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Improving health outcomes is the goal of every practitioner. Finding the solutions for challenging chronic conditions often requires precious time, extensive research, and sometimes even trial and error. Join Rob Lutz, the host and founder of Today’s Practitioner, as he interviews recognized experts and shares their knowledge and proven treatment protocols. Peer to peer guidance can be the most direct path to finding effective solutions for the conditions impacting your patients.
Rob Lutz 00:02
Hello and welcome to the OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader. Some you'll know, and others you'll probably meet for the first time. We cover topics important to you, always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today.
Rob Lutz 00:24
Hello, and welcome to the One Medicine podcast. I'm Rob Lutz, your host and the editorial director of Today's Practitioner. And I'd like to take a quick opportunity to thank Doctors Supplement Store for sponsoring this episode. I will share links to their website and a little bit more about them in the show notes. But let's get started. Millions of patients struggle with fatigue, anxiety, poor sleep, and diminished resilience, even though conventional testing often appears normal. In this episode, we explore the sympathetic spiral of doom, a new clinical framework that connects mitochondrial dysfunction, oxidative stress, autonomic imbalance, and immune endocrine signaling into a self-reinforcing cycle that keeps patients stuck. Our guest, Dr. Scott Sherr, explains why treatment sequencing may matter more than the individual therapies themselves, how clinicians can identify where patients are in the recovery process, and why interventions such as breathwork, peptides, and nervous system retraining sometimes fail, or even make patients worse when introduced too early. Welcome, Doctor Sherr. Before we jump into our topic, which I think the audience is really going to find interesting, can you just share a little bit more about your background and any context you think that will kind of be pertinent to today's conversation?
Scott Sherr 01:38
Sure. Well, thanks for having me, Rob. So, an internal medicine physician, been in training, out of training now, for a long time. I have an integrative practice outside of Boulder, Colorado, where I see people from my home. I was formerly a hospitalist for many years, so a hospital physician. Did my last shift just about a year ago doing that. I also grew up pretty alternatively. My father's a chiropractor. He's a still-practicing chiropractor on Long Island in New York, at one of the largest chiropractic facilities, I think, probably in the country, if not the world, and how many people he sees. And so I grew up in that alternative space, and so I have a very significant--I'm very much acknowledging the combination of things. The integration is really where I find to be the most important for patients, not just a zero-sum game. It's really how best we can use allopathic, integrative, you know, functional, it all together, and that's what I do in my own clinical practice.
Rob Lutz 02:29
Awesome. Well, thanks, and I'm really glad you joined the episode. So, you know, I mentioned, you know, the sympathetic spiral of doom, I think, which is a phrase that you have come up with. You know, what inspired you to develop what you now call the synthetic spiral of doom?
Scott Sherr 02:48
It's a, you know, it's a funny story, Rob, actually. I was talking to a friend of mine in California. She's an acupuncturist, and she had all of these people in California going and doing trauma work, so people that are looking at trauma, you know, in a very deep way--sometimes somatic therapy, sometimes psychedelic therapies. And they were doing this trauma work and seeming to improve a little bit, but not actually gaining a lot of steam afterwards. And she was really understanding--and we were, we were talking about it--is that they were feeling just so depleted after doing the trauma work, so tired, so washed out. And what this really was is that they no had--really, these patients had no energetic floor to stand on. And what this meant really was that, like, you could do all the downregulation of the nervous system that you can, but if you don't have enough energy to be able to sustain the capacity to make energy, then you're not going to see the benefits long-term for patients. And so, she was seeing all these patients that way, and I was also seeing people that were trying everything out of the book, every tool, supplement, things like that, sometimes having a paradoxical response to these kinds of things--doing breath work, doing meditation, doing yoga, doing cold plunges--and seeing how they actually would have the opposite effect. And I realized that there was something there that was missing, and that was a pattern that I've, you know, lovingly, although sort of ominously, named the sympathetic spiral of doom, so.
Rob Lutz 04:04
Yeah. So you know, it makes me think about, you hear a lot of times about, you know, practitioners that are seeing patients, and the patient doesn't feel good. The labs come back normal. Nothing's really standing out. What do you think we're missing there?
Scott Sherr 04:25
Yeah, in this pattern specifically, there's two major aspects of it. Right? So, when you have, just to go back to the trauma example, you have somebody that is chronically stuck in fight-or-flight. Right? They've had trauma as a child or as an adult or whatever. Their system never feels safe. They're always in sympathetic mode, okay. If you're in sympathetic mode all the time, you do these things to the system constantly, like produce tons of cortisol, tons of neurotransmitters like norepinephrine and epinephrine, on a regular basis. And what this does over time is significantly dysregulates the system in multiple different ways. It dysregulates your hormones. It dysregulates your immune system. But how does it actually do that? It does it by dysregulating mitochondrial function. So the mitochondria, as everybody knows, powerhouse of the cell. We have quadrillions of these things in the body. That's after trillions, if you're following at home. So tons of mitochondria, especially in your reproductive organs, your brain, your heart, your liver, your musculoskeletal tissue. And so, if you are stressing the system at all times, what the mitochondria start doing is being unable to keep up with demand, and they get flipped over into a whole stage of processes called the cell danger response. And the cell danger response are basically three stages of what our cells try to do to protect themselves from a stress--doesn't matter if it's physical, emotional, traumatic, etc. What they try to do is go through all these three stages to heal. But if you're under chronic sympathetic all the time, you can't do that, and they get stuck, typically in CDR1 or in CDR2, which is where you cannot make energy effectively anymore.
Scott Sherr 05:56
And then what the system tries to do as a result of that is compensate by making more energy. They're trying to get you outside, like, actually get you to make more energy, but you can't do it very effectively because you're always in this chronic stress mode. So, that's the classic loop that we would see is that you have sympathetic activation causing mitochondrial dysfunction, causing compensatory sympathetic activation, leading to more mitochondrial dysfunction. Right? So, that's classic, and this is what most of us think about. But there's another way you can enter this loop, and this is the big deal, whereas, yes, sympathetic activation is a big deal, but also direct mitochondrial dysfunction is happening very, very commonly to many of us all the time. The most common reasons, outside of the sympathetic activation, are insulin resistance; medications like metformin or statins or other drugs we use, like PPIs, all the time; infections, your COVID infection, your viral infections, your severe infections when you had to go to the hospital or something like that. Those are all mitochondrial dysfunction generating. Right? And then you also have hormone changes, things like around perimenopause, where estrogen goes up and down all the time, and like, estrogen is a fantastic mitochondrial enhancer. And so, what you have here is a direct mitochondrial stress. That direct mitochondrial stress causes that same CDR to be activated, that same CDR to not actually fully go through its whole process, getting stuck. You flip over into the glycolytic state, or glycolitic lock is really what it is. You're not making energy effectively, and you get compensatory sympathetic activation. So, even if you didn't have a sympathetic activation from the outside of the world--I call that a top-down stress--you had mitochondrial stress directly, which is your bottom-up way into this loop. So top-down, bottom-up, getting into the sympathetic spiral. and the key is that they feed on each other no matter where you start.
Rob Lutz 07:36
Hm.
Rob Lutz 07:36
Mm hm.
Scott Sherr 07:42
And oftentimes, it's not just one or the other. It's usually a combination where you're going alright, you're sympathetically activated, until something sort of falls out from underneath you, like your estrogen level, for example, if you're perimenopausal. Or, you just suddenly got an infection, and then all of a sudden, things just never feel the same. You start going into this loop where, and the patients, what they'll feel is that they can't recover as well. They're tired but wired. Everything they try, they're sensitive to. Their mood is all over the place. Their sleep is fragmented. Like, their relationships are suffering. And there's obviously phases of this, but in essence, that's the sympathetic spiral in a nutshell.
Rob Lutz 08:24
Wow! And my guess is so many people are somewhere on that spectrum. Right? They're, you know.
Scott Sherr 08:30
Yeah.
Rob Lutz 08:30
Whether they're full on chronic fatigue syndrome or they're just, they're not sleeping great or whatever it might be.
Scott Sherr 08:35
Yeah, and that's really what I've decided here is that really there's four phases of the sympathetic spiral of doom, as I understand it, and as I've been developing this. Phase Zero is where we all want to be, which is not in the spiral. And the way, the best way to describe Phase Zero is that, "Do you remember how it felt to be 21 to 30 years of age?" You kind of wake up, you're fine, no issues, no pain, no discomfort. Like, your mood is good, your energy is good. Maybe you didn't sleep as well last night, but you still feel fine the next day. Maybe you went to college and went to bed at 3 o'clock in the morning, went to class at 8 o'clock in the morning the next morning, or later in the next morning. The Phase Zero is what I call relaxed capacity. It's where you have the capacity to rev up your nervous system anytime you need to, but you can downregulate as as easy as you can upregulate at any moment. Mm hm.
Scott Sherr 09:30
So, it's not like you're laying on the couch not moving. It's a dynamic capacity to maintain your capacity on either end of the spectrum. Right? And then you have Phase One, Two, Three, and Four, where you have the the spectrum of being in the spiral, and people do bounce around typically between Phase One and Three, One and Two, pretty commonly, but Phase Three and Four are the more extended levels of where people have a very difficult time getting out of that without significant help. And then the sequencing of the help is what I found to be so helpful here too, Rob. It's not just you can just do everything to the same person or different people the same way. It's like you have to be very clear. That what's so important, no matter if you're sympathetically activated, primarily, or the mitochondria are are also being dysfunctional, primarily or secondarily, you have to focus on the energy side first if anything else is going to work better. And so, not only is it a pattern that all of us are seeing in practice that I've just been able to sort of create here in a way that I hope can be helpful for you all that are listening, but also the sequencing and how do we get out of it is absolutely essential too.
Rob Lutz 10:26
Mm hm. You know, I had Doctor Jacob Teitelbaum on the podcast, and we talked about Long COVID, you know, and it kind of relates to what you're talking about here. You know, he said it's an energy problem primarily. You know, that's--if we're going to talk about the mitochondria, why do you put cellular energy production at the center of this model?
Scott Sherr 10:45
Right, and yeah, it has to be, right, because if you don't have enough energy, nothing is going to work. And this is a classic example, I had a a colleague of mine a couple months ago now, a very prominent doc, he was seeing a patient that was just always, you know, very fight-or-flight, chronically anxious. So, what does she decide to do? Now, she has multiple medical problems, of course. She has POTS. She has common chronic fatigue. She's on Phase, you know, Four of my spectrum here. She goes ahead and gets a sympathetic ganglion block, which is anesthesia to the sympathetic ganglion in her neck to shut off her sympathetic nervous system. What happens? She stays in bed, can't move for just about a month. Right? Because you just took away her nervous system's sympathetic tone, but she had no ground to stand on, no energetic ground, okay. And this is why I've been now saying very often, it's energy first. Energy first. Energy first. And what I mean by that is, if you can create more of a mitochondrial support, so that when you downregulate the nervous system, then there is a floor to stand on once the nervous system is no longer in fight-or-flight. And so, if the mitochondria are not working well, nothing else is going to work well. Your immune system is not going to work well. Your hormones aren't going to work well. You know, your heart's not going to work well. I mean, your musculoskeletal tissue and, you know, the kidneys and everything.
Rob Lutz 12:06
Yeah.
Scott Sherr 12:06
Goes from there. And so, if you focus on the energy-first framework, that is the key here. Because if you give somebody enough energy that you can actually decrease their nervous system tone appropriately and effectively, and so one thing I've been very fond of saying to my patients lately that have anxiety is that, "You know what? You need more energy. You'll have less anxiety that way." And that is a bit of a paradoxical idea.
Rob Lutz 12:34
Yeah.
Scott Sherr 12:34
Right? Because you think, well, if you have anxiety, well, you got to calm down. Right? That may be the case, but if I calm you down and you're in Phase Three or Four of this spiral, you're not going to feel very good when I calm you down. And I've seen it in front of me, like when somebody had taken something to calm them down, and they had this--they crashed. They had this anxiety that's worse, and sort of like a reactive anxiety. And so for me, it's all about focusing on how well the cell can make energy, allowing it to be able to transition through those cell danger response phases and complete them, and go back into optimal functioning, where they can make energy effectively from oxygen again.
Rob Lutz 13:14
Mm hm. So, that's your starting point, typically, is really kind of looking at--too early in this conversation to kind of share a little bit about how do you do that?
Scott Sherr 13:21
Yeah, no, I think that's that's exactly where we're rolling here. Where is--we all recognize our patients on some level attributing, having attributes, of being in the spiral in some way, right, I think. And for me, as a clinician, the question just becomes, "What is the sequence that's going to best support them to escape said spiral and maintain their capacity to do the things that they want to do?" Become in that Phase Four, so--in relaxed control, the capacity returns. Right? And that's really what we're working with, or trying to work towards, with our patients is to give them that capacity back. And that capacity starts with energy, and for me, it's a process that I've developed over the last several years now, where I really understand that if you can focus on mitochondrial function first--it's not the only thing you need to do, but focusing on mitochondrial function first--optimizing vitamins, minerals, nutrients, cofactors, all the aspects that are related to mitochondrial function. You look at toxins in the environment, and you have to look at, you know, what's happening in the gut. You have to look at neurotransmitters and hormones. Like, these are all very very essential, but you don't want to wait too long to start downregulating the nervous system too.
Rob Lutz 14:37
Mm hm.
Scott Sherr 14:37
Now, the problem with that is that the things that I just mentioned--vitamins, minerals, nutrients, and cofactors, gut health, and optimization--that takes time. It doesn't happen overnight, and you have to be super careful on how you start bringing that in, in a patient that's already significantly dysregulated. And this is very common for a lot of practitioners that are listening, is that you give something to your patient and they react to everything. Like, they react even to small amounts of supplements. They crash or they just don't do well. These are your, you know, very sensitive patients. Right? That's like a Stage, you know, Four of this particular pattern that I've been describing. And so, what I've realized is that what you can really do right now is support mitochondrial function with some very simple things that can work very quickly. And the compound that I found to be the most compelling here is a compound called methylene blue.
Scott Sherr 15:29
And methylene blue is a very, very interesting compound. It's been around for a very, very long time. It's not the only thing that I use, mind you. Right? I'm using the other things at the same time to support mitochondrial function. But within about three to five days of being on the right dose, your patients is going to start feeling better. They're going to start having more energy, more capacity, and that's because of the the amazing ways that methylene blue works in the mitochondria. And using that has been a game changer in my practice, because now I can give my patients a leg or a floor to stand on and--or to sit on a chair, I guess, whatever the analogy might be. And then as a result, they're able to make the capacity, make the efforts, and do the other things to support their system, like change their diet, their lifestyle, start drinking more water, and things like that. And we can also downregulate the nervous system now, because they have a more energetic floor as well.
Rob Lutz 16:22
Mm hm.
Rob Lutz 16:23
Mm hm. That's really interesting, and it makes a lot of sense. You might have touched on this a little bit, but how do mitochondria and the autonomic nervous system communicate with one another? How is that happening? What's, it doesn't--I mean, I'm not a practitioner, but that seems, I'm trying to figure out how that kind of fits together.
Scott Sherr 16:39
Oh yeah, absolutely. So it's--they're very much related. If you have chronic sympathetic activation, you are stressing the mitochondria at all times. Your mitochondria--your body--thinks that you're running from a lion at any moment, even if you're just doomscrolling or yelling at your kids or something like that. Hopefully, not yelling at your kids too often, but you get what I mean, right?
Rob Lutz 16:58
Yeah, yeah.
Scott Sherr 16:58
And so when you have the chronic sympathetic activation, you're pumping out cortisol--you know, cortisol, your primary steroid hormone. It's your, one of your, primary hormones for revving up the nervous system, getting in that sympathetic dominance and staying there. And what that does is tell your mitochondria, "We need to make as much energy as absolutely possible so that we can manage the demand that you're putting on us."
Rob Lutz 17:23
Mm hm.
Scott Sherr 17:23
And what that does over time is significantly stress the mitochondria into a place where they cannot keep up. We don't only just make energy in our cells. Right? We make ATP, but we also make reactive oxygen species or free radicals. We make water. We make carbon dioxide. Right? But the free radicals have to be neutralized, when they're made, by antioxidants, and if you're continually under stress mode, you can't keep up. Your antioxidant capacity cannot keep up, and as a result of that, you get too high of a reactive oxygen species load, you get into that cell danger response, and you cannot get out of it. And that is where the sympathetic activation really does huge amounts of harm on our cells, because the mitochondria can't keep up. Those cells cannot do their functions that they're supposed to do, so they can't make hormones, they can't make neurotransmitters, they can't make immune cells, they can't make your gut lining, they can't--you know, and the the list goes on and on. And so, the sympathetic activation is absolutely crushing the mitochondrial capacity to keep up. And where the parasympathetic nervous system comes in, which is your rest and digest mode, is that's where you have the capacity to shift out of the cell danger response. That's where you have the capacity to detoxify, to heal, to recover. Right? And that's where we're really trying to get more of our patients is to be in parasympathetic mode, at least more of the time. Right? And it's not like you want to always be there, but your default state shouldn't be in sympathetic. Your default state should be in parasympathetic. And I see this all the time with my patients. Their HRV is in the tank. Their sleep scores are terrible, like, but they feel fine. Like, this is just how they've been operating. Right?
Rob Lutz 19:03
They think they feel fine.
Scott Sherr 19:04
Yeah, exactly. With feel in quotes.
Rob Lutz 19:05
They feel normal for them.
Scott Sherr 19:05
Yes, in quotes, they think they feel fine.
Rob Lutz 19:08
Yeah.
Scott Sherr 19:08
But their HRV is in the tank, and they don't know why. Like, "I'm doing everything right, Doc. My HRV is terrible, though. I sleep okay, but my HRV says it's really bad. I'm not getting enough deep sleep. I'm getting 10 minutes. Although I feel like I'm getting some rest, I'm not getting much at all."
Rob Lutz 19:21
Yeah.
Scott Sherr 19:21
Like, "I don't know why my mood's all over the place. It used to be just fine." Like, "I used to be able to recover from exercise after you know a day or two, max, and then it takes me a week." And so the list goes on. And you have to answer--you have to always ask the right questions as a physician or practitioner. Taking a history is really, really important here, or having good screening tools, and you know, or having a good questionnaire, or seven, depending on the person and.
Rob Lutz 19:46
Yeah.
Scott Sherr 19:46
The kind of clinic you run. But, you can really piece this out quickly, and I think if you've been in practice long enough, within about three to five minutes, max, you really understand--at least, I understand--whether I'm going to be able to help this patient directly by doing labs and giving them supplements, or if that's not even going to go far. Right? And that's the sympathetic spiral that I'm talking about, where the labs and supplements on their own, they're not going to cut it, because you have that sympathetic overload, or that overhang, that's coloring everything. And where we get stuck as practitioners is either place, either let's just downregulate the nervous system and they're going to feel better, and they crash, or let's just give them stuff for their energy capacity and see if they feel better, and they don't.
Rob Lutz 20:29
Mm hm.
Scott Sherr 20:29
Why? Because you didn't address the sympathetic or you didn't address the mitochondria on either side of things. And that's really what I think has been so crucial to helping so many of my patients recently is--over the last year or so, when I've really kind of figured this mode out.
Rob Lutz 20:42
Yeah. So again, I think you touched on this, but what does the typical SSD patient look like in practice?
Scott Sherr 20:50
The typical SSD patient is going to look like your average person going to the to the doctor, saying that they don't feel good anymore. And it can be mild, like, coffee is structural. You need coffee every day, not sleeping as well, a little bit more fragmented, mood is a little bit dysregular. You're just kind of feeling like whenever you travel or any additional stress comes on, you have a hard time handling it. To the end of the spectrum, which is you know chronic fatigue, always tired, wired, fragmented sleep. No matter what you do, you feel like things are worse. You try to do the breath work, the cold plunges, the yoga, and try to calm down, but things feel like they're actually falling by the--you're actually getting worse instead of better.
Rob Lutz 21:34
Yeah.
Scott Sherr 21:34
And so, it's a spectrum there, and we we do move around in that spectrum, as I mentioned. But it's, most of us some of the time, at least in that Phase One and Phase Two side of things, and that's okay. There--what's nice about the Phase One or Phase Two of this is that you don't necessarily have to be so sequenced about it. If the system still has significant energetic floor--at least some--you can just work on calming down the nervous system, and things are going to be all right. Taking more breaks during the day, getting some sunlight, getting off the screen, working on getting the same bedtime every night.
Rob Lutz 21:57
Yeah.
Scott Sherr 21:57
You know, in Phase One or Phase Two, it can be fine for a lot of patients. But in Phase Three and Phase Four, it's just not going to cut it, because they need energetic floor, so that they have something to land on when you're downregulating their nervous system.
Rob Lutz 22:19
Is there a way for you to determine their energetic floor? What do you look for?
Scott Sherr 22:23
Yeah. So, I do a lot of testing with patients. I do metabolomic testing, which is small molecules that are responsible for the real-time working of the cells. And you can do metabolomic testing. This is organic acid, specifically, testing. I use a number of different companies to do this, but that's my way of really understanding what's happening real time. And also, look at the gut, look at neurotransmitters, look at hormones. So, I'm looking at all that, but honestly, as a clinician, within about, again, two to five minutes at most, I get a pretty good sense of where people are and where they're going to need to go.
Rob Lutz 22:56
Yeah.
Scott Sherr 22:57
So a lot of this is going to be subjective for your patients. Right? But there are some markers you can absolutely see, especially in people under chronic sympathetic activation, that you can see improve as you're starting to unwind this loop and really find ways out of it.
Rob Lutz 23:11
And so, would a patient need to have some kind of a tracking device for their sleep and their HRV? I mean, obviously, that could be helpful for this.
Scott Sherr 23:19
It's absolutely helpful.
Rob Lutz 23:20
Yeah.
Scott Sherr 23:21
It's absolutely helpful. But they don't have to have it.
Rob Lutz 23:23
Yeah.
Scott Sherr 23:23
A lot of this can be objective in the sense of, "Well, how do you feel, you know, day to day? How well do you recover? How, you know--does something that's stressful make you feel like the world is going to end, or do you have a capacity to work your way through it pretty quickly?" So, I've created a questionnaire that I think is helpful for patients, and it's also a way to kind of scale them on a number, at least a number scale, as to where they might fit on the sympathetic spiral, which can be helpful, because then you can also repeat it over time and see how things change.
Rob Lutz 23:53
Sure.
Scott Sherr 23:53
it's one of those things where the challenge, Rob, that we have is that our society has really developed an affection for the hustle, for stress, and it's very difficult for people to take that gas pedal off. But once you start doing that, and you give people the experience of being able to function better, even in high-stress situations, when their nervous system is not as activated, that's when you can see massive benefit. And you know, we talked about the mitochondrial side of things, but there's also the the downregulation of the nervous system and how well you--how do you do that, right? Obviously, you want to deal with the trauma and anything major that might have happened in their past, but do you have enough energy, or do your patients have enough energy to do that? And the answer is, "Probably not," if it's been going on for a long period of time. So, you have to think about what are the small things you can do now to start downregulating before they can do the deeper work. It might happen three or six months later, once they've built that energetic floor. And so I really try to leverage the GABA system here, specifically. GABA is your primary brakes of the brain, so glutamate excitatory, GABA inhibitory.
Rob Lutz 25:04
Mm hm.
Scott Sherr 25:04
The combination is about 80% of your brain's neurotransmission, and glutamate gets converted into GABA in the brain. They're supposed to be in balance with each other. And so GABA, GABA is the unsung hero of the brakes. And most of our patients that are chronically stressed, they are GABA deficient. And the challenge is you can't just give GABA as a supplement. GABA is too big of a molecule to get across into the brain. If GABA works for your patients, it is diagnostic for a leaky brain or a leaky blood-brain barrier, which is almost always correlated with a leaky gut. So, if you optimize somebody's gut, their blood-brain barrier typically gets better, as well, and so you want to use other compounds that can then enhance the GABA system. I use things like l-theanine and kava and CBD and CBG, which are non-psychoactive, and I use others for sleep that are more longer acting, like magnolia bark and honokiol, dihydrohonokiol, something called agarin, which is from a mushroom called the Amanita mushroom. These are really great at optimizing the GABA system directly, and so I use these so that my patients can get the experience of what it feels like to have a nervous system that is not as activated. Having the experience allows them to know where "there" is, because many of my patients--and many of yours that are listening--do not remember what it feels like to not be in sympathetic mode. And so to give them the experience, then they can get back there with meditation, with yoga, with breath work, when they have an energetic floor, of course. But they know where "there" is, and that's what I think supplementation could be so powerful for in this particular capacity.
Rob Lutz 26:44
Mm hm. Yeah. What you said made me think of something. I work with some other entrepreneurs with a coach, and one of the things we talk about is, you know, slowing down to speed up. You know, you've always got so much stuff going on, but if you can't slow yourself down to react appropriately and be present and so forth, then you're not going to get where you need to go. And so that was something that you just made me think about. Okay, so let's talk, one last thing. You know, how do you distinguish between SSD from burnout, and adrenal dysfunction, chronic fatigue syndrome, and Long COVID, or is it all all part of it? What kind of various?
Scott Sherr 27:18
Right. So, the sympathetic spiral of doom is not a diagnosis; it's a pattern that we see in a lot of different conditions, including the ones you've just mentioned. What this just helps, I think, me understand, and I hope some of you, is that we have this loop that's happening with a lot of these chronic conditions. If you have a chronic condition, you are in the sympathetic spiral on some level, and if we work on that energetic floor, then everything else is going to get easier. But it's not the only thing you work on. You work on sympathetic activation, and then all of a sudden, that loop starts breaking. It starts opening up and stops spiraling, and then all of a sudden, the treatments that you're looking for that, to work are going to land. And that's the big difference is that we're trying to really help these patients, but we are so stuck on sometimes just that specific marker, that specific issue, when we don't realize if we just take a 30,000 foot view, that all of a sudden, if we just energetically support them, drop their sympathetic nervous system down, then all the things that we're trying to do with our patients, help them do, facilitate them, are, is actually going to finally start working.
Rob Lutz 28:31
Mm hm.
Scott Sherr 28:31
And it's one of those things where, and I've seen this in practice, you just give somebody supplements for their mitochondria to start working better, and nothing gets fixed. Right? Everything is the same. It's because they're so sympathetically clamped down. Right? And the other part of this is that if you just deal with their sympathetic nervous system and don't optimize mitochondrial function, they can crash. And so it becomes like a base level, Rob, for me, is that--you know, I have a a nonprofit that I help run. It's called Health Optimization Medicine in Practice, and this is--it was founded by a colleague and mentor of mine named Dr. Ted, and the and the idea was, well, if, what is this sort of foundation that sometimes we get lost finding? Right? Because as clinicians, you're looking at for the--you know, we're better than we used to be. Allopathic doctors, band-aids for blood pressure, diabetes, you know, et cetera. Right? Functional medicine, integrative doctors, are looking more for that root cause of illness, which is great. Right? You're looking for the root cause of the fatigue and the fibromyalgia, whatever. Right? So, you're looking for the virus and the bacteria and the, you know, whatever. Right? What we have done is, like, "What if you looked at the root causes of health as a foundation?" Right? Not just looking at the root causes of a disease, and then how does a system stay healthy?
Rob Lutz 29:42
I like that.
Scott Sherr 29:43
A system stays healthy with optimizing mitochondrial function, with the cellular function. Like, the cell itself is the root, is the base of all of your tissues, your cell, your basic cell, its nucleus, its cytoplasm, its mitoc--its organelles, including the mitochondria, its cell membrane. Right? And so many of us in the functional integrative worlds are doing this work, but we're doing it in the context of a root cause analysis, which I think sometimes can lose the forest from the trees in the sense of if you just focus on foundational biomarkers, then a lot of the other things are going to get better on their own, rather than having to address them. And this is where--this is where it gets interesting, where you have immune system reactivation of things like Lyme and mold and EBV, and oftentimes those aren't the problem. The problem is the immune system itself and optimizing immune system function, optimizing the gut, optimizing the mitochondria, downregulating the nervous system. Right? And so it doesn't take the place of any of that stuff. It just says, "Well, maybe there's a energetic floor," as I've been describing it, "and a Phase Zero where we can try to get our patients, so that they can heal, detox, and recover better from anything else that life has or may throw at them.
Rob Lutz 30:55
Mm hm. Yeah. Just support them in such a way that their ability to be resilient to whatever comes across, they're just more--they're more suited for it at that point. They're more.
Scott Sherr 31:04
Right? Or just simply that's it's easier to treat them. Right? If, like, if you have a trauma to a limb and you're more well optimized, you're going to recover faster from that trauma.
Rob Lutz 31:14
Yeah.
Scott Sherr 31:15
If you get an acute Lyme tick bite and you're relatively optimized, you're going to heal faster. Right? And so the idea is that we create a foundation of health, of resilience and capacity. And what I think is just so important--all of the practitioners listening know this--is that it's pretty easy to do lab testing on patients. It's pretty easy to give them supplementation, but it's pretty hard to downregulate their nervous system, and that's really where we have, as clinicians, really have to spend a ton of time and give people a roadmap. But, the the roadmap is only going to work if they have that energetic floor, and this is where a lot of us, me included, failed in the past, because I just thought, "Okay, you know what, this person's crazy," or, "They just have a lot of anxiety. We need to just work on their anxiety." Right? And then I would get nowhere, and then I would be like, "Well, why am I getting nowhere? Well, every time I try to do something, they crash, or every time I do something, they have a paradoxical response," or whatever it might be. And so, a lot of clinicians, and me included, for a long time, would send them to psychiatrists or send them to another doctor instead of trying to address it themselves, because it felt like a psychological issue. And yeah, there might be psychological things there for sure that need to be addressed, but it's that--again, I keep going back to it--but that energetic foundation that we can do as clinicians that's going to make every other intervention from a sympathetic downregulation perspective work and land so much better, and then you open it up. You--instead of being contracted, you expand your patient's capacity to finally heal from their Lyme and their mold, and their--those things need to be addressed 100%, not 100%, but many of the times. And so it doesn't take the place of it; it just makes everything work better.
Rob Lutz 32:38
Yeah. That's great. So, can you give me--so, we talked, we're talking sequencing a little bit here. You know, I think that's an important one for us to stick with for just a minute. But can you give an example from your clinical practice where sequencing completely changed the outcome?
Scott Sherr 33:14
Yes, and so, a couple different examples. I'll give you one interesting positive example first, because let's start positive. Right? So there was a colleague of mine, decades of anxiety, tried every SSRI in the world, multiple interventions, nothing worked. He started on some methylene blue. Within about a week, his anxiety went away for the first time in his adult life.
Rob Lutz 33:36
No kidding. Wow.
Scott Sherr 33:37
Yeah, first time in his adult life. He called me and he's like, "Scott, why did this happen?" And I was like, "Well, you're not the first person to tell me this." I've had people who started telling me, "Yes, I took methylene blue. My anxiety went away. I took methylene blue, and I started sleeping better. I took methylene blue, and my HRV is better." Well, why is this, right? Because all of a sudden there is more energetic floor, like I said, and then is, or are, anxiety and depression, a lot of mental health disorders, are they purely neurochemical? We know that's absolutely not the case. We know that there is a huge mitochondrial component to every single mental health disorder, okay.
Rob Lutz 34:12
Mm hm.
Scott Sherr 34:15
And so, once they started getting enough energetic support, at least some of my patients--this one friend of mine; I've had others with depression, even bipolar, and others--they start feeling so much better. Now, on the other side of this, there's a patient of mine who was working with another doctor at the same time. This other doctor was focused on Lyme, mold, and I don't typically work with that in my particular practice. She was doing that. I was starting to work with her, just, very, I just had started working with her on some of these foundational biomarkers, and so I had, we had just got done on an intake, and then I get a call from her the next week that she's in bed. She can't move. And I asked what happened. She's like, "Well, my doctor, you know, very well-meaningly, you know, obviously, gave me something to calm down my nervous system, and I crashed." This is the lady that had mold in her house, that she was still trying to leave the house. She was still getting exposed on a daily basis. She had been diagnosed with Lyme. She had, you know, chronic fatigue, her energy was all over the place, you know, poor girl. And so, she wanted to come see me to do some foundational testing. And well, what I realized, you know--when we realized what happened here. So once she recovered, which took her some time, we did the reverse. Right? We started with energetic support. You know, I started on methylene blue. I started on very low doses, about eight milligrams to start off with. Maybe she was up to 12 and a half at the end of it, so a small amount, you know, clean stuff. You know, you've got to make sure you're getting clean methylene blue when you're getting it.
Rob Lutz 35:34
Mm hm.
Rob Lutz 35:37
Mm hm.
Scott Sherr 35:39
And then we slowly, over the next couple of weeks, started very slowly downregulating her nervous system, starting with GABAergic compounds that I mentioned earlier. We started also working on, you know, some of that vitamin, mineral, nutrient, and gut support, and then slowly over about a month or so, we were able to see this shift. It was like this crossover moment where her nervous system was much more regulated, and her energy was not trashed. Now, did she feel 100% better? No, no, she did not feel--like, this took her months to feel better, like entirely. Like, she's still on her path, but she's still significantly better now. But it was after about 30 days or so where we could really start going deeper into some of her cellular machinery and start making bigger interventions that she could actually handle. And that would mean actually working on doing a gut cleanup, for example. I don't necessarily do that right away in somebody like this, because you're going to make them crash. And so we waited about a month. We started cleaning up her gut. We sealed up her gut, and then all of a sudden, things got significantly better. Peeled off her methylene blue; she didn't need it anymore. I still had her on the GABAergic support, and she's done great. And this was--and I've seen this, like, across the spectrum. I've seen people that are perimenopausal women--a number of them I've been, that I've worked with and also my colleagues--where again, the floor goes out underneath them during menopause, or perimenopause, when estrogen levels go drop down, because midlife, women in midlife, are doing a lot. They have kids, they have--many of them have jobs, and their stress is, you know, high.
Scott Sherr 37:14
They're doing okay until that mitochondria starts getting less support because of the estrogen levels. And so, what I've seen in these patients is that you can just start giving them HRT, right, and they, and maybe some methylene blue depending on the patient, and all of a sudden they feel better, and then you can start working on their stress at the same time. So, I've seen it in a lot of different categories.
Rob Lutz 37:36
Yeah, that's--it makes so much sense the way you're describing all this. I mean, obviously, you've seen it in your practice.
Scott Sherr 37:41
Yeah.
Rob Lutz 37:41
Is there anything else that you want to talk about, that as far as the Four-Phase model? You know, I think you touched on it. Bridge interventions? So, there's some that you kind of, you didn't use that term yet, but I know that's something you've used before. Anything else you want to say about the Four Phases?
Scott Sherr 37:56
Well, I think, again, these are relatively arbitrary, of course, everybody. I just created them, because I felt that it's always nice to have some categorization, but in general, it's a spectrum of how severe their sympathetic spiral is looping and spiraling, really. And so, the deeper they are in the spiral, the more important it is to sequence things from an energy-first perspective. The less steep they are, or the, you know, the more shallow, I guess, in this capacity, the less important it is.
Rob Lutz 38:23
Mm hm.
Scott Sherr 38:24
But when it--really, what it comes down to, is meeting the person where they are, and then taking them slowly through this journey. I think the main aspect that we all want to do--that all of our patients really want--is to feel better tomorrow. And so, we have to acknowledge that if you're further down that spiral, it's going to take more time to get there. But, finding ways to help right now is absolutely essential, and that's why I found this particular compound, methylene blue, to be so essential. Even though I know it's controversial on some level, it's not--it's a very, it's a very blue coloring, and it doesn't come from the ground. It's a synthetic material, but we live in a synthetic world, and we need synthetic things to help us sometimes, like antibiotics for infections. And not everything natural is good for us. We already know this. Right? We can--cyanide is natural, and so is arsenic.
Rob Lutz 39:11
Right.
Scott Sherr 39:11
Fun fact: the antidote for cyanide poisoning is methylene blue, by the way. And so the nice thing about methylene blue is that it helps right now. And so, I use that as the energetic support, and then I use GABAergic compounds very quickly once the energy support is in place, so that you have a way to again downregulate the nervous system without getting them to crash. And then everything opens up, you know, everything opens up, so you can actually see your vitamins, minerals, and nutrients land. The lifestyle--people are willing to make more changes.
Rob Lutz 39:40
Right.
Scott Sherr 39:41
They're willing to get out of a relationship that sucks, because they have enough energy to do it. They're willing to think about their work in a different way, or do some mindfulness training, or go to yoga class, or do some breath work, because now they have enough energy and capacity to do it. So, I think that the phases aren't as important as understanding that there's a spectrum here. I do have questionnaires available. I have a whole Sympathetic Spiral of Doom protocol that I've developed as well, and people can, that people can reach out and get. I'm sure we'll give them some links at the end here. But I think in the end, what I--the goal is to understand that this is the foundation that some of us are not thinking about in this way, and I think you'd be super helpful to kind of bring into your practice and integrate into the things that we're already doing.
Rob Lutz 40:25
Mm hm. Yeah, it really makes a lot of sense. I know we're kind of running out of time here, but so maybe a clinical pearl. If a clinician remembers only one concept from our conversation, what would that be?
Scott Sherr 40:37
That's a good question. Well, a couple things come to mind. The first thing that comes to mind is that I tell my patients all the time they need to have more energy to have less anxiety, and that's an interesting paradoxical way of describing this. But, it does make your patients double-take for a minute and go, "Wait, you mean I need more energy?" And the other one that I say to my patients in a very nice way is they need to calm the fuck down, you know and, but I do that in their capacity of understanding it in this way. Right? Now, the way that they're going to heal, the way that they're going to recover, the way they're going to detox is by calming down the nervous system, but let's do this in a sequenced way. And so I guess the final thing would be, "Energy first." I mean, by supporting mitochondrial capacity first, everything is going to get easier to do.
Rob Lutz 41:31
Mm hm.
Scott Sherr 41:31
It's not the only thing that you need to do, but it's the primary, the number one, thing that we can do to our patients to help them now. And there's lots of different ways to support mitochondrial function I mentioned. Many of you are doing these already. But, what are the things that we can do that are going to work within about three to five days? There are less of those things.
Rob Lutz 41:33
Right.
Scott Sherr 41:39
And that's where, again, methylene blue has become my workhorse here. It's not the only thing that I do. I change diets and lifestyles and all those things, but when they have more energy to do it, it becomes easier, and they can go further, faster on their path of of optimizing their health.
Rob Lutz 42:08
It makes total sense. I mean, if you don't have any energy just to get out of bed, let alone change your diet or get out and get some exercise or try to meditate, forget it. You know, you're just--you can't do it. So, that makes a lot of sense that that's where you start is to get that base level up. We will definitely include links in the show notes, so other practitioners can get in touch. The methylene blue, I know that'll be something people are going to have some interest in learning more about. I guess maybe one last--if, you know, if listeners could adopt one new habit in evaluating patients, what would it be?
Scott Sherr 42:42
That's a good question. I'm just thinking about the best way to describe it. So, one new habit that a practitioner could start bringing into their practice? I think it would be, as I said, is an energy-first framework. Right?
Rob Lutz 42:55
Mm hm.
Scott Sherr 42:55
Which is that we know all of our patients are complaining about low energy or anxiety or depression or insomnia or weight gain, but all these things, in essence, are an energy problem at their base. It's not the only thing that they are, but it's a huge piece. So, mitochondrial medicine is the wave of the next several years, at least. And so, if you're not looking at mitochondrial function now, in some ways, I would highly recommend, as a practitioner, you start doing this. There's a lot of advanced testing out there for mitochondrial function. That is controversial still. There's not clear evidence that those tests are great yet, but they likely will soon. They are data points. I use organic acid testing in my clinic, in my practice. That's what we teach at Health Optimization Medicine in Practice, which is a a nonprofit that trains practitioners on how to optimize health rather than focus on disease. And so, if you're interested in bringing something back into your practice that's truly going to be transformative, I would say metabolomic testing and looking at organic acids and looking at mitochondrial function in that capacity. And then, if you want to get fancy, go look at some of those other mitochondrial tests that are out there as well, and potentially use those as another way to support your data and to support the frameworks you're using with your patients.
Rob Lutz 44:08
Yeah. Well, that's great. I know we're short on time, so I really appreciate everything that you've shared today. This was really, I found fascinating, and I think our listeners will as well. And really giving them a different way at looking at probably so many of their patients that are coming in, and a new way or new framework, and how to approach it. You know, it sounds like you've had a lot of success taking this approach, enough that it's something you really want to share with others. So, thank you so much for coming on the show. I appreciate it.
Scott Sherr 44:38
Yeah, it's my pleasure. And if those are interested at learning more--is it okay to give them links and things, Rob?
Rob Lutz 44:43
Yeah, we'll give them links and everything, but you're welcome to, you know, share it verbally right now. But, it will be in the show notes.
Scott Sherr 44:49
Yeah, yeah. For those who're just interested, I mean, I have a couple different places you can go. I help run a company called Transcriptions, which is a company that makes precision-dosed formulas in the form of an ingestible troche. You can check it out at transcriptions.com. We have a practitioner-only ecosystem, so as a practitioner, you can really get a sense of what we do there. We have products with methylene blue. We have products that help downregulate the GABA system. We have protocols. We have the Sympathetic Spiral of Doom protocol down there, or in there. We can also give that probably as a free gift to your listeners if they'd like to, Rob.
Rob Lutz 45:18
Awesome.
Scott Sherr 45:18
We also have a questionnaire that you can send to your patients to get them a sense of where they are on the sympathetic spiral, in Phase Zero through Four, as mentioned. So, my goal is education here. You know, you guys check out the ecosystem. If you think you'd like the products, that's great, but I hope this really does help, you know, think about things a little bit differently than you have already, and give you some additional ways of helping your patients.
Rob Lutz 45:39
Well, again, thank you so much for this and sharing it, and I'd like to have you back on the show sometime. And there are a lot of other things I'd like to talk to you about. But thanks so much.
Scott Sherr 45:48
Thanks for having me, Rob. This has been fun. I appreciate your time.
Rob Lutz 45:52
Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes, they can be found in the link below. If you want to go deeper on this topic or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time.