Episode 6 - Treating Nerve Injuries with Dr. Alan Tillotson
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Episode Summary
One of the toughest conditions to treat is nerve injuries, particularly when it’s related to spinal conditions such as sciatic nerve injury. There are a lot of options for treatment when it comes to these conditions, which often involve a lot of pain relief medications, for instance. However, there is growing evidence on the effectiveness of the inclusion of herbal and alternative medicine and systems in treatment plans for patients suffering nerve damage. And a growing number of doctors are considering these types of products too.
This episode of Back Talk Doc features Dr. Alan Tillotson, a registered herbalist and natural medicine specialist, with an expertise in Western and Oriental herbal medicine for over 30 years. He gives insight into the causes of nerve injury, which not only include poor lifestyle choices but exposure to harmful chemicals, trauma and hereditary factors. He also reveals how inflammation of the connective tissues in the nerve system and poor circulation leads to damage in the nerves.
The body has its own healing process and many times, we are prohibiting it by using medicine, like many pain killing medications that only provides temporary relief. He suggests using substances that contain specialized pro-resolving mediators (SPMs) which can provide better pain management without the side effects that most traditional opioids in the market have.
For Dr. Tillotson, treating nerve injuries need to involve a more holistic approach – reduce the inflammation, improve the body’s internal circulation of nutrients and remove harmful toxins. And you can adopt certain practices outside traditional Western medicine, like yoga or meditation, to help supplement the healing process.
Key Moments In The Episode
Links Mentioned In The Episode
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
One of the toughest conditions to treat is nerve injuries, particularly when it’s related to spinal conditions such as sciatic nerve injury. There are a lot of options for treatment when it comes to these conditions, which often involve a lot of pain relief medications, for instance. However, there is growing evidence on the effectiveness of the inclusion of herbal and alternative medicine and systems in treatment plans for patients suffering nerve damage. And a growing number of doctors are considering these types of products too.
This episode of Back Talk Doc features Dr. Alan Tillotson, a registered herbalist and natural medicine specialist, with an expertise in Western and Oriental herbal medicine for over 30 years. He gives insight into the causes of nerve injury, which not only include poor lifestyle choices but exposure to harmful chemicals, trauma and hereditary factors. He also reveals how inflammation of the connective tissues in the nerve system and poor circulation leads to damage in the nerves.
The body has its own healing process and many times, we are prohibiting it by using medicine, like many pain killing medications that only provides temporary relief. He suggests using substances that contain specialized pro-resolving mediators (SPMs) which can provide better pain management without the side effects that most traditional opioids in the market have.
For Dr. Tillotson, treating nerve injuries need to involve a more holistic approach – reduce the inflammation, improve the body’s internal circulation of nutrients and remove harmful toxins. And you can adopt certain practices outside traditional Western medicine, like yoga or meditation, to help supplement the healing process.
Key Moments In The Episode
- Basics of nerve anatomy - 09:08
- Health risk factors for nerve dysfunction - 13:37
- Differences of treatment in acute and chronic nerve injuries - 14:45
- Importance of guidance from a professional clinician before starting on alternative treatments - 17:51
- Sample treatment models - 19:10
- Problematic area in healing injuries - 20:32
- What are specialized pro-resolving mediators - 22:31
- The problem with pain relief - 34:12
- The goal of inflammation treatment - 35:55
- Diet and food plan for healing nerve injury - 40:12
Links Mentioned In The Episode
- Chrysalis Natural Medicine
- The One Earth Herbal Sourcebook
- Ayurveda in Nepal: The Teachings of Vaidya Mana Bajra Bajracharya
- Chinese Herbal Medicine Combined with Prednisone
- Alan’s Food Preferences
- Research Articles on SPMs
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Intro: 00:01 Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 00:35 After almost 20 years of training and clinical practice, I would say that one of the toughest conditions I encounter on a day-to-day basis is that of nerve injury, whether it's nerve damage from a medical condition such as diabetes or traumatic nerve injuries. And in particular we see a fair number of nerve injuries in our practice related to spinal conditions such as a sciatic nerve injury. So it's one topic that I really wanted to dive into deeper and try and provide some solutions or at least stimulate some thought around the matter for those of you listening today, cause I know many of you are suffering from nerve injuries.
Sanjiv Lakhia: 01:12 Today it is my privilege to bring to you a guest that I have known now for 25 years both on a personal and professional basis. He's a master clinician, a scholar, scientist, and educator and, I would argue, is one of the top minds in the country, if not the world, on herbalism and natural medicine. And it is my pleasure to welcome to the show Dr. Alan Tillotson. Alan, welcome to the show.
Alan Tillotson: 01:41 Thank you.
Sanjiv Lakhia: 01:43 By way of introduction, Alan has extensive qualifications and I just want to review these for the listeners today. And Alan, this is your bio that we just discussed from your website but feel free to add in if I'm missing anything. But he's a registered herbalist and natural medicine specialist and has been practicing Western and Oriental herbal medicine for over 30 years and a professional member of the peer-reviewed American Herbalist Guild. He holds an accredited Master's degree in Asian Medical Systems and a PhD in Integrative Health Sciences. He holds a Delaware medical license to practice herbal medicine and acupuncture and has a practice, Chrysalis Natural Medicine Clinic in Wilmington, Delaware. Alan is known throughout the country for his extensive knowledge and expertise in Ayurvedic medicine and traditional Chinese medicine. He is a master in meditation and Qigong, and an author as well.
Sanjiv Lakhia: 02:43 He has published The One Earth Herbal Sourcebook, which I think is a fantastic resource. I've had this for years and I still look at it frequently. He's also put together a terrific online herbal medicine course on his website. He has published a book called Ayurveda in Nepal and really his accomplishments just go on and on, so he's definitely qualified to speak on the topic. In particular, he has worked as a formulator in the natural foods industry and developed a product he called the Myelin Sheath Energy, which we will likely get to today.
Sanjiv Lakhia: 03:19 And then on a personal note, I met Alan, it's been, we were just talking, about 25 years now, Alan and for the listeners, my introduction to Alan was through my own personal medical condition. When I was in college, I had a rather sudden onset of glaucoma and through combined efforts of terrific ophthalmologists in Cincinnati, Ohio, and through Alan's guidance, I've had a complete recovery and near reversal of any visual field damage and it's really quite remarkable and unheard of. So first of all, I want to personally thank you, Alan, for all the time and energy you've put into my health, the health of my family and friends that I've sent to you through the years.
Alan Tillotson: 04:02 You're very welcome. My pleasure.
Sanjiv Lakhia: 04:05 Did I miss anything you want to add about your background that you think the listeners need to know?
Alan Tillotson: 04:11 No. I think you did a pretty good job there.
Sanjiv Lakhia: 04:14 Well then, let's dive into some of the questions here. Can you just describe for our listeners what a typical clinic day or week looks like for you so they can get a sense for how you practice?
Alan Tillotson: 04:26 Sure. I usually see about 50 patients a week. I get up early in the morning, maybe around 3:30 or 4. I've been doing that ever since I lived in Nepal and kind of got my whole habits changed. And that's why I'm living a healthy lifestyle. And I get to the office, I review all the patient charts, answer emails, do research and study. I do that when there's nobody around. And then I start seeing patients around 7:30 in the morning and I'll see patients throughout the day and that goes on day after day. And that's typically what happens. My wife, Naixin, also works here. She was a former professor of Chinese medicine and she's also a licensed acupuncturist and she sees patients and does the acupuncture part for our clinic.
Sanjiv Lakhia: 05:13 Can you inform my listeners what sparked you into the field of herbalism and natural medicine?
Alan Tillotson: 05:20 Oh sure. Back when I was young, in my twenties, after college undergraduate, and I thought I was going to travel around the world and see things, which is kind of a task because I'm a type 1 diabetic. I got diabetes when I was 10 years old, but I kind of packed up my insulin and food and stuff and then traveled around the world. But then I got deathly ill when I ended up in Afghanistan. I was in Afghanistan, suddenly got dysentery and blood poisoning at the same time, really sick, started to lose a lot of weight. I'm six foot three and my weight went down from about 185 down to about 130 from massive sickness. And the bus drivers said there was a master herbal doctor living up in Kathmandu in Nepal, which was one of our destinations and they were going to take me to him.
Alan Tillotson: 06:14 And about a week or so, two weeks later we ended up in Kathmandu, Nepal where I met Dr. Vaidya, or Dr. Mana for short. Vaidya Mana Bajra Bajracharya, a herbal master living in Kathmandu, where his family has been doing Ayurvedic global medicine. Ayurveda is the medical system of India and Nepal, from father to son for over 750 years. And he gave me herbal medicines and basically saved my life. So I got really interested in that and then came back. I recovered and then when I came back, I then began to work on my Master's degree in Medical Anthropology at Goddard College and I went back to Nepal again and started studying herbal medicine with them and started learning that medical system that had been handed down father to son. So that's kind of how I got started. And I came back here and met my wife, who's Chinese. And, like I said, I was a teacher of Chinese medicine at Chinese medical colleges in China. And we set up this practice and been going that way ever since. And I went back and added a lot of scientific study too.
Sanjiv Lakhia: 07:26 Sometimes in life we find our career, but other times the career finds us. And I think for you that story is just fascinating. I really appreciate you sharing that, some personal information, and I know we have some physicians listening and I just feel like it's okay to talk about our own personal health conditions, particularly with our patients. We're in a high stress field in the healthcare field. And guess what? We do get sick and we do have challenges as well and I think we can learn through sharing with each other. So, I appreciate you sharing that story.
Alan Tillotson: 07:59 Now you know, when I got back, at that time there was no internet, I went down to the local university library in Newark, Delaware and started looking up diabetes and found out that I was going to go blind and lose my feet and develop neuropathy and all that stuff. And that really spurred me to start looking into methods of helping myself. So a lot of it had to do with my own personal needs of not wanting to have all those problems. And I can say now that I'm almost 70 years old and I've been diabetic for almost 60 years. I have no neuropathies, no retinopathies, no kidney problems, nothing. I'm basically still healthy. I don't have any of the problems that normal diabetics have, especially type 1 diabetics, because of a very strong health regimen I follow. I still have to take insulin every day cause my pancreas doesn't produce any, but other than that I'm pretty healthy.
Sanjiv Lakhia: 08:53 So you're a testament to your own philosophy and practice so that's terrific. Let's get into the topic of today, which is healing nerve injuries. Can you give our listeners a basic understanding of nerve anatomy and how nerves function, kind of how you break it down and how you see it?
Alan Tillotson: 09:08 Sure. Okay. Well the first thing is that in the early stages of embryology, three primary derm layers form called endoderm, ectoderm, and mesoderm. And out of the ectoderm, the entire nervous system develops. So one way that I look at the anatomy a little bit differently than other people - and this is a lot of based on how they look at the body in Ayurvedic medicine, - you could say that the ectoderm, which develops into your entire nervous system, peripheral nervous system, central nervous system and everything else, and the ectoderm and the mesoderm which forms into other parts of your body, that you really only have three organs in the body. You have three organs in your body and those organs are very large. And what we normally call organs are sub-organs. Sub-organs would include brain, the central nervous system, the peripheral nervous system, the senses, vision, hearing, et cetera.
Alan Tillotson: 10:00 So those systems all work in conjunction with each other. So, one of the things you need to do in natural medicine is to make sure that all three of these primary systems are functioning. The neurological system, the endocrine and the metabolic system, and the digestive system all developed from the endoderm and the lungs, the liver, internal organs all are functioning together. As far as the actual anatomy of the nervous system, it's very important to know that the body super protects the nerve tissue because it's very easily disturbed. That's why your brain, you have a big, thick skull. And you have the dura and the pia and then you have the ventricles, which are like shock absorbers to some extent and the fluids and the spinal cord. All those things are designed to protect the nervous system. Then the individual nerve fibers are surrounded by a myelin sheath.
Alan Tillotson: 10:59 Myelin sheath is produced by Schwann cells in the peripheral nervous system and by oligodendrocytes in the brain and they wrap around the nerve fibers and protect them. But more importantly they also, we now know, provide nutrients to keep the nervous system healthy. And outside of that, there's this connective tissue, the endoneurium, the perineurium, and the epineurium, which are kind of like connective tissue that surrounds and protects. And that also creates a problem when you're trying to treat the nervous system because nutrients don't easily flow through all of those layers. So sometimes inflammation in the nervous system, it takes time for nutrients to get in there.
Alan Tillotson: 11:47 To heal nerve tissue, you have to be able to get to the location. You have to get nutrients get absorbed into the tissue. There's also little blood vessels in there too that supply the nutrients, veins and arteries, and so that's the basic thing you need to know. Equally important is that in the intestinal system, which is where you absorb all the nutrients that ends up going for all the tissues, a lot of the neurotransmitters are developed in the intestinal systems, so intestinal health is a very large part of keeping the nerve system healthy. Then there's also issues with circulation, microcirculation that have to be addressed whenever you're dealing with healing nerve tissue.
Sanjiv Lakhia: 12:31 That's a terrific point and one that I talk about with patients in terms of why bones heal faster than nerves. I appreciate you discussing that. While there's-
Alan Tillotson: 12:40 Yeah, that's the reason that they do and also the myelin itself is fatty and it's composed of sphingolipids, phospholipids, and cholesterols. And the inflammation, in many nerve diseases and nerve injuries, that inflammation just stays there and doesn't get resolved and starts to tear down the actual nerve fibers, the axons. So that issue of chronic low-level inflammation in nerve tissue that's hard to resolve is a big deal when you're trying to solve these problems and that's why people are so frustrated. If you cut yourself, skin will heal in just a couple of days. Connective tissue takes longer to heal if you stretch a ligament or tendon or something, but nerve tissue heals really, really slowly because of all these protective barriers that make it more protected, but also harder to get to from external interventions by doctors.
Sanjiv Lakhia: 13:37 You touched on this briefly, but from a holistic viewpoint, what health risk factors lead to the development of peripheral neuropathies or nerve dysfunction in the body?
Alan Tillotson: 13:48 Okay. Poor diet, diabetes, chemicals like in chemotherapy is a major cause; physical traumas, sometimes hereditary disorders, infections, other sources of noninfectious inflammation, autoimmune disorders, abnormals in the proteins, spinal issues, exposure to chemicals sometimes, or failure of some of your other organs like kidney failure or really bad things like chronic alcoholism. Those are the kinds of things that lead to peripheral neuropathies.
Sanjiv Lakhia: 14:26 So impaired circulation, toxicities, and then of course there's trauma or you can have a fall or an injury that can damage the nerve.
Alan Tillotson: 14:34 Exactly.
Sanjiv Lakhia: 14:35 When you see these different mechanisms, are your principles of treatment different in acute nerve injury versus chronic nerve injuries?
Alan Tillotson: 14:45 Yeah, in an acute nerve injury, the body itself is going to try to repair. If there's not another problem, there's no diabetes, nothing that's contributing to it externally, the body's going to go through a normal healing process and so you want to stimulate that healing process. And part of that is done ... going back in China, going back a thousand years, martial artists would get these kinds of traumatic injuries all the time, and also soldiers would get these traumatic injuries. And they began to look for natural medicine, herbs and things, that would repair. So there's a group of herbs in a formula called Sanchi 17 which is 17 different herbs that have been used in China traditionally for healing nerve injury, for healing injuries of any kind, including nerve injuries. We often want to give that to people after they've had a trauma as one mechanism for healing.
Alan Tillotson: 15:38 Another mechanism to stimulate nerve healing from traumatic injury of course is acupuncture. Acupuncture in my thinking is an ancient wound healing system. In other words, the point ... You know how if you have a city and you have different alert systems and different places where the police can get information about problems? So there's these points on the body, when you stick a needle into them, the body, because they're so sensitive, if you touch them they kind of hurt and stuff. So the body sends a signal, "Oh my God, there's a big injury here." And that mobilizes the body to heal. Oftentimes after an injury or something that's taking place for a while, the body kind of stops working on it. And then people end up with these problematic long-term issues, neuropathies, and their body's not really working on it, so acupuncture can be used to stimulate that.
Alan Tillotson: 16:31 And once you mobilize the immune system, their body will start producing neuropeptides and nerve growth factors and also bring in white blood cells to repair the blood vessel or the microvasculature. So it's a mechanism of stimulating that. That can also be done through things that people never even think of. Meditation, breathing exercises, all the things that come from yoga or from Buddhism and other spiritual systems around the world have profound effects on the nervous system because they also mobilize our natural healing capacity. Humans have a fantastic natural healing capacity if you can mobilize it. You see?
Sanjiv Lakhia: 17:12 And the scientific research to support these strategies has just exploded in the last five to ten years, so everything that Dr. Tillotson has covered has good peer-reviewed literature to support and very safe with low side effects. One thing I would say though, if you're listening and Alan mentions a product or a supplement, I would advise you that this podcast is primarily for informational purposes and I would not start any of these supplements or products without the care of a clinician who knows about this or has a bit of expertise with this. So having said that...
Alan Tillotson: 17:51 That's very important because if you're trying to build a house and It's really hard to do that if you don't know anything about how to build a house, just by going out and buying a bunch of nails and hammers and glue and whatnot and try to build a house, you won't get very far. People can take care of simple problems by themselves oftentimes, but when it comes to complicated, and nerve problems are very complex, you have to know how to put these therapies together in a proper way, in the proper order, in the proper sequence, in the proper dosage in order to produce a result. Otherwise you'll just buy something off the internet that somebody's suggesting and take it and it doesn't work and then you'll get frustrated.
Sanjiv Lakhia: 18:29 Yeah. Not to mention potential interactions with drugs and other treatments. In our clinic, Alan, I work at Carolina Neurosurgery and Spine Associates and we're essentially the largest neurosurgery practice in the country, and we see a fair amount of sciatic and lumbar nerve root injuries from herniated discs, joint arthritis. So what treatment model do you use to address these types of injuries in your patients? So for example, last week I saw someone who had herniated a disc and developed a footdrop. I also had a patient who fell on their arm and had ulnar nerve injury. And then we see a lot of carpal tunnel syndrome. All of these are different types of nerve dysfunction or nerve injuries. How would you approach these when they come into your office?
Alan Tillotson: 19:10 Well, when somebody comes into the office, I have to do a full evaluation. I evaluate every system in their body and then I put together a picture of ... I want to look at the system from the time sequence of when the injury or the external problems started. I look at the time sequence and I develop a picture of what happened to that tissue. And then when they walk into the office, are the muscles around it tightened up? How much pressure is there? Is there arthritis in between itself? Are there bone fragments? Whatever is actually physically going on, I have to see that and then I also look at it through a systemic, or system by system by system, going through the body systems to look at it from a different point of view.
Alan Tillotson: 19:54 So you get the time sequence as one trail and you create a picture of how this problem developed and then you look at the individual body systems to see what areas of weakness there are that would be inhibiting or needed to be stimulated in order to produce the healing so that we could then decide do they need acupuncture right now or do they need immediately go to the surgery or do they need physical therapy or do they need herbal supplements or some combination of those things together.
Alan Tillotson: 20:24 And we put together a protocol for them based on that. Now, if there's an underlying arthritis that gets to another area. One of the areas that's problematic in healing injuries of any kind, including the kind we're discussing here, is that many of the medicines that are used for injuries such as steroids and including NSAIDS, have their own set of side effects and they actually slow down the healing process. So if you want to heal a tissue and then there's a lot of swelling and inflammation, you have to get that out of there and if you give somebody a steroid, that'll give them some short term relief but it's also going to inhibit the parts of the immune system that do the repair process. So one of the key areas we're looking at these days are ...
Alan Tillotson: 21:11 There are specific signaling molecules called specialized pro-resolving mediators, and those signaling molecules which are derived from nutrients, especially oils like coconut or fish oil, but need to be gotten into the person in a high enough dose and they start to signal the white blood cells to clean up the debris to start to get the vascular system healed up, to heal up damage to the micro-vessels and then to start to deliver the nutrients for the healing process. There's also the physiology. Pressure is a big deal. So that's why manipulations such as osteopathic manipulations or physical therapy manipulations to create space for things to drain away and for nutrients to come in for the white blood cells, that's also a part of it.
Alan Tillotson: 21:58 So if you think of each one of these mechanisms as being part of the healing process, when you put them together, you magnify the results. I always used to say, "One plus one equals three" and we'll need to give somebody a nutrient for healing arthritis, but you also give them physical therapy or osteopathy or acupuncture. One plus one equals three, it gets much better results that way.
Sanjiv Lakhia: 22:22 What you said there was fascinating. Can you repeat that? You said specialized pro-resolving mediators. I have not heard that term. Did I get that right?
Alan Tillotson: 22:31 Yeah. Specialized pro-resolving mediators, SPM, are signaling molecules that are extracted largely from oils like fish oil and from coconut oil and olive oil, that sort of thing. And everybody in natural medicine gives those kinds of products as part of the healing process. So as far as 20-some years ago, 30 years ago, Dr. Abel is the ophthalmologist that I work with a lot. He's a local ophthalmologist, we've been basically partners in the field of ophthalmology for over 30 years. Dr. Abel and I noticed like 30 years ago that when people came into the clinic with dry eyes, we would give them fish oil, because fish oil is moistening, and about half the patients, their dry eyes would disappear, and the other half, nothing. And it didn't matter how long you gave it to them or what dose you gave. It just didn't work. We didn't know why.
Alan Tillotson: 23:19 It turns out that some people who have neurological disorders or inflammatory disorders lack the capacity to properly extract and manufacture, or extract these specialized pro-resolving mediators, or SPMs, from their nutrients. To give you a very clear example, in multiple sclerosis - You can actually measure these things. Okay? So multiple sclerosis, which is a chronic inflammation of the nervous system, lying chief in the brain, I have a study where they measured the amount of SPMs, or mediators, in the brain tissue of MS patients is basically zero, which means that the inflammation in that myelin is never going to be resolved because there's no signaling molecules in there to tell the white blood cells to go in and remove the debris, to start to repair the vasculature, and that sort of thing. It's just not available.
Alan Tillotson: 24:18 So these SPMs or specialized pro-resolving meteors are a new non-opiate, non-NSAID, both painkillers and tissue repair medicines and they're now actually available by a few companies. They know how to extract them. And they're especially useful for people that have inflammation that does not resolve such as nerve tissue, like I said it's very slow healing, but also auto-immune disorders. The SPMs, they're a new and very important part of our protocols for this. They don't replace the other things we do, the other anti-inflammatories. What they do is they add an extra piece for the jigsaw puzzle so we have a more complete solution.
Sanjiv Lakhia: 24:57 I know you have an extensive database of articles on research. Anything you have on this topic that you want to email me, I'd appreciate it and we can link to it in our show notes.
Alan Tillotson: 25:07 Well, I'll be glad to email you. I've got a whole bunch of them, about 30 or 40 articles on this. It's kind of been well-known in the research field and one of the ways I keep myself up on these things is that I have run an algorithm through Google, which I get up early in the morning and then I run this algorithm through, which then finds me all these articles in the fields that I'm interested in the field of natural medicine healing throughout the world. So I can couple 10, 20, 30 new articles every week. Some of them will jump right out at me as something I've never heard of before, some new nutrient or some new mechanism. Now I put those in my database I've been collecting, there's 40,000 articles in my database now.
Sanjiv Lakhia: 25:48 That's terrific. Moving forward there. So you just touched on one, but I kind of want to maybe roll these next few questions together. I know you have worked on a customized herbal formula for nerve repair, so I want you to talk about that and just in general talk about other nutritional strategies that you recommend to support nerve repair.
Alan Tillotson: 26:10 Of course, now that product is called Myelin Sheath Energy. It's only available currently to my patients although there is a commercial version of it out there, but my latest version is available to my patients here. What happened was that back when I lived in Nepal, when I was doing my Master's in Medical Anthropology back in the 1970s, when I lived at the clinic in Nepal I mentioned earlier, an MS patient came in. He was a British engineer and even back that far, the British were really, really good with people that have these disabilities and he was primarily in a wheelchair. He was getting around pretty well and it was really hard to do that in Kathmandu. He was working on a bridge project there and he was coming into the clinic to see the Nepalese doctor, herbal doctor that I was studying with.
Alan Tillotson: 26:58 And he started to treat this guy with herbal medicines and at the end of a six-month timeframe, this guy who hardly could stand to walk went from about five or eight feet with a cane to about 200 feet or more with a cane from this treatment, which really fascinated me. [inaudible 00:27:15] was just a neophyte at that point. In the 1990s, I had a patient come in with multiple sclerosis. I'll give the first name only of course for privacy. Her name was Barbara, she's now passed away, but this was about 27,more than 20 years ago, certainly 25, 30 years ago and she has MS. I really just didn't know how to treat, but I remembered what the doctor in Nepal, Dr. Mana had done and just by coincidence about two or three months later, Dr. Abel and I flew out to Kahtmandu to do some research on glaucoma. We wanted to study with these guys and Dr. Abel was a really great doctor here. He contributed his time doing cataract surgery for free to the Nepalese people at that time. We brought a bunch of corneas in from Baltimore hospitals and also Johns Hopkins and we did a lot of surgery.
Alan Tillotson: 28:05 But while we were there, I went to the doctor in Nepal and said, "Remember that patient with MS that I saw when I was here 25 years ago? How did you do that?" And he said, "Well, this disease is called [foreign language 00:28:13] in Sanskrit and it's caused by [foreign language 00:28:23] and the treatment process is to use [foreign language 00:28:26]." So I immediately knew what he said. Translating from Sanskrit, he said this disease is called [foreign language 00:28:33], which means progressive leg weakness. It's caused by [foreign language 00:28:38], which translated from Sanskrit, means poisonous fats. Right? And then he gave the name of two herbal medicines which strengthen the body's ability to process digestion and move toxic fatty poison, so what today we would call lipid peroxide. And of course immediately, because I understand anatomy and physiology, I immediately knew what he was saying because I know the myelin was made primarily out of fats and he was basically saying that the myelin itself was toxic and that we had to remove the toxicity from the myelin sheath, that is, to remove the inflammation from the nerve tissue.
Alan Tillotson: 29:14 That's almost the same as Western medicine except he was able to do it. I looked at what he was doing and I looked at the herbal medicines. When I came back, I put a formula together to treat this patient Barbara and just like the British engineer six or eight months ago, my treatment, I still have the physical therapy report, I got her from being able to walk just a couple of feet up to over 200 feet which continued until she basically passed away later of old age, something different. And that was my first evidence of being able to treat this. Now, when I look back at it from the herbal medicines that I gave to them was all based on Oriental thinking, improving, strengthening chi, calming Vata, these kinds of terms that don't mean very much in Western thinking. But when I look at it now, what I've now discovered from looking at those herbs over the years that we were actually strengthening the myelin, we're actually strengthening myelin by strengthening the oligodendrocytes in this case in the central nervous system that produce the myelin.
Alan Tillotson: 30:10 And that means increasing proven ATP energy in that tissue. And when you looked at the individual herbs, that's the kind of things they do. And we are also improving microcirculation. So the herbal medicine formulas that I developed actually has this healing effect. Now, one of the early things I discovered was that in order to get that medicine into the tissue, it's also important to add alpha lipoic acid because of the structure of the nerve tissue, because of the way it's hard to get into and it has that parineural sheath, the connective tissue sheath and the fatty layers. It's hard to have nutrients that are both fat soluble to pass through that, but alpha lipoic acid is both fat and water soluble, so it's able to pass through and it tends to carry these anti-inflammatory nutrients into the tissue. You see?
Sanjiv Lakhia: 31:00 Yeah, which I have prescribed that for some of my diabetic patients to help with their neuropathy and definitely seen some benefits.
Alan Tillotson: 31:07 It's extremely good for neuropathy. Exactly correct. That one nutrient by itself is good for neuropathy, but when you add to it nutrients that are healing for the nerve tissue and put those two things together and work on circulation, then that's it. Another issue has to do with multiple sclerosis in this case is that, and this came later in my understanding, but that the immune system normally does not allow these aggressive immune system cells to get into the brain because we have what's called a blood-brain barrier and that's close tied to endothelial cells that line the blood vessels that feed up into the brain. And those close-packed cells are kind of restrictive. They're like a guard at a nightclub. They don't let you in unless you have the right pass. But in MS, people have what's called in early stages, what's called relapsing-remitting MS, and then later on it goes to what they call chronic progressive.
Alan Tillotson: 31:58 Why? Nobody ever answers that question. I ask patients why, I ask the doctors that are treating them why. Nobody seems to know. It turns out that research that was done in France that I had seen shows that during the initial MS attacks, there's an opening and bridging of the blood brain barrier and some of the aggressive immune system cells can get into the brain tissue. And then they notice this damage in the myelin, this weakening of the myelin, and then they start to attack and then it closes up and the MS attack goes away. Sometimes you close it up quickly with steroids to repair it.
Alan Tillotson: 32:33 Then it opens up again. You have your second attack, but eventually that blood brain barrier is weakened enough that it stays open all the time and then you go into chronic progressive. That's my understanding of it. I could be wrong, but that's the way I understand the sequence of how that process goes. You see? So a key part for MS and some other neurological disorders of the brain and including the spinal cord of course would be to keep vascular integrity so that the wrong kind of stuff doesn't get in so that the body's natural filtering mechanism is properly functioning.
Sanjiv Lakhia: 33:03 So it sounds like several mechanisms you've touched on. Number one is improving localized circulation. Number two is reducing inflammatory reaction in the tissues, detoxifying the tissues, and just developing a healthy microenvironment to promote nerve repair. One thing that we struggle with a little bit just in traditional medicine is treating pain. In particular, obviously the country right now is really, really looking at the opioid epidemic and trying to find proven alternatives or suitable alternatives. Nerve pain as well. Just recently the FDA put out a warning on the use of Gabapentin. They've documented some cases now of respiratory depression when Gabapentin is taken with opioids. So our options, our tools in the toolbox are quite limited from a prescription medicine perspective, so that means patients look elsewhere and I've had ... Recently, there's a big run on CBD oil. There was news about Corydalis. Obviously you talked about acupuncture. What are your thoughts on some of these other options that [crosstalk 00:34:11] ways to treat pain?
Alan Tillotson: 34:12 Pain relief is a big, big deal. Now, ultimately pain relief is killing the actual tissue. That's not going to do you any good. If it takes two years to heal your tissue you're in serious, serious pain. And the opiates, of course, hit the brain stem and they slow down the breathing and basically you die because you stop breathing. You know? That's the big deal. I didn't know about it. I just heard because you told me that Gabapentin has a similar problem. CBD oil, which has anti-pain, CBD oil and also medical marijuana, both have painkilling properties, but they do not depress respiration, so they're much, much, much safer. Another one, the Corydalis is a Chinese medicine. It's been used for pain forever and Western doctors are working on researching it to find out the key component in it, but we use it right here in the clinic as a pain killing medicine which works sort of like an NSAID, but without the side effects of NSAIDs.
Alan Tillotson: 35:09 The reason that NSAIDs have side effects is because of the way that they work. For example, there's three primary pathways for inflammation in joint tissue, COX-1, COX-2 and 5-LOX, so Cyclooxygenase-1, Cyclooxygenase-2, and 5-Lipoxygenase. Those three pathways, if you only block two of them, like Aspirin or Tylenol does, you end up increasing inflammation through the third pathway. And that's why when you take Aspirin, it will take your pain down in your joints or whatever, but it will also cause stomach bleeding or you take Tylenol, pain will go down. But you can have problems with your liver. Or Aleve, same thing is your pain will go down, but you're going to have problems with blood vessel breakage with your eyes or whatever.
Alan Tillotson: 35:55 That's the reason. So the goal of treatment of inflammation is to broaden and to dampen inflammation down enough so that it's not causing a lot of pain, but also not so much that you stop the healing process. And so the pro-resolving mediators I just talked about earlier, the SPMs, are a new class of non-opiate non-NSAID painkillers. They actually reduce pain through their process because they work. So they're being investigated now for that purpose. And there are so many natural nutrients that also work as anti-inflammatories without the side effects. Curcumin is one of them. Myrrh is another one. We mentioned folic acid.
Alan Tillotson: 36:38 There are so many different natural medicines that have pain killing properties, but the ones that are the strongest - there's also Western medicines that, natural medicines been known by Native Americans that reduce pain down also, so we use some of those as well. So we have a quite a variety of these products and different ones work for different people. DL-Phenylalanine, which is an amino acid, can often work wonders reducing pain because it stimulates the production of the body's natural endorphins, so sometimes people with chronic pain, you give them some DLP and it will help a lot in some cases. So I have about 10 of these things and which ones I use varies depending on the case. And then if something doesn't work we just use another one. We have a lot of safe ones to use.
Sanjiv Lakhia: 37:28 The other one I would add to that that I've used is actually vitamin D, which has a steroid-like effect. And it's not necessarily a substitute for Prednisone, but I've read research on it in MS as well, where a high-dose short course of vitamin D under a physician's direction can reduce the inflammation. There's literature that vitamin D deficiency causes subclinical swelling in the bone, so spinal pain, back pain, so I always look to check that for some patients who have chronic back pain.
Alan Tillotson: 38:02 That's a very important one. What you said is exactly correct. We usually use something like 50,000 a day for a week or so. I don't know what levels you're using for that, but that can be very, very effective. Another one is you can just use plain old licorice root. Licorice root also is a steroid like molecule, but we don't use licorice root as a direct pain killer, but we use it because it extends the life of steroids. So if you have a steroid that you're giving twice a day and you give licorice with it, give it once a day and it will stay in the system for about full 24 hours. So it's extending, you're using half as much and getting the same result. You see?
Sanjiv Lakhia: 38:38 Again, if you're listening, please don't run out and start taking high-dose vitamin D or any of these products without consulting with your physician first. They certainly can be helpful but they have to be done properly and in a safe manner.
Alan Tillotson: 38:51 Another fascinating study that was done in Japan showed that when they crosschecked the painkilling properties, anti-inflammatory properties of steroids versus herbal medicines, the steroids were faster and stronger with a lot more side effects and the herbal medicines were slower, not as strong but much safer. But when they combined very low-dose Prednisone, like 2 milligrams or 2.5 milligrams, along with a strong course of herbal medicines, they could get results that were steroid-like in terms of power but with much less side effects.
Sanjiv Lakhia: 39:23 If you have that abstract, I'd love to see that as well, Alan. That would be terrific.
Alan Tillotson: 39:27 And I do.
Sanjiv Lakhia: 39:29 So we've covered quite a bit of information today. It's quite fascinating and I wanted to get inside your mind and see how you approach some of these problems and issues that we encounter on a day-to-day basis. And the other thing I would say is every time I see you or see a picture of you, in 25 years, you look the same. So obviously you know how to take care of your health. And I always like to close Back Talk Doc when I'm interviewing individuals, I love to pick their brain about personal health strategies that maybe my patients or listeners can adopt. And you touched on this a little bit before, but how about your diet and food plan? There's a lot of debate out there about keto and vegan and what have you. What's your thoughts on that?
Alan Tillotson: 40:12 Okay. I have a much more simplified idea. If you look at the work with Dr. Katz, who's the head of the Yale School of Public Health, he did a fascinating study in which he cross-compared all the healthy diets that people always report get them better. And that includes vegetarian, paleolithic, Mediterranean, ketogenic, all these different diets. And what he found was that they all work, but there's a central core to healthy diets that's necessary for them to work. And if you do the central core, the rest of it is not anywhere near as important and that means real food, close to nature, minimally processed, with lots and lots of vegetables. And if you do that without any meat at all and call it vegetarian, you'll have anti-inflammatory health benefits. If you do it with some meat, call it paleolithic, you'll have health benefits. If you do it with pastas and call it Mediterranean, you'll have health benefits. But real food, close to nature, minimally processed, with lots and lots of vegetables and that's kind of the way I eat.
Alan Tillotson: 41:12 My wife is an excellent cook, Chinese, and so we will have cooked vegetables, we'll have chicken, turkey, meats, and we'll also have organic eggs. And I usually eat a humongous raw salad with everything you can imagine, olive oil, vinegar, lettuce, carrots, onions, tomatoes, every vegetable raw. I eat about a pound of raw vegetables every day. And I probably eat another pound or so of cooked vegetables and then the proteins and the oil. Healthy oils, I always use healthy oils, olive oil, coconut oil for cooking. When you cook with oils, it's always important to put garlic, onions and ginger into them because the antioxidant, that will keep the oil from breaking down for about 15 or 20 minutes, instead of buying or oxidizing the oil. So those are just a couple of things. And of course I do my exercise, I taught Chinese martial arts for 30 years, so I do Tai Chi and Qigong and breathing exercises. I do those regularly. Go out to nature. Going out in nature is very important. My wife and I will go to one [inaudible 00:42:15] is close to us. We'll go out there a lot. And those are just some of the health strategies that I follow. I take lots of nutritional supplements, probably something on the order of an ounce of concentrated vegetable nutrients every day.
Sanjiv Lakhia: 42:31 And that makes for a very healthy lifestyle and productive clinical practice where you've helped hundreds if not thousands of people through your career. Alan, for those listening today, how can people get a hold of you if there is a patient out there who wants your expertise or a physician or other colleague who would like to speak with you? Can you share some contact information? We will put this in the show notes too.
Alan Tillotson: 42:56 We have a website called Chrysalis Natural Medicine. Chrysalis is spelled just like the Chrysalis butterfly. Chrysalis Natural Medicine. If you just type that into Google, you'll get right to my website and there are instructions there for how to contact us and all of that. So we do consultations with people all over the world actually.
Sanjiv Lakhia: 43:18 I would definitely say go pick up his book, The One Earth Herbal Sourcebook. It's written in a way that I think both lay people and medical people could really benefit from. And again, it's been on my bookshelf. I don't know, I don't know when you wrote it. It's been quite a while, but I think the information is still very relevant today.
Alan Tillotson: 43:37 1997.
Sanjiv Lakhia: 43:39 Yeah. And some of the stuff is timeless, so it's just a great resource to have on your bookshelf. Alan, I really appreciate your time today. I think we put together a very informative episode for the listeners. My hope here is just to at least stimulate some thought. He really illustrated for us how simple things like maintaining a healthy diet, exercise, lowering your stress can be important with healing chronic nerve injuries and then discussed some principles of acute nerve injury treatment. And I think the most interesting thing you discussed there was how you need to get a balance of treating the inflammation, but kind of letting it ride out since it's your natural healing response.
Sanjiv Lakhia: 44:15 And I think that has led to the birth of a lot of these regenerative medicine techniques. We do PRP in the office, placental tissue injections or STEM cell clinics and all of those really fundamentally, prolotherapy, they try to actually create inflammation on a micro level and stimulate your body's own capacity to heal itself. So for me as a practitioner, just what you've told me today will make me hyper aware of how much NSAID I'm prescribing, how much Prednisone we're prescribing, try and find a balance to promote wellness and recovery while treating an individual's pain. So I really appreciate that. And again, thank you so much for your time, Alan.
Alan Tillotson: 44:50 My pleasure.
Outro: 44:51 Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
Sanjiv Lakhia: 00:35 After almost 20 years of training and clinical practice, I would say that one of the toughest conditions I encounter on a day-to-day basis is that of nerve injury, whether it's nerve damage from a medical condition such as diabetes or traumatic nerve injuries. And in particular we see a fair number of nerve injuries in our practice related to spinal conditions such as a sciatic nerve injury. So it's one topic that I really wanted to dive into deeper and try and provide some solutions or at least stimulate some thought around the matter for those of you listening today, cause I know many of you are suffering from nerve injuries.
Sanjiv Lakhia: 01:12 Today it is my privilege to bring to you a guest that I have known now for 25 years both on a personal and professional basis. He's a master clinician, a scholar, scientist, and educator and, I would argue, is one of the top minds in the country, if not the world, on herbalism and natural medicine. And it is my pleasure to welcome to the show Dr. Alan Tillotson. Alan, welcome to the show.
Alan Tillotson: 01:41 Thank you.
Sanjiv Lakhia: 01:43 By way of introduction, Alan has extensive qualifications and I just want to review these for the listeners today. And Alan, this is your bio that we just discussed from your website but feel free to add in if I'm missing anything. But he's a registered herbalist and natural medicine specialist and has been practicing Western and Oriental herbal medicine for over 30 years and a professional member of the peer-reviewed American Herbalist Guild. He holds an accredited Master's degree in Asian Medical Systems and a PhD in Integrative Health Sciences. He holds a Delaware medical license to practice herbal medicine and acupuncture and has a practice, Chrysalis Natural Medicine Clinic in Wilmington, Delaware. Alan is known throughout the country for his extensive knowledge and expertise in Ayurvedic medicine and traditional Chinese medicine. He is a master in meditation and Qigong, and an author as well.
Sanjiv Lakhia: 02:43 He has published The One Earth Herbal Sourcebook, which I think is a fantastic resource. I've had this for years and I still look at it frequently. He's also put together a terrific online herbal medicine course on his website. He has published a book called Ayurveda in Nepal and really his accomplishments just go on and on, so he's definitely qualified to speak on the topic. In particular, he has worked as a formulator in the natural foods industry and developed a product he called the Myelin Sheath Energy, which we will likely get to today.
Sanjiv Lakhia: 03:19 And then on a personal note, I met Alan, it's been, we were just talking, about 25 years now, Alan and for the listeners, my introduction to Alan was through my own personal medical condition. When I was in college, I had a rather sudden onset of glaucoma and through combined efforts of terrific ophthalmologists in Cincinnati, Ohio, and through Alan's guidance, I've had a complete recovery and near reversal of any visual field damage and it's really quite remarkable and unheard of. So first of all, I want to personally thank you, Alan, for all the time and energy you've put into my health, the health of my family and friends that I've sent to you through the years.
Alan Tillotson: 04:02 You're very welcome. My pleasure.
Sanjiv Lakhia: 04:05 Did I miss anything you want to add about your background that you think the listeners need to know?
Alan Tillotson: 04:11 No. I think you did a pretty good job there.
Sanjiv Lakhia: 04:14 Well then, let's dive into some of the questions here. Can you just describe for our listeners what a typical clinic day or week looks like for you so they can get a sense for how you practice?
Alan Tillotson: 04:26 Sure. I usually see about 50 patients a week. I get up early in the morning, maybe around 3:30 or 4. I've been doing that ever since I lived in Nepal and kind of got my whole habits changed. And that's why I'm living a healthy lifestyle. And I get to the office, I review all the patient charts, answer emails, do research and study. I do that when there's nobody around. And then I start seeing patients around 7:30 in the morning and I'll see patients throughout the day and that goes on day after day. And that's typically what happens. My wife, Naixin, also works here. She was a former professor of Chinese medicine and she's also a licensed acupuncturist and she sees patients and does the acupuncture part for our clinic.
Sanjiv Lakhia: 05:13 Can you inform my listeners what sparked you into the field of herbalism and natural medicine?
Alan Tillotson: 05:20 Oh sure. Back when I was young, in my twenties, after college undergraduate, and I thought I was going to travel around the world and see things, which is kind of a task because I'm a type 1 diabetic. I got diabetes when I was 10 years old, but I kind of packed up my insulin and food and stuff and then traveled around the world. But then I got deathly ill when I ended up in Afghanistan. I was in Afghanistan, suddenly got dysentery and blood poisoning at the same time, really sick, started to lose a lot of weight. I'm six foot three and my weight went down from about 185 down to about 130 from massive sickness. And the bus drivers said there was a master herbal doctor living up in Kathmandu in Nepal, which was one of our destinations and they were going to take me to him.
Alan Tillotson: 06:14 And about a week or so, two weeks later we ended up in Kathmandu, Nepal where I met Dr. Vaidya, or Dr. Mana for short. Vaidya Mana Bajra Bajracharya, a herbal master living in Kathmandu, where his family has been doing Ayurvedic global medicine. Ayurveda is the medical system of India and Nepal, from father to son for over 750 years. And he gave me herbal medicines and basically saved my life. So I got really interested in that and then came back. I recovered and then when I came back, I then began to work on my Master's degree in Medical Anthropology at Goddard College and I went back to Nepal again and started studying herbal medicine with them and started learning that medical system that had been handed down father to son. So that's kind of how I got started. And I came back here and met my wife, who's Chinese. And, like I said, I was a teacher of Chinese medicine at Chinese medical colleges in China. And we set up this practice and been going that way ever since. And I went back and added a lot of scientific study too.
Sanjiv Lakhia: 07:26 Sometimes in life we find our career, but other times the career finds us. And I think for you that story is just fascinating. I really appreciate you sharing that, some personal information, and I know we have some physicians listening and I just feel like it's okay to talk about our own personal health conditions, particularly with our patients. We're in a high stress field in the healthcare field. And guess what? We do get sick and we do have challenges as well and I think we can learn through sharing with each other. So, I appreciate you sharing that story.
Alan Tillotson: 07:59 Now you know, when I got back, at that time there was no internet, I went down to the local university library in Newark, Delaware and started looking up diabetes and found out that I was going to go blind and lose my feet and develop neuropathy and all that stuff. And that really spurred me to start looking into methods of helping myself. So a lot of it had to do with my own personal needs of not wanting to have all those problems. And I can say now that I'm almost 70 years old and I've been diabetic for almost 60 years. I have no neuropathies, no retinopathies, no kidney problems, nothing. I'm basically still healthy. I don't have any of the problems that normal diabetics have, especially type 1 diabetics, because of a very strong health regimen I follow. I still have to take insulin every day cause my pancreas doesn't produce any, but other than that I'm pretty healthy.
Sanjiv Lakhia: 08:53 So you're a testament to your own philosophy and practice so that's terrific. Let's get into the topic of today, which is healing nerve injuries. Can you give our listeners a basic understanding of nerve anatomy and how nerves function, kind of how you break it down and how you see it?
Alan Tillotson: 09:08 Sure. Okay. Well the first thing is that in the early stages of embryology, three primary derm layers form called endoderm, ectoderm, and mesoderm. And out of the ectoderm, the entire nervous system develops. So one way that I look at the anatomy a little bit differently than other people - and this is a lot of based on how they look at the body in Ayurvedic medicine, - you could say that the ectoderm, which develops into your entire nervous system, peripheral nervous system, central nervous system and everything else, and the ectoderm and the mesoderm which forms into other parts of your body, that you really only have three organs in the body. You have three organs in your body and those organs are very large. And what we normally call organs are sub-organs. Sub-organs would include brain, the central nervous system, the peripheral nervous system, the senses, vision, hearing, et cetera.
Alan Tillotson: 10:00 So those systems all work in conjunction with each other. So, one of the things you need to do in natural medicine is to make sure that all three of these primary systems are functioning. The neurological system, the endocrine and the metabolic system, and the digestive system all developed from the endoderm and the lungs, the liver, internal organs all are functioning together. As far as the actual anatomy of the nervous system, it's very important to know that the body super protects the nerve tissue because it's very easily disturbed. That's why your brain, you have a big, thick skull. And you have the dura and the pia and then you have the ventricles, which are like shock absorbers to some extent and the fluids and the spinal cord. All those things are designed to protect the nervous system. Then the individual nerve fibers are surrounded by a myelin sheath.
Alan Tillotson: 10:59 Myelin sheath is produced by Schwann cells in the peripheral nervous system and by oligodendrocytes in the brain and they wrap around the nerve fibers and protect them. But more importantly they also, we now know, provide nutrients to keep the nervous system healthy. And outside of that, there's this connective tissue, the endoneurium, the perineurium, and the epineurium, which are kind of like connective tissue that surrounds and protects. And that also creates a problem when you're trying to treat the nervous system because nutrients don't easily flow through all of those layers. So sometimes inflammation in the nervous system, it takes time for nutrients to get in there.
Alan Tillotson: 11:47 To heal nerve tissue, you have to be able to get to the location. You have to get nutrients get absorbed into the tissue. There's also little blood vessels in there too that supply the nutrients, veins and arteries, and so that's the basic thing you need to know. Equally important is that in the intestinal system, which is where you absorb all the nutrients that ends up going for all the tissues, a lot of the neurotransmitters are developed in the intestinal systems, so intestinal health is a very large part of keeping the nerve system healthy. Then there's also issues with circulation, microcirculation that have to be addressed whenever you're dealing with healing nerve tissue.
Sanjiv Lakhia: 12:31 That's a terrific point and one that I talk about with patients in terms of why bones heal faster than nerves. I appreciate you discussing that. While there's-
Alan Tillotson: 12:40 Yeah, that's the reason that they do and also the myelin itself is fatty and it's composed of sphingolipids, phospholipids, and cholesterols. And the inflammation, in many nerve diseases and nerve injuries, that inflammation just stays there and doesn't get resolved and starts to tear down the actual nerve fibers, the axons. So that issue of chronic low-level inflammation in nerve tissue that's hard to resolve is a big deal when you're trying to solve these problems and that's why people are so frustrated. If you cut yourself, skin will heal in just a couple of days. Connective tissue takes longer to heal if you stretch a ligament or tendon or something, but nerve tissue heals really, really slowly because of all these protective barriers that make it more protected, but also harder to get to from external interventions by doctors.
Sanjiv Lakhia: 13:37 You touched on this briefly, but from a holistic viewpoint, what health risk factors lead to the development of peripheral neuropathies or nerve dysfunction in the body?
Alan Tillotson: 13:48 Okay. Poor diet, diabetes, chemicals like in chemotherapy is a major cause; physical traumas, sometimes hereditary disorders, infections, other sources of noninfectious inflammation, autoimmune disorders, abnormals in the proteins, spinal issues, exposure to chemicals sometimes, or failure of some of your other organs like kidney failure or really bad things like chronic alcoholism. Those are the kinds of things that lead to peripheral neuropathies.
Sanjiv Lakhia: 14:26 So impaired circulation, toxicities, and then of course there's trauma or you can have a fall or an injury that can damage the nerve.
Alan Tillotson: 14:34 Exactly.
Sanjiv Lakhia: 14:35 When you see these different mechanisms, are your principles of treatment different in acute nerve injury versus chronic nerve injuries?
Alan Tillotson: 14:45 Yeah, in an acute nerve injury, the body itself is going to try to repair. If there's not another problem, there's no diabetes, nothing that's contributing to it externally, the body's going to go through a normal healing process and so you want to stimulate that healing process. And part of that is done ... going back in China, going back a thousand years, martial artists would get these kinds of traumatic injuries all the time, and also soldiers would get these traumatic injuries. And they began to look for natural medicine, herbs and things, that would repair. So there's a group of herbs in a formula called Sanchi 17 which is 17 different herbs that have been used in China traditionally for healing nerve injury, for healing injuries of any kind, including nerve injuries. We often want to give that to people after they've had a trauma as one mechanism for healing.
Alan Tillotson: 15:38 Another mechanism to stimulate nerve healing from traumatic injury of course is acupuncture. Acupuncture in my thinking is an ancient wound healing system. In other words, the point ... You know how if you have a city and you have different alert systems and different places where the police can get information about problems? So there's these points on the body, when you stick a needle into them, the body, because they're so sensitive, if you touch them they kind of hurt and stuff. So the body sends a signal, "Oh my God, there's a big injury here." And that mobilizes the body to heal. Oftentimes after an injury or something that's taking place for a while, the body kind of stops working on it. And then people end up with these problematic long-term issues, neuropathies, and their body's not really working on it, so acupuncture can be used to stimulate that.
Alan Tillotson: 16:31 And once you mobilize the immune system, their body will start producing neuropeptides and nerve growth factors and also bring in white blood cells to repair the blood vessel or the microvasculature. So it's a mechanism of stimulating that. That can also be done through things that people never even think of. Meditation, breathing exercises, all the things that come from yoga or from Buddhism and other spiritual systems around the world have profound effects on the nervous system because they also mobilize our natural healing capacity. Humans have a fantastic natural healing capacity if you can mobilize it. You see?
Sanjiv Lakhia: 17:12 And the scientific research to support these strategies has just exploded in the last five to ten years, so everything that Dr. Tillotson has covered has good peer-reviewed literature to support and very safe with low side effects. One thing I would say though, if you're listening and Alan mentions a product or a supplement, I would advise you that this podcast is primarily for informational purposes and I would not start any of these supplements or products without the care of a clinician who knows about this or has a bit of expertise with this. So having said that...
Alan Tillotson: 17:51 That's very important because if you're trying to build a house and It's really hard to do that if you don't know anything about how to build a house, just by going out and buying a bunch of nails and hammers and glue and whatnot and try to build a house, you won't get very far. People can take care of simple problems by themselves oftentimes, but when it comes to complicated, and nerve problems are very complex, you have to know how to put these therapies together in a proper way, in the proper order, in the proper sequence, in the proper dosage in order to produce a result. Otherwise you'll just buy something off the internet that somebody's suggesting and take it and it doesn't work and then you'll get frustrated.
Sanjiv Lakhia: 18:29 Yeah. Not to mention potential interactions with drugs and other treatments. In our clinic, Alan, I work at Carolina Neurosurgery and Spine Associates and we're essentially the largest neurosurgery practice in the country, and we see a fair amount of sciatic and lumbar nerve root injuries from herniated discs, joint arthritis. So what treatment model do you use to address these types of injuries in your patients? So for example, last week I saw someone who had herniated a disc and developed a footdrop. I also had a patient who fell on their arm and had ulnar nerve injury. And then we see a lot of carpal tunnel syndrome. All of these are different types of nerve dysfunction or nerve injuries. How would you approach these when they come into your office?
Alan Tillotson: 19:10 Well, when somebody comes into the office, I have to do a full evaluation. I evaluate every system in their body and then I put together a picture of ... I want to look at the system from the time sequence of when the injury or the external problems started. I look at the time sequence and I develop a picture of what happened to that tissue. And then when they walk into the office, are the muscles around it tightened up? How much pressure is there? Is there arthritis in between itself? Are there bone fragments? Whatever is actually physically going on, I have to see that and then I also look at it through a systemic, or system by system by system, going through the body systems to look at it from a different point of view.
Alan Tillotson: 19:54 So you get the time sequence as one trail and you create a picture of how this problem developed and then you look at the individual body systems to see what areas of weakness there are that would be inhibiting or needed to be stimulated in order to produce the healing so that we could then decide do they need acupuncture right now or do they need immediately go to the surgery or do they need physical therapy or do they need herbal supplements or some combination of those things together.
Alan Tillotson: 20:24 And we put together a protocol for them based on that. Now, if there's an underlying arthritis that gets to another area. One of the areas that's problematic in healing injuries of any kind, including the kind we're discussing here, is that many of the medicines that are used for injuries such as steroids and including NSAIDS, have their own set of side effects and they actually slow down the healing process. So if you want to heal a tissue and then there's a lot of swelling and inflammation, you have to get that out of there and if you give somebody a steroid, that'll give them some short term relief but it's also going to inhibit the parts of the immune system that do the repair process. So one of the key areas we're looking at these days are ...
Alan Tillotson: 21:11 There are specific signaling molecules called specialized pro-resolving mediators, and those signaling molecules which are derived from nutrients, especially oils like coconut or fish oil, but need to be gotten into the person in a high enough dose and they start to signal the white blood cells to clean up the debris to start to get the vascular system healed up, to heal up damage to the micro-vessels and then to start to deliver the nutrients for the healing process. There's also the physiology. Pressure is a big deal. So that's why manipulations such as osteopathic manipulations or physical therapy manipulations to create space for things to drain away and for nutrients to come in for the white blood cells, that's also a part of it.
Alan Tillotson: 21:58 So if you think of each one of these mechanisms as being part of the healing process, when you put them together, you magnify the results. I always used to say, "One plus one equals three" and we'll need to give somebody a nutrient for healing arthritis, but you also give them physical therapy or osteopathy or acupuncture. One plus one equals three, it gets much better results that way.
Sanjiv Lakhia: 22:22 What you said there was fascinating. Can you repeat that? You said specialized pro-resolving mediators. I have not heard that term. Did I get that right?
Alan Tillotson: 22:31 Yeah. Specialized pro-resolving mediators, SPM, are signaling molecules that are extracted largely from oils like fish oil and from coconut oil and olive oil, that sort of thing. And everybody in natural medicine gives those kinds of products as part of the healing process. So as far as 20-some years ago, 30 years ago, Dr. Abel is the ophthalmologist that I work with a lot. He's a local ophthalmologist, we've been basically partners in the field of ophthalmology for over 30 years. Dr. Abel and I noticed like 30 years ago that when people came into the clinic with dry eyes, we would give them fish oil, because fish oil is moistening, and about half the patients, their dry eyes would disappear, and the other half, nothing. And it didn't matter how long you gave it to them or what dose you gave. It just didn't work. We didn't know why.
Alan Tillotson: 23:19 It turns out that some people who have neurological disorders or inflammatory disorders lack the capacity to properly extract and manufacture, or extract these specialized pro-resolving mediators, or SPMs, from their nutrients. To give you a very clear example, in multiple sclerosis - You can actually measure these things. Okay? So multiple sclerosis, which is a chronic inflammation of the nervous system, lying chief in the brain, I have a study where they measured the amount of SPMs, or mediators, in the brain tissue of MS patients is basically zero, which means that the inflammation in that myelin is never going to be resolved because there's no signaling molecules in there to tell the white blood cells to go in and remove the debris, to start to repair the vasculature, and that sort of thing. It's just not available.
Alan Tillotson: 24:18 So these SPMs or specialized pro-resolving meteors are a new non-opiate, non-NSAID, both painkillers and tissue repair medicines and they're now actually available by a few companies. They know how to extract them. And they're especially useful for people that have inflammation that does not resolve such as nerve tissue, like I said it's very slow healing, but also auto-immune disorders. The SPMs, they're a new and very important part of our protocols for this. They don't replace the other things we do, the other anti-inflammatories. What they do is they add an extra piece for the jigsaw puzzle so we have a more complete solution.
Sanjiv Lakhia: 24:57 I know you have an extensive database of articles on research. Anything you have on this topic that you want to email me, I'd appreciate it and we can link to it in our show notes.
Alan Tillotson: 25:07 Well, I'll be glad to email you. I've got a whole bunch of them, about 30 or 40 articles on this. It's kind of been well-known in the research field and one of the ways I keep myself up on these things is that I have run an algorithm through Google, which I get up early in the morning and then I run this algorithm through, which then finds me all these articles in the fields that I'm interested in the field of natural medicine healing throughout the world. So I can couple 10, 20, 30 new articles every week. Some of them will jump right out at me as something I've never heard of before, some new nutrient or some new mechanism. Now I put those in my database I've been collecting, there's 40,000 articles in my database now.
Sanjiv Lakhia: 25:48 That's terrific. Moving forward there. So you just touched on one, but I kind of want to maybe roll these next few questions together. I know you have worked on a customized herbal formula for nerve repair, so I want you to talk about that and just in general talk about other nutritional strategies that you recommend to support nerve repair.
Alan Tillotson: 26:10 Of course, now that product is called Myelin Sheath Energy. It's only available currently to my patients although there is a commercial version of it out there, but my latest version is available to my patients here. What happened was that back when I lived in Nepal, when I was doing my Master's in Medical Anthropology back in the 1970s, when I lived at the clinic in Nepal I mentioned earlier, an MS patient came in. He was a British engineer and even back that far, the British were really, really good with people that have these disabilities and he was primarily in a wheelchair. He was getting around pretty well and it was really hard to do that in Kathmandu. He was working on a bridge project there and he was coming into the clinic to see the Nepalese doctor, herbal doctor that I was studying with.
Alan Tillotson: 26:58 And he started to treat this guy with herbal medicines and at the end of a six-month timeframe, this guy who hardly could stand to walk went from about five or eight feet with a cane to about 200 feet or more with a cane from this treatment, which really fascinated me. [inaudible 00:27:15] was just a neophyte at that point. In the 1990s, I had a patient come in with multiple sclerosis. I'll give the first name only of course for privacy. Her name was Barbara, she's now passed away, but this was about 27,more than 20 years ago, certainly 25, 30 years ago and she has MS. I really just didn't know how to treat, but I remembered what the doctor in Nepal, Dr. Mana had done and just by coincidence about two or three months later, Dr. Abel and I flew out to Kahtmandu to do some research on glaucoma. We wanted to study with these guys and Dr. Abel was a really great doctor here. He contributed his time doing cataract surgery for free to the Nepalese people at that time. We brought a bunch of corneas in from Baltimore hospitals and also Johns Hopkins and we did a lot of surgery.
Alan Tillotson: 28:05 But while we were there, I went to the doctor in Nepal and said, "Remember that patient with MS that I saw when I was here 25 years ago? How did you do that?" And he said, "Well, this disease is called [foreign language 00:28:13] in Sanskrit and it's caused by [foreign language 00:28:23] and the treatment process is to use [foreign language 00:28:26]." So I immediately knew what he said. Translating from Sanskrit, he said this disease is called [foreign language 00:28:33], which means progressive leg weakness. It's caused by [foreign language 00:28:38], which translated from Sanskrit, means poisonous fats. Right? And then he gave the name of two herbal medicines which strengthen the body's ability to process digestion and move toxic fatty poison, so what today we would call lipid peroxide. And of course immediately, because I understand anatomy and physiology, I immediately knew what he was saying because I know the myelin was made primarily out of fats and he was basically saying that the myelin itself was toxic and that we had to remove the toxicity from the myelin sheath, that is, to remove the inflammation from the nerve tissue.
Alan Tillotson: 29:14 That's almost the same as Western medicine except he was able to do it. I looked at what he was doing and I looked at the herbal medicines. When I came back, I put a formula together to treat this patient Barbara and just like the British engineer six or eight months ago, my treatment, I still have the physical therapy report, I got her from being able to walk just a couple of feet up to over 200 feet which continued until she basically passed away later of old age, something different. And that was my first evidence of being able to treat this. Now, when I look back at it from the herbal medicines that I gave to them was all based on Oriental thinking, improving, strengthening chi, calming Vata, these kinds of terms that don't mean very much in Western thinking. But when I look at it now, what I've now discovered from looking at those herbs over the years that we were actually strengthening the myelin, we're actually strengthening myelin by strengthening the oligodendrocytes in this case in the central nervous system that produce the myelin.
Alan Tillotson: 30:10 And that means increasing proven ATP energy in that tissue. And when you looked at the individual herbs, that's the kind of things they do. And we are also improving microcirculation. So the herbal medicine formulas that I developed actually has this healing effect. Now, one of the early things I discovered was that in order to get that medicine into the tissue, it's also important to add alpha lipoic acid because of the structure of the nerve tissue, because of the way it's hard to get into and it has that parineural sheath, the connective tissue sheath and the fatty layers. It's hard to have nutrients that are both fat soluble to pass through that, but alpha lipoic acid is both fat and water soluble, so it's able to pass through and it tends to carry these anti-inflammatory nutrients into the tissue. You see?
Sanjiv Lakhia: 31:00 Yeah, which I have prescribed that for some of my diabetic patients to help with their neuropathy and definitely seen some benefits.
Alan Tillotson: 31:07 It's extremely good for neuropathy. Exactly correct. That one nutrient by itself is good for neuropathy, but when you add to it nutrients that are healing for the nerve tissue and put those two things together and work on circulation, then that's it. Another issue has to do with multiple sclerosis in this case is that, and this came later in my understanding, but that the immune system normally does not allow these aggressive immune system cells to get into the brain because we have what's called a blood-brain barrier and that's close tied to endothelial cells that line the blood vessels that feed up into the brain. And those close-packed cells are kind of restrictive. They're like a guard at a nightclub. They don't let you in unless you have the right pass. But in MS, people have what's called in early stages, what's called relapsing-remitting MS, and then later on it goes to what they call chronic progressive.
Alan Tillotson: 31:58 Why? Nobody ever answers that question. I ask patients why, I ask the doctors that are treating them why. Nobody seems to know. It turns out that research that was done in France that I had seen shows that during the initial MS attacks, there's an opening and bridging of the blood brain barrier and some of the aggressive immune system cells can get into the brain tissue. And then they notice this damage in the myelin, this weakening of the myelin, and then they start to attack and then it closes up and the MS attack goes away. Sometimes you close it up quickly with steroids to repair it.
Alan Tillotson: 32:33 Then it opens up again. You have your second attack, but eventually that blood brain barrier is weakened enough that it stays open all the time and then you go into chronic progressive. That's my understanding of it. I could be wrong, but that's the way I understand the sequence of how that process goes. You see? So a key part for MS and some other neurological disorders of the brain and including the spinal cord of course would be to keep vascular integrity so that the wrong kind of stuff doesn't get in so that the body's natural filtering mechanism is properly functioning.
Sanjiv Lakhia: 33:03 So it sounds like several mechanisms you've touched on. Number one is improving localized circulation. Number two is reducing inflammatory reaction in the tissues, detoxifying the tissues, and just developing a healthy microenvironment to promote nerve repair. One thing that we struggle with a little bit just in traditional medicine is treating pain. In particular, obviously the country right now is really, really looking at the opioid epidemic and trying to find proven alternatives or suitable alternatives. Nerve pain as well. Just recently the FDA put out a warning on the use of Gabapentin. They've documented some cases now of respiratory depression when Gabapentin is taken with opioids. So our options, our tools in the toolbox are quite limited from a prescription medicine perspective, so that means patients look elsewhere and I've had ... Recently, there's a big run on CBD oil. There was news about Corydalis. Obviously you talked about acupuncture. What are your thoughts on some of these other options that [crosstalk 00:34:11] ways to treat pain?
Alan Tillotson: 34:12 Pain relief is a big, big deal. Now, ultimately pain relief is killing the actual tissue. That's not going to do you any good. If it takes two years to heal your tissue you're in serious, serious pain. And the opiates, of course, hit the brain stem and they slow down the breathing and basically you die because you stop breathing. You know? That's the big deal. I didn't know about it. I just heard because you told me that Gabapentin has a similar problem. CBD oil, which has anti-pain, CBD oil and also medical marijuana, both have painkilling properties, but they do not depress respiration, so they're much, much, much safer. Another one, the Corydalis is a Chinese medicine. It's been used for pain forever and Western doctors are working on researching it to find out the key component in it, but we use it right here in the clinic as a pain killing medicine which works sort of like an NSAID, but without the side effects of NSAIDs.
Alan Tillotson: 35:09 The reason that NSAIDs have side effects is because of the way that they work. For example, there's three primary pathways for inflammation in joint tissue, COX-1, COX-2 and 5-LOX, so Cyclooxygenase-1, Cyclooxygenase-2, and 5-Lipoxygenase. Those three pathways, if you only block two of them, like Aspirin or Tylenol does, you end up increasing inflammation through the third pathway. And that's why when you take Aspirin, it will take your pain down in your joints or whatever, but it will also cause stomach bleeding or you take Tylenol, pain will go down. But you can have problems with your liver. Or Aleve, same thing is your pain will go down, but you're going to have problems with blood vessel breakage with your eyes or whatever.
Alan Tillotson: 35:55 That's the reason. So the goal of treatment of inflammation is to broaden and to dampen inflammation down enough so that it's not causing a lot of pain, but also not so much that you stop the healing process. And so the pro-resolving mediators I just talked about earlier, the SPMs, are a new class of non-opiate non-NSAID painkillers. They actually reduce pain through their process because they work. So they're being investigated now for that purpose. And there are so many natural nutrients that also work as anti-inflammatories without the side effects. Curcumin is one of them. Myrrh is another one. We mentioned folic acid.
Alan Tillotson: 36:38 There are so many different natural medicines that have pain killing properties, but the ones that are the strongest - there's also Western medicines that, natural medicines been known by Native Americans that reduce pain down also, so we use some of those as well. So we have a quite a variety of these products and different ones work for different people. DL-Phenylalanine, which is an amino acid, can often work wonders reducing pain because it stimulates the production of the body's natural endorphins, so sometimes people with chronic pain, you give them some DLP and it will help a lot in some cases. So I have about 10 of these things and which ones I use varies depending on the case. And then if something doesn't work we just use another one. We have a lot of safe ones to use.
Sanjiv Lakhia: 37:28 The other one I would add to that that I've used is actually vitamin D, which has a steroid-like effect. And it's not necessarily a substitute for Prednisone, but I've read research on it in MS as well, where a high-dose short course of vitamin D under a physician's direction can reduce the inflammation. There's literature that vitamin D deficiency causes subclinical swelling in the bone, so spinal pain, back pain, so I always look to check that for some patients who have chronic back pain.
Alan Tillotson: 38:02 That's a very important one. What you said is exactly correct. We usually use something like 50,000 a day for a week or so. I don't know what levels you're using for that, but that can be very, very effective. Another one is you can just use plain old licorice root. Licorice root also is a steroid like molecule, but we don't use licorice root as a direct pain killer, but we use it because it extends the life of steroids. So if you have a steroid that you're giving twice a day and you give licorice with it, give it once a day and it will stay in the system for about full 24 hours. So it's extending, you're using half as much and getting the same result. You see?
Sanjiv Lakhia: 38:38 Again, if you're listening, please don't run out and start taking high-dose vitamin D or any of these products without consulting with your physician first. They certainly can be helpful but they have to be done properly and in a safe manner.
Alan Tillotson: 38:51 Another fascinating study that was done in Japan showed that when they crosschecked the painkilling properties, anti-inflammatory properties of steroids versus herbal medicines, the steroids were faster and stronger with a lot more side effects and the herbal medicines were slower, not as strong but much safer. But when they combined very low-dose Prednisone, like 2 milligrams or 2.5 milligrams, along with a strong course of herbal medicines, they could get results that were steroid-like in terms of power but with much less side effects.
Sanjiv Lakhia: 39:23 If you have that abstract, I'd love to see that as well, Alan. That would be terrific.
Alan Tillotson: 39:27 And I do.
Sanjiv Lakhia: 39:29 So we've covered quite a bit of information today. It's quite fascinating and I wanted to get inside your mind and see how you approach some of these problems and issues that we encounter on a day-to-day basis. And the other thing I would say is every time I see you or see a picture of you, in 25 years, you look the same. So obviously you know how to take care of your health. And I always like to close Back Talk Doc when I'm interviewing individuals, I love to pick their brain about personal health strategies that maybe my patients or listeners can adopt. And you touched on this a little bit before, but how about your diet and food plan? There's a lot of debate out there about keto and vegan and what have you. What's your thoughts on that?
Alan Tillotson: 40:12 Okay. I have a much more simplified idea. If you look at the work with Dr. Katz, who's the head of the Yale School of Public Health, he did a fascinating study in which he cross-compared all the healthy diets that people always report get them better. And that includes vegetarian, paleolithic, Mediterranean, ketogenic, all these different diets. And what he found was that they all work, but there's a central core to healthy diets that's necessary for them to work. And if you do the central core, the rest of it is not anywhere near as important and that means real food, close to nature, minimally processed, with lots and lots of vegetables. And if you do that without any meat at all and call it vegetarian, you'll have anti-inflammatory health benefits. If you do it with some meat, call it paleolithic, you'll have health benefits. If you do it with pastas and call it Mediterranean, you'll have health benefits. But real food, close to nature, minimally processed, with lots and lots of vegetables and that's kind of the way I eat.
Alan Tillotson: 41:12 My wife is an excellent cook, Chinese, and so we will have cooked vegetables, we'll have chicken, turkey, meats, and we'll also have organic eggs. And I usually eat a humongous raw salad with everything you can imagine, olive oil, vinegar, lettuce, carrots, onions, tomatoes, every vegetable raw. I eat about a pound of raw vegetables every day. And I probably eat another pound or so of cooked vegetables and then the proteins and the oil. Healthy oils, I always use healthy oils, olive oil, coconut oil for cooking. When you cook with oils, it's always important to put garlic, onions and ginger into them because the antioxidant, that will keep the oil from breaking down for about 15 or 20 minutes, instead of buying or oxidizing the oil. So those are just a couple of things. And of course I do my exercise, I taught Chinese martial arts for 30 years, so I do Tai Chi and Qigong and breathing exercises. I do those regularly. Go out to nature. Going out in nature is very important. My wife and I will go to one [inaudible 00:42:15] is close to us. We'll go out there a lot. And those are just some of the health strategies that I follow. I take lots of nutritional supplements, probably something on the order of an ounce of concentrated vegetable nutrients every day.
Sanjiv Lakhia: 42:31 And that makes for a very healthy lifestyle and productive clinical practice where you've helped hundreds if not thousands of people through your career. Alan, for those listening today, how can people get a hold of you if there is a patient out there who wants your expertise or a physician or other colleague who would like to speak with you? Can you share some contact information? We will put this in the show notes too.
Alan Tillotson: 42:56 We have a website called Chrysalis Natural Medicine. Chrysalis is spelled just like the Chrysalis butterfly. Chrysalis Natural Medicine. If you just type that into Google, you'll get right to my website and there are instructions there for how to contact us and all of that. So we do consultations with people all over the world actually.
Sanjiv Lakhia: 43:18 I would definitely say go pick up his book, The One Earth Herbal Sourcebook. It's written in a way that I think both lay people and medical people could really benefit from. And again, it's been on my bookshelf. I don't know, I don't know when you wrote it. It's been quite a while, but I think the information is still very relevant today.
Alan Tillotson: 43:37 1997.
Sanjiv Lakhia: 43:39 Yeah. And some of the stuff is timeless, so it's just a great resource to have on your bookshelf. Alan, I really appreciate your time today. I think we put together a very informative episode for the listeners. My hope here is just to at least stimulate some thought. He really illustrated for us how simple things like maintaining a healthy diet, exercise, lowering your stress can be important with healing chronic nerve injuries and then discussed some principles of acute nerve injury treatment. And I think the most interesting thing you discussed there was how you need to get a balance of treating the inflammation, but kind of letting it ride out since it's your natural healing response.
Sanjiv Lakhia: 44:15 And I think that has led to the birth of a lot of these regenerative medicine techniques. We do PRP in the office, placental tissue injections or STEM cell clinics and all of those really fundamentally, prolotherapy, they try to actually create inflammation on a micro level and stimulate your body's own capacity to heal itself. So for me as a practitioner, just what you've told me today will make me hyper aware of how much NSAID I'm prescribing, how much Prednisone we're prescribing, try and find a balance to promote wellness and recovery while treating an individual's pain. So I really appreciate that. And again, thank you so much for your time, Alan.
Alan Tillotson: 44:50 My pleasure.
Outro: 44:51 Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.