Show Notes — Dr. Sean Altman: The Nervous System, Nutrition, and the Truth About AI in Medicine

Melanie Suzanne Wilson (00:00) Dr. Sean Altman, welcome to the podcast.

Dr. Sean Altman (00:05) Thank you, thank you.

Melanie Suzanne Wilson (00:08) You have quite a specialty, quite an expertise. I'll let you explain to everybody what exactly you do.

Dr. Sean Altman (00:16) Absolutely. So it's taken me quite a while to come up with a name for what I do, but I think the best way to describe it is orthopedic functional medicine. I work within the longevity medicine space, and I help people with various types of pain — orthopedic injuries, nerve pain, neuropathy, all different types of pain. We get to the root of what's causing their pain, both from a structural standpoint but then also from a systemic standpoint, by looking at the body as a whole, by looking at the body holistically. We forget that pain and muscle tension and inflammation are local processes, at the level of the injury, but they're also global processes where they affect the whole body. When we start to treat the body in that global, holistic sense, people get better a lot faster and they feel better a lot faster. And that has really anchored the type of medicine I've begun to practice over the past seven to ten years. It's something that gets reaffirmed every single day, when I see patients breaking through and feeling better about themselves, about their injury, and just getting that vitality back, that zest for life.

Melanie Suzanne Wilson (01:51) Getting the vitality after an injury, that's a good place to start. A lot of people get some sort of injury at some point, or they might have a phase where they can't get as much movement. How much of this is about mindset, having the courage to get back out there and get back into what we should be doing?

Dr. Sean Altman (02:16) I think it's a combination, but I was talking to someone about this earlier today — I think traditional medicine often puts the cart before the horse. In order to move, and to feel safe to move, the body and the nervous system have to feel safe. What I find is if we're able to spend two, maybe three treatments calming down the inflammation in their body, re-regulating the nervous system, getting their body and nervous system into a place where it's more comfortable, then exercise and movement become much easier, and the recovery ultimately moves much faster. We shouldn't really be stuck in this mindset of pushing through the pain, no pain no gain — we learn that in athletics, but it doesn't serve us well in the long run. It's important to look at these symptoms — pain, inflammation, muscle weakness, nerve symptoms — as signals that your body is telling you something's wrong. If you're able to right that wrong or start getting the body into a place where it feels better, you can get back on track much quicker. It's this intuitive nature — you should listen to your body and find what it needs first.

Melanie Suzanne Wilson (03:57) Absolutely. There's a lot of talk about the nervous system now from all sorts of professions — the mindfulness space, the medical space, probably a few other specialties as well. I'm wondering how do we know, firstly, what our nervous system is and what that means in practical reality, but also how do we know if something is off?

Dr. Sean Altman (04:37) The way I investigate someone's nervous system is more data-driven — looking at actual metrics, things like heart rate variability and sleep quality. There are ways to measure how well the nervous system is performing, looking at that in terms of a snapshot, a period of time where you're tracking the person. In a lot of cases patients these days have wearables — Apple Watches, Fitbits, etc — where there's historical data, and you can look back and see if there's been a change in various metrics. That becomes very definitive evidence that there's been a change in the nervous system. And yes, very often it's precipitated by either trauma — big-T trauma, meaning a major accident, a car accident, an injury, a fall — or little-t trauma, like having a very stressful job or a challenging time parenting, or some sort of life struggle. That can cumulatively add up to a heightened state of sympathetic nervous system activity, where we're stuck in fight-or-flight mode, and our heart rate, blood pressure, cortisol levels, various hormones are consistently elevated. There's metrics behind this — ways to test it through wearables, and we can even verify it in someone's blood work if things like cortisol are elevated, or salivary cortisol testing too. I try to use the data when possible for two reasons: diagnostically it holds up better — someone's more likely to believe you if you have data attached to it — but we can also use it to show progress, to re-measure and see that someone is doing better and responding well to interventions. That's an objective way to track it. I do think the concept of the nervous system has been a bit oversimplified in the way we talk about it on social media, or even in mindfulness spaces. The reality is our nervous system should be able to be variable — that's what heart rate variability measures, the variability between heartbeats. A healthy nervous system has high variability, meaning it can escalate during times of stress — physical or emotional — like working out at the gym, weight training, running a marathon. And then when we need to calm down, a healthy nervous system can de-escalate, rest and digest, promote healthy restorative sleep, and we can recharge and do it again the next day. It gets oversimplified where people think just teaching their nervous system to meditate and calm down during one interval is going to make it more adaptable to daily life stresses, and it doesn't always translate that way. I often tell patients — can you meditate when you're on the verge of a panic attack? Probably not. My goal with patients is to teach the nervous system to be more balanced, but also to teach it to be more resilient, more able to handle stress and then calm back down, without having that difficulty de-escalating.

Melanie Suzanne Wilson (08:55) Are you saying that the nervous system is doing better not being in a straight line, but when it's able to level out after it is required to be heightened?

Dr. Sean Altman (09:06) Yes, exactly. And that's really how I gauge a healthy nervous system — I'll look at wearable data in terms of, when someone exercises, how quickly their heart rate and vitals are able to drop back to normal. Something useful in training that is things like interval training, high intensity interval training, where you're teaching your body to sprint and then come back down, sprint about — having that flexibility preps your nervous system for times of stress and decreases the likelihood that it'll overreact to that type of situation, because you're training it — that's what exercise and a lot of things we do are geared toward, teaching the body to handle what it encounters.

Melanie Suzanne Wilson (10:07) I have a couple of questions about all that. Firstly, I'm wondering if different people are more sensitive to nervous system issues than others. And also where fear plays a part in this — it's great to hear we can measure things like sleep, but the underlying emotions, where does fear fit into all of this?

Dr. Sean Altman (10:34) Absolutely. There's people of all types, they can have backgrounds that involve abuse and emotional issues, and that certainly is extremely relevant — obviously psychotherapy and treatment and addressing that is part of the process. But I think very often nervous system regulation, in addition to being a mental and emotional state, is also what we'd call an energetic state — it has to do with how energy flows through our nervous system, and emotions are going to affect that. But there's also a way to address it from the other end — the energetic, molecular, chemical, more scientific way. I'm not saying one or the other, I'm saying both — a combination of the two. It's important to think of it like tools in a toolbox — there are tools that work on emotions, which may involve talk therapy, CBT, DBT — I know all about that from my wife, who's a therapist working in trauma for quite a number of years. But then there's somatic — body problems — then there's chemical problems and system-level problems, and those are going to be addressed more with a physical intervention instead of a verbal or emotional one. So it's often the blend of the two. But you're absolutely right, fear is definitely part of this. Just like in orthopedics, where we're looking for the root of someone's pain, there's probably a root to someone's fear that they're dealing with, and getting at that is helpful. Doing it from that physical and chemical standpoint also helps, because whenever we experience any type of emotion, there are hormones and chemical signals and electrical signals going on within our body that accompany that feeling and emotion. So you can treat that simultaneously, or in conjunction with whatever therapies you're doing.

Melanie Suzanne Wilson (13:14) It's encouraging to know there are physical solutions beyond simply talking about things, because when we're dealing with the physical body — although the mind is connected — it's clear there can be something else going on, or the memory can be stored in the body in some way.

Dr. Sean Altman (13:36) There are many examples of emotional states being caused purely by physical issues. I've had patients dealing with anxiety and depression because of simple vitamin or mineral imbalances that come up on blood work, and that entire emotional state resolves once that's corrected. There's a very interesting case of a patient who got this fancy infrared sauna that also had phototherapy — different types of light to stimulate brain waves and mood, different light wavelengths for making you more calm or more attentive and focused. He really enjoyed the blue light, which is only supposed to be used sparingly, and he was actually doing too much of it and gave himself depression from the blue light. As soon as he stopped doing the blue light therapy, it resolved. So it shows there's that interplay between the physical and the emotional, and having that differential diagnosis, that functional medicine approach, helps us tease out all of these factors and establish the nature of their issues.

Melanie Suzanne Wilson (15:08) It sounds like sometimes people are using too much of a good thing. I have an example — a few times in the past year I went to four yoga classes in a row, all in one go. That's on the extreme end. Everybody has something they're doing to the extreme — maybe getting a bit obsessed with the ideal diet, even though we need to eat healthy, how far do we take that? Or people go to the gym a lot — how do we know where to draw the line?

Dr. Sean Altman (15:53) I think it goes back to that theme of listening to your body — when you do too many yoga classes in a row, the poses and stretches start to feel a little more uncomfortable, because you've probably crossed a line where now you're overstretching areas instead of promoting flexibility and mobility, and now you're starting to create more micro tears and the body's not responding well to it. The same thing goes for other lifestyle activities. I think it depends on the person — having someone like a health coach is excellent because they can coach you and make sure you're not overdoing things. I recognise that's not always within everyone's budget, so if you can have someone keeping you motivated and watching along the way, that's great. If not, you have to become more aware of yourself and listening to your body, and figuring out that balance of what's the right amount for you to feel good and not push too far. People get hooked and start doing too much yoga, or spin classes, or running — I see a lot of runners with overuse injuries, stress fractures, Achilles issues, because running is also addictive — we get that endorphin rush when we run. It's part of this larger process of listening to those signals your body gives you — "now I'm starting to get a little bit of pain, maybe I need to take a day off." That goes to the larger message that we need balance for our nervous system — our body needs rest days occasionally, at least once or twice a week, to repair, to build new muscle, to respond to these positive interventions. If we're not doing the appropriate amount of rest, it turns into overtraining and injuries. You only need to look at professional athletes to see examples of what can happen when you push the body too far. So if you're not being paid to do yoga or exercise, you have the autonomy to decide, "let today be a rest day, let my body reset and recharge," and you'll realise you're all the better for it. I've had patients on training programs who are always fascinated that structuring it a little differently — adding a rest day, actually working out less — makes them feel better, and sometimes they'll put more muscle on that way. They're always confused, like "I feel like I'm doing less, but getting more out of it," and I say it's because the body needs rest, and it needs a certain amount of stress to get better — but too much stress is harmful. A classic example of hormetic stress is something like a sauna or cold plunge — there's a specific temperature range that's therapeutic, but if the sauna's too hot we could burn ourselves, and if the cold plunge is too cold we could get frostbite and freeze. There's a just-right amount for everything.

Melanie Suzanne Wilson (20:05) There really is. The cold plunges, the ice baths — there are all these names for it. I feel so cautious about those. I dipped a limb into one of those and it was very much electronically managed, it wasn't just someone putting ice cubes in water, and I felt numb instantly. I thought, I don't know what this is meant to — it felt like something was happening to me. So I totally agree we need to be careful and listen to ourselves. Beyond listening within, I'm so keen to ask about AI. I wonder, in your work, where AI has fitted into all of this, and whether we can trust what it tells us, and if someone is going to experiment with using AI for these purposes, how can they do it responsibly?

Dr. Sean Altman (21:14) I think the best way to utilise AI is as a research tool, but it's not capable of making sound medical decisions for us. By its nature it's designed to please — when you send a query to AI, it's trying to give you the answer you want, not necessarily the correct or most accurate answer. There was an experiment some radiologists did to test AI's ability to read imaging — they fed it thousands of imaging images, explained how X-rays work, what to look for, tried to program this model to read imaging like a radiologist. Then they took the same set of images and gave it ten different prompts. They knew the actual diagnosis was a fracture in a specific area of the bone, plus some cartilage damage in another area — but of the ten prompts, only three identified the fracture, and all ten had completely different reports, because the prompts were different — the prompts indicated to the AI what to look at more, and it wasn't able to have an unbiased view of the images, and therefore wasn't able to have an accurate interpretation. So I think we can certainly use it to help write something, to help research a topic, but ultimately the ideas need to be our own — or at the very least, we need to fact-check, and there needs to be a human element behind it. I get a little concerned hearing about AI models being built into hospital systems, being able to help prescribe medication to a patient — because if AI is built to give us the answers we want, and you're someone who's drug-seeking, you can fool the AI into giving you the drugs you want. Drug addicts do this to doctors all the time, and it takes human judgment by the doctor to realise it's not appropriate to prescribe that medication to that patient because of their history. So it does concern me that there are possibilities of this hurting people. I think there's tremendous benefit in some of the things AI can discover and help with, but I'd like to see it used more as a support structure, not the primary structure.

Melanie Suzanne Wilson (24:43) For sure. I've heard about AI being introduced gradually to even therapeutic spaces, like for social support and some forms of psychological support. It seems like with any of these specialties there's a slippery slope, where a human can use intuition or read someone, especially meeting in person. And the prompt is a big part of this — most people haven't been taught to prompt well, but AI can also be set up however someone wants to set it up. And it doesn't mean it's going to have all the information, because we're all unpredictable — even if AI has been told the general norm, someone's going to come in and be the exception.

Dr. Sean Altman (25:27) Absolutely. And as you said, in person there are things like nonverbal cues that AI clearly cannot pick up on, that could be paramount to a correct interpretation of what someone's trying to say — it could be very easily misheard. I've read a text message and not realised someone was being sarcastic about something. Humans have the ability to dissect something like sarcasm a bit better. So if the physical context, the body language context isn't part of the communication, there can certainly be things that are lost.

Melanie Suzanne Wilson (26:32) Absolutely, that's a whole thing in itself — we're all texting so much and it's not the same as interacting in person, or even having a talk like this. I really appreciate doing video calls for the podcast, because you can read the other person even from a distance — and of course being in person is even better. It would be great to look at burnout at least a bit. I don't know how extremely busy your work is, whether — you mentioned people who run and take that too far, I don't know if that's a version of burnout, but I'm wondering whether people come to you with all sorts of things.

Dr. Sean Altman (27:23) I've experienced some professional burnout in my career, and I've worked with quite a few people who've dealt with it. I think it's quite common in the medical field, especially with the way health insurance has become — much lower reimbursement, higher quantity of visits we're expected to see, and it can get overwhelming. I worked for a large corporation with hundreds of offices around the country, and I was director of rehabilitation at a hospital, and I ended up in situations where I was seeing a lot of patients and had a lot of responsibility, and I started to burn out. I started to feel like I was really drifting away from the reason I went into medicine to begin with, which was to help people. I felt like the job became much more focused on money, on profit and loss and financial statements, and how well the department was doing, and the reimbursement, getting a certain amount of things approved by insurance — and it really watered down the inner drive I had to help others. I reached a tipping point where I really wasn't happy with the life I was living, with the job I was doing. I probably would have burnt out if it weren't for an annual review I had with one of my bosses, which basically pushed me out of it — he said my biggest weakness was that I cared too much about my patients.

Melanie Suzanne Wilson (29:30) My goodness.

Dr. Sean Altman (29:31) That the office, while profitable, he wanted it to be — he wanted us to make twenty to thirty percent more profit, we needed to increase the volume, this, that. And that hit me really hard. I said, if I stay, I will burn out, I cannot stay in this environment, it's not healthy, it's not me, it didn't represent the ethics and the values I believed in. With the support of my family and my wife, who's amazing, I was able to carve out a career and go outside of insurance and give the care that I wanted. It hasn't been an easy path, but it definitely helped me avoid the burnout I most certainly would have experienced. I know people who are still stuck in the system and aren't happy, and are just kind of pushing along to retirement, and it's really difficult — something not everyone has the resources or support to do. That's often what drives burnout — you're literally stuck in that position, you don't have the ability to leave, you can't support yourself or your family, and it just keeps building on you.

Melanie Suzanne Wilson (31:16) I feel so concerned hearing about that issue within the hospital space. It's safe to generalise and say this would be beyond hospitals themselves — you mentioned the insurance situation in America, I've seen implications from similar funding insurance issues over here in Australia. It seems like the bottom line is that very large spaces are focusing on return on investment and profitability, or even efficiency. A former general practitioner on the podcast said the assumed average time of an appointment in her work was about seven minutes. Was it kind of like that for you — people needed to show up and get out very quickly?

Dr. Sean Altman (32:19) Yeah. It really weighed on me for quite a while — I started to become more and more aware of the people I wasn't able to help, and I'd try to fit in an extra minute or two here or there, and it just became unsustainable. I would work through lunch and not do a single bit of paperwork all day so I could squeeze in ten minutes instead of seven, but then you're exhausted and can't do that forever. It gets challenging, and as you said, this isn't just exclusive to medicine — there are corporations that work that way, lots of companies that are more cutthroat and more focused on the finances than on the quality of life, the quality of the jobs for their employees.

Melanie Suzanne Wilson (33:30) Absolutely, it happens in so many spaces. I'll stay super vague, but recently I was dealing with a professional who I realised wasn't aware of any of the facts of what that person was dealing with — how many people were involved, what requirements, nothing — and I wondered, how can you give me advice if you know nothing about this at all? It doesn't make sense. But I'm hoping you can give some comfort or guidance to people who do have to interact with the medical system and want to still feel seen, because eventually someone will go into a hospital or something else, and it can feel scary. My experience on the other end of it — not as a professional — I mentioned before, it was in 2017, I slipped in the bathroom, and a paramedic came to my home, unwrapped some crutches and said, "Look at YouTube to learn how to use these." Turns out I needed surgery. I was terrified, wondering what's going to happen. So people go into medical spaces of any sort feeling like they don't understand what's happening to them, what's happening around them, it's all confusing. They might feel scared of the solution or what has happened. So how can people feel cared for and heard, or even helped sufficiently within these spaces, given the system they're within?

Dr. Sean Altman (35:25) I think there's two things. Number one, just improving your health literacy in any way — reading books, listening to podcasts, understanding — that's what I've tried to do with my social media work, putting information and content out there so people can learn and understand more about their bodies, because having a better understanding of your body and of medicine, and how the system works, makes you feel a little less lost within it. The second thing is being your own advocate — asking questions, getting answers. It may feel like you're holding people up or getting in the way, but you have every right to ask these questions, to find out what's going on, what procedures are being recommended, what your test results say — to make sure you're informed and actually making these decisions. A lot of people get pushed through the system and don't even know what's going on, and it shouldn't be that way. There's no reason you can't ask a question and get information — it may be a little inconvenient for the people who have to help you, but that's okay, you have every right to.

Melanie Suzanne Wilson (37:16) For sure. I'm encouraged, and I hope everybody can be, knowing we can turn to people like you. You're putting content out there and we can trust it. At this point most people know anyone can put anything on the internet, and there's a bit of a stigma around influencers to some extent, because anybody can become one — but you're an expert and you know what you're talking about. So it seems like part of the solution is for people to turn to the experts online, trust it — this is the better side of the internet. People talk about scrolling and all of that, but it's okay to browse social media and use it in a constructive way.

Dr. Sean Altman (38:14) Absolutely, I just ask people to be critical of the content they're reading. For my part, what I try to do with anything I post — and what I've been posting a lot more of lately — is information backed by a scientific research article, advice grounded in actual science, in an actual research trial, which is much more sound than just a tip someone gives you in an Instagram feed as an influencer. There has to be some evidence behind it. In America there's been a big trend toward things like peptides, precursors to proteins, some supplements that have various effects, accelerate recovery — and these GLP-1s people are using for weight loss, like semaglutide and tirzepatide, which are peptides. There's absolutely merit in those peptides when used appropriately in the right people, but that doesn't mean everyone should be taking them — and it certainly doesn't mean you should be taking them if you're not under a doctor's care, not under some sort of medical guidance to make sure you're taking the appropriate dosage and taking care of your body the right way. All of these things have evidence, but there's also a structure that needs to go behind it.

Melanie Suzanne Wilson (40:10) The common thread here is to apply the general information to individual specific needs, with guidance. Are you saying it helps to get guidance from someone who can help individually and personally?

Dr. Sean Altman (40:27) Absolutely. And even if you're making some of the decisions on your own, make sure they're based on actual scientific evidence, reliable guidance — not just tips from someone who doesn't necessarily have the background, or hasn't done the research behind what they're doing.

Melanie Suzanne Wilson (40:55) There's an abundance of expertise out there. I'm so keen to see more of what you put online, and people can use the same approach to learn all sorts of things. It was during COVID that I started following people who guide nutrition, and there are specialists who use nutritional knowledge to help things like mental alertness. Whatever we're trying to learn, it's about finding the people who know what they're talking about. How can we tell the difference — I was going to ask how we tell, but this is beyond just looking at who's wearing Lululemon — what else can someone look for?

Dr. Sean Altman (41:49) I think you kind of hit the nail on the head when you said individualised. Everyone's body is chemically, biologically, energetically different. People giving the same advice to every single person, or to the majority of their followers or patients, it's unlikely that's going to be appropriate for everyone. It's more likely an individualised approach will be best. With mental illness, we know ketogenic diets can be very helpful for certain mental illnesses — for some people the carbohydrates and insulin have a lot to do with the way their brain is metabolising sugar, and it's at the root of their issue. But it's only about twenty to thirty percent for whom that works — not everyone — but in that twenty to thirty percent, ketogenic diets can be incredibly effective treating certain mental illnesses. But for the other seventy, eighty percent, it doesn't work, it doesn't do anything — it's highly individualised. I was reading a very interesting post by a colleague talking about that — he was saying it's very hard to prove that with research, because research is all watered down. If the diet works really well in twenty percent of the research group, the evidence of the study isn't good, because the other eighty percent didn't do well, and when you average the effect it's not a very significant effect. It's interesting how these things work and how research interprets them, that there are these hidden treasures in terms of treatment that work for certain people and not others, but you have to find what's best for you.

Melanie Suzanne Wilson (44:05) Is it that research is about what works for the majority?

Dr. Sean Altman (44:11) Or what works for the average — but the reality is, who is that? No one's truly average in every category — we all have various idiosyncrasies where we're average maybe in a few categories, but not in others, so no one really fits that average individual. These studies are guides — I see them as potentially useful interventions, and the important part of the research is also showing the safety of those things. So the ketogenic diet — it may work, it may not, but it's entirely safe, there's no side effects, no risk in trying it, so those are good interventions to try, especially if there's evidence it might help you. But it's better to have someone guiding you and helping to individualise your plan than just trying different things and seeing what sticks. A colleague of mine who's very into lab work, way more than I am — these functional laboratory tests — she loves to say, "test, don't guess." There are excellent labs you can do to figure out if you have gluten sensitivity, these various things, and based on that you can structure an intervention that's much more likely to be successful because you have data behind it. I think that's really the best way to use these things. AI is helpful in some of those in terms of reading that data and coming up with potential connections we may not have found because we don't have that processing power. So it does fill in in certain places, but it should be used as part of the whole, with someone behind the wheel.

Melanie Suzanne Wilson (46:16) It's fascinating hearing about the keto diet. I'll share that I eat whole plants, but I find on some weeks having a bit extra olive oil feels right for me — so even what I need varies between different weeks. I've seen some people want those other categories, but the thing that got my attention a lot in what you said was the carbs. I was on a trip recently where over a few days most of what was available was bread and jam — I could feel it. I'm not anti-carbs, I think carbs are awesome, but I'm curious what people have seen with how a spike in carbs or sugar can affect the mind.

Dr. Sean Altman (47:22) In a lot of people, carbohydrates — sometimes specific types depending on your body — can cause spikes in insulin, inflammation, bloating, and then this post-prandial insulin spike with a glucose drop, where there can be that kind of fatigue, hangover-like feeling when you eat too much. That's a very real thing. When it comes to carbs I think it's about identifying how your body responds to them, and if it doesn't respond well, either minimising carbs or figuring out what carbs are compatible with your body. One of the things becoming more popular in the longevity medicine field is using continuous glucose monitoring, CGM — the little attachments — in non-diabetic individuals, to determine what foods work best with your body, what foods are causing glucose spikes, and then you can identify what diet is best suited for your gut and your microbiome. It's different across the spectrum — I have a friend whose body doesn't respond well to apples, he has a massive glucose spike with apples, but no glucose spike with pasta. Another colleague, sweet potatoes — his body responds really badly to sweet potatoes, but regular white potatoes, no problem. So there is no generic diet that's going to work for anyone — we all need to establish something more precise, more specific, and if we can't, at the very least there are diets like the Mediterranean diet, or just eating more whole food, less processed, that we know to be safer and better on the whole. But adding that level of precision can make a big difference in how you feel day to day, and figuring out how best to keep your vitality and energy up.

Melanie Suzanne Wilson (50:04) Have you seen that a common thread for pretty much everybody is to at least start with eating real food instead of processed foods? Is that a good general guideline for everybody as a starting point?

Dr. Sean Altman (50:19) I think so — at the very least, trying to incorporate more whole food into your diet. We're realising more and more that America is considerably worse in terms of how we process food, with GMOs, microplastics, high fructose corn syrup — there's a lot of additives in our processed foods. I was reading something the other day — a list of things in American processed foods that are illegal in many other countries throughout Europe, not even allowed in foods there. It makes you think twice about having something that has that in it, because if it's illegal elsewhere, there's got to be a reason — it can't be good. The more you read and learn — I think that's where being an educated consumer helps you realise the why. I think that's the best way to help someone improve their diet — rather than telling them to just start eating XYZ, showing them why it's beneficial, why it might be harmful to have these other things, what's in it, and what the long-term implications might be — because then they're making the decision and more likely to stand by it.

Melanie Suzanne Wilson (52:11) They will feel informed. Will these new habits also help the nervous system?

Dr. Sean Altman (52:17) Yes, absolutely. Having a cleaner diet — the gut, the immune system, and the nervous system are interconnected. I'll go a little into the science, but the vagus nerve is located in our neck and dictates how our nervous system works, but it also plays a role in our gut, our immune system, and digestion. So if we have a cleaner diet and digestion is easier, that frees up resources for our nervous system to be stronger and function at a better capacity. It's useful to think of the body as a closed system with a finite amount of energy — kind of like a car having a certain amount of fuel. All of these systems use some fuel, use energy in a certain way, and if one system is monopolising the body, using energy too much, it leaves less energy available for the remainder of the systems. If you're eating a clean diet and your gut has less on its plate, it doesn't have to work as hard, and other systems are able to dedicate more resources to repair — and that's where we've seen people with GI issues improve their gut health, the lining of their gut, in response to healthy diets. It's actually not the food that makes the gut heal — the body heals the gut, but the body's able to heal the gut because you make it easier on the body, you've allowed it to finish the job. It works the same way in orthopedics, in terms of injuries — if we're able to optimise the way the body's functioning in terms of gut, nervous system, all of these systems, more energy can be dedicated to laying down collagen tissue, scar tissue, fibroblasts, and healing that particular soft tissue injury in your meniscus, rotator cuff, ankle sprain. It's just that the energy has to go somewhere, and it makes a lot of sense when you see it that way.

Melanie Suzanne Wilson (55:02) Are you saying that if we look after our dietary habits and our nervous systems, the basics, we can have more progress towards healing?

Dr. Sean Altman (55:15) Yes, absolutely. And often that's the reason people are unable to heal — their body is too taxed in terms of the other things going on, so it's not capable of mounting an appropriate healing response.

Melanie Suzanne Wilson (55:38) Whatever is going on, whether we have a small issue or a small or big-T trauma, looking after the basics will help us.

Dr. Sean Altman (55:49) Absolutely, it's essential, and it factors into virtually every type of healing. Something that's easier to think of in terms of visual proof is wound healing — a big wound and its ability to heal, in individuals with better health, cleaner diet, less systemic inflammation — the wound heals much quicker and actually much cleaner, the borders of the wound, the scar tissue, the way it heals will look nicer. Versus someone who's diabetic, or has chronic stress, or improper diet — there'll be a significant visual difference in the quality of wound healing and the time it takes to heal. We've all heard about diabetics and how they can have ulcers that don't heal — that's because their body is overwhelmed dealing with the diabetes and all the sequelae of it, so it's not able to finish that healing process.

Melanie Suzanne Wilson (57:07) We are what we eat. You look at so many different topics — I'm keen to wind up by checking which issues someone will learn about and get empowered to improve by looking at your content. We've talked about the nervous system, food, orthopedics, burnout, all sorts of things. What do you teach everybody in your content, and how can they connect with that?

Dr. Sean Altman (57:42) I think my larger content is geared around pain, illness, and injury — better understanding the context behind the struggles you may be dealing with, looking at it from all of these various angles, and once you do that you're able to get the full picture of what's going on and address the primary cause, the root cause of the problem, as well as secondary causes. When you do that, the outcome is obviously going to be much better, and the resilience — the risk of recurrence, which is really key when it comes to chronic pain, preventing it coming back — will be much lower, because you've identified the key factors that led to it in the first place, or led to it coming back. So it's about learning, being able to be your own detective, asking the right questions, and knowing how to advocate for the right care. In the case of going to a hospital, you don't have as much freedom to choose who's conducting your care, because you're in an emergency situation — but for other routine medical appointments, for nutritional advice, for personal training, other health-related advice, you do have a choice, and you can seek out people who have the right qualifications and are really invested and really do care. It is not a weakness to care too much about people — I don't care what my former boss said. You want to find people to be on your medical and health and wellness team who have your best interests in mind, and who are helping you learn how to better take care of yourself, and when you do that you start to become much more empowered, and feel like you have more control over your destiny and your fate. That's my goal with every person I work with, every patient, and everyone I try to reach on social media — to make you feel more powerful and more informed about your own body. It's a little corny, but I like to say, you are the medicine. There's a lot you can do if you figure out the right interventions, the right strategies, and learn how to better take care of yourself.

Melanie Suzanne Wilson (1:00:39) This is empowering. Dr. Sean Altman, thank you so much for talking about all of this on the Motivate Collective podcast.

Dr. Sean Altman (1:00:49) Thank you.