#170 Getting Rid of Joint and Muscle Pain For Good with Dr. Josh Levitt

07/27/23 • 68 min

In today’s episode I get to introduce you to my friend and colleague Dr. Josh Levitt. He is a Naturopathic Doctor who graduated from Bastyr University like me and also holds a degree in physiology from UCLA. He is also the author and creator of several popular books and is a clinical preceptor for the Yale School of Medicine.

Dr. Levitt draws upon the science of both conventional and natural medicine and artfully combines the two into a “best of both worlds” treatment strategy. He employs a unique blend of nutritional therapy, herbal medicine, and physical medicine to treat a wide range of common and complex medical problems.

Today we talk about musculoskeletal health, especially what people experience in terms of joint pain and not only why they're experiencing joint pain, but also the frustrations navigating the medical system related to joint pain and joint issues.

His interest and passion in helping people with their musculoskeletal health, and pain in general, comes from being a surfer and skateboarder as he was growing up in Southern California. Being in casts and braces of various sorts and going through lots of X-rays and lots of broken bones he developed an early interest in orthopedics and musculoskeletal health. Later in life, after going through a very serious skin infection while travelling through Europe, he discovered a new world of natural and herbal remedies and was instantly drawn to the naturopathic health world.

Conventional Medicine vs Naturopathy. Are They Mutually Exclusive?

Like so many things in life, health and medicine exist on a spectrum. Within that spectrum there are different domains, you have nutrition and herbs, and surgery and neurosurgery, medications, laughter, community, love, gratitude, etc. There is a long list of things that qualify as medicine in that context and conventional medicine and naturopathy should not be seen as mutually exclusive. In Naturopathy, the philosophy is to use the lowest amount of force that's necessary in order to promote healing. That is just one way of looking at medicine and what it means to heal. Using the least invasive or the least forced therapies for what a person needs is what Dr. Levitt uses in his approach to treating orthopedic and musculoskeletal health issues.

What Are Some of the Most Common Joint or Muscle Issues?

The most common complaint in primary care offices across the country is low back pain. We can go from there and say low back pain, mid back pain, and neck pain. So, pain in or around the spine is a big one. A common diagnosis is a bulging or herniated disc. It might be causing sciatica, and it might be degenerative disk disease in the neck or back. These kinds of spinal complaints are the things that people might go to an orthopedist for, but also might go to a chiropractor or an acupuncturist or a naturopathic doctor.

Other common causes of joint pain are rotator cuff problems in the shoulder, tennis elbow or carpal tunnel syndrome in the upper extremity, hip pain, knee pain, foot pain, and plantar fasciitis. There are so many different diagnoses in musculoskeletal category, but they all relate to people who have something that hurts and are looking for a way to heal.

What Is the Conventional Medicine Way to Treat Joint and Muscle Pain?

There's a very like predictable pattern of prescriptions that happen for people who are in pain. It starts with over-the-counter pain relievers or anti-inflammatory medications. It goes up from there to injectable forms of those drugs, to steroidal medications and corticosteroids, to some kind of surgical intervention. That's just a very common and predictable pattern we see in conventional medicine.

A lumbar fusion, a microdiscectomy, a laminectomy, an arthroscopic knee surgery, or a full-blown knee or hip replacement. There are hundreds of thousands of surgeries being performed in this country on spines, necks, backs, knees and hips that are outright unnecessary or totally inappropriate, and that's a tragedy.

In naturopathic medicine there are so many options and tools that could prevent the need for medications and even surgery. Why use such a powerful invasive tool when another less powerful, less invasive, less toxic, less forceful intervention would do the trick?

A knee replacement in the appropriate patient and circumstance is a beautiful thing. In fact, it's almost miraculous, but only when done on the right person in the right situation. If you do it on a person who doesn't need that level of intervention, that's almost criminal.

When we look at people who are in their 40s who do not have back pain and take MRIs of their backs, you will find that 40% of them have bulging discs in their lumbar spine. Same with knees with meniscus tears or chronic degenerative meniscus tears in the knees - 40% of people have those and their knees feel great. And then you go up every decade f...

Conventional Medicine vs Naturopathy. Are They Mutually Exclusive?

What Are Some of the Most Common Joint or Muscle Issues?

What Is the Conventional Medicine Way to Treat Joint and Muscle Pain?

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#169 Getting Your Microbiome Back on Track

In today's episode we're going to be talking about the gut microbiome. Why it's important, how to know what's going on with your microbiome and how to optimize it.

The microbiome consists of microbes that are both helpful and potentially harmful for us and our bodies. Most of these organisms are symbiotic, meaning they and us benefit at the same time, but some are pathogenic, which are those that cause trouble, produce toxins, and increase inflammation.

When we are healthy, both symbiotic and pathogenic microorganisms coexist without problems in a perfect balance and without causing us to get sick. The problem comes when this perfect balance is disrupted, causing our metabolic and immune function to be negatively affected.

That’s why it is so important to identify and to get your microbiome back on track.

Today we will focus mainly on the gut biome, although it is now well known that it is important to have a healthy balance of microbes in all different areas of our bodies, including the skin and vagina. They all relate back to the gut, so let’s focus there.

What Is the Gut Microbiome?

I'm thinking that a lot of you probably have heard about the gut microbiome, also known as the biome or the gut microbiota. Essentially, it's referring to the microorganisms that are living in our digestive tract.

This group of microbes living inside of us fluctuate on a daily, weekly and monthly basis based on our diet, physical activity, medications we take, toxins exposure and stress exposure.

The important thing here is to try to have a healthy balance of this microbes as much as possible. When there's a healthy balance, the good bacteria counterbalance the potentially harmful bacteria. When our microbiome gets out of balance, it’s either that there are not enough good bacteria, or too much of the potentially harmful bacteria. And that’s when health issues start.

Research is showing that if the gut microbiome gets out of balance, it can increase the risk of many health issues including infections (bacterial, yeast, and viral), autoimmunity conditions, metabolic disorders, even weight gain, anxiety, depression, menstrual irregularities, PCOS, endometriosis, fertility issues, osteoporosis, kidney diseases, heart disease, diabetes, and dementia. Having a healthy balance of microbes in the gut is essential for our health.

What Is This Gut Microbiome Doing for Us?

As you might suspect from the various health issues that I just mentioned, the microbiome communicates and supports our immune system and help protect us from infections and autoimmunity (which is when our immune system gets confused and starts trying to protect us from our own self) so, by having a good balance of microbes in your gut, you're helping your immune system stay on track and protect you.

These microbes also communicate with our nervous system via the Vagus nerve and other mechanisms. These guys are sending messages to our brain and our nervous system, they're communicating about what's happening down in our gut, they can cause us to crave some kinds of foods in order to feed them. They can affect our mood, our memory and our focus.

They also make certain nutrients like B vitamins (including activating B12), vitamin K and short chain fatty acids (which are protective to the colon). Furthermore, they participate in making neurotransmitters such as GABA and can influence the production of serotonin and dopamine in our nervous system. What we're learning from research is that they help us recover from stress and toxin exposure!

As you know I specialize in how humans are affected by stress and what we can do to recover from stress, and so I would say that optimizing the microbiome has a huge impact on our stress recovery.

How Do We Maintain a Healthy Microbiome?

So, we now know they're important, but how do we take care of them? It’s like having a pet, you must know how to feed them and how to take care of them so that they can be healthy.

What we eat is what feeds our gut bacteria. Of course, they're living in our gut so what we swallow is going to influence them and what's going to feed them potentially. Our gut bacteria can ferment foods what we as humans are unable to digest, like fiber or complex starches for example. They can ferment fruits, vegetables, grains, nuts, seeds.

Foods and fibers that feed our microbiome are called “prebiotics.”

Fructooligosaccharides in garlic, onions, leeks, asparagus, artichokes, kale, dandelion, as well as bananas, contain the highest amount of prebiotics, or super food, for our gut bacteria.

It’s important to know that it's possible to over feed your gut bacteria!

In fact, I would say that it is much more likely to overfeed your bacteria than to underfeed them. I see a higher percentage of patients with overgrowing bacteria rather than with too few bacteria. Going back...

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#171 Joint Hypermobility Syndrome: How to Get Out of Pain

In today's episode we're going to be talking about joint hypermobility. This is a topic that's important to me both clinically and personally because I was diagnosed with it a few years ago. What I find is that joint hypermobility is much more common than previously suspected, and there is so much we can do to help with the symptoms of pain, anxiety, fatigue, and more.

Joint hypermobility is sometimes referred to as joint hypermobility syndrome (JHS) or hypermobility spectrum disorder (HSD). It shows up a little bit differently in each person and is not well known by practitioners, which means that many people with hypermobility have seen numerous practitioners without receiving a diagnosis.

When they do receive a diagnosis, they are often told that “there is no cure,” which can make it seem as though there is nothing that can be done to help. That is simply incorrect. I’ll be sharing more why that is my perspective in this episode of How Humans Heal.

First, it is important to understand the various potential symptoms of hypermobility, so that you can start to understand how they are interconnected and unique to each person. That will also help us to understand why the approach needs to be individualized as well.

Mainly I want listeners/readers to know that I’m here as proof that it is possible to feel good, to be out of pain, and to thrive even when you tend toward joint hypermobility.

What is Joint Hypermobility?

Joint hypermobility is considered a connective tissue disorder. Connective tissue involves our skin, joints, ligaments, tendons, and fascia. Hypermobility syndromes are associated with joint instability and chronic pain. If you or someone you know has been experiencing joint pain and/or muscle pain for long periods of time, this is something to consider and to talk with your practitioners about, especially those who are experts in hypermobility, so they can help guide you.

Although it has been improving in recent years, still there is very low awareness for joint hypermobility amongst practitioners. I believe that is for two reasons: 1. it's a relatively newly identified condition. It was first described in 1967; 2. It’s considered to be a rare condition, otherwise known as a “zebra”in medicine, meaning that if someone comes in with joint pain, practitioners are more likely to think of the most common causes for joint pain before thinking of hypermobility syndrome. Research indicates that about 3% of people have joint hypermobility, but I actually think it's higher than that and is more common than we realize.

Now, joint hypermobility may or may not be part of another diagnosis called Ehlers-Danlos Syndrome (EDS) which includes joint hypermobility, with unstable joints that dislocate easily, as well as stretchy skin, easy bruising, wounds that are slow to heal and leave wide scars, hernias and organ prolapse. There are thirteen different types of Ehlers-Danlos syndrome, some of

which involve the blood vessels and digestion. To be diagnosed with EDS requires a genetic analysis to identify collagen-related gene variations.

The important thing is, if you feel joint pain or discomfort, you should start taking action now, regardless of it being hypermobility syndrome or Ehlers-Danlos Syndrome. You have to start taking steps to protect yourself and prevent it from causing further health issues.

To me the awful thing is that so many people who are diagnosed with joint hypermobility or with hypermobile Ehlers-Danlos syndrome are told it's a genetic condition and that there’s nothing they can do, or that all that can be done is manage the pain.

To me, that is unacceptable. As a naturopathic doctor, and as someone with hypermobile Ehlers-Danlos Syndrome, I can tell you there are so many things that help me feel better, and that help me prevent symptoms and health issues associated with hypermobility. There's so much you can do about it. I'm not saying that there's a cure, but by understanding it and by being proactive, you can get yourself out of pain and prevent health issues associated with hypermobility.

How to Know if You Have Joint Hypermobility

Our joints and a lot of other parts of our body are made of collagen. Collagen is so important for joints, bones, ligaments, tendons, blood vessels, intestines, and more. We all make collagen slightly differently. If the way your body makes collagen makes it a little more stretchy, then you may have very flexible collagen and hypermobile joints. But remember, it's a spectrum so not everybody with hypermobile joints can do extreme movements. The best way to identify if you have joint hypermobility is to do a Beighton score test, which is a nine-point scale related to range of motion of joints in the body. The higher you score, the more flexible your joints are.

The Beighton test starts with evaluating if you can touch the floor with your hands with y...