Ayurvedic approach with Gillian Ehrlich, DNP, ARNP: Mast Cell Matters with Dr. Tania Dempsey

Jill Brook: [00:00:00] Hello, Mast Cell patients and wonderful people who care about Mast Cell patients. I'm Jill Brook and this is Mast Cell Matters, Deep Dives on Mast Cell Activation Syndrome or MCAS with our incredible guest host, Dr. Tania Dempsey, world renowned expert physician and researcher. Dr. Dempsey, thank you for being here and which of your fascinating colleagues did you bring with you today?

Dr. Tania Dempsey: Well, I'm thrilled to have Gillian Ehrlich here with us today. Gillian is the founder of NeuroVeda Health, an expert, and an expert in integrative medicine. She combines functional medicine, Ayurvedic principles, and advanced diagnostics and therapeutics to address complex health challenges with a focus on optimizing brain health, longevity, and overall well being.

I'm so excited to, to talk today. Gillian let's, let's, let's dive in. I want to hear all about Ayurvedic medicine. Can you, can you give [00:01:00] us a, a crash course?

Gillian Ehrlich: Yes, yes. That is my favorite thing to talk about. So it's kind of like, a spigot. And from what you know, you've just turned it on. So, you know, you just give me the signal when you're ready for me to turn it off because I can go for days.

I want to say it's great to be here with you today. And so Tania thanks for having me on. It's always so fun when we get together to just talk story and talk about patients and medicine. And what I love about our community is we are a community of practitioners that continues to learn and grow and integrate new

therapeutics, new diagnostics. Like it is a constantly evolving field. And so, I'm happy to be here and thanks for having me on the show.

So, what I'll say about Ayurvedic medicine is that I actually learned it first, and my background, I think this helps kind of understand my perspective of Ayurveda.

I got interested in health and healthcare when really health when I was in my early twenties, late teens, early twenties. And I was working, I ended up not, I looked at what medical school was [00:02:00] where it's like you aren't allowed to sleep and you aren't allowed to have any natural circadian rhythm and you're like inside for hours and hours at a time.

And I was like, I worked for Pacific Crest Outward Bound school. I did a ton of sailing and climbing and skiing and camping. And I just thought that physician life, like that physician training looks not healthy. And so I was like, I think I can't do that. And then and then a childhood friend of mine Anisha Durvey, who's an incredible clinician, was studying acupuncture and Ayurveda at the same time.

This was back in about 1998. And she had me come visit her in Albuquerque, and she brought me to a class with Dr. Vasant Ladd. And Dr. Vasant Ladd, if you've ever if you ever want to meet a modern guru, Dr. Ladd is the guy. He is so kind and, he's so kind and thoughtful. And he's a classically trained Ayurvedic physician from India. He's been in the US since kind of the mid to late 70s and has been living, he lived in Albuquerque for 40 years and started and ran the Ayurvedic institute and now they've shifted to [00:03:00] Ashville, North Carolina and they have this incredible mountain resort called Sohum Resort and they have a classroom and they have yoga training.

And so anyway, Dr. Ladd, she took me to see Dr. Ladd, who taught me about this Vata Pitta Kapha framework, this constitutional framework. Ayurveda is the original genomic medicine. So from the moment of our conception, all the forces acting in the universe, and this is like where the stars are, what's season it is, what your parents had for dinner before they made you, where, whether it was in the back 40 at the Four Seasons, everything that was going on in their systems at that moment, whether they had an active infection, whether they were, you know, underslept, whether they were rested, all of those things,

come into force to make your unique constitution. And that, and there's, you know, when you get, when you dive into the pieces of Ayurveda, there's like controversy about when your prakriti or your original constitution is set. Is it the moment of constitution? Is it through the nine months of pregnancy?

Is it on your first [00:04:00] breath? So we don't need to go into those like modern Ayurvedic discussions, debates. But just to say at that moment, our constitution for life has set. And so in Ayurvedic medicine, you're always trying to get back to that, to get your current constitution, your epigenetics to essentially match and support your genetics, you know, your original constitution.

And so for health for one is not health for another. One, something, an intervention, you know, even something as simple as like a really healthy food, like an avocado, you know, that can be, or a peanut, can be healthy for a person who's starving and poison for a person who has a peanut allergy. So we know that intellectually, know that emotionally, but Ayurveda has really codified this.

And so I sat with Dr. Ladd and I learned about these constitutions and I was kind of like dumbfounded. And I went back to my little, my little Outward Bound life. And I remember the next summer. I had three different students and I kind of practiced with them. So Vata, the constitution of Vata. So in, [00:05:00] let me back up one step to say Ayurveda is a five element medical system, kind of like Chinese, but different elements.

And the elements are ether or space, air, which is space moving, fire, water, and earth. So they go from subtle to gross. And Ayurveda comes out of something called Sankhya philosophy. There's seven philosophies in India. You can talk about that, about that ad nauseum also, but you know, Samkhya is this one from which Ayurveda comes and it basically notices that we are spirits in the material world, that our gross tissues are the, the final manifestation of the spirit of our

like even beyond our mind, you know, even beyond the things that we think. And so if you're practicing Ayurvedic medicine, part of what you're doing is you are impacting the body, but you're always kind of recognizing where somebody's spirit and mind are sitting and how they're directing the tissues to be created.

In from these five elements, they get collected into three baskets of qualities. And they're described instead of by [00:06:00] carbon, hydrogen, oxygen, that unites us with the air and the trees and the water in the ocean and the whales and stars they're, they go by qualities. And so these qualities, these pairs of opposites can be like hot and cold.

Light and heavy, stable and mobile. And so these collect, these qualities are collected into three constitutional types of which all of us are a little bit of each of them. It depends on where we have them, how intense they are, what part of our body. And so Vata is, the Vata predominant person, with that constitution is tends to be a skinny mini person who learns quickly but forgets quickly, has a really sharp mind, is tends to be very creative loves to dance, sing, talk. Is a person who often will make connections that other minds don't because they can really kind of see through the veils of the world. But this is also the princess and the pea, you know, 18 mattresses down,

they're like something's different. And that's Vata constitution. And I had a Vata student. Her name was Kelly, skinny mini student. And I, we were coming into an [00:07:00] anchorage. We were in these big open wooden rowing and sailing boats. We were coming in and I was like, Kelly, I want you to anchor the boat, and I want you to do these 10 things or 12 things.

And I listed them off, like number one, number two, number three. And she was like, got it, got it, got it. And she then stepped back and did it beautifully. She told all the other students what to do. She did, she anchored the boat. And I remember thinking in a past life, I would have said to, or, you know, before learning Ayurveda, I would have been like, Kelly, you did that beautifully.

Why can't you just repeat it? But I, I now knew Vata learns quickly, forgets quickly. And so I never asked her to do it again. I asked her a couple of days later, she's like, I don't remember. And I was like, okay. And usually that would piss me off because I'd be like, you just did it. But I learned not to expect that of her.

Pitta is the middle constitution. So Pitta people tend to have medium bodies, medium size, medium musculature, and Pitta is the principle of transformation. It's fire and water. And so Pitta is you and I are really Pitta people. So we like things that are funny, we like things that are [00:08:00] critical. We like to debate, we like to be detectives with our patients.

But when Pitta goes out of balance, Pitta can get itis inflammatory conditions. And Pitta can be cruel with their words or vindictive. So that's the Pitta constitution. And then there's Kapha. So Kapha, the, the principles of Kapha are stable, stable, solid, strong. We say that Kapha can eat anything, sleep anywhere, poop a banana a day and live forever.

You know, these are our Arnold Schwarzeneggers and Oprahs and, you know, people who are just, they're, they're not as quick, but they're stable. And so I remember I had a Kapha, I had a Kapha kid out on this long boat and Kapha is the opposite of Vata in terms of learn slowly remembers forever. So I spent an hour with him teaching him how to anchor the boat.

I talked slowly, I repeated things slowly, I gave him time. And then we didn't talk about it for a week. And then I said, anchor the boat. And he was like, okay, fine. And he just got [00:09:00] up and did it for the first time beautifully. And I remember thinking like, if this, if I, if I can help people with this simple understanding of what I got out of a weekend workshop, just imagine what I could learn if I kept studying this.

And so I went back and spent a year with Dr. Ladd. And after that, I thought this needs to be our common ground in medicine. It is amazing. And so I went back initially for nursing school and then I went, I did prerequisites, I did nursing school. I was a nurse at our downtown inner city hospital for a number of years on the cardio on the cardiac dialysis floor, which was amazing.

You know, I watched people code a lot. I watched you know, lots of incredible ways that the human body can function in time. And then I went back for nurse practitioner because it just wasn't enough. And so I've combined that with functional medicine now and with neuro immunology and with all sorts of things.

But when we talk about what is Ayurveda, there are some, there are some critical concepts in Ayurvedic medicine that as I've been in this functional medicine, neuro immunology, mast cell world, the last 15 years, [00:10:00] we have gotten closer and closer to Ayurvedic concepts, but like not quite there yet. So there's still, Ayurveda can fill in some of these gaps.

So Ayurveda is a 10, 000, five to 10, 000 year old system of medicine. It still uses the ancient texts that were used, that were recorded, two to three thousand years ago. So Charaka Samhita, Sushruta Samhita, Ashtanga Hridayam, those are some of the ancient texts that are still used.

It is a current medical degree, BAMS, Bachelors of Ayurvedic Medicine and Surgery. There's a huge, one of the entire branches of these eight branches is surgery. So Ayurveda does a ton of surgery. This is not like, woo woo meditation medicine. The other branches, so there's surgery, there's ear, nose and throat,

there's internal medicine. There's pediatrics and pregnancy, prenatal, postnatal care. There is toxicology. And then the last two branches are really interesting because one is called Vaji Karana, which is actually fertility and virilization. So, you know, talk about what's important now. It was [00:11:00] important too. And then the last one is Rasayana and Rasayana is my favorite because it actually represents rejuvenation.

And the thing that I tell patients is that when we have, you know, we, we both see a lot of complex and chronic disease. And so, there was an initial trigger, and I think of that as like a pebble in the shoe. But if you have that pebble in your, if you have a pebble in your shoe, it's a problem. If you have a pebble in your shoe and you walk 10 miles, now you've got multiple problems.

You've got the pebble, you've got the blister in your foot, you're probably limping. So now you've got some kind of like musculoskeletal thing, and you probably have a neck pain. And you would never think in Western medicine that for a pebble in your shoe, you would, you know, you would address a cervicalgia, you would address a neck pain.

But what Ayurveda has always said is that these issues ripple out. And so you need to kind of correct them at every level. If you just take the pebble out, you're still going to have possibly the blister, the limp, the neck pain. And so Rasayana is really about recognizing and doing rejuvenation for the [00:12:00] system, rejuvenation and kind of recovery for the immune system.

It's exactly what Naviaux talks about with the cell danger response. And so here it is, this 10, 000 year old branch of restoration medicine.

So Ayurvedic medicine is, kind of in summary, an entire system of medicine that treats patients cradle to grave and beyond on both ends. And is a current medical degree in India and there's over a million registered Ayurvedic Vaidyas or Ayurvedic doctors.

So it is currently, it's not, this is not something that is old. It's not something you can learn in a weekend, at a weekend workshop. This is an advanced medical system that has a lot to teach us. And I use it in my everyday practice.

Dr. Tania Dempsey: That's amazing. Because it's so complex, right? And the fact that you're integrating allopathic medicine,

integrative medicine, and Ayurvedic medicine, right? So my, my mind is blown because it's really, it's really very, very [00:13:00] right. At each one of those alone, right. It's complicated.

So how do you integrate it? What, like, what is your approach with a patient? Are you always using sort of all three systems.

Are you primarily using Ayurvedic medicine for some patients and maybe not for others? How do you, how do you approach it?

Gillian Ehrlich: I mean, I would say that the Ayurvedic approach is all I really know anymore is how to see people from an Ayurvedic lens. And so the approach is always, I approach the person, the human being, like from the Ayurvedic perspective, but that Chikitsa or treatment in Ayurveda doesn't preclude any particular intervention.

Chikitsa or treatment is, is translated as like whatever works. And so there's no limitations on what these treatments can be. So whether it's plasmapheresis or stem cells or peptides or NAD or CBD IVs or whatever it is, or, or breath work or pranayama or meditation, none [00:14:00] of those things are closed out from being categorized as Ayurvedic interventions.

It's always about what is the right approach and treatment for this patient at this time. And as you well know, you know there are some patients that you know, this particular intervention would unlock everything but they're not able to access it. So for example, if you want to tell a new mom with a three month old baby that if she just slept eight hours a night all of her problems would be solved.

That's just not accessible. So even though you can have an appropriate for disease treatment plan, it may or may not be tenable in the life. So this is all about customized care. And so I use everything, you know, I approach the patient from an Ayurvedic perspective and then decide what is, what is the piece that's, that needs to, you know, what are the dials that we need to turn in order to get them kind of on the straight and narrow with their health.

Dr. Tania Dempsey: Can you give us maybe a case example of how you would, you know, maybe it's a patient with mast [00:15:00] cell activation syndrome or something that maybe our audience would be interested in and how you would sort of evaluate a patient in this way.

Gillian Ehrlich: So I can think of, so I can think of two mast cell patients off the top of my mind.

Out of the, you know, so many, so many. So I had one mast cell patient who is a very Kapha patient. So she was stout, strong and she had these allergic reactions, you know, to foods, her food was really limited. She was anxious and kind of upset all the time and irritable.

And she had been seeing an allergist for the last three years and came to me with a prescription for Cellsept and said, this is, you know, this is what I've been told to try, do you have any other options? Because it's this, you know, it's kind of an intensive immunosuppressant. This was actually pre pandemic, to be honest.

So we weren't worried quite about that yet. But it was, she was like, I don't want to take this if I don't have to. She was actually a yoga instructor. Actually, both these women are yoga instructors. But anyway, so, so for [00:16:00] her, I looked at her Kapha Pitta constitution, so the stout, solid, hard to move, and I looked at her Pitta.

She was really irritable. Pitta is, is like red and rashy, itchy, irritable. And so that's a lot of the mast cell symptoms. And so we came up with a treatment plan that was a lot of the same things that we would always use. So Cromolyn, DAO. And then some, there were some Ayurvedic herbs that I had used. What, there's one called Guggulu, which does, it's a tree resin and then they partner it with other herbs. So, and it does like a, it's supposed to do like a scraping action inside the body. So it's kind of like a detox or a clean out these Guggulus and you can have Kaishore Guggulu, Punarnava Guggulu or Amalaki Guggulu, like all these different Guggulus.

And so we so we put together this treatment plan for her based on her Ayurvedic constitution, but also based on these mast cell pieces and she actually, and a low histamine diet and she actually improved considerably. But it was a lot of Kapha Pitta interventions from the Ayurvedic medicine along with Cromolyn, [00:17:00] DAO, low histamine diet. And then for and then I have another patient that I've been seeing for a while now,

who has mostly angioedema and kind of some flushing on her on her chest as well. But mostly like her face gets so red and hot and scalding so also Pitta and in itchy but she's got more of a Pitta Vata constitution. So we did more specific Pitta quieting herbs. And then we did similar things with Cromolyn and DAO.

I think she's also on Ketatofin. And then I did a Pitta digest herb blend and then some other Vata things so that her whole system would calm down in a different way. So that's kind of like two general examples of how a patient's constitution can kind of drive what the treatment plan is.

It's not just for the diagnosis. You would never just treat the diagnosis. You always treat the person who has the diagnosis.

Dr. Tania Dempsey: But you mentioned these other, you said, well, there's the, we'll use a Pitta intervention or whatever. [00:18:00] What does that look like? What does that look like?

Gillian Ehrlich: There's there's a whole host of other herbs that get used in Ayurvedic medicine.

And I really like, Banyan Botanicals is a company that I really like. Ayush is another company that I really like. Let's see, what are some of the others? Organic India. So like Banyan Botanicals has some a supplement or an herbal mix called Pitta Digest. And so it's, the idea is to kind of bring down the Pitta in the system to balance it out.

So it would be cooling herbs. There's a Vata digest and so that would kind of help stabilize, or there's a Kapha digest, which would help a person to move to get movement.

Dr. Tania Dempsey: So how do your patients who are, you know, sensitive, you know, they, they may be, they maybe reactive to certain things.

How do they do with some of those herbs? How do you feel that they respond?

Gillian Ehrlich: So, you know, I always go really slow and with really sensitive mast cell patients, you know, it's kind of like I have them [00:19:00] hold the bottle, open it, waft it, close the lid, put it away, and say like hours later, how are you? You know, how am I?

How am I doing? And then it's kind of like lick a tablet and then put it away, you know. So we start really slowly with all interventions, but a lot of times Ayurvedic herbs are much better tolerated. And when you see kind of these herbal tablets, they look like herbal tablets of old. They don't have the same, some of them have similar like microcellulose crystalline and all those other, you know, magnesium stearates, but a lot of them don't.

A lot of them are kind of like pressed herbs or will do just the raw powder. And so then people tolerate those typically a lot better. You still have to be careful. So for example, even ashwagandha can be something that in like instigate some fire. And so in a mast cell patient, you have to be careful with ashwagandha.

And again, it can be really appropriate for somebody who needs that strengthening, who maybe has a Vata, dry, light, restless, mobile sort of energy. The ashwagandha [00:20:00] can be very stabilizing, but you have to, you know, you have to go slow and be careful with all of these interventions.

Dr. Tania Dempsey: Yeah, yeah, absolutely. But, but it sounds like just to have this additional path that you can take the patients on that integrates with the other stuff that you're doing, right?

That's, that's very powerful.

Gillian Ehrlich: Yeah, there's, I mean, I, I mean, I think that, you know, so many of us have tools like that in our toolbox. And so it, you know, I think I just tend to use these tools because they've how they're, how I've been trained and Tania, I'll tell you, it's the weirdest thing, like, I, you know, I, I remember Ayurveda, I remember Ayurveda better than I remember almost any other part of life.

I mean, just like, I can tell you the word for earwax, I've known it for 20 years. Like, I, you know, just, it's it just stuck with me. I don't know why, but it just did, and so it's been really helpful over the years. And looking at also, [00:21:00] you know, what do patients want out of their life? How do we teach them how to know their own bodies?

And so, you know, we're starting to do more and more education so that other clinicians can kind of learn. And there are some concepts out of Ayurveda. You know, one is this original genomics with this Vata Pitta Kapha. And then there's another really interesting concept in Ayurveda this partnering of Agni and Ama.

So Agni is considered digestive fire. So it's any kind of enzyme that falls into a transformative role, which is all enzymes. There's all these different kinds of Agni. And so digestive fire, the ability to actually digest something and transform it into something is something that Ayurveda looks at really carefully that we don't even think about in Western medicine.

And from the Ayurvedic perspective, food is supposed to transition to being heat, to being bodily tissue, to being immunity and cellular intelligence, and then to being consciousness, and then be gone or be poop. And [00:22:00] so that is the transition that food is supposed to take through our system. But what we find, and everybody knows this, if you think about it what we find is that if you don't cook your food, well, it can kind of turn into trash.

And Ama is the, the Sanskrit word for metabolic trash. And so if the body is stressed, if it's not in a parasympathetic state, when it's digesting, if it's hurried to digest if it's, if it's if it gets interrupted digestion,

then

we get gas and bloating. And then we, instead of producing that tissue, heat, intelligence, immunity, and consciousness, we're essentially producing of this metabolic waste, which is described as being

toxic, morbid, smelly, sticky, yellow, or white, and it's like a gunky material. And it's what you can see on the coating of a tongue that's not that's, you know, not candida, not yeast. It's what is if you're, if you have like a lot of bodily odor, it's if you have joint pain or stiffness, like you want, you drive in the car for half an hour and then you have to [00:23:00] like, you know, warm up your joints to get out of the car after watching a movie.

If you have aches and pains, myalgias, arthralgias, if you have confusion in the mind or mental Ama would be like, I can't make a decision. Or it would be like you know, you have recurrent misperceptions. And so you can have mental or physical Ama or emotional Ama, you know, that would be trauma. I didn't realize how much those rhymed, but they do.

Emotional trauma and Ama. And so the idea in Ayurveda is that we want to clarify, clarify our digestion, and then we also want to get rid of Ama. And what Ayurveda says is that that's the root of autoimmune disease. So the idea is that so much of our system is cellular communication. And so the cells are kind of like, I'm cool, you cool, I'm cool, you cool.

And so if Frank over here is covered with Ama and isn't responding well, even if Frank is behaving appropriately, if that communication isn't there, then the cell [00:24:00] here alerts the immune system and says, Frank, isn't doing the right thing. And then they get rid of Frank. And lo and behold, Frank is like, you know, is a part of our connective tissue or collagen or our

endothelial lining and then all of a sudden we have an autoimmune disease. And I really think that that's where a lot of our autoimmune disease comes from is in interruptions with our cellular communication because our digestion, our food quality can be so poor, our stress can be so high, our circadian rhythm can be so disrupted, our meal patterns are so disrupted, we're not held within our community, we're not safe in the world. Under this kind of like, you know, nobody ever has enough money sort of thing, except for like 10 people.

And so there's these ways that like, you know, we are constantly messing with our digestion and the transformation of our food into consciousness. And we end up with this Ama that interrupts communication, and so now we have autoimmune disease.

Dr. Tania Dempsey: You know, it's really it's really brilliant, right? This is an [00:25:00] ancient medicine, right?

Thousands, thousands of years, right? But the, the, the language or the understanding is, is like so ahead of its time, right? It seems to me like what you're, what you're describing is how we're just starting to realize about medicine, right? That's, that's incredible.

Gillian Ehrlich: Incredible.

And what I know, I am not BAMS. I did not go to medical school in India. Like I do not have an Ayurvedic medical degree. This is what I've picked up. I mean, yes, I've been doing this for 25 years now. But it's, you know, I still, it's kind of like, it is not that hard to understand. And when we, when we have this perceptual, like this perspective or this kind of like conceptual understanding, then we can apply.

You don't have to apply Ayurvedic herbs to understand that, you know, we can use digestive [00:26:00] bitters. We can use water and lemon in the morning to stimulate our digestion. We can use, and if you're not tolerating citrus, you know, lime is actually less heating than lemon. So, you know, we can understand, or maybe a little bit of fresh ginger, and fresh ginger is less heating than dried ginger.

So these, there's these subtle things. That we can use to stimulate our, or even just plain hot water or warm water, if your Pitta's too high. So these things that we can do to kind of calm ourselves down so that we can digest well, so that we diminish that Ama production, or ways that we can use red light, or ways that we can use Ayurvedic massage, or ways that we can use just any any massage, or the ways that we can use lymphatic drainage or whatever it is to kind of find our stable place, and improve our digestion and diminish our autoimmune activity.

Dr. Tania Dempsey: Yeah, I mean and you're using the term autoimmune but I would say that you know, I would I would put mast cells right in that mix, right because the mast cells are are in the [00:27:00] gut they're responding to garbage or whatever else.

So that's yeah, yeah, it's really genius.

Gillian Ehrlich: And so infectious disease also. Like we know with we, I mean, I just saw a patient. This is perfect. Because I just the new patient that I just saw had was like a sensitive patient. So some had some Vata characteristics. She's 24 year old gal now, had some sensitive characteristics and then had a series of infections.

So it was two COVID and a flu, but then a sprinkled through with a bunch of upper respiratory infections and sinus issues. And so, and then her system kind of fell off the cliff. And so that's not a surprise, you know, she's not been able to regroup or rejuvenate, restore. And then mitochondria, you know, the battery of the body, these mitochondria come in.

And if they're not able to pass all the way through the three stages of the cell danger response, then they're stuck in that emergency mode. They're not producing [00:28:00] ATP. They're, they're functioning to divert their signals to make more cytokines and more inflammation, more alert signaling. And so suddenly we are stuck.

We have, you know, again, here we are in the land of Ama.

Jill Brook: You're, you're so fascinating in addressing these things. And it sounds like you combine some really new, modern, advanced techniques with some of these ancient techniques. And I was just wondering if you could do one more case study for us, but maybe this time about POTS, because a lot of our listeners have POTS.

Gillian Ehrlich: Oh, yeah. So POTS is my favorite thing to treat. I will be honest with you. POTS, I mean, mast cells, you know, things that I can get, you know, traction on, I love treating POTS because, so, POTS, we're looking again at Vata and Pitta because we're looking at the dizziness, the lightheadedness, we're looking at the vessels not having the right kind of compliance, not having the right instructions.

So, I'm seeing one gal right now. So I will treat for symptoms because in my experience with [00:29:00] POTS you have to kind of step on the symptoms, which is really easy with a lot of our medications, right?

So between the beta blockers and Pyridostigmine or Mestinon and Midodrine and Fludrocortisone and fluids and compression and salt. You know, a lot of those things we kind of can get some POTS under control.

So in my experience with POTS you know, I, I, so I don't treat necessarily just for symptoms, but I find that with POTS, if we can stabilize those symptoms, yeah, even with medications, then we can often kind of drive more stability with other interventions.

But until you have, and it's like this a little bit with mast cell also. I don't start as reliably with like, anti histamines as I used to. I typically start with like Cromolyn or even sometimes low dose naltrexone or, but I'm trying to kind of step on the symptoms a little bit. I think some of the most challenging, the two symptoms that I've seen patients complain about the most, like even more than pain, have really been the [00:30:00] unpredictability.

So I can't go out, I can't do anything, I just never know when I'm going to have an attack. But that unpredictability means that a person can't really live their life.

And when you think about it, like how traumatic to not understand how the world is going to affect you. So you don't know whether a barbecue smell is going to come by and you're suddenly going to, you know, pass out, you're going to get syncope or you're going to have to lay down at the Pike Place Market and put your feet up, or you're going to have to, you know, in the Christmas rush, or, you know, you just don't know what your body's going to do with the world.

And so that's a very Vata symptom. That's a very princess in the pea and it's very unpredictable. So if we can kind of get people, we use, we actually use in our clinic a lot of Ayurvedic body work, and I use a lot of oil. And so those things can be really stabilizing when there's not a lot of stability in the body.

Jill Brook: What do you mean by oil? We use a lot of oil.

Gillian Ehrlich: I know, we use a lot of oil. So oil, so when, so the opposite of Vata, which is dry, light, [00:31:00] mobile, restless, too sensitive, sensory like photo, like I'm sensitive to lighter sound, you know, feeling overwhelmed, sensory processing sorts of symptoms, the opposite qualities in the world are really embodied in oil.

So oil is heavy, it's stable, it moves a lot slower. And especially if it's warmed up, it can be a really nice remedy. And with mast cell, with POTS patients, you have a little bit more freedom with it. With mast cell patients, you have to be really careful if you're putting oils in or essential oils or herbs

into

the oils.

But we use a lot of oil either like, for sleep, you can rub your knees to your feet with oil or oil your body after you get out of a shower or a tub or a Epsom salt bath. So classically it's sesame, not roasted, toasted, but just cold pressed, like in the food section of the store, sesame oil.

You can use coconut oil. You can use sunflower oil. They don't use any of the seed oils like canola or anything like that. They rarely use [00:32:00] olive oil, but you can use olive oil. You can use jojoba, you can, avocado is actually a really typically benign oil. So, and then you add, they put all these herbs into the oils.

And so, you can use ashwagandha in there, or bala, or there's just like a whole host of herbs and or essential oils that go into oils.

Jill Brook: So you'd always put it on your skin. You're not eating it. Is that?

Gillian Ehrlich: So internally we use a lot of oil internally as well, depending on how people's digestion is.

So, there is oil application into the nose in Ayurveda, which is called nasya oil or nasya is that treatment. And so, I will never have a patient do a neti. So neti is from Ayurveda, right? That word is Sanskrit for nasal rinsing. But if you're doing nasal rinsing, like with salt water I always have people oil afterwards because you don't want it to be too drying or too caustic.

And especially it, when I treat for something like MARCONS with, [00:33:00] or a sinus, sinusitis with a topical nasal spray, then I'll always have people do nourishment, do nasya for nourishment afterwards either in the day or after like a series, like if you're doing a nasal spray for three weeks, then I have people kind of step down to either ghee or coconut oil.

You just put your pinky fingers in the ghee and coconut oil and then massaged as far as is comfortable so that those membranes are nourished, especially like in the northeast in the winter when it's so dry and crackly because then you can really shift the microbiome of the sinuses, which is right across that cribriform plate from, from the brain.

And so we know that if there's microbiome, how do we shift the microbiome of the sinuses without just antibiotics? You want something nourishing. So coconut oil or ghee. And then you can also buy pre pre, pre made nasya oil. So Banyan Botanicals has one that has camphor, camphor and eucalyptus. So again, mast cell patients often won't tolerate this, but you can do one or two drops each [00:34:00] nostril every morning to kind of get them to coat.

And then there's Ayurveda. com has another one that's a little bit more gentle. And then they will also put a lot of herbs into ghee, like Brahmi ghee can be really nice as a nasal treatment. So again, still Brahmi. Brahmi is a real is a nootropic and so here you are putting it in the vehicle, which is what they call the vehicle of medicine in Ayurveda.

So the Brahmi is the medicine and then the ghee is the vehicle to drive it in, but it goes right into those mucous membranes. So here you are putting a nootropic nearest to the brain as you can kind of reasonably get it with a driver. So Brahmi ghee, and you can buy that, there's a few places you can get Brahmi ghee. But those are things that I definitely, and, and and for mast cell patients, actually I have a few mast cell patients right now on something called Tikta Ghrita, which is an old Ayurvedic remedy that is bitter herbs in ghee, and you can do it either by the teaspoon, you might like it Jill, you might try it, Tikta Ghrita.

I [00:35:00] think it tastes absolutely disgusting, but I have patients who are like, I can't live without it. You know, please, and I've heard over the years with Ayurvedic interventions, patients will come back and say, I can't stop doing this. Please don't make me stop. And so Tikta Ghrita is one of those things that is very bitter herbs infused into ghee.

And you can do a teaspoon twice a day, a teaspoon three times a day. You do have to watch cholesterol a little bit with, with ghee to make sure people are processing it and you have to make sure that they have enough, you know, they have enough bile in their system, you know, or add ox bile to help with digestion.

So, again, you don't want to create Ama with something that's undigestible. But so that's how we oleate internally. And, you know, it mirrors, like, so a lot of times when I pick interventions, I use a lot of PEA in my practice, the palmitoylethanolamide. And I use a lot, and I think about that, like that to me is like a Kapha, a sort of influence, right?

Cause it's an oil. It was originally from palm oil. It's now [00:36:00] made in a lab, but it's, it has that heavier quality. I feel like PEA somehow, and I don't have the research to show this, I will admit, but you know, somehow goes to the nervous system and it feels like it diminishes pain and it feels like it kind of stabilizes,

so

I use

a lot of stabilizers, things that in Ayurveda would be heavy and grounding for a Vata problem. And so that's kind of how I pick interventions.

Jill Brook: So, you know, as, as a patient who has been like searching the internet for decades for things to help, it seems like whenever you get into the Ayurvedic space, the world really wants to warn you about heavy metals in products.

Can you talk about, is that a concern or was that?

Gillian Ehrlich: Yeah, it is totally a concern. That is a real concern. So when you, so when we, when I was in India 2005 doing, studying Ayurveda with my, with Dr. Ladd, my teacher in India, he lives in Pune half the year and outside of Mumbai. You know, first of all, India is like, At least in [00:37:00] those days, and I'm sure it's not that much different today, we know that the smog in India is like unrelenting.

Like there's days you can't even see the Taj Mahal. And also India, like Mumbai, even in 2005 was having rolling brownouts. And so when that happens, people just fire up their generators. And so people would just walk around with their gas cans and just fire up their generators. And a lot of the way that herbs are made is they will, you know, this is how it was traditionally done is that you would harvest, you would roll them into these little balls, and then you would lay them on a blanket to dry in the sun.

And so here's kind of all this like generator, you know, dust you know, and petroleum, you know, all that kind of gasoline sort of stuff that would just settle on anything that was exposed. And so I do think it's an issue. I don't think it's the nature of the herbs themselves. I think it's I will say boldly, I think it is a result of colonialism, because I don't think, you know, that pollution was not inherent to India. But, you know, after, so the [00:38:00] British also closed all of the Ayurvedic universities in the 1830s, and so the teaching that had, was really advanced, obviously, for, you know, thousands and thousands of years, had to essentially go underground,

and then became what's called Gurukula or the sitting with the teacher. And so transmission was passed very specifically, but you know, that, that the heavy metals that are in Ayurvedic herbs are from pollution that is a result of colonialism. The second piece to think about, which is even potentially more interesting is that there are Ayurvedic medicines called Bhasmas. And these are intentionally heavy metals. They are processed heavy metals and then they are, they are, like literally the silver bullet. So you use them in cancers, you use them in these very advanced medical treatments, things like, you know, a chemo, it would be like people in India saying like, I heard chemotherapy is really bad for you.

Is that true? And it's like, well, yeah, yeah. But sometimes use it for a particular [00:39:00] condition. And these Bhasmas are not bad for you, but they are intense medicines. And they actually, there's all this training about how you make Bhasmas and that by the end, you know, you, it has to the Bhasma is finished when you put your finger in and it falls into the ridges of the fingerprint.

Like it has to be that small. And this is the original like nanoparticle medicine that, and we're seeing a lot more nano medicine now, but Bhasmas were the original nano medicine. And they use, I mean, it's crazy, they use a lot of gold. Gold is very grounding. They use gold tincture. There's gold that you can get, golden ghee, gold infused ghee.

So they use gold. They use mercury just like they did in the 1800s for, as anti malarial or anti cholera. That's what it is. But they do use mercury in these Bhasmas. They use rubies. They use emeralds. They use, like, they use a ton of gems. And so these are things that are processed into medicines.

And again, the idea is that they can drive so far into the system. And so then they can pull the [00:40:00] qualities of medicine deepest into the tissues. So in terms of, and, and they've been, you know, just for reference, Bhasmas have been used for thousands of years. And so in terms of like, I don't know what kind of double blind placebo controlled trial that you're going to get, that's going to be more effective than thousands of years of trial and error.

Dr. Tania Dempsey: I think what's interesting is that gold was used even in allopathic medicine for various like rheumatologic conditions. So I wonder if it came from Ayurvedic medicine. I wonder if that's where the where they got the idea to use gold.

Gillian Ehrlich: It might be, I mean, you have no idea how much of, so the Greeks learned their medicine from the Indians, from India.

So when we look at the Caduceus, even the Caduceus, right, the, the Caduceus, we all know the symbol of medicine, the classic [00:41:00] symbol of medicine. Do you know where it comes from? So fascinating. So this, so there's a, there's a, you know, there's like a staff and then there's two snakes that wind up the staff, right?

And it is it is Ida and Pingala nadis, the channels that travel up the spine and cross at each chakra. And then Sushumna Nadi is the primary Nadi or channel, Nadi means channel. And that is the spinal, the spinal canal essentially. And so what the Caduceus is, is an Ayurvedic symbol for how the energies come from, you know, rooted at the base of the spine, cross at every chakra and interact and come out essentially like the Godhead.

And that's what we use for medicine. In allopathic, in the allopathic trade.

You know, part of what I'm really interested in kind of pushing forward in the world is this idea that, you know, I think that our, our understanding of genetics right now, or genomics, you know, the idea of how the whole genome [00:42:00] works together is really in its infancy.

And so, you know, we know about some genes. What we don't know is how all of these things interact together. And Ayurveda really talked about this unique constitution as assessed by the pulse, you can feel it in the radial pulse. And by looking at a person and hearing and talking to them, and you can understand.

And there have been some genetic studies that have confirmed the Vata Pitta Kapha framework. So there's some CYP four 50 enzyme system studies that have looked at that and find, you know, fast Vatas, fast, fast, metabolizers, Kapha are slow metabolizers for some of those enzyme systems. And I'm trying to remember what the other ones are.

I think there's coagulation. You know, Vata doesn't coagulate as well. Kapha does coagulate or Pitta. You know, so there's, there's just ways that, like, we have seen this a little bit. I mean, there's no money in confirming it because there's, you know, you can't make money off of understanding an Ayurvedic constitution.

Dr. Tania Dempsey: So, [00:43:00] yeah, but I think that we, I think that we have a lot to learn from Ayurveda and I use it with these complicated patients every single day.

Wonderful. We're going to be finishing up soon, but one of the things I really wanted to talk to you about, so maybe we could spend a few minutes. It's not so far off topic, but I do want to talk to you a little bit about plasmapheresis. Because I know you're doing a lot of it and you even mentioned that, you know, obviously you're integrating it with the Ayurvedic work.

Dr. Tania Dempsey: Maybe you could just talk a little bit about, you know, what you're doing with it, what you're finding, just give us a little background on it because I know that there are going to be people interested.

Gillian Ehrlich: So, in Ayurveda, when we talk about panchakarma, pancha meaning five, karma meaning actions panchakarma is the classic Ayurvedic detox and reset.

So there's not, there's, we don't have anything like it in Western medicine. It's the only way that I know of to kind of essentially hit the reset button on a person's kind of like body, mind, and spirit. And one of the class, [00:44:00] one of the five types of detoxification in India is called Raktamokshana. Raktamokshana literally translates as blood liberation.

And traditionally, you know, thousands of years ago, they used leeches, you know, just like they did in Greek medicine, just like they did in Benjamin Rush used, you know, in Philadelphia in the

1790s.

And that's essentially what plasmapheresis is today. We are not pulling out all the quantity of blood, like the whole blood, we are using a technique that's been used for over 50 years and has been traditionally kind of kept as an inpatient procedure, this plasmapheresis.

So the umbrella over top is called apheresis, and apheresis is the process essentially of using a machine to pull some component of blood. You have two IVs. Blood is pulled out. You're removing something from the blood and then the blood without whatever that component is is returned to the body.

Plasmapheresis is removing specifically the plasma and in the plasma is where [00:45:00] we find our antibodies. There's a lot and there's a lot of other kind of Ama,, you know, we're pulling out Ama.

We're pulling out the garbage, we're taking out the trash. And what I love is that contrary to a lot of our treatments, which are putting something into the body, it's very rare that we pull something out of the body and that, and because of that Ayurvedic framework, that's why we have plasmapheresis in our clinic is because sometimes people can be so sensitive,

and so the best thing that you can do is actually pull junk

out.

I don't think of plasmapheresis as curative. I think of it as lightening the load so that the body can kind of do its thing again. Like we can restore that intelligence because it's not in the middle of a hurricane anymore. plasmapheresis is, it's an intensive procedure.

Patients come to us sometimes seeking plasmapheresis and sometimes for, you know, conditions, and we recommend plasmapheresis. You do an intake with one of our practitioners who is going to prep you. We draw labs. Lab [00:46:00] work, especially fibrinogen is really important because we're pulling out coagulation factors and we have to make sure that those will rebound before we do another session.

For longevity, we'll often do two sessions or just to kind of like lighten the load to do other work underneath. A full complement would typically be six sessions and they're done typically twice a week if the fibrinogen in the other labs hold or we can do them once weekly. And we put it in part, we put, we, we use other therapies around it to essentially get that trash taking out to hold.

But that's how we use plasmapheresis. And we have people flying in from all over to do it and staying for a couple weeks in Seattle. And then we, you know, we have a, we have local folks as well who come. And so, and then there's some people, we have one anhedonia patient who found that it helped with libido, drive libido a little bit.

So, you know, he has continued treatments. The biggest limitation with plasmapheresis, honestly, is the is access is veins. The vein [00:47:00] itself. You know, exactly. And so if we're going to do, if that's the problem we will, sometimes we can put in a tunneled line or we can put in a port so that access is assured because we don't want that to be the limitation to the treatment.

And I've used it, I think, the most for patients who are in a free fall. So, for example, you have patients that are either they come to you in a free fall and you do all the things to kind of buoy them up or bolster them up or try to kind of step on those symptoms and kind of get at the underlying root.

And either they just can't stabilize or they, you've been keeping them stable like mast cell, POTS, hypermobility patients, you know, who chronic fatigue patients, who you've kept them fairly stable. And then they get a COVID, then they have another round of COVID or another blue and suddenly they're in free fall and they cannot stop.

And so sometimes we'll use plasmapheresis for that as well. And plasmapheresis has been like the classic uses of it were these acute, deep neurologic conditions like Guillain Barre or myasthenia gravis.

Or ITP, [00:48:00] idiopathic thrombocytopenia purpura.

So some of those big autoimmune conditions. But you know, you know, even with those conditions, we can look, we can see the antibody, we can see the symptoms, but you know, our patients live with like so many more symptoms and there's so much more disability. And so being able to remove something to actually remove this and give their body a break.

And we will partner it with, we do ketamine assisted psychotherapy at our clinic, we have IV, we do the Ayurvedic therapies, and so we'll do, often partner it with body work so that people's systems can quiet, so the intelligence can return, you know?

Dr. Tania Dempsey: I think that's great. We're, we're looking at bringing plasmapheresis to our clinic as well.

So that's why I'm really, really excited to talk to you and I'll, I'll pick your brain some more offline once we're, once we're there. But I think it's yeah, I think, you know, from all the reading that we've done and all the people we've talked to, and of course your experience is just, it's a, it's a, [00:49:00] it's an additional tool that you need for, for complex patients.

I think it has two, I mean, two roles, obviously in the longevity world, but also obviously more importantly in getting people better.

Gillian Ehrlich: Yeah. And I'm really glad that we have it and we have, you know, I mean, just we're just like you, Tania. So, you know, there's like a million things that you can try. You know, we've got a Gamma Core and we've got these Neuro 20 suits for like Tens unit suits.

And we've got, so Gamma Core is a vagal nerve stimulator that we're finding more and more beneficial for POTS and for dysautonomia.

You know, so there's all these different things that you can put into place, but just, you know, plasmapheresis, all of them often do something to the body. And so by removing not that many therapies that do removal.

We are overwhelmed. We are under resourced. You know, I used to think I used to describe it to patients like if you're sitting on a stool and you got four legs and you're just hanging out there, you know, you're pretty stable. But if you start getting these burdens [00:50:00] handed to you of this environmental pollution and all the things I mentioned before, the dysregulated circadian rhythm and stress and unsure about the future,

capitalism and racism and sexism and planetary change, like all these things, if you are loaded with all those things, your burden is so heavy. Now, if you knock, if you start knocking out some of the actual legs of the stool, because you don't live in the dirt anymore, so you don't have that recurrent supportive microbiome.

Even like, think about, you know, having our hands in dirt. We know there's microorganisms in dirt that transdermally cross into our bodies and can impact a mood. There's research on that. There's, you know, when I go into the woods and I'm surrounded by trees, I can actually feel it in my lungs. Like if we think that somehow we are separate from this earth and we don't need, we don't need her, we are sadly mistaken.

So it's like you have a bigger, bigger burden and you have fewer and fewer legs on the stool that you're sitting on it's very [00:51:00] destabilizing. And so how do we kind of remove some of that burden? How do we put those legs back into the chair? All of these therapies, you know, you can find plasmapheresis, it can be fairly, is very expensive, you know, and we can partner it with breath work, with grounding mats, with

you know, red light, home, red light used at home, acupuncture, you know, everything. It's, it takes the whole, it's a whole picture. But that's the fun part of like, which dials do you turn and when. And then the mind, you know, looking at, you know, when did things go bad for you and, you know, what association, when did, when did the world start to feel like it was a threat?

Was it after that sexual assault? Was it after your dad left and you didn't know where he went? Was it after your brother was killed in a car accident? Was it after, you know, so many of these things, or after you had a GI illness in a, in another country where suddenly you couldn't, you know, your GI tract couldn't recover.

So there's lots of [00:52:00] kind of traumas to the body that don't get that time to process.

Dr. Tania Dempsey: Gillian, this is amazing. We're going to have to have you back because we can, I can just talk to you for hours and hours and hours. I love, I love all that you have to offer.

So where can our audience find you?

Gillian Ehrlich: So we have a clinic in Seattle, Washington, a brick and mortar building. And we're actually adding more and more classes and events as we speak. So if you're local to Seattle or you want to come see us, come see us. We've talked about now we're dreaming about like ketamine sound group ketamine sound bath on full moon.

So, you know, if you have to have already been kind of approved and gone through an individual ketamine session with us, but you know, we're getting real jiggy with it in terms of like what we were excited to offer. But we do have, you know, you can come see us for massage or Ayurvedic bodywork or breathwork training, or in addition to kind of any medical consultation, we also have a podcast of our own, which I'm going to have you on Tania.

And [00:53:00] so that is called Nerve Data Podcast for Complex Health. And we're on all the platforms and you can find that on our website as well. We have a blog, we're going to be adding some classes. I think if you are a person who needs continuing education credits, we're going to soon be on a website called RNegade.

RNegade. Renegade. But they do they actually offer continuing education credits for things like listening to the podcast episodes or for classes or courses. So more and more to come.

Dr. Tania Dempsey: Great. Great. Thank you so much.

Jill Brook: This definitely expanded my mind so much. Thanks a million to you. Okay listeners, that's all for today. We'll be back again soon with another episode. But until then, thank you for listening. Remember you're not alone. And please join us again soon.