Chronic Pain Relief Using GLP-1s w/ Dr. Asare Christian

If you’ve noticed your pain improving on a GLP-1 medication, you may not be imagining it, and it may not be just because of weight loss. In this episode, Ana sits down with Dr. Asare Christian, an integrative pain management physician, to talk about why chronic pain is often treated too narrowly, how inflammation, sleep, trauma, stress, and metabolic health all shape the pain experience, and why GLP-1 medications like semaglutide may have a direct pain-relieving effect even at low doses. They also dig into migraines, how low-dose semaglutide may fit into pain care, the micronutrients that still matter when appetite is lower, and why lasting pain relief usually takes more than a single medication or procedure.

About our Guest:
Dr. Asare B. Christian, MD, MPH, FAAMFM, is a board-certified longevity medicine physician and founder of Aether Medicine, a concierge performance  & longevity clinic in Pennsylvania. Trained at Johns Hopkins and Harvard, he specializes in solving pain, optimizing hormones and metabolism, and advancing healthspan through precision diagnostics and evidence-based cellular therapies. He combines rigorous science with innovative medicine to help patients improve performance, resilience, and long-term vitality.

Connect with Dr. Christian
Website: Aether Medicine - Integrative Pain Management Specialist - Wayne, PA

Episode Sponsors:

Metagenics: Explore our complete collection of science-backed supplements.

Harvest Snaps:  Harvest Snaps by Calbee America Enter SNAPS15 at checkout for 15% off your order, now through June 30.

Want to Learn More about GLP-1 Hub?

Join the Steady State newsletter and get a FREE 7-day meal plan + weekly support and strategy to optimize your journey: 

http://join.glp-1hub.com

Join the membership:

https://glp-1hub.com/membership

Visit our GLP-1 Hub store:

https://shop.glp-1hub.com

Want to connect more with GLP-1 Hub?

Instagram:   https://www.instagram.com/glp1hub

Tiktok: https://www.tiktok.com/@glp1hub

YouTube: https://www.youtube.com/@glp-1hub

*Some of the links shared are affiliate links. When you make a purchase, I will receive a small commission at no cost to you. Thank you for supporting the show.

*The content of this show is for informational purposes only and does not constitute medical advice. The goal of this show is to provide various points of view about GLP-1 Medications. The personal and professional opinion of the guests and their content does not necessarily reflect the opinion of Ana Reisdorf or GLP-1 Hub.

Transcript

SPEAKER_01 0:00

There is a study that looked at just giving people a little GLP1, and then right away the pain went away, even before we saw the metabolic improvement. So it has a direct anagesic, which is pain relief, and then it has all these other metabolic issues. And when it's used well, and then comparing, you know, combining that with everything else we talk about, then everything tends to work a lot better for people.

SPEAKER_00 0:20

What if GLP1s could reduce chronic pain even before weight changes happen? I'm Anna Reisdorf, registered dietitian, GLP1 user, and welcome to the GLP1 Hub Podcast. Today I'm joined by Dr. Asari Christian, an integrative pain management physician outside of Philadelphia, and we're talking about how GLP1s may be affecting pain in ways most people don't even realize. In this episode, you'll hear why pain is more than just tissue damage, and how GLP1s may have a direct pain-relieving effect, and why low-dose semaglutide may help with things like migraines, and why nutrition, sleep, and metabolic health still matter if you want your body to actually feel better. And if this episode or the podcast helped you, please consider leaving a quick review on Apple Podcasts and Spotify, or share your thoughts if you're watching over on YouTube. Let's get on with the episode. Welcome to the GLP One Hub Podcast. I want to welcome Dr. Christian today. I was so lucky to see him speak at a longevity conference that I went to last year about pain in GLP One. And I have been hearing from my audience that they are using GLP1s for managing migraines and other types of pain. And I was like, oh my gosh. And I was telling them I don't know anything about this. And then here he is. So, Dr. Christian, will you introduce yourself and tell us what you do, please?

SPEAKER_01 1:48

Yes, thank you so much, Anna, for having me. Uh my name is Osara Christian. My background is in pain management, but currently I have a practice in Wayne, a suburb of Philadelphia called Ether Medicine. And I focus on integrative pain management, performance, and longevity because all of those things are connected. You know, as we're going to be talking about, pain is something that we all experience. But in America and the rest of the world, pain is poorly managed, pain is poorly treated. And it's just because we treat pain based on blocking a pain signal without looking at the underlying process and all the things that goes on with pain. So hopefully this will be uh helpful to get people to be educated about pain. And then also looking specifically even the role of GLP1s in in modulating pain, as your audience have already uh experienced. And we have a lot of science to support that as well.

SPEAKER_00 2:33

So, what made you interested in pain management?

SPEAKER_01 2:36

So, my background is in physical medicine and rehab. And when I was actually finishing residency, I did not want to do pain because it's very complex and we don't have good options. But then I kept coming around people with pain. I was dealing with people that have spinal cord injury, brain injury, and pain was not treated well. So I got to this rehab hospital and I kind of became the pain doctor. So got into it, and then since then trying to figure out better ways to solve pain. And in fact, that's what have led me here. My practice at the inception was I recognized people had better pain relief when they were healthy. Whatever they are, whatever the intervention is, whether it's surgery, whether it's physical therapy, whether it's medication, energy medicine, whatever it is, when people are healthy, pain gets better because the body can modulate itself well. So my inception for this practice is really focusing on how do we get people healthy as a way to solve pain. And from there, solving health, so many things that we have to do. So that's how I got into pain.

SPEAKER_00 3:29

Sure. So explain to me, like, just in the real basic, like what pain is, because you know, we all experience like we cut ourselves, it hurts, it gets better, it goes away. But that's not always the truth about what pain is. Like people deal with it very chronically.

SPEAKER_01 3:46

Yeah, so I I love that question. And I'll I'll define it based on how the people with our study of pain uh define it. And then we can also talk about it in terms of how people experience pain because that's also very different. So pain is defined by this International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with tissue or potential tissue damage. So it has these two components. It's a sensory experience and it's personal, and it has an emotional component, and then it may be related to a tissue damage or no tissue damage. So you talk about the fact that we can cut ourselves, and then yeah, that's a tissue damage that will lead to pain. And then you can have people that have fibromyalgia, you can have people that have migraines where there's no tissue damage and they can still have pain. So that's the diagnosis of pain in a broad terms. But we know that that alone is not the whole picture of pain because pain is also influenced by various degrees of your biology, your psychology, and your sociology, the environment. So pain is a protective mechanism. The reason why we have pain is that it's there to protect us, to warn us. But how we experience pain is based on whatever psychological experiences we are having or we've had in the past, including trauma. So trauma will influence how people experience pain because it's a nervous system that interprets pain. So, as you talked about, when you catch yourself, there is a cascade of events or inflammation, inflammatory markers that create, and then your nerves take that information and it goes all the way to your spinal cord and it goes all the way to the brain. And so that signal gets to the brain. We don't even know that we feel pain. So pain is always an output from the brain. So anything that's implicated in how the brain is interpreting that signal can make pain either bigger or smaller. We also know that pain is also influenced by our environment, which houses you grew up pain. Your parent growing up say, you know, tough up, all of those things that influence how people experience pain. And then even in different cultures and different countries in America, how we experience pain is very different than how people experience pain, maybe in Canada, in Germany, in Africa. I'm from Africa, I'm from Ghana. And when we look at that contest, America is only 4% of the world population, yet we use 80% of the world's opioid. So why is that? So it's also the culture. So there's all of this things that influence pain. So when we're trying to address pain, and the reason why most people are still in pain, despite all these advancements we have in America and some of these developed countries, is that we are looking at pain just through the biological. If you don't address psychological issues, chronic pain doesn't get better. If you don't address cultural contest, the environment, trauma, all of that influence pain that if we are not doing those things, then people don't really get better. So this is why it makes pain a little bit complex, because people will come to my clinic and they will say, My pain level is two, and they can't even hold themselves up. They're really miserable. And somebody will come in, my pain level is eight, and they're sitting there chatting and laughing and all of those things. So there's a lot of subjective, it's a subjective experience. So it's really, really important for people that are experiencing pain to understand pain. And the simplest way for people to understand pain is that pain is always an output from your brain. So when you're trying to fix chronic pain, you have to deal with what's happening in the periphery you catch yourself. And then let's also work on the brain to calm the brain down to help you navigate a lot better.

SPEAKER_00 6:56

Okay. So what in your your you know, practice, what do you think it is about Americans that make us pain? Is that we want to pop pills or we like are too stressed out, or we're unhealthy, or what do you think?

SPEAKER_01 7:09

Yeah, so I mean that's a that's a complex question. There's some other factors. So one is this environment, we have a lot of stress, we are exposed to a lot of inflammatory markers. And I'll give you some examples of that. You know, I have patients who have pain. They in America, they eat bread, whatever, they blow up, they have more pain, their hands swell up, they go to Europe or some other place, they eat, they don't have any pain. So even the food, in the environment, the toxins, all of that influence that. And then the bigger piece of it is also how we deliver care. How we deliver care also influences how we look at disease. So in America, I remember when I was a resident, we came up with this idea of making pain a fifth vital sign. So then I remember as a resident, you have to document, you know, what is your pain level and you have to treat it and you have to give opioids. So that actually led to this opioid crisis. So the delivery of care, the environment in which people navigate, and also, you know, accessibility to other things and trauma. And people here, we have a lot of stress. We don't have a lot of environments that are calm unless you're in a place where you have access to natural places and spaces. We are always in this place of all of this entropy and all this forces, electricity, uh toxins, they're all there. And all of that influence how we process pain. So all of those tend to factor into how people experience pain.

SPEAKER_00 8:21

Sure. And so today, was the main treatment for pain, at least in the United States, opioids, or are there other types of treatments available?

SPEAKER_01 8:30

Yeah, so when it comes to how we treat pain in America right now, uh we can look at pharmacological and non-pharmacological ways. And then the third piece of it is surgery and intervention. So when we look at pharmacological ways, basically medications, and it's very narrow in terms of medications that we have for pain. So we have acetomedaphen or tylenol, which is not as effective. And again, we've done all this cochrane review. This is like the body of science that looks at how effective some of these therapies are for back pain, for chemical pains that individuals deal with. Tylenol doesn't work as well for most people. And most people can validate, it doesn't do too much. The other options we have are NSATs. So this is your ibuprofen, the alleve, naproxene, all of those things are within the class of NSAT. Again, those are also not as effective. And then more importantly, we have to worry about specific side effects. They can affect the kidney, they can cause GI issues, they're receiving a black box warning for cardiovascular disease and stroke. So that's also limited. And then from there, we go to gabapentinoids. So people have heard of gabapentin, you know, or neurantin. So those are medication, class of medications that are also basically work to slow down how the signal is going to the brain. And it slows down everywhere, including the brain. So there's also side effects, not as effective. And then beyond that, we go to opioids. And opioids has a place, but again, a lot of side effects and a lot of you know issues that we've dealt with opioid, huge public health crisis. So, in terms of medications that we have, those are not that effective. And in fact, we've not even had a new pain medication since we came out with Celebrise. This was 20 years ago. And then we just have a new medicine called Juvinax, which kind of works like um like gabapentin. It also works on sodium channels. So, again, from a pharmacological standpoint, it's very limited. And the reason being it's not that the medicines are not effective, it's that pain is more than those signals. It's complex things that are going on. So even if I block your pain signal and you still have trauma that you haven't resolved, a small signal getting to the brain is going to get blown up as a big pain. Okay. So I have to work on gabopentin, I have to use that medicine, and then teach you about other things. If you're not sleeping, pain doesn't get better. If you're not eating well, if you're not moving, if you're stressing, that creates the chemistry of inflammation. So all of those factors have to be put in place. But I think what we do is we just focus on this is a drug, it's supposed to solve all the problems. And that's where we have those limitations. And then from a surgical standpoint, a lot of surgeries that we do for people with back pain, we don't even have any level one evidence for any of those things. People have pain, they go, they get the surgery, surgery is fixed, they still have pain. And in fact, we have something called post-laminectomy or post-fusion syndrome, where people will have the surgery to fix the problem and develop another pain condition. And the problem isn't that the surgery did not work. Surgery is fixing structure. Structure fixing does not equate to pain solving. So that's the difference. And a lot of times patients also kind of the education. Oh, look at my MRI. Every patient wants an MRI. When we do an MRI, what do we do for you? Then we end up giving you an injection, we end up giving you surgery. We do more MRIs, that's why we end up with more surgeries. And all of that is data that we have. Places that do more MRI, they do more surgeries. Okay. So people need to understand that it's not just structure. What's on your MRI doesn't tell us anything about your pain. It just shows us structure. Maybe there's some relationship, correlation that we can make. But pain is complex. Because even when we fix that structure and everything is stable and there's a small signal going to the brain, and the brain has factors that is amplifying that pain signal, you're still going to have pain. From that standpoint, you know, I think we don't have a good way of addressing it. But I think the problem is the lack of education to get people to understand that, yeah, this things that we do have a place, but that's not going to solve your pain. Unforgiveness, trauma. If you don't work on all of those things, your nervous system is still going to take a small signal and make it big and experiences that a bigger pain. So I think there has to be better education. And then pain has to be looked through a multiple lens to even go a little bit deeper and say, what is happening at the cellular level? The microbiome plays a part in your pain. Hormones plays a part in your pain, mycotoxin, oxidative stress, metabolic issues, which is what we're going to get into. All of that modulate pain. So I think the issue is lack of education and getting people to understand that they have to do more. When you're healthy, pain gets better. How do we get you healthy? We fix your metabolic health, we do other things, and that relates to, you know, all the stuff that we're looking to talk about here.

SPEAKER_00 12:43

If you're taking a GLP1 medication, you've probably noticed your appetite is a lot lower, which often means your meals are smaller, and that's fewer chances to get in the nutrition that your body needs. This is why what we choose to snack on becomes so incredibly important. One snack I like to recommend is Harvest Snap's lightly salted baked veggie snacks. They're made with green peas as the first ingredient and deliver five grams of whole food protein and four grams of gut-friendly fiber and satiating nutrients to support your healthy weight loss goals. These real veggie crisps are crunchy, savory, and satisfying straight out of the bag, and also pair great with things like hummus, cottage cheese, or meat stick for an extra protein boost. Plus, they're minimally processed and free from common allergens, including gluten, dairy, eggs, nuts, and soy. If you'd like to try them, head to harvestsnaps.com and enter the code SNAPS15 at checkout for 15% off your order now through June 30th. So other than you, any I know there's a lot of pain centers out there that you can go to. Are are they aware of like that it needs to be a whole experience? Like, do you think that things are moving in that direction?

SPEAKER_01 13:57

I think there is some, but there it there is still way behind. And I think one area that I would say there is a little bit more push is the neuroaffective component of pain because pain has a sensory and an emotional component. So the emotional piece is where now there's all this neuroscience, which has been there for a long time. Now people are really understanding, and we have more studies to validate those things. So the neuroaffective component that's getting pushed. So uh one of the platforms, Curable, which is a great platform that you know I always give to people because it teaches people about the neuroscience of pain. And pain from that context is just a signal plus fear. And when you take away the fear, it's just a signal. I think sometimes when anytime we have pain, we're afraid. What's happening? Am I sick? And in fact, pain is one of the main reasons why we show up to a doctor's office. How do we find cancer? Somebody had pain. How do we find all of this thing? So uh pain is a signal. So getting people to understand the neuroaffective component, which you have to do that work yourself. It's not gonna be a surgery, it's not gonna be my injection, it's not gonna be IB profane. So that's where we have the limitations. So that education is becoming uh prevalent, becoming more available. I think even beyond that, we have to go a little bit deeper to look at all the factors that are perpetuating even how the brain is processing pain. Okay, because it's much, much easier to hack your physiology than to hack your psychology. So those things work. But those things work, the neuroaffective component therapy works really well when you're healthy. So if I fix your gut, the microbiome may influence what we call central sensitization and peripheral sensitization, which are all processes that propagate pain. So if we fix the gut, pain gets better. If we work on sleep, pain gets better. So all of those things have to be put in place. And I think this is where we are lacking that comprehensive approach in terms of getting people to heal. And you have to go down to the cell. And that's my approach, is always less fixed a cell. The cells have all the intelligence to adapt in a healthy weight. Again, in the brain, the cell that's making things hyperactive is an astrocyte, it's a microglia, it's a neuron. They all have to make energy, they all have to have specific ways of reproducing. And if all of those mechanisms are not working well because there's oxidative stress, because there's more inflammation, then the cell is not gonna make a good decision and the cell is gonna be stuck in a plurality that creates a lot more pain. Hopefully, it's simplified enough for people to understand what I'm saying.

SPEAKER_00 16:10

I think it's fascinating. Thank you. Like so, GLP1s, you spoke about cellular improvements, inflammation, metabolism. So, where are the GLP ones coming in here?

SPEAKER_01 16:20

Yeah, so GLP1s, I I mean, I love GLPs. I've been using GLP1s for pain for a long time, even because before it became such a big thing for weight and all of those things. Because the mechanism of action, so GLP1, besides the metabolic things, which we know it controls glucose, insulin, it has all these other benefits, it also have direct anagesic effects. So what I was doing is once I started getting into this, initially I was using GOP1s to help people lose weight, and they had autoimmune issues and they didn't know much about that. And they're like, oh my gosh, they're losing weight, and now their pain is also better. And I thought maybe just the weight loss that's kind of led to something trans trans translating to better pain, which is what we see in osteoarthritis. And then kind of did a couple more patients, and I have patients where we're using low doses to manage their symptoms, and they get better pain relief. When they stop the medicine, their pain or inflammatory things come back. And then I got into the literature and I figured there's there's all this science behind how GOP1s are controlling pain. So when you have pain, as we talked about, even the inflammation that's getting created at the, you know, let's take the example of your cutting yourself. It's a function of a cell. There's a microphage, there's lymphocyte, there's all these immune cells that are doing specific work to translate that information. And if that cell doesn't have good energy, it's all about, in a simplistic terms, for people to understand at the cellular level, your cells can make good decisions when it has enough energy. So that's why you always boil down to mitochondria. Why does this GOP1 help with everything? Inflammation, brain health, cardiovascular health, it's all improving the efficiency of how the body is making energy and getting rid of waste. So when we can do that, the cells that are propagating that signal also helps with pain. And it does that through one mechanism, which is the metabolic. If you lose weight, less weight on the joints, improve pain. And then there's also direct anagesic effects because we also have it in a context of doses that are not really reducing weight, but are actually improving pain. And how is it doing that? Anti-inflammatory, there's oxidative stress reduction, there's mitochondria improvement, uh, there's neuronal uh circulation. And GOP1s actually also provide and signal your spinal uh microglia in the spinal and to make endogenous opioids. So it also helps increase opioid. So they've actually done studies in individuals with fibromyalgia where there's decrement in their opioid use, all of these things that improve. And then even in the case of inflammatory bowel disease, there is a study that looked at just giving people a little GLP1, and then right away the pain went away, even before we saw the metabolic improvement. So it has a direct analysic, which is pain relief, and then it has all these other metabolic issues. And when it's used well, and then comparing, you know, combining that with everything else we talk about, then everything tends to work a lot better for people.

SPEAKER_00 19:03

So which GLP1 are you using? Because I mean, obviously, trzepatite is not just a GLP1. It's the other components too. But are you using semaglutide or trisepotide? Like which ones do you find most effective?

SPEAKER_01 19:16

Yeah, so my experience with pain has really been a lot with semaglutide. So a lot of the data is on lalagrutide and azenotide, which is uh, I think biator and I forgot the other victors or something. So this are all so those like way back then before the the GOP ones, semaglutide, the one that really focused on weight. So there's already literature on that showing that it did improve pain and all of those things. But of course, you know, people don't care about pain, weight loss, and everybody's into it, right? So uh in my experience has been a lot more with uh uh semaglutide. I do use some tsepitide as well as uh for pain, but a lot of the things I've I've done for pain specifically has been with semaglutide.

SPEAKER_00 19:53

Interesting. And so are you keeping the people on a low dose or is it just dependent on the patient?

SPEAKER_01 19:58

I'm keeping people on low dose. For a couple of patients, you know, patients that have autoimmune type components, so rheumatoid arthritis, lupus, all of those things. I will use a little bit of GOP1, I'll use some other peptides, thymus and alpha one, I do a lot of cellular medicine, some LDN, some other things to support the gut. And then we get into the cellular level to really regulate how these immune systems are creating inflammation and creating pain. Very low doses. If somebody has osteoarthritis and they are a lot more uh heavier, then we know that the weight itself plays a part. So those are individuals where we're getting close to like the 2.4 milligrams. But for people such as you talk about migraines, individuals with migraines, this is also great for migraine individuals because GLP1s also decrease CGLP, CGRP. So CGRP casitonin gene-related peptide is one of this neuropeptide that's released as a consequence of a neurogenic inflammation leading to migraines. And GLP1 blocks that. They've done studies where they show that it helps with all of those things. So in those contexts, we're using very low doses, but people that we're looking for metabolic, then you go up a lot of rate. So in the context of those individuals where we're using for uh just anagesic benefit, we're using for semaglitic out just 0.25 milligrams to one milligram. That's all you need. It's effective. And then obviously you have to be individualized. Everybody's different. People respond to this differently, making sure that they're tolerating, don't have any GI issues or other side effects that uh may implicate overall health.

SPEAKER_00 21:21

Sure. I mean, I know migraines can be very debilitating. I've had two and it's awful. But yeah, so so migraine uh is a big one. Go ahead. Go ahead. Are there other treatments that work effectively for migraines, or are you finding really good success with the GLP1 because of the blocking?

SPEAKER_01 21:38

Yeah, there's other I mean, migraine is one of those that, you know, the pathophysiology is so complex, so that's why there's no one there's multiple mechanisms. That's why there's there's multiple drugs that still works on migraine, right? We have tryptins, which are visoconstrictors, they work with migraine. We have NSAS, it works different mechanisms. It works. And then we have these Castetonian gene related peptides, which are very specific. Um, and then we also even have botulin toxin, botox. That we can use to help with migraine. So all of it at the cellular level is going to kind of try to influence how the body is creating neuroinflammation and neurogenic inflammation. So there's multiple treatments. Those seen individuals where we put on GLP1s, they actually develop more migraines. And I think what it is is like there's this metabolic theory of migraine where the whole issue is that the brain is so energy demanding. So your brain uses 20% of your energy. And anytime there's a drop, you have this thing called the ATP phosphocrinase. It's a pathway to make energy very quickly. And it does require magnesium. And that when anytime there's a drop in that energy, that can trigger migraine. So some people that are put on GLP1s, because you know there's a decrement, it brings their glucose down, it can trigger a migraine. So finding that balance of, you know, certain not everybody is susceptible to that, but I've seen some patients where because migraine is so different from the genetics and it and the epigenetics and what's going on. So it's really individualizing it. Lifestyle is a foundational thing for migraine. Let's make sure that you have enough energy in. And in fact, they've done studies to look at what are the biggest, huge studies looking at the biggest triggers of migraine, emotional stress. Two is not eating and hormones and a whole bunch of other things. So that energy piece plays a huge role. And it's about fixing all of those things, fixing the gut. Microbiome plays a part in migraine. Avoiding the triggers is a good way to kind of navigate migraine. But there's a lot more options. I know we're not talking about migraine, but talking about migraine. I love migraine because there are solutions. And I think it's so sad that so many individuals are struggling with migraine and all they got is some tryptins and something else. Multiple things. Figure out what works for people. Hormones plays a part in migraine. Estrogen dropping that will trigger a migraine because that also leads to, you know, estrogen works on blocking CGRP. But the interesting thing about estrogen is that high estrogen can maybe create migraine, low estrogen can create it, is the fluctuation. So making sure that, you know, the right person gets the right treatment.

SPEAKER_00 23:53

That estrogen just gotta be perfect all the time. So annoying. Absolutely. So I wanted to ask you, you mentioned a couple times about like cellular health and nutrients. My concern around GLP1, and is is kind of the message I try to hone back down, is micronutrients still matter here, people. Like you can be 120 pounds but have severe malnutrition. Like people are getting scurvy now. Like what? You gotta try to get scurvy. So what sort of micronutrients are you concerned about with the GLP1s and with the pain management? Magnesium, magnesium?

SPEAKER_01 24:29

Absolutely. Magnesium plays such a huge part. And in fact, that pathway that I was talking about, it uses magnesium. So one of the treatments we have for migraines is what? Magnesium. Okay. Magnesium is super, super important. What other things that I can think of? Zinc is important. But a lot of minerals are also involved in that pathway. I can't think of them right now. But all of those things are not just for migraines specifically, but for overall cellular function. For your body to be able to function, you need all this micronutrients and you need all this amino profile and minerals to be in balance to make that work. So that is an important education that needs to be taking place that when people on GLP1s, yes, you're gonna have decrement in appetite, but let's make sure that we're getting the right nutrient in. Because if you don't have that, then that becomes an issue with all of those things.

SPEAKER_00 25:14

As a dietitian, I work with a lot of people on GLP1s, and one of the most common things I hear is I'm eating less, but my digestion feels worse. Constipation, bloating, and irregularity are incredibly common. That's why I recommend metagenics fiber pre- and probiotic. It's not just like adding more fiber, it's supporting digestion in a way that actually works with your microbiome. Traditional fibers will just add bulk, which they make bloating worse when digestion is already slowed down. This formula uses a gentle, soluble prebiotic fiber paired with clinically studied probiotic strain shown to support stool frequency and consistency, plus prebiotics that help feed beneficial gut bacteria. The result is more comfortable regularity without harsh laxatives, added sugars, or artificial sweeteners. If you're on a GLP one or not, Metagenics Fiber Pre and Probiotic helps support your gut when eating less makes things harder. Visit metagenics.com to learn more. Yes, and the research is coming, but we're not super clear about what the people are missing exactly. So and I wanted to ask you, you talked a lot about emotions and lifestyle. And I've interviewed a few people here on this podcast about nervous system regulation, sleep, things like that. So how does that influence pain? And what are some pieces that we should put in place to sort of help us get better on our nervous system?

SPEAKER_01 26:45

Yeah, so sleep is super fundamental for all aspects of health, right? And actually, when I started this practice, before I learned all the all the cellular things, what I focus on was sleep. If you're in chronic pain and you're not sleeping, pain doesn't get better. What happens when you sleep? If you don't sleep, then you have cortisol cortisol stays up. Cortisol is up, cortisol is pro-inflammatory. It creates more inflammation, it's gonna keep pain in place. Okay, and then you also make the nervous system hyperactive. Everything is hyperactive. So there's more signal is seen as big in the nervous system. So sleep is very, very important when you sleep. You make all this antioxidants, you make collagen, you make all of these things that allows you to heal. So sleep is really, really important in pain. People don't sleep, pain doesn't get better. And people can even tell, like when you're not sleeping, they feel crappy. There's so other things, right? And pain and not sleeping also ages you quite a bit more than anything else. You know, so sleep is very, very important. From an emotional standpoint, again, the emotional piece of pain is important because the reason why we have emotion attached, and this is just just two pathways that goes to the brain. And the emotional piece of it is important because emotion helps to crystallize memory. Right? Pain is a protective mechanism, and therefore we have to remember it. When you step on something hard or if you step on something sharp, you always remember not to do that again. And because of that emotion attached to that pathway, that experience, then it crystallizes. And it's the same mechanism for trauma. When people have trauma, there's this huge emotional things, and then it crystallizes and it stays there. So when people have heart-significant trauma and they have pain and it becomes chronic pain, pain is protective. It becomes a problem when it's gone on for too long and then it's disrupting people's life. You have chronic pain, that emotional piece actually becomes more fired because there is a pathway in the brain where you have a center that's controlling pain, cognition, and emotion. They are all in the same place. So your pain can influence your cognition, your cognition can influence your pain, your pain can influence your emotion, your emotion can influence your pain, your emotion can influence your cognition, right? In a simplistic term, I ask patients, how do you feel when you're sad about your pain? Pain goes up. You're sitting there and going, oh my gosh, my pain is killing me. If you have all this cognition, the thoughts catastrophizing. So those thoughts and emotions are things that people have control over. So it's important for people to realize I have control over how I feel about my pain. I have control over how I talk about this pain. Okay. And giving pain meaning. When you give pain meaning, the pain, your body doesn't do all of that stuff. It doesn't, it doesn't make you so hyperactive. Because people can go out and they're having a good time, they have pain, they don't even feel it, right? Because the emotions, they have better mood. Emotions are better. When they come home and something bad happened, they wake up and they have a lot of pain. And I've seen this quite a bit in my patients where they will come in and go, my back pain has been really bad. It's pain going down my leg. I need an MRI, all of that. And then you ask them, what's happening in your life? They're going through divorce. Somebody died in your family. All of that creates stress and the body keeps calling. So all of that is going to influence the pain signal. Nothing has happened with your back, but the fact that there is all these other emotions and other stresses there, that pain signal, same pain signal you've had, which you were not even experiencing, is now being magnified. So it's really, really important for people to understand that emotions and their thoughts play a huge part in their pain. And sometimes people are not open to that. And this is the other problem we have. That's why they want they want somebody to take away my pain. Doctor, fix me, right? They don't want to do any work. They don't want to believe that any of their emotions plays a part in your pain. But that's what pain is. And I think people are just not open to it. And we are in this environment that when you talk about those things, you get bad reviews. No, nobody's gonna take away your pain. Okay. Pain is in your head and you can do something about it. Of course, there's other things that influence the biology, and we can always work on that side. So if people are doing, if I'm doing my part with my patient, I tell them, I'm gonna fix this thing, you have to do this other part of it. Okay. And then you are the patient, you have all the connections to why you are in pain. And sometimes people don't connect the dots. I will ask people, why do you think you're in pain? Oh, it's my x-ray, it's my biomarker elevation. No, that's not pain. That's just markers. Okay. There's other things. Maybe it's the environment they're in. They're in situations or relationships that are very stressful. That's what's creating the pain. I've had people who've gone through divorce, they leave the marriage, their back pain goes away. Not that I'm encouraging people to do that for as a pain management, but all of those factors uh plays a role in how people experience pain. So emotions, sleep, very important.

SPEAKER_00 31:12

Do you refer them to therapy for that? Or yes.

SPEAKER_01 31:15

So I will send people this curable app, and then I work with a lot of pain psychologists. And I think if you have chronic pain, that's a piece that I think a lot of times is missing. And sometimes the problem is that people are just doing that, they're doing it as psychologists, but they're not doing the other cellular component that really help address it. So you have to put it all together in the right timing. And I think that's the problem that's missing. That people go and they do one therapy without combining, they didn't do any physical therapy. They're getting all these injections, no physical therapy, no psychological therapy, no other nutritional things to help them feel better. And they go, the medicines or the injections don't work. Or they were doing therapy and they're not doing anything else. So you have to put all of that in to solve what's happening in the periphery and then to also solve what's happening in the brain. And then when you do that and you give people uh strategies and education, they feel empowered. They can give pain meaning. They can say, All right, my back is hurt because I did a little bit of walking instead of, oh my gosh, what's happening? Is it back pain bad? Is this ever gonna go away? And that cycle actually makes the painfulness even worse.

SPEAKER_00 32:12

So I'd like to ask at the end of the podcast, what are you hopeful about the future with GLP1s and maybe pain management? Because we got a lot of medicines coming.

SPEAKER_01 32:20

Absolutely. So I think it's gonna be a game changer. And I think, you know, I'm talking about metabolic pain. This is something that we gotta pay attention to because at the base of it, all is a cell that's not functioning well. GLP1s change the polarity of macrophages to an M2, lymphocyte to H2, all these states that are really helpful. So I think the future with GLP1s uh will be great uh for pain, uh because we don't have any other method of really addressing the real cellular dysfunction and dysregulation that actually goes on that drives the cells to create pain. The other piece of it is we have to go beyond just that. It's not just gonna be a drug, of course. And that's the problem with you know medicines that we get all these medicines, they have specific roles, they do specific functions. We have to do our part, educate, let's stay healthy. When you're healthy, you have better resilience. Some of these medicines are not benign, they have side effects. But when you're healthy, you manage that a lot better. Uh, so I think, you know, this is gonna be a great thing. And in fact, Tesepotite, the the study that they did to bring it out, they actually look at individuals with osteoarthritis and did document that it did decrease pain in those people. And in fact, in some studies, it's actually disease modifying for the knee for chondrocytes. So I think this it's a great place, and we just have to focus on the fundamentals nutrition, sleep, stress management, exercise, and then everything else we put on top of it works a lot better.

SPEAKER_00 33:38

Yeah, unfortunately, no, no shortcuts. Gotta work up. No shortcuts. Gotta work up here. Anyway, how can people connect with you, Dr. Christian? Where can they find out about your practice?

SPEAKER_01 33:46

Yeah, so my practice is in Wayne, a suburb of Philadelphia in Pennsylvania, USA. Uh, and people can go to my website, www.ethermedicine.com. It's A-E-T-H-E-R-Medicine. I also do some education on Instagram. I'm passionate about pain, metabolic health, uh, longevity, and performance. Um, and I need to talk more about pain because I realize that's one area that we're really missing. And there's so much science we just have to put together in a way that translates for people. But the fundamentals get good sleep. And I also believe that pain can get better. Uh, you have to find a provider who understands those things and really bring in the neuroaffective component makes a huge difference. Uh, if somebody recommends psychology for you as a way for pain, it's worth it to explore.

SPEAKER_00 34:29

Awesome. Thank you so much. I really, really appreciate your expertise. This was a wonderful conversation.

SPEAKER_01 34:34

Thank you so much for having me and thanks for the work you do in educating all of us and educating the masters about this. Really uh good drug, but like you said, we need all the pieces to come together to make sure that people uh are safe and people get the best benefits.

SPEAKER_00 34:46

Absolutely. Thank you again. Yes. Thank you for listening to this week's episode of the GLP One Hub podcast. Chronic pain is such a poorly understood condition. And I'm so glad that Dr. Christian was able to come on to talk all about it and how GLP Ones might be able to help. And if you want to stay up to date on the latest research, also get my best weight loss advice and all the information that you need to be successful on your GLP 1 journey, make sure you are on my Steady State newsletter. You can find the link to sign up in the show notes, and I'll see you in the next episode.