Safety is a Biological State

October 14, 2026
In this episode of the Health Optimization Medicine Podcast, Dr. Allen Bookatz and Jodi Duval explore:
Why is safety a biological state rather than simply a feeling or the absence of an immediate threat, and why might removing a threat and the body recognizing that it is safe happen at different times?
How does the cell detect threats such as infection, toxins, injury, and metabolic stress, and what role does ATP play as an intracellular energy currency and an extracellular alarm signal?
What are the three stages of the cell danger response discussed in the episode, from containment and rebuilding to reconnection, and why is completing the healing response different from simply removing the original injury or threat?
How can the nervous system and the cell respond to their environments in parallel, and why might someone continue to experience vigilance, symptoms, or reduced capacity even after an acute crisis has ended?
Why does safety not necessarily mean calm, and how can a person appear still or composed while their system remains in a protective state rather than having the flexibility to activate and deactivate appropriately?
How can metabolomics and other physiological data help provide a deeper picture of what may be happening when conventional tests appear normal, and what are the limitations of using these measurements for interpretation rather than definitive proof?
How does the body determine that a danger is truly over, and why does the transition back to normal function require an active completion process rather than simply the passage of time or the disappearance of the original problem?
How can cellular metabolism, nervous system regulation, perception, and emotional experience influence one another, and what does the HOMeHOPe framework mean by practicing salutogenesis across both the cell and the nervous system?
What We Discuss:

00:00 – Safety as a Biological State
01:11 – Removing a Threat vs. Being Safe
03:01 – How Cells Detect Danger
04:13 – ATP as Energy Currency and Alarm Signal
04:42 – The Three Stages of the Cell Danger Response
05:32 – Adaptation Is Not Necessarily Malfunction
06:10 – When the Crisis Is Over but Recovery Isn't
07:34 – Chronic Fatigue and Metabolomics
08:32 – What the Research Does and Doesn't Establish
11:23 – How the Nervous System Samples Threat and Safety
12:17 – Protection vs. Resource Availability
12:35 – When Reassurance Doesn't Change the Body's State
14:44 – Safety Doesn't Necessarily Mean Calm
15:22 – Activation Without Danger
16:00 – Why Stillness Isn't Always Relaxation
17:00 – Nervous System Flexibility and Recovery
17:37 – Why Humans Don't Always Shake Off Stress
19:02 – The Metabolic Cost of Prolonged Protection
21:36 – Is Stress Really the Problem?
22:10 – Stress, Recovery and Resilience
23:22 – What Does Safety Actually Feel Like?
25:00 – When the Mind Knows You're Safe but the Body Doesn't
26:47 – The Blind Spots of Conventional Testing
28:29 – Interoception and Body Signals
30:06 – How Does the System Know When Danger Is Over?
30:19 – Completing the Response
31:15 – Protection, Repair and Reconnection
32:31 – The Uncomfortable Middle Stage of Recovery
34:13 – Why Repair Can Look Messy
35:40 – Which Stage Is Stalled?
36:46 – The Measurement Challenge
37:28 – What Can Actually Be Measured?
39:24 – Metabolic and Inflammatory States
40:02 – Perception and Physiology Work Both Ways
41:16 – What We Actually Mean by Biological Safety
42:05 – Safety, Salutogenesis, and Health Optimization
Full Transcript:

[00:00:00] Jodi Duval: Like, I think it's, it's so good, isn't it? Like, you can just pull from all these different systems that have already been well-defined. Yeah. And then you add your own, which sounds like what he's doing- Yeah ... what he's done, and then now you're going to do for your own, and it just keeps evolving. That's what I just love about humans, is that we just shift into a certain set of populations where we need and have a desire to change.

[00:00:21] Jodi Duval: Yeah. 

[00:00:22] Dr. Allen Bookatz: Yes. 

[00:00:22] Jodi Duval: So cool.

[00:00:27] Dr. Allen Bookatz: Welcome back to the Health Optimization Medicine podcast. I'm Dr. Allen Bookatz. Today, we are talking about safety. Mm. Yes, you heard that right. Safety as a biological state, so not something we necessarily talk ourselves into, you know, after a, after a rough Sunday night, you know, and, "I just need to be safe."

[00:00:49] Dr. Allen Bookatz: Jodi Duval is with us and with me, who is the only other person, uh, I know who can use the term purinergic signaling other than Dr. Ted at a dinner party [00:01:00] and still gets invited back. 

[00:01:03] Jodi Duval: But I've, I definitely have been disinvited from better parties. 

[00:01:08] Dr. Allen Bookatz: Okay. So here's gonna, here's how we're splitting this up.

[00:01:11] Dr. Allen Bookatz: So Jodi's gonna take the cell today, and I'm gonna take everything, uh, we'll call it north or outside of the cell, so the nervous system and what safety might actually feel like from inside a body. Uh, and here's gonna be the third line for the whole episode: removing a threat and being safe are not the same event.

[00:01:32] Jodi Duval: Mm. So not the same event and not on the same clock either. 

[00:01:37] Dr. Allen Bookatz: Correct. Yes. Mm. Not on the same clock. Mm. So something in there has to decide that the danger is finished. And so bringing this back to my emergency work, I see a patient in the first 10 minutes in the ER, and, you know, whatever we... They come in, they have their injury, and we, we say, "Okay.

[00:01:56] Dr. Allen Bookatz: It was a bad car accident. Fortunately, you didn't break anything," and we [00:02:00] treat them and we street them. Now- They go on their life. I see them, maybe the same person two years later in a completely different room, in a completely different setting, but they still are sort of orga- organized, um, neurologically, psychologically even, around something that ended a long time ago.

[00:02:20] Dr. Allen Bookatz: And they still carry that with them, and it is sort of the lens that they now view the world. Maybe they are afraid to get in a car. Every time they see a car, they might brace themselves even though they are in the comfort of their own home. They're just, like, looking out through a window. And so that threat ended a long time ago.

[00:02:40] Dr. Allen Bookatz: But in modern medicine, or at least in medicine, I wasn't really trained to even consider that or look for that. And, you know, we're, we're often trained and to think about what's, like, actually broken. And this is... You know, nothing was actually broken, and this isn't necessarily about something being broken.

[00:02:57] Dr. Allen Bookatz: So the cell kind of gives us a map for this. And Jodi, I was hoping that [00:03:00] you could kind of help start us there. 

[00:03:01] Jodi Duval: All right. So let's start with what a cell actually has to do with this and what it has to do, right? So it has no eyes. It has no nervous system of its own. It reads chemistry, and then threat arrives as a chemical fact, an infection, a toxin, an injury, and metabolic stress as well.

[00:03:23] Jodi Duval: So then the cell runs the same response to it all. It's not differentiated between each of those things. It's an old response. And Naviaux named th- it, this particular cell danger response. And so, you know, same response, uh, yeah. So- 

[00:03:42] Dr. Allen Bookatz: A- and so wait, the same response, like, to all of it? Like, that's, that's the part that kind of got me.

[00:03:48] Jodi Duval: Mm. Yeah. And th- I think this is what we don't realize is that, you know, that the same threat of someone running down the street at us with a knife to someone calling us [00:04:00] and yelling at us on a phone or us telling ourselves that we are not good enough are all very similar threats. So one response and one of the main signals is ATP.

[00:04:13] Jodi Duval: So inside the cell, ATP is the energy currency. Outside the cell where it doesn't belong, it's an alarm. And so the cells around it read that alarm and change what they're doing, and all of that happens before any brain can have an opinion about any of it. 

[00:04:32] Dr. Allen Bookatz: Great. So you're saying that this is happening well below the level of anything you'd even call a decision?

[00:04:40] Dr. Allen Bookatz: Or like an awareness? 

[00:04:42] Jodi Duval: Yeah. Yeah. Yeah. So well below it, and it runs in these three stages. So the first one is containment. So we have a metabolism shift, we have an innate immunity that comes up, inflammation then does its job, and the cell hardens and pulls back [00:05:00] from its neighbors. You know, it ju- dives straight back into the cave again.

[00:05:04] Jodi Duval: And then the second is rebuilding, replacing what was lost. And then the third is the one almost no one talks about. It's when the cell reconnects, and then it reestablishes its relationship with the cells around it. And so metabolism normalizes, and then the tissue rejoins the conversation, you know? And that's the end of the healing cycle, not the end of the injury, but it's the end of the healing.

[00:05:32] Dr. Allen Bookatz: Okay. What-- Let's, let me unpack what Jodi just did in this, a very graceful two minutes, 'cause it took me the better part of a couple years to really understand it. So a cell under a perceived threat isn't necessarily malfunctioning. It's adapting, and it will keep adapting for as long as we keep sending the same signal to it.

[00:05:52] Jodi Duval: Yeah. That's it. 

[00:05:53] Dr. Allen Bookatz: Is that right? 

[00:05:54] Jodi Duval: That's the whole thing. Okay. Yeah. 

[00:05:55] Dr. Allen Bookatz: Right. And, and that's not necessarily like a metaphor here, right? That's the actual [00:06:00] mechanism we're talking about. It changes the question, for example, that I'm even asking in the room now. I start asking, "Hey, what's, what's broken in this person or this cell," right?

[00:06:10] Dr. Allen Bookatz: It's -- it changes it to maybe I start asking, "What is this person's cells still responding to?" This is just fascinating to me because, you know, when I think about people that we see that are hospitalized, and that's, again, my background here is, is in emergency medicine here. So, you know, I think about the, the person who survived sepsis or they came in super ill, and we got them you know, they have a bloodstream infection.

[00:06:34] Dr. Allen Bookatz: We got them better by giving them like, you know, adrenaline drips and antibiotics and lots of fluids and intensive care and, you know, it was really, really scary for them, their family, and, you know, they live and they make it out. But like eight months later, a year later, they're, they're fully recovered.

[00:06:49] Dr. Allen Bookatz: There's no, like, infection anymore, but and if we were to check all their lab cultures, there wouldn't be a single marker that may be even abnormal. If you talk to people that have been hospitalized, they're not [00:07:00] really back to normal, right? They're not-- their energy's not back. They say their, maybe their thinking isn't all the way you know, their cognition isn't there.

[00:07:07] Dr. Allen Bookatz: They don't have tolerance for the things that they used to do and, you know, they're fundamentally, they feel like things are different even though the acute threat is gone. And so, you know, it makes me reflect that, you know, we were really excellent at managing, say, the crisis that, that was happening either way, but we really didn't you know, we had sort of nothing to say about the state that it left behind.

[00:07:29] Jodi Duval: Mm. Yeah, so it's mopping up the pieces that were there- 

[00:07:33] Dr. Allen Bookatz: Yeah ... 

[00:07:34] Jodi Duval: wasn't it? Yeah. Yeah. So, you know, and this is what we look at when we look at this framework and what the framework predicts. You know, the infection's gone, the response to it never finished, and there's the, there's data underneath that now. You know?

[00:07:47] Jodi Duval: So Naviaux- Naviaux's group ran the metab- metabolomics on chronic fatigue syndrome, which is so, so common, uh, now. We see so many people with it. So about 80 people, half of the [00:08:00] patients, and half matched controls. So more than 600 markers measured, and around 20 pathways came back abnormal. 

[00:08:10] Dr. Allen Bookatz: Oh, what, what direction were those markers?

[00:08:13] Dr. Allen Bookatz: Up or 

[00:08:13] Jodi Duval: down? So, yeah, they were down. Yeah. So four out of five of the markers that separated patients from the controls were low, but not in- not inflamed. Hmm. They were just low. They were under-functioning. You know, the whole system running cold and running in a, in a, you know, coordinated way. 

[00:08:27] Dr. Allen Bookatz: Oh, so that's like the opposite of probably what most of us would guess what was happening.

[00:08:32] Jodi Duval: Yeah. Yeah. So you want it to be, you know, fair about that study because it, it looked at real criticism in the same journal, uh, and the criticism was good. You know, they never tested whether the, the pattern separates these patients from other fatiguing conditions like fibromyalgia. And some of the biggest movers were fats that shifts with how much you move.

[00:08:52] Jodi Duval: So, you know, there was, there was some variables there. And these patients move a great deal less. So it's a finding. It isn't a [00:09:00] test. Obviously, we use these things to give us i- you know, theories and support in our clinical observations. And, you know, I use metabolomics as a window, and I don't use it as a verdict.

[00:09:11] Jodi Duval: It's part of the interpretation picture, isn't it, Alan? 

[00:09:14] Dr. Allen Bookatz: This is, this is really fascinating. It seems like the cell is registering what's happening in its environment, and it's adapting in real time. Those adaptations are having real time effects- Not only in the cell itself and its own microenvironment, but also the tissue that it's part of, the organ, the entire body, and the system as a whole.

[00:09:38] Dr. Allen Bookatz: And then it helps set the agenda for how you're feeling and what's happening in the body accordingly. So we're gonna use some language here that is somewhat contested in the literature. One of those ideas is polyvagal theory, and ventral and dorsal states, or neuroception. And we're using this to just be on the same page with the clinical vocabulary here, and [00:10:00] it's helpful and, uh, illustrative.

[00:10:01] Dr. Allen Bookatz: Just to be clear, there has been a recent group of researchers who are arguing that the, some of the core premises may not necessarily hold up. And so while that's not necessarily settled yet, our position at least for the next 20 minutes is that nothing we're saying or arguing depends on necessarily winning that particular argument.

[00:10:21] Jodi Duval: Yeah. Because I think in science, as always, we are trying to look at ways we can prove ourselves wrong so we come up with better answers, right? 

[00:10:31] Dr. Allen Bookatz: Yes. 

[00:10:32] Jodi Duval: You know? Like, it's just us all trying to come up with a better way of looking at something or discover something new. 

[00:10:38] Dr. Allen Bookatz: Yeah, we have to be able to start with a theory and work with it and test it, and then allow it to be refuted and then fine-tune it.

[00:10:45] Dr. Allen Bookatz: And you're right, it doesn't mean that we were necessarily wrong. It just may not have been complete. 

[00:10:50] Jodi Duval: Yeah, absolutely, Allen. I think it's not about winning an argument. And we, as we always do here in the podcast, we try and present both sides of the [00:11:00] story, and this is what we should be doing today. And I think really if we l- we look at the details and the data, you know, we talked about the cell, and we talked about what the cell is doing, and we know biologically that's what's going on.

[00:11:13] Jodi Duval: And so now the nervous system, you know? What with all- Yeah ... we're, we're, we're sort of like we're, we're coming from a wider viewpoint here. So let's talk about that. 

[00:11:23] Dr. Allen Bookatz: Yeah, and so the, and so the nervous system is, is really just doing what Jodi's describe- description of what the cell is doing but with a much, we'll say, like, wider field of view.

[00:11:34] Dr. Allen Bookatz: It's constantly sampling what's happening. It's, it's sampling and sensing what's happening in the body. It's sampling what's happening in the room. It's thinking about what happened last time something like this may have happened in this, in a similar context. And from there it sets the physiology off- In that sort of read.

[00:11:55] Dr. Allen Bookatz: And it's not necessarily waiting for anyone similar to the cell to tell it that the threat [00:12:00] is over. 

[00:12:00] Jodi Duval: And same with the cell, right? It's clearing the infection isn't the same thing as finishing the response because it still has some work to do after. 

[00:12:06] Dr. Allen Bookatz: There is a ton of similarity here, and what's fascinating is that what the cell and the nervous system share here is, is a principle.

[00:12:17] Dr. Allen Bookatz: A living system is continually deciding how much of itself to commit to protection and how much to make available for everything else. And so that's the parallel, and that's, that's basically all the parallel here. And so I would say here's how it shows up at 3:00 in the morning in, in the ER, right?

[00:12:35] Dr. Allen Bookatz: Someone comes in with chest pain, we do the workup, and it's clean. And I tell them, I tell them, "Hey," in the most reassuring way, that their heart is fine. And I mean it. I mean, I'm telling them there's no heart attack. I'm trying to be as reassuring as I can. And maybe I have the data to support it, and they believe me.

[00:12:53] Dr. Allen Bookatz: And, uh, they're sitting there and they're still, like, breathing tight, you know? They're, you know, they're, they're concerned [00:13:00] about maybe whatever state that, you know, whatever was proceeding that got them there. And, you know, despite what I'm telling them, they can't believe it. Like, they can't feel it. They can't, um, register that in their system.

[00:13:13] Dr. Allen Bookatz: And so, you know, they might still be a little vigilant. They might still be having active symptoms. And, and it's just... It's interesting because, you know, the information can land, but the state that you would expect them to follow because of the reassurance just, it doesn't move. And so, um, you know, what do we do in medicine?

[00:13:35] Dr. Allen Bookatz: We just say, "Oh, that's anxiety," uh, and maybe g- give them something like an anxiolytic and then refer them to psych once we make sure that they're not a danger to themself. And then, you know, move them along. And what's interesting after doing this for many years is that they're... It's not about giving them enough information or evidence to reassure them.

[00:13:56] Dr. Allen Bookatz: Um, they intellectually get it, but... And, [00:14:00] and for us, we're really good about delivering that information. We might tell them what labs they have. We might even show them the EKG. We might tell them about our experience. But we don't have any protocol for delivering the evidence to the body itself, so. 

[00:14:13] Jodi Duval: Mm-hmm.

[00:14:14] Jodi Duval: Yeah. 

[00:14:14] Dr. Allen Bookatz: And, and in turn, the sense of safety just cannot be registered 

[00:14:21] Jodi Duval: Yep. Yep. And I think it's a really tricky thing, isn't it? Like, how do we help someone deliver that safety to their own nervous system? You know, and this is where all the techniques come from, right? And so yeah, I think we should dive into this a little bit more as well.

[00:14:44] Dr. Allen Bookatz: Yeah. Yeah. So, um, what's really interesting is one of the most common misconceptions and, and moving, uh, moving outside of, we'll say, the acute stressor now, and now this person, say, is going home, um, is the concept that [00:15:00] safety has to mean calm. 

[00:15:02] Jodi Duval: Mm. 

[00:15:03] Dr. Allen Bookatz: Right? And it doesn't necessarily require calm. A, a calm person can feel safe, and a safe person can feel calm, but a safe system doesn't always have to feel calm I would say it, it's more about having a full access to activation and deactivation.

[00:15:22] Dr. Allen Bookatz: So think of it like when you're doing a hard exercise. You... Right? Or you're competing at something. You, you know, your heart rate's up, you're breathing fast, you're mobilized, and but psychologically we know that we're not in danger, but we're able to mount the same physiologic response as if we were in danger.

[00:15:41] Jodi Duval: And so therefore the opposite is true, right? We can maintain calm. 

[00:15:45] Dr. Allen Bookatz: Yeah. Yeah, exactly. Yeah. And this is the one that kind of fools other, everybody including us, is that you can st- someone can be very still and quiet and seemingly composed from the outside, and be completely shut down on the inside. [00:16:00] 

[00:16:00] Jodi Duval: Mm. 

[00:16:00] Dr. Allen Bookatz: Uh, and so we might read them as relaxed from the, you know, from, from just a, a visual, but they aren't.

[00:16:09] Dr. Allen Bookatz: It might indicate that the system's completely dropped off l- like dropped offline, and that's not necessarily one that's settled. 

[00:16:17] Jodi Duval: And I, I, I like to give this example 'cause I always explain it to my clients. It's a duck underwater. You know, like the duck- Ah ... going under here like this, and then it's- It's 

[00:16:25] Dr. Allen Bookatz: like Yeah.

[00:16:28] Jodi Duval: Like, best way to, to, to, to know that particular state of nervous system. Yeah. Mm-hmm. Um, but we normally call the first one healthy and the second one compliant, isn't it? 

[00:16:38] Dr. Allen Bookatz: Yeah. No, we would, and we would probably be wrong twice there. 

[00:16:42] Jodi Duval: Yeah. Yeah. 

[00:16:43] Dr. Allen Bookatz: And so, and so I guess the, the thing we'd wanna measure necessarily is not necessarily of how calm somebody is, but we'll just say how, how flexible they are to be able to bring their body into an activated state, and then bring yourself, bring themselves into a, you know, a [00:17:00] calm state.

[00:17:00] Dr. Allen Bookatz: So, like, can they mobilize what's needed when the context genuinely demands it? And then dropping all of it and coming back down when it's finished, right? No strings attached. And then how long does it take to come, you know, for, does that come down take? Like, just an example of someone in real life where they can mobilize something and then let it off or maybe give an ex- or a dog maybe.

[00:17:20] Dr. Allen Bookatz: Like, you watch a dog or someone in nature- Or like an animal in nature, the predator comes and they get spooked and, you know, they make a dash for it 'cause they're gonna be eaten. And then, you know, they stop when it's free and they shake it off and move on, right? Yeah. 

[00:17:34] Jodi Duval: Yeah, exactly. No, but I think we, we should definitely...

[00:17:37] Jodi Duval: Like, that's a, that's a fantastic example. Um, but we also don't have that in the human. You know, we, we, we get stress constantly, and we are in... This is why I try and explain to my clients all the time, is that we're in a state of stress even sitting at our desks on a computer, and we're getting these horrible emails, and, you know, you know, threats from whoever or, you know, like, pressure to, to get tasks complete, and we just sit [00:18:00] still.

[00:18:00] Jodi Duval: There is no mobility- Mm ... of the internal stresses. And so therefore it gets stored, and therefore it is, you know, clocked somewhere different that we are not actually able to, to shift. And so when the dogs, you know, or, um, yeah, anything happens, you know, like for my dog, postman will come, he'll go psycho at the postman.

[00:18:23] Jodi Duval: Yeah, mine too. And it's like the postman's the worst person 'cause he's always coming into the house every day. Uh, and then we'll shake it off, and you'll see it then return to state of ca- or rest- to return a state of equilibrium for the nervous system. Yeah. Do 

[00:18:34] Dr. Allen Bookatz: you think that's a doodle thing, by the way?

[00:18:36] Dr. Allen Bookatz: 'Cause I know you and I both have doodles. I think it might be. Right? Yeah. 

[00:18:41] Jodi Duval: Yeah, yeah ... 

[00:18:41] Dr. Allen Bookatz: maybe they got the- Hypo ... the worst of both, you know, of both breeds. 

[00:18:46] Jodi Duval: Yeah. Yeah, yeah, yeah. Well, well- Oh my goodness ... 

[00:18:48] Dr. Allen Bookatz: I, well, I gotta imagine, right, there's probably some type of metabolic price tag and cost to that, Jodi. So, like, what would it cost, say, a system to hold onto that for, you know, [00:19:00] 5, 10, 15, 20 years?

[00:19:02] Jodi Duval: Yeah. Yeah, and that's that sort of allocation, isn't it? Like that, that long cost that gets paid out. And like we say for anything, you know, that nothing's for free. Nothing that we do is for free, and there's always needing to be a balance, um, you know, on the other side for it, and e- everything has a cost.

[00:19:21] Jodi Duval: So in the cell, defense and repair gets funded first. You know, we have to have the essential processes looked after, and then growth reserve capacity, the long-horizon projects, you know, they get deferred. And um, you know, which is completely fine for a week. Over 10 years, you know, you get a system that's technically alive, but with no margin in it.

[00:19:43] Jodi Duval: And I- Right ... you know, and I, I just wanna give an example here, 'cause I also say this to my clients quite a lot. Mm-hmm. This is one of my, my, my metaphors and analogies try and come out to make them understand it. But, you know, like your... s- especially with exposomics, you know, the, it's the stress of the environment, and they're loading up, and the toxins, and then the [00:20:00] food, and the bad things, and they're loading up, and there's a bucket, and it's filling and overfilling.

[00:20:05] Jodi Duval: And the body can't do anything with those things. It's storing, it's shuffling, it's shifting. It's like, I can't... l- like I've got my junk cupboards, and they're all full- Mm-hmm ... and I can't do anything with them. And, um, it has to p- it has to be triaged. Like the body- Yes ... has to triage at that moment, you know?

[00:20:22] Jodi Duval: Like, ER s- Mm-hmm ... ER speak, but you're, you're triaging across the body to be able to then, like, look after the essential processes, but that doesn't mean it, it's an ef- efficient, well, um, functioning, optimized body or cell. 

[00:20:38] Dr. Allen Bookatz: Yeah. 

[00:20:38] Jodi Duval: Mm. 

[00:20:38] Dr. Allen Bookatz: Yeah. Well said. It's, uh- Yeah ... you know, we, we often say you don't wanna be the person that's, you know, rushed back first, right, when you check in to, to follow along your triage al- That's right

[00:20:50] Dr. Allen Bookatz: you know, your triage analogy. Yeah. And, uh, you know, if you're a, you know, walking wounded, then, you know, you can wait. And- Yeah ... you know, and [00:21:00] but unfortunately, those are also the people that, you know, it comes at a cost for them, right? They, they're the ones who are gonna be able to go back to their, you know, homes and communities and, and be productive.

[00:21:10] Dr. Allen Bookatz: But, you know, the system, the system is triaging. It has to address the sickest first- Yeah ... and prioritize their survival over Whatever relationship or mood or, you know, other cost of productivity to that person or, or s- you know, society. So, you know, the, the model even fits in the ER that we're talking about here, you know- Exactly

[00:21:31] Dr. Allen Bookatz: in addition to the cell and, and the, the nervous system. 

[00:21:34] Jodi Duval: Yeah. Yeah, no, absolutely. 

[00:21:35] Dr. Allen Bookatz: Um- 

[00:21:36] Jodi Duval: And I just wanna mention really quickly here, because I think stress is the biggest word that we say- Mm ... everywhere. You know, it's... Stress is the cause of everything. Yeah. Everyone's so, "You're too stressed. You need to not stress so much.

[00:21:49] Jodi Duval: You need to get less stress in your life." 

[00:21:51] Dr. Allen Bookatz: Yeah. 

[00:21:52] Jodi Duval: It's like, well, how do I bloody hell do that? Like, that's, that's impossible. Yeah. You know? But stress, we know, is good to some degree. We've got [00:22:00] hormetic stress, which is a good part. Um, so, you know, stress actually isn't always the h- the problem because sometimes that can actually build capacity.

[00:22:10] Jodi Duval: It is that we don't get, um, renewal or, um, removal from that stress, and this is exactly back to the analogy of the shaking dog. Like, we will just stress, stress, stress, stress, stress, stress, stress, stress, stress, stress, stress, stress, and we never get to shake it off. And so if we stress, shake it off, stress, shake it off, we're like, "Ooh, great.

[00:22:28] Jodi Duval: I'm resilient. I'm stronger. This is amazing, and I've dealt with what I needed to deal with at the time or after the time of the stress." 

[00:22:36] Dr. Allen Bookatz: Yeah, yeah. It's... Yeah, we blame the stress, but it's, you know, stresses can be good, and it's, it's the, it's the thing, provided we have capacity, right, to overcome it and repair, re- grow and repair from it, that helps us get stronger, right?

[00:22:50] Dr. Allen Bookatz: It's not, it's, it's only when we, you know... It, the, the response to the stress doesn't finish. That's, that's really what the problem is here, so. 

[00:22:58] Jodi Duval: Exactly. 

[00:22:59] Dr. Allen Bookatz: Um, [00:23:00] and maybe that, that, like, brings us here to, to, like, getting maybe concrete inside the body and if you were to ask, say, you know, the thing we never really talk about, and this is gonna get a little, little out there for those of us that are, you know, clin- clinicians in, in medicine, um, the part that patients can actually report on that we really never ask them is, "Hey- What does safety actually feel like?

[00:23:22] Dr. Allen Bookatz: Not, not what does it mean to you, what does it feel like? And for those that are listening, if we just take a moment and just think about when we do feel safe, what happens? We, we feel that we can just take a breath and we can breathe, right? We're not forcing anything. Perhaps we are, you know, able to let our jaw loose a little bit.

[00:23:42] Dr. Allen Bookatz: We can... Our shoulders relax down. That's, that's like a form of guarding, right? Putting our, our kinda stance together. Um, that's bracing ourselves for a threat. We would find our muscles more relaxed, right? We might find that feeling that, you know, our hands are not necessarily, you know, clenched or our feet are sort of [00:24:00] planted.

[00:24:00] Dr. Allen Bookatz: It's a sense that we have a, a kind of a choice in how we're feeling. And let's just say if, you know, a, a, a good example would be like if you were sitting in a room and you had a choice, you could just get up and leave if you wanted, and that you could just... Or you couldn't. And those, both of those options are available to you regardless of, you know, consequence.

[00:24:22] Jodi Duval: I think that that's that freedom, isn't it? And it's, it's not a small thing. I think that is really at the end of the day how we can determine, uh, what was the reaction, isn't it? We are in control of our reactions. 

[00:24:32] Dr. Allen Bookatz: Yeah. And it's, it's not like this softer thing either. It's like whether they have control over what happens to them and the changes to their physiology.

[00:24:42] Dr. Allen Bookatz: That's, you know, that's the... It's, there's a conscious awareness that I f- this is how I'm feeling, and maybe aware of it, and then there's like, can I actually, you know, can I actually do something about it? So, and, and I know there's been a lot of- data and [00:25:00] studies over this over the decades. And so the mismatch we can see is that someone can sit there in, in front of you and say, "I know I'm, I know I'm safe."

[00:25:07] Dr. Allen Bookatz: Right? "I have no reason to fear my life," right? "I have, I have a roof. I'm, you know, there ... I'm not in the street. I have plenty of food." And yet they're sitting in this body that's, like, completely braced and vigilant and sleeping poorly and, you know, waiting for something to happen. Even though they, they have all maybe the right thoughts, the body just cannot sign off, right?

[00:25:27] Jodi Duval: Mm. Absolutely. And then there's the other direction as well. 

[00:25:31] Dr. Allen Bookatz: Yeah. What does that look like? 

[00:25:32] Jodi Duval: Yeah. So, you know, that's just such an enormous physiological activation, isn't it? It's something that, you know, is genuinely hard. You feel fundamentally fine, you know, but that, that activation, it's, it's gotta go somewhere, you know?

[00:25:45] Jodi Duval: And it's going- Yeah ... somewhere. 

[00:25:47] Dr. Allen Bookatz: And I, I tend to see that first one pretty frequent where, you know, someone's been told they look completely fine maybe, you know, 5, 10 times. They might even be doctor shopping or provider shopping, all having normal [00:26:00] workups and, you know, they're just... Sometimes even they're, they're just so aware of it and they, they apologize for, for coming for care, you know?

[00:26:06] Dr. Allen Bookatz: 'Cause they know they just, they just... They know what they've been told, but they just feel terrible. 

[00:26:10] Jodi Duval: Yeah. And they keep on coming and, and that's nothing s- Yeah. For, for me in, in clinic, it's nothing worse than when someone comes in and says, "I'm so sorry. I'm gonna have to com- I'm complaining about all these things."

[00:26:19] Jodi Duval: I'm like, "That's, that's my job. I need to listen to those." Like, I, that's my way of gaining information of your body and then reflecting that back to you so you then know what you're looking for, and then can be aware of the different sensations, feelings, messages, and screams from your body. 

[00:26:37] Dr. Allen Bookatz: And I think for those that are, those that are listening, it's important what you're h- what you're hearing us talk about 'cause this is definitely a, a little different than what we would typically be talking when we have the whole team here.

[00:26:47] Dr. Allen Bookatz: Mm. Um, but you know, Jodi and I are in our, in the fields right now, and, you know, we want those to hear that the patient... And what we want you to hear is that the patient is not the client or patient. They're not imagining it, right? And, and we weren't lying to [00:27:00] them either. So, you know, the tests that we ran were the right tests for what we've been trained for, and they were totally normal.

[00:27:05] Dr. Allen Bookatz: Mm. But the thing that's wrong with them now was never going to be on those tests, right? And, and so the-- that's like the blind spot in how we're tr- what and how and what we're trained to look for. The good news is those blind spots are, are fixable. 

[00:27:18] Jodi Duval: Yep. Absolutely. And I think this is where we just look at, um, different ways of interpreting data, and data is data in different ways, and this is where we have to have clues and we're listening in different ways.

[00:27:29] Jodi Duval: You know, I'm speaking for myself. You know, as soon as a client comes in to my office, I'm reading them in all different ways. I'm watching the body posture. I'm seeing the, the, you know, their skin color, the way they're expressing themselves, the, the constant, um, you know, words and sentences that they're repeating.

[00:27:50] Jodi Duval: You know, the way that their body is moving and holding themselves in different positions. And all of this comes with, with- within not even a second sometimes you can read some of this. And [00:28:00] then it's this consistent, you know, we use a lot of energetic medicine here in my clinic as well as very medical, scientific medicine.

[00:28:07] Jodi Duval: Hmm. But some of these medicines from the energetics require listening to those little, um, belief and perception points. And so-- and they're the ones that are stuck. You know, their belief systems are stuck. So we can help- Hmm ... shift that, and then bring the physiology back to normal as well, or balance, and then you've got both.

[00:28:27] Jodi Duval: You're working in both areas. Yeah. 

[00:28:29] Dr. Allen Bookatz: Yeah. It's-- And that's interesting. Even interoception has its own challenges here, right? 'Cause it's the-- someone's read off of, like, what their own internal state is telling them can be sometimes just turned up too high, right? Like we've seen in certain types of, say, in the c- like, for example, in the tryptophan, uh, metabolism pathway where the kynurenic pathway is, is upregulated.

[00:28:54] Dr. Allen Bookatz: We can see that the NMDA receptors are, you know, the, the dial has been, has been tuned [00:29:00] up to the point where, you know, every ordinary sensation is flagged as a threat. You know? And this is-- there's a real biochemical cause for this. And, uh, or the, the, the other side is it can be turned down so far that a person generally can't tell you whether they're hungry, tired, frightened, terrified.

[00:29:18] Dr. Allen Bookatz: And both of those, you know, kinda- change what the system concludes about safety here. Th- that's why, you know, listening to your body isn't always the best advice either for those of you that are listening and say, "I just, you know, my body's not telling me what I'm not getting good information from my body."

[00:29:33] Dr. Allen Bookatz: And that there might be, uh, an issue with the, what the tuners are, um, tuned at. 

[00:29:38] Jodi Duval: Yeah. And I think that's, you know, such an important point, Alan, actually because you need to know when the person is not reading that in a r- in a, in a well way, and they can get back to that. Like you say, like there should be messages that they're hearing but they're not, and why not?

[00:29:53] Jodi Duval: And so, you know, we look at m- metabolomics, we look at all these different data points, and we get the cell back to a [00:30:00] optimized state. But also we have to work within other areas too for that, for that safety. 

[00:30:06] Dr. Allen Bookatz: Mm. All right. So then none of us probably have a super clean answer to this, but how does the system know when that danger is over?

[00:30:14] Dr. Allen Bookatz: Mm. Not necessarily how does it detect the danger, but how does it get that all clear signal? 

[00:30:19] Jodi Duval: Yep. So the cell obviously isn't a timer. It's like ding, ding, ding. We're, we're good now, guys. Uh, it's permission, so each stage obviously has to complete before the next, and what moves it forward is generally a signal, you know.

[00:30:34] Jodi Duval: So it's not the passage of time. It's the response, you know, as one response resolves, that ATP alarm in- outside of the cell calms or cal- calms down and calms down. And the drop itself isn't the permission, so it's part of what the, the cell actually makes, you know, when it makes contact again and goes back to normal work or normal function.

[00:30:56] Jodi Duval: So the exit is this active event. [00:31:00] It isn't the absence of the original problem. It's actually a completion cycle. Yeah. 

[00:31:04] Dr. Allen Bookatz: Mm. So, like, think of it, what you're saying is you have to think of them as two very s- different processes. Removing the threat and then telling the body that-- it's telling the cell that it's actually safe to resume.

[00:31:15] Dr. Allen Bookatz: That's so funny how these, these, these mechanisms just map at every, at every level. On the nervous system side, right, the first is obviously protection, right? Something happens, you know, someone's attention narrows, their muscles brace, breathing is maybe tightened and changes. It's, it's rapid. It's fast.

[00:31:33] Dr. Allen Bookatz: You know, everything kind of gets committed, we'll say, physiologically, you know, and psychologically to that, like, immediate problem that's ahead of them. And, uh, everyone know-- everyone recognizes that. Then, then, you know, something, something changes, and the-- we're able to then not have that same, uh, acuity of focus on the issue.

[00:31:55] Dr. Allen Bookatz: We can then go, "Whew, okay, I have a, I have a moment that is no, you know, I'm no longer under [00:32:00] that threat." But I, uh, I'm not necessarily back in, back in full business. So-- And we'll say that that may be that third, you know, that last stage, which we're all familiar with, is that reconnection stage. So your, your more-- your curiosity's back.

[00:32:14] Dr. Allen Bookatz: We're interested in maybe other people. We can be social. We can play. You know, that's, that's the one-- that's the state we all desire to get to, right? 

[00:32:21] Jodi Duval: Yeah. Absolutely. You wanna be feeling open, you know? 

[00:32:24] Dr. Allen Bookatz: Mm-hmm. 

[00:32:25] Jodi Duval: Then there's the middle, right? That's that middle part. What's that? 

[00:32:28] Dr. Allen Bookatz: Yeah. I t- I ta- you know, t-touched upon it briefly.

[00:32:31] Dr. Allen Bookatz: It's- 

[00:32:31] Jodi Duval: Yeah ... 

[00:32:31] Dr. Allen Bookatz: it's sort of the one where we all get stuck, right? And we don't talk about it enough, that, like, the threat's over, and- And we don't have to, we don't have to put a ton of attention here anymore, but, like, the system hasn't concluded that the threat's over. 

[00:32:48] Jodi Duval: Mm. 

[00:32:48] Dr. Allen Bookatz: So it keeps asking, okay, is it actually over?

[00:32:52] Dr. Allen Bookatz: And, and that phase is sort of, uh, like an uncomfortable one that people are really not warned about. It's where we [00:33:00] sort of let go of that posturing or that muscle tone, right? That can feel like shaking or being braced or, you know, our muscles being activated to respond to a threat. We might need to run away from something, towards something, get in a fight.

[00:33:11] Dr. Allen Bookatz: Who knows? The, the feeling kind of starts to come back that maybe it was switched off, so now we're starting to feel a little bit more. And some of maybe what comes back doesn't feel so good, right? It can be, like, painful, and maybe you didn't notice what... You know, you didn't notice when you were mobilized what was, you know, what you were sort of guarding from, and that can be maybe even painful emotions.

[00:33:31] Dr. Allen Bookatz: Um, sometimes those can come later. And, and so, you know, you can imagine, I guess, if someone's moving from that first state to the second, even though we're no- in a no longer an acute threat, it's not a really comfortable place for them to, to be. 

[00:33:46] Jodi Duval: No. Absolutely not. So, you know, when we it's, it's a tricky thing, isn't it?

[00:33:54] Jodi Duval: Because then we, we wanna sort of bring it back to something that we can action, right? And so, you know, when we, when [00:34:00] we look at the cell, you know, we, we sort of like mis- we misread also when we, um, look at the cell. And then the rebuilding stage isn't this sort of quiet stage either. It's that, you know, it's a construction site really, you know?

[00:34:13] Jodi Duval: You, if you measured it, you expected, you know, health to l- look calm. And sure, I think it was a really cool thing to be thinking about. You're like, you know, it's all packing on top of each other in these beautiful, nice, little neat bricks. But it's a mess. Like, there is shit flying everywhere- ... out here and there, and it's being tossed out, and enzymes are being activated, and things- Mm

[00:34:35] Jodi Duval: are moving this way. So it does look like, you know, that it's, um, you know, something has gone wrong, but no. 

[00:34:43] Dr. Allen Bookatz: Yeah. I love that. The constru- it's the, the constru- it's like a construction site that was bombed. It's, uh- 

[00:34:49] Jodi Duval: Yeah. 

[00:34:49] Dr. Allen Bookatz: Yeah ... it's like just 'cause there's no more bombing doesn't mean it's pretty. It just means you're not, like, getting bombed anymore.

[00:34:54] Jodi Duval: Yeah, yeah, yeah. You're not, not actively under threat. Exactly. 

[00:34:58] Dr. Allen Bookatz: But it's still not a [00:35:00] safe place to walk around, you know? Really. Uh, there's rebar sticking out. And, and so what's... Okay, so what's funny is that I, you know, we, we often will, will- kind of come back and say, "Does th- is this person, like, regulated?" Um, and I never really know how to sort of answer that question.

[00:35:15] Dr. Allen Bookatz: And so when we refer to regulation, are we saying that, okay, are we, are we asking ourselves are they still in a protective mode years maybe after doing the thing that started it? Or maybe did they begin coming out of it, but never come, you know, really come to that third stage where they can be social and have full resolution?

[00:35:36] Dr. Allen Bookatz: And are they, you know, stuck in that middle, that middle ground that we just talked about? 

[00:35:40] Jodi Duval: Yeah. Yeah, and, you know, I guess that's what we have to ask, is that which stage is stalled, right? This comes back to the cell danger response is what we're, you know, really aiming for here. You know, because, you know, what the support and the things that we do for each part of the, the cell danger response or the stages [00:36:00] isn't the same.

[00:36:01] Jodi Duval: So when, you know, what helps the cell in the containment is not what helps it trying to rebuild. Yeah. 

[00:36:08] Dr. Allen Bookatz: Mm-hmm. Yeah, and it- if you can tell, this, this part of the, this part of the discussion, we really haven't mentioned the cell danger response, but if you can-- if you notice, there are some pretty stark parallels here to active danger, to danger is over, we are in, like, repair state.

[00:36:27] Dr. Allen Bookatz: And then, but we're not in necessarily proliferation and, you know, um, you know, times are good and plentiful and safe state. And so we have to kind of move through those various stages, not only at the level of the nervous system, but also at the level of the cell. So I guess, uh, how does the s- how does the system know that it, it's over?

[00:36:46] Dr. Allen Bookatz: Let's step into the shoes of our harshest critic here, because this is what we do best here. We try to steel man all of our arguments. Uh, so if I'm the intensivist listening to this, here is what I would say back. All right? I would say, "Dr. [00:37:00] Bookatz, you've built a lovely story here, right? With no measurement in it.

[00:37:03] Dr. Allen Bookatz: It's always-- it's all great to hear about protection and, um, moving through to, moving through to a state of safety. Um, but you know, you can't really tell me that when this person perhaps entered protection mode, and you can't really tell me when they left it. And any patient who doesn't improve, you basically get to explain that as a system that doesn't yet feel safe enough, um, which means that your model can never be wrong."

[00:37:28] Jodi Duval: That's a real problem, isn't it, with this sort of s- side of it and, um- You know, we're not gonna talk our way out of it, but this is where we have, you know, a look at the deeper things underneath it. So look, the ... We can measure metabolites, right? We can look at the patterns and we can say, this looks like a system running a conversation program instead of a repair program.

[00:37:52] Jodi Duval: What we can look at is, you know, the test saying that this person is in, you know ... Or we can gain enough data to put it this way. [00:38:00] You know, we, we learn the system to be able to go stage two, maybe that's we're looking at here. But we don't have the exact test. We only have interpretation around this. So when we're, you know, if anyone is saying that this is a thing, well, the, you know, let's have a look at that.

[00:38:17] Jodi Duval: Maybe they've, they've cracked the code. But you know, when we've, Alan, when we've got these, you know, tests that we've got, yes, we can understand some of the parts of these stages that people are in, but from an emotional stress point of view and in, you know, these, these reactions that we're talking about, 'cause we're really covering both sides of the coin here in this conversation, is that we're looking at the cell, and then we're looking at the nervous system or the emotional connections and the stuckness that people feel in different stages.

[00:38:46] Jodi Duval: And we can, we're, we're sort of modeling it off their cell danger response, right? So, you know, it's, it's now, it's the skills of the clinician really that we need to come down to being, and also then looking at [00:39:00] how we can support our clients and, um, guide them through understanding each parts of these processes of the cell and the, the, the, the stages of, you know, completion and also, you know, emotions and y- you know, where we're, we're storing things, how they've been stuck for years possibly, and what they're, what they're costing us now.

[00:39:24] Jodi Duval: Mm. And so, you know, when we look at conditions, which we don't always look at in health optimization medicine and practice, because we need to come back to the cellular environment and optimizing that. But metabolic and inflammatory conditions, they do shape how the body does read the world. You know, because the signals are there, right?

[00:39:43] Jodi Duval: And so it is a threat-based issue, and so the state of the body shapes that perception of how our body is also maybe hypersensitized around protecting it at a greater degree. You know, this is the- Mm ... psychoneuroimmunology field, isn't it? Right. Um- So perception shapes what [00:40:00] you're, what you decide is dangerous.

[00:40:02] Jodi Duval: And that decision feeds straight back into the physiology. So e- the arrows point always both ways. And so if someone's cells are short of what they need, we can do excellent work on that, um, you know, the physiological side. But we also need extra support to go, okay, so the psychological component, how do we create safety so then they both, both worlds come together and we can actually have that, you know, safety signaling and network signaling.

[00:40:31] Jodi Duval: So, you know, the body keeps filing these reports. They keep filing like, "Oh, store that one. Oh, I remember that thing." You know? Yeah. Same with, same with foods and intolerances. You know? Mm-hmm. The intolerances come in, it's like, "Oh gosh, this one was naughty last time and it caused us inflammation." Yeah. "We're storing that in our file, and every time that one comes in, then we're gonna get rid of that one or we're gonna ramp an attack."

[00:40:54] Jodi Duval: So, you know, I think it's just like maybe what we can do now, and let's, let's ha- [00:41:00] look at that, Allen. 

[00:41:01] Dr. Allen Bookatz: Yeah. 

[00:41:01] Jodi Duval: Mm. 

[00:41:02] Dr. Allen Bookatz: I love that. Mm-hmm. I love what you just said there. So I think it's a great... I think that's a, a great place to, um, to, to, for us to end. And so w- I guess, folks, uh, you know, what did we actually talk about today?

[00:41:16] Dr. Allen Bookatz: We didn't give a, we didn't give a do this on Monday protocol. We didn't tell you to stop anything that your doctor prescribed you, not that they, not that we would. If, uh, you know, if you're in acute danger or bleeding, we're not, I'm not telling you, I'm not gonna talk to you about safety signals. We're gonna stop the bleeding because that's what's appropriate.

[00:41:32] Dr. Allen Bookatz: But today what we did do is we took this one idea about cellular safety or just safety, and we took it very seriously at two different scales here. And I hope you took a, uh, what you came away with was or took away with was safety isn't necessarily the absence of danger, right? It's the capacity of a living system to recognize when protection is necessary and then to reorganize when it isn't necessary anymore [00:42:00] and to make its resources available again for repair, connection, adaptation, and growth.

[00:42:05] Dr. Allen Bookatz: And so in HOMeHOPe that's what we mean by practicing true salutogenesis, supporting the root cause of health rather than suppressing the symptoms of disease. And whether that is at the level of the cell or at the level of the nervous system, it's the same thing. And if you're the person whose crisis, say, ended a long time ago and who still isn't back, then just know you're not imagining it and you're not failing at relaxing.

[00:42:28] Dr. Allen Bookatz: We just haven't been looking in the right place. And for a long time we didn't know that there was even another place to look. So if this resonated with you, just like our other podcasts, please join us for the Health Optimization Movement at homehope.org. We'll see you on the next episode. 

[00:42:46] Jodi Duval: All right.

[00:42:47] Jodi Duval: Thanks everyone. Bye. 

[00:42:49] Dr. Allen Bookatz: Bye-bye.