Season 1 Episode 7 of Quiet the Diet Podcast with Michelle Shapiro, RD
How Trauma Affects the Body with Dr. Robert Kachko, ND, LAc
In this episode, Michelle sits down with her long-time friend and mentor, Dr. Robert Kachko, a Naturopathic Doctor and trauma-informed practitioner. They dive into what trauma is and how it affects the body both physically and mentally (in ways we may not even be aware of!) You’ll learn about reconnecting your mind and body, and how the two may have become dis-connected in the first place. They discuss:
- What is trauma-informed medicine?
- The difference between stress, anxiety, and trauma in the body
- How trauma can manifest physically (think: IBS, joint pain)
- The cellular/ biological impact of trauma
- How to integrate trauma work into talk therapy and other therapeutic modalities
- Mind-body reintegration
- Simple steps to take (today) to increase your body’s resiliency and calm the nervous system through breathing techniques
I know I don’t have to tell you this but this post is only for educational purposes. It is not nutrition or personalized medical advice. We want you to get the most from the episode but to keep that in mind as well and we really hope you enjoy it.
How trauma affects the body both physically and mentally
Michelle Shapiro
If you’ve been listening to other episodes of the podcast, you know at the beginning, I always go into how excited I am for the guest and I mean it every single time but I’m not being hyperbolic. When I say the guests that I have on today. It has been the most influential in my personal health journey, my professional journey, probably of anyone I’ve ever met. So I am so excited to introduce all of you to Dr. Robert Kachko, he’s a fantastic trauma informed naturopathic physician.
And our story started with a personal health journey which we’ll go into he was literally my doctor and I through complete coercion made him one of my closest friends and colleagues. And we co created anxiety proof which is our eight week online self study program to help people through a naturopathic and functional nutrition. And for in his example, medicine and supplement lens, heal their anxiety from the bottom up. So not only the mindset strategies to help with anxiety, but also the physiological strategies. If you listen to episode two with Amanda, we really focused on anxiety. From a mindset perspective, we talked about what happens inside of the body during a panic attack during prolonged stress.
Today, we’re going to take the kind of lens of talking about trauma in addition to stress and anxiety, which we’ll We’ll also touch on in this episode. But if you haven’t watched episode two, I really, really recommend it. And these two episodes are going to be a little bit different in that Dr. Kachko. And I kind of go into again a little bit more about trauma’s effect on the body. And I find that trauma is such a buzzword right now it seems to be kind of like I make this joke that at the root cause of everything is either mold or trauma. It seems to be our answer to everything. And I think that instead of making these kind of broad, sweeping generalizations that everything is trauma in the body, and there’s nothing we can do. I think it’s better to look at it from a really understanding, compassionate and of course, nuanced ones.
So I’m hoping to bring a little bit more tangibility to the conversation of trauma for people as opposed to kind of like I’m hearing on all social media platforms right now. It’s just like everything’s trauma in the body. You know, I wanted to bring Dr Kachko on to really talk about what that means for you, in a real way, not just this conceptual way. And I couldn’t do with anyone else besides him.
Because again, we co created anxiety proof together, which you can still join, by the way at the link below in the show notes. I feel like anxiety proof was the culmination of in some ways, both of our life’s work because we after a cumulative about close to that, I’d say 20 years of experience between the two of us, we did find that at the root cause of much of chronic illness was on checked or unnoticed stress. And again, it’s so catchy to say you know, meditate and do all these things.
But what it really looks like for people is that their lives become something that feels like it’s not theirs after some point because of stress. And we get to this this point of burnout, where our physical selves start to send us all these signs and symptoms and it’s really after quite a while of unacknowledged stress or trauma. And I do believe and I know Dr. Kachko believes that there is so much healing that can be done on either from a mindset perspective, you know, a top down approach with anxiety, and stress and trauma, or a bottom up from the physiological up. And for that reason, I am very excited to share this episode with you. I just yeah, I’m so freakin excited and joy
Michelle Shapiro
I have the absolute honor and joy to be sitting down with one of my closest friends and my probably favorite practitioner of all time, Dr. Robert Kachko, I can’t believe you’re here today. That’s a lot of pressure. Yeah, the goal was to put a tremendous amount of pressure on you and squeeze as much information out of you as we can, we’ll see what happens exactly. So I have told our friendship story, our let’s call it a hero arc of our
Dr. Robert Kachko
pressure for you this time, exactly, of how we
Michelle Shapiro
came from literally being in a doctor patient relationship, and now ending up being super close friends, and I would say best friends, and also having a tremendous amount of collaboration and the work that we’re doing and the work that we do with clients. So I went to Dr. Kachko, because during the time I was a patient, this was during my anxiety part of my journey when I had, you know, already implemented a lot of things to help myself and I would say it was about 70 to 80% better from the interventions I put into place and came to you and really took me to that, you know, finish line, so to speak.
And in our first session, which was a 90 minute session, what are we talking eight years ago, or something like that was the first time that the light bulb went off in my head. And I was like, Oh, this is what coaching is, this is what medicine is and felt like I understood for the first time what I wanted to turn my career into as a dietitian. And you are, of course, you’ll have heard from introduction before you are a naturopathic physician. So we’re going to talk about what naturopathic medicine is. But so much of my healing journey, and my practice is dependent on the work that you’ve done and our friendship. So just thank you for that.
Dr. Robert Kachko
Thank you for coming in that day and for forcing me to be your friend. Exactly.
Michelle Shapiro
Yeah, that was really the more of what happened is I was like, Oh, it’s so weird that you think you’re my doctor because we’re best friends and business partners. And we ultimately ended up making an eight week online program anxiety proof to help people reverse panic attacks and anxiety. We’re definitely going to talk about that. And a little trauma, a little stress, a little anxiety, and really some tangible strategies for people today. So welcome. That was a very long introduction. How you doing?
Dr. Robert Kachko
Thank you for having me. I’m just I’m just enjoying listening
Michelle Shapiro
To your own story of your life. Tell me more. Exactly. So, recently, you have shifted your naturopathic practice to kind of incorporate a really trauma informed lens into your business. Can we talk about what led you to this shift? And then we’re gonna walk it back to naturopathic medicine on a general level. But I want to talk about a little bit about what that shift was for you.
Dr. Robert Kachko
Yeah, well, I think in a word frustration, because you go through naturopathic medical school. And basically, for people who aren’t familiar with naturopathic medicine, we’re talking about holistic primary care, it’s about taking a comprehensive view of a person’s health. And in, you know, in practice, you really want to help people and you use all the tools you can. And I had this issue, especially early on in practice, where I tried to do too much. And I was putting them on all these protocols, dietary recommendations, lifestyle changes, helping them with stress, and people got better. People got 50% better, they got 70% better, some people didn’t get better at all. Some people got 100% better. But what I found was the people who struggled to find full, sustainable, vibrant health had something else going on.
And so it just, it required asking the right questions required asking about the environment within which people lived, where they went back to, you’ve heard me say this phrase that it’s hard to heal within the environment within which you got sick. And so if you’ve got, just a couple of days ago, I had a mom of four, who just doesn’t have time to take care of herself. She has early childhood trauma, she has trauma from past relationships. And then in this moment, she doesn’t have the space to take care of herself. So I started understanding that I can make all the best recommendations possible, she can make all those changes, as you know, she can make dietary changes for a month or two months. And then life goes back to normal goes back to that baseline.
And so I got more interested in resetting that baseline. And in my experience, we have to consider three factors. To do that. We have to consider the person’s biology, right. That’s nutrition, that’s lifestyle. That’s the biochemistry and physiology. We have to consider their ecology. That’s the environment I was talking about. What are their relationships, like? What exposure to they have to environmental toxins, but the most important piece that I found was, we have to consider their biography. What happened to them what was the story of their life was the narrative arc of their lives? And when I started asking people these questions, it was just impossible to ignore that pillar of long term sustainable health.
So that sent me on a journey to do all kinds of trauma informed training, somatic experiencing which we can talk about hypnotherapy, we use acupuncture in a very trauma informed way, of course, all kinds of counseling and things like that. And what we try to impart on patients now in our clinics is that we have to address both, we have to walk both paths, right, first of all, they’re coming in not for therapy, they’re coming in to see a doctor. And so they want to address the physical causes of their challenges. But we also help them understand that we have to address that what happened to you challenge, whether it’s it’s big T, capital T trauma in the body, or sort of the smaller stressors that happened during the person’s life.
Michelle Shapiro
And I think, you know, when I think of functional medicine, or I think of naturopathic medicine, one of the first things that come up is this idea of, like, the timeline of someone’s health, right, the story behind their health. So it does feel really challenging to support or treat a person without understanding their biography that like exactly like you said, I think that’s like the, like an essential part of functional medicine that’s often missed. Recently, I think people are really more into like, hey, what supplements can I give you? How can I inject you with something cool, a cool new cutting edge drug, but the missing element is really that biography piece and for you felt like you were able to incorporate that biography, but now using a trauma informed lens, Does it feel like you can add more support to that to with what you’re learning? Yeah, so
Dr. Robert Kachko
both approaches, they potentiate each other. You know, the reason most, whether they’re holistic providers, or conventional providers, we can call it functional naturopathic integrative, whatever you want to call it. The reason we tend towards things like vitamins and injections and IVs. And all that kind of fancy stuff, is that it’s much more direct. It’s, it’s in many ways, it’s so complex, but it’s much more linear, it’s much more understandable. And it’s also much more marketable, because who really wants to face their pain, right?
And so that is something I think that’s missing in that world. But again, I would offer you have to do both. And so yes, the, let’s just take an example, I think that’ll paint the picture more, someone comes in with irritable bowel syndrome, IBS, 80%, of people dealing with IBS. First of all, you have to rule out all the other true causes, right? It’s a diagnosis of exclusion, most of the other factors are not excluded often. But we have to work on their gut. And if we can get them to be less anxious, and to sleep better, and to face their trauma, their body healing is potentiated that their gut healing is potentiated we could talk about mechanisms and how that happens and why that happens.
But the bottom line is, if we look at the statistics, with IBS, let’s just use that example. Again, 85% of people dealing with true IBS, when everything else excluded, have dealt with some form of early childhood trauma the affects the body. And so we’re ignoring this whole subset, a majority of that population, if all we’re doing is saying, Well, we’re going to send you for a SIBO test. And you know what, everything else doesn’t work, we’re gonna put you on an antidepressant, there’s an understanding that the mental health component is, is valuable, but that’s just an insufficient, you’re bringing the wrong tool to that to that aid,
Michelle Shapiro
or whatever it is. Yeah. Would you say that it is? Impossible? This is like a hard theoretical question. But would you say it’s impossible to heal without facing the trauma that’s affecting the body, either big T or, you know, stressor, element of your life?
Dr. Robert Kachko
I wouldn’t say impossible, because that feels disempowering for people. I think that what’s important is understanding, first of all, how we define healing as our first step in that, right, what’s the operative definition of healing. For a lot of people, it’s being symptom free. But if true, healing is feeling connected to purpose and feeling connected to the people in our lives, and feeling pain free and not having the symptoms and feeling like you wake up every morning with vibrant energy, I do think that it would be necessary to face those things. That said, our body, our nervous system tends to heal sort of, by example, examples of, let’s call it safety.
When the body feels safe enough to move forward, that healing happens, it’s not in the therapy session, or in the session, doing trauma work. It happens in every single moment in your life, when you feel supported, and you feel like you have what you need. So in healing up someone’s digestive issues in finding the root cause and discovering that physical challenge, true healing can happen because the nervous system takes that and says, Okay, we can be okay, we can be safe. That thing that I’ve learned to do to protect myself, and let’s talk a little bit about what I mean by that. That’s gotten me this far. And maybe I learned to do when I was 12 years old, and I had a disordered eating pattern or whatever else. That thing no longer serves me because I know what it feels like to feel okay now, and so you can heal in that way as well. So it’s not that you have to go do the very difficult work of facing your pain from your past life experiences. But again, it certainly potentiates the work
The biological process of storing trauma as a survival mechanism.
Michelle Shapiro
and do you think that there’s because there’s something in what you said that I want to elaborate on? Do you think that there’s a way that a state of stress becomes a new norm for people so that also becomes hard on a neurological level, a nervous system level and also in like a, you know, just our behavior level? Do you think that that happened?
Dr. Robert Kachko
Yeah, in many ways, we have sort of different physiologic set points. So the most probably direct ways to describe sympathetic and parasympathetic balance, people have heard of the autonomic nervous system also consider the automatic nervous system. These are processes that are always happening sort of at odds with each other where we somewhere on this balance of full sympathetic, sympathetic being fight or flight, people have heard of it that way more, or parasympathetic people hear about it as Rest-Digest basically physiologic function happening the way it needs to when we’re not focusing on running away from I think you’d like bears, right? That’s, yeah, like they’re running when they’re, when that happens, for long enough, and again, either an extreme trauma, we don’t have the resources in the moment to deal with. And we’re stuck in a state of called what’s called tonic immobility.
Again, we can talk about that. But in extreme situations, or chronic stressors throughout life, our physiologic setpoint changes. As a result of that our hormonal pattern changes our production of things like cortisol and our thyroid production, all of our sex hormones, estrogen, progesterone, and men, testosterone will plummet when that happens, our inflammatory cascades change as a result of that, our neurotransmitters much more quick acting, but always often secondary to these hormonal changes. Also, we’ll find a new set point. And so what ends up when a person goes to a psychiatrists office as what looks like a serotonin or dopamine deficiency, had about four layers before that, and so the body quite literally changes. And in many ways, and, again, I don’t want to use this as a disempowering phrase, get stuck in that experience, and then that trauma affects the body,
Michelle Shapiro
yeah, well, we’ll call it gets temporarily stock or whatever, because it can be moved out of two. But it seems like when you’re in that stage, it’s easier to stay in that stage. And to move out of it is what it sounds like it feels harder or not as natural to move out of it. So that stress becomes a new norm kind of for people.
Dr. Robert Kachko
I mean, these are survival mechanisms, right? The body that survives an extreme experience and extreme event. And the key word there is survived that experience, learns how to be in order to keep surviving in life. And so that experience is then applied through a different lens, to everything that happens in the modern world. And so if we take like a evolutionary biological lens, that bears chasing us in the woods, well, now I’m at work, and my boss is yelling at me, or my spouse and I are not having conversations that serve us very well. Absolutely, those same mechanisms are turned on. And so the fact that we survived, and the fact that we got, again, temporarily stuck, hopefully temporarily stuck in that experience, means that the only way through it is to, unfortunately, that’s what makes it hard to re-experience that trauma, but in a in an accessible way, in a safe way, in a tolerable way for the nervous system so that it doesn’t overwhelm us a second time. And people use this term re traumatize, that’s certainly not something that we’re looking for.
Michelle Shapiro
And I think that in the like, current model of treatment that I see, mostly in modern medicine, we talked about one modality, which is medication treatment, you said something I want to go back to because it was important. You said by the time something looks like a dopamine or serotonin deficiency, and you’re given medication, there’s already been a biological process going on for a bit, can we talk about what that looks like? That leads to that level of either, you know, symptoms of depression, or what doctors would say is a chemical imbalance, quote, unquote, yeah.
Dr. Robert Kachko
So what manifests as a change in neurotransmitters is usually a function of something else that’s misaligned with the body’s needs, right? Those needs could have changed because of some past experiences, those needs can be unique to that individual because of genetics. But the fact is, in that moment, when they come into your office, they have very specific needs. We talked about the root cause, right? So maybe there is a deficiency in certain cofactors. So vitamin and mineral cofactors, that the body needs to convert that say, let’s just take serotonin, that tryptophan that we get from Turkey, which everyone loves, into serotonin, and then downstream melatonin, so it could be something as simple as that deficiency.
It could also be that our brain is chronically flooded with that cortisol, that stress hormone. When that’s happening, that step that converts is just turned off. Same thing happens when we’re chronically inflamed. All the reasons why a body can be chronically inflamed from environmental toxins, sort of manmade chemicals that we’ve been exposed to, to again, affected by things like stress and trauma to lack of sleep, to sedentary lifestyle.
So all of those root causes, antecedent – causes a response in the body turning off an enzyme for some reason, we don’t always fully understand why that’s happening, but the enzyme is impacted to consequence the consequence then becomes suffering. And to some degree, when we look at it from a reductionist lens and say that the challenge is a serotonin deficiency, or, frankly, an SSRI deficiency, we’re missing that whole, I guess we can call it an iceberg beneath, beneath the water, all those other layers that are contributing, because what we do when we when we only look at that consequence, when we look at that end result is we forget about the fact that the body again is always working to keep us Safe has an innate capacity for healing that is disrupted by all these factors that we’ve talked about. But if we’re working with the physiology, we’re not trying to turn off those symptoms, that the body’s feeling we’re trying to support the physiology so that it can heal itself because no medication heals, no health care provider heals, the person has to do the work themselves.
Integrating talk therapy and modern medicine with trauma/ EMDR work
Michelle Shapiro
Exactly. Which, by the way, stinks. I wish we could do it for our clients and patients. Yeah, I love that I would love if like the model of medicine that we see actually was the one that you could, that you could give someone a pill and it would cause healing. I would like love that. That’d be awesome. So one kind of mode of treatment that we see that’s pretty common for people is medication. And you and I are both like you have to do what works for you and work with your provider. Like there’s not an ounce of judgment here at all. Another mode of supporting anxiety that I see, of course people engaging in is going for talk therapy with therapists. Where do you find talk therapy, super supportive for people? And then where do you think people might need additional support if they don’t feel like they’re seeing progress in talk therapy?
Dr. Robert Kachko
Honestly, most people need both – talk therapy, psychotherapy, CBT, ACT, whatever approach you’re using, is very helpful to discover patterns to discover and understand this thing happened to me. And this is how it’s manifesting today. What talk therapy doesn’t do is speak to the way trauma affects our physical body. And so it’s worth talking a little bit about the difference between explicit and implicit memory.
Explicit memory is what we can use language to describe okay, I remember this thing happened when I was five years old. And it happened because my father did this, or my mother did this. And now I feel this way. Implicit memory is beneath language, it’s beneath conscious awareness. And it’s what happens when? Well, first of all, it happens all the time in our brains, our brains do it. But when it happens in a clinically relevant sense, it happens when there’s a lot of intensity to the event, think about a car accident or some kind of physical abuse, we store these memories in a very implicit way that is not available for conscious awareness.
And there’s a lot of research from forensics to psychology research that says that people’s memory of an event is not very accurate if it happened with more intensity. And it’s almost a linear response that way. And so what we’re asking people to do is come into their therapists office, and certainly a good therapist will pull out what’s important and help people remember in the right way, but we’re asking them to talk about an event that is beneath language, it’s beneath conscious awareness, like I said, and so those are the types of things to bring it back to the medical side of things that manifests in physical symptoms as well, right, because we can talk about anxiety as a symptom.
But let’s talk about joint pain, or let’s talk about migraines, or that IBS that we spoke about earlier, the deeper, more implicit memory when it’s impacted. And again, it’s quite literally begging us to be stuck in that moment. That is what manifests in physical symptoms. So what I would offer is, most people these days, unfortunately, probably need talk therapy, AND they need to be doing work that that focuses on how their body is experiencing those experiences.
Michelle Shapiro
I think that another concern I have with people only choosing one route or the other is of course, ignoring the physical for the mental or ignoring the mental for the physical. If people have a substantial amount of trauma affecting their body, and they’re not aware of it, is there. Of course, like any licensed therapist is, you know, I’m sure qualified to support that. But is there something to be said for talking something and like pulling something up? And then not knowing how to process it on a physical plane? Does that ever happen and talk therapy?
Dr. Robert Kachko
Well, let’s talk about first of all, and talk therapy. And again, I’m not bad mouthing,
Michelle Shapiro
no, no, we talked. Love talk.
Dr. Robert Kachko
Right? Exactly. We love and I’m also putting in DBT can be referring out, but those questions aren’t even asked. Right. So what’s happening in a, in a typical therapy session is again, it’s all it’s all up here. And the conversation is okay, X, Y and Z happened. But it’s not. When I think about X, my heart is racing, my stomach is static, right? It’s, it’s being ignored. And so what I would offer is that that’s actually, in some ways, solidifying the experience. If you’re doing both, that doesn’t tend to happen as much.
Mind-body reintegration after trauma experiences
Michelle Shapiro
And it’s my understanding that it’s almost part of somatic experiencing, or EMDR is your of course, we’ve done sessions together for literal recreation and fun. And because they were super supportive to me, but part of it is also you’re walking through an experience during that and intentionally noticing things and noticing how you’re feeling so if you’re just talking through something you might like you said not be connecting the mind and the body and I know I could this is a spoiler alert I know about you that the most important thing always in all of medicine in your practices is connecting the body and the mind that seems to be like if I would just say like the rob the Kachko thing. It’s like the mind and the body are super duper connected.
Dr. Robert Kachko
Yeah, and I would even take it a step beyond the mind body connection, which is often written about you read it on WebMD articles. I would phrase it from the perspective of Mind Body reintegration, that we start out as a whole being and then we lose that along the way and we can take a spiritual lens on that and we can take got more of a sort of cognitive lens on that, but but the truth is what we’re doing is bringing people back to their baseline. And their baseline is understanding and being connected to their body. Look at the typical three year old is always in their feelings, right? And in their sensations, we lose that we’re taught to lose that because we’re taught to just be very linear and cognitive. And so this concept of Mind Body integration or Mind, Body reintegration, has always resonated with me a little bit more strongly.
Michelle Shapiro
And you know, one of the tenants of the Quiet the Diet podcast is like, master your health by listening to yourself, do you think that there’s healing and just listening to your symptoms? Is there a benefit to just hearing what your body’s communicating with you?
Dr. Robert Kachko
Totally. And that’s the goal, right? Because like I said, the work happens between sessions for people. So the work is developing a skill set, it’s almost like working on a muscle developing a skill set around, okay, I’ve got a migraine or restless leg syndrome, what does that feel like in my body? And we’ve talked about this on our anxiety proof program, that the unfortunate reality is the only way out is through, right, if we’re going to try to say, Okay, I feel awful right now, please make that go away, please make that go away, we can apply that to pain or anything else. It just solidifies and makes it stick harder.
Whereas if we can teach people, and we can apply this to diet, and intuitive eating, and all these sorts of things, if we can just teach people to when they notice that, first of all, noticing it is the first step, oh, this is happening my body, when they noticed that just to track it, without the intention of making it go away. The intention is to notice it, give it space, allow it to be heard, that sounds very, you know, floofy out there. But that’s basically what we’re trying to do. And then that symptom, that manifestation of something else that happened, has an opportunity to release itself, because I’ll say it over and over, the body’s primary intent is to always keep us safe, and move us in the direction of our vibrant health can always do that, because of overwhelming circumstances, oh, I
Michelle Shapiro
felt emotionally sad, I can always do that, because it wants to, and we want to let our bodies do that. Absolutely. We love our bodies, we want them to be able to do that for us and with us. And I think that, you know, everyone will have heard in the last anxiety episode we did again about like the power of listening to yourself, you’re really putting the science behind the words, which helps me too to reinforce these ideas, which is that just your body, knowing that you’re listening is in and of itself, a healing activity, which is really, I think, so powerful for people to understand. Now, it’s not always easy to listen to ourselves. And when I think of the again, like what people generally think of anxiety, we think, like, just stop it and relax. And we know how instigating that can be for our nervous system, honestly, our body reacts with more fear and panic when we when we engage like that. I want to also, you know, take that and actually walk it back. Of course, you know, I always have to walk back.
We didn’t even do a good definition of anxiety versus stress versus trauma in the body. The reason I want to do that is because I have so many clients who say, Michelle, I’ve had a very good life, like there’s no stress part of this thing. I yeah, I work 50 hours a week, but like I handle it. And on a conscious level, they are handling their stress, they’re flexing their resilience to their knowledge. Can we define these things? And then talk about, like, what are you allowed to believe for yourself is worthy of being something that could have stuck with you? Like, how do we know what’s worthy of that?
Dr. Robert Kachko
Yeah, well, first of all, I think many of us, myself included, we sort of start to wear stress as like a badge of honor these days, especially in New York. Oh, let me tell you about how much I have on my plate. Let me tell you about the choices that I’ve made that make this very difficult today. So that’s that’s one thing is stress is more accessible for people. It seems like stress is synonymous with achievement in many ways, especially in New York City, of course. And I find in men in particular, but even in women that stress is again, more accessible, and so we can talk about their stress. Sometimes I’ll use the word stress as a replacement for both of those. Yeah, I won’t even talk about their anxiety.
The difference between stress, anxiety, and trauma in the body
Michelle Shapiro
It feels like it’s not also like real in reality feels like it’s not a mental illness, which in our society, we stratify things into categories – external, yeah – and it feels like stress is something that you’re almost “allowed” to have. But anxiety means you’re “mentally ill” and trauma means you’re “broken.” Exactly. Something like that.
Dr. Robert Kachko
Yeah, I think that the way I would describe it, and these definitions all blend on themselves, I would describe stress the way we did it sort of as something external to us that we have to deal with. It’s what we describe. In one word as our perception of the difficulties in our life trauma is generally more timestamped there’s there’s experiences they can have. You can be in chronic state of chronic tonic immobility, like I mentioned earlier, but trauma is some experience that was overwhelming for the body’s nervous system at that time, either because it happened too quickly, or because we didn’t have the resources we needed or the skill set we needed to deal with it at that time. That trauma can be biochemical burning your hand is a trauma affecting the body, it can be psychosocial, it can be relational. It can be physical and examples of a car crash or something like that. Anxiety, I would say is The downstream manifestation of that, in some ways, just like with physical pain, it is the body, quite literally screaming out in something is misaligned with my personal unique needs. So that’s again, there’s a lot of blurred lines there. But that would be the best sort of framework I can come up with.
Michelle Shapiro
I think for anxiety specifically, it’s often I think of anxiety as the absence of listening to oneself. So it’s like almost the absence of an emotion. So if you have an unexpressed, physical or emotional feeling, and it’s unexpressed, it’s usually translated as anxiety, because your body’s trying to get your attention a little bit harder.
So I’m going to do something that I wasn’t even thinking I was going to do, which is tell a part of our story, too, which is that I came to you. And when I was like halfway through what ended up being a terrible relationship, but was not at the time, I had a lot of mysterious symptoms. And I know some of them were related to my drastic weight loss. And we knew there was a homeostasis issue for sure, that was driving the anxiety. But there was like an, what I would call like an environmental mismatch that I couldn’t figure out, essentially. So we had been doing tremendous nervous system work, you know, we were doing the m wave before it was cool. Like we were doing HRV training, we were doing really awesome stuff, supplements to support the nervous system.
And then when the breakup happened, and it was like a big event, when the breakup happened, maybe like a little t, big T, whatever we want to call it. And I came to you. And I remember you saying, I’m really glad we’ve put in a year, two years of work on your nervous system, because now your body will be able to respond better and build, I had just more resilience built because of what we had done. You were like, in total honesty, it wouldn’t have been good if you came at the beginning, because my nervous system was so dysregulated when I first you know, came to work with you. So there is also something to be said for you can build your stores of your stress threshold, and you can build your stores of resilience and then might be able to process some stressors or trauma more effortlessly. Can you speak to that at all too. And thanks for that, by the way saved my life, that whole thing.
Dr. Robert Kachko
I mean, the human body is incredibly resilient. See, but first, before we do that, I thought you were going to talk about when I was offering you acupuncture, like six months before that, and you were like, am I gonna feel high from this? And what did I say? Would it be weird for you to feel it? Would it be terrible for you to feel something?
Michelle Shapiro
You’re not doing the story justice? Okay, let me just soldier, the comedian. Exactly. Yeah. So I went to you. And I remember so part of my anxiety manifested as fear of anything that could feel different from what I was experiencing. So when I was offered anxiety medication from doctors, I’m like, Are you crazy? I’m so anxious, I can’t take anxiety medication, I’m scared of them. So part of my healing process was also finding safety and things that I felt were new or might even feel good, it did not feel good and safe to feel good.
So before our first acupuncture session, first of all, we negotiated for the size of the needle, like I was like smaller needles, smaller needles, and I’m not a person who’s afraid of needles it was because I didn’t want the I didn’t want it to work. That was fear. And I said, Is this gonna make me feel high? It’s gonna make me feel weird. And you were like, would the worst thing in the world be for you to feel good? And I was like, yes, obviously, that would be the worst thing in the world. That was a big joke of ours to this day, but a super transformative part in my journey, because I had realized I was working so hard to feel less bad, but I hadn’t even considered feeling good. And I ended up loving acupuncture, and it ended up being super supportive for me. But let’s take that for a second. And then do people fear feeling good? What is the deal with that? Why did I feel that way?
Dr. Robert Kachko
I’d reframe that a little bit from the fact of there’s this concept of sort of secondary gain. And so we talked with, I think chronic pain is a good example of that, or I’ve had patients actually in a hypnotherapy session will ask this question to the subconscious. And one of the questions is, would it be okay for you to feel better for you to be out of pain? Or put on sort of on the on the flip side is, does your pain serve you in some way? And more often than I’d like to hear the answer is yes. Right. The pain allows them to not face their other stuff, because we can focus on the pain that’s very, it’s understandable, people get it, you can talk about it. I’m a person who has pain, a person who suffers, so yeah, absolutely.
Resolving trauma may bring up other symptoms in the body
Michelle Shapiro
There’s an identity piece to it for people. This is another example I want to ask you about. Because I know you have an answer to this, and I want you to explain it to people. So what will happen is I have a client who’s had a tremendous amount of physical issues going on, and maybe it’s got issues or anxiety and those issues kind of go away this really interesting thing happens where they’ll start talking and thinking about weight loss or these kind of like smaller bite things that I’m like, What do you know, obsessing over food or something? And I’m like, this is so not in your like in the conversations we have or in our relationship. It’s so interesting that these thoughts are coming up for you. Why is it sometimes when we resolve a big thing that little kind of more annoying things start coming up for us like what is that about?
Dr. Robert Kachko
The way it usually happens is you’ll do a check in three or six months later and you’ll be like, Well, how was your debilitating chest pain and like, Oh, I totally forgot about what are you talking about? I’m here to talk to you about you know, my migraine once a week. That happens for a lot of reasons that happens, though some of the more esoteric explanations would be, I’m going to keep repeating this, the body’s always trying to keep us safe, right. And that takes a lot of energy. That takes a lot of attention on the part of the nervous system on the immune system, on all aspects of our physiology and our biochemistry, once that work is no longer done, that attention can go elsewhere.
Put another way. So in the naturopathic medicine world, we talk about the Vis, the body’s innate capacity for self healing, the vis medicatrix naturae, the healing power of nature, we can call it a lot of things. But that vis needs to have an opportunity to move us in the direction of healing when we are stuck in some physical condition or emotional condition. It’s all there, it’s all focused there, again, much more of an esoteric way to describe it. But when we have the opportunity to shine a light somewhere else, we noticed that thing that we’re shining the light on, whereas before we couldn’t notice it, because we were all in our anxiety, our IBS, our pain, whatever other symptom we’re dealing with,
Michelle Shapiro
regarding that set point of stress, let’s call it I think also, it’s like a hard jump to go from Super tremendous amount of discomfort and pain to that have nothing maybe it’s also easier for people to create a new stress to kind of get them back. Maybe it’s defending the higher level of stress. It could be I don’t know, is that a component of it, too?
Dr. Robert Kachko
I think that the reality is this happens in if you see 1000 people, it’s gonna happen 1000 different ways.
Michelle Shapiro
yeah, I just noticed that I don’t like when people use the phrase addicted to stress, but there’s definitely a perpetuating components to stress where it’s like, even when we’re working with people to alter, like HPA axis, cortisol, anything like that, the level that people are operating at, and that pattern tends to continue. So if someone’s waking up at like, 2am, unless you’re doing something to intentionally change that, our body stays in that level of stress, basically. So you have to actually do things to potentially change.
Dr. Robert Kachko
Yeah, think about what happened at that waking up at 2am, the body woke up and said, Oh, I’m still alive. I’m still here. The thing that caused me to wake up didn’t kill me. I’m gonna keep doing this, because it worked. Because I’m still alive. And I’m still safe.
Michelle Shapiro
So it proved to your nervous system that it was the right thing to do. Yeah, absolutely. So you almost have to prove, like you said, create a new model that this is safe and good to to not wake up at 2am. And to show your body how to do that. How do people do that? How do we show our body that it’s okay to be safe short of, of course, working with a practitioner, which we’re gonna talk about, is there anything people can do at home, to start to increase that kind of zone of safety outwards in their lives.
Dr. Robert Kachko
So quite literally, anything that is aligned with our body’s needs can be helpful. So eating a more nutritious diet, getting deeper sleep. Now, these are all challenges in and of themselves. And sometimes they need extra support. But the point is, you don’t have to jump right into, you know, when I was five years old, this thing happened to me, you can pull back and say, what’s the smallest thing I can do right now?
Can I go for a 10 minute walk after, you know, I wake up in the morning and get some early morning sun, which is going to reset my circadian rhythm, which is going to allow me to tell my body that we’re here, we’re safer here and we’re connected to the, to the greater whole, certainly, that can be helpful. Any change that you can make, is going to move in that direction.
Similarly, from a psychosocial standpoint, one of the last steps in healing the effects of trauma, is this concept of CO regulation, of going out into the world, and having the social support that you need to feel safe, right, we’re tribal by nature, you and I have spoken about this in other ways, when those small experiences and they’re not small for the person who’s never slept well in their life, that’s certainly a huge thing. When those things build up in a cumulative way, you can then look back and say, I have the resilience to answer your question earlier, my tank is full enough to then go face this other thing.
What I would offer is short of that, that mother I mentioned in the example who just is stretched too thin. It’s not the right time to do trauma work, there’s a season for it, there’s a season for it, and life like anything else. So let’s get you focused on eating a diet that is aligned with your body’s unique needs. Let’s focus on changing your relationship with food. Certainly, let’s focus on the sleep or the movement. Let’s focus on giving you 30 minutes a day. That is just for you. Let’s just start there. Absolutely. That’s often the first place you have to start because you can give people a two page protocol and all these changes that they want to make. It’s not going to help them if it’s on a piece of paper that they can’t incorporate into their lives.
Michelle Shapiro
And it’s certainly not going to help them stress wise if it’s adding more stress to their bucket actually make when it comes to them. This is a question that I forgot to go back to before but is there like a level of trauma because I again, this is something I get from clients all the time and some mutual clients of ours so the person who’s listening to this is gonna laugh when they hear this. People say I had a great life. I don’t have trauma affecting my body. This is not influencing my pain. This is not it. Like how much trauma in the body does it have to be – I know that’s not a real question – but how do we get people To understand that even things that felt maybe small may have imprinted and maybe something that got sticky with them.
Dr. Robert Kachko
Yeah, yes. The question for anyone is, Are you suffering right now? Then probably the answer is yes. Because it doesn’t have to be those things that you would read a biography about, right. It’s not something that would be the core chapter in a memoir, it can be, let’s take it to the first days of life, there’s attachment issues that happen, right.
And so think about any older sibling, maybe a couple of years removed from younger sibling, that first day that you look at your mother, and your mother rightfully has to attend to the needs of the baby. That’s annihilation in the nervous system. So right there, that’s trauma, we all experience it, it’s a common experience. So without putting value judgments on this thing happened to you, and you handled it and this thing that happened to you and you didn’t handle it. What we have to look at is, where are you now? Are you suffering? Have we addressed all the physical reasons, right? Again, we have to walk both paths. If we’ve done that, then there’s probably something else there and that needs to be faced. And the only way to face it is through listening to the sensations that the body is, quite literally speaking out with.
The cellular impact of trauma in the body
Michelle Shapiro
In ways of trauma, being this thing that we think of more of a symptom than a sign as an we view it as more of something that is totally unseen and doesn’t really exist short of inside of our heads. What’s the like cellular impact of trauma, like if you had a big T, let’s call it what would be happening inside of your body physiologically during that?
Dr. Robert Kachko
Well, it’s some of the things we mentioned earlier inflammatory cascades, go on, think about it from the perspective of that bear that’s chasing you, what do you need to do to protect yourself, you need to pump blood to your muscles, to your heart to your eyes, get out of their fight, get big, whatever you need to do, that happens at the expense of all of our vital organs, you’re not going to be running away from that bear and digesting your food. You’re not going to be running away from that bear and processing things to your liver as effectively. That all happens, right? Because we would die if it didn’t happen. But it happens to a degree to a scale that’s not supportive of healing.
Now, you multiply that every day for 40 years, and that’s going to have physical impacts right? On a nervous system level. We already talked about the autonomic nervous system on a hormonal level. What we’re looking at is the hypothalamic pituitary adrenal axis, cortisol, adrenaline, noradrenaline, people who are chronically stressed, end up depleting their serotonin and also their norepinephrine that ends up manifesting in gut health and all that. So the right way to answer that question is to take a look at each individual symptoms and try to understand the story and then work backwards to deduce okay, this is the pattern that’s going on here.
Michelle Shapiro
And I keep making you answer the same question in different ways. Because I want to keep reminding people how important that when something’s happening, your brain isn’t cut off from the rest of your body, the rest of your body is intricately connected to your brain and all of your body’s working, like you said, always to save your life and make you happy, your body’s working really hard to do that. So it’s what’s happening in the moment that’s important for people on a biochemical level, let’s say. And then, like you said before, the imprint of what that is, in that our body remembers what happened and our body learned from what happened. We’re like AI kind of, like, we’re our bodies, like constantly, which is like scary. Chat GPT Wow. But our body’s constantly learning from experiences to further save us. So if you keep having experiences, where you’re overexposed, like that, and then you, you know, you can continue to imprint again and get into these new set points of stress. I’m just pulling together these ideas that we’ve been talking about, for sure.
Dr. Robert Kachko
I’m just thinking about in a year. So we’re filming this beginning of 2023. In a year, when someone’s listening to this, they’re gonna laugh at your chat GPT, it’s gonna cost $500 A month, but at that point, it’s just gonna be What are you talking about? There’s so many other applications
Michelle Shapiro
I hope people are still listening to it in the years to come. That’ll be so nice. Hopefully
Dr. Robert Kachko
The AI overlords are gonna actually support, just Elon Musk algorithms are gonna put your podcasts on top.
Michelle Shapiro
I do always call like, like Jeff Bezos, like our father. Basically, he’s like, the Overlords of our lives. Like super weird, Michelle. True, by the way, yes. So also laughter What a medicine for trauma and healing, right? So much so. So we really covered like the basic things, again, of what’s going on inside of the body during stress and trauma about tiny things we can do. Let’s talk about in a practitioners office. I just like to talk about what somatic experiencing is because this is something that is part of your trauma informed lens of naturopathic care. Can we talk about somatic experiencing?
Dr. Robert Kachko
As a specific modality? Yeah. So it’s one among many body-focused Approaches. None of them are necessarily better or worse. But what I really liked about somatic experiencing when I first started learning it is how systematically applicable it becomes. It’s about how you think about the nervous system in relation to experience and in a way it’s helping people to understand that they can face their experience as long as it’s in a sort of a maximum tolerable dose, and so that’s, that’s the work is going back to something that happened, or in the moment, as you’re talking about it, say, with your therapist, feeling into your body and noticing, okay, this is what I’m feeling. And this is what I’m feeling.
But then making two key changes, one is slowing the experience down, things happen so quickly, and the nervous system really needs an opportunity to process things out, to slow things down, and to feel resourced enough to deal with that resource can be having other people around who are supportive of you, obviously, and why we’re not doing that in the session, that resource can be new understanding that you didn’t have at that point in your life that can be applied. So in somatic experiencing, there’s this concept of addressing what’s called SIBAM. So sensation, image, behavior, affect – so anxiety, depression, mood, whatever – then meaning. So you have to look at all of that, within the context of that experience. What ends up happening, if done well is the nervous system has maybe the first time maybe for the first time, an opportunity to discharge some of what it’s been holding for so long.
And that’s really where it gets fun is people say, you know, this thing that I’ve been feeling, I haven’t known that I’ve been feeling it’s been there for 20 years, and I actually feel it leaving my body, it can happen in a lot of different ways. Now, that doesn’t happen in one session, sometimes it can, but it’s really about giving the body an opportunity to do it at the pace that it needs.
Michelle Shapiro
There’s also the sensation of getting of like, the body is holding on, it almost feels like it’s carrying something physically within us. And we know that again, we feel that release, we feel our shoulders, you know, unclenching Is there something happening in trauma too where there’s any is there like cellular damage, or something that’s physical that could ever be measured or seen just out of interest?
Dr. Robert Kachko
Well, the most obvious thing for people is the experience of muscle tension, that’s probably the most accessible for people. Right. And so the idea of carrying something around, or people will say it’s just the most amazing spontaneous things. First of all, the person you think would never have access to these emotions, or these words, talks about I think I’ve had armor over my chest for the last 15 years after this thing happened. Or I feel like there’s been something making my body contract as as the opposite of expansion and sort of opening up to the world, making my body contracting crunch. To get small, I feel small, right now, when I think about this, like you’re hiding, like you’re getting smaller, you can’t just tell them, Okay, open up, right? It’s too that’s too cognitive, it’s too conceptual, the body has to get there in a way that’s in slow drips, there’s this concept of titration. So giving them the minimum dose that the person needs. And there’s also another concept if we’re talking about somatic experiencing, which, by the way is not my work. Importantly, Dr. Peter Levine started his work in his observations of how animals in the wild dealt with their experiences of trauma. So a lot of really interesting work around that. But there’s this other concept from Dr. Levine of Penn’s relation undulation, is this idea that we can’t just chronically sit in that difficult emotion, so we have to go towards resource, maybe there’s something in the room, and maybe I’ll like to look out the window, and there’s a tree and there’s a bird there, that helps me to recalibrate, and then I come back into the trauma, you go back and forth, you go back and forth. And that’s how that discharge happens.
Michelle Shapiro
So just to even walk it back even further, you know, this is what I do. Somatic Experiencing is a modality that people use, it’s a tight, it’s a style, it’s a it’s a practice, it’s a certification for people to help support trauma healing, and where you are literally sitting in a session and going through distinct memories and then applying a certain lens to them and the practitioner is very safely guiding you through and kind of connecting the somatic, like the physical self, with the mind and and kind of recreating those experiences in a way that’s more favorable. Biologically, would you say?
Dr. Robert Kachko
You can redefine that. So the person is doing all that work themselves.
Michelle Shapiro
People don’t even know what is happening in a literal session. So that’s like what it was.
Dr. Robert Kachko
yeah, so you’re you’re just hopefully being a gentle guide. It’s not very directive, you’re sort of following what’s happening. I would say it’s almost like, you know, people who guide people on on psilocybin trips or LSD trips, it’s very similar, you help them understand that, it’s okay to face this. It’s okay to go towards it. But I’ll be here with you, you’re not doing it alone. And even that sort of CO regulation, that relational aspect is very helpful. There’s a lot of interesting research in terms of therapy, that it’s more about the relationship with the therapist and the techniques that’s used. So it’s very similar in that way. But that is that is what’s happening. You’re walking alongside them on their journey towards whatever wholeness they’re looking for.
Steps to increase resiliency and calm the nervous system
Michelle Shapiro
I think it’s just important for people to know that and in addition to their incredible talk therapy they’re doing there are like additional modalities they can explore too. And I know this is one that obviously you’re you believe in and are, you know, invested in let’s let’s say in ways of what people can do right now. If they’re feeling like I am filled with anxiety I’m filled with stress and filled with I aware there’s these traumas. Of course seeing a practitioner is a very it very viable solution. What else can they do at home? And I know we talked about some supportive strategies to increase safety. But what can they do? Starting now?
Dr. Robert Kachko
Yeah, and that’s an important point. And especially in our in our modern healthcare system, most mental health workers and covered by insurance will pay all this money for insurance every month, and then they can’t even go get the care they need. So that’s a very crucial and important reality. If there was one thing that people have to do, focus on changing your breath, because our breathing patterns if we talk about where can we empower ourselves, and where can we have control our breathing patterns are the only aspect of our physiology that are that can be fully under voluntary or involuntary control.
You don’t have to think to breathe, your body does it however, your nervous system and the connect the connection between your heart and your brain in particular, as it relates to the respiratory system, your nervous system is always paying attention to and listening to the signals that we’re sending in. So in slowing our breath, usually, the cadence that you’re looking for is about six breaths per minute. So you’re doing you know, a 10, second sort of cycle per breath, five, five, box breathing four to six, whatever people like to use. The key is that you want your out breath to be just a little bit longer than the in breath, the exhalation just a little bit longer, you want to take a slow in breath, I like to use the four to six, four seconds in two second hold. These are real seconds, One Mississippi, two Mississippi, and then a six second outbreath, slow and steady exhalation.
What that allows is to quiet that autonomic nervous system, which is one of those signals of safety to the body, what I encourage people to do is the next time you have a difficult conversation with someone who tends to be difficult in your life, do some breathing before that for three or four minutes, focus on that breath, moving in and out through the center of your chest or some kind of conception of coming into your body when you do it, I can almost guarantee that conversation will be easier, it’s still not fully in your control. And it might be quite difficult. But you’ll be more grounded and coming at it in a clearer way. So that would be probably the, you know, the errors free for now,
Michelle Shapiro
the errors fray. And I think that, again, I like that everything we talked about always brings the power back to in this case, the listener if you’re listening to this, because it’s not to say that Sure. On one hand, we’re saying we’ve encountered a tremendous amount of stressors, all these biochemical reactions are happening, we’ve all encountered a lot of trauma. But something as simple as taking one minute to breathe, can actually build your stress resilience so that when you encounter these issues, your body can respond in a more effective way for you that will hopefully result in less symptoms and everything like that, too.
There’s like a million things you can do you know, you can eat regularly managing your blood sugar even can help create feelings of safety, reducing inflammation in the body can do that, like anything that you’re doing to intentionally support yourself, regardless of modality is healing in and of itself, too. So I think there’s a platter of options for people to reduce their stress and anxiety or, again, gently confronting trauma effects at home, increasing your resilience. And no matter what comes out you if you can increase your resilience, you can handle it maybe even 10% better, you know, the next time or whatever that looks like for the person.
Dr. Robert Kachko
And that is a milestone, it’s a stepping stone on the path in that direction. So it’s not that it’s an end goal in itself. It’s nice to feel better. But it also is one of those signals of safety examples of safety for the nervous system to then make the next time a little bit easier, we change our physiologic setpoint. In that way.
Michelle Shapiro
The setpoint and the AI are the hot topics of this conversation, which is that our body, the fact that our body is constantly learning from experience. And though it can learn from a traumatic experience to respond with fear, or to respond with, you know, nervousness and those sensations of anxiety, we can also teach our nervous system to respond with strength and to respond with more strength and more resilience to things. So that’s very cool if we can train ourselves and our bodies to experience these traumas, and we can train ourselves to experience them a little bit better, too. Yeah,
Dr. Robert Kachko
I think the other way to think about this is that the body is what’s known as a complex adaptive system. It’s always moving us in the direction of that homeostasis that you mentioned earlier. The symptoms that we manifest in that moment, are often the work of the body to heal itself. So suppressing them actually causes a deepening of those challenges
Michelle Shapiro
we hate the only way out is through, but it’s true. It’s just, it’s just overused. But yeah, exactly. Right, which is that there is an all of this. And the one last thing I’ll add is that there is like a, a discomfort level that has to be achieved sometimes for us to get to the other side of comfort, which really stinks. And I also wish wasn’t true, but it just it seems to be and it’s really hard to say that to people who have been chronically ill or in pain for a long time. And that’s like a lot of our clients and patients. It’s hard to say like, well, you’re not uncomfortable enough. That’s really not what we mean when we say that. They’re the most uncomfortable, like they experience and are actually quite resilient as people to tolerate it. But it’s this balance of knowing when to allow and when to fight and what to tolerate and what honestly not to tolerate sometimes too.
Dr. Robert Kachko
And I think that’s an important place to also say that often when these Have conversations or had if they’re not had in a way that’s clear for the person who’s suffering, what it sounds like, Oh, this
Michelle Shapiro
is all in your head. Yeah, no, I hate that. And the important point is, it’s very much not a willpower like you can or should just fight through it, just grin and
Dr. Robert Kachko
bear it, the concept is more so that even if it started from some experience that your body has, and even if it’s experienced in your head, it is manifesting in your physical body. Exactly. And so it’s not to say you’re depressed, you need an antidepressant. That’s the translation of it’s all in your head. It’s both it’s always in your head. It’s always in your body because they’re inseparable. So I really want to make that point very clear.
Michelle Shapiro
Like many other episodes, I’m going to wrap us in with that with the Harry Potter quote, If you don’t mind, which is that Harry asked Dumbledore is this all happening inside my head? And then he says, and we’re like, is this real? Or is this all happening inside my head? And doubler says, of course, it’s happening inside your head inside of your head, Harry, but why on earth should that mean that it’s not real? So I know so good, right. That really wrapped us up? I know the our videographer Stephen birch media, he’s smiling a lot at that he loves the Harry Potter quote, Dr. Rob Dr. COSCO My dear darling friend where can people find you if they want to work with you? How can they work with you tell us
Dr. Robert Kachko
so the easiest way probably is to just go on our website for multiple clinics New York Center for Integrative Medicine is in New York we also have a similar clinic in Stamford, Connecticut, so the New York tri state area Connecticut area we’re here for you, if you go to www dot NYC integrative.com You can also your LinkedIn Shawn, perfect you can schedule a discovery call. We don’t charge for those we want to just make sure that people have an opportunity to describe their story to make sure that we can help them in the right way so we’re here for you. If also
Michelle Shapiro
you’re planning on having a terrible breakup I’d say go to Kachko a year before get that resilience of just you know if again if you’re planning you know get yourself set up for it this is your gonna be your new clientele. Yeah,
Dr. Robert Kachko
we’ll do our best to not make that a self fulfilling prophecy a year later.
Michelle Shapiro
Exactly. Thank you so much. Thanks for having me. Thank you so much for tuning in to the quiet the diet podcast. If you found any of this information relevant or you related to it, please feel free to share the podcast it would mean the world to us. Also remember to subscribe so you don’t miss any episodes. And you can follow us on Instagram at quiet the diet pod. We’ll put the link in the show notes after each episode. Thank you again for listening and I can’t wait to see you in the next episode.
Transcribed by https://otter.ai
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