The Impact of Childhood Trauma on Disease - 045

SPEAKER A The following program presents principles designed to promote good health and is not intended to take the place of personalised professional care. The opinions and ideas expressed are those of the speakers. Viewers are encouraged to draw their own conclusions about the information presented. SPEAKER B Welcome to healthy living. I'm your host, Margot Marshall. Studies have shown that adverse childhood experiences are associated with an increase in many adult diseases. But healing is possible with attention to holistic health. Stay tuned. SPEAKER C Healthy Living is a production of 3ABN Australia television focusing on the health of the whole person, body, mind and spirit. You'll learn natural lifestyle principles with practical health solutions for overall good health. SPEAKER B Today we're talking about the impact of childhood trauma on disease. My guest is Dr. Andrew Pennington, an integrative general practitioner who is committed to holistic lifestyle medicine. Welcome, Andrew. And would you like to explain again what integrative medicine actually is? SPEAKER D Sure. Thank you Margot, for having me on the programme. It's a real pleasure to be here. SPEAKER B It's our privilege. SPEAKER D Thank you. Just so your audience understands integrative medicine, I guess the simplest way to look at it is it's a combination of using traditional orthodox medical practices along with evidence based complementary medicine practices. And those obviously can take the form of many different practices. And integrative medicine is bit heterogeneous. Unfortunately it doesn't have a very standardized kind of like we don't have a professional training that means we all learn the same thing. So integrative doctors all have different skill sets and they might bring different aspects of complementary as a strength point into their traditional training. For me, that's more around nutrition, lifestyle medicine and using judicious supplemental medicine and trying to do that to enhance medical outcomes with patients. That's probably where I have most of my focus. But there are other doctors who may focus on physical manipulation, acupuncture, other sort of modalities which I'm not quite so into, but they can be also included in integrated medicine. SPEAKER B And lifestyle is a big part of what you do, isn't it? SPEAKER D Absolutely. SPEAKER B And that mural that you have in your waiting room says it all. So just go through that again. SPEAKER D That's right. So I think your viewers may have heard this on previous programs too, but certainly my philosophy of health revolves around an acronym. And that acronym you can see there on the program on the screen, and it's New Start. So it stands for nutrition, exercise, water, sunshine, temperance, fresh air, rest and trust. And that forms a really lovely way of holistically looking at how we thrive in health and life. SPEAKER B Yes, and it's very powerful. Back in I think it was about five, the US Surgeon General said that lifestyle which is embraced, encompassed in all of what you've got there, and that you use accounts for 70% of our health status. That's huge. SPEAKER D Absolutely. SPEAKER B And don't be offended, but it was only 10% for medical care. Except for integrative doctors. SPEAKER D There's a reason why I'm interested in lifestyle medicine. SPEAKER B That's right. SPEAKER D It's the stats you've quoted because it does medicine. We've got that's right. It really is. Yeah. Now, of course, good lifestyle is not 100%, as you've rightly said. It's a really big, important black, but there are other aspects involved. But perhaps today when we talk a little bit about adverse childhood experiences, it's not an area of great expertise for me, but it's an area that I've been exploring in the last year or two to understand a little. Bit more about how the nurturing environment of childhood, how that impacts the developing brain and how that eventually impacts what happens to us in terms of disease later on. And I think your viewers will find it incredibly profound. SPEAKER B I do, too, because I've seen the pyramid that you're going to be showing, and it's really shocking in the truest sense of the word. Shocking? SPEAKER D Yeah. So, I mean, this information has been around for a little while now. The first studies were conducted 2030 years ago in the United States. And so it's certainly not new information, but I think I haven't found a lot of health professionals or the general public are actually aware of it. And they may well, I mean, if you ask people a little bit about exactly what causes disease in someone, they may be familiar with risk factors for disease, but they may not necessarily know actually why you got a particular disease. And I wouldn't say that we always know as doctors exactly why someone gets a disease process, but I think this gives us a lot of clues as to what foundation is laid in the preparation for a certain disease or diseases. So I think, as I say, it's very profound. SPEAKER B Yes. So there's a whole range of things besides food and exercise and so on, that we've talked about. But there's more, and this is really the topic that you're talking about today, the impact of childhood trauma. And that's not a nice thing to even contemplate. SPEAKER D No, it's not at all. Margot, I firstly want to say to the audience, I apologize if this brings up any poor memories or provokes anything. I obviously have no intention to do that. But we're going to need to discuss briefly some of these factors that are involved because it really helps us understand what's been set up later in life. And I think we're increasingly understanding predominantly from these Ace studies and the lead investigators who have gone into them, ace stands for Adverse childhood experiences, and you can Google that and find some of this information. And we're increasingly understanding that the environment that a child grows up in is so important for their development. Now, that's a fairly obvious statement in many ways, but it goes more than food, shelter, water, et cetera. That clearly is important. And the World Health Organization has made a number of comments about what are human rights and what are children childhood rights and those things are a part of that. But it also goes even deeper. It actually goes to the way a child is treated by the significant adults around them. And we're understanding that there can be various levels of childhood trauma, if you want to call it that, and that umbrella and encapsulates quite a large degree of issues that crop up. And it's basically these studies started to tease out initially finding that there was associations between some of these experiences and disease processes later in life. I believe the investigators then became a little bit more formal about it, and they actually did a very, very large survey of about 15,000 people in the United States. I think a couple of insurance companies that were involved in that research, and they essentially collated a number of questions, and they have now standardized it into ten questions that involve childhood adverse experiences. And that can be things like having a significant physical sickness in the child or in the parent, the death of a parent, the divorce of parents. It obviously includes physical emotional abuse, sexual abuse of children. It also includes even harshly spoken sort of consistently violent or aggressive verbal words to a child and then obviously lack of provision of food, clothing, water. All of those things are also part of that. The more that numbers that you tick off on that you've experienced those things in childhood, the greater the chance of you having a certain disease process later in life and they're very broad the diseases. So we're talking about physical disease, so cardiovascular disease, we're talking about obviously psychological trauma. And mental health problems are quite significantly more prevalent in those who've had adverse childhood experiences. And there's a number of other things and actually if I can just read some of these data actually I might come to that a little bit later but perhaps just to explain why this happens and what might be going on and the body is so complex. I think medicine is moving a lot in the future. We're moving into realizing that single organs or single processes rarely explain what's going on. It's a complex interaction between a number of things. And most recently, I think medicine is probably the biggest buz area of medicine is to understand the gut and the brain connection, particularly the gut, where we're starting to realize that early in life. We are developing a connection in our gut between the diversity of the bacterial content that are in there and the way it relates and interplays with the immune system. Now this is really important because the immune system of course also talks to the brain and it also talks to the hormonal system, the endocrine system. And all of this is connected because when we look at how we relate to various things that come into our sphere of, let's say, trauma, our body is designed to react a certain way to trauma. And let's just say somebody was running at you with a knife, then your design is to get quite frightened with that. And I've got to either fight or flight this. And hopefully you're going to flight this and get out of there very quickly to not obviously get in danger or you're going to stand up and get ready to fight. That's sort of an innate response and that's built a complex response between hormonal control from the release of adrenaline and cortisol from the adrenal glands that is also related very strongly to the nervous system. We have an autonomic nervous system that basically keeps our heart ticking, keeps our sweating and a lot of other functions. It keeps the gut working. But the sympathetic and parasympathetic nervous system also have a role in hormonal control and gut control. So the sympathetic nervous system and parasympathetic nervous system for those who don't know what that is, that's what we call the autonomic nervous system and very, very broadly speaking they have completely different functions. The sympathetic is the fight or flight. Let's get ready to go. The parasympathetic is the rest. And relax. Time to take stock and chill. Down and chill. But what happens with adverse childhood experiences and we might bring up the pyramid slide if I can just bring that up on the screen and I want to show you and talk you through a little bit of this diagram. So down the bottom, on the bottom layer it's a five tiered pyramid for those of you who might not be able to see this. And down on the bottom layer we've got adverse childhood experiences and this is what we've just been discussing the traumas that can happen to a child that they weren't really designed to have. I mean, I should say before I preface it is normal to have stressful events and our body actually does need some level of stress but this is where it's gone beyond a normal stress into actually being a problem. Then what this doesn't there is some knowledge into how that you can see on the right hand side there, there's arrows that say we do have scientific gaps in the knowledge as to how these things impact one another and this is true but there is some knowledge of this. But the adverse childhood experiences seem to set up social, emotional and cognitive impairment. So what you find is that individuals who've had a lot of this struggle socially that their emotional regulation is not so great so they may not know how to behave to certain situations and this actually has a brain impairment. Now that affects, as we just talked, the nervous systems, the autonomic nervous systems and their control over the adrenal glands and the immune system and the gut. SPEAKER B Bit like a domino effect. SPEAKER D Absolutely right. And then of course we find that people who have these problems are more likely to adopt risky health behaviors and from here on so that's the social emotion is the second bottom layer. Then the third bottom layer is adoption of the health risk behaviors. And then we've got two on top of that. SPEAKER B And the second, what sort of things might they be? SPEAKER D Well, I think we understand these very well. And these are things like drinking, excessively smoking, engaging in harmful practices, mentally eating, unhealthily, not exercising. There's a lot of adverse health behaviors that we understand quite well traditionally, that most doctors and it's from here that we probably understand best most doctors come in at this level. We know, oh, okay, well, your family has a history of cardiovascular disease. Okay, well, we know that you need to keep your cholesterol down, you need to do regular exercise, you need to eat a lot of good quality foods, and we know that your blood pressure needs to be kept low. Those things are health behaviors or risk of disease. And it comes in at that third stage. But when that sort of behaviors continue, you end up with disease coming on disability and social problems. SPEAKER B So we're looking at an adult now? SPEAKER D Absolutely. These behaviors take years. Yes, okay. I should say these effects take years. And then of course, there may be various adoption over years of health behaviors and disease, disability and social problems ensue. And of course, we know when you get early disease, early disability, early social problems, you're more likely to die early. So this pyramid is very, very profound because you are basically looking at a model of propagating disease. And that's why it's so important for us to understand. And I think the two bottom layers, the adverse childhood experiences and their impact on the brain development and its role here is what's not well understood in the general population and probably not even that well understood in the medical profession, even though the data has been there for quite a while. But perhaps to go into it a little bit, I'll just give you some data on this from the A study. And there's a lot more data. I can't remember how many studies have come out of the A study, but the original A study, that's the adverse, adverse childhood experiences study experiences. Remember, we had ten sort of questions, and a lot of people have a score of zero where they've had very little or no essential childhood experience compared to someone who had a score of zero to someone who experienced four or more on their A score. They had a four to twelve fold increased risk of alcoholism, drug abuse, depression and suicide attempts, I should say a two to four fold increase in smoking and poorly rating their own health. So that's part of that health behavior stuff. And having increased rates of sexually transmitted diseases. And they had a 1.4 to 1.6 fold increase in physical inactivity and obesity, severe obesity. So you can see all of this. SPEAKER B Is just piling up, isn't it? SPEAKER D Piles up and it compounds. And this is actually why I find this so interesting as a medical profession is that we're peeling back the onion to actually get to the core of what's going on. SPEAKER B And I like that because really, if you don't know the underlying cause, how are you ever going to? Absolutely right, you're just guessing. SPEAKER D But look, be that as it may, I want to spend the rest of the time hopefully in this segment today talking about how do we do something about this, how can we heal? Can we heal? SPEAKER B Can you help people who are now adults and starting to see the adverse effects of the adverse events? And so what do you do? SPEAKER D Yeah, look, it's a really good question and the answer of course, is that we can help and we can heal. A lot of what we do is a downstream effect because we can't remove the adverse childhood experience. Clearly that's in the past. And the damage that that does at the brain development level and ability of the brain to then regulate its own stress response, that's what's actually causing problems with disease because it basically plays with the immune system. So what we actually have to do is we need to look very holistically at these people. And I think the first thing is knowledge is empowerment. So when people understand this, it's almost like the AHA moment of all right, yeah, okay, I can understand why now that has contributed to the way that I am. And when they understand that, that's when they can then take steps to address it. And how do I address it? It's through new start. SPEAKER B Okay, we use that holistic, run it through again, the different things. SPEAKER D We look at the nutrition, nutrition, and clearly if you put good nutrition into your body, you start to give the gut the right type of food for the bacteria. The bacteria say, woohoo, thanks very much, I'm going to now give you some really nice substances back. And then you start to improve your immune function, you start to improve your brain function and those things are important. Clearly exercise, exercise also has a role on the gut and clearly the muscles and various other things. SPEAKER B It affects every cell in our body. SPEAKER D It sure does for good. We need clean water because that's important. And so I work with people trying to get rid of the unhelpful beverages. Alcohol is not a helpful product for us to have. It's a carcinogen and it makes our brain function worse. So we've got to get rid of that kind of stuff. Sugary based drinks, caffeinated based drinks, they're not particularly helpful for us. So we want to actually get rid of that and get people drinking water. SPEAKER B So we're talking about a few things that could actually come into the category of addictions by now. How do you help people to deal with multiple addictions? SPEAKER D It's possibly a little beyond the scope of the talk. Margot that's a complex question and I think there is a lot of sometimes they do need very specialized care, these people with addictions. And I do provide some help to these people and again, it's around holistic principles, but even then, sometimes I need to refer to people who have even more skill sets in specific in addiction. But I think we can assist people with addictions by an understanding of the nutritional aspects, the physical aspects, helping them with. So people have addiction have a high rate of mental illness too, so helping them to cognitively improve there and then also looking at psychospiritual issues. So I think it's an important issue that often gets overlooked in that people have these health problems with addiction or otherwise. There'll often be some issues where they are not satisfied with their core value systems or life or they've had problems with their relationships. It's so common for me to see this, Margot, people who've actually they've got high blood pressure and anxiety. And one of the reasons for that is that they actually have a poor relationship with one of their family members and they have not reconciled that. They may have tried, but it hasn't worked. And I don't want to attribute blame to any particular individual here, but having an unreconciled family issue or issue with work colleague or whatever, it will eat you away at the core. And if you've had adverse childhood experiences to predispose you to not deal with that well in the first place, it's going to be even worse for you to deal with those situations. So planning reconciliation wherever possible forgiving people, these are psychospiritual concepts is a very important part of healing for these people. And sometimes for these now adults usually who've had childhood experiences, it's going to require forgiving some of the significant adults in their life for the neglect or abuse that happened. And that may be incredibly difficult, very, very difficult, but it may be very difficult for that person to move on unless they actually learn to forgive. SPEAKER B And you can help them, I think, with motivational counseling, certainly. SPEAKER D So at the level, talk to us. SPEAKER B About this motivational counseling. SPEAKER D So we know a lot about what's good healthy practices and behaviors okay. SPEAKER B But there's this big gap usually between knowing and doing. And it's not just for people who had these experiences. It's across the board. SPEAKER D Not at all. I mean, I find it hard to do healthy things all the time. I think nobody's entirely consistent all their life in doing healthy practices. But yet motivational interviewing or motivational counseling is a technique. Interviewing, yeah, it's a technique that we use and many doctors are familiar with it and of course, counselors and psychologists and other allied health professionals too, techniques that we use to empower people to make change. SPEAKER B That sounds wonderful. SPEAKER D And essentially what it means is when we have the doctor patient relationship where you come to see me, it's not okay right, Margot, you have to do X-Y-Z. Here you go, here's your prescription. Go and do it. That has a limited effect at some people that will work for but this is more okay, Margot, so you're overweight at the moment. What kind of things do you think you can do to be able to help that? Oh, well, you might say, okay, well, I really don't sort of get out exercising very much, so I might then ask, so what sort of are the barriers for you to not get out exercising? And essentially it's a problem solving approach where you're actually coming to understand and own the issue and not just sit back passively and get the doctor to tell you what to do. Okay, so that's what motivational interviewing is, and it's very powerful. SPEAKER B You're very good at that. I heard you in action one time at a public forum, and I was very impressed. I remember it to this day. So I think that's wonderful to think that you have that skill and that you use it to help people, especially in a situation that's got so many things going wrong. SPEAKER D It's not actually a particularly difficult skill either. It really just revolves around rephrasing things for the patient or the individual whose health has the issue to start to come up with the solutions, with guidance from the practitioner. And we know that this is much better. If I tell you to do something, if I say stop smoking to you, Margot, maybe 5% of people have stopped smoking. Now. That's awesome. 5%. SPEAKER B Hallett. SPEAKER D Great. But I want to do better than that. I want a higher percentage of people. And that's going to revolve around getting you on board to make the change, to actually problem solve it through. And that's what I'm basically motivational interviewing does. So we certainly use the techniques quite a lot, and as a number of GPS and other practitioners will use that technique. I mean, that would be an ideal scenario. One of the problems we have is often a lot of doctors don't have enough time with patients to do these techniques very well. SPEAKER B That's an interesting point. So what sort of time do you feel is necessary when you're perhaps you're talking to someone in this very situation? What sort of time would you be expecting to spend with them? SPEAKER D Well, again, it depends on the intervention required, but sometimes you can do it very quickly. You can sometimes use two or three minutes of motivational interviewing, and that's great. But look, I think if someone's got complex health needs, I spend an hour with my patients first up, because I feel that it's very hard to solve a complex. In fact, it's impossible to solve a complex health problem in ten or 15 minutes with your GP. So I would advise patients who want to make change to get a hold of your GP and ask for longer consultation with them as hopefully they'll provide that at least half an hour. And don't provide them 50 things to work on, just give them two or three of the top points that you want to work on and ask them to help you work through how to make change. Now, for me, as I say, I spend an hour with patients first up, and I generally have half an hour follow up appointments, so that's longer than most general practitioners. But it's because of the style of medicine I want to practice. SPEAKER B That's right. So in that time, that gives you a chance to peel back the layers, get right down to the root cause and see where you have to go from there. SPEAKER D Absolutely. And look, I tell you, often that's not enough time. Often an hour is nowhere near enough time with a patient to really get to the crux of what's going on. And one of the arts of what I have to do as a medical doctor. There's plenty of science, but there's a lot of art too. And that is to do my utmost for this person, to understand where they're at, what's going on, what sort of are the key issues for that person, what do they want to work with and then try to work with them and not against them? And I'm constantly trying to hone my skills doing that. SPEAKER B That's really fantastic. And I just think it's marvelous what you're doing and the approach that you're taking, because I really like the idea that you help people to understand themselves, what's going on, and to work through with you. And we're not against you. Just excellent. SPEAKER D I just want to touch also on one point for anyone out there who may have had some of these advice childhood experiences, and they're very common, a lot of people have had them, I think it was in the order of 70% or so had had at least one adverse childhood experience. So it's incredibly common. SPEAKER B That's really OD, isn't it? SPEAKER D But often you're going to need to get a trained psychologist or counselor because some of these issues are quite deep. You need to unpack them. SPEAKER B Sure. SPEAKER D And look, some GPS are good at that, or some doctors are good at that. I do a little bit of counseling, but I wouldn't say I have qualifications as a psychologist or counselor, of course. So it's going to often take a multidisciplinary team for these people. SPEAKER B Yes. SPEAKER D Not just a doctor, although they may be the coordinator of care, a good quality GP, and then involving other health practitioners, both a psychologist and sometimes some of these other, like, dietitians, et cetera, to really help them make those changes. SPEAKER B And you do have some other health professionals? I do. SPEAKER D In my practice, I have a nutritionist, a naturopath and a psychologist, and I'm hoping to add more with time as I can. SPEAKER B There might be someone out there wishing that they say, pick me, pick me. SPEAKER D Sure. But yeah, look, it's very much about attention to all of those things. Holistic health looking at the new Start approach about how it can really assist people who've had these adverse childhood experiences that have disease to try and heal. SPEAKER B Holistically well, that's a beautiful approach, and thank you so much for all that you shared with us, because I'm sure that's giving hope to seven out of ten people who probably need that kind of intervention. Well, thank you for joining us. To watch our programs on demand, just visit 3abnaustralia.org.au and click on the watch button. We look forward to you joining us next time, and God bless you. SPEAKER C You’ve been listening to a production of 3ABN Australia Television.