SPEAKER_1: Coming up on StarTalk Special Edition, we're going to explore some of the innards of the National Institutes of Health and that branch of them known as complementary medicine.
SPEAKER_1: What is it, how does it work, what does it mean, is it real, is it fake, what role does science play in all of our decisions related to supplemental health?
SPEAKER_1: All that and more coming up on StarTalk.
SPEAKER_1: Welcome to StarTalk, your place in the universe where science and pop culture collide.
SPEAKER_1: StarTalk begins right now.
SPEAKER_1: This is StarTalk Special Edition.
SPEAKER_1: Today, we're going to explore the National Institutes of Health, the NIH, and their special program on what we once called alternative medicine, but now it's been sort of rebranded, renamed, rethought about as complementary medicine.
SPEAKER_1: Let me introduce Gary O'Reilly.
SPEAKER_1: Gary?
SPEAKER_2: Hi, Neil.
SPEAKER_1: You are Special Edition guy, right?
SPEAKER_2: Well, I'm part of a team.
SPEAKER_2: There's no I in team, so there's…
SPEAKER_3: Yes, but there is a me.
SPEAKER_3: There is a me in team.
SPEAKER_2: I set them up.
SPEAKER_2: You make the funnies.
SPEAKER_1: That was a low-hanging fruit there, Chuck.
SPEAKER_1: Chuck, good to have you, man.
SPEAKER_3: Always a pleasure.
SPEAKER_1: So, Gary, what have you done for us today?
SPEAKER_2: Well, we sat down, and as you articulated just now, very similar thought process.
SPEAKER_2: And we came up with the idea that we all want to enhance our health, lengthen our lifespans while reducing illness and disability along the way.
SPEAKER_2: Well, most of us have that chance.
SPEAKER_2: We can't always do it on our own.
SPEAKER_2: And does anybody have our backs?
SPEAKER_2: Or, sadly, are we at the mercy of celebrity endorsements and teenage influences, those damn youngsters?
SPEAKER_2: Um, actually, somebody does have our back, and it is the NIH, or if you prefer, as you said, the National Institutes of Health.
SPEAKER_2: Their goals include fostering fundamental creative discoveries, innovative research strategies, very important, for protecting and improving the nation's health.
SPEAKER_2: Now, all of that said and done, we'll get to the hows and whys once we start talking to our guests.
SPEAKER_2: So, please, if you would introduce our guest, Neil.
SPEAKER_1: All of you join me in welcoming our special guest today, Helene Langevin.
SPEAKER_1: She's a medical doctor, and she's director of the National Center for Complementary and Integrative Health, which is part of the National Institutes of Health, the NIH.
SPEAKER_1: And you're currently chair of the Interagency Pain Research Coordinating Committee that has way too many words in it.
SPEAKER_1: And your research specializes in connective tissue, its flexibility, and how that all relates to pain.
SPEAKER_1: I'm all into connective tissue because I used to dance and I used to wrestle, and my connective tissue felt it every time.
SPEAKER_1: So I'm going to totally get into this conversation.
SPEAKER_1: And you were formerly a professor in residence at the Harvard Medical School.
SPEAKER_1: So I'm very much looking forward to this conversation.
SPEAKER_1: Helene, welcome to StarTalk.
SPEAKER_4: Thank you.
SPEAKER_1: People might have heard of NIH, but they don't really know what it is or what it's supposed to do or how it functions.
SPEAKER_1: Can you give us just a brief overview so that we're all on the same page about what to expect from the organization?
SPEAKER_4: Well, yes, my pleasure.
SPEAKER_4: NIH is the leading federal agency that's responsible for funding medical research.
SPEAKER_4: And so what NIH does is it really funds medical research, covers the whole spectrum from basic biology, really understanding how living things function, how they can function in health as well as disease, and then applying this knowledge to really provide the best treatments to enhance the health of all people.
SPEAKER_4: So that's the mission.
SPEAKER_1: And so government money funds this organization, correct?
SPEAKER_1: Correct.
SPEAKER_1: Huge number.
SPEAKER_1: I think you're better funded than NASA, I think.
SPEAKER_4: Health is important.
SPEAKER_4: Don't be jealous, Neil.
SPEAKER_1: Because I don't know that it was always funded more than NASA.
SPEAKER_1: And then, like, I remembered it passed and kept going.
SPEAKER_1: And what do you do that pharmaceutical company, the business world, doesn't do?
SPEAKER_1: I mean, we always hear that there's a new medicine that comes out from some big pharmaceutical company.
SPEAKER_1: And so do you guys make medicines or do you fund that research?
SPEAKER_1: Where does your...
SPEAKER_1: It's not just in your building there in Washington.
SPEAKER_3: I like to know how my tax dollars are being used.
SPEAKER_3: That's what I'm saying.
SPEAKER_4: Well, we cannot overestimate the importance of having rigorous research that is objective.
SPEAKER_4: What I mean is that this is research that is peer reviewed where the research projects themselves as well as the science and even after the research is being conducted, is monitored carefully for its objectivity.
SPEAKER_4: So this is not influenced by, for example, commercial bias.
SPEAKER_4: So that's why this is so important to have.
SPEAKER_4: It's an agency that monitors the quality of the research, the rigorous nature of it, and also how the results are disseminated.
SPEAKER_4: So it's really an important function.
SPEAKER_3: Sounds to me like you're part of the deep state.
SPEAKER_4: It's certainly part of the state and we do go deep in the science.
SPEAKER_4: There you go.
SPEAKER_3: Good answer there.
SPEAKER_1: What I like is if you look at any of the papers that are published in the websites controlled by the NIH, something I don't see every day in my field because we just don't have this susceptibility.
SPEAKER_1: At the end of each of those papers, and correct me if I'm wrong, Helene, that there's a disclosure on whether the results of that paper will influence the person's financial status or where the sources of money comes from so that the reader can...
SPEAKER_1: It doesn't mean it's necessarily a biased paper, but you want to be able to put your sensitivities, your skepticisms in the right place.
SPEAKER_1: In my field, if I do research on a black hole or Pluto, I don't have to really disclose my sources.
SPEAKER_1: There's nobody benefits from any of it in astrophysics.
SPEAKER_1: So, I take it for granted that we're mostly immune from...
SPEAKER_1: Not that we don't have bias, but it doesn't have the kinds of bias that are so importantly disclosed in your journals.
SPEAKER_4: There's all kinds of biases, and the important thing is to first of all disclose them and then manage them.
SPEAKER_4: And so that's what NIH does really well.
SPEAKER_3: And do you ever take a collaborative tact in your approach to research?
SPEAKER_3: So, is there ever something where you're joining research that is already underway, as opposed to just reviewing it?
SPEAKER_4: Oh, all the time.
SPEAKER_4: So, team science is now becoming so important, especially in our field, in the field of complementary and integrative health, because it is a science that by definition involves more than just one organ or one system.
SPEAKER_4: It involves the whole person, as we really have come to understand that health is something that is complex.
SPEAKER_4: And so, you need all kinds, you need teams of people to do this kind of research.
SPEAKER_4: It's very, very important.
SPEAKER_1: So, Gary, take us into your laundry list that you had set up for me.
SPEAKER_2: We did come up with this idea of a laundry list, and I think it kind of fits the bill quite nicely.
SPEAKER_2: What if we said something that on the surface sounds like it should be really good for us and healthy, like multivitamins?
SPEAKER_2: And, you know what, what if I took more?
SPEAKER_2: Wouldn't that be even healthier?
SPEAKER_2: Did your research go into that field of how this is positive and how this may be negative?
SPEAKER_1: That's so fundamental.
SPEAKER_1: As you know, Helene, we have this mindset, I don't know if it's a nation or just being human, that if a little bit of something is good, then more of it must be better.
SPEAKER_1: So let's just chug it.
SPEAKER_1: And so if you can shed some light on that, that would be delightful.
SPEAKER_4: This is a very, very important question.
SPEAKER_4: More is better is almost kind of the mantra of our current society, right?
SPEAKER_4: And what we're finding out in medicine is actually might be the other way around a lot of times, is that when we study, for example, the effect of a vitamin, and we assume that if you take this vitamin in the form of, say, for example, fruit and vegetables where the vitamin is naturally present, you might eat an apple or a bunch of grapes or something like that.
SPEAKER_4: You're not going to eat, you know, five kilograms of grapes, right?
SPEAKER_3: Turn those grapes into French fries and you got a deal.
SPEAKER_4: Yeah, but there's not too many vitamins, though, in French fries, or at least some of them are, yeah, it's sort of, let's stick to vegetables for now.
SPEAKER_4: So if you take a vitamin pill, for example, you may have a lot more of that substance than you would normally consume in the course of, is that good, is that bad?
SPEAKER_4: Research is starting to show, quite convincingly, that taking large amounts of anything is not a great idea unless you want to use it as a drug.
SPEAKER_4: Now, that's what drugs do, right?
SPEAKER_4: Drugs are substances that you take in relatively large amounts in order to really influence a metabolic pathway that's gotten diseased, for example.
SPEAKER_4: That's what drugs do, right?
SPEAKER_4: Say, for example, your cholesterol is too high.
SPEAKER_4: You could take a drug that will lower your cholesterol.
SPEAKER_4: What it does is it binds the molecule of the pathway and it pulls it down so that it actually corrects your cholesterol.
SPEAKER_4: But the problem is that drugs are very strong and they can do other things, too.
SPEAKER_4: Because that pathway is not just controlling your cholesterol, it might control other things.
SPEAKER_4: So drugs are strong.
SPEAKER_4: And as opposed to taking something in the form of a fruit or vegetable or something like that where the same substance may be very, very small, that is more likely to interact with your body naturally, the way your body normally works and support the function of the body.
SPEAKER_4: So there's a big difference.
SPEAKER_4: And I think we tend to think that by taking more of something, we're going to have a better effect when in fact sometimes it actually doesn't.
SPEAKER_4: And in fact, it could have negative effects.
SPEAKER_2: Are we seeing a sort of mantra emerging that we need to go back to what we used to do, which is not go through a processed pill, processed tablet, but go into the vegetables, the fruits, and absorb the vitamins in a more natural way with our bodies in a biome?
SPEAKER_3: Food is medicine.
SPEAKER_3: Food as medicine.
SPEAKER_2: Good thought about that.
SPEAKER_4: There's certainly a lot to that.
SPEAKER_4: It's by taking substances in the context of your diet is certainly a lot safer as opposed to taking supplements that may give very, very large amounts of something when we don't really know if it actually is beneficial.
SPEAKER_4: And in some cases, we know it's not.
SPEAKER_4: For example, taking large doses of vitamin E has been shown to cause to be responsible to cancer.
SPEAKER_4: And since then, people have really backed off.
SPEAKER_4: Or vitamin A, same thing.
SPEAKER_4: Vitamin D even.
SPEAKER_4: We used to think that vitamin D was, you had to take a lot because you want to make sure you're not deficient.
SPEAKER_4: Well, now we're finding that it actually is not so beneficial to take very large doses.
SPEAKER_1: What does that do?
SPEAKER_1: Too much vitamin D, what is that?
SPEAKER_4: Well, it's not so much what it does that's bad, but it actually what we used to think is you needed to increase your dose of vitamin D in order to protect against osteoporosis, for example, in women.
SPEAKER_4: Well, now we're finding that actually, no, it doesn't really do that much to take very large doses.
SPEAKER_4: As long as you're not deficient.
SPEAKER_4: And so, correcting the deficiency is important, but adding to that is probably not that beneficial.
SPEAKER_1: Okay, pause for a minute.
SPEAKER_1: So, in my field, in astrophysics, when there's something that we don't know very well, it's because we haven't been there yet.
SPEAKER_1: What's really going on in Pluto?
SPEAKER_1: Well, let's send a mission there to find out.
SPEAKER_1: What's going on in the center of a galaxy?
SPEAKER_1: Let's get a bigger telescope and then we find out.
SPEAKER_1: We, as humans, have been here for you in the lab, like, forever.
SPEAKER_1: And we've had vitamin D since whenever it was discovered.
SPEAKER_1: So, how is it that we can go from some earlier thinking about the role of vitamin D to some emergent thinking and have that emergent thinking be different?
SPEAKER_1: That has to mean the early experiments were not done properly or they had bias or the sample size wasn't big enough.
SPEAKER_1: Why aren't we self-aware of that at the time and to put in the uncertainties so that people don't pivot their life on some medical research that might one day in ten years show up wrong?
SPEAKER_3: What we did now was we took a spaceship and we shrunk it down and put it inside of a syringe.
SPEAKER_3: Then we shot it into somebody and we were able to do the exploration necessary to find out.
SPEAKER_1: Okay, Chuck, that's a movie?
SPEAKER_4: In answer to your question, it is frustrating for some people because they think, oh, you said this before and now you're saying something else.
SPEAKER_4: But science just doesn't go in a straight line, right?
SPEAKER_4: Part of good science is to design a hypothesis.
SPEAKER_4: You have an idea, you have a hypothesis.
SPEAKER_4: The hypothesis is based on what you previously knew.
SPEAKER_4: And then you say, let's test that.
SPEAKER_4: And then you test it and find out if it's right or if it's wrong.
SPEAKER_4: So it could be that when we decided to test larger and larger and larger amounts of vitamin, that was a hypothesis.
SPEAKER_4: And it took a long time for us to figure out that, well, you know, maybe that's actually not as useful as we thought.
SPEAKER_4: Now we're going to go back to, you know, testing perhaps smaller amounts of this compound.
SPEAKER_4: It's still very important.
SPEAKER_4: It's just the dose may need to be different.
SPEAKER_1: There's a combination of the research results as reported and the press interface to those results that brings it to the public.
SPEAKER_1: So somewhere in there, if they say this amount of vitamin D is good for you to clear your deficiencies, more might be better for these reasons we think, but it's not fully tested yet.
SPEAKER_1: We need more studies.
SPEAKER_1: And that's what I would expect it to say for you to now say, the more studies show that it's not working as intended.
SPEAKER_4: It doesn't cancel everything.
SPEAKER_4: Vitamin D is still important.
SPEAKER_4: It's still important to not be deficient.
SPEAKER_4: And so people who are not, for example, are not exposed to enough sunlight, for example, in the winter, people who live in northern climates, et cetera, it's very important to say, okay, let's just make sure either you eat food that are rich in vitamin D, like oily fish, for example, or take a supplement that gives you the amount of vitamin D that would normally be in your diet, if your diet is not sufficient, but not boosted.
SPEAKER_1: I take two vitamin D3 pills.
SPEAKER_1: Does that make a vitamin D6?
SPEAKER_4: Hopefully not.
SPEAKER_5: I am Kais from Bangladesh, and I support StarTalk on Patreon.
SPEAKER_5: This is StarTalk with Neil deGrasse Tyson.
SPEAKER_2: Are we in the middle of a battle here between the advertising budgets of Big Pharma and the supplement makers and science?
SPEAKER_2: At the moment, it seems like the advertising budget has the bigger muscles and is winning.
SPEAKER_4: Advertising is just one way that people get information, right?
SPEAKER_4: From ads, you can also get information from other places, like the social media.
SPEAKER_4: You can also get important information from the NIH, right?
SPEAKER_4: Places like that where science or from scientific papers et cetera.
SPEAKER_4: That's what we try to do at NCCIH is really very importantly educate people about what we know and what we don't know.
SPEAKER_4: And when things change, like this information about vitamins, we make sure that people know about this.
SPEAKER_4: So yeah, there are a lot of places for information.
SPEAKER_3: Also, I think that for Pharma particularly, they're pretty regulated in terms of the claims that they are able to make about their products in the advertisement.
SPEAKER_3: The FDA regulated, right?
SPEAKER_3: The FDA causes them to not only govern tightly what they say about the product itself, but more importantly, they have to list anything that could go wrong, which is why at the end you get this disclaimer that says things like, in certain cases may cause death.
SPEAKER_3: And you're like, did I just hear that right?
SPEAKER_3: Wait, to get rid of this hangnail, I got to risk death and cancer?
SPEAKER_3: Wait a minute.
SPEAKER_4: That's it.
SPEAKER_4: I mean, drugs, like I was saying earlier, drugs are strong.
SPEAKER_4: Drugs can correct an abnormality when you have, say, somebody has a serious disease.
SPEAKER_4: The drug becomes very important to correct the abnormality.
SPEAKER_4: There are some risks and side effects to the drug, but you need the drug in that case.
SPEAKER_4: The thing is though, other kinds of treatments, like the kinds of treatments that do not involve drugs, that are more what we call non-pharmacological, generally a lot safer, although we can talk about that too.
SPEAKER_4: I mean, there's ways not to overdo things even if they're not drugs.
SPEAKER_4: But as long as done in the right way, can be very effective treatments without involving the risks of drugs.
SPEAKER_1: But you're a person on the street and you walk by a store that says health supplements, and you go in, and there's hundreds, maybe even thousands of bottles of stuff, and the bottle itself will not necessarily make a health claim because they're riding on what you might have heard about it in some back alley magazine that is telling you that it cured something in some far away land.
SPEAKER_1: And so you go in there looking for it and you buy it and none of it is FDA approved.
SPEAKER_1: So what is your recommendation to people who seek some kind of solutions in their lives through these non-approved medical supplements?
SPEAKER_4: Well, first, they can seek some guidance from, for example, our website.
SPEAKER_4: At NCCIH, we have a website that's dedicated to this.
SPEAKER_4: And you can look up a substance if you're not sure.
SPEAKER_4: What does the substance actually claim to do?
SPEAKER_4: Is this actually verified?
SPEAKER_4: Because in some cases, there is science, but in other cases, there isn't.
SPEAKER_4: So on our website at NCCIH, we have a very nicely organized page where you can look things up.
SPEAKER_4: And that would be a very good way for people to not waste their money.
SPEAKER_1: They're not cheap, too.
SPEAKER_4: You can spend a lot of money on these things.
SPEAKER_3: Speaking of spending a lot of money, this is very personal right now.
SPEAKER_3: I don't mean to derail the show, but I've got to ask.
SPEAKER_3: So there's these green powders now that are out and you see them all over the place.
SPEAKER_3: And there are many different companies that make these green powders, which are kind of a dehydrated amalgam of many, many different vegetables, concentrated to a point where they're supposed to give you all that you need nutritionally in one little shake and you drink it and they cost a lot of money.
SPEAKER_3: So my question is, am I wasting my money?
SPEAKER_4: Well, for some people, they may think, well, you know, I'd rather do that than cook a meal.
SPEAKER_4: There's a lot of other benefits to cooking a meal that are not in that little powder, right?
SPEAKER_4: And so the effort, the time and effort that you might want to take to cook a meal, to buy the food, prepare it, eat it, a lot of people think, well, I don't have time for that.
SPEAKER_4: You know, I'm just going to, you know, take the pill.
SPEAKER_4: First of all, as you say, it's expensive.
SPEAKER_4: Sometimes it can be more expensive than cooking the food.
SPEAKER_4: But it also doesn't provide you with all the benefits of the actual food.
SPEAKER_4: You know, there's so much that is in the food that we eat that is not in that little pill.
SPEAKER_4: So, you know, it's a shortcut.
SPEAKER_4: And I think that especially because these projects are not regulated, you don't know what else might be in there that you don't know about.
SPEAKER_4: And also some of the substances might be so concentrated in there that you might have adverse effects from it because you don't know, you know, how much there is.
SPEAKER_4: So, I would say generally, it's not a good idea.
SPEAKER_2: Seeing as we've gone back to the future with some of our thinking and we are now thinking maybe non-drug-related treatments, therapies, et cetera, something that's been around for thousands of years, acupuncture, where would you or the NHIS stand on practices like acupuncture?
SPEAKER_1: Yeah, one point there, Gary.
SPEAKER_1: I don't like asking or inquiring where someone stands on something, because that implies that their heels are dug in and it's not an open scientific process.
SPEAKER_1: So, rather than think of stances, because anytime someone does a stance, then they're not giving up.
SPEAKER_3: What are the findings?
SPEAKER_1: What are the findings?
SPEAKER_1: That's the way to put this.
SPEAKER_4: Yeah, yeah.
SPEAKER_1: And, just to be clear, your entire branch of the NIH is entirely concerned with what has historically been called alternative medicine and acupuncture has been front and center in that movement.
SPEAKER_4: Well, the first thing is, actually, we don't call it alternative medicine anymore.
SPEAKER_4: It used to be.
SPEAKER_4: Now we call it complementary, because none of these therapies are meant to be used instead of conventional medicine.
SPEAKER_4: They're really meant to be used together.
SPEAKER_1: Very important semantic point, yes.
SPEAKER_4: As important, yeah, as appropriate, right?
SPEAKER_4: You wouldn't want to use acupuncture to treat cancer, for example.
SPEAKER_4: However, you might want to use acupuncture to help manage some of the symptoms that people have when they have cancer treatment.
SPEAKER_4: Very importantly, pain, for example.
SPEAKER_4: A lot of people with cancer have pain that is very difficult to manage, fatigue, problems sleeping, problems with stress.
SPEAKER_4: In fact, there's a very good study that has shown that there's a certain cancer drug that causes a lot of musculoskeletal pain in women with breast cancer.
SPEAKER_4: And when acupuncture was used in addition to the cancer treatment, it did such a nice job helping with the pain that a lot of the times the women were able to stay taking their medication, which a lot of times people have to discontinue this medication because the side effects are so serious.
SPEAKER_4: But acupuncture helped with that.
SPEAKER_4: So you can see it's really a complementary treatment that helps.
SPEAKER_2: That makes a lot of sense, you're saying that.
SPEAKER_1: Yeah, and where does the placebo effect show up here?
SPEAKER_1: That should be, it seems to me, a very big part of your budgetary explorations because so much of people's expectations are just fulfilled in their own physiology.
SPEAKER_1: And maybe that's fine.
SPEAKER_1: I mean, if the placebo effect works, then maybe we should harness the placebo effect.
SPEAKER_4: I agree 100%.
SPEAKER_4: So think about placebo as a healing response, as self-healing because that's what placebos are.
SPEAKER_1: Tell us afresh what a placebo effect is.
SPEAKER_4: So the classic way to describe a placebo, it's a fake treatment, right?
SPEAKER_4: Something that has no effect, that's supposed to happen like a sugar pill, for example, that you take thinking that you've taken a real treatment.
SPEAKER_4: And there's a certain placebo response to that in the sense that it's just the fact of taking this placebo substance.
SPEAKER_4: A lot of times, this helps people to get better.
SPEAKER_4: And it's very interesting because people used to think that it was a deception, but people have started to do what we call open-label placebos, where you actually tell the person, this is a placebo, and you compare that with taking no placebo, and people still can get better with these open-label placebos.
SPEAKER_4: Now, what's going on here, right?
SPEAKER_2: Positive mental attitude, doctor.
SPEAKER_2: That's what we used to call it.
SPEAKER_2: Back in the day, PMA, you heal yourself.
SPEAKER_4: But some people think that there's something about their ritual of taking something and saying, I'm taking this pill, and this is something that I'm doing to help me get better.
SPEAKER_4: Which is what, when you do, when you take an open-label placebo, you know you're taking a placebo, but you're still taking it, and there's a therapeutic effect to that.
SPEAKER_4: We still don't quite understand what it involves, but it's a very, very...
SPEAKER_2: Why not?
SPEAKER_1: This is 2024, you're the NIH, you get a bajillion dollars a year, more than NASA.
SPEAKER_2: Jealousy.
SPEAKER_1: And you cannot tell me how placebos work.
SPEAKER_4: Well, we have some idea.
SPEAKER_4: We know that there are pathways in the brain that have, for example, for pain, right?
SPEAKER_4: We know that there are pathways in the brain that influence how much the pain bothers you.
SPEAKER_4: You may still have pain, but you may have a certain amount of stress or anxiety or suffering associated with the pain.
SPEAKER_4: It involves some areas of the brain.
SPEAKER_4: The placebo, interestingly enough, when you take a placebo and you do studies using a functional MRI in the brain, you can see these pathways being activated by the placebo.
SPEAKER_4: The pathways that interact.
SPEAKER_4: It's not just, I mean, you still feel the pain, but it's how you respond to the pain.
SPEAKER_2: Well, I would flimsily describe as changing your brain chemistry, then.
SPEAKER_4: What?
SPEAKER_4: Your brain mechanisms, yeah, are being reflected by the system.
SPEAKER_4: That's well documented.
SPEAKER_1: Your brain changes, yeah.
SPEAKER_2: Okay, so let's come out of the placebo for the minute.
SPEAKER_2: People have heard of the term acupuncture, but don't know how anatomically it's worked.
SPEAKER_2: Yes, it's pain management, but what systems is it connecting to?
SPEAKER_2: Because it's just needles in your skin, and what's that, the knee bone connected to whatever the hell is going on here?
SPEAKER_3: And by the way, sticking a bunch of needles in me sounds very painful.
SPEAKER_1: I'm in pain, give me acupuncture.
SPEAKER_3: You're in pain, let me stab you 8,000 times.
SPEAKER_4: Well, it's funny what you're saying, distraction.
SPEAKER_4: Actually, you know, like if you, you know, when your mom did, when you hurt your knee and you rub another part of your body, that's actually distraction, that actually works, you know.
SPEAKER_4: It's just a temporary distraction.
SPEAKER_4: But acupuncture does something more than that.
SPEAKER_4: It does two things that we know about.
SPEAKER_4: One is it stimulates sensory nerve information that can actually modify the mechanisms of not just pain, but other functions.
SPEAKER_4: What we call the autonomic nervous system in the body, which is the part of the nervous system that controls the internal organs, the gut, for example, the heart, the lungs, et cetera.
SPEAKER_4: That can be modified, believe it or not, by mechanical stimulation of points that are on the ear.
SPEAKER_4: And these are points we know now are linked to the nerve that connects to the organs.
SPEAKER_4: So this is a very, very, very interesting part.
SPEAKER_4: And people have been doing this for a thousand years, but now we're starting to understand that it has a connection to the nervous system.
SPEAKER_4: But there's another part of acupuncture besides the nervous system that's also important, we think, is that acupuncture can actually stimulate the connective tissue, which is a part of the body that is very important but not very well understood yet, and that links the various different across the muscles, for example, of your body.
SPEAKER_4: And this may be the basis for these acupuncture points that people use to do acupuncture.
SPEAKER_2: We've heard about it, people have done it.
SPEAKER_2: There are challenges, and it can be extended from ice baths into cryogenic chambers where athletes with lots of money can spend thousands and thousands of dollars to spend X amount of minutes in there.
SPEAKER_2: What are our findings here for ice baths?
SPEAKER_4: Ice baths.
SPEAKER_4: This is such an important and interesting, I think, question, is the amount, what happens when you expose your body to a little bit of stress.
SPEAKER_4: So we all know, right, we are exposed to a lot of stress in our lives and everything.
SPEAKER_4: But there's a kind of a form of sort of natural medicine that dates back over a hundred years.
SPEAKER_4: A lot of, in Europe, people used to do this, where they would expose the body to different stresses by going into cold, you know, water or something, and then to hot and then cold and change that and expose your body to that stress.
SPEAKER_4: And that was thought at the time to help, you know, build your resistance, you know, to think.
SPEAKER_4: And there is not a lot of research on this, but we're starting to understand is that stressing your body a little bit can actually be a good thing.
SPEAKER_4: Not to the extreme that you would get, like for example, you go in an ice cold bath for, you know, an hour or something and you get hypothermia.
SPEAKER_4: That's not good.
SPEAKER_4: But again, this whole idea of more is not better.
SPEAKER_4: You don't want to die, no.
SPEAKER_4: But just a little bit of stress can actually stimulate the body to be more resilient to other kinds of stresses.
SPEAKER_1: Is that any different from going to a horror movie and you're getting shocked and scared every five minutes?
SPEAKER_4: Or having children?
SPEAKER_4: Well, that's called psychological stress, right?
SPEAKER_2: So what we're saying is we push the boundary of our envelope that bit further every time, just that little bit.
SPEAKER_2: So what was stressful, dramatically stressful, I can't take anymore.
SPEAKER_2: We're now quite comfortable because it's been inside our envelope.
SPEAKER_2: And this must be physical as well as psychological?
SPEAKER_4: Psychological, yeah, yeah.
SPEAKER_4: So we're now starting to research on the physiology of what we call resilience.
SPEAKER_4: What is resilience?
SPEAKER_4: It's the ability to resist, recover, adapt or grow from a challenge.
SPEAKER_4: What kind of challenge?
SPEAKER_4: All kinds of challenges.
SPEAKER_4: So one challenge might be jumping into a cold bath.
SPEAKER_4: Another challenge might be doing some new exercise that you've never done before.
SPEAKER_4: There is all kinds of different challenges that we encounter in life that if the whole adage of what doesn't kill you makes you stronger.
SPEAKER_4: You know, it's maybe it'll go quite that far, but a little bit of stress is actually good for us.
SPEAKER_4: The problem is when stress becomes overwhelming and is there all the time and that's where it can be damaging.
SPEAKER_3: Now, how does that stress relate to recovery?
SPEAKER_3: Because you see in sports arenas, you have athletes that stress their body, so they're not using this stressful circumstance to create any type of psychological stress.
SPEAKER_3: They're using it to speed recovery itself.
SPEAKER_3: I had the chance to actually be in a cryo chamber.
SPEAKER_1: Chuck, you haven't been the same ever since.
SPEAKER_1: I haven't told you that.
SPEAKER_3: And let me tell you, I've never felt more refreshed in my life.
SPEAKER_3: For the rest of the day, I was like more alert and more awake.
SPEAKER_3: Wouldn't that benefit kind of wane over time as I became kind of, forgive the pun, numb to the experience?
SPEAKER_1: Because what I don't want to have happen is if I do it, and it's kind of interesting, but now I kind of want more of it, then all of a sudden I become a thrill seeker.
SPEAKER_1: When before all of that, I was just fine on the couch watching television.
SPEAKER_4: Well, everybody has to kind of judge their own, you know, what they want.
SPEAKER_4: Some people really like doing things that are a little bit more out of their comfort zone.
SPEAKER_4: Let's put it this way.
SPEAKER_4: You just have to determine what your comfort zone is.
SPEAKER_4: You know, somebody who...
SPEAKER_1: But to Gary's point, athletically, you're pushing yourself to limits that your body's never seen before.
SPEAKER_1: The recovery of that puts your body in a new place so that what was extreme for you a month ago is now standard physical output so that you can then push it even further, ultimately perhaps setting a world record.
SPEAKER_4: But somebody who stays sitting on their chair all day, for them, getting out of their comfort zone might involve maybe just walking around the block.
SPEAKER_4: Like for them, that's a stressful thing.
SPEAKER_4: It may be good for them, you know?
SPEAKER_3: Or a 15-second cold shower.
SPEAKER_4: Or a 15-second cold shower.
SPEAKER_4: You know, everybody has to know.
SPEAKER_4: And it's also individual, right?
SPEAKER_4: So, everybody has to kind of do and figure that out for themselves.
SPEAKER_2: So, what this reminds me of is the mantra we used to have, train harder than you perform.
SPEAKER_2: So, you're always...
SPEAKER_2: There'll be guys who are sprinting, who are quicker in training, and sometimes they'll perform in a competition.
SPEAKER_2: So, it's a very interesting scenario.
SPEAKER_2: But you said something, Dr.
SPEAKER_2: Belsky.
SPEAKER_2: Sitting down and they get up and they walk around the room, that for them is one of their small triumphs in a day.
SPEAKER_2: This popped up a while ago, and I've got the right person, I think, to answer this question.
SPEAKER_2: Is sitting the new smoking?
SPEAKER_4: Well, I've certainly heard that, and I think it's, you know, I mean, you can't compare it, apples and oranges, but I would say sitting all day, we know, is very, very bad for us.
SPEAKER_3: Alright, I'll be right back.
SPEAKER_4: And let's all get up.
SPEAKER_4: Well, when I give a talk very often, that's what happens, the audience stands up.
SPEAKER_4: But the interesting thing, right, a lot of people think, oh, I sit all day, it's fine, I'll just go to the gym on Saturday and I'll work out and it doesn't cancel the effect of sitting all day.
SPEAKER_4: It's independent of the amount of exercise you get.
SPEAKER_4: It's a very serious thing.
SPEAKER_1: No, wait, wait, wait, wait, I'm not going to let you get away with that.
SPEAKER_1: What happens to you from sitting?
SPEAKER_1: What is the bad thing?
SPEAKER_1: Well, I mean, Winston Churchill said, why stand if you can sit?
SPEAKER_1: Of course, of course, he said that because Roosevelt.
SPEAKER_3: He was drunk.
SPEAKER_3: He was fat and drunk.
SPEAKER_2: Well, I wouldn't say, how dare you diss Winnie like that?
SPEAKER_4: Give him your help.
SPEAKER_1: So, but I think that was out of respect for Roosevelt, of course, because Roosevelt would be as a polio victim.
SPEAKER_1: But can you be a little more detailed about the consequences to long time sitting, which everyone does who works in an office?
SPEAKER_4: Right.
SPEAKER_4: So, first of all, it's really the effect of not moving.
SPEAKER_4: When you don't move, when your body is in the same position for hours and hours on end, what happens is your connective tissue overall over the time of your life, but even day by day remodels to the shape of what you are.
SPEAKER_4: If there's a part of you that never moves, that always stays in the same position, connective tissue is going to say, oh, okay, let's just remodel around that.
SPEAKER_4: Pretty soon, when you try to do that movement, you can't, because the connective tissue has stiffened and has remodeled around that shape.
SPEAKER_4: And so if somebody, for example, never moves their arm back here, well, pretty soon they can't move it up, though, because the connective tissue has remodeled here.
SPEAKER_4: So sitting kind of remodels our bodies in the shape of our chairs, essentially.
SPEAKER_1: Okay, so it's not the sitting, it's the not moving.
SPEAKER_4: It's the not moving.
SPEAKER_1: Okay, but we spend a third of our lives laying down flat in a bed.
SPEAKER_1: Why doesn't the connective tissue mess us up there?
SPEAKER_4: Well, I mean, you know, laying down is important to sleep, right?
SPEAKER_4: We need that, but no issue you do in the morning when you get up.
SPEAKER_4: You stretch?
SPEAKER_4: A lot of people spontaneously just stretch.
SPEAKER_4: You know, you have to sort of undo this effect of having not moved.
SPEAKER_2: Just think of a cat and a dog getting up from a nap.
SPEAKER_2: The first thing they'll do is they'll stretch out.
SPEAKER_4: Every animal in the kingdom does this.
SPEAKER_4: It's incredible.
SPEAKER_4: I've seen pictures of lions and kangaroos and, you know, all kinds of animals stretching.
SPEAKER_4: It's a universal response.
SPEAKER_3: Do they also sit on the edge of the bed and cry about the coming day that they have to face?
SPEAKER_4: I've never seen a kangaroo do that, but hey.
SPEAKER_2: So, Dr., do we have advice for airline pilots?
SPEAKER_4: Get up once in a while, you know, go and stretch them.
SPEAKER_4: They do.
SPEAKER_4: That's why they are close.
SPEAKER_1: When the flight attendant's barricaded the area, they let them out.
SPEAKER_4: I know, but they do that.
SPEAKER_4: They get up.
SPEAKER_4: They should.
SPEAKER_4: I mean, you know, it's not good if you don't sit.
SPEAKER_4: If you're on an airplane, for example, I don't know about flying the plane, but if you're a passenger on a plane, there is a recommendation.
SPEAKER_4: You should move your feet up and down.
SPEAKER_4: You should stretch.
SPEAKER_4: You should get up once in a while.
SPEAKER_4: You should move because blood pools into your legs.
SPEAKER_4: You can have blood clots.
SPEAKER_4: I mean, there's all kinds of reasons to move around.
SPEAKER_1: Plus, they have these under desk treadmills and pedals that I've seen.
SPEAKER_1: We own one, but I've never used it.
SPEAKER_1: It's like a little bicycle.
SPEAKER_1: Just stick it under your desk.
SPEAKER_4: Yeah.
SPEAKER_4: It's a little hard when you have to write notes, though.
SPEAKER_4: I've tried it, and it's difficult.
SPEAKER_4: But it's cool.
SPEAKER_3: See, now, what it should do is power your television.
SPEAKER_1: That little glass.
SPEAKER_1: That should happen in the clubs where you're watching something.
SPEAKER_1: You should only get to see your streaming service if you are pumping energy into the system.
SPEAKER_3: Yeah.
SPEAKER_1: Gary, keep going on the list.
SPEAKER_1: What else do you have next?
SPEAKER_2: Okay.
SPEAKER_2: We've gone from sedentary bad now to yoga.
SPEAKER_2: What are the findings on yoga?
SPEAKER_2: Because there's that nice sitting down, stretching, doing yoga, then there's this hot yoga, and then there's people who go into this ultra yoga, and I'm thinking, whoa, it's that competitive stretching.
SPEAKER_2: What are our findings here with this?
SPEAKER_4: Generally, the way that I think is most useful way to think about yoga is it's moving while paying attention, but paying attention to what you're doing, paying attention to the sensations of your body.
SPEAKER_1: Dancers do that.
SPEAKER_4: And paying attention means not injuring yourself because I think there's a tendency, again, this more is better mentality, which we do not want, is to say, oh, if I can stretch this much, oh, I'll stretch even more and they'll be even better for you, but then you can injure your shoulder doing that.
SPEAKER_4: So it's really paying attention to being, what is your range of motion?
SPEAKER_4: Just going a little bit past that and stretching, but not going so far that you can injure yourself.
SPEAKER_4: So that's really the idea.
SPEAKER_2: But for years, doctor, we were told more stretching is better for us because otherwise we'll end up like human pieces of cardboard.
SPEAKER_2: When you weren't aware of stretching, then you go through stretching as an athlete, then you feel kind of like I'm done with that and you leave that stretching behind.
SPEAKER_2: And as you said, your body, the connective tissue goes into this form and it's difficult to rearrange that.
SPEAKER_2: So, what's going on?
SPEAKER_2: Really what is going on?
SPEAKER_1: I'm a big stretcher, by the way.
SPEAKER_1: I'm a stretching man.
SPEAKER_1: I used to be able to split.
SPEAKER_1: I can't do it today, but I spend an hour stretching for any hour I spend otherwise working out either running or with weight.
SPEAKER_2: Because of the spinal surgery I had, I worked really hard on as much flexibility as I could.
SPEAKER_2: So, I would end up during my playing career stretching three hours a day.
SPEAKER_2: Stupid.
SPEAKER_4: That's a lot.
SPEAKER_2: I know.
SPEAKER_1: But you had spinal surgery?
SPEAKER_3: But wait, Gary, you were a professional athlete, bro.
SPEAKER_3: Like didn't you have to stretch like that?
SPEAKER_2: Yeah, there is.
SPEAKER_2: But then, but see, because of the complications of my lower back, I made sure that I kept it in as good a shape as I possibly could so as it wasn't going to be a detrimental aspect to my playing career.
SPEAKER_1: Helene, what happens if you over-stretch?
SPEAKER_4: This is the important thing.
SPEAKER_4: It's the amount of stretching, what we call the amplitude of the stretch.
SPEAKER_4: Not just how much, how long you do it for, but how much, what we call the strain.
SPEAKER_4: The strain is the amount of stretching compared to the initial length.
SPEAKER_4: So if your initial length is like this, this tissue, you want to stretch it by a certain amount that's, in my lab, we say 10 to 20%.
SPEAKER_3: That slight strain for the person, what are we feeling at 10 to 20%?
SPEAKER_3: Are we feeling discomfort, slight strain, pain?
SPEAKER_3: What are you feeling?
SPEAKER_1: No pain, no gain.
SPEAKER_4: No, no, no, no.
SPEAKER_2: That's not old school.
SPEAKER_2: That's bad school.
SPEAKER_4: When I say 20, 20, 10 or 20%, it also depends on the person.
SPEAKER_4: For some person, it might be 5% because they are so stiff.
SPEAKER_4: So you want to start very, very small.
SPEAKER_4: And also the amount, the way that you do the strain, it should involve what we call the shear plane.
SPEAKER_4: So muscles are meant to move kind of one next to the other like this.
SPEAKER_4: Not so much pulling on the muscle directly, but allowing the muscles to glide past one another like that.
SPEAKER_4: And so thinking and paying attention to the direction that you stretch in and do it gently, just right past the amount that you feel that you've reached the end and just go a little bit further and that's it.
SPEAKER_4: But you can, and that is the right way to stretch it.
SPEAKER_4: If you go past that to the point where it hurts, you're probably injured.
SPEAKER_2: What if I stretch too much?
SPEAKER_2: What then becomes an issue?
SPEAKER_2: I mean, apart from tearing.
SPEAKER_4: You can cause inflammation.
SPEAKER_4: You can cause injuries.
SPEAKER_4: You can actually cause, especially people who are already very mobile, people who have loose tissues, they can actually dislocate their joints.
SPEAKER_4: They can do a lot of damage to their joints by doing too much.
SPEAKER_2: So let's go back to inflammation because after I finished playing, I had to have surgery on my hamstring because I had a lump the size of a small orange, it apparently turned out.
SPEAKER_2: It would be nine, luckily, thank you.
SPEAKER_2: Is that possible?
SPEAKER_2: Is that something I've created by pulling a hamstring and tearing it just by performing?
SPEAKER_2: Or would that be something that could have, because I'm not expecting to diagnose it now, have been something that built up from all of that stretching?
SPEAKER_4: It's hard to say.
SPEAKER_4: I think that you were mentioning inflammation and inflammation is something that is very interesting.
SPEAKER_4: It's a part of healing that is important.
SPEAKER_4: You cannot heal an injury without inflammation.
SPEAKER_4: On the other hand, after a while, when inflammation is no longer needed, it needs to turn itself off.
SPEAKER_4: And we have built-in mechanisms inside us to turn off inflammation.
SPEAKER_4: The problem is a lot of times what we do is we take anti-inflammatory drugs to reduce inflammation.
SPEAKER_4: And there's some evidence that that can retard healing and impair the healing process.
SPEAKER_4: So, I don't know what was the problem when you had the issue with your muscle.
SPEAKER_4: But generally, what we now know is that small amounts of stretching can actually reduce inflammation naturally, but exaggerated amounts of stretching can increase it.
SPEAKER_4: So it's finding that right balance, a little bit like the Goldilocks, not too much, not too little.
SPEAKER_4: It applies to a lot of the things that we talked about today.
SPEAKER_2: But we have a mantra of kill stuff, don't we?
SPEAKER_2: What is it, the one aside or whatever it is, just kill stuff.
SPEAKER_2: We see it in industrialized farming.
SPEAKER_2: We know people just take anti-inflammatories, and now it's turning itself around.
SPEAKER_2: It's a kind of about face.
SPEAKER_4: It's less wanting to suppress and anti this, anti that.
SPEAKER_4: It's more support the health.
SPEAKER_4: What are the natural healing mechanisms that we have inside us, and how best to support them?
SPEAKER_4: A lot of this is lifestyle.
SPEAKER_4: Having a good diet, managing stress, getting enough in the right kind of physical activity.
SPEAKER_4: These are the things that we have that are built into us to help us be healthy.
SPEAKER_3: We are absolutely screwed then.
SPEAKER_4: Well, I mean, yes and no, in a sense that we have it.
SPEAKER_4: We have those mechanisms, but we need help sometimes to be able to support all of that lifestyle.
SPEAKER_4: And this is, I think, unfortunately, what our health care system is lacking right now, is the structure in place to help people to improve their health.
SPEAKER_1: Could you reflect on the prevailing assumption that anything artificial is bad and anything natural is good for you?
SPEAKER_1: I mean, the prevalence of packaging that says all natural, all natural, and I think of all that.
SPEAKER_1: And every time I see that, I think of everything that's natural that is poisonous, right?
SPEAKER_1: I mean, strychnine, arsenic, that's all natural, right?
SPEAKER_1: So where is the messaging coming from?
SPEAKER_1: And what role do you have in your niche within the NIH to try to influence that?
SPEAKER_1: Because getting back to the earliest point Gary made, there's a teenage YouTube influencer that's peddling some new cure that they found works for them.
SPEAKER_1: And these are influencers paid as such.
SPEAKER_1: So where should the inquisitive consumer place their confidence?
SPEAKER_4: Well, first of all, I would say follow the science.
SPEAKER_4: At NCCA, one of our mantras is natural does not necessarily mean safe.
SPEAKER_4: If something is natural, there's all kinds of things that are natural that are harmful, right?
SPEAKER_4: And so we have to protect ourselves against harms, whether they're natural or not.
SPEAKER_4: And so again, at NCCA, one of the things that we pride ourselves on is that one of our important parts of our mission is to inform the public on the science that's available.
SPEAKER_1: So there's the messaging, which wasn't previously there before your branch of the NIH was carved.
SPEAKER_4: Exactly.
SPEAKER_4: That was the founding mission of NCCIH, is to inform the public about what we know and what we don't know.
SPEAKER_1: I think Congress forced that to be funded because their constituents wanted to know more about alternative medicine, it was such a rising commercial force in our culture and in our economy that Congress felt we've got to get some kind of authentic messaging here and thus got carved your piece of that pie, correct?
SPEAKER_4: Yes, and also it was not just a commercial force, it was a what we call a sort of a grassroots.
SPEAKER_4: There was a paper published in New England Journal of Medicine in 1994 that did a survey of I believe it was 20 or 40,000 households, 40% of people were using some kind of what they called alternative medicine at the time, which we now call complementary.
SPEAKER_4: And of those 40% of people, 75% did not inform their doctors about it.
SPEAKER_4: This was, this revelation shocked people to, people didn't realize that.
SPEAKER_4: This was back in 1994.
SPEAKER_1: And that was before the internet was a big force on our lives.
SPEAKER_1: It was just only beginning.
SPEAKER_1: Right?
SPEAKER_1: So that was already embedded in the system.
SPEAKER_4: Yeah.
SPEAKER_4: And has increased since then.
SPEAKER_4: The number of people who are using complementary therapies is greater now than it was then.
SPEAKER_3: You should tell your doctor, like whatever you're taking outside of prescribed medicine, you should get a list and give it to your doctor.
SPEAKER_4: Absolutely.
SPEAKER_4: That's extremely important.
SPEAKER_4: We don't have two different sources of health care.
SPEAKER_4: One, you know, they don't talk to one another.
SPEAKER_4: That's what integrative health is about.
SPEAKER_4: That's why it's about integrating, bringing together.
SPEAKER_1: Whoa.
SPEAKER_3: That might be the most important thing that we've talked about today.
SPEAKER_4: Good thing to end on.
SPEAKER_3: Because I'm sure, I'm telling you right now, I am sure most people that are, including me, I'm sorry to say, which I can't believe that I haven't done this, have not taken a list of whatever supplements, whatever, you know, extra pharma materials that they're putting in their body and giving that list to their doctor, which I am definitely going to do immediately.
SPEAKER_1: Yeah.
SPEAKER_1: And Chuck, that's happened since you took that cold bath.
SPEAKER_1: Your brain hasn't been the same.
SPEAKER_4: You can tell your doctor about the cold bath, too.
SPEAKER_1: Helene, the last I checked the budget for that branch of the NIH was around $30 million.
SPEAKER_1: Has it gone up since then?
SPEAKER_4: No.
SPEAKER_4: Our budget is about $175 million.
SPEAKER_1: So, that's what's going on.
SPEAKER_3: More budget envy.
SPEAKER_1: Look, that's just her bid.
SPEAKER_1: All of NIH is in the billions.
SPEAKER_4: Oh, billion.
SPEAKER_4: Yes.
SPEAKER_4: In addition to NCCIH's own budget, we also collaborate with many other institutes across NIH to do this kind of research.
SPEAKER_1: Right.
SPEAKER_1: But all of NIH, their budget is in the tens of billions.
SPEAKER_4: Billions.
SPEAKER_1: Which are much, much larger than the 100 million that you're getting.
SPEAKER_1: But still, that's a lot of money to put us in a new place that we never even knew needed attention from before.
SPEAKER_1: So I'm delighted to see this kind of attention given to it.
SPEAKER_4: The attention on these types of non-pharmacological whole person approaches to health is growing for sure.
SPEAKER_1: Well, Helene, thank you very much for this interview, oh my gosh.
SPEAKER_1: And we learned that Gary had nine back surgeries, I did not know that.
SPEAKER_3: You're like the 50 cent a back surgeon.
SPEAKER_4: Keep moving.
SPEAKER_2: Yeah, thank you.
SPEAKER_2: Yeah, I got that scar down my back where you could put all the batteries in.
SPEAKER_2: That is what that is, yeah.
SPEAKER_1: Alright, Chuck, good to have you, man.
SPEAKER_3: Always a pleasure.
SPEAKER_1: Alright, Gary.
SPEAKER_2: Thank you, Neil.
SPEAKER_1: I've learned something about you every time.
SPEAKER_2: Just keep reading the book.
SPEAKER_1: Alright, and Dr.
SPEAKER_1: Langevin, again, thank you for joining us.
SPEAKER_4: Thank you, it was a pleasure.
SPEAKER_1: I'm Neil deGrasse Tyson, your personal astrophysicist, as always bidding you to keep looking up.