E109: Polyvagal Theory and Trauma Release with Dr. Kimberly Hindman (part 1)

Episode 109 January 10, 2023 01:03:54
E109:  Polyvagal Theory and Trauma Release with Dr. Kimberly Hindman (part 1)
The POTScast
E109: Polyvagal Theory and Trauma Release with Dr. Kimberly Hindman (part 1)

Jan 10 2023 | 01:03:54


Hosted By

Cathy Pederson Jill Brook

Show Notes

Have you wondered why symptoms seem to loop over time? Why you are stuck in hypervigilance when you are safe? If so, this is the episode for you. Learn the science of the cell danger response, vagus nerve, and the limbic system in POTS flares.

Please visit Dr. Hindman's website for more information: https://healingdragon.net/wordpress/index.php/news-and-information/

You can read the transcript for this episode here: https://tinyurl.com/potscast109

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Episode Transcript

Interview with Dr. Kimberly Hindman Jill: [00:00:00] Hello, fellow POTS patients and super people who care about POTS patients. I'm Jill Brook, your hyper adrenergic host. And today we have an episode of the POTS practitioners with Dr. Kimberly Hindman who is going to discuss some really fascinating and potentially really practical ideas about the cell danger response, the vagus nerve, retraining the limbic system and trauma release exercises that may have some benefits for some of us. Don't worry if you don't know what that stuff is. I don't really know what it is either. But we have been receiving quite a few requests from you listeners to cover these topics. And since I did not really know much at all about them, I went looking for a great expert to help us learn about this. And I was so happy to discover the wonderful Dr. Hindman who has been teaching her patients and her colleagues about these topics. She not only teaches about these things, she has [00:01:00] experience helping her own patients, many of whom have POTS, MCAS, EDS and other chronic illness. Dr. Hindman's credentials include being a naturopathic physician and also a licensed acupuncturist in Portland, Oregon. She graduated from the great college of William and Mary with a degree in biology, then completed a master's degree in Ecotoxicology at Duke University and worked in the environmental consulting field before finishing her degrees at the national college of naturopathic medicine. She came to study naturopathic and Chinese medicines through her own healing journey. After the drugs of caring and well-intentioned doctors failed to provide benefit and physicians ran out of ideas. Dr. Hindman herself has hyper mobile EDS, POTS, MCAS and has had release surgery for an occult tethered cord so she [00:02:00] understands our complex health conditions. At her practice, she uses the best of modern Western medical science while valuing patient ideas and intuitions. Yay. She has what I think is a really empowering message, information and energy. So I'm just excited to learn from her today. Dr. Hindman, thank you so much for being here. Dr. Hindman: Thank you so much, Jill, it's very exciting to talk about these things. As you said, I want to talk about the cell danger response, vagus nerve dysfunction, limbic system dysfunction, and how all of these fit together and how they can actually contribute to a patient's cellular and neurologic experience, but then their whole personal experience, like what they actually experienced in their bodies. And I want to share treatment ideas, but I want to start with some of the science, because I think it's really important for people to understand the science, and people get science. We can talk about this and, and people can really understand it. And I think that changes the experience that people have because they have a better idea of what's actually [00:03:00] happening. Jill: Well, definitely. And I have to say that these are things that maybe I had heard about, but until you explained just a little bit of the science to me, they sounded like a little bit too out there and woo, woo. But then once you told me some of the science, I was like, oh, dang, okay. I'm in now. Dr. Hindman: Yeah, and it's real and it's legit. And so that actually brings me to like one of the first points I really want to make sure is that I want to be absolutely clear that none of this is psychogenic, made up or imagined, and I think that sometimes people can get those messages and that's really disempowering. It creates a lot of blame. It creates a lot of shame and it's not actually what's happening. This is about your autonomic nervous system and how that nervous system both receives input and then signals back to all of your tissues and even the individual cells. And a lot of that is stuff that happens outside of our consciousness and outside of our control. So we know when things are happening, cause we know the experience that we have, but how we got there [00:04:00] may be a completely different process. So I will tell patients, if somebody tells you, oh, this is all in your head, you can reply by saying yes, it is because my brain is in my head and that's where this is all happening. Jill: Okay. So I just want to make sure that I am summarizing for everyone and on the same page. So that first we're going to start with a science with these three topics, and then we might need a part two for this but you will get into some practical exercises that we can do. Dr. Hindman: And I have two whole big handouts that I have on my website about the vagus nerve supports and the limbic system retraining ideas. So when we get to that point, people can actually use those as resources as well. Jill: Oh great. And we'll link to those in the show notes. Dr. Hindman: Perfect. So we're gonna start with the science. And we'll start with a cell danger response. And so I want to first give a big thanks to Dr. Neil Nathan for introducing this theory to me. I heard him talk about it briefly and I was so interested. I was like, I need to read the original papers. So this was a theory developed by Dr. Robert Navio, who published several papers in [00:05:00] 2014 and 2019 in the journal Mitochondria. And what his theory is, if people want to go read them and they're really science heavy, but they're really, really interesting and they really make a lot of sense. And so what he talks about is that the cell danger response is a metabolic response that's activated when a cell encounters any sort of threat: physical, chemical, microbial, anything that could potentially injure or kill the cell. He lists out a whole bunch of threats. Infection could be virus, bacteria, fungi, parasite. Physical trauma could be heat, salt changes, pH changes, radiation changes. I would also include things like falls, accidents, injuries. And I wonder if, for patients say who developed fibromyalgia after a car accident, is this part of why? Because the physical injuries that the body has sustained have kicked this response in and that's then what keeps everything going? He talks about heavy and trace metals, all sorts of chemicals, flame retardants. [00:06:00] I would also add things like low oxygen, which can change chemistry. I mean, there's a lot of different chemistry and then he does include psychological trauma because we are whole being so that if we have a significant trauma that will affect us as well. And this response that we're going to talk about is coordinated in the brain and with the microbiome in our guts and with all of the cells and the mitochondria. So this is a very coordinated response. It's all done on purpose. Jill: And that starts to make more sense to me because we're hearing information about how the microbiome changes after a head injury and things where maybe in the past, you would've said, come on, how can the microbiome know what's going on in a different part of the body? But now we have all kinds of evidence of that. Dr. Hindman: Right. And outside of the central nervous system, outside of the brain and the spinal cord, the majority of the nervous system in the body actually is in the gut. So when we talk about thinking with your gut, you do. So there's all kinds of [00:07:00] neurologic connections with the Peyers patches in the intestines, which are where immune cells hang out, with the microbiome, between those cells. So you have all this crosstalk between these different systems that's happening there. So it makes sense, knowing that a head injury is gonna change the microbiome. Jill: Okay. So you were about to say that any danger that is sensed by your cells could result in a coordinated response that involves microbiome, nervous system... Dr. Hindman: And then the cells of whatever that tissue is directly. So, and this is something that they see that Dr. Navio saw over and over. Doesn't matter if it's your skin, muscle, liver, this is what happens in the body. And so this response happens with any threat. And if it's small, let's say it's the regular old, common cold, or a cut on your hand, and there are no other interfering factors. The cells will go through this process really quickly and easily, and then get you back to a state of [00:08:00] health. So like, you might feel lousy for the week with the cold, or may have some pain with the cut, or if you have a bruise, but that resolves after a pretty short period of time and off we go. The problems really arise when you have a mixture of threats. So let's say you have Brelia babesia and Bartonella infection all at the same time, or you have repeated or ongoing threats. So somebody say has chronic strep, so they get sore throat and then it goes into remission and then it comes back and it keeps going. They can never clear it completely. Or let's say somebody has susceptible genetics. So if there's somebody who doesn't clear Lyme well or mold toxins well, or has chemical sensitivity risk. That's going to create some synergistic effects and that's going to create some problems with these responses. Because the responses they've all evolved to help the cell defend itself from microbial attack or physical harm. And to basically to protect you as a whole organism. And there's a whole range; I'm not going to get into the too much of it, but [00:09:00] there's a whole range of different changes. Some of the most interesting ones are the cell membrane around an individual cell should be normally really fluid to let things in and out. It'll change its structure to make it really stiff. So that if there's a virus that's gotten inside, it can't get back out. Jill: What a smart response. Dr. Hindman: Right. That will then release antiviral, antimicrobial chemicals to signal: Hey, there's something going on here. And then it'll release other kinds of chemicals that will go to neighboring and even distant cells to say: We've got danger. Changes will also then change our behavior. So when we're sick, we may not eat as much. We may not have as much of an appetite. We want to sleep a lot. That's all happening because our cells are changing their chemistry to make us do that so that then we can get better, faster. Jill: So that all sounds brilliant to me. Super smart. Dr. Hindman: Yes it is. And Dr. Navio has probably dozens of changes that happen. And it all makes sense in terms of what's [00:10:00] happening. One of the biggest changes though, that I think is really interesting is that cellular metabolism is slowed down. So the cells stop making energy because an infection will hijack the cell's metabolism for its own purpose. Jill: Right. Okay. We're learning about that with COVID now. Dr. Hindman: Right. And so this primarily happens in the mitochondria, which is where the energy is made in a cell. So the mitochondria decreased their oxygen use. So they make less energy. This does two things. It means the virus can't use that energy for itself. And it means there's a lot of oxygen now sitting around in that cell. That actually helps to protect the cell from further injury, because that can be damaging. That high oxygen is particularly damaging to the virus or the bacteria. Jill: Okay. So again, this sounds super smart. Dr. Hindman: Super smart. So what's interesting though, is that Dr. Navio's theory is that this is actually creating what he calls oxidative shielding, not oxidative [00:11:00] damage. So I'm curious if we have somebody who has a whole lot of indications of high oxidative damage and high oxidants. So we're thinking, oh, we need antioxidants. The question may need to be is why, why are these cells continuing to try and shield themselves? What I think is really interesting about this is I've had patients where I see indications of high oxidative damage, or low mitochondrial function on labs or their symptoms. And I'll give them antioxidants or I'll give them mitochondrial support and it does nothing. And I'm like, this is baffling. Why? I'm wondering now, if it's because this process is going on and the cell is saying: Hey, I'm smarter than you. We need this high oxygen. We need to slow down mitochondrial function because we're trying to do something over here. And we're not ready for it yet. Jill: That is so fascinating. And I feel like we already have a ton of examples of that, where we thought we were doing the right thing to prevent the [00:12:00] fever, but it turns out the fever was helping. Don't assume you're smarter than your body... Dr. Hindman: Right. But I think it's interesting then if we're in that situation and we don't see the change we would expect, then we need to ask why, what's going on. That somebody has low CoQ 10. We give them CoQ 10 and their energy doesn't change. They don't feel any different. Well, why aren't the cells using that to make more energy? Is it because something like this is going on? The challenge becomes though, is that as some of these responses keep going, so remember they're all designed to be short term to help you get over whatever it is, is they keep going. This higher oxygen level makes it harder to eliminate heavy metals. So they can then accumulate, which then creates another layer of problem on top of what already started. So all of this stuff that is very wise is great. As long as we don't basically overburden the system, which is what we can see with some of these threats and threat combinations. And [00:13:00] what is also interesting is that this is initially, as you said, very wise, this is a very smart response and everything's coordinated, but it can actually become very maladaptive once the original danger is gone, because some of these cycles and processes can keep going on their own, once that danger is gone. And we see that with the nervous system response that we'll talk about in a little bit. And so he talks about three specific stages and I want to just go through those quickly, because they're different things are happening at those stages and people can get stuck at different stages. So I have a little quote from him that I really like, he says "the three stages of the CDR, the cell danger response, are energetically and metabolically distinct. The completion of each stage of the CDR appears to be decided largely on a cell by cell basis. So for any given cell one step of the healing cycle, can't be entered until the previous step has been completed, and the mitochondrial function is ready for the next step and restoration of [00:14:00] normal communication between neighboring and distance cells is the last step of the healing cycle." And I think that's a piece that's really important is that these cells then stop communicating with other cells when they have this initial threat, he calls it actually like a cellular autism almost, they stop communicating, they shut off. And at the end, when everything's back to normal, they reconnect and that's the signal that says: Hey, everybody's good. So the first phase, the function of that is basically to activate the innate immunity, basically detect intruders, detect the toxins, damage control and containment. So if you've got a virus or something, let's prevent its spread. And there'll be a level of inflammation that'll be produced that's adjusted according to whatever the issue is. And so remember that initial list of triggers could be huge in terms of what gets this going. Jill: right. OK. Dr. Hindman: And to move out of that into the next phase requires then that decrease in that cellular oxygen and less inflammation, because the [00:15:00] next phase is going to be rebuilding. but people can get stuck in this CDR one. Jill: And are you saying that too much chronic inflammation is the problem there? Dr. Hindman: Well, actually if somebody has chronic infection, they may be stuck in this phase of the danger response because they can't ever clear the infection. They're always in damage control, containment, trying to fight, building up more inflammation, to try and deal with the infection, which then starts creating damage to other cells in the body. As this.. Immune system is trying to deal with its infection, it just can't completely clear. Jill: Okay. And it could be a combination of different things that maybe the infection, plus some psychological stress plus an injury plus... Dr. Hindman: right. And if somebody is in this and let's say somebody has a chronic infection, and then they have an injury. That just keeps them in this state, because now the cells are dealing with two threats. And then if they have a stressor or a family member dies, something that's traumatic happens, then you've [00:16:00] got a third stressor in there. So, you know, you have a third trigger. So all of these things start building up, which creates then a very different situation than if you're just dealing with one of them. And this is why these supportive, rebuilding kinds of treatments don't work in this phase. Jill: Okay. Dr. Hindman: So this is then about the initial, defense from the attack. When that seems like it has settled down again, then we can go into what he calls the cell danger response two phase. This is where you have cells rebuilding, you have cellular replacement. So in that first stage, there may have been cells that were damaged or maybe that died or maybe are too damaged to be repaired. This is where you need to build some new cells. So this is where the stem cells come in and say, we just need to make new cells. We just need new ones. People can get stuck there. And that's like, what Dr. Navio is thinking maybe happening in cancer, where there's just cell growth, growth, growth, growth, growth, and those cells [00:17:00] are not functioning normally. And they're not connecting up and communicating with other cells. Jill: Oh, interesting. Dr. Hindman: This might also be what happens when people develop a lot of scarring or fibrosis or keloids where you basically just have a whole lot of cells building up more than what they need to. Jill: Okay. So what's the third stage that they're supposed to progress to? Dr. Hindman: Right, is then where you get differentiation. So that means you've got all these stem cells. That could be anything that learn from the cells around them, that, oh, I'm supposed to be a skin cell to help heal that cut, or I'm supposed to be a liver cell. I'm supposed to be whatever. And then that's then where detoxification starts. So basically the damage that happened in that first phase, all those metals that accumulated there, the body said, I can't deal with all that. I have to put all that on hold, just deal with the infection, I'll get to that later. Well, this is when you get to it. So now it can start to detoxify and eliminate. The cells that are in this stage don't divide [00:18:00] anymore, which is good. And they start establishing these cell to cell connections with their neighbors. So they start communicating. And Dr. Navio says that healing is incomplete until these cells receive instructions and materials from the older neighboring cells that carry the metabolic memories and programming from before the time of the injury or threat that activated the cell danger response. So those are the cells that know this is how we're supposed to function normally. And they teach the new cells, which I think is absolutely fascinating. I just finished reading a book by Suzanne Simard called Finding the Mother Tree. She's a forester, and she found that in forests, there are older trees that are actually mother trees and they connect through mycorrhizal fungi networks under the soil, through their roots to saplings. To their children, basically the new trees and give them carbon, give them nutrients, give them water. It feeds these new cells and teaches them. This is what you do in drought. This is what you [00:19:00] do. If there's a bug infestation, this is how you function as a tree in this forest. We do the same thing in our own bodies after injury, which I think is so cool. Jill: That's so neat. So there's communication going on there that we maybe didn't know about? Dr. Hindman: Right. And at the very end, then these cells also then reestablished connections with the autonomic nervous system and the tissue lymphatics, which is basically the final piece of, it's not just reintegrating into the tissue itself. It's reintegrating into the whole body, through these bigger networks. And in his theory, he says that people can get stuck in this phase and he thinks this is what's happening with ongoing pain syndromes. And I think what's happening there is the connection then with the nervous system isn't happening correctly. So the sensory and pain modulation doesn't work between the tissue and the nervous system, because they haven't connected up right. So once you get through that phase, that should get you back to, okay, everybody's [00:20:00] back on board, everybody's working right. And you go back to your normal functioning. What can happen though is then in chronic illness, that original triggering event may actually no longer be present and the illness may be caused by our body's reaction to that original injury. And that's what they think may be happening with COVID is that it's an overreaction of the immune system. This cascade of the cytokine storm that may be what's triggering long COVID. So the virus itself is gone, but our system is acting like it's still there and is still responding. Jill: So our systems can be stuck in one of these phases. They didn't get all the way back to good health again, after the threat was gone. Dr. Hindman: Right. And so our bodies are acting like the threat is still there, even if it's not, and this may be why then sometimes someone will look like they have an issue, but they're not responding [00:21:00] to treatments directly for that. It's because that's not actually what's happening anymore. It was originally, but it may not be now. And so we need to come at this from a different perspective in terms of our treatment. And so this getting stuck in things can happen if, say healing is incomplete between injuries or there are ongoing things like a chronic infection. And so you get caught in this loop of incomplete recovery. So let's say somebody started, they got through that first phase, got moved into the second phase. Yay. But then something new came along, they kicked them back into the first phase and they just can't ever get going. Which then will create these alarm signals and cells that can't then do that final phase of that reintegrating. So then you start getting nervous system dysfunction and immune dysfunction because they're seeing stuff that they shouldn't be. Jill: Okay. So you have been an eco toxicologist, and so in a world that has more toxins in it, more mold, do you think that's why everybody's maybe just a little more susceptible this. Dr. Hindman: I [00:22:00] do. So I did human health risk assessments, and we looked at acute exposures and then we looked at sometimes at chronic exposures, but this was many years ago and it may have changed since then. But part of the challenge was is that we didn't have good ways of modeling or really understanding multiple exposures. So if you have low level exposures from multiple sources that are in air or food. Multiple pesticides in food, things in the water, things you can't control people wearing perfume, all, you know, all of the chemicals in everything. We didn't have good ways of modeling that and understanding that if you have someone who has all of that, who then say lives near an actual toxic site, what happens to that person? And at some point, does the body have a limit on how much it can detoxify at any one time? So I do wonder if that plays a role in why people are more susceptible, why we're seeing more chronic illness, because people are stuck in these cell danger responses that they [00:23:00] just can't completely get out of. And I think a lot of people have a lot more stress in general, just in life. So you put that as one of our triggers and then all the chemicals, and then you throw an infection in there and the body just says, I can't do all of this. I wasn't designed to do all of this, not all at once. And so that's where we run into some of those problems. Jill: That is a really interesting theory though. Okay. So where do we go from here. Dr. Hindman: So what's interesting is then I want to talk a little bit then about how this cell danger response then plays a role with the nervous system. So during acute illness, the sympathetic nervous system is dominant and it's supposed to be because it really is like, okay, let's mobilize the troops. We've gotta deal with this infection or to heal with this injury. Whatever's going on. The problem becomes when the cell danger response is chronically activated the coordination between the two branches of the vagus nerve is disrupted. And we'll talk about that in a minute. And because of that, the [00:24:00] sympathetic nervous system then can stay dominant. It never calms back down again. So when the vagus nerve is supposed to be going through this normal cyclic variation in what it's doing, and when those variations are disrupted, you can get all sorts of autonomic issues, including POTS. And so there is also autoimmune components that then can be tied to this absence or decrease of the normal anti-inflammatory signaling by the vagus. So the vagus nerve, as it signaling actually sends out anti-inflammatory signals. That gets disrupted, that's then gonna contribute to what you're talking about before in terms of that chronic inflammation. And that's then gonna keep you in more of a sympathetic state. And what happens is the nervous system can learn. So we'll get into that with much more into the limbic system. The metabolic changes that happen every time we have, one of these issues gets stored in a memory and it's why we can [00:25:00] respond better maybe the next time we have one, if we've gone through the whole complete healing cycle. The problem becomes when all this gets, hyperactivated this primes the cellular response to any future exposure to have a response, even again, when that original trigger or stress isn't present anymore. Jill: So, could you give an example of what you're talking about? Dr. Hindman: If someone has had a negative experience with a certain smell, they felt really awful. The next time they smell it, they may have a stronger response to an even smaller amount because the nervous system knows, Hey, I remember this. This was bad. So I'm gonna respond to it bigger and faster with a smaller trigger, even though we haven't smelled it in a really long time. So there's this memory that builds up that should be protective if it's actually stuff that is truly dangerous to us. Jill: Yes. Okay. As my dad would say [00:26:00] dorkily, I resemble that remark. Yes. Wildfire smoke is that for me and some other things. Dr. Hindman: Right. Part of that is if a person has gone through the trauma of a wildfire and losing everything, that's a personal experience. That is huge. That is traumatic. There is also something happening on a cellular and neurologic level that is completely separate from that and that stuff happens outside of our conscious thinking. So we don't think about that. The body just responds. And it's part of our safety mechanisms that are designed to protect us that have gone a little haywire. They've gotten a little hyperactive there. Jill: Wow. That's so fascinating because just yesterday I was walking with my husband in a beautiful clean air location. We actually have gone to a clean air location for wildfire season because I've had such bad experiences with wildfire smoke. And we had looked [00:27:00] at Purpleair.com and we saw that back home the air was between 500 and 700 AQI. And just talking about it was starting to make me feel really sick. And I said, oh my gosh, I think I have to stop talking about this. Even though we were talking about how lucky we were not to be there. Dr. Hindman: Right. And that's all nervous system. Your body is remembering what you experienced before and saying, oh, I don't want to do that again. Which is a safe thing, but that's good. Okay. We don't want anybody breathing that air, but it's interesting that you had that response, even when you weren't actually in the situation, it was the memory of it that actually brought it up. So again, that's all nervous system. So that's where we need to work with, from a treatment perspective, looking at any of those actual possible triggers that are still around and those threats that are still around, because if they are, they need to be addressed, but we also need to look then at that direct nervous system support to help the nervous system functioning. [00:28:00] So if that original trigger is strong enough or long lasting or somebody can't ever complete the healing cycle, the nervous system is gonna actually change how it's functioning because of that significant or ongoing threat. And then that change will continue on after the threat is gone. So the nervous system then needs to be retrained on how to function when there is no threat. So This is where then like the vagus nerve and polyvagal theory and the limbic system all comes in and the treatment of those things may be needed for somebody to really fully, completely heal. Jill: And just to give our listeners a little preview. What I love about you is that you actually have some practical ideas for people like me who are now freaking out, just talking about wildfire smoke. And so after we get through the science, this stuff is to come. Dr. Hindman: Oh yes, it absolutely is. And there are many things that people can do. There's a whole ranges of things that you can do. So people may find that one thing [00:29:00] works better in certain environments or for certain triggers. There may be things that work better when you know, you're at work versus at home. And some things may just straight up, not really be the best thing for somebody, but something else works beautifully. And most of the things that I'm gonna talk about are things that you can do at home are free, are fast and they work. So I want to into then vagus nerve. You'd ask me about what the vagus nerve is. So this is one of the cranial nerves, and it exits the brain in the back of the head and goes down the back of the neck and then basically goes to the internal organs. And so it send signals to the esophagus for swallowing. The pharyngeal muscles in the bronchi for breathing. It goes to the heart, stomach, liver and for movement through a food, through the intestines, to the colon. So vagus nerve dysfunction can be involved in symptoms that involve any of these systems. And there's a lot of work looking at vagus nerve dysfunction in POTS because it does involve the heart and blood pressure [00:30:00] regulation. Heart rate regulation. And I'm wondering if this is also why then POTS also have multi-system symptoms. So are these people also who have difficulty swallowing have slow GI motility? These may be clues that, okay, this is all vagus nerve. It's actually all coming from the same place. Because they all received this signaling. Jill: So, what I'm hearing is that there's that little saying in EDS about if you can't connect the issues, think connective tissues, but you're saying you could also think of the vagus nerve. Dr. Hindman: Right and especially with POTS things, if we look at the number of symptoms that could relate back to vagus nerve functioning, there are a lot. And they're in all of the systems that the vagus nerve actually goes to. So we used to think that for the autonomic nervous system, there was the sympathetic, which was fight or flight, and then there was parasympathetic, rest or digestion, that was the vagus nerve. Dr. Stephen Porges came up with this idea of a polyvagal theory. Because he actually found that there are two [00:31:00] branches of the vagus nerve. And so these were these two branches that Dr. Navio was talking about how they're supposed to balance with each other and cycle with each other. So you still have the sympathetic fight or flight. And thinking about if somebody's in fight or flight, fight can be actual physical or verbal fighting, but I've also seen some people who are in a fight state because they're interpreting other people as aggressive or attacking, like they're on the defensive, they're looking for who's gonna fight with them. So that might be a clue that, oh, maybe I am in sympathetic more than I think that I am. Flight can also be like withdrawing from people or avoiding conflict. Might be more actually a sympathetic dominant indicator. Jill: Okay. Dr. Hindman: The vagus nerve though, we then have these two branches. So there's ventral, meaning the front and dorsal in the back. The ventral branch is what everybody thinks about, when they think about parasympathetic. This is relaxation, social engagement. This is where we feel happy and good. The dorsal branch is [00:32:00] basically freeze. So our stress responses are actually fight, flight and freeze. And this is the freeze branch. This causes shutdown, disengagement, basically like playing dead. So this branch gets activated when we face an overwhelming force. So when we can't run away and get away, when we're not strong enough to fight and win, we immobilize. This is our equivalent of when an animal plays dead because they know I can't win this fight. Jill: Okay, so it sounds smart again. a survival instinct. Dr. Hindman: The problem becomes as people get stuck in it. Because for humans, this also then creates feelings of helplessness and hopelessness and apathy, and we can just get completely shut down and disengaged. I wonder if this is what's happening when people then have crashes and are like on the couch for three days and really can't function, is it because they're in this state? Jill: Ah Dr. Hindman: One of the things Dr. Porges realized was that a sudden or extreme surge in [00:33:00] dorsal vagus activity causes an actual shock response, which looks like loss of muscle tone drop in blood pressure, fainting, sweating, nausea. That sounds an awful lot like a POTS attack. Jill: Whoa. Dr. Hindman: This could be much more complicated from an autonomic nervous system than just hyperadrenergic. You might be, but it might be other times where you're actually super hypo. Jill: Right. Dr. Hindman: And what I have seen with the dorsal vagus and what I think might be happening here is that there can be physical shutdown, but there can be mental shutdown as well. And I see that different as brain fog. Sometimes people can be foggy, but this is like, I got nothing. I can't make a decision. I am completely overwhelmed with just trying to think about what to eat for dinner. Or I just have nothing. I have no idea can also lead to emotional shutdown. That's really more than just like, I need a little time to myself. They really disengage from people. This is really different than somebody say who like over does it a little bit and needs to rest for a couple days. [00:34:00] And I think it's difficult for other people who've never experienced this to understand that the person can't just push through. This isn't well, you know, you could do it if you really cared. No, this is a nervous system state. And I think that this may be involved in POTS, especially when we're switching between these two nervous system states. Jill: So just literally like an animal playing dead. Dr. Hindman: Right. So all kinds of nature shows where, you see the lion and they're running after the antelope and they catch the antelope and the antelope stops fighting. It goes completely limp. What it's counting on is that the lion is a carnivore, not a scavenger. And so it doesn't want to eat something that's already dead. it's gonna drop the antelope because it's like, I don't want to eat this now. And the antelope will wait until the lion has walked off and get up and run away. May obviously have some holes in it that it needs to repair, but it is still alive. And so it's exactly that playing dead response that I can't win this, so I'm gonna basically try and disengage [00:35:00] until it goes away. Jill: So it's actually just yet another response to danger at a different level of granularity. Dr. Hindman: Right. Exactly. But the important thing that I think that you just said is that it is still a danger response. And so when I'm seeing people who are in hyper sympathetic and then they go into this disengagement place, it's just going from one threat state to another threat state, depending, basically on how much energy they have. Jill: So I thought there was a good nervous system state and a bad nervous system state. But now you're telling me there's only one good one and two bad ones. Dr. Hindman: Right. Well, bad ones are , they're just basically different sides of the same coin. They're still a threat state. The problem that I see then is because over time, if someone is still in a threat state, then you're gonna start activating cortisol levels. DHEA, because you're gonna have an acute stress, you're gonna get those adrenals involved. Over time, that's gonna fatigue out the adrenals and so high or low levels of those hormones can then impact [00:36:00] thyroid, insulin, estrogen, testosterone, progesterone, and those all will then affect every cell in the body, including the nervous system. So when cortisol levels are really, really high, that will trigger sympathetic nervous system response. That's also then gonna knock out immune function and then cause immune dysregulation. So this starts having a much bigger cellular response throughout the whole body. And mammals are the only animals that have this ventral vagus branch. This is the one that's the good one that we want. And it's activated when we are, and we feel safe in our bodies. And this is important because we've gotta be in that state for healing to occur. We do not do healing when we are in sympathetic or the dorsal vagus. Jill: Let's say that again. that seems important. Dr. Hindman: It is so both the sympathetic and the dorsal vagus branches are at the threat states. We do not do healing in those states. We only do it when the ventral vagus branch is the one that is activated. That's the state we're in. [00:37:00] When we're in that state, we have social engagement, which means we experience feelings of love and friendship, cooperation. We bond with others. We have meaningful communication. This is where we share meals and stories and songs and dancing and games. This is the foundation basically of group culture and safety and health for individuals. We've gotta be in that state to be able to heal. So with the polyvagal theory, Dr. Porges is saying that the nervous system evaluates risk to decide which of these states am I gonna be in. Sympathetic, ventral vagus, dorsal vagus. That does not require conscious awareness. That's something your nervous system does all by itself. Jill: So, this is where you are coming back to what you said at the very beginning about how this is only in your head, to the extent that your nervous system is largely in your head. Dr. Hindman: Right. Your brain is basically assessing danger, assessing different [00:38:00] features, your different characteristics and deciding is this safe, dangerous, or life threatening because those are our three branches. So if it's safe, great, we stay in the ventral vagus, if it's dangerous and we gotta fight or flight response, it's sympathetic. If it's life threatening, we go into shut down and the dorsal vagus. We freeze and play dead. And the challenge becomes is that, although we are usually consciously unaware of the stimuli that actually triggered that response, we know what our body's responses are. We may not always know what triggered a POTS flare, but we certainly know when we're feeling those symptoms. Okay. Here I go. Why? What caused that? Jill: And then you factor in some mass cell activation syndrome, and I can see where that really snowballs fast because you get reactive to one thing and you get scared of more things and now you're even more sympathetic. So now you're even more scared. Dr. Hindman: Yes, exactly. And because mast cells also like to hang [00:39:00] out around nerves, they can get some direct nervous system signaling. And then if they start releasing more inflammatory chemicals and reactions to that signaling, then that's gonna keep that whole thing going. And you start getting these cascades that are all happening. Absolutely outside of our conscious understanding. The problem with that though, then becomes as the next step is that then leads to hyper vigilance because we don't know what just happened. So we get scared. We get worried about when is this gonna happen again? What do I do? And that then leads to a hyperreactivity, that alone can keep the cell danger response, going to bring this which then can prevent healing because then you have gotten all this nervous system input to the cells saying there's danger and the cells say, oh, okay. Then we gotta respond to danger. Jill: This feels like another important thing that we should repeat. So I am the queen of hypervigilance and this is all starting to make sense. I have MCAS, I have autoimmunity, I have [00:40:00] POTS and when I talked to you the other day, I was in a bit of that mast cell spiral where more and more and more things keep setting you off and you don't know why, and now you're scared of everything. And I just wanted to remind our listeners that you actually have some practical strategies and they did help me a lot. Can you just repeat that last thing you said, because it seems like it was so crucial for perpetuating the problem. Dr. Hindman: Right. So when we have this situation where the nervous system is evaluating risks, and it's all based on past experiences, and if your nervous system is not functioning correctly, because you're stuck in one of these cell danger responses, or you've been through that and not had complete healing of the nervous system from it, it's gonna be hypervigilant. It's gonna be looking for things that may not actually be dangerous and registering them as dangerous. So remember it only does, is it safe, dangerous, or life threatening? Well, those last two are gonna get you a really big response. And sometimes we can't identify [00:41:00] consciously what triggered that neurologic response, but we know when it's being triggered because we get all the experiences of it. We get all the symptoms of it. That then can lead to hypervigilance because we get scared because we don't know what's happening in our own bodies. And some of these symptoms can be really significant and feel like they come out of the blue and it just took me down. That then leads to more hyperreactivity and more hypervigilance, which then will keep that cell danger response going because the nervous system is now sending those alarm signals back to the cells. And it prevents healing either at a neurologic level or at a cellular level. Jill: Right. And I was about to say, wow, this sounds like a terrible way to live. And then I remembered, oh yeah, that's how I've been living. Dr. Hindman: There are a lot of people who are living this way and they don't know why. And they get told it's all in their head and they get told they're just being overly sensitive and you just need to get over this. And you just need to tell yourself everything's fine. Which is baloney. This is happening at a neurologic level. It's important for people to know that we can use [00:42:00] consciousness to help retrain. And that's part of what the limbic system retraining is, but that's because there are elements of the nervous system itself that need that retraining because they are actually dysfunctional. This is a nervous system issue. So Dr. Stanley Rosenberg has a great book called Accessing the Healing Power of the Vagus Nerve. And I'm gonna talk about some of his exercises coming up because I love them because they're super simple and great, but he found that the best way to move someone out of either the sympathetic, which is that fight or flight, or the dorsal vagus, which is that life threatening, is to activate the ventral vagus. Because when that's activated, it inhibits the other two. So you don't have to worry about what do we do to stop those. We just need to get the thing we want going. And that takes care of the rest of it. Jill: So you stimulate the right part of the nerve and it'll get you out of those other two bad states. Dr. Hindman: Places. Right. And that's why then this is what we're gonna talk about for treatment is gonna be all about how do we stimulate that [00:43:00] ventral branch of the vagus nerve? What are the things that make it happy and get you into that state? Because that will shut off the other ones. The last part of this is then getting into the limbic system. So that's a part of the brain and all of this vagal activity then gets sent to the limbic system, which assesses at that higher level, again, dangerous or safe. So this is part of the reptilian part of our brain. So this is a much older part of our brain, and it's mostly concerned about assessing for survival. Also a mostly binary system. Something's either safe or dangerous. And it relies on our past experiences and associations to assess current ones. This is an extremely protective part of our nervous system and it is designed to keep us safe. So this is a good thing. You gotta remember that because I think that people also, when they have these experiences start to get very frustrated with their bodies and feel like their bodies are betraying them and they're not safe in their own body. I want people to know that all of these things are like very [00:44:00] wise. They're very adaptive. They're actually designed to keep you safe and keep you healthy. They've just gotten off track and we just gotta get 'em back on track. And that can change the way we look at these processes and the way that we talk to ourselves, the way we talk to our bodies, and we can then work with that piece of it in a different way, rather than just being, oh, everything is bad. No, it's not. We just need to tweak it a little bit. Jill: Well, it's funny because as you say that what's going through my head is that you're making it sound like my own survival instincts are just torturing me. Dr. Hindman: Right. Because they are basically overreacting to try and keep you safe. Jill: Mm-hmm Dr. Hindman: So they're thinking that you are under constant danger and they don't want that for you. They want you to be safe. All those parts of your brain want you to be actually safe. And so if they're seeing danger everywhere, they're doing things that would be appropriate. If there was an actual danger, the problem is there isn't. So like other parts of the brain,[00:45:00] the limbic system can learn. And it learns, especially with repeated stimuli or signals. And what it learns is gonna completely depend upon that input. So the limbic system, it regulates and controls emotion, energy, it is involved in sensitivity to stimuli, to pain. It's how we interpret and then remember, and respond to stimuli. So this is the part of the brain that's working with the vagus nerve to do that neuro evaluation of risk that Dr. Porges was talking about. So when he was saying the nervous system doesn't need your conscious mind, it just evaluates risk. The vagus nerve and the limbic system are the parts that are doing that. And it's involved in memory storage and retrieval. So this is where it goes back to those past experiences and says, Ooh, what do we do with this? And there's a link between the conscious functions of the brain and the more autonomic functions of the brain stem. So if you think of something really happy and really relaxing, and your heart rate drops a little bit [00:46:00] that's because those thoughts connected to the limbic system, the limbic system said, oh, this is good, safe, happy sends that signaling to the brain stem and the brain stem then reduces heart rate. Jill: Okay. Makes sense. Dr. Hindman: So the limbic system gets input from a whole bunch of different places and then has output. So it's like this central hub of things come in, what does it mean? What do we do about it? What does this mean for us? So then how do I respond to it? Jill: Okay. Dr. Hindman: So there are two main parts in the brain called the hippocampus and the amygdala. That are generally agreed to be part of the limbic system. There are other parts of the brain some people feel should be part of it. Some people feel they're just connected to it, but not actually part of it, but I just want to mention those two parts because understanding their functioning really makes the whole limbic system make a lot more sense. So the hippocampus is essentially the memory center of our brain. So this is where memories are formed and then cataloged to be filed away, for long term storage than in other parts of the brain. [00:47:00] Connections in the hippocampus help us make associations between memories and different senses. So if you have a memory that's really strongly associated with a specific smell, when you smell that smell again, that memory may come up. Jill: Okay. Dr. Hindman: This association, and this whole association process, can work against us if associations are made under these constant danger conditions, because after a while these associations start becoming very broad. So it's like, oh, I was in pain when I smelled that smell. Oh, it must have been because of the smell. Oh, I was in pain when I ate that food. Oh, it must have been because of that food. I was in pain when I was listening to that music. That may be the cause of my pain. Which then starts leading to greater and greater experiences of like, oh, okay now everything is causing me problems. It's because the hippocampus has made these associations with these different stimuli and external environment triggers with this experience.[00:48:00] And it's because the brain's trying to be efficient and use past experience, but it's making these associations that are way too broad and actually are not correct from a causative perspective. This is one place where our research has shown that new neurons are made from adult stem cells. And so this means the hippocampus can learn. So we can use this. This may have worked against us, but we can use this fact to then reteach it what we want it to know. Jill: Okay. That's very hopeful because I was about to say you're telling me that my body's taking precious stem cells to make these negative associations and torture me. Dr. Hindman: But that's where we then teach them that, okay, this is what you may have learned in the past, but now this is what I want you to learn for now and for the future. Jill: Okay. Empowering. Dr. Hindman: So we're not denying that those things have happened. We're trying to teach the brain that just because you had that before, there is no guarantee that that's gonna be what's happening now, or any time in the future. We gotta open the [00:49:00] possibilities, be like, oh, there could be something different here. And that could include some positive things. So the other part of the limbic system is the amygdala and this plays a central role in our emotional responses, especially anxiety, aggression, and really primarily fear. So this attaches emotional content to our memories, and that plays a really important role in determining how strongly those memories are stored. So any memory that has really strong, emotional meaning or experience tends to really stick Jill: Ah, Dr. Hindman: and playing a role then in forming new memories is specifically related to fear because whenever we're afraid, the brain says, Ooh, is that because there's potentially danger to our survival? So fearful memories are able to be formed after only a few repetitions, because the brain really pays attention to any memory where there's fear involved. Jill: So that really sucks, but I'm guessing it's good for survival. Dr. Hindman: Right? It's really good for survival so that if you are, you know, hiking in the woods and you see a bear and you go,[00:50:00] this is really dangerous for me, your brain is gonna remember that. So the next time you go hiking and you hear a crackle in the woods somewhere, you're gonna go on high alert because your brain is gonna say, could that be a bear. Jill: right? Dr. Hindman: Remember you, had that bear experience and you almost died. Yeah, we don't want to do that again. Oh, it's a squirrel. Okay. We're fine. Or it's another bear I need to get away and I need to find a new trail because clearly what I like is also one the bears like. So when the amygdala then is sending signals out, it can go both to our conscious minds and to the body. So if you then have that experience, you might have a fear response and you might start sweating or have other body responses because the amygdala is sending out, Ooh, this is a fearful experience. So you're getting both in the emotional response and the body response. Good thing is the amygdala also gets new neurons being made in it. So the amygdala can learn. So both of these things are really important. Jill: Thank goodness. Dr. Hindman: Yes. So we have these two parts that are making [00:51:00] associations with environmental triggers and stimuli and our emotional responses. So this is a good thing. So like a great example is let's say we eat some spoiled food and we get food poisoning. The brain's gonna say, Ooh, that was not good. Let's not do that again. So I'm gonna make an association with, I felt that sick when I ate that food that tasted that way and smelled that way. So the next time we smell food that smells like that, or we take a taste and we go, Ooh, that smells off. We stop because we remember somewhere, oh yeah. The last time I did that, that was not good. That is a specific and correct association because it's causative. So that's helpful to us. That's what the brain's supposed to be doing. But if the limbic system starts making these associations that are too broad, too general and therefore incorrect, meaning they're not causative, then stimuli that are actually safe may start being interpreted as being dangerous and in a potentially causative way. So it may be that, I had that POTS flare [00:52:00] when I ate that food. The food may not have done it. It may have been something completely different that actually caused it. But the limbic system says, oh, oh no, it was that food that made you feel that way. Therefore that food is dangerous. So the next time you sit down to eat that food, your nervous system says, oh no, that's bad. And so you have this whole response and it'll start then spreading to any food that is similar. Looks the same, smells the same, tastes the same, same in the food family. And that starts getting broader and broader and broader. The problem then becomes is then if you have a negative response and experience because of your nervous system, the limbic system then says, oh, see, I told you Jill: self-fulfilling prophecy Dr. Hindman: Exactly. And so then that confirms that association and the cycle continues. So that's what we're gonna be breaking the limbic system retraining. Jill: And I'm guessing that the hyper vigilance does not help with that. Dr. Hindman: Right? And so when [00:53:00] you have a limbic system that has this ongoing inflammation and abnormal signaling, then you get this total disruption in what should be the normal neuronal circuits. That then leads you to distortions in sensory perceptions. And then these protective responses that then becomes a habit and nerves that activate together will start doing so automatically with repetition. So then you get stuck in this hypervigilant state and then there's emotional hypervigilance, which then keeps feeding into this. And that then actually continues a certain degree of neuroinflammation as well as the dysregulation. Jill: I'm sorry to laugh. This all just sounds like such a disaster. Dr. Hindman: But I think it's so interesting to me because it explains what so many people experience on that neurologic level. And again, there's things we can do about this. The whole second half of what we're gonna talk about is all the stuff to do about it. Jill: I already Tried some, and I already swear that some of them worked quickly, Dr. Hindman: Yeah. They do. And I think that understanding what's happening is also a really [00:54:00] big part of the retraining process. Because I think there are so many people who have tried so hard and they haven't had success and they feel that they can't, they get blamed. They blame themselves. They're not working hard enough. They're not trying hard enough. And that again is all baloney. Jill: Right, Dr. Hindman: That's not what it's about. that then becomes very frustrating and demoralizing. I want people to understand what's happening. So they go, oh, this is my nervous system. Okay. I need to take care of my nervous system. I need to help my nervous system and this is what I'm gonna do about it. So they actually understand now when they have say a POTS flare, that feels like came outta nowhere, they can say, oh wait, this is my limbic system and my vagus nerve. So what do I need to do to help them and feel then more empowered and understand what's happening and go, okay, I know what's happening because when we get those fear responses, as you just said, that keeps the hypervigilance going. So I feel like having understanding of what's actually happening can help to negate some of that fear [00:55:00] response and create that to be more of an empowering experience of, oh, okay. I know what's happening here. I know what to do. I want to little bit about this brain plasticity idea. So brain plasticity is the idea that the brain can create new connections, which allows us to learn. So this is happening whenever we learn anything. And with repetition, we become faster and more skilled at whatever we're learning. When we were all young, we had to learn multiplication tables because over and over repetition, in the beginning, we all had to think about, oh wait, two times two. Okay. So we've got two times and then, okay, that's four, if you ask somebody that now they know it because that's gotten into their memory. Has they learned it over and over and over again? This is also then like where someone may regain function after a stroke. It's because the brain has made new connections around a damaged area and the person can regain some of the function that they may have lost. So this is then neurons making up new connections with each other. So they're firing [00:56:00] together. They're sending different information. That's all really, really good. All brain plasticity is dependent on what the input to the brain is. I think of this limbic hypervigilance as the dark side of brain plasticity. So it will cause dysfunction if the repeated stimuli are traumatic. And remember again, Dr. Navios list is huge. This could be almost anything. And reinforcement of this trauma loop then can spread to these other forms of sensory stimuli because the entire system now has become hypervigilant as its baseline. So we're gonna use this idea of brain plasticity to undo the learning that happened under these danger conditions. This is important because when you're in this danger, survival mode, it starts affecting basically everything in the body. So it takes energy away from growth, absorption of nutrients, detoxification elimination, ,all these other processes don't have the energy that they need anymore cause it's all going [00:57:00] into the hyper vigilance. So this is where then over time, sometimes we will then start seeing like other symptoms, digestive symptoms may start showing up and it's because the system just doesn't have the energy that it needs because it's all going into this hypervigilance. And Annie Hopper, who is the developer of the dynamic neural retraining system, DNRs, which we'll talk about with limbic system she says that this increased reaction to lesser amounts of stimuli and to more classes is called kindling. So that may be a kindling. So that may be a term that people hear and it can spread. So it may start out with one sense, maybe touch and it'll spread to sound. It'll spread to light, it'll spread to food, it'll spread to EMF. It'll starts encompassing more and more of the sensory. Stimuli that we have. This whole process really happens all outside of our conscious control. So can I want to really, really emphasize this is all autonomic nervous system and limbic system, which are outside of conscious control. The limbic system is designed to be faster than conscious control so that you don't [00:58:00] have to think about assessing a situation and what you should do. The limbic system says danger activates the sympathetic nervous system. You get that flood of adrenaline, you react. And so nobody is choosing to do this. None of this is made up. It's not imagined. But it's this limbic system basically trying to protect you. It can't really do a good job when it's being hypervigilant. So I want to give an example which I think really fits. So this is about my dogs. So my sister had a dog. That was named freckles and freckles would bark at everything. Freckles would bark. If a leaf fell off of a tree outside of the window, this became a problem because she never knew if he was barking. If this was something that was significant or not, I have a dog named Rose Rose never barked. Like she just never barked. So when she did, we knew you pay attention to this because she's seen something, heard something that she thinks is actually significant. And it was, somebody was coming to the door. There was something that was significant in her world that said, Hey, I need my human to pay attention to this. [00:59:00] So what we want is a limbic system that is like Rose, not Freckles. Because freckles is not helpful. Jill: Right. Dr. Hindman: So to put all of this together. So if someone has a cellular threat. If this threat is large, ongoing or repeated, a person can get stuck in any of the three stages of the cell danger response, and that's gonna prevent healing. As part of the cell danger response, there are changes in the functioning of the vagus nerve, which leads to more inflammation and danger signals to the limbic system, the limbic system then becomes sensitized to all of this input and becomes faster, more sensitive and more reactive to this stimuli and starts making incorrect associations between external factors and these internal dangerous signals. And these changes in the vagus nerve and the limbic system can continue even after that original threat is gone. These changes can then also feed back and keep someone in the cell danger response. So our [01:00:00] treatment needs to include both assessing and treating any of the actual threats, stimulating that ventral vagus nerve to get it going again, and then retraining the limbic system so that it can do its job of discerning true danger. So it can actually keep us safe. Jill: So you're training freckles to be more like Rose. Dr. Hindman: Yes, exactly. Exactly. If everything is addressed at the cellular level, we're getting the input up healthy, but then we're also getting the signaling back down again to the limbic system to be healthy. So we know when the limbic system fires it's because there actually truly is a danger. There is a bear, not a squirrel running across the drive. So that's the end of the science part of it. And these are all theories, so they may not fit exactly for every patient, but they do give us a framework to look at treatment and understand what may be happening for somebody. Because for some people, that original threat is gone. And the nervous system dysfunction is what is keeping all their symptoms going. And that's [01:01:00] why they have all these tests run. Everything looks normal, they're told they're fine. And they're like, but I still have all these symptoms. How I feel is not fine. This hopefully then gives them a way of understanding what's happening and then some treatment things to be able to, what do I do about this? Jill: Right. Okay, we are gonna wrap it up for this episode, but we're gonna have another episode very soon where I think you're gonna talk about how to stimulate that part of the vagus nerve. That is the right part, how to retrain the limbic system, how to maybe become a little bit less vigilant. Dr. Hindman: Yes, absolutely. All of those things. Now that we understand what's happening, what do we do about it? So, absolutely. That's the next part that we talk about? Jill: Excellent. Well, this has been so much amazing information and I know that I might go back and listen to this episode again, because I want to catch all those sciencey details that really make a lot of sense out of some of our [01:02:00] histories, like my own, of how it started with like an innocent little infection. And it seems to have snowballed into POTS and MCAS and autoimmunity and hypervigilance and blah, blah, blah. I cannot imagine how much work it was to learn all of these theories and all of the science, but I see how important it is. The next part is just so empowering and exciting too. So thank you a million. Dr. Hindman: You are so welcome. It's been super fun and I really look forward to the next part. Jill: Yay. Okay, listeners, we hope you enjoyed today's conversation. We'll be back next week. And until then, thank you for listening. Remember you're not alone. Stay strong and please join us again soon.

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