Helping Spasticity, Pain and Cognition in Multiple Sclerosis (and neuroimmune) Patients
Many people living with multiple sclerosis (or other neuroimmune conditions) are plagued with problems due to spasticity, pain, and cognitive issues. These are often the most common problem areas for patients.
In this interview, Garett Salpeter, the founder of NeuFit and I will discuss the science behind these conditions to explain how Neufit’s protocols and devices hack into the flawed communication between the brain and body.
I know firsthand that electric stimulation, specifically the direct current stimulation delivered by Neufit’s Neubie device has made a tremendous difference in my physical therapy, rehabilitation, and mental well-being.
By using this type of current, they’re able to tap into the nervous system at that level to make changes that, typically, come faster and, typically, are more significant or more meaningful over time.
Neufit is a Wahls Protocol® Sponsor. You can learn more about neufit here: http://neu.fit/wahls. Find a Neufit provide near you at https://neu.fit/search-providers/
*These statements have not been evaluated by the Food & Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
Dr. Terry Wahls: Okay, this is Dr. Terry Wahls. I’m here with my very good friend Garrett, and I want you to know that he is a Wahls Protocol® sponsor. Doing these interviews are really a terrific way for me to introduce you to the products and services that I believe in and that I use every day as part of my healing journey, in supporting my goal of thriving to 120.
Garrett, welcome, and why don’t you tell us just a little bit about your background and how you got into electrical stimulation.
Garrett Salpeter: Thank you, Dr. Wahls. It’s a pleasure to be here. Love getting to catch up with you and just absolutely love the work that you’re doing and the impact you are making, so really thank you.My background is a blend of engineering and neuroscience. I did graduate work, was actually in a PhD program. I decided to take a leave of absence to launch our product, but I was grateful to have found an area where I can combine those academic interests in engineering and neuroscience, along with my passion for the human body.
I first really got on this path during an experience I had where I was playing ice hockey in college and I had an injury and many of the greatest blessings that actually started with a big challenge. I met a doctor who introduced me to functional neurology and direct current. And functional neurology is interesting because my experience in sports to that point was all about the tissue, the thing that was broken; the tendon, the ligament, the muscle, the bone, whatever it was. And this was a paradigm shift where we focused more on the neurological response to the injury and trauma and how the nervous system will shut off some muscles, create tension in others, and how that creates pain, how that delays the healing process. Can be as simple as that tension where the nervous system is guarding and protecting, creates tension and pressure that reduces blood flow, for example, and can slow down the body’s ability to repair.
And so focusing at this level and then using direct current. I had an injury where I was supposed to have surgery, be out for a few months, and my ligaments healed on their own and I avoided surgery. I mean, it was cool to recover faster. Yes, that part was great. But what really got me excited, what really changed my life, was to find something that actually made sense from first principals.
I was a physics major. I was set to go to engineering school and to find something that really made sense at that level, that’s where it just so resonated with me and where I felt called to share this work with as many people as I could. And so using these neurological principles first in the sports medicine realm and working with athletes, people more kind of like myself, because we’re using so many neurological principles and techniques and that was kind of the whole thing, we very quickly started working with neurological patients as well. Patients with neurological injuries, neurodegenerative diseases, and saw just some really wonderful transformative outcomes, which I know of course I’m excited to talk with you about here.
But that’s been in many ways, even more fascinating, even more really rewarding, humbling, gratifying, amazing.
Dr. Terry Wahls: Now many people are familiar with my story of using electrical stimulation to speed my muscle recovery. But in addition to motor weakness, there are three other really big problem areas for MS patients, that do not respond at all well to treatment; spasticity, pain and cognitive decline.And I’m real curious, Garrett, is there any role for electrical stimulation to address any of those three?
Garrett Salpeter: Yeah, fortunately all three, and we can take them one by one. But starting with spasticity. So the Neubie actually, so our Neubie device here. Neubie, neuro bioelectric stimulator. It’s a direct current as opposed to alternating current. Has some really unique effects on the nervous system. It’s actually FDA cleared for reducing spasms or spasticity.
And part of how it does that is… Well, in order to understand that, we just have to set the stage here. So our brains and nervous systems send signals to muscles and there’s essentially two signals they can send. A signal to contract or turn on and then send a signal to relax and turn off. And both of those are active signals that are being sent. And in a case of spasticity, there essentially is a signal of too much on and then not enough signal to turn off. Of course an oversimplification, but I promise it’ll be a useful one when we get there.
So the cool thing about this type of electrical stimulation that we’re using is that a lot of, most applications of electrical stimulation, like people listening to this who have experience, may have used FES, functional electrical stimulation, where it’s about getting muscles to contract. If there’s motor weakness that can cause muscles to contract and there’s some benefit in that, but you typically have to be dependent on the machine to do it for you.
Whereas with this, we can change the settings and harness the unique effects of current to bypass a lot of those contractions, actually preferentially relax muscle. But the way that it does it is very interesting where what we’re doing is actually creating this sensory input that actually improves proprioception. And we can explain what proprioception is for a moment here, but what we’re doing is basically helping the brain see that muscle more clearly, so that it can better understand, “Oh hey, there’s this imbalance. There’s too much contraction signal, not enough relaxation, not enough turn. Too much on, not enough off.” And when the brain more clearly sees where that muscle is and what’s happening in the current state of that muscle, it’s better able to send that signal to turn it off.
So one of the things that we would do in a treatment for example, is actually scan around, take one of the electrodes and scan around on the body. And what we’re doing is finding where there might be hypersensitivity, or guarding, or these excessive contractions in the nervous system. And when we stimulate that area, we’re we’re sending more signal from there, increasing that proprioception, that word I’d mentioned just a moment ago.
So proprioception, a good way to conceptualize it is to imagine that everyone listening here, imagine that you’re in a room and there’s a table and chairs or different things on the floor here and you’re trying to walk around that room. So if your eyes are open, you can walk around the room and you can see where obstacles are. You can move around them very easily and you’re shouldn’t really be any risk or threat or anything that unusual there. And so that that’s having a good sense of proprioception.
So, proprioception is the brain’s ability to see the body, to know where the body is in space. To know that my arms are here instead of here. To know exactly where they are. Very fine-tuned, precise communication, line of communication, to know exactly where the various parts of the body are in space.
If proprioception is decreased or diminished, it’s like walking around that same room with the chairs and different obstacles around there, but doing it with your eyes closed. So imagine for a second. Please don’t try this if you’re in a safe environment.
But imagine if you’re walking around that room with your eyes closed. Instead of walking around smoothly and gracefully, you’re going to be taking smaller steps. You’re going to be very guarded. You’re going to be feeling around with your hands to make sure you’re not running into anything, kicking, taking smaller steps, making sure you don’t trip over anything. And so when you don’t see where, when you don’t have a good proprioception sense, your brain causes a lot more contraction and limits your movement to protect you because you can’t see where these different obstacles or threats are. And so a similar type of thing happens there.
And when you create these inputs, when you take advantage of the ability of the direct current to increase proprioception, that neuromuscular reeducation, it often helps people get to the point where they can being their brain and nervous system can now start to send more of those off signals there and start to balance the activity in that area. And sometimes it’s faster. Sometimes they can do it, they just need to reconnect and it happens quickly. Sometimes it takes longer because it’s actually a matter of triggering remyelination, or repair, or tapping into the power of neuroplasticity to make long-term changes where you need that direct current electric field, that electric charge gradient, to help stimulate the healing over time.
So sometimes it’s and functional sometimes and you need the functional support, but it’s more like structural software and hardware changes.
Dr. Terry Wahls: Okay. So, let’s talk about pain. Pain is another area that people can have immense amount of pain for MS immune, with polyneuropathies, a wide variety of chemo or radiation neuropathies, and MS can have a lot of pain with it. Does the Neubie have any role in diminishing pain?
Garrett Salpeter: It does. And pain is such an interesting topic of conversation. We’ve actually learned so much about pain in the last 30 years or so. It used to be thought that we had pain signals, pain receptors in the body and when you triggered one of those, it was just automatically the experience of pain. And we now know that it’s a little more nuanced, a little more complicated than that. So we do have nociceptors in the body. We have receptors that perceive threat, but there’s more that goes into the experience of pain because the experience of pain is actually, it’s an output signal created by the brain and it’s the brain’s way of saying, “Stop that. Don’t use that area or do something different.” It’s the brain’s way of saying, “Change your behavior.” And there’s so many interesting components to that if I may just help set the stage with some of them.
So we often think that pain means damage and damage is going to trigger pain. We often think there’s this clear connection there, but there are so many cases where that’s not true. There’s examples of 50% of people in their fifties who don’t have any back pain at all. If you look at their MRI of their spine, they’ll have issues with their discs, issues with their facet joints, things that we think would cause pain, and yet they don’t experience any pain. So, damage or structural things don’t, does not always equate to pain.
And then people may have pain without any damage at all. And that’s because pain is the brain’s way to cause people to change behavior. So sometimes people will have pain in an area and it will kind of ebb and flow. It’s not just like, “Oh yeah, I move it there and it hurts.” Sometimes it’ll kind of come and go. And there’s an interesting part about phenomena, an interesting kind of model of pain called the bio-psychosocial model of pain. So biological, psychological and social model of pain where because the brain only has so many things like we talked about proprioception. As if walking around the room with your eyes closed, the brain is going to limit your movement. It gets you moving slower, kind of more contained and confined and stiff, to prevent you from going out and injuring yourself or running into something.
So pain is also a response just like that and it can happen in response to even things that nonphysical influences that shouldn’t hurt us. So if you’re someone listening to this, maybe has the experience of going through either a rough time at work or the fear of losing one’s job, or having issues at home and the fear of losing a family member or breaking up a relationship or something like that, those create a perception of threat at a very deep level of the brain.
Because if we lose our job and lose the ability to provide for our family, that could literally mean getting kicked out of our home or starving or things, places where our brains will go.
And yet, there’s no… If your brain wants to create a change, it doesn’t have, I’m at risk of losing my job muscle to trigger pain there. So, it’s going to trigger, use pain, but it’s going to trigger that in an area a well-rehearsed existing pain pathway. So, it’s going to go into that same elbow or hip or low back or wherever someone has the experience of pain. So, there’s this interesting disconnect there.
And of course this can all be exacerbated by MS and autoimmune conditions and things like that because there’s already going to be an elevated perception of threat when the immune system is so high. So it’s a matter of finding where this perception of threat is coming from, where these hypersensitivities are in the nervous system, and sending those signals at a level where the brain can start to see, “Oh, okay, I can understand that,” and actually teach the brain to down regulate that perception of threat. Teach the brain to calm down.
So there’s a very interesting strategy for how to do that. Even if the source of pain is more psychological or something that couldn’t hurt. That shouldn’t hurt. Being able to scan around on the body and see where the brain is guarding and holding onto that hypersensitivity and then gradually introducing input into that area. It’s sort of like desensitizing that pathway. It’s a very powerful process, very powerful way to down-regulate the experience of pain, of perception of threat, and the output of pain.
Dr. Terry Wahls: So I want to see if I understand the process here. So, I come to you and say, “Garrett, my back and my hip is really bothering me.” You and your team do a body scan with your electrodes to figure out where my hypersensitive areas are. And then we design a program where I’m using the direct current Neubie to stimulate those hotspots and over time, my brain responds and what we discover is my back pain and hip pain diminish, even though there’s really been no change necessarily in my muscle strength.
Is that a fair description of how the pain is reduced?
Garrett Salpeter: That is. That’s a fair description of a common pattern.
There certainly are times when someone sprains an ankle or someone is in a car accident and they clearly just have a traumatic impact. And there there’s times where there is a physical damage and there is that correlation between pain and injury. And in that case it certainly takes time for the tissue to heal and this approach can help in that.
But then, yeah, there’s these times where it’s not so much damage as it is this kind of overall part of this overall suite of neurological protective patterns and it’s not necessarily about strength in an area, or this being right, it’s more about that overall reaction.
Dr. Terry Wahls: And so there might be times where we’re doing both muscular training and this pattern re-training.
Garrett Salpeter: Yeah, yeah. Absolutely. Doing both in parallel.
One other thing too, that I know you and I have talked about before, but we have a protocol. We call it our Master Reset or Electronic Meditation, basically intended to stimulate the vagus nerve but shifting the body into that parasympathetic dominant state. Part of the perception of threat that leads to the output of pain, it’s part of the stress response, part of this response to any sort of stresses or challenges or perceived threats. And so if you can down-regulate the overall global stress response and cause a shift out of that fight or flight state into the parasympathetic, the rest and digest, or the feed and breed state, where the stress response can calm down so the body can focus on long-term growth and repair, that makes a big difference as well. So, that’s another kind of part of it, is that more global approach.
Dr. Terry Wahls: Now everyone who’s listening, I want to remind you that in order to repair, I have to be out of that fight or flight state. I have to be in that parasympathetic state because that’s the only time my cells will take resources and allocate them to the work of repair.
Otherwise, if I’m in the fight or flight state, my cells are going to take resources and allocate them to protect me by making me strong to fight, or strong to run. I can only heal and repair when I’m in that sense of safety. And I really like doing the Master Reset. I used to do it after my workouts. I finally realized, no, no, no, I should do it just before going to bed. And the quality of my sleep is certainly much better when I take the time to do that.
Now, the third area that I inquired about is cognition and so I’ll share with everyone who’s listening that when my physical therapist had me first start doing E-Stim, what struck me before I was able to see anything with improving my muscle strength, was my mood improved. And it is very clear that my mood was better and I just felt more mentally clear and I just really, really liked doing my E-Stim.
And so Garrett, I’m going to hand it back off to you to talk about why you think that’s going on and what you’ve observed.
Garrett Salpeter: That is such a fascinating area and the good news, in terms of understanding, is that we can piggyback on a lot of the well-established research of exercise and brain health. So, there’s a lot of beautiful work that’s been done to show that physical exercise of the body does help the brain. A lot of people say that the reason we have a brain in the first place, or such a large well-developed brain in the first place, is to control complex movement.
And it’s interesting. There’s these little kind of jellyfish type creatures that are born and live in the water and they have a small brain and then they move to an area on a coral reef or something like that, whatever. I forget exactly the surface. And then they fasten there for the rest of their life and they actually eat the neurons that form their brain.
So when they stop moving, they actually no longer have a need for their brain. So, there’s this interesting, it’s a two-way street, where having a better brain helps us move more and then moving more helps us use and reinforce proper brain health. And so there’s a lot of benefits.
We know that bodily exercise helps increase BDNF, for example, brain-derived neurotrophic factor, which helps, literally is like fertilizer for brain cells. It can help with neuron regeneration. It can help with stimulating the growth of connections between neurons, which is a large part of how patterns are stored in the brain and that leads to memory and cognitive function and things like that. And then other growth factors that help with angiogenesis, the growth of new blood vessels and different, this whole kind of host of wonderful growth factors.
And then we also see benefits from exercise in the release of neurochemicals like epinephrine, neuro epinephrine, which it gives us energy, mobilizes that neural energy or adrenaline, noradrenaline, gives us that neural energy to be alert and have this cognitive ability and that sense of energy.
And then also dopamine and acetylcholine, which give us energy, the ability. Dopamine is about pursuit and drive and things like that. And then acetylcholine is about the ability to focus and those are released during exercise. And by the way, those three, epinephrine, dopamine, acetylcholine, those three chemicals are the underlying substrates for neuroplasticity.
So if you want to learn something just a little aside here. If you want to learn something, exercising beforehand and causing the release of those three chemicals opens up this window where you can actually learn something faster and more effectively because you’ll have the chemical substrates for neuroplasticity.
So we know that bodily activity causes these. Just doing any movement at all will cause some of that. If you’re doing more complex movement where you’re putting more weight on the bar for more strength, or you’re using things that movements that require coordination. So it could be a sport. It could be dance or martial arts or anything that requires the learning of skills, that also has additional effects on the brain in terms of creating new connections and new remodeling. So just being active kind of creates the environment to reinforce and maintain existing structures and then you can build new connections as well.
And where we come in then with direct current, this technology like the Neubie, by amplifying the neurological input, you get those same benefits of exercise, but amplified, like times two times three, times four. So you get even more of the boost of these neurochemicals that are going to give you, like you talked about Dr. Wahls, the experience of having increased cognition and clarity, help with mood.
So we have people that are working with us here at our clinic in Austin, Texas, they’ll say, clients will say, “I’ve been away for a week. I just landed. I had to come here. I had to get back on the Neubie because it just kind of helps my mind feel right.” And it’s not necessarily that people become dependent on it, but getting that boost is just good for mood, for cognition.
And then it’s so important for maintaining cognitive function over time to for preventing cognitive decline and triggering. I mean, building back up because there’s going to be some natural, use it or lose it, right? If use it or lose it tells us that, that principle tells us that people are going to have cognitive decline over time if we don’t do something, to cause some regeneration, it’s going to go down instead of up or at least maintain there. So very, very important to help with longevity and maintaining cognitive function to 120.
Dr. Terry Wahls: 120.
Garrett Salpeter: I know you’re going to be publishing papers at 119.
Dr. Terry Wahls: Absolutely. I’m going to have more medical students, more postdocs, more junior faculty. We’ll have a large research center here at the university. It will just be so marvelous. Now, this has just been so wonderful. Again for everyone with MS and other neuroimmune problems, spasticity is difficult to treat. Pain is difficult to treat. Cognitive decline is also difficult to treat. And exercise vitally important. The electrical simulation of muscles can be a very useful adjunct to help manage spasticity to help treat and resolve and better manage your pain, and to help resolve your issues with cognitive decline.
So Garrett, where would people come find you and how would they work with someone who uses NeuFit?
Garrett Salpeter:
So, if you’re listening to this and you’re interested in potentially trying this out personally or something about it feels like it may resonate or something that might be worth trying, I would invite you to go to our website, which is www.neufit and there’s a special page actually. You go to neufit/wahls and of course, Dr. Wahls last name. Go to NeuFit/Wahls and on there you can find a map of the physical therapist, chiropractors, athletic trainers, other movement professionals that have a Neubie. And if there’s someone in your area, we encourage you to go see them.
If for some reason there isn’t, or it’s time or cost prohibitive to go frequently enough, we have ways where our team can remotely support people who get a device to use at home, so that’s an option. And then also one other thing, if you go to that website, you’ll see there will be dates on there for the MS boot camps that we do. We call them a boot camp. It’s a weekend intensive where people can come down into our office in Austin, Texas and do a three-day intensive where you would get two one-on-one with a physical therapist, two treatments per day, and then we’ll do a group activity at lunch, a kind of lunch and learn or do some, whether it be talking about a certain topic or actually trying something or demonstrating something on the Neubie and we serve Wahls compliant meals, of course. Got to follow the Wahls protocol.
And those have been so cool because even in those three days, virtually everybody, I guess, I don’t know if I can say a hundred percent, but 90 plus percent of people going through that, even in just the first weekend, notice some improvements. And it’s not like you just flip a switch and someone’s in a wheelchair and all of a sudden is running sprints. But people notice changes in pain and spasticity, in cognitive, the things we’re talking about today or motor function or enhanced sensitivity or dexterity in their hands or feet or things like that.
And many of them going through that experience are motivated to want to continue. So they either go see the local practitioner or they choose to rent or purchase one of the devices and continue using it at home. And we can of course support that with custom programs and then get on video calls. We have a staff of the wonderful therapists that can support people like that too. So there’s a few different ways to interact.
If anyone listening is a practitioner, of course, we have a whole certification training program to teach you how you can use this in your practice as well. There’s a link. If you go to our website, there’s a link for practitioners that kind of gives more information there.
Dr. Terry Wahls: Okay. Well, Garrett, I love doing E-Stim. I love the Neubie and I love chatting with you and I really look forward to the next time we get to see each other in person.
Garrett Salpeter: Yes, me too. Thank you Dr. Wahls. I love you and your work.
Dr. Terry Wahls: Okay. Now, for all of you who are listening, I invite you to please share below what were the key things that you learned? What are you going to try? And also go to my website TerryWahls.com and be sure and sign up for the newsletters. You can hear and receive my weekly research updates. Now, much love to you and your family.
Garrett Salpeter: You too. Thank you so much.
