Arpita: Hi everybody and welcome to Doctors Living Deliberately. We are here today. I'm excited. We're gonna talk a little bit about the mind-body connection, and I have had the luxury of having my husband be involved within an integrative medicine fellowship. And so he's actually done a lot of changes in our diet and implemented these changes, and it's kind of mind boggling for me how little I knew about this topic and how our gut health is very important to our overall health, and so I'm excited today to talk a little bit about this with our guests. But first, I wanna welcome our co-host, Dr. Michael Hersh. Hey Michael. How you doing?

Michael: I am great. Yeah, I'm, I'm super excited for this topic also. We as gastroenterologists, we see the mind body connection pretty much every day that we are seeing patients. This happens just, you know, with true mind gut diseases like irritable bowel syndrome and it also comes up in other conditions like inflammatory bowel disease and really touches the lives of every patient in some way, shape, or form. And it's something that I really enjoy talking with patients about so much so that my medical assistant sometimes says, come on Tony, we gotta get back on track, we're running behind schedule. In other words, she's calling me Tony Robbins. But you know, it's something that I really enjoy talking about and raising awareness about in my clinical practice. And so it's so great that when worlds overlap like this. And so I'm really excited to have as our guest today another gastroenterologist, Dr. Cecilia Miñano. She is a practicing gastroenterologist. She's a certified trauma-informed and somatic coach, and she has a passion for helping people living with chronic gut issues, regain control of their lives to help them overcome debilitating symptoms and conditions. And so we're super excited to have you here with us. Hi Cecilia. Welcome. 

Cecilia: Oh, thank you so much. It's such a pleasure to be here. 

Michael: Absolutely. So I, I was just doing a kind of a brief overview, but maybe you can tell our listeners a little bit more about you and what you do. 

Cecilia: Yeah. So in addition to being a gastroenterologist during the day, I also am a certified life coach, and what I do is I help clients who are struggling from the gamut of like reflux to irritable bowel syndrome, to inflammatory bowel disease, even people with fatty liver who are working on weight loss. I sort of help them, you know, reintegrate the mind and body. For many of us, we've been living like disconnected from our bodies. We are just constantly cerebral, especially in the medical fields. What we don't realize is there's such a strong impact of how chronic stress and trauma live in our bodies. And unless we pause and sort of address it, it wreaks havoc and it's showing up many years later, sometimes, like especially with inflammatory bowel conditions because we're not making good choices, which is having a consequence on our gut and then our mood, our sleep, and so it's all a big interplay. So I'm really excited to be here to talk a little bit about that.

Arpita: Ah, I am excited too to have you here because there is, like we mentioned, this interplay, and I think we are not taught that in traditional medicine, right? This is something that has been evolving and a lot more attention has been placed on it over the past couple of years. And it's a growing field. So it's very interesting to see how these are intertwined and interconnected. And personally, I've done a couple of courses, and work with trying to learn a little bit about this, but I'm scratching the surface. I'm realizing there's so much more. And I've heard you talk in the past about this subject. So I think just to jump right in, tell us a little bit about the basics of what we have discovered regarding the connection between the mind body, the mind gut specifically with regards to inflammation and how that impacts us. 

Cecilia: Yeah, so I'd just like to highlight that there's a strong interplay between the mind and body. So there's things occurring bidirectionally. So the way we think our mood is impacting our gut health and all the physiological processes. So in an ideal circumstance, when we're in a calm and alive state, we're able to think, well, we have clarity, we're connected with others, and that's sort of happening at our mindset. And we're releasing good neurotransmitters, right? Like dopamine, serotonin, and at our physiological gut level, we're allowing those normal digestive processes to occur such as peristalsis, the absorption of micronutrients, we're keeping that gut integrity intact, right? We hear about this term called leaky gut and we'll talk about it, but basically it's where those tight junctions that should keep out the bad pathogens and just taking the good pathogens are now allowing different things to get absorbed which is then creating havoc on our whole physiological process. But when we're also back into that like calm state, we're able to like eliminate, well, we have like good bowel movements, et cetera. And so for a lot of people, they don't realize what their nervous system is doing and the havoc it has on that gut physiological processes. 

So we all know about that sort of sympathetic surge, right? That fight and flight state. It's where we're releasing adrenaline, cortisol, epinephrine. And what it's doing to our nervous system is it's putting us in a danger detector state. So, if your gut is not gonna work optimally when you're thinking, you're like surviving some major catastrophe or you're running from job to jobs, just surviving, putting food on the table. So people come to us, Michael and I, with like, you know, I get bloated, I get pain when I eat, but it's like, you know, you're throwing down like five minutes of food to really like, try to have your, all these digestive enzymes and these processes happen. It's just not feasible. So part of our work is to teach them, for example, to mindfully eat, to really give yourself like the 10 minutes, turn off the electronics and really be present with that meal in front of you. Right? Express a little gratitude for like from the seeds to the mother earth, to the people that prepared it, right? Taking some few deep breaths. So you're bringing in that calm vagus nerve, that parasympathetic, that's gonna allow you to break down that food. And so it's really teaching people how to integrate little small practices that can serve them in the long run. Right? We all know that habits start as one simple thing that over time can really have a large impact, right? If we do these little things over time. 

Michael: Yeah, and there's gonna be a lot of people that struggle with this concept of the parasympathetic and the sympathetic nervous systems because this isn't something that we are taught a lot about in medical school. And if you think about physicians and how our days go, we are in a sympathetic response pretty much from the time we wake up in the morning until the time we go to bed at night. And especially when I think about my midday meal, when I am rushing to, you know, scarf down my lunch in five or 10 minutes so I can get back to work. Of course that is not optimal for digestion. Maybe we weren't taught it in medical school, but it's very clear and obvious to see that there is something about that that's not normal. And I've heard you speak before about one simple thing that you can do before you start eating is just to take a breath just as a pause, as a moment to activate your parasympathetic nervous system, which we were taught in medical school is imperative for normal digestion and then allow yourself to eat the meal normally. You're going to digest your food better, you're going to have a better response to the meal afterwards can you talk a little bit more about that?

Cecilia: Yeah, so I totally echo what you're saying. You know, I preach a lot of this. I would say I'm like 70% there. You know, a lot of it is that rush to rush and we just don't wanna negatively impact the patient to be late. But the reality is, if we don't take care of ourselves, we can't take care of others. Right? So what I do with a lot of my clients is perhaps you don't have those 10 or 15 minutes to eat mindfully. Right? But at least then don't like scarf down some ginormous meal that does take time to digest. Maybe for the lunch break is really like some sort of shake or a small snack. And then really reserving like your heavier meal when you can be more mindful maybe for the evening or early morning. Right? I try to cater it to sort of what the symptoms are and what they're sensing but I really think a lot of it too is are just our mindset. We just don't believe that people can wait, but make your schedule a little bit more flexible to work for you. I remember getting a kidney stone in residency because I never peed and it, it's just like now that I look back on it, it's like I was in this belief system that I just had to go, go, go. And it's just not reality. You have to really care for your own self. So it's really learning what does my body need, what does my nervous system need in this moment? Like when you're activated, for example, with the stress of work, right? If you're getting to a point where you're like snapping at people, that should be a pause for you to say, you know what? I need to take like five minutes. And whether it's step away or meditate, you have to be your own best detective and advocate for yourself. 

Michael: I'll just interject very quickly here that after I began my coaching journey, I decided that on my endoscopy days I was going to insert a 30 minute break for lunch, and I used to do procedures from seven 30 in the morning until nearly five o'clock in the evening, every single day without a break. And I will say that even when I made the decision to insert a 30 minute break, I got a lot of pushback. I got pushback from my colleagues, I got pushback from the managers. So it's not just in us that we need to make the decision, but you know, the system that we work within is pushing us to keep working and to not take that break. But I have to tell you that that 30 minutes that I gifted myself, has made a tremendous difference in my day, and so again, just, I know we're echoing each other a little bit right now, but going back to what you're saying, being intentional about it and making sure that you are taking care of yourself will help you get back to work and take better care of your patients. I am a much better doctor when I have food in my stomach. That's all I'm gonna say. 

Arpita: I'll add, I think it's also, you know, yes, as you both have said that we are activated throughout the day. Our sympathetic system is just in overdrive because of the nature of the work and the nature of the schedules that we have. And so what we need to intentionally do is build in little mindfulness moments per se, throughout the day. And I think you and I, we all have done a positive intelligence course, right? So these PQ reps, such as like rubbing your forefinger and your thumb together and just really focusing on the ridges, or maybe taking five seconds or two minutes to sit and listening for the most farthest noise that you can hear and the closest noise. How can you get yourself outta your brain to help kind of reactivate the parasympathetic nervous system? 

Another option that you have is that heart rate variability, right? And so when we have the heart rate variability biofeedback, that helps us kind of put ourselves into this parasympathetic mode where that can impact our gut health and our inflammation that we're having within the gut. And that can really further improve how we think about things, it can improve our emotional state in the moment when we are activating that heart rate variability. And the way we do that is just taking intentional breaths and considering ideas that bring us gratitude or bring us joy or bring us compassion and really breathing it in and allowing ourselves to have moments of that. Envisioning, breathing it into our heart, envisioning when we exhale that we're breathing it out to the world. And yeah, it sounds a little bit woo, but honestly it does work. The whole point of doing this is to help bring that parasympathetic system into play to kind of override the sympathetic so we can get into a good state. Cecilia, have you had any input with that, with regards to the role of that heart rate variability biofeedback with gut inflammation? 

Cecilia: Yeah, so I intentionally teach my clients about those same exercises. The one I love more for us who are in the, you know, in the moment, stress. So first one is grounding. So Michael, when I'm facing like a difficult colonoscopy, sometimes I just really let go of like all the drama that my mind is saying, hurry up, you should be quicker. And I just really ground it to the floor and really feel like the feet below me. And I like the same thing, gratitude for Mother Earth. But really it gets me out of that like, is coming to get me to really just being present. And the other one I love is the physiological sigh. That I can't always do in the moment, but definitely in between. And again, that's just my own mindset now that I think about it. So what you do is you inhale as much as you can through your nose and then you do a second quick inhale, and then you have a very prolonged exhale. And what that's doing is that's again, you know, being very intentional with your breath, that extra prolonged exhale activates the vagus nerve even more. And there's been numerous studies, one outta Stanford that showed that it was actually better for positive affect, including like joy and helping with mood, doing a more intentional one, like the physiological side as opposed to like the box breath, which is where you're breathing equally, inhale, pause, exhale, pause. 

So again, with all our coaching practices, you know, we teach people about, you know, the thoughts and the mindset, but we actually need like real life skill sets that help us to function in our day, right? We all have like the work stress, the spouse stress, the kids stress. It's just life. We don't have always the time to escape and do things, and we shouldn't wait for that next vacation, right? To really say, okay, I'm gonna decompress there. These are things we have to really integrate into our system. And so I tell my clients, you absolutely have to do this before you eat. Whether it's like one minute or three minutes, right? You bring that Vegas nerve on now you're releasing good like hormones that allow that peristalsis, you're really helping to break down food and when you mindfully eat, you don't have to break down as much because you've really chewed and been intentional with that. You're really protecting that integrity. There's a lot of immune function in our gut and endocrine function, and when you're stressed out, you're making more glucose because you're in a panic state, and that's affecting like insulin resistance, right? You're also not able to optimize the good bacteria, which are a layer of gut protection for us. So it just has so much of an interplay. It's so critical that people understand this. 

Arpita: I think another little piece of this also, and I think again, we've all kind of really dived deep into the trauma aspect of it, right? When we have the stress continuum with stress, toxic stress, and then trauma, how, if we have prior episodes of trauma, even if they're microtraumas, how that kind of activates our sympathetic nervous system at times and we're not even aware of it, right? Things in our environment that set us off. So if we are constantly feeling the pressures in the endoscopy suite of maybe, or we had an incident happen years ago and something reminds us of that incident in this patient that we're working on today, we may not even recognize that our body is going back into that activated sympathetic state. So doing these measures or doing these exercises routinely also kind of will help put you in check with that in my opinion. So it's something that you want to be really aware of how it's showing up for you in your body, whereas your embodiment of the activation, maybe that's your first sign that, hey, I need to take a moment for myself.

Cecilia: Yes. And just to highlight the trauma aspect. So the way I looked at it, it's, for me, the stress is more that sympathetic oversurge with a trauma. The way I've learned about it through somatic work is that that trauma response is very individualized. Whether you call it a microtrauma or just a traumatic experience, it's something in your life that happens that was too much and too fast for your nervous system, and sometimes it's very subconscious. There's like five E's to it. It's an exposure to an event in an enviornment. It's effects on you, which is physiological, psychological, or emotional, and then your experience of it. And with the somatic world, they really believe that trauma response puts you into a dorsal vagal response, which is that freeze response. And that shows up for people with like shame, overwhelm, avoidance, shut down. Both the sympathetic surge and that freeze response are both very inhibitory to your gut. You can't expect your gut to function when you think you're either fighting a lion or you're conserving to like preserve energy. Right? 

And then the last one I wanna highlight for your audience is, I know I don't wanna get too nerdy, but the ACEs study, I just wanna highlight it was the study done by the Centers for Disease Control and Kaiser Permanente from 95 to 97 looking at 17,000 individuals of a middle class. And it looked at adverse events when they were children from the age of zero to 17. Five personal and five related to a close family member. And it include things like sexual abuse, verbal abuse, physical abuse, and its impact. They looked at them over many years, and what we know is that these traumatic experiences have an imprint on our bodies and minds, and it led to a increase of risk of autoimmune diseases, cancer, diabetes, suicidality. It impacted negatively financial and emotional relationships. So what we may or may not even perceive it as, what has been traumatic to our system is leaving these, you know, messages in our system and we may not even notice it for years later. So it's really important that we understand that that piece is critical to how we show up in the world. And as I look back at my own coaching journey, I realize all these stories, I believe, like why couldn't I be different? Or why does this keep happening to me? Part of it was the story I was telling myself, but a lot of it was these adverse early experiences for me, and it was through coaching that I sort of learned to integrate this and how can I open up perspective and what did I learn from that? Instead of being this victim, right? How am I a hero now? And what do I have to share with the world? And so that's part of my passion with this, this gut piece is in addition to the mindful eating, it's like we have to dive into some of these sensitive topics and see how it's showing up in our bodies.

Michael: I think that that has been a very surprising aspect of all of this for me as well. I had a very kind of black and white definition of what I thought trauma was, and I think as I have kind of expanded my viewpoint I've learned a lot more about trauma and, and I know all three of us have done some work in trauma mitigation and and learning how to be trauma responsive. For our audience if you have not listened to episodes three and four with Dr. Kemia Sarraf, we go in depth about the trauma of medical education on all physicians and how one particular situation can be perceived as traumatic for one person and not for another. And so it just has to do with the dose effect of the trauma and how resourced we are. And there's so much that goes into this. And anyway, she's a wonderful speaker and so if you haven't listened to episodes three and four, I highly encourage you to go back and listen to those 'cause she's phenomenal.

I wanted to touch on, you were talking about and intrigued me when you were talking about kind of you're in the middle of a difficult colonoscopy. You're feeling overwhelmed, you're feeling frustrated, you're reminding yourself that there are patients waiting for you. There's one in admit that is ready to come back. You're last one is in the recovery bay waiting to talk to you so that they can go home. And you are grounding yourself. And I know that you have done a lot of work with somatic processing and I was hoping you could talk a little bit about what you do in those moments when you're feeling overwhelmed and how that can benefit our audience.

Cecilia: Yeah, so I really notice, like Arpita said, really being your best detective. For me, when I'm in that stress response, my ears get red, my face gets flushed. So now that I've been tracking my nervous system, I sort of know when I'm starting to surge and then my thoughts become very like, hurry up, you should have done this already. And so it's very negative. You know, self critic here that shows up. So what I do in those moments is in addition to the grounding where I'm really getting present, some of the tools I also extend to myself is like if I am frustrated, okay, I allow the moment of that frustration to come. So how is frustration showing up for me in my body? And like I mentioned, it's like the ears and the face getting flushed. And so I give it its moment and I just go, okay, let's see what I am sensing right now, am I sensing the heat over here and oh, do I notice anywhere else? What if I breathe into it? And sometimes just by activating that breathing response, it's like that heat, which was at an intensity of a 10, is now down to like a 4 or 5, and so I'm extending, bringing in extra emotions to that I'm bringing in some compassion to myself because of how hard I'm working, right? I'm not letting like Judge Judy be at the forefront anymore. I'm like allowing all of the sensations. 

So what I teach people is, all your feelings are welcome. So that frustration, that anger, that even that judgment, they all at some point were serving us in some way, which is another conversation, but these parts of us have evolved to be here with us and it's how do we learn to integrate that, right? We're never gonna pretend that like shame is never gonna show up for me or judgment, but it's like, how can I allow it to show up in itself and be present, bring it into it? And then when I have a better mindset and a vagus nerve, then I can choose additional options. I can choose to believe something different, right? I can choose to bring in that like self-love, that compassion. And so I've let go of the beliefs too, of like who's waiting and who's not. Because that's, like I said, I'm very intentional with like, for me to serve better, I have to take care of me. And so now no matter what is happening, Well, I can't say no matter if somebody's coding, obviously I'm gonna run to that, but for people's inconvenience, I just won't do it anymore because I also have to be here for the long run. 

Arpita: Yeah, and I think part of it is also just being okay and recognizing that sometimes the awareness is around the sensation in the body, right? With regards to the emotion. We may not be cognizant of the thought that I need to hurry up, or the next one's here, oh my God, I'm getting behind. But instead, we might feel that tension, like how we feel tight in our shoulders, or that heat, like you're saying, you feel the redness in your ears. So noticing that the awareness may show up in different areas. First, it might serve you better to focus on your physical sensations as those are the first things that you cue into. And then from there, you can start to allow yourself to process that emotion first. Breathing into it, being present with it, allowing it to just sit there and then noticing it slowly shifting. 'cause when that shifting that you're noticing or that lightening of it, or maybe it's moving somewhere else, that's actually you processing the emotion where it's getting lighter. And it may not go away fully, but the fact that it's moving or lessening is allowing you to be more productive on the other side of it. So that's the part that doctors don't know how to do. 'cause we've been taught not to feel the emotions, just hurry up and move on to the next thing.

Cecilia: Yeah. I think for many of us, we've learned to compartmentalize, right? It's like, I can't deal with this right now, but what you don't know is you're trying to like stuff it down and then more is gonna be added on and then you're just gonna explode. 

Arpita: Exactly. So we have to like slow down and say, okay, I'm feeling this palpitations right now. Let me just be here for a moment. And again, nobody has to know that you're doing it. You could just stand there and look and say, I need a minute to think real quick. And you're doing your breathing. They don't need to know what's happening. You can take a minute for yourself and reground as you've said. So, 

Cecilia: Yeah, and like I said, even during a colonoscopy, Michael, I'll like really ground, I'll be present, really focus on the screen, you know, I get out of my head and I'm just like, alright I am present. And that's my way to like break that downward spiral. 

Arpita: Exactly. Yeah. 

Michael: The key here, I've heard it said before, is slowing down to speed up, right? Because when you start putting the pressure on yourself, oh, there's all these other things and I'm stuck here and it's difficult. And when is this gonna be done? You're not fully present for the moment and you're not using all of your brain power that you have to get you through this difficult situation, right? And so when you can ground yourself, and by the way, we haven't talked about this before, but I do the exact same thing where I will, you know, briefly focus on the screen or, you know, where the pressure is in my feet just to get me out of my head so that I can be present and make sure that I am fully focused, where I need to be focused, and it has made all the difference, right? And, and then it doesn't matter who's waiting because the only person that's important is the person that's right in front of me. And so incredibly important. So thank you for sharing that.

Cecilia: And I think I just wanna highlight with the coaching world, this is, you know, where we help clients, right? Because we, these are skill sets none of us have ever learned, right? And like for me, growing up with like a difficult childhood, I'd never learned this stuff until my mid forties, and it would've been nice. And so the beauty of it is that I now have different resources, right? Sometimes the breathing may work, sometimes it's the grounding. Sometimes it's like connecting with others. But you need to have this your own personal toolkit, and that's where we come in and we help guide people and we're teaching it to our next generation. Right? That's the beauty of this whole journey for all of us, is we're implanting these different tools for our children so that when they're like our age, they're much more seasoned than us and have a more regulated nervous system 

Arpita: I just wanna, just reminded me when you said that, right? Like, we are doing this now, like, I'm almost at half a century and I wish again, like that I had these tools potentially to use earlier. But I do remember, if I think back to it when I was younger, I have a book from Deepak Chopra from med school, right? I never read it. I never paid mind to it. 'cause I was like, this doesn't apply to me now. I don't need to worry about this. This is not a big deal. So it's also kind of recognizing that it is, and it might sound a little woo sound, sound a little crazy. Like, this is really not important. I'll deal with this later. But the sooner we can implement these practices for ourselves, honestly, I believe the longer your lifespan and your longevity will be because that stress is already accumulated. We're working to help mitigate some of it by doing the work now. But if we can start the doing this work even earlier, imagine the benefits of that. So even to the younger listeners out there, it might sound a little crazy, but it definitely works and I wish I had implemented a little bit. Everything happens the way it's supposed to, but we can definitely think and be mindful and open to some of the other perspectives that we're being exposed to now as we get more knowledgeable in this field.

Michael: So, you highlighted the younger listeners. I'm gonna say that the older listeners, like the people like us in our forties and fifties are gonna be the most skeptical, right? Like, this is not, you know, a Gen X thing to be kind of in tune with all of these things. And so I think allowing yourself to question, is it possible that there could be a different way or maybe dare I say a better way? Just allowing yourself to get curious with that. It has made all the difference for me. 

Arpita: Well, thank you Dr. Miñano. It's been great having you on our show today. I, I really think our listeners are truly lucky to have the gifts of what you've provided them in terms of your knowledge today. And tell our audience a little bit about how they can learn more about you and your programs. If they wanna reach out, give us a little snippet of that. 

Cecilia: Yeah, so they can visit my website, which is my name www.ceciliamiñanomd.com. I am currently doing one-on-one clients, but I hope to launch a membership sometime in the fall because I really wanna expand this to, you know, average Joe, Mary, Maria, et cetera. I think everybody needs these resources. In the medical field we have constraints, we have to rule out severe diseases. And so I see myself as an ally with your functional medicine doctor, with your traditional doctor, with your nutritionist, right? With chronic gut issues it's like a multidisciplinary team, and we have to sort of tackle it at multiple levels. And so I would love to help people learn about, you know, somatic mind integration, how to make better decisions, and I'm excited for the future.

Michael: No doubt there is an incredible need for this. And you're gonna do amazing work. So thank you so much for being here, for sharing all of your wisdom with us, and thank you to all the listeners for tuning in, and we will see everybody next time on the next episode of Doctor's Living Deliberately. 

Arpita: Take care. Bye.