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Alyssa Luck

Alyssa Luck

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Polyvagal Theory: A Critical Appraisal

Alyssa Luck · Oct 29, 2022 · 1 Comment

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.”

[Read more…] about Polyvagal Theory: A Critical Appraisal

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.

[Read more…] about Heart Rate Variability 101: What It Is, How It’s Measured, and Controversies in the Literature

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.

[Read more…] about Autonomic Nervous System 101: Anatomy and Physiology

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!)

[Read more…] about Brain Retraining: How to Choose a Program?

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?

[Read more…] about About Alyssa: Background, Biases, and Philosophy on Health and Disease

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.

[Read more…] about Ketogenic Diet for Ulcerative Colitis and Crohn’s Disease
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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
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
I first stumbled upon polyvagal theory during the I first stumbled upon polyvagal theory during the course of my heart rate variability research. I was surprised to encounter it again "in the wild" shortly after, in the book "Accessing the Healing Power of the Vagus Nerve." Before long, I saw it popping up everywhere, (Baader-Meinhof, anyone?) 
 
Digging deeper, I discovered scientific controversy bubbling just beneath the smooth surface of polyvagal theory's popular presentation. Three months later, I posted a 13k word analysis of the topic. 
 
The technical details are far below the level of practicality for the average person, but the way polyvagal theory has propagated outside of academia has some important ramifications for clinical and scientific progress. 
 
In the wake of a wave of health complaints that our current medical model is poorly equipped to treat, it's clearer than ever that a new paradigm is needed. The grassroots push to emphasize diet and lifestyle factors has been a huge step in the right direction, but it's becoming more and more common to see people who have done everything "right" and are still struggling with persistent health complaints that could range anywhere from mildly annoying to debilitating. 
 
What we need is a genuine integration of mind and body in medicine – not the weak lip service that our current paradigm pays to "stress reduction," like the vague suggestion to relax more and maybe try meditation. And if we're going to develop a sophisticated mind-body medicine, we need a sophisticated mind-body science. And if we want a sophisticated mind-body science, we must subject such topics to the same standards of inquiry as we expect from molecular biomedicine. And that means rejecting pseudoscience like polyvagal theory. 
 
Full analysis and references at alyssaluck.com/polyvagal-theory-a-critical-appraisal
To continue my recounting of the health things I'm To continue my recounting of the health things I'm experimenting with, let me tell you about DNRS: the slightly cheesy, arguably outdated “brain rewiring” program that has changed my life. 

I found it because I was looking for ways to “retrain” my nervous system. I watched some success stories. None of the “target” health conditions matched mine, but I went for it anyway. Probably the best decision I’ve ever made for my health. 

The core of DNRS is built on the principles of neuroplasticity. They call it "brain rewiring" because you intentionally take triggers that would normally stimulate a negative response in your body or mind, and associate them repeatedly with neural signals of safety. If that sounds pseudosciencey, I hear ya – one of my goals with future posts is to bring some concreteness and specificity to the topic. I imagine there are lots of people who could benefit from this type of thing who are turned off by the overly abstract or touchy-feely language. 

There are tons of "brain rewiring" programs like DNRS, but they're all built on similar ideas. Most bring in elements of other popular approaches, ranging from the scientifically validated (cognitive behavioral therapy, mindfulness, acceptance and commitment therapy) to the type of new-agey stuff I always scoffed at (shadow work, inner child work, parts work). 

For me, DNRS has provided the perfect framework to finally achieve what meditation experts and therapists and mystics alike are always advocating – the ability to step into the role of “curious observer.” It's given me everything therapy and meditation promised but could never deliver, helping me recognize my own patterns of thought and behavior and consciously redirect unhelpful ones. If this sounds vague, that's because there isn't a single area of my life that hasn't been improved by using this framework. 

I spend far more time in states of joy and peace and gratitude, and less time in states of anxiety or depression or frenzy. Many chronic worries that used to occupy my mind or keep me up at night – whether related to health, relationships, or my future – have disappeared, and the others are on their way out. (Cont. in comments)
Isn’t it crazy how something can be so easy and Isn’t it crazy how something can be so easy and natural for one person, but so hard for another? 

Me doing food: I can totally cook everything I eat from scratch, no prob

Me doing mental health: just doing my hour of daily mindful cognitive gratitudinal journalization

Me doing physical therapy: I can’t do it I don’t have that muscle

I’ve done many hard things in the name of health, but I think they’ve all been the types of hard things that come naturally to me. And frankly, that hasn’t gotten me where I want to be. 

So I’ve decided to finally tackle something that feels very unnatural: developing a real relationship with my muscles and bones, and learning - through experience, not from a book - how they coordinate with each other and how to use them. 

I never really considered my musculoskeletal system a key player in autoimmune or digestive woes, but now I realize it’s naïve to think dysfunction in one part of the body doesn’t affect another. And since this is so obviously my weakest link, it’s high time to make it a priority!

Even though I’ve done strength training in the past, I never dedicated the time and focus to figure out what my body actually needed to function better, and workouts often felt awkward or led to injury. 

I’ve always dreaded PT-type exercises because they felt simultaneously like “not enough” and also SO HARD, especially when there’s no way to confirm whether I’m doing them “right” (my nightmare). 

But I’m pretty sure the fact that targeted “mind-muscle” work is so hard for me means it’s what I need the most. (That’s how that works, right?)

Anyway, I’m happy to report that I’m finally through both the initial phase of being a giant baby because I have to do something I’m bad at, AND the second phase of neurotically worrying about doing it “wrong.” And hopefully I’m on my way to better posture, improved breathing, and greater strength! 

Super thankful to have people in my life who remind me to have fun and stay curious, when my natural disposition is to write a 27-step plan to “fixing” everything “wrong” with me. And to remind me that it is, in fact, a JOY to be a novice at something (as @_john_the_savage_ would say).
"If your nervous system is balanced, your heart is "If your nervous system is balanced, your heart is constantly being told to beat slower by your parasympathetic system, and beat faster by your sympathetic system. This causes a fluctuation in your heart rate: HRV." (whoop.com) 
 
This statement is a formidable example of one of the biggest misconceptions about heart rate variability (HRV). 
 
HRV is highest during rest or sleep, when sympathetic input is lowest. If HRV was the result of an autonomic “tug-of-war,” why would it be greatest when one of the contenders has entirely dropped the rope? 
 
Part of the misunderstanding may stem from failure to recognize that the heart has an intrinsic rate, well above the resting heart rate maintained by the vagus nerve. Varying vagal impulses create HRV without any sympathetic input at all. 
 
There are many other common misconceptions, such as the notion that HRV metrics measure autonomic tone, or that HRV itself is a metric with one interpretation. 
 
Such misconceptions aren’t only found in layscience – they also pervade academic and clinical literature. For instance, you’ll see LF used as a measurement of “sympathetic tone” and LF/HF as a measurement of “sympathovagal balance,” even though it’s been clear for decades that those interpretations are not physiologically accurate.
 
This post (and the associated article at alyssaluck.com/hrv101) can be thought of as “foundations for understanding HRV research.” And it provides a good example not only of the insufficiency of “sound-byte” science, but also of real science in action. 
 
The unfortunate reality is that we can’t always take researchers’ conclusions at face value. Few have the time to adequately assess a field before adopting one of their metrics, and once a misinterpretation has taken root it can easily become an accepted fact that propagates through repetition, becoming more entrenched with each published paper.
 
Thankfully the ramifications in this case are not very serious - misdirection of experimental design and analysis, and many false statements, but no dire consequences. Nevertheless, it’s a good reminder that science is a human institution, and it never hurts to question oft-repeated “facts.”
My latest diet experiment: the bean protocol! This My latest diet experiment: the bean protocol! This was one of the changes I made immediately prior to my drastic increase in HRV. 

Brief background: the bean protocol entails eating lots of soluble fiber (particularly beans) as a way to support detox. It rests on the assumption that most chronic health issues are the result of fat-soluble environmental toxins, excess hormones, and other fat-soluble things being recirculated in the body rather than eliminated. 

There is some scientific merit to this: the liver does eliminate many toxins and other compounds through the bile, these things can be subject to reabsorption via enterohepatic recirculation, and certain types of fibers do interrupt this process by binding bile, preventing reabsorption and allowing excretion in the feces.

That said, there are many unanswered questions that would need to be answered for me to be on board with that as the sole or even primary explanation for the anecdotal success of those on the protocol. I think there are almost certainly other mechanisms at play, and I doubt things work exactly as proponents of the protocol describe. 

But at the end of the day, what matters is not mechanisms, but practical outcome. And whatever the reason, it works for many! It seems especially popular and effective for hormonal issues and acne, but the preeminent bean spokesperson @uniquehammond cured her severe Crohn’s with it. 

For me, I experienced better digestion and clearer skin, among other benefits (like not having to wear deodorant). On the less-good side, I lost weight I didn't need to lose, had cold hands and feet, and developed some dry patches on my skin. 

(The dry patches [and perhaps weight loss] were probably because I kept fat too low – mostly because their favored fat source, nuts, is a no-go for me.)

I'm continuing to experiment, hoping to find a balance that lets me reclaim the benefits (which I lost after returning to my normal eating pattern) while avoiding the pitfalls. I’ll share any exciting developments, and will eventually dig into the science behind it too. 

For info about what the protocol entails, you can visit alyssaluck.com/the-bean-protocol-for-ibd!
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Recent Posts

  • Polyvagal Theory: A Critical Appraisal
  • 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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