Dr. Joe Tatta: Dr. Zaphiris, Thank you for joining the Healing Pain Summit this year and taking the time out to talk to us about opiates. We’re glad you’re here.
Dr. Zaphiris: Thank you so much. Glad to be here.
Dr. Joe Tatta: So just tell us about your practice. If you could first, I understand that you are board certified in integrative medicine as well as you treat a lot of people with addiction problems.
Dr. Zaphiris: I do. I’m actually board certified in addiction medicine and family medicine as well. And so I ended up seeing people who all of those factors interface with, um, you know, we obviously have this huge problem with opiate addiction. I got into it probably about, I first learned about it when I was a resident in Maine, underserved rural medicine. We had a lot of problems with opiod addiction going back over 10 years ago when I was a resident and that’s where I first got exposed to it. And then about four years ago in my practice in San Francisco, um, we started treating patients and it became really clear to me that an integrative approach made the most sense. Um, we don’t have great, you know, there’s not once, once it’s not like an antibiotic, you just give an antibiotic. The infection’s gone. Treating addiction is a lot more complicated.
Dr. Zaphiris: And so I had been treating people with depression, anxiety, insomnia, fatigue, using integrative approaches, a lot of people who didn’t necessarily want to take medication if they could help it. And then I found out when I started treating people with addiction that those people had depression, anxiety, insomnia, fatigue as well as addiction. And so all of those integrative approaches, um, just made so much sense and we were able to start moving, getting people some traction in their addiction treatment. So, um, that’s, I also see people for family medicine and integrative medicine and not for addiction necessarily and people who have pain. I know this is a focus of, of this summit, you know, a lot of people have pain and want, um, you know, other ways of dealing with pain that doesn’t involve more medications. And in some cases that crosses over to become addiction. And we can talk more about that today.
Dr. Joe Tatta: Yeah, I mean it’s really interesting. I have not run into too many physicians who are integrative who are also treating addiction at the same time. So, you know, I think your, your approach is really welcome on this summit. And I thank you for, for being here. We read about addiction so much. No, I mean this year it really exploded as far as the whole opioid addiction. Yeah. NIH and the CDC released some statements around opioids, which were I think helpful in some ways, but I mean, you’re really on the front line, so you’re not a, you know, blog posts. You’re seeing people one-on-one. So tell us how big this epidemic really is and what it’s really doing.
Dr. Zaphiris: Yeah, I mean, part of it is getting fueled by just the huge number of these prescription pills that have gotten out there. We used to think that, you know, uh, less than 1% of people would get addicted to them, which is why they got to be so widely prescribed. Um, probably a variety of factors. Um, some ignorance, probably some positive spin by the pharmaceutical companies, some optimism, but reality is from the latest studies. Uh, look like about 25% of people who are on chronic opiates are going to develop some addiction problem with them. So just with the huge numbers of people, I mean it was 140 million prescriptions of ICANN and were prescribed in 2011 the last date that we had good data for the last time I looked. And so just 140 million prescriptions. I mean there’s only 350 million Americans. So you know, it, uh, at 25% of those people are going to have a problem with it.
Dr. Zaphiris: So the way that I frame it with P for people is you may not know that somebody who has, who this is a problem for, you may not be aware of it, but there, there is somebody in your circle of friends. If you think you have 200, 300 friends in your circle through your community, through your church, through Facebook, probably two or three of those people have this problem. And because of all the stigma and shame, you just may not be aware of it. So, um, you know, we used to have the stereotype of this sort of, you know, heroin junkie on the corner, but, you know, um, my patients who take these prescriptions are, you know, range from, you know, the 30 year old with menstrual cramps to the seven year old with, you know, stable cancer with cancer pain. You know, somebody with chronic back pain, somebody with chronic migraines, you know, it’s a lot of people from all walks of life.
Dr. Zaphiris: Um, it doesn’t discriminate, you know, from rich to poor or urban to rural. Um, you know, so the people who this addiction then is affecting is really all walks of life. And I have 20 year olds, um, uh, you know, young men in my practice up to nurses and computer programmers and, you know, um, it’s not, uh, it’s not something that’s a moral failing. And I think finally we’re starting to get around to realize that this is actually a disease, um, a disease of the brain. Um, you know, certain people have this neurochemical predisposition and we can talk more about that. And, uh, you know, this isn’t a moral failing. You’re not a bad person, you know, this is actually a problem that requires treatment. And, and unfortunately, most of the people in the past, I’ve gotten incarcerated, you know, 80% of people in jail now or in prison or jail for some drug related charge. Um, either selling or buying. And you know, if we actually treated addiction as a medical problem, you know, a lot of those people wouldn’t have ended up, you know, in the criminal justice system.
Dr. Joe Tatta: So you brought up something that was not on my radar. I wasn’t even gonna talk about it on this summit. But, um, you mentioned a nurse being addicted to opioids and obviously how as healthcare professionals, we have our health challenges also. So we find our way into, you know, the medical system just like everyone else does. But in my practice of 25 years, I have had a number of physicians who actually have self-medicated themselves. And at times, you know, it’s, it’s not a, it’s not an easy conversation for me to have as a doctor, physical therapy with a physician about their medicine. But at times, I often wonder how many professionals are actually self medicating themselves and where the danger is in that.
Dr. Zaphiris: Yeah, I mean you have access. So you know, the perfect storm is, um, we can talk about this, the genetic predisposition. So you know, about 50% of addiction thought is thought to be from this kind of genetic risk. So that’s, you know, grandpa was an alcoholic grandma, you know, not just substance use, but alcoholism too, especially, you know, that was the more socially acceptable drug, you know, a few generations ago. So you know, that, you know, genetics are not your destiny. We have this whole thing called epigenetics. And, um, so the genetics are sort of the seed and then it’s, and then it’s the environment as to whether that seed gets planted to grow. So, you know, it’s depression, anxiety, um, underlying, um, trauma is a big one. So either underlying, you know, previous unresolved physical or emotional or sexual trauma and not just for girls, but boys also.
Dr. Zaphiris: So, um, that, um, is a huge contributor, um, in, um, you know, in having somebody have this neurochemical predisposition of business, unresolved trauma on whatever level. Um, unfortunately that’s one of the things that, um, can make that addiction kind of blossom. Um, uh, those are the main things underlying mental health problem and trauma that I’ve seen, you know, also physical pain. So, you know, the other way somebody gets here, you’re a physical therapist, you’ve seen, you’ve seen this lots of times, you know, someone has the failed back problem and they end up, you know, you keep going to the doctor enough times, you’re going to initially get one of these prescriptions because at a certain point it is, you know, there’s not much we can offer some of those patients. And some of those patients unfortunately are going to get dependent and addicted and, um, you know, healthcare providers are not immune to having any of those problems.
Dr. Zaphiris: You know, often, sometimes we go into healthcare because we had our own problem that we have overcome or that we’re motivated to help other people. So, you know, uh, w it’s compounded if you have access. So a floor nurse, you know, who’s constantly having morphine and Dilaudid and Norco and all this stuff in her pocket or his pocket, you know, yes. If you have that other sort of perfect storm of life, circumstance of life, stress, um, it’s, it’s, uh, how are you able to cope with your life stress, you know, so we think about sort of what are the ways that somebody, um, what is it, what do they need to do in order to start healing and recovering? And so, you know, neurochemical imbalance, which is something that I feel like a lot of doctors don’t, aren’t, don’t think about. And from an integrative point of view, we think a lot about.
Dr. Zaphiris: So, um, um, especially with the appreciation that addiction is now a brain disease. Um, so that’s something from my integrative sense that I look a lot of, and diet is a fundamental part of that. Um, and, uh, we use different supplements that we need, um, in order to help the brain have the raw materials that needs to heal and recover. So the way I talk about it with patients and really resonates with people, they can take something that’s not a medication to actually help their brain, um, start to heal and recover. Um, you know, that’s a whole, it’s a whole, it’s not just one thing. We wish it could just be this one thing, but, you know, it’s, it’s, uh, it’s a neurochemical imbalances, having the right mix of diet and exercise for that person. And I know sometimes people have chronic pain and they’re not able to do certain things, but, you know, it’s the starting with what you can.
Dr. Zaphiris: Um, it’s at your, um, you know, those underlying emotions. Um, Oh, emotional problems, depression, anxiety, inability to tolerate stress or distress and sort of what that was the thread I was going back to. Um, you know, what’s your community, your support, who’s in your life, who loves you and gives a shit about you, you know, those are the people that are gonna help you walk this path. And then what’s your life purpose? What’s your, what drives you, what motivates you? What inspires you? You know, when my patients get all of those boxes lined up, all of those check boxes, then I know they’re on the road to recovery and it’s, um, it’s, you know, it’s a path and it requires daily, um, daily practice. Really it’s a practice. So, you know, unfortunately health care providers aren’t, um, in your, to any of this stuff and because we have access to, um, all of these medications, unfortunately we end up right there with, with com with our patients. Unfortunately.
Dr. Joe Tatta: Yeah. I mean I think the integrative approach to, you know, getting out of addiction is very similar to the approach it requires to get out of chronic pain. Absolutely. Not just one thing, but it’s a functional or integrative approach that, you know, it takes you and your specific case or your pain experience into consideration. And some of the things that one person might need may be very different than, than someone else. But you know, one of the questions I have for you, and I think people would love to hear you, maybe talk about or just maybe comment on, is, is there a place for opioids in pain treatment or should we just pull them off the market? 100%.
Dr. Zaphiris: No, I think, I don’t think that’s realistic. Um, you know, a lot, they do help a lot of people and some people do need to take them on a regular basis. So this question, people ask me, you know, if I take them every day, is my doctor prescribed to them? Am I, am I addicted? And you know, not necessarily. I mean, if you, you know, the challenge is, uh, it’s very easy to get tolerant to a tolerant means you get used to taking eight Viken in a day and now eight doesn’t work anymore and you need to take 12 or 14 or 16. Or the patient I spoke with the other day is on 800 milligrams of oxycodone a day and that would kill anybody else. But he’s gotten there gradually over 15 years. And, um, you know, that’s, that’s the amount that he’s taking.
Dr. Zaphiris: So, um, uh, you know, if you’re taking the medication as prescribed and it’s working for you, great. Um, but it’s a slippery slope and now you have this bottle or these bottles in your house and that is an invitation to anybody walking into your bathroom, you know, your 14 year old nephew, son, grandson, you know, teenagers or want to experiment. Um, it’s their nature. Um, and um, the best thing we can do is to not give them access to it. So, um, you know, over 50% of people who use opiates get them from a friend or family, either knowingly or unknowingly. And so my public health kind of, you know, my heart goes out, you know, as a family doctor and I see, you know, young kids in my practice as well and you know, what can we do to prevent, you know, this path for, for our young ones. And, um, I think, you know, if you are taking these medications, please put them away, lock them in a box and only you have access to, um, because the least likely person who you would expect, um, you know, may have this problem. And that is such a temptation for them if they’re actually trying to stay in recovery or for your teenager who you know now is, you know, curious about what that might be like. So
Dr. Joe Tatta: yeah, that’s a really great point. Um, talk to us about brain chemistry. A lot of people on my summit are talking about the brain cause the brain is actually what causes pain for your, your brain outputs, pain. Um, it’s the source of all pain. But what do opioids do on a neurophysiologic basis to the brain? Spinal cord, central nervous system.
Dr. Zaphiris: Yeah, it’s really interesting. So, you know, we all have dopamine. We all have serotonin, epinephrin and norepinephrine. Um, Gabba and endorphins. Those are all of our kind of the main neurochemicals. Um, Oh, we should just note opiates. Probably people know what opiates are. Um, but we should probably just be transparent about that too because we use that jargon around this medical people. So we’re talking about meds like Percocet, Vicodin, Norco, oxycodone, morphine, um, Dilauded, Demmer, all, all of those. And plus heroin, that’s also an opiate. So, um, those are the kinds of medicines we’re talking about. Um, just just so that we’re really clear for people. So, um, we have our own natural, uh, all those neurochemicals. And you know, when you see a friend you love or, um, you know, hug a baby or pet a dog, we get a burst of these natural chemicals and makes us feel good.
Dr. Zaphiris: When we take one of these pills, it’s like an Inn or a Norco or oxycodone, and we get a huge rush of dopamine in particular. It makes us feel good. It makes our pain go from a 10 to a zero. Gosh, it’s impact rate. It is great. We get this huge rush of dopamine that over time will actually start to turn down our own receptors in our brain because our brain sees this huge flood from the outside. It says, Oh, well I don’t actually need to make any of my own anymore cause I’m getting this huge hit already. And so our own receptors just, they call them, they call down-regulate it. They just sort of, they just started disappear over time. It takes weeks to months for them to just go away with chronic opiate use. When we’re using our, we get that rush of dopamine and we also get a rush of serotonin, which is that feel good.
Dr. Zaphiris: It’s our natural antidepressant, natural anti-anxiety. And um, if those medicines go away, now we S we stopped taking them after we’d been taking them for a few weeks or months. Now we’ve gotten dependent. So there’s difference between dependence and addiction. You could be taking a, if I could in a day, just as your doctor prescribes, but if you stop taking them after two or three months, you will likely experience withdrawal. You’ve been, your brain has gotten used to taking them. So what’s withdrawal? You feel anxious, your muscle pain comes back 10 times stronger. You can get nausea and diarrhea. You can’t sleep. This is all from the of epinephrine and norepinephrine adrenaline. So when those, that, that dopamine little spiker, that opiate, it’s not there anymore, not only is your own dopamine has gotten turned down, the serotonin has gotten turned down, now your epinephrin surges and then you feel withdrawal and that lasts for about a week.
Dr. Zaphiris: It’s pretty crummy. Um, and then there’s something called post acute withdrawal syndrome, which can last for weeks to months. And that’s where it takes weeks to months for those, those dopamine receptors, those serotonin receptors to get rebuilt. One at a time back online because they have gotten sort of, they had gotten turned off and so we wish you would be just like a light switch that we could just switch, flip the switch and back to normal off the bike and back to normal. But there’s this thing called post acute withdrawal, which is you’re out of the acute part but you just feel bad blahs. Your pain is bad and you’re depressed and you have no energy and that’s from your brain is no longer used to. It doesn’t have the opiate that had been used to getting and it just needs some time to rebuild.
Dr. Zaphiris: And that’s again where an integrative approach is. It really well suited both diet and the right activity and the right supplements to help give your brain the raw materials it needs to start making the serotonin and the dopamine and the epinephrin and the GABA and endorphins, all that on your own again. So we want to just help you know, bridge people through that period of time. You know, there’s some other things from an integrative point of view, we think about you and I talked before, low dose naltrexone can sometimes help people if we sensitize as the opiate receptors can. I’ve been treated patients with fibromyalgia successfully with that medication and we’ve been able to get her off some of her prescription. She’s now off Ambien and she says, I have no pain. I can’t believe this off. The ambiance seemed to have been doing something to centrally sensitized.
Dr. Zaphiris: So that’s a phrase you might hear. That’s where the pain now has gone, kind of entered the central nervous system and the central nerve, it’s like, it’s like this, it’s like all awake ready. It’s like prickly. It’s like it just takes a little something and your nervous system feels a lot of pain. It’s the central part of the nervous system sort of becomes hypersensitive the way that I kind of think of it. So low dose naltrexone can be a great tool. Um, we think about hormone balancing. So longterm use of opiates can decrease testosterone. Um, and both men and women have testosterone. So sometimes, you know, if you’re, if you have a lot of muscle pain and fatigue and chronic pain and you’ve been on opiates for a long time, maybe having your hormone levels checked and treated if they’re very low can help, um, boost you a little bit. So we were talking about how do we make you more resilient so that we can get you off these prescription drugs if that’s what’s necessary.
Dr. Joe Tatta: And just talking from an integrated perspective or a functional medicine perspective, what opioids do to the gut. And are there receptors there? Is it picking up, you know, the medication not only centrally and your brain and spinal cord, but is it also affecting other parts of your body?
Dr. Zaphiris: Yeah, there’s a lot of serotonin receptors in the gut. Um, the vast majority of people who take chronic opioids will get constipation, slowed gut motility, which often then causes gas and bloating and abdominal pain and all the rest. Um, we know that ensades cause leaky gut and intestinal permeability. I actually have to check and see if that’s associated with opiates. Um, all the Tylenol, we don’t love what that does with the liver. Um, um, in terms of, um, impairing detoxification, um, which is what you need if you’re, um, and taking all of these medicines. Um, do you know off hand if opiates also cause intestinal permeability? Has that been fleshed out?
Dr. Joe Tatta: It’s a really wonderful question. I’ve done some research myself and the intestinal permeability issues from opioids are typically, so not direct like an EnSite direction lining, you know directly, but the opioids since the transit time slows down and then you have toxins kind of brushing up against the border of your small intestine or your large intestines just for a longer period of time. So you know, they both can cause leaky gut. The mechanism is slightly different. That makes sense to me. Yeah. I mean ultimately if you’re not having a bowel movement once every three days, which is not sufficient, then you know both toxins in your food and the toxins in your gut don’t get cleared as fast. So you have that IP issue, which can be a problem for many people and create a whole nother different inflammatory cascade.
Dr. Zaphiris: Yeah, I mean if anything I think about the stress of chronic pain or the stress of addiction also causes there to be an imbalance in the nervous system. And if you don’t have enough of the parasympathetic nervous system, then you’re going to have what’s called dysbiosis. You need enough, you need enough of that good bacteria to be there to be the kind of terrain so that other opportunistic bacteria don’t come in there or yeast don’t come in there to kind of taken, take up the space. So, um, almost certainly all of these patients have some degree of dysbiosis. And so yeah, making sure that you’re drinking enough water and having enough fruits and vegetables and fiber that you’re, you can eliminate regularly and good doses of fermented foods and or probiotics. Um, I think just make rational sense.
Dr. Joe Tatta: And what kind of supplements are supportive for someone who is, is weaning themselves off an opioid?
Dr. Zaphiris: Yeah. Yeah. So there’s a few, uh, a few options. Um, so I think about all the amino acid precursors to help, um, give those raw materials. So amino acids come from protein in our diet. So the first thing is having enough protein in our diet. And um, some people aren’t used to eating protein in the morning, then maybe a protein shake. Um, sometimes we use, um, amino acid, um, blends. Uh, but if my patients are eating enough protein in their diet, and then that’s not necessarily necessary, um, most of us aren’t having a good balance of fats. I’m not eating enough. If we’re eating a diet high in processed food, then we’re not getting those good healthy fats or brain needs saturated fat as well as I may get three, six and nine. And, um, most of us, you know, if we’re dealing with pain, you know, we’re more on the inflammation pathway then, you know, especially in those situations, we want more of Omega threes, which are naturally anti-inflammatory.
Dr. Zaphiris: So lots of wild salmon. I try to do food as medicine first and not necessarily give people a bunch of pills, but you know, so diet is, you know, is food as medicine. You know, Hippocrates started at all with that. So, you know, we tried to get people to eat real food and, um, as a, as the first priority. So, but, uh, fish oil for sure. One that’s, um, molecularly distilled or you know, refined in a way that we know that doesn’t have any mercury in it. That’s an issue with some larger fish. Um, vitamin D, most people are deficient in vitamin D depending on what part of the country you live in. And um, I aim for vitamin D level of 60, 70, 80, something in that range, which most of us aren’t at unless we live in Hawaii. So, um, low vitamin D is associated with chronic pain as well as depression, high blood pressure, diabetes, all the rest.
Dr. Zaphiris: So especially with the chronic pain people, um, thyroid, I think about that. I’m not a supplement, but I’m making sure your thyroid is maximized and dialed in. Um, a relatively underactive thyroid can contribute to chronic pain. Um, you want to make sure the bees are all dialed in. So learning about 30% of people have a methylation defect. So, um, now we can start doing genetic testing on people looking for something called MTHFR, which people may have heard about. And that’s the final step in converting the B vitamins from the inactive to the active. And about 30% of us don’t have that little enzyme to do that last step. You need active B vitamins in order to make all the neurotransmitters we just talked about in order to make hormones in order to detoxify from the whatever you’re taking medication wise, whatever you’re experiencing from the environment.
Dr. Zaphiris: So super important is to have enough B vitamins. Um, this is a huge area now and kind of integrative functional medicine is thinking about, well how many bees do you need? And this is an area that a lot of people have a lot of different opinions about and I think is still getting flushed out, but at least taking kind of the basic amount that you would from a multivitamin as an activated B. So it might see, you might see the word methyl methyl cobalamine or methyl folate. And then I think about all the other BS because if you’re low in B12, you’re probably low in some of the other ones. Cause these guys all check the travel as a pack. So I think about that. And magnesium is, you know, a lot of, so you wanna think about also what medications am I taking? And now you can actually start to look up online and say, Oh, I’m taking this medication.
Dr. Zaphiris: And this medication, for instance, private sacrum medicine, a lot of people take for their stomach acid depletes B 12 and magnesium. Look at that be 12. Again, magnesium, low magnesium associated with chronic pain as well. It makes it hard to sleep. So I know if you’re trying to get off opiates, you’re not going to be sleeping. So this particular formulation of magnesium called neuro mag magnesium L three and eight, which, um, they, they’ve studied and it gets into the brain more than magnesium citrate or magnesium oxide or one of the other magnesiums and it’s less likely to cause diarrhea then, which is a problem that a lot people can’t tolerate taking magnesium. So I think about that. Those are probably some of my favorites just off the top of my head. Um, but we tried to do food as medicine first. Um, and um, and then the, and then the amino acids as you need them.
Dr. Zaphiris: Um, a good multi too that’s kind of fills in and NSL sustain. So we’re talking about glutosiome so I think about, you know, you’re detoxing and we want to kind of help your liver process all of this stuff. So one of those met supplements is called N-Acetyl cystine or lyposomal glutathione. You may hear about that. So some of these are things that help your body kind of work better. And the other one, the other stuff is stuff to help your body, um, have the precursors or it needs to start making some of those neurotransmitters. So most of you know that acute withdrawal period and then that sort of more chronic, um, post acute withdrawal. There are a lot of people can have, you know, a lot of times we use a medication Suboxone, sorry, just to jump in on that one. Um, and that’s a medication that works really well with people with chronic pain than I, I just don’t want, I don’t want to be remiss in not talking about that for a moment because I’m, it’s also called buprenorphine.
Dr. Zaphiris: And so that medicine is a partial opiod agonist and it works really well. Um, it doesn’t have that tolerance effect that oxycodone does, for instance. And so a lot of my patients who have chronic pain that isn’t either isn’t being controlled or they’re starting to kind of cross over to addictive patterns with the medication. Um, they’re getting it from more than one doctor or they’re taking more than they’re prescribed. They’re taking it for other times besides just for their pain, you know, those kinds of things. Then I think about buprenorphine or Suboxone and that medicine is really long acting. So it helps kind of be even, and what I found with my patients is oxycodone may take your pain from down up from a, you know, from a 10 down to zero. But the problem is it only lasts an hour or two and then it comes back and they used to take more and you end up doing this sort of yield yoyo Suboxone, um, takes the pain generally down to a three or four.
Dr. Zaphiris: So it doesn’t take it down to zero, but it takes a low enough that it’s not what you’re thinking about. So you can move on with your life, you can go do your daily living and go do your shopping and take care of your kids and all the stuff and the pain doesn’t stop you. So the vast majority of my patients feel normal on it. They don’t feel doped up. There’s a lot of kind of Crow, you know, conflicting information online about Suboxone or buprenorphine. And I just feel like I want to put out there that it helps many, many people get off the roller coaster after addiction and as well as treat chronic pain. And it’s a great option for many people as we’re thinking about for yourself, if that’s an issue for you.
Dr. Joe Tatta: So you were talking about food as medicine a couple of minutes ago. So, you know, when we’re talking about diet, there are many different types of diets as I think probably some of the more common ones are the Mediterranean diet and elimination diet, the paleo diet, and all their versions, a ketogenic diet. Is there any one diet that you’ve used that has really helped, um, addiction, you know, overcoming addiction? Or is it really just dependent on who you have in front of you?
Dr. Zaphiris: It’s kind of dependent. I mean, in general, moving somebody towards an anti inflammatory diet. So away from McDonald’s and processed food, no offense to McDonald’s, but, um, fast food, um, sodas which have 13 teaspoons of sugar in each candle. Coca-Cola, which is, you know, inflammatory. So, you know, if you’re already an inflammation is kind of the, um, the lens now with which our generation of doctors is looking through all these different health problems. So diabetes is now inflammatory. Depression is now thought to have an inflammatory root. Chronic pain is inflammatory. Alzheimer’s is really inflammatory now. So almost every cancer is a flounder. So every disease has its inflammatory nature. So you know, any diet that is an anti inflammatory diet will be healthy, you know, move your towards the direction of health, you know, in your overall life. So foods that are inflammatory are sugar, highly processed, white flour, um, and these kind of trans fats, kind of bad fats.
Dr. Zaphiris: So any diet that moves you towards a whole food based diet, chicken, fish, some red meat, um, lots of vegetables, some whole grains. What’s a whole grain? So it’s like Keane was a little bit of rice. Um, you know, some of these kinds of grains that are, um, you know, some grains are okay for some people. And there’s some people who can’t eat any grains because their rheumatoid arthritis gets much worse. So, you know, this is where we kind of individualize. Um, but some people may not need to go on an autoimmune paleo diet and maybe just eating more Mediterranean. It helps them feel well enough. And you know, I, you know, I’m a family doctor. I treat along the whole spectrum. So I don’t want you to just be better. Now I want you to be, find a way of eating and living that will let you, you know, live longterm your life.
Dr. Zaphiris: So the problem with some of the, you know, elimination diet, people think they need to eat that way forever. And it’s just meant to be a temporary thing as an experiment to see, you know, what, if you eat super clean for a period of time, kind of clear the slate and then add back in one food at a time. You may actually learn for yourself how each of these foods make you feel. And so that can be a great experiment if somebody is at the place of their life where they can organize, you know, to, to do that kind of experiment. Um, so you know, in general it’s moving towards a whole foods based, um, diet, organic when possible. I’m at least avoiding, you know, the foods that have the highest amount of pesticides just cause there’s one more chemical that your body has to deal with. Yeah.
Dr. Joe Tatta: So as a primary care physician, um, you often see pain as the number one complaint. So people coming into your office and not people who are addicted, but just your normal patient population. A lot of people come in, they complain of whether it’s back pain, knee pain, joint pain, um, you know, multiple pain types of syndromes. What are your top three recommendations for someone who may be watching, who is not on opioid, does not want an opioid, but wants to say, Hey, what do you, what is your recommendation to help me alleviate my chronic pain?
Dr. Zaphiris: Chronic pain? Well, it depends what the etiology is. Um, um, you know, I see a lot of people who come in for this or that before it because as a primary care doc, I get people before it becomes chronic pain. So, um, you know, it’s much easier to treat something before it’s long lasting. So I also do osteopathy, which is a kind of manual medicine. So we use our hands to analyze and diagnose and treat people through the musculoskeletal system. And, um, many, many times, uh, you know, after assessing somebody with an osteopathic kind of lens, you know, um, I’ll find that, um, you know, they’re, they have flat feet when they have flat feet, they internally rotate at their hips and it contributes to knee pain. Super common, you know, or they have really tight. So as, and so their glutes aren’t um, working and so the lower back muscles are doing the lion’s share of the work.
Dr. Zaphiris: And so some specific targeted exercises to help them kind of undo those, um, muscle firing patterns. So I’ll often do an osteopathic kind of check in to see kind of what’s going on. And often there’s something easy, um, you know, that can be addressed early, which is really nice. Um, you know, once somebody gets to the point of chronic pain, then you know, are these things called visceral somatic reflexes and Somat or visceral reflexes, which is, you know, um, when you have pain, the muscles tighten the muscles, tighten blood flow out of those areas is limited. So then you get, you can get low back pain with constipation even if you don’t, not on opiates because now the blood flow to the intestines is less than this. Less function in the less functional motion and the intestines cause your back muscles are all seized up.
Dr. Zaphiris: So, you know, we treat what we find osteopathically and often the patient gets better. So even if you have chronic pain, I think, you know, osteopaths, the sort of the hidden gems is what we call them. You know, most people don’t find their, they don’t see an osteopath first. They go to an osteopath after seeing three, four, five, six different people. And often finding someone who’s trained in cranium, particularly cranial osteopathy, which you can through the cranial Academy website, um, uh, often can make a really big difference in people who have either acute or chronic pain. Um, by addressing those, um, mechanical strain, strain, asymmetries compressions, restrictions in a way that, um, other modalities tend to not be able to, um, address. So I love, uh, osteopathy for chronic pain. Um, um, it often has been able to help people where, you know, the traditional approaches haven’t, um, I think about diet, um, going back to diet and we talked about that at length.
Dr. Zaphiris: Um, you know, um, the basic one is the, you know, smoking. I know, I, I, you know, hopefully most people are moving past that and getting help with that if they’re not. But smoking is one of the worst things for chronic pain. So, um, just to sort of state the obvious, but I know that’s a really hard thing to break. You know, it’s an addiction and I know it’s really hard, but some of the amino acids and some of the other stuff we talked about can help. Treating underlying anxiety can really make a difference with quitting smoking, which is really probably still the best thing you can do for your health. You know, think about some of those nutrients, the vitamin D deficiency in B12 we talked about fish oil. Um, excellent. So I think you’ve, you’ve given a number of strategies that are extremely helpful to, with chronic pain.
Dr. Joe Tatta: Um, if they want to learn more about you, how can they find you both in your practice and on your website and tell us about some things that you have going on.
Dr. Zaphiris: Thanks. Yeah, my office is three, six zero dash M D like medical doctor and.com, and that’s my office in mill Valley, California, just North of San Francisco. And, um, I also do something called medical advocacy, which is a way to help people, um, uh, outside of this immediate geographic area. And it’s a way to, I’m not actually taking over of your medical care, but to help people who have either complex medical problems, um, or medical mystery cases, um, you know, have, be a fresh set of eyes and I’m really widely trained and I have a lot of different points of view and can go on pub med and find the latest and who’s the expert in this and that. And so I’ve started doing more work like that. And so that helps me have a wider reach and take care of people beyond just this geographic area as a medical advocate.
Dr. Zaphiris: So that may be of use to some people listening to this summit to have a doctor with fresh eyes. Take a look at their case. Um, I also have an online education and support program, particularly around people in recovery from addiction and that’s called recovery superstar.com recovery superstar.com. And I had my big class so we just ran this last year and getting ready to give up and do another one. Probably it’ll be 2017 cause I’m moving my office now and get a few projects that people can sign up there on the website, recovery superstar.com and then, um, when we announced the next class they’ll get an email.
Dr. Joe Tatta: Great. So I want to thank Dr. Zaphiris for being on the healing pain summit this year. I think she has a really great message and the integrated approach to helping people with opioid addiction is really key. So please check out her website, check out her online program. You have an opportunity to help her. So make sure you click the like button below for friends and family on Facebook and Twitter and check her out in the Healing Pain support group online and we will see you in the next video. Thank you.