Healing the Physiological Effects of Trauma

Please note: this podcast episode discusses examples of psychological trauma, including physical and emotional mistreatment, that may be uncomfortable for some listeners. Kalea Wattles, ND, IFMCP: Emotional and psychological trauma impact more than just a patient's mental health. Several studies demonstrate that the experience of emotional trauma can have tangible physiological impacts, including modulating the composition of the gut microbiome, altering brain plasticity, and contributing to chronic pain. Trauma presents with several biological, psychological, and social factors that can impact a patient's health throughout the lifespan. Aimie K. Apigian: And so we're seeing all of these downstream effects on a person's physical health, including all of these chronic health conditions from these emotional truths that we hold because of our prior life experiences. Kalea Wattles: On this episode of Pathways to Well-Being, AIC 2025 presenter Dr. Amy Apigian will discuss physiological disruptions that may be rooted in past trauma and explore the systems involved in the body's response. Welcome to the show, Dr. Apigian! Aimie K. Apigian: Thank you so much. It's so good to be here. Kalea Wattles: Well, this conversation about mind and the mind-body connection is so powerful, and I'm really excited to learn more from our conversation today. I know that you have such passion for this topic, and I think we know intuitively that trauma affects us all to varying degrees. So to start, can you tell us a little bit about your story and how you came to work in this area specifically? Aimie K. Apigian: Yeah, it's quite the story because I did not ever imagine that this would be my life and my career. I was actually headed towards a very, what I thought was a normal medical career. And when I started medical school, I was also a researcher. So I was also doing research in biochemistry, and it was just after finishing my master's in biochemistry, I had a few months free before jumping back into the third year of medical school. And I did something that changed my life. I foster parented. And at the time, it was just with that intention of foster parenting, it was never the intention to adopt. And one day the phone call arrived, and they had a four-year-old, and he had been born to a teenage mom. She had just barely emancipated from the foster care system herself. And he had been in the system since age nine months old, and he needed a home. And it was an immediate yes for me. And bringing him in, I thought I had everything figured out. I had the stable routine, I had the healthy nutrition. I ensured that we had all of this bonding and attachment tools around us. So I bought the perfect rocking chair, and I thought that I knew what he needed in order to overcome his childhood past. And I didn't even question the fact that he just needed time and stability, and of course, my love. And several months into it, I realized that that was not what he needed. I didn't know what he needed, but that was not going to be enough. It became clear that he was bringing his trauma with him and that it was literally driving his body. He would go into rages at the smallest trigger. I would tell him no, that he couldn't play with his toys right now because we needed to go to the store. And just me telling him no, he would break down, fall apart. And these weren't just temper tantrums. These would be hour-long rages where I was peed on, kicked, bit, slapped, punched. And this became, then, my life. And yes, I did decide to adopt, not because I thought that I was the best choice for a little boy who was filled with so much trauma but because I saw that I was his best chance, perhaps his only chance, of getting out of the foster care system. Unfortunately, the reality is that it is a system that only compounds and creates more pain of abandonment. And once I made that decision, I threw myself into trying to find answers and solutions for him. And here I am on a medical school campus, so I have resources. I've got the best therapists and psychiatrists, and I'm going to all the different things. I'm putting all of my money and time that I can into helping him, and nothing is working. And that was what prompted me to then really do a deep dive into what is trauma then, what am I missing? What do I not understand that I am not able to give him what he needs to heal and overcome his past? And I did figure it all out. It took six long years, six very, very long years, if you can imagine that being your home life. And it was all worth it when at the end of these six years, and I take him to this last therapy that we go to, and we're walking down a road, and for the first time, he reaches out to hold my hand. And I look down, and he's looking into my eyes with love, with kindness, with life. They had just been void before. And he says, "Thank you. Thank you, Mom." Just, “Thank you, Mom. I love you." And that totally transformed my whole view then of what I thought I knew about trauma, and what ended being the result was, I now could see that so many of my patients who were coming in with chronic health conditions were also struggling with some of these same emotional insecurities that I was seeing in Miguel. The need, the survival need to guard my heart, the need to people please, or the, I mean, so many women that I would see had become caretakers and were literally killing themselves in order to help other people. And it all came down to this root insecurity of, I don't feel lovable just being myself. I feel like I have to perform, I have to do, I have to be worth something. I have to be meeting someone else's needs to be worthy of attention, worthy of belonging, worthy of love. And I realized how much of chronic health has this, not just emotional component but trauma component that gets wired into the nervous system, creates this baseline dysregulation. And over the subsequent years, being able to see just how much, and the mechanism by which that trauma in our earlier life that would've instilled in us, I'm not lovable, I'm not enough, actually creates disease in our body as adults. Kalea Wattles: Wow. I just have to like take a pause for a moment and acknowledge what a powerful and compelling origin story you've had. And in the functional medicine model, we really focus on what we call the center of the matrix, which is our mental, emotional, spiritual health. And part of that is helping our patients and ourselves find a sense of meaning and purpose. And as I'm listening to your story, it makes so much sense to me how you would've found meaning and purpose in this work, and watching it transform your son, I mean I had chills the whole time. It's really powerful. Aimie K. Apigian: It was quite powerful, and that's why it changed my life. I actually went into surgery residency after medical school, and I did four years of general surgery, which taught me a lot about the body, ultimately taught me a lot about trauma and stress to the body and why the body holds onto those things. But then I realized that that was not what would give me meaning. And what I really wanted to do was to be able to bring this trauma conversation to functional medicine, to the chronic health table where we're struggling to find all of the pieces and the right pieces. I went to Loma Linda University for medical school, where it's known for its more integrative and holistic model. They have their kind of their phrase of, you know, whole person care. So I feel very privileged that that was my medical training because I know that many other professionals, practitioners did not get that holistic training. And yet what I was taught, even in that holistic center, was that we address the emotional component, we bring it into the conversation, but then what do we do about it? I was still left with recommending, well, you should probably go talk to someone about that. You should probably go to therapy about that. And actually, that is not the answer. But I wouldn't have known that if I didn't have this experience with my son and realizing that no, actually going to therapy where we talk about a story is not the answer. In fact, it can make our physical health conditions worse because our body has this memory of those events, or those situations, or even our childhood. And by talking about it, we bring it up, but we need to have the resolution for it. And that was the piece that was missing for Miguel, and then ultimately, I found that was the piece missing for me as well. And so once I found that out, it was like this is what I want to bring to my patients. I no longer am finding meaning in writing a prescription for a medication. That prescription for a medication needs to come with a prescription for somatic practices, for example. It needs to come with a prescription for let's spend some time and really get to know this younger part of you that went through that experience, so that the prescription now that I wanted to give people was something that was going to actually change their core, not just the downstream symptom of their stored trauma. Kalea Wattles: Well, I imagine all the clinicians who are listening right now are feeling motivated to help recognize patterns or try to find a good candidate for doing this type of work in making these recommendations. Would you talk to us a little bit about how trauma might show up in our physiology, or at a cellular level so that we can start to kind of look for these patterns in the patients that we're seeing? Aimie K. Apigian: Yes, and it's so fascinating what you're kind of digging into, which is really the difference between stress in the body and trauma in the body. And so often what we find practitioners still doing is talking to their patients about stress management, and actually, what we're dealing with is trauma, not stress. Stress management is not going to work when it is stored trauma in the body. So being able to recognize the patterns, like you said, the patterns, there are patterns that come from stress and then there are patterns that come from trauma. And being clear on the difference allows us to be more strategic about what are those practices, what are those practitioners that I want to resource my patient with, because I know what the problem is. So in short, let me just say that the difference between stress physiology and trauma physiology in the body is that stress physiology is driven by adrenaline. And adrenaline is that hormone that moves us to action. When you think of what people do when they are filled with adrenaline, they do the superhuman things that they would normally not be able to do. I think of even an example where a mom lifts a car off of her child who's pinned underneath. That is only adrenaline. That is the stress response. But our body is designed to respond with incredible strength to different challenges that come our way. That is a stress response. It's taking our metabolism, taking our physiology, and saying we're going to push it to the limit with what we can do with energy production. Our mitochondria get upregulated, which means that our thyroid is being utilized in order to help upregulate that mitochondria. The adrenaline actually is also making changes within the cell so that it forces the mitochondria to switch to the fast-acting energy production mechanism, because now is not the time to be burning fats for fuels, for example. That is great when we're in parasympathetic, but not when we are in stress. When we are in stress, we need the fast energy, which means glucose. So there's all these changes that happen in our physiology to be able to do superhuman responses to a danger or a challenge in front of us. That is stress. But there comes a point where that stress may turn into a trauma. It doesn't have to, but it may. And that's what I wanted to study. I wanted to figure out, what was that difference? What was the line that was being crossed that now would make the body go into a different type of response? And the effects of that would last, not just a temporary response like, oh, my heart's beating fast, but now I'm going to get a lasting impact on the biology in the form of cellular damage as a result of this trauma response. And after reviewing all of the descriptions that people would tell me, and being able to observe them, it was clear that there is a line, and it's really a line that overwhelms the system. And by the system, I really mean the whole body system now. So that if we are responding to a danger, there's only a certain degree that we can respond. We only have so much resources. We only have so much nutrients. We only have so much magnesium, for example. We only have so much ability to upregulate our mitochondria and our energy production. If the danger feels like it's bigger than what we have the capacity to respond to, that is when our body crosses the line. And it's actually a feature of our nervous system. It's called neuroception, comes from the polyvagal theory by Dr. Steve Porges. And our nervous system is making that decision, which is why it's not based on reality, it is based on our perception of reality. And so this is when we can have a trauma response when we're having a conversation with someone because even though we're not in physical danger of our life, our body taps into our attachment wounds and insecurities, just like my son. Those attachment wounds stay with us, and they inform us that if this person does not like us, then we would not survive, because we will be abandoned, because we will be all alone. And then we'd have to figure out life alone. So there's all these beliefs and concepts and constructs that our nervous system has in place already that inform it, how big is this danger compared to my capacity to respond? And so whether it's a real capacity difference or whether it's a perceived capacity difference, the end result is the same. And our body shifts operating modes. So that we go from saying, well, what I need to do to survive right now is I need to respond, I need to take action, and I need energy to do that. That is the operating mode for surviving stress. But if there's nothing that we can do, if the danger in front of us is too big for us, our nervous system says our best strategy for survival is not to respond, but it's actually to shut down. In the trauma world, we use the word freeze, the freeze response to describe that. And the freeze is a very specific moment in time in which our physiology is at a unique place that it does not exist at any other time. We have two operating modes at the same time as it transitions from stress to shutdown. And so going from stress, it's like having our foot on the accelerator in the car. We are pedal to the metal. We are all the way trying to respond and overcome by taking action. And the moment that our nervous system, again, that neuroception makes the decision, ooh, this is too big for us. We're not going to survive this by responding to it. Instead we should paralyze, we should stop taking action and instead we should conserve our energy. But in that moment of time for this freeze response, our foot is still on the accelerator. Our sympathetic nervous system is still pumping out adrenaline, but we have just pulled on the emergency brake. And so that adrenaline is no longer effective. If you were to take a blood sample, there'd be lots of adrenaline, but it's not actually doing anything because our nervous system has said, no, we need to shut down, and this is how we shut down. We make it ineffective, we block, and that communication is actually coming down the vagus nerve. The message for our body to shut down is coming from our vagus nerve, the same nerve that also communicates the rest and digest and the parasympathetic and the social engagement. It's the same nerve. I think of it as the nerve is just the train tracks. And so it depends on which train is going down the train tracks. Is it the parasympathetic train that tells us that we're safe, that we're secure, that it's time to digest our food, that it's time to connect with other people? Or is it the other train that's going down the train tracks, the train that will tell our body, we're not only in danger, we are faced with an inescapable life threat. We can't believe what's happening. It feels so awful, it feels unbearable, and it's all so overwhelming. When that is the situation that we feel, then the other train goes down the train tracks and initiates the freeze and then the shutdown. So that then the shutdown really is that full on trauma response, and that's what starts to have…be embedded into the body and get stored there. And so we have certain conditions that are very much associated with the shutdown response, not the stress response. When we are in shutdown, that will look like adrenal fatigue. And it may not be that anything is wrong with the adrenal glands, it's just that the body has crossed a critical line and says we need to shut down to survive, which means shutting down the adrenal glands, because it's pointless to keep producing adrenaline. It's pointless to keep producing cortisol. Instead, we're switching our strategy to survive this moment in our life. I know that I've just given you a lot, so I'm going to pause there and see what questions come up. Kalea Wattles: I mean, it's really fascinating. It almost… this shutdown phase almost sounds to me like adrenaline resistance. I've never thought about that before, but that's almost what it sounds like to me. Aimie K. Apigian: It very much is, because there is this, I mean there is an incredible ability of our body to survive even the worst of situations. And looking at the world history, we've had a lot of terrible situations that people survived. The body has a drive to survive. I even saw this, again, in especially in my surgical residency where so many patients were on that edge of life or death, life or death in the ICU, and to watch their body fight to stay alive. The body has an incredible ability to adapt and utilize a strategy that will help it survive in that moment. And the shutdown is a very effective survival strategy. Again, when I can look at the situation that I'm in and come to the conclusion that there's nothing else that I can do, there's nothing else that I can do. We are generally people of action. We want to be able to do something. But if there's nothing else I can do… In my book, I call this hitting the wall, where if we were in an alley, and a dog were chasing us, and we're running, and we're trying everything, and then we come to a wall. And the wall is so big and so thick that there's nothing that we can do anymore. At that point, my survival strategy changes. It's no longer going to be to keep running because I can't run anywhere. And so the survival strategy changes when we feel that the danger in front of us is so big that we've hit a wall. And when we hit that wall, whether that's actually a physical wall, like being trapped in a car accident, for example, being trapped and I can't physically get out, that would be a form of version of hitting the wall. But so many of the walls that we hit are emotional. So many of the walls that we hit are emotional, where it goes back to my attachment style and my attachment insecurities that inform me that I need to be very afraid of being abandoned. I need to be very afraid of not being lovable. I need to be very afraid that I have to be perfect, which means that when I make a mistake, guess what my body is going to do? You made a mistake, you're going to die. And the response to you're going to die is to shut down in order to conserve energy. And literally we see this happening. The research coming out of Bob Naviaux's research in San Diego University where it's the cell danger response. Literally, when that is the message coming from our vagus nerve that we need to shut down because we think we might die, it actually changes our mitochondria, and it changes our whole cellular structure. So when we are in the stress response, you can see it in a microscope, the mitochondria, it's like they hunker down. And they're like, we got this. We're going to give it our best. And they do. They do their best. But when we cross that line, or when we hit that wall, and we literally think, I'm going to die, our mitochondria also shut down and fall apart because no longer do we want to make energy. The deeper strategy for this is quite fascinating, is that from a standpoint of being detected by a threat, say if a monster were chasing us, or if we were out in the wild, there's a lion that's chasing us. If I can shut down my metabolism, and I can make my body go colder. If I can shut down my breath so that my chest is not moving and there's not the breath sounds that I would be making, I am more likely to survive because they don't detect me. Out in the wild, they detect things by warmth, by smell, by sound. And so that is another way in which this shutdown becomes a very elementary survival strategy where our body says, I need to shut down my metabolism. I'm literally going to have my mitochondria fall apart. And all of these proteins start to travel, not only to our nucleus to signal we're shutting down, stop making those proteins and instead make these proteins. But those proteins from the mitochondria also go to the extracellular matrix, and they signal to the other cells in the area, it's time to shut down. It's time to shut down. We think we might die. Again, I'll just finish with this because what's so fascinating about this is that that message of, I think I might die is more often than not an emotional belief and thought and feeling, not actually something that's real. But for us as human beings, those emotions are so real. The beliefs that we form about ourselves are so real that our body says that this is real. And our body says, if I just made a mistake, or if my friend no longer likes me, or if I'm not needed because I'm not useful and I'm not productive enough, and I'm actually taking a break and resting, the message that we believe to be true is I might die. And so we're seeing all of these downstream effects on a person's physical health, including all of these chronic health conditions from these emotional truths that we hold because of our prior life experiences. Kalea Wattles: One of the major questions that's coming up for me is what factors influence when or how someone crosses that line between “this is stressful” and “this is traumatic.” And you mentioned you spent some time investigating that, and this feels like an appropriate time to bring social determinants of health into the conversation. Because I can imagine that all of those factors that lead to you feeling safe, whether your basic needs are met or not, are going to influence that emotional response that you have of, okay, this is stressful, or I am actually going to die? Will you tell us a little bit about how we should factor in, or assess, or account for some of these social determinants? Aimie K. Apigian: Yes, and it's fascinating to be able to take the social determinants and translate them into physiology and biology. Because typically we see them as two separate things. The environment in which you live and then your actual physical health. And even being able to see, well, yes, but you know your social determinants, like your social support and community, well that's, I mean, that influences your health, but not to the degree of what are you putting in your mouth? What food are you eating? And this is where that gets challenged because, wait a second, if what is driving my physiology is the perception of my nervous system of how safe am I, or what is the degree of danger that I am in? Then it's the state of my nervous system that is even more important than what I'm putting in my mouth. And that is where we look at what are all the factors that influence the state of my nervous system? Because it is going to be everything. It is going to be, how much support do I feel like I have in my life? We know that when we go through something stressful, if we feel that we have someone's support, if someone has our back, if someone is holding our hand, someone is standing side by side with us, we are able to respond to that stress and not get overwhelmed like we would if we were all alone. It's when we feel all alone that something that would normally just be a stress now becomes unbelievable, unbearable, and overwhelming. It becomes a trauma response. And so we look at, well then, how do social determinants influence one's perception of how resourced they are? It is true that the more money that a person has, the more they might feel that they are able to respond to a stress than to someone who has limited financial resources. A stress comes into their life, and they might be overwhelmed by it because they're looking at their bank account and saying, there's no way I can pay for this, and if I can't pay for this, again, here's where the nervous system then makes its logic. If I can't pay for this, I'm going to get kicked out of my house. If I'm kicked out of my house, all of my friends are going to leave me. If all of my friends are going to leave me, I'm going to die alone on the streets. I might die because there's a roof leak in my house, and I don't have the finances to repair it. But we see how, again, like the mind can say it's just a leak in the roof, but our body and our nervous system say, hmm, but what does that mean? What is the significance of that? And if the significance is I might be all alone, I might be opened to shame, to public ridicule, I might die. And we go into a shutdown. So at the end of the day, there are two factors that make a person cross the critical line of overwhelm and make something that would be a stress actually become a trauma for their body. And those two factors are feeling that something is too much, too fast, or too little for too long. Too much, too fast would be an example of everything is just happening too fast, and I don't have the time to actually breathe. I don't have the time to process what is happening here. It's just happening too much, too fast. And that can happen within 30 seconds, like an oncoming car, for example. It's actually the first patient story that I share in my book, because Elena, she's in a car accident, and the car that's coming towards her is just happening too much, too fast. She's not able to turn her car to get out of the way. And that's when she goes into the shutdown. She freezes as she's watching this car come towards her and hit her. So it can happen within a few seconds, but it can also happen over a period of time. We can have multiple losses or change that happens in our life over a month's period. And if it were only one thing, we might be okay, we might be able to get through it. But no, it was this thing, and then it was this thing, and then it was this thing, and then it was this thing. And it's all too much, too fast. That will, again, create the scenario where our sense of capacity is so small compared to the size of the danger that we see. If it were just one thing, I have the capacity for responding to one thing, but it's when it's multiple things, and my capacity is now stretched too thin, and I just don't have the capacity to respond. Too much, too fast. But the other reason that is very common in my patients with chronic health conditions is also the other reason. Too little for too long. Now we can look at one's childhood and see examples of too little for too long. When babies are not held enough, it's too little of touch for just too long. Or if there's neglect, it was just too little attention to the basic needs. Whether that was food, water, diaper changes, it's too little and for too long. There's, you know, all kinds of ways around responding to a baby's needs. A baby can cry and it's going to be fine. But what if that crying goes on and on and on because now it's just for too long. No one ever comes. At some point that baby is going to change its strategy for survival. Obviously crying out for help is not working. That's the stress response. Crying out is a stress response. And eventually, and we see this in orphanages, we see this. We see this, they shut down. They've given up even trying to do something because it's been too little for just too long. And that happens in many childhoods, even where someone does not think that they've had trauma, because our parents have their own generational trauma, they have their own patterns. And so parents can be very busy these days, busy with work. But now that we have screens and cell phones, it's very easy to miss those times of connection with a child, and it just be too little connection for too long. And so even if someone doesn't think that they had trauma in their childhood, we're not talking about that. We're talking about just that felt experience of, you didn't get enough of what you needed, and it instilled something in your body that you're still operating from a place of feeling deficient. Feeling like, I don't know if I have enough. I don't know if I am enough. And that deficiency then compounds with other things in life. So that again, my patients with chronic health conditions, at that point, they're usually working with both. It's both been too little for too long, sometimes all the way back to their childhood, but also too much too fast. And it's been compounded over time. And you know, I mean there's the whole science around why and how the body holds on to pain, fear, and overwhelm from our past. And a lot of it is this whole concept of the biology of trauma because it does become our biology. And part of the biology that it creates, which then perpetuates these trauma responses is nutritional deficiencies. And our body can have been in so much stress that it's now depleted in magnesium. It has been through so much stress that now it's depleted in zinc and B6, which means that you're coming into a situation already being maxed out in your capacity. Your body, your cells, your mitochondria are already doing their best. They don't have any extra level to give you. But what happens when you need that extra level? What happens when that phone call comes, and someone close to you has just died or passed away or is hurt, and there's a real danger, and you have to respond. If your cells are already operating at their best because of the nutritional deficiencies that you have, you're less likely to be able to respond with upregulating energy production. And instead your body, your nervous system is going to do a good assessment and say, we don't have what it takes to take you to the next level. Instead, we're going to make you feel that it's too much. We're going to make you feel that it's overwhelming so that you don't take action because if you did, you would compromise your life. We call this homeostatic capacity in functional medicine, right? The homeostatic capacity of our physiology and our nervous system, its job is to protect that. And it will make decisions to shut down when our mind tells us we should take action but our nervous system is collecting information from our cells, from our nucleus, from our mitochondria. And it can sense, but you don't have enough of what it takes to respond. So I'm going to protect you, and I'm going to shut down. And this is so much of chronic health conditions. Chronic health conditions are a form of the body saying no more, I can't do anymore. I'm shutting down to protect you because otherwise you would probably still be trying to go out and do things and to overcome problems in your life. And we don't have what it takes. So I'm going to shut down to protect you, even if that looks like a chronic health condition. Kalea Wattles: I'm visualizing the implications of trauma through all of these body systems. And it's certainly so important as we think about chronic disease and the rise of chronic disease and all of this unaddressed trauma. I know you'll be taking a deep dive into this at the Annual International Conference. And without giving too much away, will you just give us a very brief little sneak peek of what our attendees can expect to hear from your AIC presentation? Aimie K. Apigian: Yes, I'm really excited to share with them. I'm going to be going into the five steps that the body takes when it experiences a trauma. And there are five specific steps, and that's it. Like these are the five steps. If a body is going to experience a trauma, these are the five steps that it takes. And when we can understand that, it not only helps make us better practitioners to better address the chronic health conditions that we're seeing, but we can also notice a person sitting in front of us right now, whether that's in person or on Zoom, what step are they at right now? Because so many of the people coming to us are so beaten down, are so broken down, they've been through so many other practitioners that they're already in shutdown, and we are unintentionally overwhelming them with more information, more protocols, more treatment plans than what they can realistically take in right now, cause they're already in shutdown. So being able to recognize, these are the five steps of the body's trauma response, what step are they at, how would you recognize each of those steps? And then I will be going into a lot more solutions for knowing that the body holds onto these trauma experiences. What does that mean for us as practitioners to give them the right prescription for if their body is holding trauma, not just stress? Kalea Wattles: Well, Dr. Amy, it's clear to me that the work you're doing is so critically important, and so well-suited for the functional medicine model where the mental, emotional, spiritual considerations are really at the heart of what we do. So I wanted to thank you so much for your time today for sharing your insights and your personal story, which was so powerful, and we can't wait to see your presentation at the Annual International Conference. Thank you so much. Aimie K. Apigian: Thank you so much. I'm really looking forward to it. Kalea Wattles [Voice over]: Discover the latest research and innovative clinical practices at IFM's Annual International Conference. For more information, visit aic.ifm.org. The future is functional.