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Alyssa Luck

Alyssa Luck

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Polyvagal Theory: A Critical Appraisal

Alyssa Luck · Oct 29, 2022 · 3 Comments

Pressed for time? Jump to Summary and Conclusions.

If you’ve ever seen the terms “ventral vagal” or “dorsal vagal” outside of an advanced anatomy textbook, you’ve probably encountered polyvagal theory. This theory, introduced by psychologist Stephen Porges, makes specific claims about the evolution, anatomy, and physiology of the vagus nerve and autonomic regulation of the heart, and parlays those claims into hypotheses about the interplay between the autonomic nervous system and human psychology and sociality.

Polyvagal theory as an explanatory model, while receiving little to no acceptance in the fields of autonomic physiology or neurobiology, has become – dare I say – gospel in the communities of “trauma-informed” somatic and psychotherapy. (6, 7, 8)

Polyvagal theory also makes frequent appearances in communities that promote “rewiring” the autonomic nervous system as a way to treat illnesses such as chronic fatigue syndrome, POTS, and various autoimmune diseases.

I’ve even seen it in health and wellness spaces that aren’t focused on trauma or illness – for instance, on the Bulletproof YouTube channel, or in the Instagram posts of “pro-metabolic” nutrition influencers. It seems that polyvagal theory has become relevant for just about anyone interested in human health.

The comments below the Dave Asprey video give an idea of the enthusiasm and gratitude with which polyvagal theory is most often received. However, the theory has also been criticized by some scientists, most notably psychosomatic researcher Paul Grossman.

The exchanges between these two researchers have been largely unproductive, and I suspect this is in large part due to the fact that Grossman is critiquing polyvagal theory purely at the level of biology, while Porges conceptualizes the theory primarily within the contexts of experimental psychophysiology or broadly integrative “mind-body” research. Thus, I propose that polyvagal theory and its attendant controversy cannot be understood through analysis at the level of biology alone.

As such, in this article I’ll provide a critique of polyvagal theory as biology, as a model for psychophysiology, and as a biopsychosocial framework. I also include two additional levels of analysis that reflect the sociocultural roles that polyvagal theory has taken on: as direction and justification for clinical therapies, and as an “illness myth.”

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Lymphatic Support for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Sep 15, 2022 · Leave a Comment

Yet another topic I’d like the time to delve more deeply into, but for now, I’ll share a couple references! I’m still new to this topic, so I’ll have more/better resources to share in the future, but for now, the main person I’m aware of who shares at length about the role of lymph in health is Perry Nickelston of Stop Chasing Pain. Leah from Lymph Love Club also shares interesting information (including the second reference below!).

Nikolakis et al. The Role of the Lymphatic System in the Pathogenesis and Treatment of Inflammatory Bowel Disease. Int J Mol Sci. 2022.

D’Aiessio et al. Targeting lymphatics in inflammatory bowel disease. Oncotarget. 2015.

Heart Rate Variability 101: What It Is, How It’s Measured, and Controversies in the Literature

Alyssa Luck · Jul 12, 2022 · Leave a Comment

Updated September 26, 2022; text and figure added in Does HRV index autonomic tone?, and text added in Respiratory sinus arrhythmia.
Updated August 10, 2022; text added in “Measuring RSA” section.

Heart rate variability (HRV) is a fascinating metric. It’s been around for over a century in the clinical and research space, and has exploded in popularity both in research and household settings because it can be measured easily and noninvasively, providing a window into the complexities of physiological and psychological processes without perturbing the underlying systems. Athletes use it to optimize training and recovery, doctors use it to predict patient outcomes, and psychologists use it to measure a whole host of cognitive activities…yet still today, nobody seems to be able to agree on precisely what these measurements actually mean.

As I’ll explain below, HRV is not a single measurement but rather a biological phenomenon that can be quantified in a number of different ways, which one needs a fair bit of technical and mathematical expertise to correctly interpret. A thorough understanding of the physiology underlying HRV has lagged well behind enthusiasm for its potential, which has led to a number of very persistent misunderstandings and a glut of unhelpful or misleading research. Reading through recent reviews and editorials, you often get the sense that the experts in the field are sighing with exasperation at the fact that controversies that ought to have been laid to rest in the late 1990s are still alive and well today.

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Autonomic Nervous System 101: Anatomy and Physiology

Alyssa Luck · Jul 12, 2022 · Leave a Comment

The autonomic nervous system (ANS) is responsible for controlling all of the unconscious (autonomous) functions of the body. These autonomous functions maintain internal homeostasis, and also prepare the body to support appropriate voluntary (ie, non-autonomous) responses to external stimuli.

As such, dysfunction in the ANS can contribute to problems maintaining internal homeostasis in general (including problems with digestion, heart rate, and blood pressure, among others), but also problems involving maladaptive responses to external stimuli.

Many levels of control and regulation ultimately feed into control of the ANS, so by no means is this “autonomous” system detached from conscious and voluntary thoughts and behaviors, but understanding the inner workings of the ANS is very helpful as a foundation for understanding the physiological regulatory processes of the body, including emotional and cognitive processes.

To that end, this article will provide a general overview of the structure and function of the ANS, and a brief discussion of some problems with the common “fight or flight” versus “rest and digest” dichotomy of ANS function.

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Vitamin A Detox Diet for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Jul 9, 2022 · 2 Comments

I have not yet had time to delve as deeply into this theory as I’d like, so in a moment I’ll be directing you to other sources for your own exploration, but I wanted to give a brief introduction to the topic and a few of my own thoughts.

Back in 2014, a man named Grant Genereux (an engineer, unassociated with the science or medical fields) introduced a radical new hypothesis about the underlying cause of eczema, which he later expanded to include all autoimmune diseases and most other “diseases of Western civilization” as well: vitamin A toxicity. He even goes so far as to argue that vitamin A is not a vitamin at all, but a toxin.

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Brain Retraining: How to Choose a Program?

Alyssa Luck · May 5, 2022 · Leave a Comment

“Brain retraining” has become an increasingly common approach to chronic illness. It’s especially popular for conditions like multiple chemical sensitivities, EMF sensitivity, chronic fatigue syndrome, fibromyalgia, and POTS, but people have had success with an enormous range of chronic mental and physical conditions, from depression and anxiety to IBD and other autoimmune disorders.

I’m a bit biased because this is where my focus currently is for my own health, but I do think brain/nervous system approaches are the missing piece for many with chronic illness, especially people who have tried every diet and supplement regimen under the sun and still haven’t seen much improvement.

The central ideal of these approaches is that it isn’t the environment that’s the problem – it’s the way your body is responding to it. Maladaptive response patterns can be conditioned into us in a number of different ways and at any point in our lives, but the common denominator is that the body has learned to operate from a “threatened” mode, rather than a “safe” mode. It’s not quite as simple as the classic dichotomous “fight or flight” vs. “rest and digest,” but that idea does roughly get at what’s going on.

The body does not heal efficiently when it feels threatened, so all these programs use various tools to teach the body that foods and social experiences and exercise and other environmental stimuli do not need to be defended against; that it is safe. (If this sounds a little intangible or pseudosciencey, I hear you – one of my current research goals is to bring some concreteness to these approaches!)

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Dynamic Neural Retraining System: Can DNRS Work for IBD?

Alyssa Luck · May 5, 2022 · Leave a Comment

Summary: The Dynamic Neural Retraining System was created by Annie Hopper to heal herself from severe multiple chemical sensitivities (MCS), and since 2008 has been widely used by others with MCS and other “mysterious” chronic illnesses such as fibromyalgia, chronic fatigue syndrome, and even long-COVID, with seemingly miraculous results. The program is built upon the premise that at the root of all these illnesses is a maladaptive brain response to environmental stimuli, causing the body to react as if harmless stimuli are life-threatening. Although DNRS is not widely used or marketed for IBD, evidence indicates that maladaptive nervous system responses are likely a component of the disease, and at least one IBD patient has reported success using DNRS. Although DNRS is not designed with IBD patients in mind, the principles it teaches may very well be the missing piece for many people who have tried just about everything else.

This article is part of the IBD Index. Last updated on May 5, 2022.

The Dynamic Neural Retraining System, or DNRS, is one of those programs that appears to toe the line between “this is totally miraculous” and “this is total bullshit.” How could someone possibly go from, say, being wheelchair- and house-bound, and only able to eat a few foods, to being totally and completely healthy, just by doing some mental exercises?

It sounds like magic, but this is the promise of neuroplasticity. It’s not easy, but it’s powerful. And for many with ulcerative colitis or Crohn’s disease, it could be the missing piece – the reason that all of the drugs and diets and supplements haven’t worked, despite great effort and dedication.

Table of Contents:
What is DNRS?
How does DNRS work?
Do people with IBD have limbic system impairment?
Can DNRS work for ulcerative colitis or Crohn’s disease?
How much does DNRS cost? Is it worth it?
Helpful resources

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Ketone Supplements for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Apr 27, 2022 · Leave a Comment

Summary: There are a few mechanisms by which having elevated blood ketones could be therapeutic for IBD, and one case report demonstrated benefit of ketone salts in the context of a low-carb (but not ketogenic) diet for Crohn’s disease. Exogenous ketones can reliably elevate blood ketones as well as or better than a ketogenic diet, without the potential attendant downsides of such a diet. Ketone esters elevate blood ketone levels more than ketone salts, and may be better tolerated, but are also more expensive. MCT oil (particularly pure caprylic acid) can promote ketogenesis in the liver, but has a limited ability to do so compared to exogenous ketones. All of these supplements have various strengths and weaknesses and may be worth experimenting with for someone with IBD who is attempting to achieve therapeutic ketosis, whether in the context of a ketogenic diet or not.

This article is part of the IBD Index. Last updated on May 2, 2022.

In my (rather lengthy) article about the ketogenic diet, I discussed the background, risks, and potential benefits of a ketogenic diet in the context of IBD. Ketone supplements have become popular as both an adjunct to a ketogenic diet and as a way to get some of the benefits of ketone metabolism without the stringent dietary restrictions. But do they actually work? Are they safe? And are they worth trying if you have ulcerative colitis or Crohn’s disease?

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About Alyssa: Background, Biases, and Philosophy on Health and Disease

Alyssa Luck · Apr 21, 2022 · Leave a Comment

Last updated on April 21, 2022.

Most of us decide whether a bit of information is trustworthy in large part on the basis of who has conveyed it to us. You shouldn’t trust everything people say on the internet, and I’m no exception. This post is meant to give you a sense of who I am as a person, what my biases are, and the perspective I’m writing from, so that you can figure out whether you’ll be taking the information I provide with a grain of salt (or several).

Table of Contents
What qualifies you to talk about health and disease?
Why do you bother writing and sharing this stuff? Do you make money from it?
How do you do research for and write your articles?
Are you one of those anti-Western medicine types?
Are you one of those woo-woo New Age-y energy medicine types?
What’s your perspective on the causes of and solutions for chronic illness?
Are you anti-vegan? Anti-low-carb?
What does your own diet look like?
What are your current research interests and personal goals?

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Ketogenic Diet for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 22, 2022 · Leave a Comment

Summary: Ketogenic diets have exploded in popularity for weight loss and overall health optimization. While we are still sorely lacking in clinical research on ketogenic diets for IBD, there are a few compelling mechanisms – particularly modulating intestinal immunity and overcoming energy starvation in colonocytes – indicating that ketosis could be a helpful therapeutic strategy for some people. However, there are also some risks, with a potential increase in hydrogen sulfide production being a particular concern since hydrogen sulfide is often already elevated in people with IBD. Therapeutic effects of the diet are likely mediated both metabolically (by emulating fasting) and via the microbiome, but both of these mechanisms appear to be highly context-dependent, contributing to significant disparity in results across the existing literature on ketogenic diets in health and disease. In the context of IBD, my current assessment is that a strict ketogenic diet could be helpful as a short-term strategy for certain people, but is unlikely to be an optimal long-term strategy.

This article is part of the IBD Index. Last updated on April 27, 2022.

As the name would suggest, a ketogenic diet is a diet that promotes the metabolic state of ketosis. This is generally accomplished by consuming very few carbohydrates, a moderate amount of protein, and getting most calories from fat.

Note that I discuss the carnivore diet separately, because while a carnivore diet is necessarily ketogenic, its defining feature is the elimination of all plant foods, which is not necessary on a non-carnivore ketogenic diet.

For information about exogenous ketones (including brands), MCT oil, and some comments about breath vs. urine vs. blood testing for ketosis, check out my article on ketone supplementation.

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Hi! I’m Alyssa. I like thunderstorms and cats, hate wearing shoes, and enjoy devising extensive research projects for myself in my free time. This is me in Bali with a monkey on my shoulder. And this is my blog, where I muse about health-related topics and document my relentless self-guinea pigging. If you want to know more about me, click here!

alyssa.luck

alyssa.luck
Photo dump from the last year. Thanks to everyone Photo dump from the last year. Thanks to everyone who made 28 the best yet - excited for 29🥰

(PS. In case anyone wants to know what it’s like in my head, I was going to write something like “year 28” or “my 28th year” but then I realized that the year between your 28th and 29th birthdays is not your 28th year of life, it’s your 29th year. I am turning 29 because I have been alive for 29 years. So then I had a whole thing about how to word it without being inaccurate and ended up going with what you see above which is vague and weird but the point is it was a good year and I love all the people in my life dearly)
Biology of Belief (2005) was written by Bruce Lipt Biology of Belief (2005) was written by Bruce Lipton, who earned a PhD in developmental biology in 1971 and was an anatomy professor and academic researcher in the 70s and 80s. Despite the book's presentation and Lipton's background, this is not a science book. It is an exposition of an ideology, supported by haphazard and poorly contextualized nuggets of evidence, rhetorical leaps, and a mind-boggling overuse of analogies. 

The book largely failed to deliver on its promised content. What it does is argue for the primacy of the environment over DNA in controlling life; propose that the cell membrane rather than the nucleus is the "brain" of the cell; invoke quantum physics to explain why modern medicine fails; explain that our behavior is largely controlled by our subconscious mind; inform parents that they therefore have a great deal of control over the destiny of their children; and conclude that humans must become nonviolent protectors of the environment and of humanity because Everything Is Connected.

It’s not that these points aren’t relevant to the topic at hand - they are. But they were not connected in a coherent way that would explain how “belief” actually works (like…biologically), and the treatment of scientific concepts throughout was careless, or perhaps disingenuous.

I think he's correct about many things, some of them being common knowledge. For instance, the "new" science of epigenetics is now old news, as is the critical role of parenting and early environment in shaping a child’s future. But however important these and attendant concepts may be, the book did not do a good job explaining, supporting, or connecting them. 

As far as practical guidance, he refers the reader to a list of resources on his website, which is fine, but I expected some scientific insight into how/why those modalities work. None was given. 

On the plus side, the book was quite thought-provoking, and I came away with loads of references and topics to follow up on. My favorite line? "There cannot be exceptions to a theory; exceptions simply mean that a theory is not fully correct."
Friedrich Nietzsche, The Gay Science (section 382) Friedrich Nietzsche, The Gay Science (section 382), as quoted in the introduction to Thus Spoke Zarathustra because I like the translation better.
This paper totally changed the way I think about e This paper totally changed the way I think about early nervous system development and the relationship between physiology and sociality. 

The authors propose that newborn babies are not inherently social, and have just one goal in life: physiological homeostasis. I.e. staying alive. This means nutrients, warmth, and regulation of breath and heart rate, i.e. autonomic arousal (it’s well-accepted that newborns sync their breathing and heart rate with caregivers through skin to skin contact). 

All these things are traditionally provided by a loving caregiver. So what the baby experiences during the first weeks of life, over and over, is a shift from physiological perturbation to homeostasis (a highly rewarding event inherently) REPEATEDLY PAIRED with things like the sound of a caregiver’s voice and seeing their face. Thus, over time, the face/voice stimuli become rewarding as well. 

The authors argue that THIS is the beginning of humans’ wiring for sociality, and may explain why loving social interactions can have such a profound regulating effect on physiology throughout life: because the brain was trained for it at an early age. 

This framework holds all kinds of fascinating implications for what happens if that initial “training” isn’t so ideal. What if the return to nutritional homeostasis via feeding is paired with negative expressions and vocalizations rather than loving ones, perhaps as could occur with PPD? What happens if the caregiver has poor autonomic regulation, such that social stimuli become paired with cardiorespiratory overexcitement in the baby? Could that have potential for influencing later introversion vs extroversion? (Because if social interaction is paired with autonomic overexcitement, that could lead to social interaction literally being more energetically draining, which is what introverts experience. Thoughts?)

For my energy metabolism enthusiasts: Table 1 in the paper draws a link between metabolic rate and sociality across species. Swipe for a screenshot. 

Anyway, check out the paper! It’s free, just google “growing a social brain pdf.”
I’ll be under general anesthesia in a couple day I’ll be under general anesthesia in a couple days to have two tooth implants placed, and I think I’ll take the opportunity to have a little heart-to-heart with my subconscious mind. A bit of medically-assisted self-hypnosis, if you will. 

I randomly stumbled upon these papers a couple months ago - an RCT showing reduced post-op pain in patients who listened to recorded positive messages while under general anesthesia, plus a post-hoc analysis of the same data that found reduced post-op nausea and vomiting in a subset of high-risk patients. 

The full review paper from the first slide is unfortunately in German, but it has long been recognized that even when unconscious, the patient is listening (for better or for worse). 

It boggles my mind that it isn’t standard of care to have patients listen to recordings like this while under sedation, considering that almost nothing could be easier, safer, or cheaper, and we have at least some evidence of significant efficacy. I mean c’mon, what more could you want from an intervention? 

(Yeah, I know. Profit. If anyone still thinks that our medical system operates with patient well-being as the foremost goal, you’re deluding yourself.)

“There should be a fundamental change in the way patients are treated in the operating room and intensive care unit, and background noise and careless conversations should be eliminated.”

“Perhaps it is now time to finally heed this call and to use communication with unconscious patients that goes beyond the most necessary announcement of interventions and is therapeutically effective through positive suggestions. When in doubt, assume that the patient is listening.”
If you've seen "vagus nerve exercises" that have y If you've seen "vagus nerve exercises" that have you moving your eyes or tilting your head, you've probably encountered the work of Stanley Rosenberg. The exercises he created and introduced in his 2017 book now appear in instructional videos all over the internet. 
 
The book itself has much to recommend it: it's accessible, it's practical, it's inspiring. But it has one major flaw: the solid practical and informational content regarding the cranial nerves is framed in terms of the scientifically dubious polyvagal theory. 
 
I particularly enjoyed the book as an introduction to the therapeutic arena of bodywork, of which Rosenberg is a skilled practitioner. His book is full of case reports that demonstrate how immensely powerful extremely subtle movements and physical manipulations can be. These do need to be kept in perspective: it's a small sample size of the most remarkable cases, and the results were achieved within the supportive clinical environment of a skilled practitioner. You can tell from his descriptions how refined his technique is. But nevertheless, it was a paradigm-shifting read for me, and the exercises give you something concrete to play around with. 
 
The book also brought the cranial nerves and the concept of “social engagement” to the fore as arbiters of health. Rosenberg has a solid background in cranial nerve anatomy and shares many interesting tidbits and considerations that you don’t typically hear; for instance, the potential impact of dental and orthodontic work on cranial nerve function.
 
So, is it worth reading? If any of the above piques your interest, go for it! Just read my post on polyvagal theory first – you can use the book to practice separating the wheat (solid informational content) from the chaff (pseudoscientific framing). If nothing else, the book is a nice reminder that genuine healers who get lasting results for their patients do exist.

But if you just want to try the exercises, you can easily find them all on YouTube. 

“You learn techniques to understand principles. When you understand the principles, you will create your own techniques.” -Stanley Rosenberg
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  • Lymphatic Support for Ulcerative Colitis and Crohn’s Disease
  • Heart Rate Variability 101: What It Is, How It’s Measured, and Controversies in the Literature
  • Autonomic Nervous System 101: Anatomy and Physiology
  • Vitamin A Detox Diet for Ulcerative Colitis and Crohn’s Disease

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