Episode Transcript
[00:00:00]
Jill Brook: Hello, fellow POTS patients and beautiful people who care about POTS patients. I'm Jill Brook, your hyperadrenergic host, and today we are interviewing Dr. Derik Anderson, Doctor of Chiropractics and Clinic Director of the Muscle and Joint Clinic in Northern California. He is an expert on hypermobility spectrum disorders, hypermobile Ehlers Danlos Syndrome, POTS, and the common comorbid conditions.
He has many honors to his name and to his clinic, including the Ehlers Danlos Society has named his clinic a Center of Clinical Excellence and has awarded him research grants. He is also a leader in research on fascia, pain management, and the many ways that hypermobility can affect health and function besides just causing a lot of joint pain, which I'm excited to hear about.
Dr. Anderson, thank you so much for being here today.
Derik Anderson, DC: Thank you so much for having me, Jill.
Jill Brook: So, for starters, do you mind telling us a bit more about yourself and your background and your clinic?
Derik Anderson, DC: [00:01:00] Absolutely. I've been in practice, this is my 28th year.
Really started in sports and specifically ballet and that was a mainstay for 15 plus years and then started treating EDS. Really with sports realized, you know, how important getting proper fuel to the body is so I have done a fair amount of graduate work in functional nutrition, in functional medicine something that we significantly incorporate with our POTS and EDS patients, taught at the graduate level,
and really our focus here at the clinic is to approach the physical, chemical, and emotional aspects of care [00:02:00] because reality is any chronic disorder, no matter where it starts of those three it will then affect the other two, as we call them, the pillars of health.
Jill Brook: Okay, Physical, Chemical, and Emotional. I'm going to remember that. Can you say a little bit more what you mean by that? Like I'm sure some people are sitting here thinking chemical, like what do you mean chemical?
Derik Anderson, DC: So, being noradrenergic yourself you know, I, maybe we translate that as you know, lay terms, an adrenaline junkie, you know, it really we want to look at the systems of the body and how chemically balanced they are. So, you know, if somebody has, for instance dysbiosis, you know, that is really gonna you know, can really interrupt their serotonin production.
[00:03:00] So did that start because of emotional stress, was it post major physical trauma you know, was it something that somebody eats, you know, a food allergen for instance you know, this is how three different cases, one emotional, one chemical, one physical, that, you know, all end up disrupting one of our key feel good neurotransmitters of serotonin.
Jill Brook: Oh, that's so interesting. And that gets into a question that I have about, I know that you're famous for talking about your multidisciplinary care and approach, but can I ask you one question first before we get to your approach? Since you work in a clinic that has so many athletes and ballet dancers and stuff like that, can I ask, like, first of all, how common is hypermobility at your clinic, and how much [00:04:00] difference does it make to you clinically whether a person has
definitive Hypermobile Ehlers Danlos Syndrome versus, you know, like, quote unquote just hypermobility, and like, but they don't, like, quite, they only get, like, a Beighton score of, like, four. Like, how much of a difference does that make to you? Is that, is that two totally different worlds, or is it practically the same thing to you, or?
Derik Anderson, DC: You know, at the end of the day, it really, we treat the person. So, you know, health, the healthcare system in the U. S. definitely, functions on diagnoses. So, whether somebody has, you know, a Beighton score of four or five, if they're one checkbox off in the EDS Society's hypermobile EDS questionnaire, which currently is the official way to diagnose as we await the [00:05:00] release of the genetic marker for hEDS.
Does it matter? Yeah, it matters, but it is it really, what matters most is what the person in front of us is presenting with.
Jill Brook: Okay, okay, so it's not like you say, oh, you have definitively met the diagnostic criteria for hypermobile EDS, so now we're gonna go do this whole special thing.
Derik Anderson, DC: You know, we will definitely give people their diagnosis but, you know, particularly in the Ehlers Danlos space, which over half of our patients now have EDS. You know, it really is a significant part of our practice. So, if somebody shows up who they know they're bendy and they want to find out if they have EDS, we do the EDS workup, but I'm also considering how POTSy are they?
How much mast cell activation syndromes, you know symptoms are [00:06:00] they displaying? You know, do they have a lot of gastroparesis type symptoms? That is what really goes into the bigger, clinical picture, and then really determines what we do from there testing wise, treatment wise. That's what I mean by we treat the patient much more than we ever treat a diagnosis.
Jill Brook: Okay, fantastic, because I know people are always wondering how much it matters whether they are, you know, just quote unquote on the spectrum of hypermobility or if they've know that they full blown have it. But what I'm hearing from you is that it's one factor, but just one of many.
Derik Anderson, DC: One of many, and particularly going back to, you know, starting, you know, practice and working with a lot of ballet dancers. You know, reality is I started working with hypermobility very early on as most ballet [00:07:00] dancers actually are innately hypermobile. So, you know, have seen this spectrum for over a quarter century now, but it's been a decade since I've really focused on it, and the clinic has moved in, in that direction.
So, yes, we do look for the official signs of EDS, but 20 percent of the general population is on the hypermobile spectrum. So, it really, it does matter how we treat whether somebody has EDS, whether somebody has some hypermobility or they have normal or even less than normal flexibility.
Jill Brook: Okay, well this sounds like this gets to my next question, which is about your approach to care. Because I know that you are sort of known for a multi factorial approach. Can you, can you talk about how you, how you go about [00:08:00] looking at your patients and treating them?
Derik Anderson, DC: Yeah, when we start off with a patient, you know, I really, really want to make sure that want to understand what their most important symptoms are. It, you know, if somebody's coming in and they're talking about that they noticeably get dizzy and, you know, that that is really affecting their quality of life, for instance, then, you know, that they might not have ever heard of POTS.
They might not know that their heart rate takes off. But we will then start to really dive deeper into that and, you know, with that, I, I want to see what other signs of dysautonomia that they might have and that usually we then start to see interconnection between [00:09:00] their POTS or their MCAS you know, Hashimoto's, whatever those other, you know, symptoms or diagnoses that they have we do see if there's a common thread.
So that way we can really go after the 20 percent of things, the 20 percent of causes that are resulting in 80 percent of their symptoms.
Jill Brook: Can you talk about examples of what you have sometimes seen those be in your patients?
Derik Anderson, DC: What we very often see is there is a fair amount of adaptation in people's systems. So, you know, we definitely talk about the, what's called HPA access. So kind of starting like the gut, you know, brain, adrenal system connection. Our, bottom line, our bodies become efficient at what they do a lot of, [00:10:00] and so if somebody has adapted and has
really become good at becoming hyperadrenergic and really secreting a lot of adrenaline and norepinephrine and cortisol you know, we're going to start seeing signs and symptoms, maybe it's Irritable Bowel Syndrome,
you know, it could be inability to build muscle bulk. Chronic pain is definitely a symptom yet another symptom of that. Then the question becomes, all right, what is the one or two, maybe three factors that are, you know, most likely the biggest drivers of this adaptation?
It then becomes a matter of, once we determine that, then it's a matter of either in [00:11:00] office or laboratory testing to see, alright, do we have metrics on this now? Confirms what we have, and when we do, we now also have a baseline that we can go back and make sure that we're actually, not only subjectively, that is, getting rid of the pain or POTS, but that we're also normalizing system function.
Jill Brook: So, I think that you just said something that probably is like common knowledge to you, but I'm not sure that anybody that I know is talking about it, where you, you sort of mentioned that the high adrenaline or cortisol could lead to IBS or difficulty putting on muscle or pain and I almost did a little, what, what, what's that now?
Can you talk about that?
Derik Anderson, DC: Yeah I think we'll take cortisol, for instance. It, it liberates sugar in [00:12:00] our body. You know, it really allows us fight or flight. Which, you know, that's great in the short term. We definitely need it. We're late for an appointment, you know, you want that little burst of, of cortisol. Sitting there, you know,
piling through email for six hours with, you know, or hours and hours without moving. Definitely being concerned about how you're going to make rent you know, or your mortgage. Worrying about your job, having children that you're really concerned about. I mean, these are drivers of chronic elevated cortisol level, levels,
which means we're going to have, in general, higher blood sugar levels. And, we'll take the example of yeast. Yeast love sugary environments and we don't even have to be diabetic or even pre diabetic. It's the sugar, [00:13:00] the spikes in our blood sugar that these yeast, you know, this dysbiosis,
they love these sugar spikes because that's when they, it's feeding time for them.
So, you know, you start elevating cortisol on a regular basis, the body will become efficient at elevating cortisol and you're literally going to start changing the microbiome in a, in a bad way, but it's the body's adaptation. It's really these opportunistic organisms that can thrive in this stressed body.
Our job is to find is to find out, okay, how do we best stop this adaptation? Again, going back to the 80 20 rule, you know, we want to find the 20 percent of causes you know, maybe if somebody's eating some pretty starchy foods, the stresses [00:14:00] are gone, say, you know, are manageable but they've been eating their comfort food still.
That's where, you know, we will take a look at diet history and say, wow, you know, there's a lot of
bread, rice, pasta, and potatoes in this diet, you might look healthy, but, you know, we got a number of signs, as well as symptoms, that there's an issue here and, you know, it's dysbiosis we can see from the labs.
Here's how we're going to change your diet.
That then,
including using things like adaptogenics, really help decrease that chronic cortisol release.
Jill Brook: And how does cortisol make it harder to to gain muscle. Is that, is that the other one that you mentioned?
Derik Anderson, DC: Yeah, you know, we, we are, we need recovery, [00:15:00] right? That is what sleep is about, particularly deep sleep. That is our, it's night time is when our bodies literally recover from the day's activities. So, you know, in chronic disorder management, we very often talk about spoons. You know, in spoon theory. So we use up our spoons during the day.
We get them back at night.
It's also during this restoration phase that our body's part of healing is being able to you know, be, be anabolic. I mean, it literally means to build. Muscle is part of that building. If our cortisol levels are up, absolutely disrupts sleep patterns and we're going to start cutting into that
anabolic phase, that, that building phase of the body. For, you know, for our patients, particularly in the hypermobile [00:16:00] spectrum, there already can be a challenge because of sensory input changes in the soft tissue. There can be challenges for them to put muscle on. Then you add in elevated, chronically elevated cortisol levels, interesting, interrupting sleep patterns.
And, you now can really have challenges putting muscle on.
Jill Brook: And can I ask what you think of, there's a hypothesis out there, I've heard from some of the mast cell specialists, that they suspect that some of the mast cell mediators, especially like tryptase and elastase, I think it's called elastase 2, that they might help create a vicious cycle because they can then help break down collagen and actually be a [00:17:00] driver of hypermobility.
Derik Anderson, DC: They, yes, and they, part of this, they break down the gut wall, I mean the gut wall is made of collagen, so now we get food and bacteria and just things leaking through the gut wall that should have been selectively not allowed in, which creates an autoimmune response, or it creates an immune response really,
but now the body is literally attacking the food that is supposed to nourish us.
So with that, you, we start to get this cascade that definitely can turn into an autoimmune disorder. Like I was mentioning Hashimoto's earlier.
Uh, that really can be a challenge, but in this case and then decrease the [00:18:00] the release of things like tryptase and allow collagen you know, whether it's the gut wall or ligaments it, it, it allows collagen production to start to normalize.
And this really feeds back to what we were just talking about in terms of the anabolic phase or the, the restorative phase of our day.
Jill Brook: Yeah, so this starts to show how it can become such a big, hot mess when you have, I think you've mentioned that Ehlers-Danlos can contribute to the, to the cortisol or the hyperadrenergic state and the POTS and it ties into the GI problems which can then lead to the autoimmunity and we've talked about MCAS and so everything, it kind of, it kind of feels like it can snowball if it gets out of control and that each thing can help keep making the other things [00:19:00] worse.
Are there connections we haven't talked about yet that you think about where certain things can like, you have a famous diagram that's in one of your great talks where I think it also shows that the Ehlers Danlos can lead to a lot of pain and that pain can then contribute to some of these other things.
Am I remembering that properly?
Derik Anderson, DC: Yes. And, a number of diagrams, I, of the ones that I have put out there, there definitely is a diagram that shows, and we'll start at the top of the diagram, that it shows the brain and how, again, chronic stress then fires off the adrenal glands, releasing the adrenaline and norepinephrine and cortisol and how those directly deteriorate
the gut wall you know, [00:20:00] causing an immune response that is an IgG release we'll see tryptase alterations this then signals the mast cells.
Mast cells are, are needed, but again, it's small doses are good as a general rule, prolonged elevated levels are absolutely unhealthy. And particularly the histamines that are released in this process, the histamines really, they're pain magnifiers.
You know, they're known for causing us to be sniffly and sneezy, but it's, you know, what chronic pain that exists now is getting shouted through a megaphone. And that's where we can just see the, this snowball effect that really, it's not measurable by labs, but we, you know, we can [00:21:00] see all the smoke, so we know that there's a fire in there.
Jill Brook: Okay, that's a great way of saying it. Okay, so, so yeah, I really would encourage people to check out some of your diagrams, and we can link those in the show notes. We can link to some of your talks that that talk about how all of this is interconnected. So, what are some of the more effective strategies that you use at your clinic for people like this?
Derik Anderson, DC: Yeah, I gotta say, the first thing we start off with is learning, or really re learning how to breathe. You know, we all were belly breathers when we were young. Most people in developing countries are still very good belly breathers. And there's significance on several levels but in, you know, inhalation is excitatory.
Exhaling is actually calming to the central nervous system. So, you [00:22:00] know, we talk about, theories like box breathing. Four seconds in, 4 second hold, 4 second exhale, 4 second hold. You know, of that 16 seconds, 12 of those seconds were spent not inhaling. So, 75 percent of that cycle is actually calming to the nervous system.
The second aspect of that, particularly for our bendy bodies, for our hypermobiles, is that when we belly breathe, and when we talk belly breath, it's not just the front of the belly, it's literally the side of the abdominal walls, the back you know, the abdominal muscles that reach around to our spine, our pelvic floor, you know, as we breathe in and out, which is 15, 000 times a day, it, we really start to activate those muscles like they were designed to, you know, like we've done for over 250, 000 years that we've been on this planet.[00:23:00]
So, we really start with breath work because it is a fantastic way to, one, signal the body what we want, which is to calm that nervous system down, and two, to build some very fundamental strength that we all need. You know, it really, again, it's how we were designed. We just don't move like we historically have. you know, fewer steps and way less dynamic motion. Belly breathing is a great, is really the place to start to regain those really fundamental and essential motions.
Jill Brook: That's a good one, because everybody can do it, hopefully.
Derik Anderson, DC: Yeah, absolutely. And that really, you know, ultimately, what we're seeking is to help make patients as independent as possible. So, you know, [00:24:00] we're really guides in the healthcare process. We definitely have tools and machinery, et cetera, that, you know, need to be done in office, but as patients move through their care, the goal is to really, you know, allow them and enable them so that they can do things anytime, anywhere, with minimal or preferably no equipment.
Jill Brook: Great, okay, so what other strategies or treatments are you excited about these days?
Derik Anderson, DC: You know, I gotta say, focused shockwave therapy is an absolutely fantastic tool. It, we all develop scar tissue. If you've ever given somebody a massage and you feel that lump or bump, you know, in there that almost guaranteed is, you know, scar tissue you're feeling under the skin there. So, that really impedes
you know, [00:25:00] muscle function it impedes flow of blood in and toxins out of the muscles and tissues. Shockwave therapy, and again, focused shockwave, really is a fantastic tool for freeing up those tissues, and which ultimately decreases stress on the system, you know, and really is a incredible tool for helping restore, you know homeostasis or really in this case, a central nervous system balance. So that is definitely a favorite.
Jill Brook: Okay, so you're making me now remember that you're a big expert on fascia, and I know that it's become kind of fashionable in some bendy communities to do a lot of work with like foam rollers and other little tools that you kind of like roll on your skin to try to get the [00:26:00] fascia to, well, I don't even know what it's for.
I know I've just seen, I've heard talk about it, but is that, do you know what I'm talking about? If so, is that a good idea? Is that a bad idea?
Derik Anderson, DC: How's maybe?
You know, yes, there are really three different ways to mobilize the fascia. Far the most common are compression therapies. So that's using rollers, that's using you know, gua sha tools
metal tools that are becoming, you know, very easily sourced massage. Another compression tool, wherever we're kind of squishing the tissues together definitely is a way to get the tissues mobilized.
Again, it's a way to really increase this flow through the tissues,
which is very important because our fascia is now really considered our second nervous system, which is really important with [00:27:00] POTS. you know, as well as Ehlers Danlos Syndrome. The second is decompression therapy. You know, Michael Phelps helped make this famous in the 2006 Olympics when we saw the cup marks.
But cupping is really the main form of decompression therapy can also be very useful. And the third is vibrational type therapies. We have things like vibrational plates, particularly low level vibration or which it doesn't break anything up but it definitely promotes flow. Or, again, I would say my real favorite is focused shockwave therapy where we're breaking up the tissues, or the scar tissue, and in doing that, we're vibrating the healthy tissue that really restores [00:28:00] the, the balance in, in, in the healthy, healthy tissues.
Jill Brook: Can I back up to something you said a moment ago that I'd love to hear more about where
you said you might think of the fascia as a second a second nervous system?
Derik Anderson, DC: Yes we could talk quite a bit about this, but this really comes out of research from Germany, Ulm University, Stecco out of Italy is another one then there are a number of researchers out there. What we know is that there, we now know, is that there is an electrical flow over the fascia a split second, like milliseconds, before the muscles actually contract.
That accounts for about 50 percent of our strength, but it is also being found that it really is a communication method, an incredibly fast, [00:29:00] efficient, regional communication tool, that not only outputs to tell the muscles what to do, it's also sensory, and feeds back into the spinal cord and the brain, hey, this is what happened.
You know, as a massive network of sensors, separate from the mechanoreceptors, the different types of mechanoreceptors that we have in the joints and the tendons themselves.
Jill Brook: Wow, that's so fascinating. And it's funny because when I was expecting to hear you talk more about heart rate variability because we had spoken a couple weeks ago and that had come up. So I didn't realize you were doing all this other stuff and but do you want to say a minute about that and how you're using that?
Are you still seeing, that help your POTS and hypermobile patients?
Derik Anderson, DC: Heart rate variability is arguably the best, you [00:30:00] know, in terms of most accessible tool out there to really look at the state of our nervous system. And when we talk heart rate variability or HRV, we're talking about the time between heartbeats and how much that can change. So if we say somebody has 60 beats per minute,
it's not that their heart beats exactly one beat per second. We want to see that the body can adapt, you know, very quickly. That it can rev up quickly, and even more importantly, calm back down quickly after a stressor. That is what heart rate variability measures. So, as we decrease the stressors on the body you know, whether we're talking dysbiosis whether we're talking about, you know, receiving an email that you're like, Oh my gosh, I need to respond immediately and rearrange some stuff [00:31:00] right now or, you know, eating a food that doesn't agree with us you know, or going out and, you know, working out you know, that our heart rate can then slow back down to a, to a.
a more balanced state. And we're literally, again, we're talking in matters of, of beats. So in, and we're talking about milliseconds of time. So it's not like you can just put your fingers on your wrist and feel your pulse. On the other hand, there are so many pieces of wearable tech out there now that measure HRV.
And our research, which, and this is what our research grant is focused around, is really looking at heart rate variability and how it improves as [00:32:00] different stressors are taken off of the body.
Jill Brook: Wow, so you can actually, like, watch a patient's heart rate variability change as you, you know, for example, get their gut healthier or take away foods that are, are causing an immune response or something like that, or is it, is it that granular?
Derik Anderson, DC: It literally is that granular. I mean, our sample sizes are over weeks, but yes, the heart rate variability at this point, we expect to improve. You know,
when, when we're doing our job properly it does improve. And absolutely there is a ton of literature that
in different areas, That says that it should, but when we look at chronic disorders, which there's not very much research out there, which is what we're working on changing, we do see [00:33:00] improved, and very often significantly improved HRVs.
Jill Brook: Wow, and do you also use that for people's exercise? I know that sometimes like athletes use it to see when is a good time to take on a new stressful hard workout and when they should just like take it easy and keep resting. Do you also use it for that kind of thing?
Derik Anderson, DC: That's where actually I started using HRV. It really does come out of the sports arena. It's where where my background and working with, I still work with pro athletes and particularly the PGA Tour. And so we get early exposure to this stuff. And, you know, my thought is, hey, how can we use this, you know, with people who don't make a living, which is most of us, you know, playing the sport.
And that's, that is how we brought HRV into the [00:34:00] practice seven, eight years ago, I'll bet.
Jill Brook: Okay, but now you've found that it also can apply to all these other things.
Derik Anderson, DC: Oh, it absolutely applies to everybody else. Indiana University actually has some excellent research on this, and it has been repeated worldwide. But there is a lot of research, particularly around athletics but now they're looking at it for cardiovascular risk, for instance. Well established, better HRVs equal lower cardiovascular risk.
Now, with that, I was like, okay, so, if we, you know, we're improving you know, fitness and those type of metrics, what is it going to be like when we decrease stresses on the body? Again, the physical, the chemical, or the emotional stresses. So we have seen HRV improve with [00:35:00] doing just breathwork. It's not the only tool in the bag, but again, it's where we most frequently start and yeah, we will see with that alone how people's HRV will quickly improve.
Jill Brook: Do you know, does HRV get worse with pain alone?
Derik Anderson, DC: Absolutely. Yeah, pain is a big stressor to the nervous system. And so it's HRV will definitely decrease with pain. Which makes it that vicious cycle that you've been been talking about, you know
really, pain makes it worse. So it's a matter of figuring out, okay, what is the biggest driver of this pain?
Is it, you know, that they've got a lot of mast cell activation? You know, is it they're working out too hard that is for them? You know, or more so, is it that they're working out inappropriately for that person? Pain, [00:36:00] pain does make HRV worse.
Jill Brook: So, do you give out devices to your patients to use, or how does it work exactly for them to learn this about themselves?
Derik Anderson, DC: We do give out devices to patients so this way, most platforms these days are using similar, very similar algorithms, but not all. And so, in looking at a number of different wearables I definitely did see wearing multiple devices at the same time over periods of weeks. I saw different HRV readings.
So with that, we go with one wearable. And it's one that
we have found in research seems to show that it, it is consistent and consistent with the published data that looking at other measurables, you know, this is about where we would think somebody's HRV would be. And that, that really, [00:37:00] this one seems to, to nail it, and it's nice.
It's just a little band you wear, it feeds info to your phone, and you know, you can look at it in short term, you know, you can look at it a day, week, month and it really gives you some really nice graphs and charts.
They're great devices.
Jill Brook: That's great. So I want to be mindful of your time. I know you have a busy clinic to get back to, but can I just ask, what do you wish more people understood about hypermobility disorders?
Derik Anderson, DC: I really hope that people gain better understanding that it's not just cool party tricks bendy bodies can do. Hypermobility, because it affects the ligaments that holds our brains in place, our, you know, it affects our gut barrier, all of our soft tissue [00:38:00] can be affected with
hypermobility. Hypermobility really is an invisible disorder, and with that, it's because our receptors in our soft tissue are the single biggest input into our brain.
Being hypermobile really affects the whole body. And
that as awareness builds, which I definitely have seen it increase dramatically in the near decade that I've been involved with Ehlers Danlos Syndrome, we're hoping that that understanding really starts to take off and people to understand, hey, I'm bendy,
you know, or somebody I know who's bendy and that has way more significance than just them being able to, you know, make their elbows do, you know, funny shapes or what have you.
Jill Brook: Okay, last question, then I'll let you go. [00:39:00] Where can people find you online? And we'll put the links in our show notes.
Derik Anderson, DC: We can be found at MuscleJointClinic. com And we're also on Instagram, Facebook, and YouTube, and post a variety of things including some how tos and, you know, some, some educational pieces to really help people better understand about hypermobility in POTS and get a better understanding of what they can do to empower themselves to start getting healthier.
Jill Brook: Fantastic, and we'll put those links in our show notes for everybody to find them. Dr. Anderson, thank you so much for your time today. Thank you for all the thought that you put into all the issues with with these complex bodies and and I just want to give a plug, you have some fantastic talks out there, so we'll put some links to those in the show notes as well.
[00:40:00] But thank you for all you do and good luck with your research.
Derik Anderson, DC: Jill, thank you so much. I really appreciate you having me on, Standing up to POTS today.
Jill Brook: Awesome. Well, hey listeners, that's all for today, but we'll be back again next week. Until then, thank you for listening, remember you're not alone, and please join us again soon.
