Dysautonomia is a condition where the nervous system becomes dysregulated, causing disruption in the functions of various organ systems. Common symptoms include fluctuations in blood pressure, fatigue and anxiety. The condition seems to be increasingly common in the post-COVID era, and conventional medicine is unable to resolve the causes of this condition for patients.

Shilpa P. Saxena, MD, an expert in cardiometabolic health and regular guest on the podcast, joins us to explore why functional medicine clinicians are uniquely positioned to support patients experiencing dysautonomia.

Listen to the full conversation to learn more about:

  • The importance of polyvagal theory for understanding dysautonomia
  • How vagal tone impacts multiple organ systems
  • How to regulate and improve vagal tone
  • Functional medicine tools that help heal dysautonomia
  • How community, loneliness and group visits impact vagal tone

Dysautonomia and Cardiometabolic Dysfunction | Ep 292

Shilpa Saxena: …especially with these post-COVID and long-COVID patients, their morbidity is significant. There’s many people with COVID that have residual symptoms greater than six months out, and it could be related to this dysautonomia. It’s not just, “Hey, I had a bad infection.” It’s that infection, inflammation irritated and inflamed the vagus nerve, and the vagus nerve, because it hasn’t been addressed, continues to dysfunction.

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community.

Hello and welcome to the podcast. This week we are speaking about a topic that is pretty interesting for practitioners who are on the front lines dealing in this post-COVID world. We’re going to talk about dysautonomia, and—because this is such a critical topic and we’re talking about dysfunction of the nervous system—it took us to some interesting places. We talked about post-COVID syndrome and long COVID. We talked about the vagal tone and polyvagal theory, and we talked about group health and some of the new gadgets and supplements you can use in this area.

I think this was one of my favorite podcasts, clinically, because there’s something really in here for everyone. And it shows yet again how functional and lifestyle medicine are right on the cutting edge for the future of medicine. It was an epic episode. Enjoy.

This episode was brought to you by the Lifestyle Matrix Resource Center. Dr. Saxena is actually one of their critical educators in the cardiometabolic space. She made all of the group visit toolkits. If you haven’t gone to goevamed.com/lmrc, go and check it out. They’ve been long-term sponsors of the show. They’re actually the ones that connect us with Shilpa. And as I mentioned at the end, this is 10 years that I’ve been doing stuff with Shilpa. She’s an absolute gem. Enjoy.

So, a warm welcome back to the podcast, Dr. Shilpa Saxena. Welcome, Shilpa.

Shilpa Saxena: Hello James. Lovely to be back with you. Like 10 years we’re doing this.

James Maskell: I know. Yeah, we keep doing it, but the people want to know about dysautonomia, and I thought Shilpa would know. So, here we are. So, I’m excited to be back and having this kind of conversation. I mean, obviously, you’ve got so much expertise in areas of cardiometabolic health and group visits and… The life and times of a storied functional, integrative medicine doctor by its very nature takes you into all of these different sort of areas of health. But, I guess, we’re talking about dysautonomia today. I guess, what is it? And then how have you come to view it through the functional/integrative medicine lens?

Shilpa Saxena: Yeah, I really like your introduction because you’re really pointing to everything that we do in functional and integrative medicine is a journey, and we respond to what’s happening. So, dysautonomia has been around for a long time, obviously. The definition for it, for formality, is when the autonomic nervous system—remember, that’s that involuntary nervous system that’s automatic—it’s innervating all the organs of our body. And it really maintains homeostasis—or I’ll say homeodynamics—at rest. But when it gets stressed out, it starts activating this intricate network of central and peripheral neurons that, again, without your voluntary, conscious activation, starts to take care of business.

And what’s happening recently is that we’re seeing other mechanisms of injury to this autonomic nervous system, and then it’s going to produce a variety of physiological phenomenon. I mean, that can be low function or high function, just like we know from any other like adrenals or insulin. So, what I think the difference is with functional medicine is we have the opportunity to, again, identify and address the underlying causes. So, the conventional paradigm, James, as you may know, is many times oriented towards symptom management. And the functional one is, “Yeah, let’s take care of symptoms, but what’s going on from a systems biology approach?” And we can definitely explore that. I mean, I can make this a one-hour answer if we needed to, but I need to stop talking so you can keep it interesting.

James Maskell: Yeah. Well, I guess let’s get into it. I mean, the symptoms come up. What would the conventional approach be: cortisone cream, or watch and see hope it doesn’t get worse, medication? What would it be for a conventional approach?

Shilpa Saxena: Yeah, the first thing that the conventional system is really working on is diagnosis. And I would have to say that that should be the focus right now for functional medicine docs and providers as well, is just, can you identify that’s what’s going on? Because, many times, it can show up looking like so many other things. So, if somebody’s got palpitations, we might think it’s thyroid, or if they have hypotension, we might think it’s neuropathy or hypovolemia from adrenal issues. So, we have to first know that it’s existing and it’s more common, and we’ll talk about this with COVID.

But many times, after diagnosis, what the conventional system is really interested in is, “Okay, let’s address the symptoms.” So, what do we need to do to address the volume? Maybe we can put some steroids, not creams, but steroids to be able to expand the volume. Or maybe they’ll use an alpha-1 agonist in order to vasoconstrict because they don’t want the person to have the orthostasis or the low blood pressure. Of course, there’s education and they do sometimes get a little bit lifestyle medicine and bring in some exercise because it’s been shown that endurance training—so putting them on a recumbent bike, for example, and having them work on their vagus nerve through exercise—is a part of it. But a lot of it is like symptom management. Trying to keep them from being dizzy and fainting and just feeling horrible because of those symptoms.

James Maskell: So, why do you think this has become more common in the last few years?

Shilpa Saxena: Well, there’s this thing called COVID that has happened. And what COVID has been is this dramatic textbook example of how a chronic co-infection can take down the autonomic nervous system. So, prior to COVID, we still had bugs that we knew could get in and stay in, like mono or HSV, herpes simplex virus or chicken pox. We always knew that they were at the root cause of a lot of autoimmune issues, these infections that would come in and then chronically live and irritate multiple organ systems, including the autonomic nervous system.

But COVID is particularly evil to the vagus nerve. And autonomic dysfunction is very related to the inflammatory response that COVID creates. We all know that COVID creates this huge inflammatory response, and one of the things that it inflames is the vagus nerve. And then it’s just this ping pong, back and forth, between the vagus nerve reacting to the inflammation, then creating inflammation, which then perturbs the body, which then perturbs the vagus nerve. And it’s just this ping-pong match between the inflammation and the vagus nerve. And then the whole system is just dealing with the ramifications and shutting down.

James Maskell: So, what are the ramifications of that? If the autonomic nervous system starts going haywire, how does it affect, say the things that you talk about a lot, cardiovascular system, cardiometabolic system?

Shilpa Saxena: Well, the first thing to know is that your cardiovascular system is innervated, and it’s got nerves that are very integral for functions. So, palpitations and blood pressure control, being able to just have general wellbeing, like having good energy. So, when people show up with this extra ordinary fatigue or unexplained palpitations or blood pressure issues that seem labile or super low and they don’t make sense, this is when we start wondering: Are the nerves of the cardiometabolic system being affected? And then what do we need to do? Because when the nerves are affected, what’s happening is that you’re going to lose sympathetic tone, relatively speaking. And… Excuse me, you’re going to lose parasympathetic tone, which is the relaxation, vagus-nerve response.

So, when you have less vagal tone, that means you have net more sympathetic tone. And what that means is we have resting tachycardia, and resting tachycardia is just an extra burden on the cardiovascular system. And I’m not even going into how this is also being fed by hyperglycemia, whether you have prediabetes, metabolic syndrome or frank type two diabetes, that hyperglycemia is also inducing neuronal injury through oxidative stress and advanced glycation end products. So, all this net damage is affecting cardiometabolic organs and outcomes.

James Maskell: Interesting. And is there something specific to diabetes in that?

Shilpa Saxena: Yeah, it’s the specific hyperglycemia, right? So, when you have high blood sugar, it’s just a great milieu to damage nerves, specifically the autonomic nerves. So, what’s interesting is you can actually progress diabetes and heart disease considerably faster because the neurological system is affected. It’s not just that old like, “Oh, we have neuropathy in the feet.” We have neuropathy in the heart. We have neuropathy happening in the cardiovascular system, not just the end organs that they feed.

James Maskell: Yeah, it’s really interesting. I mean, when it all shakes out on the public health numbers of the pandemic, do you think this will be one of the key drivers or part of the physiology that drove the poor outcomes for America and COVID?

Shilpa Saxena: Yes, that’s what the research is really showing is that, especially with these post-COVID and long-COVID patients, their morbidity is significant. There’s many people with COVID that have residual symptoms greater than six months out, and it could be related to this dysautonomia. It’s not just, “Hey, I had a bad infection.” It’s that infection, inflammation irritated and inflamed the vagus nerve, and the vagus nerve, because it hasn’t been addressed, continues to dysfunction.

So, just like if you injured your leg playing soccer, otherwise known as football in your language, you’re not going to just put a cast on it and afterwards think that the leg is great. You’ve got to rehab that leg back, all the muscles and everything back. And what we’re doing post COVID is we’re thinking that, after COVID, that vagus nerve is just going to pop back up. But many things we do in our current lifestyle is not very friendly to the vagus nerve. So, we have to bring back lifestyle medicine to bring back vagus tone.

James Maskell: So, is this conversation happening outside of lifestyle/functional medicine worlds, or is this just another thing that we know what’s going on and no one else cares?

Shilpa Saxena: I think they’re starting to catch on in research. I don’t think that it is known in—

James Maskell: So, in 17 years, we’ll be able to have the conversation with them clinically.

Shilpa Saxena: Yeah, I think maybe there’s some people who are pioneers who will look at the research ahead of time, but I’m going to say this out loud and hopefully it won’t be too bad, but there’s no money right now in treating that vagus nerve in the conventional world. The pharmaceutical approach is really related to symptom management. There’s not this great pharmaceutical that’s gonna help with repairing the vagus nerve. So, until that’s developed, people don’t have another option in their head in the conventional mindset.

Now, in functional and integrative medicine, we’ve been using mind-body medicine for a long time to take care of a variety of other issues. So, we’ve got an arsenal of options and then we could be—now with some of the new research—even more targeted with what we do. I think we have to expand our understanding. We just can’t say, “deep breathe.” Although that’s great, it may not be enough for someone who’s got significant dysautonomia.

James Maskell: Yeah, interesting. Well, you know, you mentioned vagal tone. I want to go a bit further into that because, last year, we did a functional forum in Austin, and one of the speakers was a functional neurologist trained chiropractor and worked with vagus nerve and polyvagal theory and did her talk was on polyvagal theory. And I could just see that everyone in the room was sort of like really paying attention because I kind of get the feeling that, unless you’re a DO, and this has been like you have some chops in hands on medicine, there was things that she was talking about that I could see that maybe the functional medicine physicians in the room recognized was important but didn’t really have like access to and wanted to learn more about it for some of the reasons you’ve spoken about here today. So, where’s that research going? And I guess, how do you see that maybe that finds a place for the manual therapist in the functional medicine-focused team of the future?

Shilpa Saxena: Yeah, I surely think that the integration of manual therapists and wish the DOs wouldn’t lose their manual skills and turn into like these MDs only because it’s a valuable thing that they have when they keep their manual medicine skills. I do think that they have an understanding of functional neurology that’s deeper than our training as MDs. So, holding onto that and understanding the interplay between nerves and muscles and organs, the visceralsomatic reflex and the somatovisceral reflex. I learned about it in my integrative medicine fellowship, but I surely don’t know how to do the manual medicine.

So, we definitely want to encourage those practitioners to keep those skills. Having said that, there may not be enough. So, it still behooves the non-manual provider to understand the latest theories because I think this—whether it’s the COVID, post-COVID or long COVID that got you, or the relative stress related to the pandemic that’s reducing your vagal tone—you probably want to know about this because it’s going to only help your patients to improve it. It’s kind of like if you know the anti-inflammatory food pyramid, you don’t have to have a diabetic for it to be useful. That can help Joe Schmo. And same thing with vagal tone. You’ve got to know that as a foundational lifestyle medicine tool.

James Maskell: Yeah, when you’re talking salutogenesis, anything can help anything. You’re creating health and that could be through diet, and it could be through increasing vagal tone. And there’s lots of different ways to do that. Do you want to talk anymore about like polyvagal theory? I know that’s sort of becoming a little bit more like sexy in our space, and doctors are learning about it. What role do you think that has in care?

Shilpa Saxena: So, big role because… I don’t know if other providers are noticing this, but we’re going to find—and we’re continuing to see—a lot of what I lovingly call conventional medicine rejects, meaning people who have been disillusioned because nobody has an answer in the conventional medical world, and they end up at the functional medicine provider’s doorstep. But they are tough. They’ve got multiorgan symptoms. It’s not like, “Hey, I have Hashimoto’s thyroiditis.” I mean, that used to be the old bread and butter, if you will, for functional medicine providers, autoimmunity or Hashimoto’s, or I’ve got IBS.

Now, we’re dealing with people who have palpitations, malaise, fatigue. I can’t breathe. My brain doesn’t work. Multiorgan symptoms. And so, I think this vagal tone and polyvagal theory is key. So, what you were mentioning, James, is… I myself, until I started researching polyvagal theory and did the course by Dr. Stephen Porges, did not understand that there were actually two branches of the vagus nerve.

And it’s important to understand this when you’re looking and evaluating patients. Because, when you see a patient, we think of the two categories, sympathetic nervous system response, which is that tiger response, the fight and flight. So, either you’re going to run from the tiger. It’s a very active—I’ll call it the hot button response. It’s the movement, action, anger, you know, that response. Then you also have another survival response, which we forget about. And that is what we call the dorsal vagus nerve. And that is the deer-in-headlights, frozen response. So, that I’m going to call the cold button survival response. So, when you see people who have malaise, fatigue, MV, low blood pressure, just pre-syncope, this is all the dorsal vagal response. The palpitations is the hot button response.

And in dysautonomia, those buttons keep getting flipped. And that’s the problem is it feels horrible to be hot and then cold and hot and then cold from an autonomic point of view. So, I look at these as two children, the hot button and the cold button. And then you have your ventral vagus nerve, and this is the calming mama. It could be the calming parent, but this is the calming mama. And these are the two kids, hot and cold.

So, if you have great ventral vagal tone, she or he will kind of keep these two kids in check so that they can’t just go all over the place. However, if you lose ventral vagal tone, this kind of like back and forth starts to become really old for patients. And because conventional doctors are always looking for, well, is it hyperthyroid or is it an SVT? They only know it as one or the other. They don’t… Oh, middle finger. The idea is that they don’t think about it as alternating. And the way you get that alternation to stop is to increase ventral vagal tone. So, don’t think of it as just sympathetic and parasympathetic. Think of it as ventral vagus mama, and then you got your hot and cold kids, sympathetic and dorsal vagal nerve.

That’s polyvagal theory, and it’s all about increasing ventral vagal tone. And you use heart rate variability as a measure of ventral vagal tone to see how you’re doing. In fact, what’s really cool is if you measure heart rate variability, you can find dysautonomia early and start preventing all the autonomic dysfunction to the heart, to the nerves, to the brain. It’s like an early marker of what’s to come.

James Maskell: So that, I mean heart rate variability, obviously, has been around forever and increasing in popularity and increasing in access for a long time. So, I think a lot of practitioners love getting that information, even if it’s not easy to add into your workflow, but, ultimately, that’s powerful. What are some basic lifestyle medicine stuff that can increase that number or can improve that. Sleep, I’d imagine?

Shilpa Saxena: Sleep is absolutely great. Exercise is likely the best one in terms of… Well, I guess I’m going to say it’s the best one for certain personalities. Some people just live movement, so exercise would be a great one. And obviously, you have to stage that exercise. If you’re prone to dizziness, you’re not going to get on a bicycle. Meditation or deep breathing mindfulness. As long as you’re exhalation is longer than your inhalation, you’re activating ventral vagal mama. Okay, that’s what we want, and that’s what exercise is doing. When you get in the zone with exercise, that’s vagal mama controlling the two children. The other things that we don’t even think about are anything that can cause the vagus nerve to be activated.

So, gargling. You’ve got a vagus nerve in your vocal chords, humming, laughing, singing, chanting, all that. You’ve got a vagus nerve up here, so you can activate the vagus vagal tone just by doing something like that. Also, think about what you could do to be good to your gut. Because anything that kind of gets good to your gut is good for the brain, and the brain is kind of central for autonomic nervous system health. Then there’s all that stuff related to cold water therapy. I’m sure you’ve talked about that or heard about it, James.

James Maskell: Not only have I heard about it, but I worked out that the elevation that I live right now, which is higher, I’ve lived for the last year, my pool—instead of just being, basically, for the whole nine winter months—is like a massive Wim Hof bath.

Shilpa Saxena: Right. So, for those who like that, that’s another way to stimulate the vagus nerve. You can use that for migraine headaches, by the way. You’re just triggering the diver response reflex by doing that. I’m going to say this other thing. There are some people, including myself, like, if you ask me to sit down and try to meditate on some single thought, I could last maybe 90 seconds before my mind is thinking of 17 different things. So, there’s a lot of technology in this space as well. You can use binaural feedback because you’ve got your vagus nerve coming into your auricular branch here. You could use pulsed electromagnetic field. You could use microcurrent stimulation to the vagus nerve.

There’s also like heart rate variability, biofeedback devices. So, some people are really techy. So, I feel like we need to find people with how they would like to, just like exercise. Not everybody loves weightlifting, so you got to find out which exercise gets them to do strength training. For me, it’s yoga. I don’t like dumbbells, but other people want to go to a gym. It’s the same thing here. We got to find out is it movement, is it diet, is it sleep, is it technology. We got to get that vagus nerve exercised.

James Maskell: Yeah, great. Well look, I want to talk about groups because I always have to talk about groups somehow with you because I think we’re both clear that this is where things are going. And it’s very healthy to be in groups. So, what things happen in a group that might improve vagal tone? Obviously, you can layer on top of those things all the lifestyle medicine stuff. You could hum in a group. You could chant in a group. Probably the reason why that kind of thing… One of the reasons why that kind of things became popular historically is because of the health benefits of them. But what is unique about in the group in creating safety and improving vagal tone?

Shilpa Saxena: Yeah, thank you for bringing that up because I completely agree that this is our thing. You and I. So, when you’re in a group, first of all, the whole ventral vagus nerve came about in an evolutionary perspective because when reptiles existed, they did not need their mothers for milk. But when mammals came along, we needed to develop this ventral vagus nerve because we needed to be able to consider our mother safe and socially engage with her in order to survive. But, in order to know if X was my mother or Y is my mother, you have to be able to read facial expressions. So, your ventral vagus nerve is essential to read other people’s facial expressions and know if you feel safe or not.

It’s a subconscious thing, whether I can look at James and get a sense of whether or not I feel safe with him from a subconscious level before my consciousness is ever able to determine that. And that’s related to the ventral vagus nerve. So, for social engagement to occur, you need a healthy ventral vagus nerve. Now, the more you get into healthy social situations, like a group visit, where you’re meeting with people and you have a sense of security and a sense of belonging, please remember those two things: a sense of security and a sense of belonging. Because you’ve got to have the sense of security to keep ventral vagal mama in play. Because, remember, if sense of security is not there, then these two kids come out to play.

So, you got to have your sense of security first for ventral vagal mama to even get strong. And then a sense of belonging is just next level in terms of getting that ventral vagal mama to get strong. So, any type of community. That’s why you see so much literature about community being a big part of healing because when you socially engage with people, and you feel safe, and you feel a sense of belonging, you are working out your vagus nerve.

James Maskell: Yeah, that’s awesome. Well look, I’ll definitely follow up more on that because I’m really interested to go as deep as possible into understanding that because of how critical I think that that conversation is. And I’m glad you sort of got me into the first steps on that. I guess, what is some of your experiences with some of the tech that’s being used for this? I mentioned HRV. I know there’s things like PEMF and microcurrent and acoustic therapy and that kind of stuff. What do you think about that?

Shilpa Saxena: Can I say one other thing about our previous point?

James Maskell: Sure.

Shilpa Saxena: That I think is worth it. If someone doesn’t have good ventral vagal tone, they won’t feel safe in group, and that social isolation and loneliness will be a risk factor for them for all physical disease. So, if they don’t feel comfortable in group because that ventral vagal tone is so low that they can’t control this response when they’re in a social interaction, then the goal is to find other ways that are maybe non-group related to increase ventral vagal tone so that they can get back into social settings. So, just know that that’s a risk factor. If they cannot even get in group, that is a potential sign of autonomic dysfunction because it’s like they can’t compute the social engagement because everything appears a threat because the kids are in charge in that sense. So sorry. I think it’s important.

James Maskell: No, I think maybe there’s a point to that, which is that, yes, one, you can sort of build that up with some of the other things that we’ve spoken about. And then they’re ready to go into the group. But also, I think if you organize the group in the right way and potentially, the virtual group is a good piece for this, people can participate less until they feel comfortable. Right? The signal of safety comes, and that tone comes back. And then, what is the thing that flips when people are not interested in participating, suddenly being interested in participating? I guess my intuition tells me that like that’s almost the moment where some of that’s come back because they feel more safe and now they’re willing to turn on their Zoom stream or whatever, right?

Shilpa Saxena: Its social engagement, completely right, James. Your ability to socially engage is related to ventral vagal tone. And that is related to your sense of security, first and foremost. And one of the things that I just say, as an aside, that I’ve started changing in the way I interact with my patients after taking Dr. Porges’ coursework is the first thing I do when I meet a patient is establish it’s a safe space. And I keep reiterating words that keep having them know that they are the ones in control during the visit. Because the automatic default in most provider visits is like, “Hey, come have a seat. I’m going to take over and tell you what’s going to happen, and I’m just going to do what I’m going to do.” Which is not a very safe situation for someone who has uncertainty and feels ill.

So, an example of that that providers here can consider is when somebody comes in—especially for all my new patients—I will start off by saying, “Hey, my name is suchity-such. I’m so excited to have you here. Would it be okay if I tell you what I was planning to do and you let me know if that works for you?” So, see, like starting it off with, “Would it be okay?” And then I’m going to tell you what I’m going to do, and then you have a choice in the matter. Now, what’s interesting is nobody’s ever told me, “No, I don’t want you to do your timeline analysis.”

But the fact that I ask them, and they had the opportunity to choose, increases a sense of security. It automatically changes the power differential and puts the power with the patient. And then whenever I sense that something is happening, I will reestablish a sense of security because you’ve got to know that when there’re these little kids are in action, their memory is impaired, their executive planning, that all these things that we need with ventral vagal tone health are not available to the patient. So, your history is going to be limited. Their engagement in your care plan is going to be limited, all that. And all you have to do throughout the visit is create a sense of security for them over and over and over because you’re bringing ventral vagal mama back in the room.

James Maskell: And I got three things I want to say to that. First is the practitioner better have their vagal tone together to be able to read those signs, right? Because that is a subtle thing, and I can even feel that is also part of like the journey from being an entry-level physician or entry-level functional medicine physician to going up the food chain and being an excellent one is that you’re aware of those subtle changes. That’s the first thing.

The second thing is if, just following on from last week’s podcast that we just recorded with Sandy Scheinbaum, a lot of clinics now are using a coach in this sort of like friend, you know, guide role in the clinic because it’s someone that they would feel safe to share, maybe that they wouldn’t feel comfortable with the doctor. There’s at least some outlet for someone to be able to say, “Hey, I stopped taking my supplements, or I’m not doing the diet,” or whatever. And that someone sits between the doctor and the patient to fulfill that role because of safety.

And then the third thing I was thinking of is it’s exactly the opposite of parenting. Dr. Palevsky, who is my pediatrician for my first baby, was like, “When you say, ‘We’re going to the store now,” to the kids, ultimately, like the kid is in charge because you’ve just… By using the word okay, you’ve sort of intimated that they’re the ones making the decision.” And I could see why that’s useful in exactly what you’re saying for patient care, but, in parenting, not actually that helpful because that’s how you end up having the inmates running the prison.

Shilpa Saxena: Yes, that’s right. In this case, with adults, it works. For most adults, I should say.

James Maskell: Cool. Well, look, I guess, let’s come back to the other question I had, and we can wrap up. And I would like to know what you think about all the gadgets for vagal tone.

Shilpa Saxena: I think that they are a great… There’s definitely some moderately-priced technology. Oh, you’re muted, James. Okay, so what I would say is that the devices are super helpful. They’re generally low cost. Use them as passive vagal, no-nerve-tone stimulation. And then the last thing that I would just say is there’s some really exciting new dietary supplements because of all the burgeoning research on dysautonomia. So, look out for some of the newer supplements that are going to be there to help with autonomic dysfunction as well.

James Maskell: What are some of your favorites? And are there things that you’ve used already, and then new ones that you like that are coming? Or what do you think is… What’s hot right now for you in that space?

Shilpa Saxena: Well, anything that’s going to help that endothelium is going to be useful. So, all the things that you’ve used before for endothelium, but some of the new stuff that’s coming out, in my opinion is… I haven’t had a chance to use it yet because we need a company to kind of make some of the good blends and good products because I find that, right now, I need to get their vagal tone up so they even can digest and assimilate that. So, I’m working on that while these new products are coming out. But the oldies on endothelial function, nitric oxide, that’s the stuff that you can focus on right now. And adrenal health. Adrenal and mitochondrial support supplements. I think that’s a great foundational thing until we get into the nitty gritty of the specialized ones.

James Maskell: Well, Shilpa, you’ve done it again. This has been amazing. I always find that you are super clear about the topic at hand, but, also, we end up weaving in some of my favorite topics, like group stuff. And it’s super relevant to this topic, and so I’m really glad that we’re able to do that. So, thank you for coming and sharing your wisdom as ever. It’s such a gift that you share this with us and our audience. As you said, 2023 will be our 10-year anniversary of doing these kind of interviews together, since the very first one where it was actually me interviewing you that I was like, “Hey, I’m quite good at this, and I like doing this.” So, thank you for all of your support throughout the years. Thank you for setting up our Year of Connection next year really well because, ultimately, it’s these connections between different parts of the body. The polyvagal theory is a great example out there that is what creates dynamic health. So, thank you so much. Have a great holiday break, and look forward to connecting again in 2023.

All right, well, this has been the Evolution of Medicine podcast. I’m your host, James Maskell. We’ve been here with Dr. Shilpa Saxena. We’ve been talking about dysautonomia. Thanks so much for tuning in. We’ll be back in 2023. In the meantime, thanks so much for listening, and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.


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