Season 7, Episode 2: Battling Addiction with Functional Genetics and Lab Testing with Dr. Sam Shay

Evelyne: Good to see you, too. It’s been a long time. I’m excited to talk to Sam today. He’s a functional medicine expert who has dedicated his career to understanding addiction, brain health, and personalized recovery strategies. We’ll talk about the neurobiology of addiction, the role of functional genetics, and how lab testing can provide deeper insights.

We’ll talk about Sam’s 5-phase model of addiction and looking at this through a functional medicine lens. And maybe you’re thinking, well, I don’t work with people who have alcohol use disorder or drug addiction, but maybe if patients or clients who are addicted to social media, or workaholics, or who are addicted to food. So, stay tuned. You’ll get valuable tips on clinical applications, testing and treatment strategies.

And Sam, before we start, what’s lighting you up this week?

Dr. Sam Shay: Well, I’m also a stand-up comic. And next, in two weeks, I’m going to be performing a show in which ten of the minutes I’m performing is talking about addiction, through stand up, through the lens of stand-up comedy.

Evelyne: Love that. That’s awesome. Very cool. And you’re in Colorado, right?

Dr. Sam Shay: Mmm-hmmm.

Evelyne: Awesome. Now, before we dive in further, just a little background. Dr. Sam Shay solves health puzzles for busy, health-conscious parents, entrepreneurs and professionals, women and adults on the spectrum so they can exit survival mode and reenter community by improving resilience, energy and brain health through personalized, data driven genetics and lab testing.

He has an extensive and broad academic and clinical background, including three bachelor’s degrees, a Doctorate in Chiropractic, Post Graduate Diploma in Acupuncture, eight years as a functional neurologist with the Carrick Institute before switching full time to virtual practice in functional medicine. He is certified with the Institute for Functional Medicine and studied with Doctor Kailash of the Kailash Institute for four years. Additionally, he has studied nutrition for over 25 years and has an extensive background in mind body medicine.

So, Sam, I’m curious how did you get into this field? What’s your personal story?

Dr. Sam Shay: Well, I got into medicine, I got into health the same way I got into comedy through tragedy. It started both, actually, when I was about six years old, when both my parents went through a nuclear divorce in which both me and my sisters were caught in the blast radius.

The divorce was so bad that one of my sisters ended up in the hospital with a bleeding stress ulcer. Another sister left the country, and another sister went off in another direction as well. So, I dealt with it by coping with an eating disorder, mostly involving sugar, also overeating. And then also I drowned myself in screens, especially video games when I discovered them.

And the divorce was pretty horrible. I don’t need to go into the details. Let’s just say both my parents handled it exactly the wrong way. On top of that, there was a lot of violence and hypocrisy at school in which no one protected me. Or held the moral flag that they were talking about but doing nothing about it.

So, I retreated into screens and sugar and in screens, it was primarily escapism through video games and then studying human behavior through watching comedy shows. I have Asperger’s syndrome. I didn’t find this out until six years ago. Those of you who are listening to this who knew me back in chiropractic school will be chuckling like, oh yeah, that maps. Yeah. Of course it does.

And I actually did a one-hour comedy show called “NeuroSpicy: Love, Life and Comedy on the Spectrum”, which is a full one-hour show available for free on YouTube. About what it’s like to have Asperger’s syndrome. And the connection is that, as someone with Asperger’s, I wasn’t born with social software, and that further perpetuated the difficulties at school and what was happening at home, because I didn’t understand what was going on.

So I looked to comedy shows like Family Members, Full House, Cosby Show, obviously, before we knew anything better, before we knew better about Bill’s behavior off camera, and I, unfortunately did have enough self-awareness to know that Married With Children was an ironic inversion of what a healthy family should be. Simpsons was kind of that hybrid between healthy and distinctly unhealthy family dynamics, and I found that screens and comedy were the only things that gave me some sort of sense of fulfillment when everything in the analog world was not.

And I was very, very sick, starting at age six with crippling insomnia to the point where it stunted my growth, and I was exhausted. I also got Lyme disease. I didn’t realize it so much later of going to summer camp in Maine for nine summers, and I also was deeply anxious, had a lot of depression and a lot of chronic pain from the injuries sustained at school and really bad digestive problems as well.

And my medical doctor parents, in the 80s, didn’t know anything about health and just thought I was attention seeking and told me I was making it all up and wanted to medicate me into submission. And in high school, I decided to take control of my own health. And this is on top of the fact that they were feeding me a low fat, high carb, high gluten, high dairy diet because they determined and this is true at age seven, that my cholesterol was too high at age seven.

And probably another reason my growth got stunted, and I just took control of my life, of my health when I was a teenager because I realized my family and the pharmaceutical heavy, top-heavy farm system that I was being thrust into was not working.

So, I was supposed to be a third-generation medical doctor. My grandfather was the founding director of the Fels Cancer Research Center, Temple University in 1937, and he published over 300 research articles, and including he was the developer of chemo oncogenic breast cancer models in mice, which was the basis of a ton of research in the field of cancer. And my father is also famous. Both my parents are doctors. My father published two books on PTSD and moral injury. His work is good, his parenting was less so.

I was supposed to be a third-generation medical doctor, but I just took the hard pivot into natural medicine instead. And, then I went through this very long, circuitous journey through all sorts of fields of natural medicine and, over time, I overcame the video game addiction and the sugar addiction and developed a very specific model to explain the super structure of addiction as such, of which you can plug in video games, sugar, alcohol, shopping, sex, gambling, doom-scrolling, exercise, whatever it might be, whatever vice of choice may be.

The model will explain any of them and also fill in the gaps of existing addiction models and then help seemingly warring addiction models were fighting with each other over dominance actually helps see where they fill in the missing gaps of each other. So, the intention of the model is to act as an umbrella model, in which all of the different models can now start working together under one coherent system.

And that’s my goal. That’s my long-term play. It’s a 50-year play, but it’s my long-term play is to change the way the world sees addiction. And it’s going to be a bit of a journey, but it’s things like this that help move that forward.

Evelyne: Thank you so much for sharing your story. And I’d love to dive deeper into that model. So, can you tell us what do you see as the five phases of addiction?

Dr. Sam Shay: I’d like to start with what addiction is first. So, there’s addiction. There’s a wonderful book called It’s Not Okay to Be a Cannibal. And that may sound like a very strange thing to start with, but it’s an incredible book by Poznanovich and Wainwright, and they redefine the term addiction as cannibalism.

And the reason why is because mere use of the thing does not an addiction the addict make. It’s are you consuming and destroying yourself and your environment and the people around you in the name of that thing? That’s addiction. So, they’re reframing the term addiction into cannibalism in a way that actually makes a lot more sense and also more optimistic because we got rid of cannibalism.

If you understand addiction as destruction of yourself and those around you in the name of this thing, as opposed to just use of the thing, then addiction makes a lot more sense. And there are specific signs of addiction. So, for example, there’s using it to anesthetize or numb out. There’s not trying to stop and not being able to stop.

There’s continuing despite problems. There’s preferring lot of these over other things. There’s nine signs by the APA that define addiction and it’s more of looking at what are the consequences of the addiction to actually know if you’re in an addictive state. So, there’s preoccupation when you’re thinking or planning about it, there’s withdrawal, which is that there are side effects if you stop. There’s tolerance that you need more and more. You’re trying to reduce and stop, but you can’t. Giving up other activities in the name of it, continuing despite physical problems. Deception, covering up like hiding or lying about your consumption, using it to escape adverse moods, and then risking or losing relationships and opportunities. And those are nine main signs.

I would add as it relates to video game addiction or screen addiction, there’s a couple of red flags to really look for. So, when we talk about alcohol, alcohol is kind of one of the most famous types of addictions that are out there. And when I looked up heavy drinking on the CDC, heavy drinking, as according to the CDC, is over 14 standard drinks for males, over seven drinks for females, so standard drinks a week. So, meaning that if you’re a male, and you have two drinks a day for seven days, you are at the border of heavy drinking. If you have a third drink on any one night that you’re technically a heavy drinker, it doesn’t mean you’re an addict.

Addict means you’re doing all those other nine things or enough of them, but it’s really a red flag, for binge-drinking, it’s technically defined as over four drinks within a two-hour period if you’re a male.

So, I wanted to find the version for heavy gaming or heavy screening, and I just borrowed it. So, if you’re playing over 14 hours of video games a week, you are a heavy gamer. Does not mean you’re an addict. It means you’re a heavy gamer or and you can replace video games with social media scrolling, like nonproductive, clearly just out to escape or whatever the screens are used for.

Same thing with heavy sugar use. So, if you have over 14 servings of let’s say a candy bar, you have over 14 candy bars a week, I’d call you a heavy candy bar user. Now we’re talking to functional medicine docs here, primarily in this audience, you know, anything over one is probably too much for our purposes because we’re trying, the professionals are helping people get optimal. But when I’m talking broadly about the general public, again, I’m just borrowing, templating from the CDC there on that.

And then there’s one other red flag that I came up with when it comes to screen and video game usage, it’s that if you video game or use screens more hours than you sleep in a given day. And that one’s inarguable. I mean, it’s bulletproof. So, like, oh, I got eight hours of sleep. Yeah, but you gamed for nine. I only watched five hours of a thing. Yeah, but you only slept four. It’s pretty bulletproof, that one.

So, I’m giving you the nine official signs that there’s addiction and three separate red flags to look for. To see if there is a problem. Look deeper, look deeper. If you see those three flags or 1 or 2 of them, look deeper into those nine signs. And if you understand it’s cannibalism, meaning you’re destroying things in the name of the addiction, then you understand it is an actual addiction. So that I wanted to start there with definitions. And I actually forgot what your prior question was.

Evelyne: That’s okay, we’ll get into that. And I’m glad you brought up the screen time, because I actually do want to talk about that one more down the road once, we’ve covered some of these other things. So, you have a framework that you called Tame the Beast. Can you talk us through that framework and the phases of addiction?

Dr. Sam Shay: Sure. So, when we’re talking about addiction, I want to create this metamodel so described before. So, it had to be something that’s easy to remember and that the trick whenever it’s so practitioners are listening. Everyone wants to ‘framework’ their system. You know, it’s the five pillars of this, the triangle of that, the inverted hypotenuse of wellness, whatever. People are trying to create a model. And the thing of the ideal way to make a model is the name of the model carries the emotionality of the thing you’re trying to present.

So, Tame the Beast of Addiction is my a registered model. So, beast. B-E-A-S-T. It’s the five phase model of all addictions, and so far, this may be a grand claim, I have yet to find a single exception anywhere of someone who is an addict, who has who’s not going through these exact five steps, in order, always. And they just keep spinning on it. So, I know it’s a tall claim, but hear me out.

So, B-E-A-S-T. B- It’s where addiction start, is where they believe a stressful thought and the most common stressful thoughts that people have are, he/ she hurt me. He/she betrayed me. The world is unsafe. The world is too much. There’s too much to do. There’s not enough time. I’m bored. Nobody loves me. The world is, I think I said the world is unsafe already. Life is unfair, etc.

It’s filled with thoughts like that. And by the way, the most sinister, stressful thought on that list is ‘I’m bored’. And by sinister, I mean it’s hidden. People don’t realize how stressful the state of boredom actually is. I mean, just watch as you see kids like, freaking out that they just can’t sit by themselves, and they must have something to distract them.

So, there have even been famous studies where they try to see or digitally detox kids for two hours, and the kids just freaked out to the point where they had to give them the iPads back where they were going to do self-harm. So, boredom is the most sinister, stressful thought out there because on the surface, boredom doesn’t show just because you’re not stressed. No, it’s a deeply stressful state.

And then people move to E when they have the worst. When they believe a stressful thought, they move from B to E. They have an emotional physical stress response. So, an emotional physical stress response would be anxiety, fear, grief, anger, insecurity, nervousness, irritation, sadness, rage, physical sensations in the body like tightness, clenching, tension, heavy heaviness, pain, whatever it might be.

So, you have a stress, you believe a stressful thought, you feel bad, and then you go to A which is you anesthetize with a vice. And this is important to see that the vice is step three, not step one. The mistake that people new to the field of addiction is they think that the vice is the problem. The vice can create massive urgent problems. But people addicted to a thing, the vice itself was is not the first step of the problem. It’s actually step three and there is a place to do damage control and to try to contain the vice itself, but just know if you successfully contain the vice but don’t work backwards on the emotional physical stress response and the original belief system that was triggering it, they’re just going across the deck to something else, possibly something that’s less destructive.

But the addiction cycle will continue. So, types of anesthesia are, I’ve broken them down into six main categories six types of addiction substances or usage – technology, which is video games, social media, TV, porn, movies, news, Netflix, checking emails, text messages, instant messages, Facebook, smartphone, whatever. The second category is food. Everything from overeating, sugar, chocolate, bread, ice cream, candy. And there’s also the rejection of food, which is anorexia and bulimia. Behavior – gambling addiction, sex workaholism, thrill seeking, kleptomania, recreational substances like alcohol, cigarettes, street drugs, weed, tobacco, pharmaceutical addictions, opiates, stimulants, etc. And then there are nonpharmaceutical stimulants like coffee, energy drinks, soft drinks and so on. So those are the six categories of identified as the types of anesthesia that people use to numb the stressful feelings from believing the stressful thought.

Then once they use after A anesthetize with a vice, then they go to S, which is they smolder in the consequences. So again, when designing a framework, you want to capture the emotionality of the with using the acronym. You don’t want a random acronym. You want an acronym that actually captures the emotionality.

So, smolder actually stands for the seven types of consequences S-M-O-L-D-E-R. But smolder as a verb is that slow burn whenever. If anyone listening to this has ever like been in the grip of a device and they use it and they just like, afterwards, that’s the feeling, that’s the emotionality of smolder. And I that was the hardest part of this model to create was to how can I create this emotionally accurate acronym.

So, smolder are the seven types of consequences that addicts experience. Now, the depth and diversity of these consequences vary wildly between vices, between individual people, between cultures. It is wildly, wildly different. The categories are the same. The details can be completely different. So, for example, video game addiction has a very different set of consequence is than meth addiction. Very different! Still in addiction, one or the other, but a very different set of consequences.

So, the seven categories are for S – societal consequence. So, with video games it is obviously not a part of the Amish or, or low or no tech cultures. But in South Korea. And this is true, video games are the national sport, like soccer in many countries or rugby in others. It’s literally video games in South Korea. So, video games are celebrated. In fact, the number one League of Legends player in South Korea. Some of you listening to me have no idea what I’m talking about. Those of you with kids may know exactly what I’m talking about. The number one video game player in South Korea was going to be conscripted to the mandatory draft service of the army. There was like near riots, and people were like, what’s the use of video gamer? Well, imagine if Michael Jordan in the 90s was suddenly drafted. You don’t think there would have been a bit of pushback? Just a smidge? Like it’s the same thing. You may think it’s ridiculous. It’s video games, but you know what? It’s not your culture. That’s their sport. It is what it is. So that’s the societal.

Then there’s M and smaller for monetary consequences. So, gambling addiction has a very different set of monetary consequences compared to workaholism.

The O in SMOLDER stands for occupational or depending on your age, educational consequences. So, your vice can destroy your occupation or your educational opportunities.

The L in smolder is legal consequences. So there really aren’t that many legal consequences to video games, except in some countries they have what’s called a Cinderella law, where your children under the age of 16 or 18, depending on the country, are not allowed to game between like midnight to 6 a.m. That actually was implemented in South Korea, but they had to rescind it because there was so much theft of the personal identification numbers of adults.

Now, people may not know this, but in South Korea, every person has a personal identification number to log on to the internet. Okay, if you think Big Brother is bad, just go to South Korea where they literally track everything of you at all times, everywhere. And you have you may not log in unless you, it’s like putting your Social Security number to log in to the internet. So, what was happening is all these kids who were being savvy and stealing adults numbers in order to be able to play. So, they had to change the law. And you can read about it on Wikipedia. It’s fascinating. A bit, a bit Orwellian, but, you know, here we are.

Then the legal consequences of video games are effectively none to very little. Whereas the legal consequences of illegal street drugs, are very, very highly consequential.

Then there’s D in SMOLDER, which is the domestic consequences. So that’s your home space. How does your usage affect your home life? D is different from the R in SMOLDER, which is relationships because you can be living, the domestic situations that you’ve just like isolated yourself and you’re living by yourself and you’re lonely and you’re just living alone. Or it could be like, you don’t clean up. There’s famous video streamers where the guy literally has candy bar wrappers up to his armpit playing because he’s just never cleaned his room in years. He’s just playing video games, streaming all day. Domestically, you get into fights about your alcoholism or domestically you’re an abuser or are you being abused because of your usage or whatever it might be.

Then the E in SMODLER is for energy/health. So clearly someone who’s got an exercise addiction has a different health arc than someone who’s got, a meth addiction.

And then the R is the relational consequences, and that that’s pretty self-explanatory. And it’s the one letter that has the most common ground with the least variation amongst all the vices. It’s the one thing that most people will experience similar consequence to, is the relational consequences.

So, then we’ll get to the T. So, the B is, we believe a stressful thought. And we have an E, an emotional physical stress response than A, we anesthetize with a vice. We have S, smolder and the consequences. Then we have T – have terrible thoughts about ourselves from the consequences we rendered, from the vice we use to numb the feeling we felt from the thought we believed. And this is real important. The new thought we have about ourselves is different than the thought that began the addiction cycle. We have a new thought like I’m a bad person. I ruined my health, my career, my relationship, my this that I’m a bad person. And then if I B believe that new terrible thought, then I feel bad, want to numb out, have consequences of another terrible thought. If I believe that, then I feel bad. I want to numb out and the cycle just keeps going and going and going.

The key thing I learned from Byron Katie, I actually lectured at her 2017 annual conference on this model and how I use her methodology to help people identify and question their root stressful belief systems. I learned from her that the thoughts that perpetuate addiction are not the same thoughts that initiate addiction.

So most people are trying to chase after the ‘I’m bad’ thoughts as opposed to going back to ‘the world’s unsafe, I’m bored, he/she hurt me, he/she betrayed me, I have to make a decision, there’s too much to do, there’s not enough time’, etc. etc. So that’s the model. And then functional medicine fits into all five of those phases.

Evelyne: Let’s dive into that more, though I do have some follow-up questions. And thank you for explaining that so thoroughly.

So one thing that comes to mind is with the behaviors that people exhibit. I interviewed Dr. Austin Perlmutter last season. And one of the things we talked about because he talks a lot about neuroinflammation, and I saw him give a talk on this and I thought it was phenomenal, but often there’s that like biology versus psychology model.

And so here you’re starting with the psychology right. Like we have ‘believing a stressful thought’. So I guess I’m wondering what about the part where because we’re dysregulated and inflamed and all of those things because of our lifestyles, like the way we eat, sleep drink, and I’m not talking about alcohol, I’m talking about even not drinking enough water, Right?

But just all of those basics of lifestyle medicine, those perpetuate inflammation and so those, could those cause those stressful thoughts? I’m curious on that psychology versus biology part.

Dr. Sam Shay: So we’re getting into phase two. So where functional medicine sits mostly is in the E, the emotional physical stress response in which we have lowered resilience based on our genetics or epigenetics, our nutritional states, states of inflammation, all the rest of it. So believing a stressful thought, people can have stressful thoughts, but not everyone that has a stressful thought spins into an addiction.

So it’s the E phase, the second phase, the emotional physical stress response, where to get out of that phase, that’s where functional medicine fits. And to increase resilience by working on inflammation, our epigenetics, hydration, exercise, diet, we know of Lyme rage, people have infections that affect their resilience. And so they’re much more readily able to act on their stressful beliefs because the dampeners are gone, and they just flip in to rage because the bartonella or whatever it is.

Functional medicine fits squarely in lifestyle analysis and lab analysis to increase the resilience. So people, when they have a stressful when they believe a stressful thought, it doesn’t immediately spin people into an addictive cycle. And it’s, to me the biological model is very appropriate. But I would say that it’s more about resilience to just the thoughts, the, the effects of believing a stressful thought. Because if people don’t have a stressful belief system, they’re not going to spin into addiction. I have not seen that their resilience can act as a blockade to spinning into the cycle. So they’re connected. But I don’t think biology is prime. I think it makes people way more vulnerable to addiction based on their genetics and their lifestyle and all the rest of it.

Evelyne: Gotcha. And then, with this cycle, too, you’re constantly in all of the parts, right? It’s not like it goes into each other perpetually. Is that right?

Dr. Sam Shay: Sort of. When people are in the thick of it, it can feel like the cycle is spinning. It’s kind of a blur. So that’s where the ‘Tame’ of the Tame the Beast of Addiction comes in. So tame stands for take a breath, accept you’re in addiction cycle, make a decision to exit the cycle and then exit the cycle.

So the tame is a way to create some psychological distance using like breath and mindfulness to say like, whoa, okay, am I believing a stressful thought or am I really stressed out right now? I’m about to reach for the thing. Am I in the middle of using the thing? Am I careening from all the damage from using the thing? Or am I spinning out psychologically from the damage I wrought from the thing.

It’s important to create a sort of stopgap system, to create a pause and some distance to see what phase you’re actually in, because each phase has a different intervention.

Let me talk about the second phase, which is functional medicine, and that, you know, sleep hygiene, exercise, diet, all those things I mentioned function testing, genetics, all that’s there, that’s there. And if I was looking at belief system, the top of the top of the cycle, that’s where things like the work of Byron Katie, cognitive behavior therapy or any number of very, very good systems that actually take the belief by the horns and question it, integrate it, whatever your word is, to deal with the root belief systems and then to deal with the A, the anesthesia phase.

When you’re dealing with a vice, you can look at as remove reduce, replace. Those are the three different ways to deal with a vice. You get rid of it. You actively reduce it, if you’re overeating, you can’t get rid of all food because you’ll die. And then there’s replace. Not replacing is not the same thing is cross-addicting.

It may look the same. So for example, a lot of people go to Alcoholics Anonymous. They switch to being addicted to exercise, but at least they’re not drinking. I have my criticisms of AA, but I also have my gratitude towards it. So for some people just merely not going into blackout, violent alcoholism is a huge win no matter what the cost, even if it’s to trading it for sugar, caffeine or exercise or whatever or going to meetings.

So replacing is you consciously switch to a less damaging device in order to buy time, to work backwards, to work on your resilience and the root belief systems. Cross addicting means you just simply swap it out for a different vice and you continue spinning in the cycle. It’s directionality that makes the difference between cross addicting, and you’re continuing the spike cycle or replacing as you’re consciously buying time to go backwards in the cycle.

And then the intervention for the SMOLDER phase is you make amends, you reverse the damage. I have a checklist for people to. What is the damage you’ve done in all seven sectors? And then what is the single first, easiest, most winnable step to reverse the damage, which then builds momentum and positive directionality to actually make the change.

And then the T phase, when I have terrible thoughts, that’s when you reach out for help. This is where people have to find community. So people get into AA because there’s a plug in community and or any community or just talking to people they can trust who will help them, as opposed to like, shame them.

So every phase has a different way to be helped. And this is where the different models compete with each other, because most models are like you have to do this one thing. It’s like, okay, that one thing fits over here, not over here. And so this is why I want to create this metamodel. So everyone’s tools can slot in appropriately.

Evelyne: Right? I have a question about kids and how the model fits kids because I guess as a kid you could have the thought that I’m bored, or maybe it’s not even a conscious thought, but can you talk more about that part of it? I’m just trying to conceptualize that.

Dr. Sam Shay: So the first thing to understand about kids is that they’re sponges of everything around them, including the stressful beliefs that have that are in the news, on television, or from their parents or from the school system.

You’re not good enough. You’re expensive. You’re a burden. Those are the three things my parents told me in so many words repeatedly for, I don’t know, two decades and that I took that on. And then there was the all the school, bullying and assaults and all the stressful beliefs that were there. So kids are very absorbent of the stressful beliefs.

Number two, they’re way less resilient because they’re sponges. They’re way less resilient, so there’s a high vulnerability. I mean, this is why you don’t allow cigarette commercials to kids. There are rules around certain things that are known vices that you cannot advertise to children.

So, the other thing that people should be aware of is that there’s some neurobiology components particular when it comes to screens that make screens particularly dangerous when it comes to children. So with screens, you’ve got the physical endocrinology of why kids and also adults are glued to the screen. So whenever screens trigger a stress response, you spike cortisol. And when you spike cortisol you go into your lizard brain effectively. And it’s either largely or marginally, but you start to look for danger and you look at the thing that caused the cortisol spike. And that’s just hard-wired because we’re built on a hunter’s platform evolutionarily. So you look at the thing and are you predator or are you prey? When the stress response you look you fix it, you saccade, you target.

And so you’ve got the hormonal response and then you’ve got the dopamine compulsion loops that come from variable reward systems. So for example in video games, loot boxes, meaning that you get random loot or random items or a random generated thing in a video game, that’s the same thing as pulling a slot machine. So the video game industry harnesses the same, dopaminergic circuitry as casinos, literally to the point where you can actually go into Wikipedia and look up loot box. And at least at the time when I looked at the page, loot boxes were banned in video games in China, Singapore, Belgium and Minnesota. So I don’t think you’ll ever find a sentence where China, Singapore, and Minnesota are in the same sentence. Except for that.

And then there’s the other thing behind being glued to screens. And I truly believe I’m like the only person that talks about this or has talked about it. I’ve talked about this since this specific thing since I think like 2013, it’s called the tectospinal reflex as it relates to screens and video games. So the tectospinal reflex is a hardwired reflex in the brain stem, and specifically in the mesencephalon in the midbrain. Tectum refers to those four bumps on the anterior or front surface of the brain stem, two bumps on top, two bumps below the two on top, or for the eyes to below or for the ears. Tectospinal, so the reflex is the bright or bright lights or moving lights or changing color lights or sharp sudden sounds goes in directly to the brain stem, doesn’t go through the frontal lobes, doesn’t go into the occipital lobes, bypasses the entire upper brain structure, and then the output is to the spinal, which is the neck to term. So when you hear a loud noise that activates that you turn suddenly to look at the thing. You’re reading, and suddenly your eyes dart up and you see a fly. You never knew it was a fly. Your eyes just darted there. That’s a hard-wired reflex. When we were hunter-gatherers, if we’re walking in the bush and there’s like a quick flash of orange in the corner of your eye, you don’t go, oh, is that a tiger? Is it old? Does it have its teeth to borrow a line from Dodger Chestnut. No. You look quickly and your cortisol is firing now. Because you don’t have time to visualize to see if that thing’s a danger to you or not.

So what happens with screens is? What is a screen? It’s a rapid, ongoing assault of changing colors, light, brightness and sound. So you’re just like, locked in, glued to the screen, firing your sympathetic nervous system and cortisol constantly. And some of these children’s TV shows are so sinister, they know it. They make these squiggly, moving characters. So it’s the constant agitation of the boundaries and the borders of the frame of the person that they can’t stop looking. That’s why MTV had less than three-second frame shifts, camera angles. They keep switching under three seconds to keep triggering the tectospinal reflex to keep the teenagers hooked in. So children are vulnerable. Especially vulnerable, I would say, for those reasons.

Evelyne: Wow. That’s intense. And I just think of even how much screen time is required just for our daily jobs, right? Or for the way that we just conduct our lives these days.

Let’s talk a little bit more about solutions. So I’d love for you to take me through maybe share like an example from your practice and how you used this model to help them overcome an addiction.

Dr. Sam Shay: Sure. So what I do with practice is, so, I’ll give an example of someone with alcohol. I lived in New Zealand for eight years. And so the, the national sport second only to rugby is alcoholism. There is so much alcohol in New Zealand that no one really talks about because they’ve got great PR over there. But alcohol use is pretty awful. And a mom came to me who was addicted to alcohol, and she wanted to stop because she kept getting really, really angry at her four-year-old daughter.

And one day she brought her daughter with her, and her daughter’s like the cutest button of a child. Like, very sweet, very innocent. Just like wanting mommy to not be angry. And the mom was completely torn up about her behavior because she saw how unnecessary and cruel her she became when she was on alcohol. Now that illustrates the most important step to working with people with addiction. Do they need the help or do they want the help? The very first question I ask when someone asks me, hey, I have an addiction or my relative is struggling with video games or food or whatever it is. My first question is do they want the help? Do they need the help or want the help? And then there’s a nervous laugh and it’s like, they really need the help. It’s like, okay, do they want to help? Not really. Okay, then I can’t help you that you need to interventionists.

So the difference been an interventionist and this model and interventions gets people from need help to want help. This models from want help to succeed at getting see succeed at getting help. So the first step is do they want the help.

And so this mother wanted the help. And what I did with her was, number one, walked her through this model and helped her identify. We just went through the five phases. We identified the stressful beliefs that preceded the stressful feelings that led to the use. We looked at her functional medicine. We looked at her lifestyle. We looked at her labs. We ran liver panels. We ran, I mean, this was, this was in 2014, I believe. So it’s been about ten years. I remember the office we were sitting, and so we did an entire analysis of lifestyle and labs, and we also looked at her community. And I told her that, look, based on your labs, you have to quit drinking for at least four months because of the state of your liver.

And she got real quiet and stared at me and I said, what’s the hesitation? I actually knew the answer. I just wanted to hear it from her, she said, my friends all go drinking and I don’t know how they’ll react to me not drinking. And I said, well, you’ll find out real quickly who your real friends are, won’t you?

She laughed, and I said, I’m dead serious. And she said, I know, that’s why I’m laughing. And I actually had to help her construct, I actually wrote an article about what to say to your friends who to want you to continue drinking from this. She actually had a friend who they went drinking on Friday nights for two or so decades. She told her friend, hey, I just got to stop drinking for four months. I’m happy to come with you. I’ll just have a soda and lime. I’d love to spend time with you. I just my doctor says I can’t do alcohol because of a liver issue. I still want to hang out, and I coach on what to say. I coached you to say this and she agreed with it. And then she told this to her friend. Her friend went real silent. She’s and said, quote, call me back when you start drinking again and hung up. And, that we both love me and my patient both had a laugh about that. It was quite a rueful laugh.

So the important thing about addiction is when you’re assessing lifestyle, you cannot ignore the community and the social environment in which the person is living. You cannot ignore that. That is one piece that I think a lot of functional practitioners miss because there’s so fixated on like, what’s your CRP levels, what’s your liver enzymes?

How about the externalized liver problem of the community that’s surrounding you that’s drinking? So then we talked, we went to A, what do you do with the alcohol itself? So we looked at remove, reduce, replace. And in her place we just had to remove it because her liver enzymes were not good. There was not an option to dilly around with this, but the ‘replace’ the was kombucha. I know that may sound trite because I am in Colorado, near Boulder or whatever, but kombucha is, I actually have a colleague of mine who is a former alcoholic who brewed kombucha, bottled it in actual beer cans. It’s labeled as kombucha because he wanted to normalize kombucha in the breweries as the non as the as a near non-alcoholic substitute because he wanted to make kombucha socially acceptable as a replacement for alcohol while still going out with your drinking buddies. And that’s what I referred her to. That’s the replacement. So we’re down to like one tenth the amount of alcohol, which I was fine with, plus all the probiotics.

Now the tangent, watch out for the high sugar kombucha because we have a whole podcast just on that. Then with the SMOLDER, I gave her that checklist, like, what’s the seven SMOLDER? What are the consequences you’ve rendered? What is the smallest, easiest, most winnable step you can take? And start there.

And then the T, which is that they reach out for help. She’s already doing that with me. And we also identified who were the friends who are positive influence. What is a positive community for her?

And the great success story is she got off the alcohol. She stopped getting angry at her kid. She’s way better. She refined her group of friends. Like that was a major success story. And we just followed the model.

Evelyne: Yeah. That’s amazing. I’d love to hear more. I know you’re really into genetics and genetic testing with your patients, so I would love to hear more about that. What categories of SNPs are you looking at? How are you prioritizing that and maybe how the genetics piece fits into all of the lab testing?

Dr. Sam Shay: For sure. So there’s some there’s some common, there’s some overlap with addiction and there are some addictions that have specific SNPs that are particularly problematic. So, for example, you mentioned inflammation of the brain as being one of a principal thing you look for in anyone who’s dealing struggling with addiction. I 100% agree. And so if we’re going to look at addiction, I want to know, for example, the SNPs of what’s there, what’s their TNF-alpha, what’s their Interleukin 6? The main interleukin-1’s that initiated inflammation. And especially I want to look at the interleukin tons, to see how well they can put out inflammation. Another gene that I consider very proinflammatory, though it’s technically the main free radical, it’s a rate limiting step for free radical damage scavenging in the mitochondria is MnSOD. I consider that kind of in the same campus as inflammation, even though it’s about free radical scavenging. And then the VERs, I mean, I have seen clinically and also I went back and check with the chief scientist who has access to all the data set of the, of the GenX company, I said, I have only seen one case where, the leader, one on video or to every single person I’ve ever seen, with only one exception who’s had chronic issues has had variations in VDR1 and VDR2. And the only person who had an exception had a horrific amount of stress in her life, like child dying type stuff.

Everyone else who had ever had chronic issues always had variations in their VDR1s and VDR2s, meaning they couldn’t absorb vitamin D into their cells to activate the 3 to 5% of the genome that was related to inflammation control and immunity control. Yes, the bone density is fine. But mostly vitamin D is really important for immunity and inflammation control.

Evelyne: Okay, you answered my question because I find that to be a common SNP. And I was going to ask if it’s just the vitamin D component and that link, or if there are other associations I don’t know about.

Dr. Sam Shay: Yeah. And then there’s other genes I look for. I mean, look, COMT is obviously one that most people look at because do you have problems breaking down your stress hormones and your dopamine? You’re just always active all the time. And your brain is just constantly going, you can’t shut it off. You just want to numb it out at any cost possible, like video games and sugar, or alcohol, whatever.

And then there’s other genes that I look for in specific afflictions. So for example, if someone is, dealing with alcohol, I look for some specific genes in regard to bitter taste perception and sweet taste perception. Because alcohol is both like bitter and sweet. So if you’ve got the gene variants for bitter and then the specific genes I’m talking about, or if you’ve got variations in the it’s called the TAS2R genes, the TAS2R38, technically, that means if you’ve got variations, you’re not averse to bitter meaning you’re not a super taster of bitter, which means you’re not averse to the bitter flavor of most alcoholic beverages.

And then if you’ve got variations in the TAS1r2 or TAS1R3 that means you crave sweetness also. So if you’re not averse to bitter and you crave sweetness, then you can overconsume alcohol because you’re craving it. But then there’s another gene. When you’re looking at alcoholism, if you have, this is going to sound very strange to people, if you have a green dot in the ADH1B and the ALDH2, the aldehyde genes, what that means is that you can metabolize alcohol really well so you don’t get the flushing, you don’t get the immediate acute toxicological effects of alcohol.

So when you combine those three together, you don’t mind the bitter, you crave the sugar, and you can pound alcohol without an immediate acute effect, that’s a recipe for alcoholism. Those are the three sets of genes I look for specifically around alcoholism.

Evelyne: That’s super interesting. I want to go back to the COMT genes because I think they’re prevalent. And I think they apply to so many addictive behaviors. And I’m curious then what is your intervention? Are you giving support based on those SNPs or does it still depend on like what other testing you’re running? I’m curious about that.

Dr. Sam Shay: So it’s always best to run like run a full court press of labs if you’re dealing with issues addicts, and to just rely on genes alone is really good yet, I think, insufficient. So I just want to put that right at the top. I would not be confident that genes alone is sufficient to help an addict for testing. I think it’d be critical, but, you need more.

And also that lab testing does not replace lifestyle analysis and community analysis. You cannot separate those two or ignore those and just run testing and think it’s going to be a yellow brick road the whole way through.

Okay. Enough asterisks and disclaimers on that. So when I’m looking at, COMT, there are two strategies. Number one, you look at COMT itself. And so like my favorite thing is magnesium threonate. Just give them a ton and sometimes theanine is not a good idea because if they’ve got SNPs in their MAOA genes that go in the wrong direction, theanine can be problematic.

And so there’s, magnesium threonate is kind of the safest bet there. But more importantly than that and this is really, really important when it comes to genetics analysis. And it’s the thing that most people, even people do genetics all the time, miss. Not all genes are created equal in terms of their hierarchy on their effects on health.

Methylation is subordinate to inflammation. I don’t care if Gary Brecka says and I don’t. And in fact, if people think if things oh, them’s fighting words, great. Go look up my three podcasts on my YouTube channel where I specifically found all the research and rebutted Gary Brecka’s totally narrowed scope on his precious five methylation genes he pushed on Rogan. Methylation is downstream of inflammation.

If you want to fix someone’s comps, air quotes fix it, start upstream by helping the inflammatory genes. And by the way, the free radical damage scavenging genes in the mitochondria are also, more influence methylation and the liver detox genes. You know, whether it’s just GSTP1 or CYP1A2 or whatever, they’re at best bidirectional in their influence with methylation.

Same thing with VDRs. So to me methylation is downstream of other things and bidirectional at best with other things. So I don’t fixate on methylation, I don’t fixate on COMT, I’m happy to chuck in magnesium threonate. Go for it. It’s a party in a bottle. Take as much as your stomach can handle, but do not fixate on a singular gene like COMT because it’s fashionable. You have to know the priority of genes. And that would be, number one inflammation. And then number two would be the free radical scavenging genes in the mitochondria, MnSOD, GPX1 and catalase.

Evelyne: Super interesting. I want to go back because you said, you know, the magnesium threonate. When you say take a lot of it. I’m just curious, what are you recommending?

Dr. Sam Shay: I think I have my comedian kind of way. It’s not the best way to do it. So the thing about magnesium, as you know, if you take too much, you have diarrhea. It’s one of it’s one of the safest things you can take. Obviously you can take too much. You can too much oxygen, too much water. We all know these caveats. I’m a little more sanguine about volume of magnesium threonate when it comes to someone who’s COMT is out of control. But again, it’s downstream of looking at inflammation. So I’m not relying on what I’m looking at, okay, what are the genes that have gone rogue with inflammation. More importantly what’s triggering the inflammation? And then you can go right back to all that you brought up before about Dr. Perlmutter as what’s causing the inflammation is electeds? Is it this, is this is it, this is it, or this or this, and that that has complete validity in my worldview.

And it’s a resilience thing of which genetics is a critical part and the resilience, the physical body’s resilience, is the second phase of addiction, not the first phase. It’s the belief systems. And I don’t want to say just focus on the belief systems and ignore your physical body and functional. I’m not saying that, but there is an order to things because people can have as many stressful beliefs as they want and not go into addiction, and then people can say, it’s clearly the physiology that causes the addiction because the people with weak physiology have these issues. No, that’s not quite true.

If people didn’t have these stressful beliefs, that wouldn’t even be an issue in the first place.

Evelyne: We’re almost out of time, and I have some more questions for you that I ask every guest. But before that, I just wanted to ask you and I had literally so many more questions, but we don’t have time. But I’m curious when it comes to the lifestyle practices, what has been maybe your top recommendation for something that you recommend for somebody who is in an active addiction to kind of like maybe shake them out of it for lack of a better term?

Dr. Sam Shay: Okay, that’s actually easy. Oh, that that’s super easy. Just get the bookends of your day sorted out, get your sleep hygiene sorted out, and get your breakfast morning routine sorted out.

Those get the bookends right, get those right. Get your circadian rhythms right. So you wake up, this is going to sound super basic but people in the throes of addiction man are they out of sorts and on a different world clock. So you get your sleep hygiene dialed in, so you have a stable bedtime and a stable routine, and you get your sleep environment as dialed in as much as possible, and then you wake up and you have a routine.

You have a morning routine that is healthy and supportive. So that means water, that means sunlight, that means movement. That means whatever kind of internal contemplative practice. And that means a solid, high protein breakfast.

That’s your morning routine. If you can get the bookends done of the day, then you set yourself up for success for the rest of the day and for the next day. That is actually the easiest answer I have.

Evelyne: Yeah, it’s easy in theory, I think harder in practice.

Dr. Sam Shay: It’s great. It’s straightforward. It’s not easy.

Evelyne: Great. So I do ask our every guest three questions to close the show. So the first one is personally, what are your three favorite supplements in general that you use for yourself.

Dr. Sam Shay: From a genetics standpoint, the number one supplement that I think is the most valuable from a genetics in terms of influencing the VDR receptors. Why? Because that’s the thing. The VDR receptors are so few things, so few things that upregulate VDR expression. Sulforaphane. I put it above turmeric, way above turmeric. So, sulforaphane is number one, number two, with that it’s dependent on if someone’s deficient in vitamin D. So if they’re deficient in vitamin D, it would be sulforaphane vitamin D. If they’re not deficient in vitamin D I would put a highly absorbable broad spectrum B vitamin that actually has some of the extra components like betaine and other things. To say a multivitamin sounds a bit trite, but you know what? I’m a fan of the mitochondria. I did study with Kailash for four years, and he’s kind of pretty top-heavy on the mitochondria stuff.

And the third supplement I recommend is chewing more. Chewing more is actually, I’m moving that actually to number one. Chewing more is the best supplement you can take because then you can actually absorb the nutrients better from the food you’re eating.

So yeah, chewing more, sulforaphane, really, really high-quality broad-spectrum multivitamin. Now if someone is really struggling with inflammation and all the rest of it, it could be like higher dose fish oil or there’s so many things to pick from. But those three.

Evelyne: Okay. And thank you. And good reminder always about the chewing. What are your favorite health practices just for yourself? Or maybe like your top health practice, aside from the what you just described about the book ends of the day.

Dr. Sam Shay: Getting a dog.

Evelyne: Oh, I love that.

Dr. Sam Shay: Getting a dog. My dog who’s snoring behind me. She’s an adorable little French bulldog named Lily. She has helped me so much because I get up and I walk her for a half hour in the morning with a 50 pound rucksack on my back. And I am, I am out, I am moving, I am training, and she helps me break out of whatever solipsistic drama I’m in because I have to take care of her because she’s reliant on me, and she makes me more playful.

She’s really kind of a social ease because everyone loves her, and she’s so adorable and petable. You know, getting a really solid pet that you deeply care about that gets you out of the house is one of the most important things you can ever do for your health, at least for me.

Evelyne: I love that, I love that. Thank you for sharing. And final question for you. What is something that you’ve changed your mind about? From all of your years working in this field?

Dr. Sam Shay: That addiction was a deep, personal, irreparable, failure as opposed to a consequence of things that I couldn’t control. I just didn’t have the awareness or the tools to do it.

So, I wasn’t aware that I could change my belief systems until I got to high school and found a mentor. I wasn’t aware about all the different ways to adjust my lifestyle, because I was just living by the dictates of my highly educated yet deeply ignorant parents when it came to health. And I that addiction is a consequence, not a personality failure.

There are personalities that are more prone to it, for sure, but it’s an adaptive behavior. It’s a survival coping mechanism that that goes sideways. And it’s consequential to oneself and people around them but it’s not me. And this is where I disagree with AA where they said once an addict, always an addict. I’d say, and I’m not encouraging people to go back to alcohol because suddenly they declare I’m no longer an alcoholic. But just to make the point, if as you follow that same philosophy of food addiction, then you have to quit food forever. That doesn’t make any sense. And I don’t think addiction is a permanent fixture. I think you can have a lot of permanency to it, but it’s an adaptive strategy that went sideways real bad.

And you have a lot of tools and resources to work out of it.

Evelyne: Yeah. Thank you so much for sharing and thank you for sharing all your expertise with us today. I really appreciate it. And where can practitioners learn more about you?

Dr. Sam Shay: They can go to drsamshay.com. They can also put in my name, Dr. Sam Shay, into any podcast player. I’ve been on so many podcasts. You know those pop right off. You can go on to my YouTube channel, Dr. Sam Shay to YouTube. My comedy material is there as well, including my one-hour show. There’s a whole comedy playlist there. And I’m all over the socials, so, it’s pretty easy to find me.

Evelyne: Awesome. Well, thank you so much. And thank you for tuning in to Conversations for Health today. Check out the show notes for resources from today’s conversation. Please share this podcast with your colleagues. Follow, rate or leave a review wherever you listen. And thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts, exploring evidence based, cutting edge research and practical tips.