Embodied Cognition and Health with Cathy Kerr (LBP 056)

catherine-kerr
catherine-kerr

Cathy Kerr is the director of the Mind-In-Body Lab at Brown University. Her research focuses on whether brain rhythms underlying body awareness and movement are actively modulated by mindfulness and movement practices such as Tai Chi and Qigong. Her hope is that understanding how these therapies work will have a positive impact on conditions like aging and chronic pain or functional disorders where these approaches have shown the clearest therapeutic benefit.

She joined me today to talk about the focus of her research broadly, but also to discuss a specific research study that is in progress which is looking at the effects of Qigong on distressed female cancer survivors.

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Conversation highlights

  • What does her research focus on? The status of body awareness as a therapeutic mechanism and looking specifically at mechanisms related to body awareness in the brain; How neurons process and relate to body focused attention, primarily in the somatosensory cortex.
  • Became interested in body awareness originally a Qigong practitioner because of having a difficult chronic illness for 20 years. Cathy noticed that with her practice the sense of touch in her hands would change.
  • Started to wonder if body experience could be part of a therapeutic mechanism. Was it a way of signaling healing? Or a very active way of creating the placebo effect?
  • Initially began researching the placebo effect with Ted Kaptchuk at Harvard
  • In 2005 departure from work on placebo and learned the neuroscience of body awareness.
  • First project to look at the effects of body awareness within a healing technique- for that technique they ended up choosing MBSR (mindfulness based stress reduction).
  • It was paradoxical because they were not a part of the mindfulness research community, and mindfulness as a body based healing technique not the majority view.
  • The study showed that after 8 weeks of MBSR training people were better at exerting pinpoint control over neurons in their somatosensory map.
  • Cathy's TED talk mindfulness begins in the body.
  • There is an interesting suta by the Buddha- the 4 foundations of mindfulness, and mindfulness of the body is the first foundation. Cathy wrote a review paper on this in 2013.
  • Cathy's teaching with medical students at Brown how to have immediate access to body sensations as an anchor for mindfulness.
  • This is an immediate way of stabilizing the mind. For many Western people their mind can be floating free and ungrounded and anchoring your mind in the body is very powerful.
  • Some people don’t even know that they can voluntarily shift their attention to their body. (story of a man who jumped away from his own hand because he was so startled when he shifted his attention to it).
  • Many people with chronic pain, and IBS don’t have that ability to bring the mind to the body. The reason is that they are already always preoccupied with these negative body experiences.
  • What’s really exciting right now is that The Davidson Lab has begun to look at the effects of mindfulness and exercise. They are bringing mindfulness off the cushion. It really helps people to understand a broader range of embodied approaches like Tai Chi, or yoga.
  • At the University of Washington Dr. Cynthia Price is working with assisted mindfulness in people with trauma. In  assisted mindfulness a bodyworker helps them to be and stay present while they work with mindful attention to body sensation.
  • Cathy's current study on the effects of Qigong on distressed female cancer survivors.
  • She chose Qigong because she wanted to see what would happen if researchers expanded the number of modalities they looked at in addition to just mindfulness.
  • There is a novel undertanding of how the mind and body relate in Qigong. The hope was that they could capture these ideas and understand them in scientific terms
  • Cancer survivors are really underserved and have a lot of psychosocial needs. About 30 to 50 % of them are actively fatigued and distressed for years following cancer remission. Is this chemo? Existential effects? They don't know but the main thing is people are not able to return to their full lives. The whole pink ribbon campaign doesn’t really capture this reality.
  • Gentle physical movement in a group can really transform people’s experiences. The question is why, and how does it work
  • Inflammatory cytokines show an up-regulated process of inflammation going on in the body. Especially in people who are highly fatigued. This process of inflammation is really important for many diseases.
  • There are now some markers in blood that we can measure- giving insight into this process of daily inflammation. They are associated with feeling sick and tired daily. If you are bathed in inflammation for years it can bode poorly for susceptibility for many issues like heart disease, vascular disease, it is associated with dementia... Getting a better understanding of inflammation is one of the main scientific tasks right now.
  • We know that if you are injected with one of these inflammatory cytokines you will get "sickness behaviors" like not wanting to get out of bed and feeling generally unwell... but we don’t know how to clear these inflammatory cytokines out.
  • There is an old Chinese folk saying- the mind (yi) leads the qi, the qi leads the blood.
  • This seems to suggest a solution to the puzzle of qi. So if you behave as a scientist you can measure the mind and its ability to focus on the body. You can measure the yi and the blood... So maybe that is a pathway of how mind intent or somatic awareness might have an effect on parameters in the blood like inflammation or the ability of the blood to flow through the body.
  • Embodied cognition: many philosophers have gone on this mind trip and have posited these ideas of brains in jars and brains in vats- that we can only look at brains. They are saying no there is a relationship between brian and body and body and world and if you miss that you miss everything.
  • Interoception research has been a very brain centered endeavor to the point where all the relevant processing is considered to takes place in areas in the brain. But in fact there is a lot of bodily signaling from the heart and other centers.
  • Neurons in the body have their own way of processing experience and an ability to send independent sources of information that are not simply sensory through-puts but are actual information processing. There are independent sources of information and embodied cognitive processing to help the body in the brain.
  • We want to measure different forms of connection between the hand and the brain. Want to see if that changes during the course of practice.
  • We hear a lot about consciousness. One of the main factors is something called a brain rhythm. The gama rhythm is of consciousness. There was a study in 2004 of Tibetan monks doing compassion practice gama rhythms go off the charts. It turns out these rhythms also extend into the muscles, and these rhythms of consciousness that extend into the muscles also relate back to the brain.
  • The beta rhythm is a stopping rhythm. It’s very operative in thinking and in moving. If you need to hold something in memory beta says no more info for a bit please. Beta becomes disregulated in parkinson’s disease. Measuring beta in Qigong. Looking at quality of information that the muscle spindle neurons send back to the cortex.
  • Curious about if that somatic awareness has effects on the ways that the muscles process information. Do some of those effects tell us anything about changes in blood flow or in inflammation?
  • The rubber hand illusion tells us that there is this very interesting multi-sensory body sensing capacity.
  • It tells us that our sense of the body is being knit together by these different streams all the time.
  • Their biggest hope with this study is that they will learn something new about how some of these body awareness practices like Tai Chi and yoga might have an impact on inflammation. It could be a novel mechanism for understanding inflammation. That’s the big home run hope.
  • Being able to have an impact on the distress of this population would be wonderful.
  • Cathy asks me is there a discussion about the intelligence of the body? How do I as a practitioner use that? \
  • I talk about the Liberated Body tribe- most of us are in a variety of manual and movement therapies. The thing that makes us all stand out is that we have a reverence for the body - we believe in its importance to life.
  • My life changes the more engaged I am with my body.
  • As a larger group the thing that makes us different in terms of the broader culture is that we talk about the body as something critical to a rich thriving life.
  • Cathy: there is so much wisdom in people who are carrying that out in a daily practice. There are so many of these practices across all cultures. There must be something universal about this, it's not just something people are making up. I’m excited about people engaging with the science.
  • Fascia research: We are all learning how the nervous system and the connective tissue scaffolding are so intertwined.
  • There is a lot of exciting sense of possibility. It’s like we discovered we have the amazon right here in the body.

Resources

Dr. Cathy Kerr's Mind-In-Body Lab at Brown University

Cathy's TED talk: Mindfulness Starts in the Body

Cathy's paper in Frontiers in Human Neuroscience Mindfulness Starts with the Body

Mindfulness Based Stress Reduction (MBSR)

Ted Kaptchuk and placebo research 

The Davidson Lab

University of Washington Dr. Cynthia Price

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Connective Tissue and Inflammation with Helene Langevin

Dr. Helene Langevin received her medical degree from McGill University and did a post doctoral research fellowship in Neurochemistry in Cambridge, England. Her residency in Internal Medicine and fellowship in Endocrinology and Metabolism was at Johns Hopkins Hospital. She is a Professor in Residence of Medicine at Harvard Medical School, Brigham and Women's Hospital and is also a part-time Professor of Neurology, Orthopedics and Rehabilitation at the University of Vermont College of Medicine. She was appointed as Director of the Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital in November 2012.

As if that weren’t enough to keep a person busy… In our worlds she is best known as the Principal Investigator of NIH-funded studies investigating the role of connective tissue in low back pain and the mechanisms of manual and movement based therapies and acupuncture.

Today she joins me to talk about her research- specifically how stretching impacts inflammation resolution in connective tissue, how connective tissue is a critical component of the immune system, how movement influences immune processes, and what this all might mean for both prevention and resolution of both chronic pain and cancer.

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Conversation highlights

  • Why her research focuses on the role of connective tissue in chronic pain, and the mechanisms of movement and manual based therapies as well as acupuncture.
  • Her first NIH grant in which they designed a robotic arm to manipulate acupuncture needles and found that the cause of the force was greatly increased when the needle was rotated. This was due to the mechanical stimulation delivered to the connective tissue.
  • How this got her interested in the effects of stretching tissue.
  • Research suggests acupuncture needles interact with different pathways in the nervous system. The connective tissue can simply be the mechanical link between needle and sensory nerves.
  • They found that there are cells within connective tissue- the fibroblasts- which change shape. They expand and remodel internally. So the needle might be having an effect on the connective tissue in addition to what happens in the nervous system.
  • When the fibroblasts change shape they secrete ATP. It's a molecule we think of in terms of energy in production in the cell. However, ATP can be used in a different way and can function as a signaling molecule outside the cell. Release of ATP from cell is necessary for the cell to change shape.
  • There is research being done at The University of Rochester by Dr. Nedergaard and Dr. Takano (in resources) on the effect ATP downstream- showing an analgesic effect on sensory nerves.
  • Dr. Langevin clarifies her 2002 paper Relationship of acupuncture points and meridians to connective tissue planes (in resources) saying, “We have to be careful here when we talk about correlation of acupuncture meridians and fascial planes." and "it’s not surprising the channels aroe found between a bone and a muscle or between two fascicles of a muscle... does that mean that fascial planes are the same as meridians? I wouldn’t say that”
  • Cancer is not just a collection of tumor cells growing out of control> They need a base and that base is the connective tissue- the stroma. The cancer takes the connective tissue hostage.
  • Dr. Patricia Keely at The University of Wisconsin has studied that cancer is likely to spread along places where the connective tissue matrix forms these railroads where the cancer can spread. (in resources)
  • Dr. Langevin's paper Stretching Impacts Inflammation Resolution in Connective Tissue (resources). She defines inflammation and what it means for both cancer and chronic pain.
  • In musculoskeletal pain it’s not always clear where the tissues are that are creating the pain. In low back pain for years the belief was that it was coming from the spine.
  • How does fascia generate pain? The soft tissues of the back can be the source of pain if they have a source of persistent inflammation in the tissues.
  • Dr. Langevin defines stretching and the protocol they used with the rats at UVM in the research study.
  • Viscoelastic changes in fascia can happen fairly quickly, but the fibroblasts are much slower and didn't start changing until about the 10 minute mark.
  • I ask Dr. Langevin to differentiate between movement and stretching.
  • Static vs. dynamic stretching is a very important differentiation.
  • In the studies of athletes and static stretching, "I’m not convinced athletes weren’t stretching too much? Stretching beyond the limits is ripping the tissue, and the idea more is better may not apply. Achieving the right and specific force of the tissue may be very important."
  • The connective tissue is really the home of the immune system.
  • In her current research she is pursing the aspect of inflammation resolution with respect to the dose of stretching. She also wants to see the role of connective tissue in back pain and the response to body based treatments- both manual and movement based.
  • She is also interested in looking at longitudinal studies- observing back pain over time. Children and adolescents that are getting back pain at an earlier and earlier age- do changes in connective tissue precede the development of back pain?

Resources

Dr. Helene Langevin on Brigham and Women's website

Osher Center for Integrative Medicine- a partnership between Harvard University and Brigham and Women's Hospital

Dr. Langevin's paper Stretching Impacts Inflammation Resolution in Connective Tissue

Dr. Nedergaard and Dr. Takano research at the University of Rochester

Dr. Langevin's paper Relationship of acupuncture points and meridians to connective tissue

Dr. Patricia Keely's research at the University of Wisconsin on how cancer spreads along "lines" in the connective tissue 

If you’re inspired to leave a review on iTunes or Stitcher I would be oh so grateful. If technology isn’t your thing however you can just tell your favorite body nerds about the show. It keeps the show rolling and connects us more as a community. Body nerds unite!

The Spark in the Machine with Daniel Keown (LBP 046)

Dr. Daniel Keown, who is both a Western medical doctor and a Chinese medicine doctor joins me for a conversation about his book The Spark in the Machine

We discuss many of the crucial things that Western medicine ignores- things like fascia, extracellular fluid, how an embryo knows how to organize around a seeming blueprint, and how your spirit affects your health. We talk about how fascia explains Qi, how and why jing and shen are better predictors of lifespan and health than a person’s genetics, what cancer has to do with fascia and Qi, how we are all built like crystals, what that has to do with piezoelectricity, and so much more. 

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Conversation highlights

  • Why do you begin your book with the question "Why can’t humans regenerate?"
  • It gets to the core of what healing is. The question isn’t how does it occur by why can’t we? In primitive animals they can regenerate limbs.
  • There is this myth in western medicine that somehow doctors heal you. What they really do it allow the healing to occur.
  • Chinese medicine knows and has always known that the space between the cells is as important as the cells themselves. The spaces in the cells taken up by extracellular fluid- it makes up about 40% of the body- so it's a huge amount of fluid. If you imagine your skin as a membrane that keeps everything in, and this is the fluid that bathes all of our cells, it’s also a communication medium. Yet there is no real concept of this fluid as being living and important in Western medicine.
  • Western medicine does not really have a philosophy of health.
  • Qi is the energetic blueprint from which matter is made manifest.
  • We are one cell that develops into trillions and trillions of cells in our perfect complex organisms- there is an energetic blueprint on how that forms, and that’s Qi.
  • Jing and shen are more real than genetics in terms of predictors of health and longevity. The big problem with genetics is that it is too complex. People think you have “a code” but that’s not how it works. You have multiple different codes- this is the science of epigenetics. If you are in a stressful situation you will tap into that "code" to get you through the stressful situation.
  • That’s an example of your shen, your spirit, affecting your jing, your matter. This plugs into why meditation is so important and why living a good life is so important- it resonates through your material body. The science of genetics is not going to go much farther, it is going to go into epigenetics.
  • Fascia explains Qi because fascia is like the skeleton that your body is built around. It is a web and then the cells grow into this web or are knitted into it.
  • Doctors and scientists will talk about how they can grow a heart, but they can't actually do it. They will take the heart of a pig, strip away everything but the fascia, then inject heart stem cells- they’re kind of cheating. The Qi is like the skeleton of fascia.
  • Chinese medicine devotes two organs to fascia- triple burner and pericardium.
  • When getting the degree in Chinese medicine a lot of questions that couldn’t be answered. He couldn't get a straight answer about the Triple Burner. so looked through an old book- Giovanni Maciocia Diagnosis in Chinese Medicine and saw the pelvis, abdomen, and chest-the triple burner described the fascia which separates it and keeps these compartments behaving like they should.
  • Acupuncture points are what surgeons use everyday. Google keyhole surgery and you'll see loads of videos, the hole they are putting it into is this space within the body- they blow it up with gas so they can navigate the body. Surgeons don’t want to cause damage in the body so they go along the pathways that are already there, which are the acupuncture points.
  • When bad things happen in surgery it’s always because they have broken the rule of never crossing fascial planes.
  • Cancer spreads through fascia- Cancer is just a break down of Qi. Qi is the force that keeps everything doing its right thing, and cancer is just a group of cells who decide damn you and they are going to go their own way.
  • There are mechanisms in the immune system that are designed to mop that up, and immunotherapy is one of the most interesting fields of cancer therapy, but you also have to address the underlying Qi disturbance.
  • How does the body self organize? People say it’s genes, but Qi is a more accurate description. Google frog electric face to watch it in action (in resources).
  • What is piezoelectricity? We’re all effectively crystals. Electrical current is happening all the time within our bodies- the collagen itself appears to be piezoelectric. This is why astronauts lose bone strength. They lay down calcium and phospohorus and this creates hardness. In space there is no more gravitational stress on bones- so bone cells, the osteoblasts, feel there is no need to do anymore building and so bones get slowly reabsorbed.
  • Within Western medicine there is a slight crisis among doctors- we have completely removed the concept of spirit or shen. As a result doctors are literally becoming dispirited.
  • The miracle of antibiotics is 50 yrs old- chronic diseases now are about looking deeper into society
  • We live in turbulent times but there are a lot of good people out there. 1% of bad eggs who are now at the top of society, and we need to reclaim society and part of that is going to be making medicine simple and about people again.

Resources

The Spark in the Machine- Dr. Keown's book

Space: 21st Century acupuncture- Dr. Keown's private practice and blog

Diagnosis in Chinese Medicine by Giovanni Maciocia

frog electric face video

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How We Form and Move with Joanne Avison

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The Bliss of Your Biology with Ged Sumner

If you’re inspired to leave a review on iTunes or Stitcher I would be oh so grateful! If technology isn’t your thing however you can just tell your favorite body nerds about the show. It keeps the show rolling and connects us more as a community. Body nerds unite!