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The Neuroscience of Yoga - Jonathan Rosenthal, MD · Lucid Interval Podcast

• Andrew Heacock: Okay, we're live. Dr. Rosenthal, thank you for joining me. Jonathan Rosenthal: Thanks for having me. It's really great to be here, Andrew. Andrew Heacock: Thank you so much. So you study the neuroscience of yoga. What brought you to that study? Jonathan Rosenthal: So this is my passion project. I do this kind of on the side of my main work as a neurologist. And ⁓ I came to get so interested in this because I started practicing yoga as a teenager. ⁓ I can tell that story maybe for the next question. And ⁓ because I became so interested in yoga and was seeing the effects on myself and other people, ⁓ while at the same time going to school for neuroscience, studying medicine and all that, I was really getting curious, like, what is the research on yoga and how do we ⁓ understand its effects and how do we apply those effects to more people? Andrew Heacock: Yeah, so they were like parallel paths of medicine, science, and then yoga, and they just kind of naturally converge for you. Yeah, that's kind of a beautiful way to integrate those two areas of your life. ⁓ Jonathan Rosenthal: Exactly. Yeah. Yeah, except at first you think, I think many people have this experience where if you're doing both, you feel like a pariah in both. Like many people in the yoga world are like, you know, don't go to the doctor. Like they're just going to give you pills. It's bullshit. Um, and many people in the medicine world are like, look at Steve jobs. Like he tried to just drink green juices and do yoga and he died from pancreatic cancer. So it's kind of like, uh, you know, you feel like a little bit of an outcast in both. it's, taken me like, I think it took about seven or eight years to realize like, No, this is totally fine. They fit perfectly together. Andrew Heacock: Yeah, well, mean, to the degree that yoga affects the body, there's a physiology to it, right? I mean, there's something to be studied. ⁓ And I think that I totally get what you're saying, though, about feeling like a pariah in both because there are people who, you know, I think they'll they'll they just kind of take the worst examples from the other, you know, and kind of want to strongman that. But ⁓ there's obviously a lot of really extraordinary claims about mind, body and health that come from yoga disciplines. And they can't all be wrong. I mean, most people wouldn't have done it for so long. You mentioned that you started yoga as when you were a teenager, you said. That to me seems to be like an unusually young period of time. Usually I see people start yoga in their 20s or 30s. ⁓ What was it that drew you to it? Jonathan Rosenthal: So, I... I also recently found out that Eddie Stern has the same story, which is really funny. ⁓ He's a yoga teacher in New York, well known. And ⁓ I was ⁓ in high school in ninth grade, and we were assigned to read a book called Siddhartha by Hermann Hesse. ⁓ And for anyone who's not familiar with it, it's the story of, it's not really Siddhartha Gautama, who later becomes the Buddha. It's ⁓ just like a similar story of someone named Siddhartha. and he's born a prince and he goes through all these different experiences in life trying to achieve enlightenment and actually be happy and every single one of them doesn't result in his happiness or enlightenment and he goes through obviously like being a prince having all this power and money he goes through being an ascetic living in the forest he goes to a like, ⁓ I don't know what to call it, but it was essentially like a place of love where he just like fell in love with some woman. ⁓ And then it's really at the end of the book that it all comes together for him. And it's when he's sitting at the edge of a river and is looking at a river and realizes that the form of the river stays the same, but all of the water and all of the molecules passing through it are constantly changing. ⁓ And that's when he achieves enlightenment. There's more to the story than that, but that's just what I remember right now. Andrew Heacock: Okay. Jonathan Rosenthal: And I read that and I became very interested in it and so I started reading about other Eastern philosophy books online and ⁓ So from that, I came across a lot of stuff about yoga. I really wanted to take a yoga class, but I was afraid to because I felt like as a 14 or 15 year old boy, yoga wasn't made for me. It was made for women. That was just my perception of it from, you know, looking around. And so. I didn't go to class. I kind of just forgot about it for a while and then I hurt myself running. I was like a runner at the time and my friend was like, you know, maybe for your ankle we should like go to a yoga class and maybe that'll help. And I was like, all right, you know, maybe now's the time. ⁓ So yeah, I was afraid of being the only boy there, right? So I show up and ⁓ not only was it all middle-aged women, you know, like people my mom's age, but they were all in bathing suits because it was hot yoga. And I was like, what the heck am I doing here? Like, this is ridiculous. And then about, I don't know, I think the class was an hour or no, was 90 minutes. At the end of the 90 minutes, I was like, okay, I actually really like this. I'm going to come back. ⁓ And I kept doing it and then ⁓ someone there told me to meet my current teacher, Sri Dharmamitra in New York, and that was it for me. Andrew Heacock: So tell me about him. I've heard you mentioned him a few times in some of your talks, but I'm not familiar with him or his work. Jonathan Rosenthal: So he is about to turn 87. He is like a fantastic human being. So Dharma moved to New York in 1964, I think, from Brazil. ⁓ In Brazil, he like served in the Air Force, but really was reading, he was reading a lot about yoga and wanted to find a yoga teacher. His brother had moved to New York and found a yoga teacher in New York, Swami Kalai Shananda, who opened an ashram in New York in the 60s. So Dharma came, he stayed at the ashram, he spent 11 years there, and then he started, you know, teaching yoga. ⁓ and so he's been teaching for 51 years or something and he Yeah, he really centers his whole yogic, like he focuses so much on yama and ahimsa, so compassion and nonviolence. And so that's like his main focus in teaching people. But he really tries to do it through a way that attracts people, because we live in a world where you have to like attract people to come in. So, you know, it's also a lot of postures and humor and breathing and lots of yoga nidra and it's an amazing It's such a beautiful place that he's built. Andrew Heacock: That's wonderful. ⁓ You touched on something there that I get a question a lot when people ask me about, I'm very interested in study of different religious and spiritual practices and they'll kind of ask me about what I'm interested in and inevitably I'll mention yoga and you'll just get a quizzical look and they'll be like, what does that have to do with religion or spirituality? And I'm like, well, know, there's, know, the postures and breathing are kind of like one quarter of it. You know, there's, there's a lot more to it there. Can you take us through the eight limbs of yoga and what they represent? Jonathan Rosenthal: ⁓ Sure, so there's Yama, which is the ethical rule. So really how you treat other people And there's you know principles of non-violence compassion being truthful not stealing things not coveting things ⁓ Kind of like sexually respecting people ⁓ And then there's Niyama, which is more like how you treat yourself, which is ⁓ discipline cleanliness ⁓ self-study, but also an attitude of of surrender, so offering up the fruits of whatever you're doing. There's breathing, pranayama, which many people say is more than just the breath, but it's really just kind of like ⁓ controlling this movement within you. And then there's asana, which is the postures, and that's keeping the body healthy, radiant health, making sure that you're able to do the things you need to do, ⁓ especially sit for the next ones, which are pratyahara, withdrawal of the senses, so being able to turn the senses inward away from all of the outward directed sense objects, then concentration, and then prolonged concentration, which is called meditation or dhyana, and then finally samadhi, which is enlightenment. Andrew Heacock: Of those I was just listening and I was kind of getting a little smile on my face wondering ⁓ are there any do we are do we have any theoretical limitations on our ability to study any of those eight? Yes. Jonathan Rosenthal: Yes, significantly. ⁓ You know, I think people are... so excited about modern neuroscience, which is true and great. It's amazing to have the tools that we do. ⁓ I wish I could pull up this graph that I love that shows the resolution of different tools within neuroscience. people, like you look at these studies published and they show these brain images produced by an fMRI machine and people are like, ⁓ my God, like, look how cool. ⁓ But really an fMRI is limited in terms of time to two seconds. It gets an update every two seconds. And so it's incredibly irresolute. Like, it cannot see that much. And then in terms of space, it's limited to basically millimeters, right? So cells are on the order of 10 to the negative 6. This thing can see on the order of 10 to the negative 3. So it's missing a ton of stuff. Like, there's so much more going on under the hood. So... And then like same thing with EEG, EEG is better temporally but worse spatially. ⁓ So we have very limited tools to understand this stuff. There's no way to measure enlightenment. There's no way to measure, know, even when we look at the studies looking at meditation, they're really looking at these measures usually of fMRI and EEG or maybe fNIRs or something like that. But ⁓ it's like a snapshot of the whole picture, very small piece of the puzzle. Andrew Heacock: Right. Right. And a lot of times, mean, who's to stay who's enlightened? That's another problem, too. I you can have people playing to be enlightened and then maybe look at a brain state or some brainwave activity. But, you know, who's to say that someone else's enlightenment is not just one guy's really good day? You know. Jonathan Rosenthal: Yes. Yeah, yeah, yeah. And it's often the people who they say that the people who say they're enlightened are not. Andrew Heacock: Yeah, the ones who are the most clueless. Yeah. So ⁓ when you began studying yoga, practicing yoga when you were still in high school at this time is when you became a true practitioner of it. ⁓ What was the decision to study medicine? Was it related to yoga at that time or was it independent? Jonathan Rosenthal: Yeah. ⁓ I had been thinking about medicine since I was a child just because of experiences I had had with sick family members. ⁓ Yoga confirmed it for me because my biggest doubt was that I would not be able to handle the demands of the profession. ⁓ And then with yoga, I kind of developed a lot of just like confidence in knowing I knew how to cope with things. ⁓ So yeah, that was ultimately one of the confirming factors for me. And I have been so lucky in my life that I got to stay in New York and be close to Dharma this whole time. So I got to stay for undergrad, for med school, for residency, for fellowship, like ⁓ full package. So I really got to spend the past, you know, how long, 13 years with Dharma. Andrew Heacock: Can you give us a quick overview of what your ⁓ educational path was? Jonathan Rosenthal: Yeah, so I did my undergraduate degree in neuroscience at NYU. ⁓ So there was a lot of basic science oriented stuff, cells, systems. ⁓ I ended up doing a lot of computational neuroscience. I was really interested in modeling the brain with computers. ⁓ And then after that I did med school also at NYU. ⁓ So that I got really lucky also. I did an accelerated program. So instead of four years of med school, I did three. And with that they guaranteed me a spot in their neurology residency program. So I did three years of med school, which was everything. I mean, you you do all of medicine through that. So. Andrew Heacock: Thank you. Jonathan Rosenthal: Yeah, mean, internal medicine, OBGYN, surgery, pediatrics, psychiatry, ⁓ radiology, the whole thing. ⁓ Superficially, you you just have to understand how all medicine works. ⁓ And then I did a year of internal medicine, which also happened to be the year that COVID hit. So I spent a lot of time, you know, in COVID. ⁓ And then... I did three years of neurology residency after that. So really focusing on diagnosing and treating all the different disorders of the nervous system and becoming a specialist in that. ⁓ And then I did a fellowship to further sub-specialize in something called clinical neurophysiology, which is using electricity to try to detect and treat brain and spine and nerve disorders. ⁓ And now I do something called intraoperative monitoring, which is where I try to detect changes or damage to the brain and spine during surgeries so that it can be reversed before the patient wakes up. Andrew Heacock: Sounds like fascinating work. Yeah, all the things you were saying about computational neuroscience, it obviously seems to lead to where you're doing that now. I'm sure it's all being done remotely. Jonathan Rosenthal: It's great. It's amazing. It is all remote ⁓ and it is ⁓ not AI enabled yet, but probably someday in the future. Andrew Heacock: Mm-hmm. Now that's both kind of scary and also encouraging. Maybe we'll see. Yeah. So during this time, I mean, you've got this path where you're beginning to study neurology. How did the Neuroscience of Yoga Conference come together? Jonathan Rosenthal: Yeah. So in college I was part of the ⁓ like neuroscience undergraduate group and ⁓ There's this organization called brainy spelled. B. R. A. I capital NY so it's like New York at the end and it's this just like large body that tries to organize Brain Awareness Week events between all the different universities in New York. So it's huge. mean, before COVID in New York, there used to be thousands of events for this week, Brain Awareness Week. with the goal of like getting people excited about neuroscience so we used to like ride around in school buses with these experiments on them and stop in different neighborhoods and show kids cool experiments ⁓ and basically everyone was encouraged to come up with their own project so I was like what the heck would I do ⁓ and because I was so interested in yoga I thought maybe I'll do something related to yoga ⁓ Andrew Heacock: around what time was that? What year was that about? Okay. Okay. And what was the state of scientific research in yoga at that time? Jonathan Rosenthal: 2014. ⁓ In terms of the number of scientific papers published, I don't know the number off the top of my head. Right now there's 10,000. Back then maybe there were three or four thousand if I had to guess. ⁓ So it was... more than you would think, know, like it's not that bad. ⁓ But it was, they were very low quality studies and yoga was not in the guidelines for anything yet. It wasn't, you know, there weren't large meta-analyses. So it was kind of like there was a high quantity of research, but limited quality. ⁓ And, but it was still very exciting. mean, there were really cool ideas and papers that were out there. So basically what we did was just like a yoga class. And then at the end, we had a little lecture about one of the papers that was published. ⁓ And it was all students who ran it. So was like me and my friends. And ⁓ we also had experiments. So we would try to replicate the experiment that the paper did so that people could see the results on themselves before and after yoga. So it was a really. ⁓ Andrew Heacock: That was the first conference. Jonathan Rosenthal: It wasn't, I wouldn't call it a conference back then. It was really just a fun event. ⁓ But it has evolved into a conference and it was really COVID that did that. ⁓ So it was COVID meant that we couldn't do the in-person conference, in-person event. The in-person event was supposed to be, I forget the date, like March 14th. 2020, which was like right when COVID hit New York and everything shut down that week. So the event was canceled. And then I was really thinking like, you people always say, how can you turn a bad thing into a good thing? So I was like, you know, damn it, this sucks. What do we do about it? And I realized that we had been having students present other people's work for, you know, years. ⁓ And it would be really cool if we could have the researchers themselves present the work. And now that we were forced to be online anyway, like there's no barrier to someone from India or China or Australia or Sweden or wherever presenting. So I just started reaching out to researchers and being like, would you be open to presenting at an event? And there were enough responses that I was like, this is a conference now. Like this is, this is a lot of people. So that's how the conference started. Andrew Heacock: And does it remain online? Is that still how the format you're going with? Jonathan Rosenthal: Yes, ⁓ this year it'll be pretty much exclusively online. We'll just have like a yoga class and a brunch in New York City. ⁓ But the, we did fully online and in-person hybrid last year and it was a lot on me. Like it was a bit too much to organize both at the same time. So we're going to keep it mostly online this year. Andrew Heacock: you Yeah, you mentioned this was during also during the COVID lockdown. You were doing your residency in internal medicine at that time. What was that like? Jonathan Rosenthal: ⁓ It was a very, like, unique time, you know. I try to focus on the good things. was a time of like immense camaraderie and we had people from all over the country coming to work at our hospitals because it was so overwhelmed. ⁓ And it was so cool to see how, you know, like nothing worked. Everything was broken. We ran out of oxygen. had just like anything that you could imagine that went wrong went wrong. Like we ran out of medications. We ran out of syringes. Like the amount of creativity it took to like get through everything. and seeing everyone come up with things and work together to figure it out, it was amazing. Like, it was a really special time. And then, of course, the really bad things were like, yeah, like a ton of people died. It was insane chaos. Andrew Heacock: What role did your yoga practice play in getting you through that time? You mentioned earlier that it helped you have the courage, the confidence that you were going be able to do the work of medical school, which I found that very fascinating remark. I'd love to know more, but ⁓ how did that carry you through that time as well? Jonathan Rosenthal: ⁓ It's a really good question. My yoga practice was ⁓ really dependent on going and seeing my teacher once or twice a week. And then I had some practices I liked to do at home before bed, just like some asanas, some breathing. ⁓ And that really went away. There were no in-person classes. ⁓ My home practice was rattled because Andrew Heacock: you Jonathan Rosenthal: Basically, it would be like, okay, Jonathan, like, like when COVID started, they called me, they were like, okay, we need you to take the day shift in this ICU and the night shift in this other ICU. And I was like, okay, so you want me to work at 24? And they were like, yes. And I was like, okay, in two different places, like, so, and it was just like that, like you would just get called and it was like, can you show up at these different places? So, um, then they made a schedule and it was like, you'd be on days for, Andrew Heacock: Okay. Jonathan Rosenthal: a week or two and then you'd be on nights for a week or two like you were constantly switching what time of day you were doing stuff so my home practice went away too like there really wasn't a practice but Like my yoga teacher, he still had some online things that I would go to. And I forget if it was at this time or another time. I think it was before this that he said this to me. he, like I asked a question at some point that was like, you know, how do you practice when you have no time and you don't know how you're going to find time? And he was like, well, you just put your hand in Gyanamudra and you put it down so you know you're not making a scene and you walk in the street going where you need to go. Keep your eyes low. Obviously be safe. Don't get hit by a car. But just control your senses for the 15 minutes you walk somewhere. And. Yeah, that kind of like idea of making things a practice like that, I think is something that I continued through COVID. ⁓ So I think that was the only way I was really able to practice at that time. Andrew Heacock: Yeah, really just to have the intention to make everything, you know, objective meditation. That reminds me, I was having a message conversation with a friend this morning talking about making potatoes. Like he's a chef and he just was this incredible thing that he'd said about making potatoes. And I'm like, this reminds me of Tick Not On. Well, like, know, the point of making the dishes isn't to get to the end of it. The point of making the dishes is to make the dishes. You can be there and fully experience this, you know, making of the dishes. Jonathan Rosenthal: Yes. Mm. Andrew Heacock: ⁓ And in that sense, like everything can kind of be an object of mindfulness and concentration. And I imagine, yeah, it's like in your head, you still have your own kind of little refuge where you can be part of reality without having to be governed by it. Yeah. So ⁓ through this neuroscience of yoga conference that's come up, I registered, I guess a couple of years ago, I've got a couple of the midsyconference materials. ⁓ Jonathan Rosenthal: Exactly. Exactly. Andrew Heacock: and look through them, which I really, really enjoyed. We're to drop a link in the description of this video as well. The conference is coming up this year, is it not? Jonathan Rosenthal: Yes, it will be March 19th to the 22nd. Everyone's welcome. The base pass is free because we want to get everyone, anyone who's interested in this, want them involved. Andrew Heacock: Wonderful. So ⁓ one of the things I've seen you speak a lot about, is it kind of makes me smile every time, is just the question of, we've kind of talked about what is yoga. But there's another question I think is a little bit more obvious that is still very important, which is what is science? Can you address that for us? Jonathan Rosenthal: Hmm. Yeah, I can do my best. I'm sure there will be people who have different views than me, but I think of science as a solution to the problem of epistemology. So epistemology is how do you know what you know? And this is a huge problem. Like, we think we know so many things when in fact, we're wrong. And the Andrew Heacock: Mm. Jonathan Rosenthal: I'm trying to think of a good example of this problem in someone's life. ⁓ I tend to use this example all the time, so forgive me if anyone's heard this before, but like, let's say you're told you have high blood pressure and you are freaked out. You're like, ⁓ my God, I'm gonna have a stroke, I'm gonna have a heart attack, I need to do something about my blood pressure. And your grandmother tells you, ⁓ well, if you take garlic pills, it will treat your high blood pressure. Do you know that to be true? Many people will just start taking the garlic pills. They think they know that's true. Grandma said it. ⁓ But that is not true. ⁓ So yeah, science is really how do you know when something is going to have the effect that someone says it is or that there's a causal connection between two phenomena? And... Andrew Heacock: I Jonathan Rosenthal: So it's a process of building a model of how the world works and then generating hypotheses from that model to test it. And then you can design experiments to test those hypotheses. ⁓ really, you're trying to destroy your models. And if you can't destroy your model, then it's probably true. Andrew Heacock: What do mean by that? Destroy your model. Jonathan Rosenthal: Yeah, so I had this great professor when I was in college who used to say, science proceeds by destruction. So you build a model of how the world works. And you essentially are trying to prove it wrong. And if you can't prove it wrong, then it is ⁓ correct. Andrew Heacock: Or it's assumed to be correct. Yeah, I mean, this is I've heard this called the falsifiability requirements. I like the first question of science. The scientific method is, there a way to test this? Is it possible to disprove this hypothesis? And the answer is no, it's kind of not science. ⁓ Right, right. I've run into that before with with just certain medical diagnoses where I'm like, and especially things are like a psychological or psychiatric nature. It's like, well, like, I don't want to test it. I mean, it's kind of that's a problem, I think, with Jonathan Rosenthal: That's Exactly. Exactly. Mm-hmm. Andrew Heacock: with specifically in psychiatry with diagnosis is kind of the eye of beholder and there's a huge problem with bias because it's like, well, there's no way to disprove it. And if it's really just in the clinician's judgment, they're kind of anchored by their own biases. Jonathan Rosenthal: Yeah, no shade against the psych people, but this is what pushed me away from psych. I was like, there's so much subjectivity here that I can't function. Andrew Heacock: I mean, the people who can do it and do it well, I've got a neuropsychiatrist that I've got scheduled to talk in a few weeks. I definitely no shade to them because there's a reason they call consciousness the hard problem. know, like it's almost maybe irreducible. And when you're a psychiatrist, you say it's subjective. Actually, I think it's subjectivity. I mean, I think that's really what you're trying to diagnose is whether a person's own sense of subjectivity is flawed and that Jonathan Rosenthal: Yeah. Yeah. Yeah. Andrew Heacock: involves a lot of assumptions and value judgments that are like, it just makes it hard to study. Maybe that's why psychiatric disorders are so intractable. ⁓ Jonathan Rosenthal: Yeah, So I don't, I'm really curious your background because you know a lot about these things. So I'm curious. I don't know you too well, so I would love to get to know you. Andrew Heacock: ⁓ yeah. Yeah, yeah, we've only just met. so like I, ⁓ my background is I'm from Louisiana, and I went to college at LSU and undergrad and I studied political science, I was always not a very good student, but I tested well, and I loved public speaking and debate and writing. And so it just was thought, okay, you'll go be a lawyer. And I studied poli sci at LSU. And then ⁓ went decided to go to law school, which I did. And that was the first time I first your last moment to LSU, where I just fell in love with like scholarship. It was the first time where I was like a good student. But in my second year, ⁓ in my first year, my grades were excellent. I loved talking with the professors, I still miss it. And I still am thinking seriously about going back to graduate school. But in my second year, I just started having like this unbelievable, unrelenting fatigue. ⁓ I, what I now would call brain fog because that's the thing where people go, ⁓ I think I know what that is because of COVID. Now we have a, a, a verbiage for this, but me, just seemed like worse ADD. I never really thought I had ADD. I just always felt really tired and kind of lazy apathetic. And, ⁓ it was like that, but like times 10 and I took stimulant medication, but all of a sudden they just started rapidly losing effectiveness. You increase the dose and it just kind of went kind of hyperbolic. ⁓ and could not figure that problem out. Jonathan Rosenthal: it. Andrew Heacock: And I ended up just not able to go to class. Like I was just too physically exhausted to go to class. There's another thing in the law where they say it's like a pie eating contest where first prize is more pie to eat. Like if you, if you do really well, they give you more work to do, you know, that. And so I got all these honors, which it's like, I didn't really set out to want to go clerk for a federal judge, which I didn't do, but you know, it's like, or when I got there, I was like, you know, I think I'd like to be a law professor really. Like I just, wanted that job, but that's Jonathan Rosenthal: Yeah. Andrew Heacock: a very tough job to get that goes to the people that are, you know, generally the very top of their class and you have certain professional things you have to do. So I took on a huge workload and it just kind of buckled me. And I ended up being taken to a, for a psychiatric evaluation, which was not my idea and not what I, I would just felt like there was something wrong with my body. And I talked to a psychiatrist for 20 to about 30 minutes, I think, and she diagnosed me with type two bipolar disorder. And I didn't believe that at the time. But then I was also told that's considered part of the pathology when you doubt the diagnosis that kind of confirmed it in her mind. I'm like, what kind of, that's a tautology. What kind of sense does that make? People with mental illnesses are perceived to lack insight into the nature of their condition. So when the patient disagrees with you, it can sometimes confirm in some people's mind that they're right. ⁓ But the problem with me was that at that time in Louisiana, if you had a diagnosis of bipolar disorder, you couldn't be admitted at the bar. Or there would be a Jonathan Rosenthal: Yeah, yeah. ⁓ Andrew Heacock: very extensive and humiliating and expensive process. ⁓ That's changed since then, ⁓ their practices, but so that made things very complicated for me because if I had shown any ⁓ like non-compliance or doubt as to the the felicity of that diagnosis, it could have, you know, really jeopardize my chances of getting admitted to the bar. But then also I was like, I'm really sure there's something really wrong and this isn't it. And so ⁓ I never actually was able to finish law school. great regrets in my life. But I was essentially disabled by this medical condition for like 10 years was on psychiatric drugs. I've been on about 40 to 50. My beginning with wanting to study neuroscience was what are these drugs and how do they work? Why don't they work? What is the science behind it? I started reading drug research, clinical trials and things like that, and just trying to learn what are the neurotransmitters and... Also the DSM, that was a big thing for me was when I started reading the diagnostic criteria and I'm like, these are also subjective. You know, it's like trying to standard, trying to objectify this objective, you know, well, but we have a checklist and I'm like, yes, but each of the items involve the word sometimes. I mean, you know, like there's a problem there. so I just through a gradual process of self discovery, learned a lot about the medications and then COVID, I ended up was in a treatment center for depression and alcohol. and I was being cross-titrated on a bunch of medications and ⁓ I think I'd been on 11 different medications while I was in the center for six weeks and decided that I just wanted to deprescribe, wanted to come off, because I was like, the more medications I took, I seem to be having really adverse reactions to the drugs themselves, which was another thing that kind of sends certain ⁓ red flags in some clinicians' mind if you think that you've been misdiagnosed and it's the drugs making you sick. ⁓ So I basically had to manage that process myself. It took about three and a half years to come off of the medications I was on and to go through the withdrawal process. So I learned a lot about that, about just how psychiatric drugs work. And all along I just was studying, fascinated more and more by the mind and by psychology. I had a religious deconversion experience as part of this. Like I kind of lost my faith in God and started to study things like existentialism and... kind of gradually started finding out about ⁓ spiritual and religious practices from a point of view of curiosity and then now psychology. ⁓ Anyway, I finally ended up in Nashville, which is where I live now, but there's a disaster in Nashville right now. We have a horrible ice storm. I'm down in the Mississippi Gulf Coast, close to where I'm from. ⁓ I worked with a neuropsychiatrist there ⁓ who was a faculty member at Vanderbilt and brain guy, know, did TMS and... ⁓ neurofeedback, was a great thing for me. That actually really made it really move the needle on my ability to pay attention in the present moment. And ⁓ for a while, thought I was going to study neuroscience, want to study the neuroscience of spirituality ⁓ or contemplative neuroscience and yoga in particular. I've wondered for a long time to put a pin on the health problem. I'm now convinced it's autoimmune because if I just eat meat and berries and avocados, I don't have symptoms. Jonathan Rosenthal: Hmm. Andrew Heacock: My symptoms go away. I'm not on any psychotropics anymore. ⁓ And ⁓ I just have water, but I'm very sensitive to any kind of stimulant, which is clearly how you treat brain fog. But I've found it actually makes it kind of productive. It makes it worse. I've just realized this. ⁓ exercise, like lifestyle factors, just are the only things that have ever worked. And I've always been really curious about, why does exercise make me feel so much better than any other drug that's supposed to make you your mood better? and I became really interested in that. And then also I've had this interest in spirituality. And so those kind of come together with yoga. And in one sense, it's exercise. And you can just look at it just as a form of exercise and as an intervention for health. But then there's also a mind component too, which is why when you said that yoga kind of gave you the confidence to know that you could do the work of getting through medical school. Jonathan Rosenthal: Yeah. Andrew Heacock: I think there are some endurance runners that would say something like that, because maybe it builds grit or something like that, but there are all these psychological benefits that come from it. That is, guess, the answer to your question of where's my background in this? I'm kind of interested in everything science, for 10 years I was too disabled by ⁓ these symptoms, the brain fog and the lethargy to really do anything. It didn't really work. ⁓ And so now I've got... Jonathan Rosenthal: Yeah. Andrew Heacock: thing is pretty much under control. still have brain fog. I've been having it this week because I had to flee a storm in a hurry and I got some stress, but I've just kind of learned to manage it a little better. And so now this podcast is a lot of my effort of just like my huge thirst to learn and to learn from really interesting people about different things. And as it turns out with like my neuropsychiatric stuff, this is the easiest thing for me to do to pay attention is just to have a great conversation with someone like you. So that's my, my background. Jonathan Rosenthal: That is such an interesting background. And do you practice yoga then? Andrew Heacock: I do, I do. uh, I, well, so I have this spatial processing thing, like the ADD stuff that I really do have. That's a real thing. It's fascinating because I love photography and I can reason in two dimensions. I'm great at it, but navigating the logic of a computer, it's actually three dimensional. You think of it, there's windows that stack on top of each other and there's folders that are the, you know, drawers. That's very hard for me. So I've done yoga before. did it in high school about the same time that you did, but I find it very dysregulating to be in a class with all the middle-aged women in skinny clothes and they go really fast or it's really hot and heat is not my best friend. I do not tolerate heat. So, and there's a mirror and it's backwards. And so like, sometimes left is not right. It was very, very confusing. I found ⁓ a Yengar ⁓ and it was slow enough. I did it in Mexico city once and there were about eight asanas in 90 minutes. And I was like, okay, this is something like Jonathan Rosenthal: Yeah, yeah. Andrew Heacock: I can just hold it and I've always become an avid exercise fanatic. mainly do calisthenics now, but ⁓ I found a Shtanga and I was in Santa Fe and just passing through and wanted to drop in, was committed. I need to try yoga and open myself really to spiritual experience. I wanted to be able to sit. I'd done Kundalini ⁓ and I did have a, the second time I did it, I had an unbelievable non-ordinary state of experience. Just basically a proper psychedelic experience. And the people I was in there with, I told them after, they were like, ⁓ know, a lot of people go years without experiencing something like that, but you did it the second time. And I was like, yeah, I give it a B minus, you know, I mean, not a bad Tuesday. And that I'm grateful that that happened because I'd been meditating, but it's the kind of thing where it really does convince you that there's a there there to have these non-ordinary states of consciousness. Psychedelics are very interesting too. People will start there and then end up with yoga and meditation. so, but I have these, my hips are like, ⁓ morphologically weird. My head's my femurs, the surgeon I met with called a cam impingement, where like the head of my femur isn't like this, it's like that. And so when I go in range external rotational dig into my acetabulum, so like I had all this pain when I sat and I was told, well, you know, like the whole point of asana is to sit without pain. I think that's literally what that means. And I found Ashtanga. Jonathan Rosenthal: With modifications though. Andrew Heacock: Yeah, yeah, right. Like, well, it's like you shouldn't just sit in pain. That was hard for me. I got injuries from yoga. I've heard you talk about how that it's rare. For me, knowing that like the difference in pain and discomfort and just bodily awareness has been a journey that yoga has probably been really one of the most helpful things. One of the things I'm hoping to talk to you about today is things like PTSD and just somatic experience therapy, somatic awareness. But what I loved about Ashtanga is it's the Mysore style. my practice. I don't have to keep up with anybody. There's no shame. There's mirrors and it's very individualized and there's a have a song around it. The Nashville that I'm part of. I'm not practicing it is it's so much and I'm not practicing it as much as I would like because the stronger is so fatiguing to the nervous system. In fact, I think it's designed for that. ⁓ My you may know. Are you familiar with the stronger as a discipline? Jonathan Rosenthal: which helps a lot. So I don't practice Arstanga myself. I've taken maybe ⁓ three Arstanga classes in my life. But my girlfriend loves Arstanga, so I know some. Andrew Heacock: Yeah, it's you know, they say it's like the original power yoga. ⁓ What I've heard of it, it's it's lineage is that a wrestling coach devised it to get nine and 10 year old boys who were hyperactive to sit still. ⁓ Or it might have been a meditation teacher like to just get them sit so long enough to meditate. And you know, it's the damndest thing, Jonathan. I've got this ADD brain. I'm not ordinarily hyperactive, but my thoughts are and I've never had a better meditation than right after a stronga because my neural fatigue Jonathan Rosenthal: Yes. Andrew Heacock: is so great that you kind of are too tired to fidget. Like your brain is too tired to fidget and there is this deep calm that is remarkable and knowing that that's kind of the whole point of it is to be able to just sit and lotus without pain, which I can do at the end and just kind of sit and meditate. It's a pretty cool thing. So that's, that's my. Jonathan Rosenthal: Yeah. Yeah, and I think that's why meditation's at the end of yoga classes, because it's like, you know, people come in with so much residual anxiety about the day, their tasks, their laundry, who they have to call, everything. But then you spend so much time, you know, focusing on your body that right afterwards you're actually still, you're much stiller, physically and mentally. Andrew Heacock: Yeah, yeah. Right, right. Well, and I know I've been in three treatment centers in my life for various things for mental health. And I've known a lot of people with a lot of different kinds of issues that they work with. And there are a lot of people who just have a real sense of dread about their body. And or for me, it was really more of a disconnection. There was like, there's me and then there's this thing down here that me is attached to. And for a sense of kind of general sense of disgust or whatever. And it's good. Although I think that Jonathan Rosenthal: Yeah. Andrew Heacock: trauma-informed yoga ⁓ or trauma therapy, like yoga therapy, ⁓ there's a real thing there that people need a very particular set of training and skills to know what's gonna come up. ⁓ That actually might be a good place to transition into that, because that was one of the things that I was interested in studying back when I wanted to do neuroscience. don't now, I'm much more interested in, I'm more interested in ideas and people than data. ⁓ But... ⁓ You know, there's all these claims about, it's like, okay, there's trauma-informed yoga or there's like yoga therapy. ⁓ What is the evidentiary basis for things like that? And that's just a general question I have, but are you familiar with that kind of area of practice and what do we know about the evidence for it? Jonathan Rosenthal: Yeah. So just to be clear, I'm not an expert in PTSD or trauma-informed yoga or anything like that. My knowledge on the subject comes primarily from reading papers about it because I know other people are interested in it. And so I have organized conferences on the subject in the past, ⁓ you know, with the goal of bringing together some of the best people who work in that area. ⁓ So the. I guess. just for anyone who's listening who's not familiar with PTSD, ⁓ it really comes out of the study of war where it was first described. So for soldiers who had experience seeing ⁓ their colleagues die or been in life-threatening situations themselves, they came back with these... ⁓ incredibly sensitive stress responses where any situation that in some way recalled what they experienced in war, they would have overwhelming stress responses. They could even dissociate ⁓ and they could become very ⁓ violent, aggressive, or just like emotionally unstable. ⁓ And then there was, ⁓ and then of course, like nightmares and so many other associated symptoms. ⁓ But more recently, you know, the push has been really didn't recognize that there are non war related traumas. So PTSD can arise from domestic violence, it can arise from, ⁓ you know, many different situations. There is also ⁓ probably a bit too much where people call everything trauma now. And to be clear, a trauma is not the same thing as PTSD. PTSD is supposed to have certain features, combinations of features. But if you think about it, the physiology you can kind of extrapolate. So it's like people have these... ⁓ over sensitive or hyperactive stress responses to not noxious cues. So like something that isn't dangerous makes them react as if it were dangerous. And maybe they don't have the full blown disorder, but there's you know, something like that going on. So yeah, I think that's what people are really interested in with yoga. I don't even think we need to talk about it in terms of trauma or anything. think the evidence on yoga for stress is tremendous. And what we're really talking about is the effect of yoga on stress. ⁓ One of my favorite review papers from this researcher, Pasco, I think it includes 43 randomized controlled trials on yoga. ⁓ They also, I'm forgetting the paper a little bit. They might have included some studies that were Tai Chi as well, but like Tai Chi is so similar to yoga. And... Essentially what they found is across every population, no matter what measure of stress you included. So whether it was a behavioral measure, like a standardized scale, like the perceived stress score, whether it was a physiologic measure like cortisol or heart rate or heart rate variability or blood pressure, ⁓ metabolic measures like glucose. LDL, included, there were so many different measures that they included in this meta-analysis, and basically it was like across the board, yoga has a significant effect on all of these measures of stress. So it's like very clear yoga has a profound effect on the stress system. And... We could get way more into the nuance on that, like what are the necessary components of yoga for it to have that effect? like, it have that effect for everyone? And are there people who don't benefit from it? And, ⁓ you know, the answer is much more complicated than it's just gonna work for everyone. It's the cure. ⁓ Andrew Heacock: Basically, because yoga could be so many things. Right, right. So, yeah, I'm sorry, go ahead. Jonathan Rosenthal: Exactly. So. ⁓ so I was just going to say the, ⁓ you know, there is a movement in the literature to really focus on yoga for PTSD. And in that vein, have developed really, ⁓ what's his name? Shoot. He presented at the community showcase we had a few months ago. Dave Emerson developed the trauma sensitive yoga protocol. ⁓ And basically the idea was how do we adapt yoga to make it ⁓ suitable for people who can have these triggers and develop these kind of very intense stress responses. And so the core principles that they built into their yoga was ⁓ the students are making their own choices. So they have like autonomy over their body. They're not being told what to do. They can always make a choice and they're reminded that they can make choices. ⁓ There are four components. I forget the other three. Andrew Heacock: Yeah. Yeah. Oh, no, that that one's a big one. That's a kind of a profound one to just say that like you have you have autonomy and sovereignty over your own body. Really, if like, having that autonomy or sovereignty violated is related to the trauma. Yeah, yeah. So it's I mean, this trauma sensitive yoga, I think it's called. So you said the name of the protocols trauma sensitive yoga. Jonathan Rosenthal: Yeah. Exactly. Exactly, and I just looked them up to have them. It's a the other three are inter reception. So a focus on internal body sensations And then ⁓ present moment experience so really being focused on the president on the president and then The other ones that they're listing here are not the ones that I'm familiar with so I'm just gonna stop there Andrew Heacock: I Okay, cool. ⁓ Interoception is fascinating. Just like a sense of like your internal sense of your body that what that refers to. Yeah. Jonathan Rosenthal: Exactly. And it's a it's a really important thing. It's actually one of it. I think okay, just me personally, I think that it's probably one of the main mechanisms by which yoga works is improving people's interception and their experience of their body. Yeah. So, you know, Andrew Heacock: Can you tell me more? Jonathan Rosenthal: Yoga is what I think we can call a pleiotropic intervention, meaning it works by many mechanisms. So, you some people are obsessed with like the vagus nerve. They're like, ⁓ it's all about the vagus nerve. There are people who've had their vagus nerve cuts for medical reason, cut for medical reasons. And so, you know, I don't have proof of this, but I really think that if those people did yoga, they would still benefit from it. So I don't think the vagus nerve is necessary or sufficient to explain the benefits of yoga. ⁓ And so across the literature when they you can do this kind of thing like a it's called like a mediation analysis where you try to understand like what variables are Necessary for the other outcomes you're measuring. So what's necessary for? the stress improvements that we see. one of the, some of the things that come up over and over again, like one that you might think is like self-control, like yoga makes people more self-controlled. That one is not. That one is. disproven. It does not mediate the effects. So what mediates the effects are things like improved mindfulness. So being able to have present moment awareness, like we were talking about before, but really like, you know, paying attention to what's going on in a sensory experience, and interreception. Those come up over and over again. So yeah, interreception is like being able to feel when you're hungry or thirsty, being able to feel where your body is. ⁓ you know, how something's hurting it. Like sometimes people ignore these feelings that they have. Andrew Heacock: Yeah, you sit in this pain for a while and then eventually it's not now you got a problem. Yeah, that was my issue with warrior two is like, ⁓ no, now I've got to now I have a groin injury. So now I got to deal with that. ⁓ Jonathan Rosenthal: Exactly. Yeah. So yeah, so and then interoception is interesting because it really, I mean, it's not the most localized thing in the brain, but there's this part of the brain called the insular cortex, which is thought to underlie parts of interoception. And all the studies that have looked at ⁓ fMRI and interreception have really shown changes in the behavioral measure interreception and the brain insular cortex. So there's really something there. Andrew Heacock: between is that also sometimes called the insula or is that a different part of brain? Okay. I you know, I read about it. There's this book, you know, I feel like we've got to mention the body keeps the score that Bessel van der Kolk is being important a lot of people. And you also mentioned polyvagal theory. What what what brought me to what gave me the emphasis of saying I really need to interview this because it's fascinating. You just made like a five minute video about polyvagal theory recently. ⁓ And I would love for you to tell us what is that? What are people talking about when they say polyvagal theory? And then Jonathan Rosenthal: Same. Yeah. Yeah. Yes. Andrew Heacock: what your thoughts are on Because you mentioned that maybe the idea of the Vegas nervous, the center of everything might be wrong. Jonathan Rosenthal: Right. ⁓ So, yeah, I think that polyvagal theory is a really helpful role for a lot of people on the practice side, meaning the people who are applying yoga or other mind-body practices. And I think it's a really good example of what we were talking about before, like how do know what you know and what's true and everything. ⁓ And really what I think it comes down to is Andrew Heacock: Okay. Jonathan Rosenthal: Polyvagal theory is wrong. ⁓ That doesn't mean it's not helpful. That doesn't mean that people haven't benefited from using it and understanding it. And listen, if Stephen Porges is hearing this and thinks that I think he's a bad person or hate him or something, I don't. I think he's done a ton of good for people by getting them curious about neuroscience and having people have a way of talking about how they're feeling. And I think that's really the role that it served, is it kind of breaks out people's states into if they feel safe. if they feel threatened or like fight or flight or if they feel frozen and like kind of not able to act. And those are like two different stress states. I think it's great that people are able to recognize that they feel that way and kind of modify it and self-regulate. ⁓ However, Andrew Heacock: Yeah. Jonathan Rosenthal: The kind of like core ideas of polyvagal theory like separating the vagus nerve into this dorsal and ventral components and assigning them extremely specific and limited functions and all that. It's just wrong. Like it's just not, it's not, nowhere else does it look like that's how it works. And I think that people run with this idea because it matches their experience so much. Like it seems like it feels right. And this is a great example of how you can be misled to think things are true. ⁓ But yeah, there's really... The only people who publish about Hollywood Theory, for example, are Stephen Porges' group ⁓ and then people who critique it. And there's no one who supports it other than his group. So, yeah. Andrew Heacock: What is the word polyvagal referred to? Jonathan Rosenthal: Yeah, exactly. So I think that's like the core idea of it is, so the vagus nerve is this very large nerve that comes out of the brain. And it's one of the main mediators of the parasympathetic nervous system, but it also has a lot of information coming from the body going up to the brain. And the kind of Like I think Polyvagal is actually a great name because it's recognizing that the vagus nerve is not one nerve, it's made of many components. But Polyvagal theory, like literally the brand Polyvagal theory splits it into ⁓ two components, like dorsal and ventral. And that's just not accurate. Like it's way more than that. And the vagus nerve connects to many nuclei in the brain. And from those nuclei in the brain stem, it connects to so many different organs, each of which is really like, when you think about it, kind of its own nerve. So it's connecting to the heart, it's connecting to the lungs, it's connecting to the gut, it's connecting to receptors throughout the visceral organs. So it's much more than just two things. Andrew Heacock: So when someone feels a sense of dread and they can locate that in their body, like in their stomach, in the pit of their stomach, is that in theory because like the vagus nerve is responsible for that or it's connecting them there or is that just the idea behind polyvagal theory that is not bearing out? Jonathan Rosenthal: Okay, true answer, I don't ⁓ know. I think to answer this, and maybe someone knows out there and I just haven't read what they've studied, but I think to really answer this, you would need to remove... Andrew Heacock: That's a great answer. ⁓ Jonathan Rosenthal: individual things and see if people can still feel that sensation in their gut, right? So like, in order to know if something is responsible for something, you really should stop the thing that you think is responsible and see if... people still feel the thing, right? So like if it's the vagus nerve, those people who had their vagus nerve cuts, cut, I keep saying plural, for peptic ulcer disease, that was like a way that surgeons used to treat peptic ulcer disease, they would just cut the vagus nerve and people would stop having ulcers. ⁓ But if we found some of those patients and asked them like, do you get gut feelings? And they said no. then like, yeah, maybe the Vegas nerve does play a role there. But truthfully, I've never heard that. I don't know. Yeah. Andrew Heacock: We haven't done that and I guess are we longer doing that procedure to treat ulcers? Jonathan Rosenthal: I am sure there are surgeons who still do it, but it's definitely not like first line treatment. Andrew Heacock: Yeah, no, but it's fascinating because ulcers are I mean, I think just as a lay person, I'm ulcers stress, like, like you get ulcers if you have stress, if you cut the vagus nerve, the vagus nerve, I guess one thing we haven't talked about is sympathetic versus parasympathetic. And again, like I went to a treatment center that was just PTSD based. I mean, it was all that's what it was about. And we learned about the polyvagal theory and all that. No, it's a sympathetic is your fight or flight system and parasympathetic is rest and digest. Jonathan Rosenthal: Yeah. Andrew Heacock: Is that an oversimplification or is that a fair assessment of what those are? Jonathan Rosenthal: No, I think it's a great simplification. I think it's a really helpful simplification. ⁓ And I don't think you need polyvagal theory to describe the autonomic nervous system that way. Like that's just the autonomic nervous system. Like everyone agrees on that. ⁓ And what's interesting is yes, the vagus nerve carries the parasympathetic fibers that come from the brain. That's like 20 % of the biggest nerve, maybe less, I don't know. And the other 80 plus percent is information going to the brain. the, believe it or not, the secretion of gastric ⁓ enzymes, the ones that cause ulcers. in the stomach is mediated by the vagus nerve. So it's actually promoting the production of these acids and enzymes. ⁓ And so that's kind of the way that it can result in ulcers. And so yeah, stress is related to ulcers. That's true. But it's not as clean as... Because it's parasympathetic, it can't be the thing that causes... Like, I think we have to think of the stress response as something that uses the autonomic nervous system, ⁓ but it is not just like ⁓ a flip switch that's like up and down. Andrew Heacock: Yeah. You know, that's an interesting way to put it that the stress system like uses the autonomic nervous system, because I've been meaning to ask you, it's so fascinating for you to be a neurologist to study something like this. That's just such an amazing lens to look at. I've also begun to learn that stress is not just in the nervous system. Like there's other forms of stress there, like things like metabolic stress. Could you give us, guess, just as a physician, what do you think of when you hear the word stress like you know, what does that mean and what are the different forms of stress that you think about? Jonathan Rosenthal: Yeah. Okay. I think stress is one of the most interesting things. ⁓ And I don't, I used to have a whiteboard right next to me, but I don't have it anymore. But I love to draw this graph. like, if you were to picture what stress on the X axis and performance on the Y axis looks like. So everyone's like, you know, picturing that in your head. Like most people would say as stress goes up, performance goes down. That's like what everyone thinks, right? This has been studied. I think it was first shown in the 1890s, maybe I forget the exact year. ⁓ And it's been shown over and over and over and over again that that is not true. What it looks like is For low stress, performance is low. For medium stress, performance is high. And for high stress, performance is low. So it's a bell curve, meaning a moderate amount of stress results in maximal performance. So what is stress? It's really about orienting resources, deploying resources. It's basically the system that allows us to Andrew Heacock: you Jonathan Rosenthal: Yeah, like, what are our resources? It's like our muscular effort, our energy, our mental effort, our cognitive load, our memory. It allows us to orient those towards whatever task we're trying to accomplish. the, when we think of stressors, like it could be a deadline, it could be financial strain, it could be grief, ⁓ or it could be a physical stressor, like a serious infection. or like ⁓ a terrible injury, like, you know, crush injury of the arm. The stress response makes us survive all of those. And the goal is to adapt. The goal of the stress response is to adapt. And I think when people use the word stress, you know, like you look at, I have a slide presentation where I have a cover of a magazine from Time Magazine in the 1980s. And it's like, stress is the title. And it's this guy like, And you know, it's like, that's what people think of when they think of stress. And that's really maladaptive stress. That is the stress that ⁓ instead of helping you resolve whatever is causing the stress, ⁓ it worsens it. Right? So like a great example of this is stage fright, which I used to get like you stage fright, right? You get so you're stressed out about going up in front of people. And then the stress impairs you from being able to go out Andrew Heacock: Stay Bright. Jonathan Rosenthal: and go up in front of people. But really, like stress should make it so that you are kind of sharper. Like, like I always experienced this, like I get up now and I'm in front of people and I'm like, wow, I speak so much better out loud than I do in my head. So it's, you know, that's what the stress response is supposed to do. And then in order to do that, it's really the brain that determines that something is a stressor and we should deploy resources for it. And then it orients all of our system towards it, not just the autonomic nervous system. That's just one way the stress response works. The stress system can also work via hormones. ⁓ And then the combination of the autonomic nervous system and the hormonal system ⁓ really results in changes in everything. So where blood is flowing, what nutrients are in the blood, how much glucose is in the blood, how much energy different organs are allowed to consume, all of it. Andrew Heacock: coming. Jonathan Rosenthal: So yeah, that's my overview of the stress system. Andrew Heacock: Yeah, it's, I love it. I love it. There's so many things. There's so many places we could go with this now. So one thing I want to ask about just to put a bit on though, I've heard of this term metabolic stress. Is that I mean, it sounds like your cells are working overtime to deal with everything and they put out a lot of waste product and that stresses the system. Is that what people are talking about when they describe metabolic stress or I think there are influencers who talk about food and stuff and they use metabolic stress and that's not what it Jonathan Rosenthal: I don't know. I've never heard, like, I've never seen it published or really talked about metabolic stress. If I had to imagine what metabolic stress is, it would be the metabolic manifestations of the stress response, which are high glucose. ⁓ So like, you know, for example, people who have high stress are at higher risk of diabetes because they have more hormones circulating that promote elevated blood glucose levels. ⁓ So that's the kind of thing that I would be thinking about. ⁓ Andrew Heacock: that makes sense like downstream effects on metabolism of stress. Yeah, yeah, that that does make a lot of sense because things like cortisol are gonna affect that right or adrenaline and affect your blood sugar which is what diabetes is basically. Yeah. Jonathan Rosenthal: Exactly. ⁓ Andrew Heacock: Okay, you you mentioned stage fright. It's so interesting. On my last episode of this podcast, I was talking with a friend who's a men's and executive coach. I telling him, know, it's the weirdest thing I've never had a public speaking. I was always very socially anxious and still kind of am, but I've never had any fear of public speaking or debate. And it's so weird because it's everybody's worst fear. But and I've talked with the psychiatrist about it many times and also a clinical psychologist who's He is kind of an expert in ADHD. I'm going to have him on hopefully soon. He was the director of testing for MENSA for like 20 years. Psychometrics is his deal, but he was like, makes sense because your brain's kind of sleepy. Give me an EEG and it's very stimulating, but it's the right amount of stimulating for me. You know, it's not overwhelming, but one could see how, you know, if you really do perceive something as like mortally dangerous, that your body preventing you from doing it could be adaptive. in a way, know, the question is if that perception of mortal danger is actually not accurate, where that becomes the problem. I think that's where these things become things like personality disorders and phobias and things like that. It's where like, yeah, mean, saving your life, doing something that's life threatening is not good, but you know, leaving the house isn't that necessarily. Has your yoga practice helped you with ⁓ public speaking? Jonathan Rosenthal: Yeah. Right. Right. Yeah, I think it did. A lot, actually. ⁓ can't point to like a specific moment, but I used to do a lot of breathing exercises before I had to speak and I found that super helpful. ⁓ And over time I've really just habituated. Like I no longer, you know, I still get butterflies like so many people do, but it's not, it doesn't impair me. Andrew Heacock: Yeah. Right, yeah. For me, it's the way I would compare it is, I mean, like dread and excitement, I've heard are physiologically the same thing. Is that true? Jonathan Rosenthal: ⁓ Yeah, so I think in terms of physiologically, it's like just a very high arousal state with like a strong ⁓ sympathetic drive. But it's really the salience that's different, right? It's kind of like the kind of mental component of is this positive or is this negative? Andrew Heacock: Yeah. meaning you make of it. Yeah, that has a lot a lot of just therapy is predicated on what you just said is basically like it's the story that you you tell yourself about the experience you're having within. ⁓ And you also now you have some emotional, like memory, like you have some learning of where you did it in it, you didn't die. And so you can kind of counteract that narrative. And for me, it's kind of like the way you feel when you're going up a roller coaster. Jonathan Rosenthal: Yeah. Andrew Heacock: And you're like, I don't want to do this. This was a total mistake. What was I thinking? And then you go on and it's thrilling. It's terrifying. But then you get the end of it. You're like, I want to do that again right now. That's how I feel every time I do it. And you do that a few times. You've had good experiences. I've never died doing public speaking so far. And so you do have that thing. I said last week, was like, my next thing has got to be ecstatic dance. He's like, it's actually on Sunday. Do you want to go? And I'm like, OK, I'll do it. And did it. And it's like dancing in front of people was the thing. Like if you freeze up. Jonathan Rosenthal: Yeah. Yeah. Andrew Heacock: which is kind of what I would tend to do when I get like scared or whatever. It's kind of impossible to dance. Like that's the one thing you're not going to do. And you just, kind of had to work through it and it is a cool thing to be able to now I have the resources where I can just know like I've been through hard things in my life, dancing in front of other people. Like I will survive. They didn't play that song. I will survive. That was a bad pun, but like, you know, I was able to do it. So ⁓ there's some stresses that make us stronger. I, there's a term that I see when I've studied exercise. Jonathan Rosenthal: Yeah. Yeah. Andrew Heacock: And there's apparently that doctors are like, yeah, if you were told in medical school, there's this thing that will increase your inflammatory biomarkers and, you know, raise your insulinses or lower your insulinses or whatever. And it's like, you would never do that. And it's like, that's exercise. And this term, hormesis comes up. Can you explain to what that is? Jonathan Rosenthal: Yeah, it's basically the idea of, ⁓ so if the goal of the stress system is adaptation, it's kind of the idea that a stressor results in a more permanent adaptation, meaning that you get kind of better at that adaptation. ⁓ So like a really good example would be like ⁓ when you... are studying for something or like you're know you're learning how to be a student and the stress like makes you you're like focused you're learning you ⁓ Whatever, you're studying. ⁓ Then the next time that you're studying, you're better at it. You learn better. You're able to store things and retrieve memories faster. So it's really like the more permanent structural changes that make the adaptation easier in the future. Andrew Heacock: Yeah, yeah. It's like, I've just thought of it as like good stress, basically, pro stress, that, you adaptive stress. And that's basically what exercise is. I mean, or specifically like strength training. ⁓ Like you're, you're just, you're stressing a muscle, maybe damaging it, doing micro trauma to it. And then it comes back stronger and you have like more neural infrastructure for doing that movement again. And so it's like, it's controlled stress to make you more resilient to it later on. Yeah. Jonathan Rosenthal: Yeah. Exactly. Andrew Heacock: Do you think that's, you earlier when you were saying the yoga kind of gave you the confidence to know that you were going to do this hard thing of go to medical school? Do you think there was an element of that to it that like sometimes yoga is very hard? Jonathan Rosenthal: ⁓ Potentially yes. ⁓ I think the other thing about it was yoga helped me clarify meaning. It helped me understand that like it really was meaningful to me to pursue medicine and so I you know, I think it's easy to disconnect from that when you're seeing so many miserable people talk about how much they hate their job and then you ⁓ Knowing that through yoga I could always connect back to like, no, this is the meaning that I was seeking through this. ⁓ I felt like, okay, like I can do this. Andrew Heacock: What was the part of it that was able to give you a better relationship with finding meaning? it from like your meditative practices or the teachings that you were sitting with or? Jonathan Rosenthal: Yeah, it was a meditation practice. It was a really specific one that Dharma teaches. He calls it psychic development. It's not psychic like developing psychic powers. It's more just like your own psyche. ⁓ And we go through this series of breathing exercises and then visualization exercises. And then at the end, you kind of have this open awareness meditation type thing. And it was really during that that I was like, yeah, this is what I want to do. Andrew Heacock: Yeah, that's so fascinating. mean, it ⁓ is sometimes there's like a decluttering that I've noticed with my mind where ⁓ the noise is gone. And so the signal can kind of come through of, this is what I actually want, you know, and I've been so busy doing other things that I've never really stopped to think about, am I doing these things for me? ⁓ And it's one of those things where I think it just comes with there's probably a cumulative effect of just hours on the mat. or in the chair on the cushion or whatever it is that you just spend time with it and it gives it more time to allow it good things to happen that way. Do you think that's true? Jonathan Rosenthal: I do, to some extent. think there's also a... Like, with practice, you... You know, when you first start, you're just like learning like, what are the steps, what do have to do? And then after that, there's the working on the kind of like mental part of it, like the attitude and the... ⁓ You know... like what's going on in your mind and after that really working on like the higher purpose or meaning of something and I think as you like yeah as you do practices more and more even when they're repetitive you like progress through that ⁓ and yeah I think that's work Andrew Heacock: That's, that's been my experience with the stronger. I don't have to figure it out. I don't have to build the whole world from scratch every time because I'm going through the same motions and there's committing it to memory and it can kind of become automatic and therefore become a meditation. Yeah. You know, earlier when you're talking about you you were envisioning this chart of stress over versus productivity. ⁓ What I was thinking of, of like the intermediate stress with high productivity is this concept of flow and flow states. Jonathan Rosenthal: Right. Hmm. Andrew Heacock: Are familiar with that discussion and is there a scientific basis for it or is it just of pop science? Jonathan Rosenthal: So I am familiar with it, ⁓ it comes up a lot. ⁓ In terms of scientific research, I don't think I've ever really looked into it so much because I've always been a bit murky on what flow actually means, you know, like some people are like, like, ⁓ I'm like, so focused on work, I'm in the flow state. And I'm like, how is that the same thing as what someone experiences when they're meditating? Like, I just didn't, I didn't fully understand what it meant. Like to me, it like when I hear it in popular conversation or whatever, I really tend to think it just means someone's focused. Andrew Heacock: Thank Jonathan Rosenthal: That's what it sounds like. ⁓ What's your understanding of it? Andrew Heacock: Yeah. Yeah. I, I've had some experiences like this. and I think that, you know, what I've heard about flow is that to get into it, you need to be doing something that's, ⁓ challenging enough to, to cause you to focus, but not so challenging that it's impossible. So there's like that intermediate level of like difficulty. And then a lot of times repetitive action is helpful. So like I've kind of experienced it in swimming in a pool or running around a rowing machine. where you're doing the same motion, but there does seem to be like something I've been fascinated by with you, like the yoga's discipline of meditation is that it seems to be very ⁓ oriented around focus as opposed to like zen, which is more around emptiness. ⁓ You know, there's the idea that you can focus your mind on an object very intensely and that very fascinating things can happen. That's a very yogic idea. Jonathan Rosenthal: Yes. Andrew Heacock: I think that relates to egolessness. I think the thing that people are describing with flow is just a relative sense of egolessness, where it's like, the work is doing them, or people will describe this playing music or things like that. I don't know if there's any like validity to it for level the brain. But ⁓ I think that it's just basically you found an object of meditation. But that's your work. You know, and it's you're good enough that you're skilled enough at it. that you can go through. kind of like what you were saying with the with where you've gotten with your asana practice, your hatha practice, that you're good enough at it probably at a certain point to where the mind can just kind of focus on doing it instead of all the ways to figure it out, or I'm bad at this, or people are judging me or whatever. And then you know, that that deep focus becomes the path of meditation. I think that might be what what's going on. But it seems like we don't know a whole lot about it. Because it's like, how do you know if someone's in flow? Like, how do you study that? Yeah. Jonathan Rosenthal: Right. Right. And the markers, you know, I'm sure people who maybe have studied it have used things like EEG and fMRI. And it's like, like I was saying before, it's not the best. So yeah. Andrew Heacock: Can you tell us about what those two technologies are and what kind of what their history is and what they are good for and what their limitations are? Jonathan Rosenthal: Yes, I can talk a lot more about EEG. one of my expertise areas is EEG. ⁓ So EEG was first developed by this guy, Hans Bergman ⁓ in the early 1900s. And he was very inspired by the work that was done to measure the cardiac cycle. So putting electrodes on the chest and measuring the ⁓ electrical potentials of the heart. and he wanted, actually he was very spiritual, and he wanted to measure psychic energy. He really thought that there was a way to measure this, and so he thought that by putting electrodes on the brain, or on the scalp, ⁓ he could calculate how much energy went into someone, how much went out through other things. And then what was left and what was going through the EEG was what was left and that would be psychic That was his belief. It was like based on you know energy theory that energy cannot be created or destroyed and so the energy coming in must be coming in through food and and then it must be going out through other things and one of those must be psychic now, unfortunately I think that whole thing falls apart because I don't think that, like, I think we really can account for all the energy that comes in as food through other things. like, is some of that psychic? Maybe, but that doesn't mean like we can't measure what part of that actually measures. Yeah. And with the EEG, you're measuring only such a small part of, you know, Andrew Heacock: Okay. I wouldn't Jonathan Rosenthal: the actual electrical activity of the brain that you can't in any way estimate the energy component of the brain. So his whole idea was completely wrong, but he ended up putting these electrodes on people and was like, ⁓ like I'm seeing something. And he identified the alpha rhythm, which is one of the most like common, you things that we see all the time, I'm looking at one right now, and the the alpha rhythm is kind of like the resting state of any cortex. So like most one, the most common one that we see is the occipital cortex. When people have their eyes closed, there's an alpha rhythm there. So yeah, so that's how EEG started. EEG has gone through a lot of like ⁓ Andrew Heacock: Ahem. Jonathan Rosenthal: study and revision and how do you set it up and record perfectly. And there's an international standard for how to do this now. Research is pushing beyond that international standard and trying to add more electrodes, more channels, make it as dense as possible. But for the clinical standard, ⁓ it's 16, 18 channels. Like it's a very limited. set up, really, and each electrode can measure six square centimeters of cerebral cortex. So it's like if you took, you know, more than a more than your thumb like this, this by this of cortex, and that's a lot like it's huge when you think about it, like it's really measuring only when the brain is very synchronized and very big signals. So In research, sometimes it's used for certain things. But if you just put an EEG on someone and just let them go about and do what they want, you're not getting that much information. You're really not. So it's good for seizures. This is what it's used for clinically. ⁓ So it's really good to say like, yeah, like this is a seizure because seizures are synchronized brain activity. They show up very well ⁓ on like six square centimeters of cortex. It's very easy to synchronize for a seizure. The other thing it's really good for is seeing when there's damage to a specific part of the brain. So like right now I'm using it. There's someone who has their carotid artery clamped I'm looking to see if they're ⁓ like. like ⁓ if their waves slow down on one side, which would tell me like that side of the brain is not getting enough blood. But otherwise it's good for event-related potentials, so like showing someone like a signal and seeing how the brain responds to that, because then you get like a time-locked kind of like modifiable signal. So yeah, those are the main use cases and... Sometimes there are people who sell like, we'll do an EEG and tell you your risk for dementia or, ⁓ you know, like a bunch of other things. And right now, like that's just not a clinical grade stuff. Like it's just not at standard level. So. Yeah. Andrew Heacock: Yeah. What about diagnostics for things like neuropsychiatric disorders or things like that, ADHD or autism or anything like that? mean, is it useful for anything like that or? ⁓ Jonathan Rosenthal: zero role. There are some psychiatrists who do them and claim to have like a, you know, kind of like insider special knowledge, but it's not published. It's not shared. It's like, it's really, I don't see what they could be doing with it to make that case. ⁓ Andrew Heacock: It's just not enough information, right? Jonathan Rosenthal: Yeah, and then there's it's very noisy like the thing to know about EEG so like the signals from the heart are on the order of Milivolts so 10 to the negative 3 EEG signals are 10 to the negative 6th. They are very small signals because they're attenuated by the skull so it's like really weak signals to begin with. You're only getting things from the outside of the brain because they're the only thing close enough to the electrode to record. ⁓ And then there's so much noise everywhere. You move your forehead, you blink, you wiggle your ears, you move your tongue. All of that affects the EEG significantly in a way that it doesn't really affect EKGs, the heart measures. So it's a very limited system. ⁓ Andrew Heacock: Yeah. What about, so what it does tell us though is different brainwave frequencies and different What are those, what are the frequencies? You mentioned the alpha rhythm. I've heard of that, but I've heard of some other ones. Could you walk us through what we know about that? Jonathan Rosenthal: Yeah, so there's ⁓ Delta, which is basically from one to four hertz. Anything below one is probably not from the brain. There's Theta, which is from four to eight hertz. There's Alpha, which is from eight to 13 hertz. And there's Beta, which is from 13 to like 30 hertz. And then Gamma is like beyond that. And you're like, why? like why those numbers, why those Greek letters? It's just because those are the order that they were found in and people decided this and it ended up being kind of useful, the ranges. ⁓ like Delta tends to be very slow. It tends to represent that there is something ⁓ kind of like more white matter driven. Like the brain is ⁓ from deep structures. That's where those rhythms come from. So it tends to be people are. asleep or there's been damage to that part of the brain. Theta is ⁓ Also some deeper structures, but more specific ones like the hippocampus. And then alpha tends to be the resting state of cortex, like the outer part of the brain. And then beta is like, it's really fast. ⁓ Usually an EEG doesn't do a great job at picking up beta because of the skull. ⁓ And so the only time we see, you can see beta in a normal person's EEG. I mean, it's just very low amplitude and ⁓ it tends to be when they're like either really anxious or they're on certain medications. ⁓ And then if someone has a damage to their skull like a crack or a hole or something, you can see a lot of beta. There's a lot of beta with that. And gamma you just do not see on a surface like a scalp EEG. You only see gamma if you put the electrode actually in the brain. Andrew Heacock: And so I was going to ask, how do we know about it? Because I assume from doing brain surgery. Jonathan Rosenthal: Exactly, yeah. So if you do epilepsy monitoring and you actually implant the electrodes in the brain, then you can see gamma and people have done this not only for epilepsy, I mean it's been done in mice to study different brain waves and it's been done like the people who get Neuralink or whatever are getting brain implants too. Andrew Heacock: I was just thinking that, I mean, that's what we're doing in Neuralink, right, is implanting chips in people's brains. What do we know about gamma? I've heard of it almost in mystical terms. I've heard it's associated with these non-ordinary states of consciousness associated with meditation. What can you tell us? Jonathan Rosenthal: Yeah. Yeah, it's kind of like a processing synchronizing them. So it's really how different parts of the cortex are able to communicate with each other. They go into a gamma rhythm and are able to like send information across the brain. ⁓ But it's happening all the time. We just can't measure it. ⁓ So it's yeah, it's really like a very active. rhythm and then also for seizures ⁓ it's one of the precursors to seizures like it's seizures usually start with ⁓ a gamma variation called a hyphrate. Andrew Heacock: Okay. Do you know why these gamma waves have this association with meditative states or mysticism or is that just something that I'm making up? Jonathan Rosenthal: I don't know why. I think in order to say that they do, I would want to see implanted electrode studies of people who are meditating. ⁓ Andrew Heacock: Yeah. Which is challenging. Right. Jonathan Rosenthal: It's less challenging than you would think. ⁓ So one million people, sorry, no, three million people in the US have epilepsy and a third of them will not respond to medication. So that's a million people. And of those million people, pretty much all of them at some point should get electrodes implanted in their brain to understand their seizures better and get treatment. And so that's a lot of people who one day may get, know, electrodes in their brain. And it's... Andrew Heacock: Interesting. Jonathan Rosenthal: I've looked into this before and I'm forgetting right now, but there are studies on implanted electrodes and it wasn't yoga practices. It was really meditation practices. And if I remember correctly, they were even doing like laterality things. were like, you know, if we, they were also doing breathing. Yeah, they were like, can we control? ⁓ do you know have changes on one side of the brain and not the other if we only breathe through one nostril and i'm completely forgetting the results i looked into this a very long time ago Andrew Heacock: Yeah, it's an interesting thing. One of the things I was just struck by, you know, it's like, well, you you'd have to implant things in people's brains. And my, my name is thawing. It's like, you can't just do that ethically. Like, it's like, hey, we need to study this. So we need to put electric, but then there's all these people that already have it. You know, so it's like, you know, if we could just think things through with the technology on the front end, that there's a, there's a population that can be studied with that, which is kind of cool that, you know, these people, there are people that already have that or is it possible to just start studying people like that? I guess you have to defend. Jonathan Rosenthal: Yeah, they have to go through consent, because they need the procedure for medical reasons and it's a well established standard of care procedure, ⁓ it's like they're gonna get that ⁓ if they of course agree to it. And then for the research, it's just like an add on. So ⁓ yeah, it's like a very common thing. Andrew Heacock: Thanks. Jonathan Rosenthal: Because when they get these implants, they're not sent home. They don't go home with implants. They stay in the hospital. So they kind of sit around for weeks. They're just waiting for seizures to happen and capture them for weeks. so it's a... They almost are happy to participate in research because it's something to do. ⁓ Andrew Heacock: ⁓ I see. Yeah, right. Yeah. Do you think having them meditate while they're there might confound the results of the like, could meditation have a confounding effect on their seizures? Jonathan Rosenthal: I ⁓ do think so, ⁓ and my answer is base. Yeah, so my answer is based on a few studies that have used yoga and meditation and acceptance and commitment therapy to treat seizures. And I've shown that there is a significant decrease in seizure frequency and intensity with those treatments. So yes, I do think that it would actually be bad for the patient because they would have to have these electrodes in their brain longer if they have fewer seizures, which is... Andrew Heacock: Interesting. Yeah. Yeah. less perceptible. Yeah. Jonathan Rosenthal: Exactly, which is not good. Like the goal is for them to have seizures. We don't want them to sit around with the electrodes in. Andrew Heacock: Yeah, yeah, that's interesting. I don't know almost anything about epilepsy. I've seen people have epileptic seizures. And the weirdest thing is this, there was one guy in particular I knew I was in a treatment center with him would say, okay, I'm about to have a seizure, which is a strange thing. Like he could just feel it, he knew it was coming. And I imagine that like the acceptance and commitment therapy there, like I've just been like, okay, well, it's gonna happen. And like, instead of trying to fight it or going, ⁓ no, or whatever, which I imagine might make it worse. Jonathan Rosenthal: Yeah. Andrew Heacock: like by just raising a general sense of stress, who knows? mean, that's fascinating research that we get done on that. Jonathan Rosenthal: Yeah, the aura it's called is where people can experience like a warning that they know something is gonna happen. Some people experience a physical symptom. So they'll say like, yeah, exactly. Yeah, and seizures and epilepsy really have a lot of, ⁓ know, people 200, 300 years ago really thought this was a spiritual. Andrew Heacock: That's fast. A U R A like aura. That's fascinating. Okay. Yeah. Jonathan Rosenthal: like phenomenon, like people did exorcisms believing that that would cure people of epilepsy. ⁓ And there's a lot of kind of spiritual religious overlap with epilepsy. A lot of people become hyper religious in epilepsy. ⁓ There's many, yeah, there's actually. ⁓ Andrew Heacock: Yes. Mm hmm. Is that the one that's associated with religiosity? Yeah. Yeah. Like a profound sense of religiosity. That's fascinating. Temporal lobe is really fascinating. ⁓ Also, the oracles of Delphi. Like there's speculation that that's what was going on. know that they were women. They were all young girls. Jonathan Rosenthal: Yes, exactly. Andrew Heacock: what I've heard, might actually know more about this than me, but when they wanted them to not have their, of course they're sitting on vents of methane. So it's like, just to start with air, like they're inhaling methane fumes in this cave. But, you know, they would be preselected based on their ability to have these visions and they would brought there and I think that would bring it on. But the way, if there were times, I think when the people who were in control of these young girls would want them to not have their visions for control purposes and they would fast them. ⁓ which is really fascinating because I think it's like the origin of a ketogenic diet basically came from recognizing that the oracles won't have seizures if we don't give them food. ⁓ Jonathan Rosenthal: ⁓ that is interesting. I had no idea about that. Andrew Heacock: Yeah, ketogenic diet was one of the many things I tried that sort of works. It works more than anything, but then there was still eating lots of dairy and soy, which were like the two, two of the worst things for me with my, with my disorder. ⁓ but yeah, I was very fascinated by ketogenic diet and like there are people like Chris Palmer at Harvard is using it, studying it for psychiatric disorders, which is fascinating, but, ⁓ we know about it from epilepsy. Anyway, you mentioned we were, was asking about, I think that the stuff that I know, Jonathan Rosenthal: Yeah. Andrew Heacock: I'm thinking Jon Kabat-Zinn, I think, did some of the research on EEG and meditation, and maybe that's where I'm getting the gamma. Stuff from I don't know what I haven't read it for sure But you mentioned earlier when I asked about like what was the state of research into yoga in 2014 and it's tripled by the way I should mention it's tripled since basically since 12 years ago, which is amazing But do you had found like whether these thousands of studies it kind of sounds like when you hear people now who are psychedelic researchers they came to you know, the study ten years ago or so about and There were studies but they were from like the 60s or 70s and maybe weren't all that methodologically sound ⁓ or they would just give acid to a bunch of people and see what happens and then they would write it up. I that's kind of a case report. ⁓ Yeah, which is not it means hey, maybe there's something we should study here, I guess. ⁓ And so is that kind of what you were what you were finding when you first started going through the literature? Jonathan Rosenthal: right. Yeah, exactly. There was also a lot of pilot studies, so people would just do an experiment on like, you know, 8 to 15 people, no control groups, just very limited studies like that. if there were studies that had really interesting techniques, they were like really, really small. So it was really a point where people were just trying to get funding. ⁓ And so they were doing these small studies to be like, I think there's something here, can we get funding for this? Andrew Heacock: and then they didn't maybe or, yeah. You mentioned earlier, I used the word laterality, you were talking about some of the studies, and that's something I wanted to ask you about. There is this claim about, again, it's like you'll find in the body keeps the score about PTSD and complex PTSD, that there's a result of hemispheric lateralization, ⁓ is the term that I've seen where the left and the right hemispheres stop communicating, and that that might have some effect in like interoception. ⁓ Is that something that's, we know that is grounded in science or is that just kind of an assumption that we have kind of like Pauli Wegel theory that we are what's the state of the research on that as far as you know. Jonathan Rosenthal: Yeah. So as far as I know, ⁓ laterality is a thing. The left and the right brain are different. ⁓ Sometimes I hear people say like the left brain is for boys and the right brain is for girls and I'm like, I don't know, like, what are you talking about? Like, there's so much stuff that I'm just like, this has gone way too far. But the real difference is, which I have personally seen with my own eyes from people having strokes, ⁓ is the left brain in 98 % of people is language, ⁓ and the right brain is more kind of like spatial ⁓ awareness. So, ⁓ you know, how do we know this? Well, if a person has a stroke on the left side of the brain, they will lose the ability to talk. They may lose the ability, the ability to understand language. And that is for sure, like over and over and over and over again. ⁓ On the right brain, people who have strokes there, it's a much subtler, kind of bizarre syndrome ⁓ where they... ⁓ they won't recognize the left side of their body. They don't understand that that is their body. In anything on the left side of the world, they don't. pay attention to it. They can't attend to it and so they don't perceive it. So the most extreme examples of this would be like a patient has a big stroke on the right side of their brain. I'm trying to figure out what's going on and I would take their right, their left hand and I would hold it in front of their face and I would say, whose arm is this? And they would look at it and go yours. And they would not accept that that was their arm. ⁓ So those are the really big differences between the left and the right brain. Language and kind of this ⁓ spatial attention. ⁓ Andrew Heacock: that includes like interoception too, right? Or just like awareness of your own body spatially. Jonathan Rosenthal: Correct. Correct. ⁓ And then, you know, there are subtler things. So the right brain has a bit more prosody and musicality. So the ability to ⁓ modulate the tone of the voice to express meaning, ⁓ kind of like singing and all that stuff. ⁓ those are the really big differences that I think of. And then every part of the brain is changed to orient to those. So like the left occipital lobe is kind of more geared towards reading. because it's on the language side. ⁓ The left hippocampus is geared more towards verbal memory because it's on the language side. ⁓ So that's really the big difference between the two sides. Andrew Heacock: Interesting. Interesting. So ⁓ this claim that like trauma can result or like chronic trauma can result in like the what that's called hemispheric lateralization is the term I've seen. Where like the left and the right brain stop communicating or there's a disintegration in communication. Do you know of that as a scientific phenomenon? Have you heard about this claim or? Jonathan Rosenthal: I have not heard of this claim, unfortunately, so I don't have much to say to comment on it. ⁓ There are syndromes where people have, you know, physical non-communication between the hemispheres. These are incredibly bizarre syndromes in neurology, so... They're not common and I've never seen them, I've only read about them, but one of them is called like alien hand syndrome. And so people will actually have their, well, I actually have seen alien hand. I have seen alien hand. ⁓ But the... Andrew Heacock: just gonna just click only that thing that you said and put it on the internet and tell everybody Jonathan Rosenthal believes in aliens if you're an alien. I would not do that to you, like, it's such an unfortunate sound bite. Okay, tell us more, yeah. Jonathan Rosenthal: Yeah, exactly. I know. So I got abducted by this alien. No, I'm just kidding. ⁓ The alien hand is where one hand behaves kind of independently of your intentions and of the other hand. So the classic description is like you're taking out a shirt from your closet to wear it and the other hand just grabs it and puts it back and you're like, what are you doing? I was gonna wear that. ⁓ Yeah, so that's like a very big disconnection syndrome. ⁓ Andrew Heacock: strange. Jonathan Rosenthal: Other disconnection syndromes really depend on ⁓ where the disconnection happens. So like if it happens between the occipital lobes, for example, people can lose the ability to read. It's called alexia without a graphia. ⁓ Yeah, what other? Andrew Heacock: and I'll Jonathan Rosenthal: Those are the big ones that come to my mind, but those are like physical disconnection syndromes in terms, it seems like the more psychiatric trauma related disconnection syndrome would be way less severe than that. But I'm not, haven't heard about it and I don't know what it would entail. Andrew Heacock: Right. ⁓ Yeah, I read about it in the Body Keepers, where he talks about it. And there's all the kind of footnotes and I'm sure that there are references there, I don't recall. But I just remember thinking that that was given as the biological explanation for neurobiological explanation for ⁓ like a lack of felt in the body, because there's the somatic therapy. that's out there that a lot of it is just trying to locate feeling in the body and get comfortable with it. And the thought is that that might reverse that process, I think. But there is one thing I wanted to ask you about as well. I read in this book, Waking Up by Sam Harris. Have you read that book? It's a book. It's a guide to spirituality without religion is how he calls it. He's a neuroscientist and he writes about the split brain phenomenon, which is a fascinating phenomenon. You use the word a few times bizarre. Jonathan Rosenthal: I have not. Andrew Heacock: to describe these scenarios, but can you tell us what that is? like, it comes up with people who have epilepsy. Does it not like that there's this surgery that can be done to cut the close summer? Jonathan Rosenthal: yeah, yeah. these surgeries, a corpus callosotomy, like cutting the corpus callosum the whole way in order to try to limit seizures. By the way, very rarely done. It's a very intense procedure and it's done only for people who have horrible, horrible seizures, like really, really bad. ⁓ Andrew Heacock: Yeah. Jonathan Rosenthal: and the alien hand syndrome like really would happen with that like it's a it's that kind of phenomenon and yeah so essentially it's like your perception of the two sides of the world and the control of each side of your body, you're not able to coordinate them anymore. The coordination between those is eliminated. And also your kind of like language ability is separated from another part of the world. So it's... ⁓ I think that's a very high level understanding of what it would be like, but what it feels like for the person is like, it's like, yeah, like being split. Like, like they, they have different experiences of both sides of the world. And like, I think it's even hard for them to explain it because only one side of the world has language. Andrew Heacock: Right, right. Yeah. And like if there's experience, we can divide their vision, right? And they can only see one side. And so they are like, there's this saying one hand doesn't know what's washing the other. That's literally what it's like. Like, ⁓ and you know, when I read about this and waking up, it's a really fascinating discussion. It's a chapter that he calls the riddle of the self. Because there is this idea of like, well, I mean, we do, it does feel like we have a unified self. It feels like there's only one of me talking to you right now. Jonathan Rosenthal: Exactly. Andrew Heacock: But with split brain, it's almost like their consciousness is being divided. Like their personality is being divided. again, it's so strange. You can't really access half of it because they can't that that side can't tell you or the part that's talking to you can't access the part. The other part is such a strange thing. And we've gone a little a little far from yoga. I'll bring it back. But I just these are just fascinating things to me of just like the study of the mind. ⁓ So Jonathan Rosenthal: think the best books on this are Oliver Sacks. And he's written a lot of them. But like the man who mistook his wife for a hat, he basically writes about these neurology syndromes that are rare, mostly found in textbooks. And when he would see patients with them, he would spend an enormous amount of time with them, like understanding what their experience was. And he wrote it up in his books. Andrew Heacock: Okay. Yeah, it's fascinating. The brain is a fascinating area of study, guess, obviously. ⁓ So I'll bring it back to the neuroscience of yoga then. ⁓ We've talked some, we've talked mostly about trauma or things of like that, psychiatric disorders. But more broadly, mean, what are some of the areas of application that you see with yoga or potential areas that are just out there and that maybe you're the most excited about? Jonathan Rosenthal: Right, ⁓ trauma I think is the one that gets most press. People are super interested in this topic right now. But I'm so glad you asked this question because yoga is not in the guidelines for trauma. Yet, if you looked at the teacher trainings being offered all over the place and the number of people who are studying this and super interested in this, you would think that it was like. a cure. But that's not the level of the research right now. However, there are multiple conditions where yoga is currently in medical guidelines to treat those conditions, meaning that the level of research has reached such a point that the confidence is high enough in yoga that it's literally sent out in the guidelines, like what the clinicians, the doctors, everyone reads to say like, okay, how should we treat this person's whatever. And so it's like on the list. And so what are those conditions? Back pain, neck pain, arthritis, cancer, where it's indicated for helping with mood, quality of life, pain, and ⁓ one more thing, think it's sleep. And ⁓ for migraine, it has been given a level B of evidence in my kind of... ⁓ really put out there. ⁓ And so yeah, those are the main conditions where yoga has achieved a very high level of evidence. Andrew Heacock: So I think all of them involve pain. Jonathan Rosenthal: Yeah, that is that is correct and and yoga for chronic pain is a huge movement One more thing sorry, sorry been dropping but this one's very interesting a Huge area of research right now is using yoga to one Not let people get on opioids in the first place and to help people Who have opioid addictions get off opioids? Andrew Heacock: That's interesting. That was what I would have done my doctoral research in if I'd done neuroscience. The hardest part I think is probably is adherence. It's like getting people who were in opioid withdrawal to do yoga because it's kind of controlled pain and discomfort. And they're the most notoriously pain sensitive people ever because they've desensitized themselves to it. ⁓ I just kind of had an idea from running like this isn't like there's this this trope that like runner size endorphins. ⁓ Jonathan Rosenthal: Yes. Andrew Heacock: And then it was like quickly like, it's not, then now maybe it is. But for me, I'm like, look, I've taken a little opioids because I had an issue. had an Odyssey with drug addiction for a while and I wasn't an opioid addict, but I've had them. But I was like, this is nothing like that. This is like cannabis. I like this is cannabinoids. That's what it feels like, qualitatively, feels like to be, you know, from having exercise. ⁓ But ⁓ I was like, you know, I think that the controlled discomfort, if ⁓ endorphins were associated with like, or opioids were associated with euphoria, you would expect people who are on opioids all the time to be really euphoric. And they're actually miserable all the time, like they're really dysphoric. And I was like, I think that the pain tolerance or pain intolerance and dysphoria were probably connected. And if you just would kind of build a pain tolerance, you could probably address like the dysphoria, which it seems like from knowing a lot of opioid addicts who have relapsed, it's just an incredibly common experience for them. ⁓ You know, got the flu for 40 days and like you have phantom pain everywhere. mean, it's an awful experience to go through opioid withdrawal. But I think for a lot of them, it's just the dysphoria. Like they just don't want to feel miserable any longer. And I bet that probably lasts longer than the pain and like the physical symptoms. And to me, I was like, yeah, you know, like, and in my mind, I'm like, what's some controlled discomfort or controlled pain? Yoga. That's what I'm doing when I do yoga is kind of pushing myself to the limit of like discomfort and then just kind of sitting there and letting my nervous system adjust. Anyway, your thoughts on that? Jonathan Rosenthal: Yeah, so I think In addition, know, I think that's what you're describing is like a potential mechanism and we need to prove it but the other things we know yoga improves ⁓ sleep mood ⁓ and Stress and so I think those are three other plausible mechanisms ⁓ Because a lot of you know, the the craving and trying to resist it is a very strong stress response Andrew Heacock: Mm-hmm. Jonathan Rosenthal: ⁓ And the disturbances to sleep and mood impair people's executive function and choices. And so I think all of those together are probably what are contributing to the effect that's seen where yoga helps people with these opioid addictions. Andrew Heacock: Ahem. I have an acquaintance, I met him actually at a treatment center called The Meadows in Wickenburg, Arizona. He's a fellow there and he's a physician named Kevin McCauley and he was a flight surgeon, became addicted to opioids because he had back surgery so he could fly, which is crazy that we make flight surgeons fly and then... Anyway, he says he sobered up in Fort Leavenworth, Kansas. That's where they sent him when they found out that he was addicted to back medication. And now his kind of passion is studying safety science, which we know from like flight. safety, which is fascinating. There's a science to that. But also whether addiction is a disease, like it truly fits the disease model. And I'm not a physician, but I thought he when he gave a presentation on the neurobiology of addiction, was incredibly persuasive that it's it fits this model. But he says that addiction is a disease of stress. And like you want to take a safety science approach to relapse prevention, you would do everything that you can to mitigate or avoid stress. Jonathan Rosenthal: Hmm. Andrew Heacock: and then to have tools, technologies, applications that you can do when stress comes up. And yoga is tremendously beneficial for that. And I'd known so many people who are also in recovery, who are former or recovered addicts or alcoholics that find their way to things like yoga. And I've also said there's a certain amount of congruence to it. Jonathan Rosenthal: ⁓ interesting. Yeah. Andrew Heacock: For me, it's yoga not per se but just being healthy just being a health nut like loving myself enough to be healthy It just kind of I've said like I don't think anybody has ever said, you know, I think that's cocaine for me tonight I want to make it to 5 a.m. Hot yoga like no one would say that they would say do we have enough cocaine for me to make it to 5 a.m. Hot yoga like that's what they would say and then not go but it's just very hard to keep those two things in your mind and like oh, I'm gonna you know, I'll abuse drugs and then I'm gonna go to yoga It's just, you know, kind of, forces you to have self-love. Jonathan Rosenthal: Yeah. Yeah, and there multiple programs based on the Alcoholics Anonymous 12-step system, using yoga plus a 12-step system to try to help people with addictions. ⁓ I forget what it's called, Y12SR or something like that. ⁓ Andrew Heacock: I think I've heard of that. That's actually, need to make a note. I'll make a note because that probably would be a good follow-up guess for me to reach out to. Jonathan Rosenthal: Yeah. Yeah, we had addiction as a topic for the conference in 2022, ⁓ which was really interesting. And some of my favorite papers in the area actually relate to exactly what you said, which is like the endorphin model and like believing endorphins are the mediator of like how yoga might help with pain. And there's this researcher who I think is brilliant. ⁓ I'm actually not sure where he or she is located. don't know any. All I know is their name. Yeah. Yeah. So the person's name is Fidel Zaydan. And they did this series of papers where they used ⁓ naloxone. So an opioid antagonist. And ⁓ it was all randomized and controlled. So like very high quality experiment. And they had... Andrew Heacock: know the name of the paper. Jonathan Rosenthal: meditation and yoga-based interventions that ⁓ were done. So there's a group people who did those. meditation and yoga based interventions in a group that didn't and then they were giving them painful stimuli. So like really hot metal on their legs. ⁓ And then they were measuring their pain response. And the people who do meditation and yoga before or in general don't have the same pain response. So the question was does do endorphins mediate it, right? And how would you know that? Well, if you give Naloxone, which blocks endogenous opioids and all opioids, ⁓ then the people who did the yoga and had the improvement would no longer have improvement because you blocked the receptors that make that possible, right? And that's not what they saw. So ⁓ it does not seem that endorphins are necessary or in any way mediate the pain. ⁓ response from meditation and yoga. Andrew Heacock: Right, right. Yeah, you know, it's interesting. I bet that one thing that yoga meditation would affect though is your relationship to that pain. It's like we were saying earlier, like the story you tell. And I heard this first time I heard something like this was interestingly about people who had cancer and would use cannabis and or just for any other chronic pain, but ordinarily in 10 years ago, 12 years ago, you're hearing about it for cancer. Let's say, it still hurts. Jonathan Rosenthal: Yes. Andrew Heacock: But I don't care that it hurts so much. it's I'm not so bothered. I don't have to think about it. Like I can get it out of my mind. and in my mind, think I miss meditation is a much richer way to, to live your life and to be high on cannabis all the time, although no judgments, if that's what people want to do. But I've done both. And like, ⁓ having a little bit more of a choice and a relationship to your experience, for me has been led to a much more rich experience. But I imagine it would probably take more time and more effort and more groundwork to be laying to have this afforditude to do that. But I bet it would change your relationship. Kind of like you mentioned earlier with epilepsy, yoga, meditation and acceptance and commitment therapy. And I'm like, I bet those would make any problem better. I mean, I think they'd have to, I mean, they may not make the actual underlying condition better. That's amazing. ⁓ Jonathan Rosenthal: Yeah. Andrew Heacock: I was thinking what came up for me was fibromyalgia, something I wanted to ask because it's so mysterious. I don't really know what it is, but it seems like phantom neuropathic pain. What can you tell us about that and where yoga is being studied for that? Jonathan Rosenthal: Yes. Tons. Yeah. So there's a lot of papers on yoga for fibromyalgia. It's part of the chronic pain line of research. And what's really interesting about yoga interventions, there's plenty of things that can help with pain medications and otherwise. But a lot of these syndromes, including multiple sclerosis, fibromyalgia, they have other components besides just the pain. Andrew Heacock: him. and Jonathan Rosenthal: So people with fibromyalgia experience a lot of fatigue. They have a lot of difficulty completing their tasks because of it. And so... ⁓ And not many things help with that, but that's actually one of the things that yoga is showing some promise for, fatigue associated with many of these syndromes, including MS. So yeah, I find that really interesting and exciting. And in terms of what fibromyalgia is, I don't... I don't know. ⁓ I think the answer is there's a lot of different models of how fibromyalgia might come about and how it might work. ⁓ There is another name for it that really refers to it as kind of like an inflammation of the spine. ⁓ But like, for example, we don't measure the inflammation in people's spine to diagnose them with fibromyalgia. It's really a clinical diagnosis. So yeah, I think there's a lot of ongoing work to really describe what fibromyalgia is. Andrew Heacock: Yeah, well, mean, some of the one thing I've learned from working with lots of different physicians over the years is one of the most ⁓ credibility, one of the most the greatest credibility markers a person can have is when they just say, you know, I don't know, like, ⁓ great. Okay, great. That's wonderful. That's like, you know, lot, but there's limits and like, we'll figure it out or we won't. But, know, ⁓ and it's that's where science has to start is being like we have observed there are people who reporting pain and we can't find a reason for it. I think that's basically what we're calling fibromyalgia. or it's just kind of pain everywhere. Jonathan Rosenthal: Yeah, it's, geez, I forget all of the diagnostic criteria, because I don't really see patients who have fibromyalgia anymore. ⁓ But it's. Andrew Heacock: You Jonathan Rosenthal: Let's look it up really fast. Let's just be honest. I can't have it. Because I feel like people who are listening will probably be really interested to know. Alright, trusted Wikipedia for now. Andrew Heacock: Cool. Jonathan Rosenthal: So the core features are fatigue, trouble thinking, ⁓ pain, and cramps, as well as mood changes like depression. ⁓ So no known cause. There are several proposed pathophysiologies that affects 2 to 4 % of the population, and it affects more women than men. ⁓ There are certain medications that have been shown to provide pain relief, but they don't relieve the other symptoms. ⁓ And in terms of the diagnostic criteria, generalized pain ⁓ present for more than three months. And it has to be pretty severe if you just sneezed, bless you. ⁓ And then ⁓ they cannot have any other symptoms. It's like a very loose diagnostic criteria. Correct. Andrew Heacock: The pain seems to be necessary, right? Like that's an absolute necessity, not sufficient. Jonathan Rosenthal: in as necessary. And it seems to be, it's almost like when I read this, it's kind of serving as like a working diagnosis thing. Sometimes we have these working diagnoses, which means like, okay, I think this is what's going on. Let's start treating it. And if you get better, we'll say it was that diagnosis. ⁓ Andrew Heacock: Yeah, Yeah, just kind of a placeholder. You know, I so you know, I've given you kind of like my my story. And with this podcast, I've realized I've organized into five buckets and they are like medicine, law and policy, neuroscience and psychology, spirituality and masculinity. So like, right now, basically every guest is going to check at least two or maybe three of those buckets sometimes more. But, you know, it has made a tremendous impact on me to just have a chronic condition. ⁓ And especially one where it was, I think a lot of people who may have fibromyalgia diagnosis, probably at one point had a psychiatric diagnosis before that and just found that that line of the treatments that follow from those diagnosis didn't help. Jonathan Rosenthal: Any questions? Yeah. Andrew Heacock: And it's an incredibly difficult thing to do, especially when you don't have a name for it. mean, like I have, I'm confident that food is the cause of my cognitive symptoms. And I have this dysautonomia that can kind of go with it. And like, it's weird. Like if I eat chips and queso, my HRV will go to five. Like, and so like it, that's not nothing, but I don't have a diagnosis for it yet. I'm not a hundred percent sure that autoimmune disorders are all distinct. Like I'm. I kind of have sense that much like psychiatric disorders, it might just all be one pathology with different symptoms in different places. There is a sense that, and I know I have a loved one who has a family member that has fibromyalgia and it's devastating. And I can understand a feeling like for a long time, people telling you it's not real, that you're not really having it. Like the gas lighting or medical gas lighting, they can go with it. And then even if you do have physicians who are like, believe that you're feeling this. just, I don't know why. Like I didn't figure it out. That's got to be difficult on the clinician also. Like it just being like, I don't have a way to help this. Jonathan Rosenthal: Of course. Andrew Heacock: You know, it's coming back to really one of the first things you said that jumped out at me was. that because of your yoga practice, it kind of gave you the faith, I guess you'd say, or confidence that you would be able to do the medical training. I'm in a place there now where I'm starting to consider, you know, now I'm doing well enough, maybe I can start to do graduate study again. It won't be the law. It'll be something involving religion, spirituality, or psychology, something like that. And I don't know if I can do it. Like you mentioned all the symptoms of fibromyalgia. I'm like, I have all of those except for the pain. But I also have this weird POTS thing that I have sometimes, but not all the time. like, it's like, Jonathan Rosenthal: Right. Andrew Heacock: grab bag of stuff and there's a lot of people walking around with that and you don't have like medicine just hasn't figured it out and I think that one of the reasons you know before we when we started recording you you asked about what kind of audience you might be talking to I'm sure that there are a lot of people that I've met in like what would be called a consciousness community where they're very interested in yoga but they might also be interested in crystals or plant medicines or just ⁓ ecstatic dance is something I've done. Like kirtan is all, yoga is such an incredibly broad and diverse tradition. Maybe just singing mantra is a way to go about it. And so many of the people I meet, they almost all have their own intractable medical condition and this sense of grief that comes with it. And this angst and frustration and of not being believed. Jonathan Rosenthal: Yeah. Andrew Heacock: And it's been a very difficult thing for me because it after a while it'll make you crazy You know, even if you want to begin with you know crazy is not to pathologize it But like it's so frustrating that after a while you you develop psychiatric problems because it's like shit Something has been wrong with my body all this time and no one believes me and then you get you know You become disordered because of it Yoga to me. It's like changing your relationship to your body Changing your relationship to your pain to your mind Jonathan Rosenthal: Yeah, yeah, yeah. Yes. Andrew Heacock: to what's going on without you and you've got like this, the storm in the, like the quiet in the storm instead of the opposite. And that interoception, there's almost something mystical about interoception. mean, it literally means insight, right? Like to see within, does it not? Or to believe within. Yeah, so ⁓ that's where, you know, I think that anybody who's made it this far into this podcast, we're wrapping them out, but. Jonathan Rosenthal: Yeah, it's making internal perception, yeah. Andrew Heacock: I think a lot of those people that will make it this far are going to have something like that autobiographically. If like, this is why it's almost like their own form of self care, if not healthcare. And ⁓ there is hopefully very very little risk or downside with yoga. If you're properly instructed, I know you've mentioned there's some very rare injuries and we should be able to avoid that. But ⁓ it, to me, what the work that you're doing. of just trying to, not trying to, of legitimizing the science, bringing more legitimacy to it, more attention to it, more study to it, bringing the best minds together. It's such important work, man, because ⁓ when you have these things like chronic conditions, ⁓ conventional medicine with a disease model isn't very good with that if we haven't identified the actual disease process, you know, or know how to fix it. And so what does one do with that problem? yoga or meditation or spirituality in general, if I can use that term. Man, they just help. They just have offered a lot of people a lot of comfort and bring people to the floor. So I just want to say thank you. for your time, for talking with me, and for organizing this conference. ⁓ The materials are amazing. Anybody that, we're gonna drop a link in there, in the description here. Anybody that is interested in this, I definitely encourage you to sign up because it's so fascinating and exciting. ⁓ And so I would just ask, is there anything else that you'd like to share with us, just about yourself, or this conversation, or the conference, or anything else you'd like our viewers to know? Jonathan Rosenthal: Well, likewise, thank you for I think this conversation is like a real testament to how open and honest you are about like your experiences and things that you've been through and how you're I think people will listen to this and be helped by it. And you're doing that so much with this podcast. So thank you. And yeah, and the like. Andrew Heacock: Thank you. Thank you. That means a lot. Jonathan Rosenthal: I think for anyone who does have the experience of having a chronic condition and kind of being dismissed by... ⁓ individuals within the medical system, I think don't think that you're dismissed by the whole medical system. Like some diseases notoriously take a very long time to get diagnosed and it's just it's unfortunate and it sucks but it's like it's not a reason to give up or like turn away. ⁓ And yeah I think I think the use of yoga is incredible. I think we need to get more people to prescribe and talk about yoga. and also still recognize the limits of yoga as not a cure. But as a component of someone's treatment plan and how they self-regulate and feel good and live a productive, happy life, I think it's definitely, it has like way more room to grow, to fill that role. ⁓ Yeah, I think the knowledge is great, but doing something with it is even better. even the Bhagavad Gita says like imperfect action is better. You know, your own imperfect action is better than the perfect action of someone else. So I think like... keeping on moving forward even when you're struggling is really important and it's how all the progress in the world is made and the greatest insights come from suffering, I think. Andrew Heacock: Thank you very much. Tell us again one more time, when is the upcoming conference and where do people go to find out about it? Jonathan Rosenthal: So it's March 19th to the 22nd. The website is neuroyoganyc.com. But if you just search neuroscience and yoga conference, I think at this point it should come up. ⁓ its registration will probably open February 8th. So if anyone is hearing this before then, you may have to wait a little bit. Registration is free. The topics this year are yoga and migraine and headache, ⁓ yoga and schools and neurodiversity. which will include ADHD and autism, and then also yoga and brain longevity, which will really be looking at the literature on dementias and cognition as people age. So yeah, those are the topics and for anyone who... is looking for continuing education credits or more in-depth experiences out of the conference. We have upgrade options available for that. And it's a great community. It's really fun. even if you can't make the conference live, hopefully we'll see you during the encore of the conference. It runs year-round. And yeah, it's my passion project. Andrew Heacock: Wonderful. That's a cool passion to have, man. Those are three really cool topics and ⁓ all really fascinating for this year. And yeah, I'm here to see what we have to present. All right. Thank you very much. Yeah, me too, Jonathan Rosenthal: Cool. Thanks again, Andrew. Really appreciate it.