to be talking about dogs or talking about briskets.

Yeah. Yeah. We'll, we'll fit cats in here so that we get good numbers online. But, uh, where was I? So, uh, so a good example is that tumor necrosis alpha gene. Well, um, that gene or one of the genes that, um, uh, turns TNF on, uh, or off is, um, it's controlled somewhat by downstream processes associated with B12 metabolism. So let's say, and, and the people that are, uh, affected by that TNF alpha gene, um, uh, issue often genetically tend to be of Northern European stock and they tend to look a little bit like me, uh, redheaded and very light skin. And there are the, uh, the, the, the folks that we, you know, those of us in this camp know our skin tends to redden with some sun exposure instead of tan off. And if we, you know, we tend to have high histamine responses and things like that. So that's a reflection of that TNF alpha gene, uh, being preferentially expressed in that particular way in that genetic pool. Now, if you put, uh, since that's regulated by B12, if you put a vegetarian or a vegan diet on top of that same individual, then the B12 that normally would help to deacetylate, um, the, uh, the, the portions of the gene that turn it off, um, those things won't be present. And that person, when they are exposed to an inflammatory and so it'll tend to run, uh, faster and longer and harder than the average individual. So then, you know, and in regards to the, the two hours that are on our module that we've got here, um, part of what we discuss is how do we go in and evaluate that one in an individual in front of us? And two, how do we intervene at what points? And, uh, deep dive to try to help that person, not only in their current pain situation, but maybe to make a, uh, longer lasting, deeper impact on their quality of life.

So, so from when you're in clinic then with somebody and someone walks in and they say they're in tarlin or flexion and they can extend okay and you, you got to mechanically kind of desensitizing, do you then, do you then use an epigenetic approach immediately and talk about that kind of stuff? Or do you, you wait a little bit and, uh, wait until they're kind of like a non-responder or, uh, how does that usually go for you? Sort of, sort of along the lines of what you saw in the course when you came, um, so the, uh, part of the, the information here can be gleaned from the history, um, that the patient fills out for you and that you, uh, you flesh out in your conversation with them. And that's where a lot of these epigenetic issues where your suspicion comes out. You know, if we just look at the primary, um, points of entry that we'll have clinically for this, for dealing with this kind of stuff beyond pain, um, it could be, uh, systemic stress in that individual. Are they going through, um, you know, a, uh, a particularly difficult time in life? Is it something that they are, you know, are they, I don't know, are they losing a job or are they trying to meet a book deadline or something? Is it, it's going to be unremitting stress for a period of 18 year, years, or is it going to be an unremitting stress for the next 18 days? Um, that kind of stuff. So stress would be one, sleep and sleep quality, um, and getting inside of it and figuring out why, um, the sleep is, is disrupted beyond just saying, oh, I see you have an Ambien prescription. Well, you know, it looks like you're not sleeping well and then kind of scooting on with that, uh, diet looking for, uh, diets that are high and inflammatory, um, uh, in diets that are known to cause an increased inflammatory response, uh, diets high in, uh, simple carbohydrates, high in carbohydrates in general, uh, a hyperglycemic status in that particular individual hyper as opposed to hypo. Um, what's their alcohol intake? Are they smoking? Things of this sort. So I note those.

And then because most people, when they come to see people like you and me as chiros, they're not necessarily really there for, um, for a whole lot of deep diving into those particular areas. So sort of using motivational interviewing techniques with those patients, I might at that point in time say, Hey, I'm glad that we're getting some response here mechanically by doing our end range loading on our first visit by teaching you a little bit about, um, uh, lifting techniques and such and exposing you to some of that. But I do see that there might be some other areas here that this, um, that might be holding you back a little bit and we might want to save that for a conversation later. But since you're at a, you know, a one or a two today and you came in with an eight, then we're going to call that a good day. I'm not going to, you know, beat them over the head with that, um, right out of the gate. But in that individual, it's in the, in their history, they probably also have some other, maybe a previous knee injury or previous hip pain or previous shoulder issues. And we can link all of that back to the diet, the stress, the sleep, and all of those other things as well as the other, uh, issues in their life. You know, are they, uh, are they diabetic?

Are they pre-diabetic? Do they know, um, have they been tested? Uh, do they have family history of cancer? And does that worry them about the possibility that, you know, they, uh, they may have, uh, their mother died of cancer, of breast cancer, their grandmother died of breast cancer, and they're trying to figure out, you know, whether or not they want to be tested for, uh, the BRCA genes. Um, all of those things can factor into those, uh, those questions about the, the individual. And that kind of goes a little bit into an opinion shift that I've had as I've gotten deeper into this, which I'll go ahead and drop out there and we'll see where it goes. Um, there's a, a bit of a movement these days for, for us to look at the biggest things that take people off of this planet. Uh, those, those things, the, the, uh, biggest cardiovascular disease and cancer far and away, uh, those are the two biggest causes of death.

If stroke is high up there, Alzheimer's disease is now high up there as our baby boomer generation ages into that. Um, the, uh, uh, opioid epidemic interestingly has deaths due to, uh, opiate, uh, um, overindulgence, uh, has, uh, if memory serves recently overtook accidental, accidental, accidental death, things like car accidents is the number four cause for injury, uh, for, um, mortality. So if you look at all of those things that, um, tend to take people off of the planet except for, you know, um, uh, uh, an opiate, uh, compromise or a, um, uh, injury, uh, um, accidental death, if you, if you look at those major things, our, our current research is suggesting that we look at them from a metabolic perspective more. Um, our metabolic, um, you know, if we think about cancer and where that's gone, um, something like two thirds of cancers are, uh, tend to be diet related and associated, uh, highly with, uh, hyperglycemic status in the individual. Um, so if, uh, I'm thinking that chronic pain and a lot of what we don't know about chronic pain, if we look at it from a metabolic standpoint, um, if we look at it epigenetically, I think a lot of our current wonderings and head scratching and arguments that you hear on social media will go away. Um, because, uh, the same things, and we hear this anecdotally in people that change their diet and lifestyle significantly and they add more exercise, they eat fewer carbs. Um, they improve the, the, the profile of the fats that they eat. Um, they get a good amount of protein and they get a decent night's sleep. You hear anecdotally in talking to these people that their pain measures go down, the pain that they had in their knees in the morning when they wake up and they go down the stairs, isn't there anymore. The pain and recovery aspects, um, after exercise, uh, tends to get a lot better. I think, I think we might be just scratching the surface here of a, uh, a major watershed of information about pain management and looking at it from an epigenetic standpoint. Well, so, um, to your knowledge, is there any major, like, uh, I don't say companies, I, and, and I don't know if governmental would be the right word, but is there any major, uh, places that are attempting it to kind of blend that in or they still separating those, those, uh, morbidities with, um, separate from like just general fitness kind of thing, you know, I'm not really seeing it, Seb. Um, I mean, if you go on, uh, the last time that I did this on PubMed and just did a, uh, pulled a, uh, search for epigenetics and low back pain, um, when I last did that a few months ago, there were only three papers out there.

Um, now if you do epigenetics and pain, uh, you'll get a lot more because that pain starts to cross over then into a lot of autoimmune conditions where, um, we find that through diet, we can start to, uh, modulate those autoimmune conditions, uh, a bit better. So, um, yeah, I think, um, I think we're really, especially in our world of, of arthritis, joint pain, um, and spine related pain, we are really just getting into the pool. I'm kind of curious with, uh, that let's just say there's, so there's certain things that could be expressed of different severities. And, um, earlier when I, when I asked about, can it be reversed? I bet there's certain ones that people are like, yeah, I'll, don't give it a go. I'll see if I can reverse this thing via, uh, you know, de-expression.

Um, but other ones, it's like, it's like if you had, uh, um, cancer, it's like, huh? Okay. If I lose this one, then, you know, the, the loss is much greater than just suffering from back pain for a little bit. Um, is there, I don't know, what are your, what are your, what are your thoughts? I know with back pain, I feel like we can do it a little bit more, but with some of the other things, it might be a little freakier for people. Well, um, I don't quite get the thrust of the question, but I think if, as far as the, the, the research goes, it's harder to get money allocated to study pain than it is to study something that's going to kill you. And, uh, this, when you're studying something that can kill you, um, it's much easier to get allocation of resources. If there is some indication that there's a molecular pathway or metabolic pathway that can, can be manipulated pharmaceutically, because then of course you've got, um, the possibility of getting a proprietary drug and, you know, something that goes there, but there's not a lot of money in saying, you know, you need to get eight hours of sleep and you need to cut out, cut out your Twinkies for, and your soda for a bit. And, um, and brisket. Yeah. Brisket in the right amount at the right time and without carbs, uh, added to the whole process.

You're right. All keto. Uh, it's all about, uh, exposure and dosage with, with, uh, brisket really. Yeah, exactly. Like most things. So, so, so what's the, uh, when, when you're, when you're uncovering some of these other things like, uh, sleep and stress and, uh, you know, uh, alcohol and smoking and, and what are, at some point when you finally do get to a discussion with someone where you think it's an important part of their recovery, uh, what would be like the percentage that you've observed where people are like, yeah, I'll do that. And they just take it and run with it versus like a little bit more of a forced thrust. Uh, and then you have to put them with some type of like a coach or a counselor. You know what I mean? Well, for, for my patients, all of, all of my patients, again, you say coach and, you know, rather than a life coach or counselor, which I mean, you're in California and even though we're up in Oregon, we, uh, when we're not quite that far down the garden path yet where everybody needs a coach in order to figure out how to get their shoes on and go to work today. Well, we need a thing called ways to get us to work. So yeah, uh, yeah, the, um, hell, I don't know where we said, uh, uh, are people willing to run with it? Yeah, I think I find that, um, the degree to which people are wanting to run with it, uh, usually is directly correlated to their amount of time that they've been dealing with the issue. You know, it's a chronic issue and how severe the problem is, uh, in regards to a painful disc injury, it's often remarkably painful, like some of the worst pain that an individual is likely to feel in their life.

And, you know, they're, if they go, uh, their GP and they get told, oh yeah, this will pass and it, and it does, it gets better, but then it comes back and then it comes back again. And then they're not able to figure out a rhyme or a reason as to why it comes back when it comes back. So then they've lost their locus of control and they start looking around every corner for a clown to jump out and scare them and make their back seats up. Um, so it's, uh, I think the, uh, in this particular condition, people are much more motivated when they're wondering whether or not they're going to be able to, um, uh, take care of their kids and provide for their family or, and do all those things on their bucket list. Um, so do you have a case that comes to mind where you were able to, to implement, uh, a strategy in, in reduction of epigenetics with someone with a back condition? Um, and just kind of give me a little story with it. Sure. Um, I've worked with, um, uh, this would probably would tend to, to factor in more in the deconditioned, uh, patients that we tend to see. And in those individuals where they're, we've gone the full mechanical route, we've done all the good things, um, that we learned in the course, uh, and their pain level is remarkably down, but they keep having breakthrough episodes or they keep having breakthrough episodes of pain that, uh, aren't explained by mechanics. And we've already done our pain or a science education, and that doesn't seem to be working, uh, so well, more often than not, the biggest two things that I see that are pushing that is stress and sleep. And often those, um, blend quite nicely together. So your classic patient is not sleeping well because of work or life stress. Um, they have to get up and go to work early.

So they slam caffeine. There's a half life of 12 hours in that caffeination. So, uh, they're, uh, they get their, uh, their carb hit somewhere around, um, uh, 10 o'clock, uh, with their, uh, their coffee break and then another coffee in the afternoon at two or three o'clock. And then when they get home, they slam a little, uh, uh, uh, uh, uh, alcohol to try to take the edge off of the day and the edge off caffeine. So then they go to sleep because the alcohol helps them get to sleep. And yet, uh, about three hours later after they've been asleep for a while, that alcohol metabolism starts to cause cortisol release. And now they wake up with what's commonly referred to as the holiday heart. And they've got a, um, uh, rapid pulse rate. Um, they're feeling a little bit anxious and they cannot get back to sleep. So what do they do at that point at three in the morning as they're staring at ceiling where they perseverate about all of those stressful things that they, um, didn't get done during the day and they didn't write down. So they're not organized. And then they wake up the next morning, continue to do the same thing. And then over time, what does that do? The stress, the diet, the, uh, lifestyle issues starts to cause, uh, often they'll wind up presenting with IBS as well. So now their gut permeability is off and they're not, uh, getting as much nutritional value from the food they are eating. And, um, maybe they're grabbing more processed stuff and they're eating less raw stuff. So they're not getting magnesium and most common nutritional deficiency in the, uh, Western world is magnesium deficiency.

So now magnesium deficiency can cause palpitations and heart. And you add all of that to the process and you have the possibility for someone to have a actual clinical emergency because they don't have enough, uh, they have palpitations and arrhythmias that they can't control anymore. I can, I can see this as a whole, uh, flow chart in the, in the next, um, actually kind of funny. I bet a lot of people like since they, I don't, I don't personally believe in, in eye watches or whatever they have people now have their wrist all the time. Uh, but it takes your pulse and I bet if people check that, they probably got the holiday hard every once in a while and they can't, it checks your pulse all night, doesn't it?

Yeah. So we can kind of check that thing. Yeah. Um, just a thought as we start to wrap up epigenetics then, um, I thought you would be really good when I asked about this because, uh, me and Ben talked a little bit about the content of the course last time on, on pro chiropractic online. And, um, we're kind of going down the route of the flexion intolerant back. And I mentioned to you both that, that if, if I had a course like this, when I first got out of school, it would have been changed, changing the game. And, uh, Jeremy, who, uh, went to your fixture on back course in LA, he said, did just change the game for him.

So you seem to be very good at putting pieces together. So of the core of the pieces of the course that we have, um, is there, let's just see if you can figure out a way to, to simplify how, uh, a viewer would, would use the pain science, the epigenetics, the, uh, examination that you spoke about. We have the nutrition and, uh, let's just not bother with the ethics portion for, uh, me and Ben and, um, and, and Cody's, uh, uh, loading process. So since you're already kind of, you should, uh, I don't, yeah, it was, uh, we, we said we were, we were scared to death to touch another patient after reading those things off Nick Mick. But, uh, yeah, I, uh, I'm hoping that we don't have to do that very often anymore, but, uh, how would you kind of wrap that up and put a bow on it, uh, for the, for the listener who, uh, wants to really be good at flexion intolerant backs? Oh, uh, well, uh, as we, as we speak in the course, um, there, there is some disagreement out there about whether or not we should be talking about, uh, whether or not a disc is injured if we think it is. Um, if I went to a, a doctor and found out that he thought that I had a particular condition that was related to what I was presenting for and, uh, he withheld information on me, I'd be pissed at that doc and I'm going to treat people the way that I'd like to be treated. So if I think someone has an injury to particular structure, I'm going to tell them about it and, uh, describe the mechanics and, uh, we'll talk about mechanics and how they may or may not be related. But the biggest issue I think is to come right on the backside of that and ensure them that the injury can heal if they understand why, why it happened and why it happened, um, can be a combo platter. As you well know from, from the course and what we talked about in the epigenetics portion here, the module on, uh, prochiro, um, the, this is somewhat analogous to a gasoline and fire kind of situation. If you have gasoline, uh, uh, around a, um, uh, a source of ignition, then when you have that source of ignition, you're much more likely to have an explosion or at the very least a fire that's going to persist and burn for a good long period of time. Whereas if you have the source of ignition, if you've got the spark, but you don't have any gasoline around, you might get a little fire, but it's not going to be a big deal. Likewise, you can have a whole lot of gas. I've got gas. I've got a whole jug full of gasoline in my basement, but there's no ignition source anywhere around it. So nothing's happening there. Blessedly. Um, but you put those two things together and then we got, we've got some major combustion problems. So what's the analogy? Well, the spark in this case are the mechanics that cause actual structural injury. And the gasoline in this analogy are the cytokines that systemically are present in that individual because of the way that they conduct themselves in their day to day and how their epigenetic, uh, epigenetics, uh, as a result of that have caused certain changes in their genetics to make them more likely to hurt and to make the hurt continue to persist over a long period of time. So, um, how we put that together, uh, the first and foremost, we look for the mechanical, um, triggers that are bringing their pain and making their pain persist. And we try to intervene and cut that out. Um, and we try to do that in our explanation in a way that is empowering instead of, um, providing providing them with a whole lot of nocebo. And, um, but I don't go down the pain neuro rabbit hole with everybody, but, uh, but I've got my finger on that pulse to look for when they might be headed south and all of that.

And, uh, once we've got mechanical control there, then a lot of it is about making them more active and getting them stronger. And we put a graded program together to help them, um, uh, achieve those, those particular markers. And then beyond that, um, that's when I think the epigenetic aspects kind of come in. I'm, I'm really fascinated right now where, I mean, we're starting to get to the point where we can see, we can actually draw, uh, connections between mechanics at the segmental level and epigenetics. Now that's kind of fascinating because, uh, you know, the nucleus, um, it's primarily, uh, uh, glycosaminoglycans, agri-cans, and it's, when we're younger, it's this nice gooey, you know, jelly-like stuff, right?

And then we're, we're led to believe that as we get older, it just naturally kind of gets, um, you know, more crab meat, uh, and texture. Well, the processes that make it change consistency are, uh, epigenetically regulated. Um, for instance, uh, the presence of, uh, uh, AGEs, um, advanced glycation end products will, um, is related to sclerosis of the end plate and a change in the, um, the, um, the glycosaminoglycan concentration and a resultant stiffening of the motion segment. And, uh, that's fascinating to me. And, uh, TNF alpha can cross an intact disc, an intact annulus, and once it crosses the intact annulus and, and shows up and is measurable in the nucleus, causes a change in the metrometallics proteinases, um, uh, in the, the annulus to cause a net catabolic effect in the annulus, which stiffens the motion segment. And as you might recall too, part of what we talked about in the course is my theory that the, the, a lot of what we're looking at with chronic lower back pain, I think is a, it's a, a manifestation of perceived or actual threat at, um, the periphery, uh, at, uh, the interface between the nerve root and, and, or the spinal cord and the structures that are right there. Cause we don't tend to see everything getting loose in that area there. The net, the reaction of the body when we have an injury in that area, it's everything stiffens to make sure that that major neurology is protected.

I, I heard though, that if you use the protease REM in the area of the nucleus, it, it decreases the attack of the, uh, of all the, the problematic area of problematic, uh, stuff. I don't remember that song on the REM Murmurs album. I don't remember that at all. Was that before or after last, you know, the, the last train to Clarksville? That was the, that was the monkeys. I'm sorry. The monkeys? You're throwing me back. Um, so as we start to wrap up here, what would you like to leave everyone with? Or is there a pressing question you have for me? I'll let you even have the mic if you want. Hmm. Um, well, I'm, uh, I am a little bit curious as to how you think, uh, from the receiving side of, you've had the course material that all of our presenters, um, have contributed for the, uh, the first module. What do you think we've put out there that offers any value sub to, um, a potential, uh, consumer of that material? Um, I think so. I, I, I think we did a good job of making it, uh, making it very narrow, uh, in regards to, uh, cases. So we didn't talk about shoulders and necks and, um, extension based stuff exactly. Although some of the principles principles could apply over, but, um, I really do think, and I know that we're spending time over the next few weeks talking about this course and it's going to sound like we're just blowing smoke, but, but really it is, it's a game changer. It's kind of like going to your course. Like it's, it puts all the pieces together. And, um, even you, you had mentioned in your course about the $6 billion problem that is low back pain, um, you know, annually, I think it was, um, we just got to be really, uh, 64 billion is the low end. Oh yeah. 600 billion is the high end. 600, that was 600 billion. So it was a lot, you know, and it was, uh, like after, after learning a lot of McGill's work and McKinsey's and being able to take away some of the threatening stuff, um, that people have via like pain science and whatnot, it's, it's, it's surprising how well the communication gets, um, when working with people. And I had, uh, a shadowing doc the other day that he was just brand new grad from school. And, um, he had not really been exposed to stuff like, um, uh, McGill's work and McKinsey's and journal traction. And so these are all new topics for him. And I want to make sure everyone realizes that I'm sure they've said it, heard me say it a couple of times. I don't, I don't feel like I know everything, but I feel like I know a lot more than I did.

And so he didn't know these. And so going through, uh, some of the cases that we did, we had a few new people and he's like, wow, you're, you're able to communicate really well with your patients. And, um, like I feel confident with, with someone was doing a farmer's care. He was with like 12 kilos. It wasn't a lot. It wasn't a lot, two hands. And so, uh, I could see the expression on his face and, uh, you know, like, and, uh, it wasn't really challenging. He was bending his elbows. And so I feel confident giving him more. And he's, I'm like, how is that? He's like, uh, you know, like he's iffy about it. I'm like, good, let's give you more, you know? So just knowing the risk reward on us on a couple of things I think is helpful. And so that's something that we'd learned through Cody's aspect of the course. And just, if you're confident with these cases, the person is going to feel that and they're going to be able to trust you and hopefully they'll give you a chance to help them. And I didn't used to have that. And especially with these types of cases. And now I do. So I think when people go through the course, I think they're going to feel that. And whether the person chooses to stick with you or not is maybe a communication issue that we need to improve on. But, uh, I know that I did this with, uh, uh, that same intern is, and I probably said it last week too, but, uh, there was a person that came in that was very convinced about what their problem was. And I don't believe that their problem was what their problem was. And they kept talking about their, it was in this case was an umbra extremity as an elbow.

So the person kept talking about their elbow. And I said, look, uh, so I'd stress tested the elbow. We did resisted range of motion. I did all the tests. Nothing was positive. Really. The only thing that really changed it is posture dependent. It hurt when sitting up. It didn't hurt when laying down. Right. I knew I could reduce her symptoms with a shoulder motion. And, uh, so she's like, well, can I go golf? I said, yes. You know, or I'm like, just do short game. And she's like, as long as you're laying on your back. You're laying on your back. Yeah. So she's like, can I golf? And I said, let's do short games. She's like, but I'm really concerned. It hurts when I putt. I said, go grab a putter. Let's do right now. So I gave her a baseball bat. That's all I had. And so she's swinging that around a little bit. And so she had a little pain with it.

So I gave her some cueing, um, similar to like stuff we would do in Cody's section. And then it went away. And then she's like, I'm really concerned that my elbow is going to become damaged by putting. I said, look, there, I did more stuff in this exam, stress testing you. I should have busted your elbow in half if it was compromised. Surely go putt, you know, maybe a little chipping. And so I think the confidence she liked that I was able to release her with confidence and I feel good about it. And throughout that conversation, it was mainly about my job was to, um, to, to let her know that I heard her concerns about her elbow, but also prove to her that it wasn't her elbow. It was a neurological based complaint. But anyways, long story short is I think everyone's going to feel more confident with these cases and it's going to help out with your case management. Is that a good answer?

Yeah. Yeah. I think too, that, uh, another thing of value that's become more notable lately is I've been on the speaking circuit more. And, you know, we try to get accreditation for all the states, for all of the people that come in to see us, but sometimes we miss those, you know, and, and, uh, if you're a fellow geek, a fellow nerd, and you're more likely across state lines to go to get your continuing education, um, somewhere because you really want the information and to learn that rather than just checking off your state mandated CE box, you know, for the number of hours you got. Well, the net result of that, unfortunately, is that often you wind up crossing state lines and taking course matter that while valuable has not been accredited yet by your state board. So now you're stuck and you get to the end of your physical year as a, as a doc and holy shit, I've got to make up these extra hours to, uh, to, um, um, in order to satisfy my state board. And then everybody goes online and they start doing a whole bunch of online continuing education. And what we're trying to do here is actually get continuing education online for the geeks so that, uh, it's actually material that's of value that, uh, you're going to utilize in practice rather than doing what every single one of us knows that we do. You go on to that state mandated crap course that really doesn't have a whole lot of value for you. You press play and you walk out of the room and you cook dinner until that module is done. And you come back and you try to model your way through answering five or six questions for that module. Uh, we'd actually like to present people with information and material, that rivets you and keeps you in your seat and you're taking notes on it, not because you've got a test coming up afterward, but because you know that come Monday morning, this is going to help you with your patients. Right. And, um, I know that like, so yeah, we all do kind of go through that. I've, I've been done, I've probably done online stuff, maybe probably three or four years of, of the, of the 10 years out. And, uh, it's, uh, it's just part of the budget. And, uh, so we're just proposing that people change the budget to something better. And, uh, but the, the stuff that the people are going to have is so, um, uh, you have a course, you have fix your own back clinical companion. Uh, Greg Lemon has a course, Cody doesn't, he really should though.

Um, and, uh, in the next module, which I know, I mean, Ben alluded to the next module of being upper quarter and cervical spine, but, uh, there, I'm really excited about the people are going to be on that because it's just, it's, it's just dabbles into stuff that you're like, well, I've never had this wine before. And, oh, I kind of like a cab. And then you start to explore cabs. So hopefully that'll expose people to all the things that are at least around. So there's no excuses to not know anymore because the price is pretty good. Um, but in just kind of picking and choosing where you want to spend your CE dollar. Yeah. Yep. But yeah, so that's, it's all I kind of got on that. But, uh, by the way, you didn't ask the question. I was really hoping you were, what are you eating this whole, this whole interview? I wasn't eating you were, I know I was, it was, it was 85% cacao.

And I wanted to know if this is keto. 85%? Yeah. Keto, keto all has to do with whether or not you're in ketosis after eating it. So, um, I'll go get my, um, my, my blood, my blood test kit and, uh, we'll do it right here. Okay. Well, it's what, if I ate only that all day for like three months, what I, do you think I could theoretically be in ketosis? You'd be pretty close cause 85% it's doing all right. Good, good. All day. Okay. Um, well, thanks for being on. Um, how can everyone reach you? Uh, you can find me, uh, at, uh, Dr. Philip Snell on Twitter. Uh, I'm also on Facebook and, uh, we also have a fixture on backside on Twitter and Facebook as well. Good. What is, what is one topic that everyone should ask you about on Facebook that is going to spike your interest? Not clinical.

You need to ask me for, uh, cute pictures of my dog. Yeah. I wish everyone was on the video end, end of this. The, the dog is cute. Pfeiffer? Five. Five. Awesome. Thanks so much, Philip, for being on. I, I learn a bunch every single time that you come on, like, um, even meeting you in the airport and hanging out and, uh, you know, having a beer, I feel like, or sorry, you won't have the beer. You'll have the tequila, the keto man. So, um, I learned something every time. So thanks so much. And thanks for, thanks for being part of the, uh, the conning course. So again, if everyone's looking for more of Philip, you can find his seminars at fixyourownback.com. Um, the clinical companion, he's probably going to come to your area at some point. And I think he's going to do one. Actually, I think I saw Costa Rica or, um, uh, Riviera Maya. That'd be amazing. So, um, think about that. Again, it will change the course of the way you practice. If you, if a lot of that stuff was new to you that he said, um, open Pandora's box, figure it out. There's a lot of good stuff in there and it'll actually improve your patient care. It'll improve how happy your patients are. And, um, I don't think you'll, I don't think you'll lose any money with it. You'll, you'll release patients quicker and you'll, you'll tend to get more referrals, I think. So if you're looking for the pro chiropractic online CE platform, which will change the game as you know it, I'll put it in the show notes, but also you can go to crow, uh, sorry, pro chiropractic online CE, uh, and it will all be on there. And I'm going to attempt to distribute out some of the, uh, paraphernalia, uh, really quickly here so everyone can see. And, uh, yeah, I, sorry, I'm a little, uh, I'm a little unknowing on that. This is the first time we've released something like this. So it's, it's kind of funny. I feel like the first go around is going to be a lot of people just referring to each other. So, but I, I, we will try to make some very easy tools so you guys can figure out price and, um, what will be included and what presenters there are there and so on. But hopefully this podcast will serve you justice listening to the next few episodes. So as always leave people better in how you found them. And if you're dating, dating, dating Eagle Scout, talk to you guys soon.