Dr. Joe Tatta: Welcome back to the Healing Pain Summit. I am your host, Dr. Joe Tatta. Today on the summit, we are making the link and connection between chronic persistent pain and low libido. My guest today is Dr. Keesha Ewers. She is a board-certified functional medicine practitioner and the host of health you radio network. After curing her own autoimmune disease and discovering the key to low libido in women, Dr. Keesha developed the freedom framework, which is designed to get to the root problem of any disease or imbalance.
She is the founder of a field of medicine called functional sexology, which is a common combination of functional medicine, psychotherapy, sexology, and Ayurveda through the Academy for integrative medicine. She offers a certification course for those passionate about and wanting to become an integrative medicine health coach. Dr. Keesha has published articles and books and conducted research primarily on adrenal health, emotional pain, cultural and spiritual values, cognitive beliefs, and how the effect of female sexual desire and vitality. Dr. Keesha Ewers welcome to the healing pain summit 2.0 it’s great to have you here this year, Dr. Joe. It’s so great to be on the summit. Thank you for inviting me. So I’m very excited to have you on this year cause I really want to talk about kind of a topic that at times is kind of pushed under the rug with pain and that’s by totality and low libido. So I’m very excited to have you here. Talk to us first. I think we should kind of jump right in and explained to us how low libido can mean low vitality or ProHealth.
Dr. Ewers: The way that I look at it, dr Joe, is that it’s like a gas gauge. You know on the dashboard of your car when you’re driving, when you are driving along, you’re always checking your speedometer. You always checking your gas, gauge your oil, right? All the idiot lights that come on, you’re making sure you’re doing okay because you want to get to where you’re going. Well, libido is much like that same, it’s a feedback mechanism from your body to you. So if you’re low in your sex drive, it means you have a blockage somewhere. And if you have a blockage somewhere, can either be mentally, it can be emotionally, it can be physically, it can be in your story from your love map as you’re growing up, it can be spiritually and cultural. So there’s several different reasons that women and men too will have low libido and like if your gas gauge is going towards MD, you don’t push down on the gas pedal and expect to go longer and further, right?
Dr. Ewers: You’re going to break down the side of the road unless you go to a filling station. You know that about your car. And so often we don’t know this about our bodies that if our vitality is lagging or libido’s low, we just don’t have enough in the gas tank anymore, right? I don’t have one more thing to give to a partner or I don’t have any desire whatsoever for anything else in my life cause it’s a reflection of everything in your life. Then we somehow drink a red bull or a cup of coffee is the same as wishing down on that gas puddle and expecting to go longer and further. But the body will break down. It also will go to the side of the road, you know, and then we feel surprised and shocked when this happens to us. So I look at it as the same kind of thing.
Dr. Joe Tatta: I had some wonderful introduction. I love the way you explained that because it’s almost like this when we talk about payments, talk about a pain matrix. So there are many different reasons that cause pain. And you’re saying the same thing about libido. There are many different things from your hormonal status to your, how you actually physically function in your pelvic floor to kind of your, your, you know, your libido story if you will. Let’s start with the obvious. When we talk about low libido, low sex drive, automatically lights go off about, Oh it must be hormonal. Cause that area of my body is controlled or dictated by hormones. So what is some of the hormones that can be, let’s say out of whack or reserved around a low libido experience.
Dr. Ewers: So people often think of hormones is just testosterone, progesterone, estrogen, and they don’t realize that there’s an endocrine system and that the endocrine system actually begins with the brain and works down, right? We’ve got the thyroid, we’ve got the adrenal glands, we’ve got the ovaries, we’ve got the pancreas, all of them are part of this system. We’re not little boxes set up in the structure, right? We’re a system and we, it all works together and the body craves what we call homeostasis or balance. And if we do things, you know that are lifestyle choices that put it out of balance, it’ll Rob Peter to pay Paul until finally Peters out too. And then you just kind of say, okay, I’m overdrawn. I’ve got nothing left. And now symptoms will start showing up. So hormonally with your brain, dopamine is one of the drivers for sexual desire.
Dr. Ewers: If you’re low in dopamine because your adrenal system has been in this fight or flight mode for a chronic period of time, very persistent fight or flight, then you’re actually going to be stealing progesterone from your ovarian function. Your testosterone is going to go down. If you’re a man and a woman, eventually you’re going to become what we call estrogen dominant. And your anxiety, depression will start to come up. And that’s not gonna leave room for sexual desire. Because the way I always describe this is if you’re a zebra being chased by a lion, the zebra knows it’s not safe to stop and have sex. It can’t reproduce right now because it knows it can’t even keep itself alive. Why would it actually stop and have sex, which is biologically a signal that you’re safe to have another child, right? To reproduce. And so for women, that’s really important thing to remember. If you’re in zebra mode and you’re running for your life, there’s nothing left over for sexual desire because everything is concentrated towards getting to safety.
Dr. Joe Tatta: Hmm. It’s, it’s wonderful
Dr. Ewers: explanation. I think, you know, when I think back to all the years of treating, uh, women and they’ve come into my clinic or into my practice postpartum, and they’ve had, you know, postpartum pain, whether it’s pelvic pain or back pain. And I take a history and they say, you know, eventually in the history it comes up that they had a difficult time conceiving over the years. At the same time, they also had a history of pain. And I explained to them that it’s a direct link between your chronic pain and not being able to conceive. And a lot of times no one has articulated that to them. No one’s explained it to them, but there’s really that direct link there. So I really appreciate you bringing that to the forefront. Yeah. If you’re in chronic pain, you’re in zebra mode, you’re running right. Your body is actually interpreting that as a stress response. That’s something that’s very stressful to the body. Well, you only have so much in the gas tank, right? And so if you’re pushing the pedal down to manage pain, you’ve, you’re not going to be able to summon sexual desire.
Dr. Joe Tatta: Yeah. And I, you know, as we talk about hormones, a lot of people, you know, like you mentioned the sex hormones, what if people don’t think of insulin and the panic as being part of the endocrine system and it’s probably the most vital hormone we have actually. So talk to us about, you know, dysregulated blood sugar, high blood sugar, how does that affect the Beto?
Dr. Ewers: Oh you’re talking about the detox retox rollercoaster now. So, so oftentimes culturally what’ll happen is people awake up, cause we live in a productivity oriented society, it’s a team oriented. We get rewarded for getting stuff done right? And so we have this task list that becomes kind of a bully. We wake up, we’re focused on the task list, we have a cup of coffee cause we’re tired cause we stayed up the night before. And so that coffee sets up the body for what you’re talking about right now, which is insulin resistance. If you don’t get enough proper nutrition, if you don’t have enough protein and fat to get the body to get the message that you’re satiated, fat actually says, Oh, it’s okay because you’ve had time to ingest something that’s allowing me to feel stable and grounded. Coffee as stimulant, which is why people drink it.
Dr. Ewers: And so why is you up like this? So then the roller coaster starts to come down and people reach for carbohydrates, right? So you have that quick carbohydrate to send that back up again, and then it crashes down. And so we have these steep ups and downs that chase each other. We’ll eventually, what will happen is the cell, which is supposed to take insulin and from the pancreas to deal with that sugar says no more, can’t do this. So we start to store that sugar as fat. So often people here have heard the messages, I think really over the last three decades that fat’s bad for you. And so they’ll say, Oh, I’m going to have this Dan in fat free yogurt for breakfast, right? Which has got a ton of sugar in it. And now I’m going to chase that with a cup of coffee.
Dr. Ewers: It sets up the day, the next eight to 12 hours for that, and over time we start to get fat because the insulin resistance, well then that is actually a hormone disruptor. When that happens, fat is part of what ms reps, our estrogen and progesterone metabolism. So fat becomes in. This happens in women a lot. I see in my practice, this becomes a separate, almost endocrine organ and it’s very volatile, it’s unpredictable, and it can just shoot estrogen out at any given moment. You go to the gym, you work out, you sweat, estrogen gets released from that fat, and so what have you got? You’ve got torso obesity that starts to happen. You start looking like an Apple. And so this is a really important thing because again, you’re not going to have those really wonderful hormones that are necessary for sexual desire. If you’re estrogen dominant, you’re going to be crying all the time and crabby and mood swinging and you know, and, and coming into people like you and me and saying, I feel so bad for my family.
Dr. Ewers: I’ve just been grabbing, you know, and my, my uh, libido went off to Tahiti and left me behind. Can you give me some hormones? Well, when, when I hear that, you know, can you give me some hormones when this is the picture that’s going on? My answer is, well, why don’t we take a look and see where your baseline is first? And we do some testing. And if someone’s estrogen dominant, the thing that they need the most is actually to regulate their blood sugar. So, you know, people will come in and say, I read a magazine article, I heard a summit and I think my thyroid’s off and I’ll do lab testing of a three T free, three free T for auto immune markers, a TSH, thyroid humming along perfectly, thank you very much. But they’ve got blood sugar imbalance that hasn’t taken out the fire idea. You know? And so people often will settle on one thing and say this is the smoking gun. But with libido, it’s usually kind of a critical mass story. So there’s more than one thing going on. And finally the straw breaks the camel’s back. And there’s nothing left.
Dr. Joe Tatta: So I think that’s a great review of our kind of hormonal cascade, kind of hormonal cascade. You mentioned earlier, stress and trauma. Um, and those things can really drive your HPA, HPA access to be really out of control. How do we start to talk about people about either past trauma or maybe a current trauma that they don’t actually see that’s right in front of them?
Dr. Ewers: So this is a really interesting and very, very good question to end something that I think is so important to explore. Dr Joe, in my doctoral work, I did a study that was called the healing unresolved trauma study. Hertz study. And the Hertz study was looking at a question I was asking and couldn’t find an answer to in the medical literature, which was every single time someone would come in and say, I have low libido, can you give me hormones? I would ask just a couple of very simple questions like, do you like your partner? Oh my gosh. You be shocked at how many people would start crying, you know, and start saying, well, he or she had an affair several years ago. I haven’t been able to get over it. It’s really gotten in the way. And I see, you know, progesterone’s not going to do anything about that, right?
Dr. Ewers: We’ve really got to get to the bottom of, I call it patching the hole in the bottom of your vote. So I did this study because there was just no linkup between sexual desire and and trauma. So my dissertation title was, uh, the impact of held onto her and female sexual desire. I mean, very specific for this, right? What I found is that yes, you can have something that happens when you’re a child and you set up a meaning to that experience. So let’s say your parents get divorced and children do not have a developed brain yet. It’s not developed till is 26. And even then it’s still evolving. So at 26 years old, we can start using our frontal lobes properly and making executive decisions about meanings around our, our, our life. Right? So as a child, you’re making up meanings from a child brain.
Dr. Ewers: And so often you know the meaning will be, I’m not safe, I’m not worthy. This is my fault. I’m not good enough. And kids will take on those messages. Well then flash forward into adulthood. If you’ve got that belief system set up, these are your self limiting beliefs in every child comes out of childhood with one or two of those, if not more at in adulthood, you start to get set up by attracting people to you that will actually hit those buttons because that’s what our comfort level is, right? So we’re used to, so that button can get triggered again. So let’s say you have a meaning that I’m not safe. So I was sexually abused when I was 10 by the vice principal in my elementary school and I’m not safe was a big theme for me and my dad was in the Navy.
Dr. Ewers: So also kind of some abandonment stuff. So I get into adulthood and if somebody forgets my birthday, I’m like, Oh, I don’t matter. Right? So how often are you going to get triggered and set up this way? What you just mentioned is your hypothalamus, pituitary adrenal cascade of, I don’t matter, sets up that same adrenaline push that it did when you were a kid and this is something that is tiny in comparison to what happened to me at 10 but I started seeing that I got rheumatoid arthritis and autoimmune disease and I was attacking me. I had to look at this and as I was really looking at some of my own self limiting beliefs, I started realizing what they were connected to. And when I did this research, this study showed that yes, this is the way it works and science corroborates it. Our brains actually light up when we’re, when we have stress in certain ways.
Dr. Ewers: And it turns out, Joe, with post traumatic stress disorder or persistent daily stress, the same parts of the brain that light up are the same ones required for sexual desire. So, you know, that’s on pet scans showing that that chronic persistent stress and PTSD both act the same in the brain and they light up and you will not have sexual desire because that’s been co-opted to your survival status was what we were talking about earlier. So really fascinating. I uh, I, I’ve come to this point now where when someone has low libido, I start searching for the mental emotional parts real soon in that history taking.
Dr. Joe Tatta: Yeah. I think it’s key. I, you know, explain it to people that their brain is this like satellite that’s receiving all these impulses and some of those are sensory coming from your body, but a lot of them are actually coming directly from your thoughts. So learning to cultivate a life where you have signs of safety, so you have safety messages in your thoughts and the things you say, your language and even the people around you versus signs of danger. That’s the stress, that’s the negative thoughts, that’s the, you know, catastrophize and things like that. All of those things can really set your nervous system up to be very, very sensitive. And I think we see this, you know, the, the one group, I think of the most of those with fibromyalgia, they have this central processing problem in their brain. A lot of times it’s, it’s, it’s from their thoughts and how it’s kinda driving their entire nervous system.
Dr. Ewers: And I call this hypervigilance of your nervous system, right? So when you’re hyper vigilantly looking, if you’re safe all the time, or if you’re worthy and deserving of love or if you’re good enough, or if people are respecting or viewing you in a certain way and you’re comparing yourself to people you’re hypervigilant and means your radar is turned way up all the time. Well, your nervous system follows, it’s turned way up all the time. And so that sensory intake is too much for your nervous system over a persistent period of time. And so the beauty of that is you can actually down-regulate that. You can change it. And it’s not that difficult if you have the word I use all the time in my writings, willingness, if you’re willing to go there and to really do that work, it doesn’t take very long. But you really do have to be willing to take responsibility and not look for external sources for all of this. I call that kind of the black hole that everyone’s expecting someone else to fill up and that’s impossible. They can’t, you have to take responsibility. You have to do it for you.
Dr. Joe Tatta: So what kind of strategies can we offer people, because we’re talking about, you know, the, the physiological, hormonal reasons, but we’re also talking about the brain-based reasons which is so important. How do we start to address, you know, kind of both of those.
Dr. Ewers: I really believe in meditation very, very strongly. And I think that if you can tone your parasympathetic nervous system, which is the other side of what we’ve been talking about this whole, we’ve been talking about fight or flight, the other side is the side that we nicknamed the feed and breed side, right? So the parasympathetic nervous system is the one that gives the signal to the body. Your brain lets down those neurotransmitters that say you’re in the zone all is well, you’re safe, you know, and now yes you can reproduce even if that’s not the idea, right? That will actually give this the body the signal that it’s okay to release those hormones. It’s okay to stop and have a bowel movement. You know, lo and behold, constipation goes away when your muscles actually relax. And so pain goes away too when you can tone that parasympathetic nervous system.
Dr. Ewers: So tonifying the parasympathetic nervous system. There’s several ways to do that. I’ve got a forgiveness practice and on a recording that I give to my clients, I have an audit agentic training program. I have a progressive relaxation program. I have a meeting, your shadows self program, you know, all of these things and meditation, guided imagery. These are all really, really important. If you’re not doing kick your butt yoga all the time and doing kind of the relaxation yoga that’s meant to get you into your core and into your center and in touch with your breath instead of in touch with your personal record for handstand times. You know, I mean those are all really, really useful. That kind of yoga. I’m a yoga teacher and so I’m kind of being flippant about this, but, uh, there are different kinds of yoga for different kinds of people at different times, you know, in their lives for different reasons. And so, um, the whole eight limbs of yoga includes actual linking with the breath focus and attention and meditation, not just the body work, the Asana practice. And so that if we can spend time every day doing that, it pays off and huge dividends.
Dr. Joe Tatta: Yeah. I mean sometimes instead of a yoga class, I just recommend people just do some restorative poses for about 60 minutes and you don’t have to move. You can just, you know, rest in that position and let your body open up and kind of free itself and a little bit of stress and tension that you’ve carried throughout the day.
Dr. Ewers: Well, one of the things I found with yoga is that, uh, the reason I found yoga is because I was looking for a cure for my autoimmune disease. And I went to my first yoga class cause that’s what the research showed is yoga is good for auto immunity. And one of the things that I discovered with yoga is that you really can start to get back in touch with your body. And I think so often women with low libido and probably men with low libido, my research is in women so I keep talking about women. But this is true for men too is they become self forgetting. They’re out of touch with their bodies. They really disconnected. And I call that the brain being a bully, kind of dragging the body behind. Well the body wants to have its, you know, attention paid to it.
Dr. Ewers: And so when you’re in pain, when your sex drive is low, it starts to turn up the volume. It’s trying to tell you something. This is just feedback. And so you know, in and I or Vedic medicine, which is assist the medical arm of yoga, the sister science. That’s one of my favorite ways of approaching health and and wellness. There’s this understanding that we’re not all the same body type. And so those restorative poses that you’re talking about, there’s actually the right practice for each of the body types. And you know, the ones that are restorative like you’re saying, are grounding. And often when you’re disconnected from your body, you’re kind of spun up. It’s what we call a Vata imbalance. And so those poses that you’re recommending are perfect because that’s the exact answer to kind of ground that spin up, right? Help you get centered. Again,
Dr. Joe Tatta: I think bringing this topic of, you know, the awareness of this topic of libido and pain and the link between the two are very important. I think there’s a lot of fear around the topic there. When people are scared to actually bring it up to a practitioner or to their friends and family people to start to talk about some of these issues cause it’s another science symptom or a root cause of what’s going on.
Dr. Ewers: Well, research actually shows that, uh, physicians and a lot of medical care providers, nurse practitioners in the research are a bit better than physicians. They’re not really trained to deal with these issues. You know, I mean, it’s not part of school. If you talk about sex in school, in medical school, you’re actually talking about the treatment and the recognition of sexually transmitted disease or a contraception. That’s it. So that’s very limiting. When you start talking about libido, it’s, there’s no talk about it unless it’s a symptom of something else. Right. It’s always listed as a symptom, a side effect, you know, of if and when you’re memorizing your drugs, the serotonin reuptake inhibitor, anti-depressant classification of drugs, it’ll say low libido. Right? So low libidos is mentioned all over in school, but not as an entity or a feedback mechanism that we pay attention to the same as blood pressure and eyesight and your weight, right.
Dr. Ewers: We talk about those as these measurements we’re supposed to follow, but it’s not something we ask. So when studies have shown that when people bring up, and it’s women more often than men that will actually have the courage to bring this up in a, um, primary care visit or an LBJ GYN visit or any other kind of medical office visit, they say that only 10% actually haven’t addressed. And of those 10% 1% walk out with something that’s actually mildly helpful because lubricants are prescribed for low libido, that makes no sense. It doesn’t make any sense at all. Lubricant antidepressants right up there at the top of the charts for low libido. Well, yeah, by the time mentions it to their provider, they’re pretty depressed about it, right? Because low libido in a committed relationship actually is a relationship Buster. And dissatisfaction and relationship is the number one cause for low libido in women.
Dr. Ewers: So it’s just like this dog chasing its tail, right? And an antidepressant is not where you’re going to be breaking that cycle. It’s making little libido worse. So what I usually tell people is I say, okay, what I want you to do is be your own health advocate. And there are sex therapists out there now, but they don’t know how to test the adrenal, you know, hypo, the HPA axis system. And so I started the Academy for integrative medicine a couple of years ago and I train, uh, integrative medicine health coaches now. And what I’m doing is I’m bridging that space between psychotherapy and medical knowledge and teaching people how to do that adrenal testing. So I would say find an Academy for integrative medicine, integrated medicine health coach, because they know how to address this. And they will talk about all of those root causes that I was mentioning. And uh, use that as part of the history because psycho therapists are great with the mental, emotional part, right? Functional medicine docs are great with the HPA access, but there aren’t people out there really bridging,
Dr. Joe Tatta: no, it’s true. And I, I used to work with a women’s health physical therapist and you know, she talks to me all the time like, you know, before a patient got to her before it took months for patients to get referred to her, they were offered, like you said, lubricants and antidepressants for, and I’m like, that doesn’t really make a whole lot of sense. Basically.
Dr. Ewers: No, because what’s in your head goes to your bed with pelvic pain.
Dr. Joe Tatta: Oh, that’s awesome. That’s a great tweetable. What’s in your head goes to your bed.
Dr. Ewers: That’s my favorite tweetable and Facebook posts. I want people to really understand that there’s a lot of real estate in between your brain and vagina and it’s all being impacted by what’s going on in your head. And so that, that’s really, really important to remember that what’s in your head goes to your bed. So yeah, lubricants no,
Dr. Joe Tatta: right. The interested in your program, how can they hear about it? And just give us a quick one to how long it is and you know, some of them, maybe modules that you have in it. What’s entailed
Dr. Ewers: six month online. Uh, and it’s on dr keesha.com, D R K E S H a.com. And I’ll have certification. And the aim program is on there. Uh, it’s weekly Q and a. So it’s live Q and a calls every single week. It’s case study based. The modules include first adrenal health, then GI health because again, what’s in the gut also affects your libido profoundly. And we haven’t even touched on that, but we talked about neurotransmitters. These are all impacted by what’s going on inside of your gastrointestinal health. And so we do a huge gut module and then we move on to the food sensitivities and your immune system. Because again, if you’re hypervigilant with your thoughts, you’re hypervigilant with your immune system. So we work through each of those and then we go into the psychotherapy components and the coaching part of this that’s missing in most of the other programs. And I bring in iron Aveda and sexology because I really want, like I said, to bridge these worlds.
Dr. Joe Tatta: Yeah, it sounds really, really interesting. I’m sure it’s great content. So if anyone is interested in doing a really deep dive into women’s health and integrated medicine, functional medicine, check out dr Keesha’s program. Check out her website, dr keesha.com I want to thank her for being on the healing pain summit this year and talking about the link between low libido pain and stress. It’s been a wonderful interview. You have the opportunity to help Kesha spread this message, so make sure you click the like button below, share it out on Facebook and Twitter so your friends and family can access it. And we will see you in the next interview on the Healing Pain Summit 2.0.