Your Back Pain Isn’t What You Think, Dr. Amir Reveals the REAL Cause | Kreatures of Habit

Summary

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Podcast Summary: Your Back Pain Isn’t What You Think, Dr. Amir Reveals the REAL Cause

Kreatures Of Habit Podcast – Michael Chernow with Dr. Armin Tehrany
December 10, 2025

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Episode Overview

In this engaging conversation, Michael Chernow sits down with Dr. Armin Tehrany, a board-certified neurosurgeon, chief of surgery, and entrepreneur, to challenge and reframe common assumptions about back pain. Their discussion blends medical insights, personal stories, and practical advice, emphasizing a holistic, science-driven yet open-minded approach to spinal health. Key themes include the psychological and physiological roots of back pain, recovery routines, the promise of artificial disc replacement, and the profound roles of habits and mindset in overall health.

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Key Discussion Points & Insights

1. Dr. Tehrany’s Holistic Approach to Spine Health

• Three-Pronged Model: Dr. Tehrany stresses the importance of viewing spinal health through the lens of anatomy, physiology, and psychology—“We've ignored this three pronged approach to spinal care.” (00:08)
• Mental health, exercise, sleep, and nutrition are as critical as medical intervention in treating and preventing back pain.
• The “whole person” approach extends to alternative therapies and the inclusion of supplements and recovery rituals.

2. The Anatomy and Healing of Disc Injuries

• Discs are “basically a protein basket, which inside has a soft jelly called nucleus pulposus. Literally feels like soft like shrimp.” (09:53)
• Conservative versus surgical treatment is dictated more by patient symptoms and quality of life than MRI results alone.
• Chernow’s personal story reflects variability in recovery—even with serious MRI findings, non-surgical approaches can work if the patient’s function improves.

3. Physical vs. Emotional Trauma and Their Impact on Pain

• Discogenic Pain’s Emotional Toll:
  • “Discogenic pain does something to the brain that's completely different... it brings up this hopelessness in many patients.” (14:32)
  • Unaddressed pain can fuel the opioid epidemic; holistic care is vital.
• The Mind-Body Connection:
  • Psychological stress or life events can trigger or worsen symptoms (“recurrent sciatica after a divorce or after a real estate deal gone bad”). (16:25)

4. The Role of Habits and Rituals in Health

• Chernow emphasizes the transformative power of morning rituals such as early riser hunting and digital disconnection for mental clarity and CNS regulation.
• Dr. Tehrany endorses intentional routines for brain health:
  • “Your ritual is absolutely beautiful... the attention economy is robbing us of our lives.” (20:14)
  • He describes his own dual-mode mornings: “Clinic mode and surgery mode,” and shares his practice of inverted meditation.

5. Modern Life, Devices, and the ‘Attention Economy’

• Both speakers voice concern over the detrimental effects of constant digital distraction on brain health, energy management, and sleep.
• Early mornings and late nights are “when the brain needs its own purging of information and calm transitions.” (20:14)
• Movement and nature, like qigong or Tai Chi, are highlighted as cultural antidotes.

6. Central Nervous System (CNS) and Cognitive Fitness

• The CNS’s role in overall health is underappreciated; Dr. Tehrany calls it “the final frontier” for research and personal optimization.
• Four “horsemen” for future neurological health challenges: trauma (including microtrauma of daily living), dementia, chronic pain, and depression.
  • “We're going to have an epidemic of crazy disorders that all have to do with some form of neurologic disorder.” (24:26)

7. Recovery Routines & Practical Recommendations

• Every day should be treated as a “training day or a recovery day.” For aging populations, recovery takes priority.
• Concrete strategies: gentle walking, breathwork, foundation exercises (planks, squats, gentle yoga), ice/heat therapy, massage, cold plunge.
  • “Definitely ice for acute injury, heat for chronic injury. But I think ice at least once a week to just bring the inflammatory markers down.” (50:46)
• Importance of sleep hygiene—especially fasting before sleep to optimize “glymphatic” brain cleansing.

8. Artificial Disc Replacement: Myths, Evidence, and Candidacy

• Cervical disc replacement is now a “total success story”; lumbar disc replacement has advanced after earlier setbacks.
  • “The lumbar devices that are approved now have undergone rigorous testing... and it works.” (57:05)
• Recovery can be rapid: “You should be at 100 in three months... it's one of my favorite things to do.” (60:10)
• Patient selection is crucial; sometimes hybrid solutions (fusion plus disc) are best.

9. Alternative and Experimental Therapies

• Tehrany is open to integrating alternative medicine—energy work, acupuncture, psychedelics—into patient care when evidence supports it.
  • “Everyone's nervous system has a corridor through which we can biohack... There are many other alternative paths.” (33:33)
• He’s founded the Neurovella Brain Spa, offering both research-based and novel adjuncts like ketamine-assisted therapy.

10. Mindset, Addiction, and Habit Change

• Michael shares his recovery journey: “Habits will make you or break you. My habits nearly killed me.” (70:40)
• The key to sustainable change is stacking small wins and adopting positive identity-based behaviors, not merely seeking external “fixes.”

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Notable Quotes and Moments

• On the limitations of MRI:
  “The MRI doesn't necessarily tell the story.” – Michael Chernow (08:55)
• On psychological pain and trauma:
  “Discogenic pain does something to the brain... it brings up this hopelessness.” – Dr. Tehrany (14:32)
• On rituals and technology:
  “Right now the attention economy is robbing us... ritualistically, that's when the brain needs its own purging.” – Dr. Tehrany (20:14)
• On alternative therapies:
  “Our cognition really has a very powerful impact on manifestation of pain–manifestation of relief in pain.” – Michael Chernow (32:53)
• On disc replacement progress:
  “Cervical [disc]... totally success story. It works so well. It's my absolute favorite thing to do for my patients.” – Dr. Tehrany (57:05)
• On recovery priorities:
  “As we get older, recovery becomes so much more important than training.” – Dr. Tehrany (46:45)
• On piriformis syndrome:
  “[It’s] controversial... there is such a thing as performance-related pain... but not necessarily [from] pinching.” – Dr. Tehrany (62:47)
• On choices and agency:
  “Every single human has the ability to make a choice... the more wins I stack in the morning, the better chance I have...” – Michael Chernow (72:58)

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Timestamps for Major Segments

| Time | Segment/Topic | |---------|------------------| | 00:08 | Psychological component of discogenic pain—holistic approach | | 04:01 | Advances in artificial disc replacement—and hybrid procedures | | 09:53 | Disc anatomy explained; grading disc degeneration | | 14:32 | Emotional and psychological burden of discogenic pain | | 20:14 | Rituals vs. technology; the “attention economy” | | 21:37 | Dr. Tehrany’s morning routine: inverted meditation | | 24:26 | The future epidemic of neurological disorders (“four horsemen”) | | 40:23 | Psychedelics and the rewiring of neural pathways; ketamine therapy | | 46:45 | Recovery routines for athletes and non-athletes alike | | 50:46 | Ice, heat, and movement for acute vs. chronic injuries | | 57:05 | Fact vs. myth: artificial disc replacement—outcomes and patient selection | | 62:47 | Piriformis syndrome and atypical sciatica—diagnosis and management | | 70:40 | Michael’s journey: from addiction to building positive habits |

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Practical Takeaways

For Those with Back Pain:

• Focus on holistic care—address mind, body, and environment, not just injury.
• Conservative management is often warranted; MRIs don’t tell the full story.
• Exercise smarter, not necessarily heavier.
• Cultivate morning and recovery rituals that combine movement, nature, and deliberate disconnection.
• Don’t underestimate the role of mental health in persistent pain.

For the Health-Inspired:

• Stack small positive habits, especially early in the day, for cascading effects.
• Consider nontraditional therapies, but seek those with oversight, evidence, and credible practitioners.

For Medical Professionals:

• Expand the dialogue about spinal health to include trauma, lifestyle, and emotional context.
• Embrace patient individuality in both treatment planning and recovery pacing.
• Keep abreast of recent advances in surgical/artificial disc technologies and holistic adjuncts.

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End Note:
This episode bridges hard science with open-minded health innovation, giving both clinical knowledge and daily life wisdom. Dr. Tehrany and Michael Chernow offer a compelling blueprint for navigating back pain, aging, recovery, and peak health in our modern, distracted era—reminding us that healing is as much about mindset and ritual as it is about medicine.

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Transcript

[Michael Chernow]

I love that in your practice you think holistically, right? You're not like immediately like, okay, we gotta open you up, let's think about what we can do.

[Dr. Armin Tehrany]

Discogenic pain has a psychological component. Everything is part anatomy, which is the disc shock absorber, part physiology, which is hormones, muscle mass, cortisol levels, et cetera and part psychology. And we've ignored this three pronged approach to spinal care. If you came into my office, if you said I can't lift my children and it's really affecting me, my relationship is different with my wife and it's just not. My life is not the same anymore. I would also say what are you doing for your mental health care? Exercise definitely helps, nutritional supplements can help. Sleep quality definitely helps. And also pain control. So what do you do for your pain? Do you have a regimen? Is it all medications or is it breath work, cold plunge, other means of treating pain and also insight into psychological pain. One of the things that we need to do is just promote that more and more and more so more people will realize the benefits of it.

[Michael Chernow]

An entrepreneur straight outta New York City, Michael Chernow. What's cracking?

So you're a board certified neurosurgeon surgeon. You are.

Like chief of surgery at your hot at the hospital that you practice at. You are considered one of the greatest spinal surgeons in the country.

[Dr. Armin Tehrany]

Appreciate that.

[Michael Chernow]

And, and you're also an entrepreneur, right? You've got a really cool business that like one of the first things you shared with me, the, the these, this new brand that you've, you've launched Axon. You see a lot of you also are like one of the foremost surgeons on disc replacement which I really want to learn about that because God would I love a disc replacement in my L4, L5, potentially L5s1 and L3, L4. But I know that like I want let just give us a little bio just so everybody can get to know you first.

[Dr. Armin Tehrany]

Sure. It's truly a privilege to be here by the way. Great, great connecting. I'm a board certified neurosurgeon. I practice in Santa Monica, California and my day job is neurosurgery of the spine. And I would say, you know, at the top of my skill set is artificial disc replacement of the spine in the neck and the back. But I do it all. We do tumors, we do malformations, we do deformities of the spine. So I have a very robust and busy clinical practice and my passion since the very early days because spinal pain is associated with chronic pain and Addiction and trauma and a bunch of other related things. So my passion has become brain health as it relates to spine health and as it relates to the wellness of my patients. So because of that, these side projects started, like the Neurovella brain Spa, the supplements, and that's been the entrepreneurship angle. So when I saw you guys come up with a energy bar, you know, I've been looking at things to recommend to my patients and morning routines, et cetera, I was like, oh, what a fantastic coincidence because I've been looking into this for some time.

[Michael Chernow]

Amazing.

[Dr. Armin Tehrany]

And me and my partner look at peptides and you know, look at the degree of evidence. Like creatine is very exciting. Its cognitive effects are exciting as well as its effects on muscular health. So really a very exciting chapter. I'm blessed to do what I do on a daily basis. And yeah, I would say artificial disc replacement is something we do extremely well. So not to worry, I got you.

And it's been a godsend because in the past we used to only have to fit fuse the spine when a disc becomes extremely painful. And we still have to do it when it's like 10 level disease. But in isolated cases, we either mix and match artificial discs with a fusion called hybrid arthroplasty that we're very excited about because we got great research behind it now, as well as just one or two single or double level disc replacements in the neck and the back.

[Michael Chernow]

You know, so I've listened to a couple of podcasts that you've been on and you know, in doing my research, you know, something that you said, I don't remember which, which podcast it was, but something you said was really interesting. You know, you're a science, you're a science based human, right? Like you're a surgeon, you're board certified. The work that you perform is essentially science supported, right? However.

The outcomes are not 100% right. Like indeed, there could be things. Not everybody is going to heal the same way.

Is it a individual, is it an individual's characteristic or character that ultimately dictates how someone heals from a back surgery? Is it an individual's character that is going to make somebody eligible potentially for a back surgery based on, you know, their size and shape and the way they walk through the world? Like.

I'll give you a quick story for me. I was 30 years old. I was a competitive athlete and a dad, or not a dad yet, a husband and a restaurateur in New York City. I had, at 30 years old, I had four restaurants and I was just like, my life was insane, and I was ready to take it all on. And I was rolling jiu jitsu, and this massive guy essentially folded my body in half. And everybody in the gym heard the sound. It was audible like a. Like that. Like a.

[Dr. Armin Tehrany]

We hate that sound.

[Michael Chernow]

What?

[Dr. Armin Tehrany]

We doctors hate that.

[Michael Chernow]

Oh, gosh. And so. And I had never had back issues before, so I heard the sound. It wasn't, like, incredibly painful, but my whole entire back essentially, like, seized immediately. Like, my glutes seized up, and I was like, oh, my God. I'm having the worst, like, muscle spasm in my life. And it took me a while to be able to. It wasn't like, piercing pain. It was like my, like, like squeezing. Finally it let up, and I kind of, like, walked off a little bit. The next morning, I was done. I was completely couldn't get out of bed. Oh, I. I. Not only could I not get out of bed, I was in the most severe pain shooting down my right leg.

[Dr. Armin Tehrany]

Like, yeah, that's big.

[Michael Chernow]

Classic devastating. Devastating. And so I didn't know what to do. You know, we went to the hospital, got mri. In the mri, they. It. So the wrist, the disc had ruptured. They saw a fragment of disc sitting right on top of my sciatic nerve. And they basically were like, we have to open you. Like, that disc is not going to degenerate. It is not going to. To fall away. And if it does, the chance of it falling into your spinal column could be really bad for you. So we're going to have to open your back up and remove this piece of disc. And I just refused. I was like, I. I'm going to have to go see someone else. Like, I'm too young, you know, because I had heard stories, right?

[Dr. Armin Tehrany]

Like, incredible story.

[Michael Chernow]

Thanks.

[Dr. Armin Tehrany]

Yeah.

[Michael Chernow]

And so I went to go see a few different guys in New York, and they basically all said the same thing. We have to take this thing out.

[Dr. Armin Tehrany]

Right.

[Michael Chernow]

I love that you think in your practice, you think holistically, right. You're not, like, immediately, like, okay, we got to open you up. Like, let's think about what we can do. And I heard that in your. In your story on other Indeed podcasts. And I want to talk about those other things that you suggest to your patients if you don't think it's absolutely necessary to get surgery. But I did a couple of different things that really. I mean, I was in excruciating pain for eight weeks. I could not stand up past 45 degrees. And finally I got to a place where I felt like I could go back in and just beg for a cortisone shot because they were like, we're not giving you a cortisone shot. It doesn't. Like, it's not going. This. The disc is that the fragments on the nerve. Like, it's not. It's not going to change.

[Dr. Armin Tehrany]

Right.

[Michael Chernow]

I found an anesthesiologist who would give me a cortisone shot. I got a cortisone shot and my pain just went away.

[Dr. Armin Tehrany]

Amazing.

[Michael Chernow]

And it creeps up on me every now and again. If you look at my mri, it does not look good.

[Dr. Armin Tehrany]

I can't wait. Yeah.

[Michael Chernow]

Like, it looks. It looks bad. And another thing that you said on. On the podcast or podcast is like, the MRI doesn't necessarily tell the story, you know, and so I want to talk about. I want to ask you about trauma.

[Dr. Armin Tehrany]

Yep.

[Michael Chernow]

And the spine.

[Dr. Armin Tehrany]

I mean, your. Your example is so perfect because it shows the variability of presentation, decision making, which decision tree are you going to take? And outcome. And you're here and you haven't had surgery and you had an injection, so. And disc biology and disc pathophysiology, if you will, is very complicated. The disc is actually a dead jelly. It doesn't have any major, you know, blood vessels. The side of it has some innervation. But basically, your jelly material was sitting on this nerve.

[Michael Chernow]

What is it? What is disc?

[Dr. Armin Tehrany]

It's a. It's a. It's an proteoglycan. So it's basically a protein basket, which inside it has a soft jelly called nucleus pulposus. Literally feels like soft like shrimp or something like that. If you had to, you know, go with the consistency of it.

[Michael Chernow]

And you see them all the time.

[Dr. Armin Tehrany]

Yeah, that's. That's my right.

[Michael Chernow]

And healthy ones and unhealthy ones.

[Dr. Armin Tehrany]

Yeah, exactly. And sometimes we have, like, no disc when we're trying to replace a disc because disc has already been digested by the body. Sometimes there's even only air in the disc. The only thing that remains is a little air bubble in the disc. There's no disc because it all herniated out and it got degenerated and worn out over time. So I can't wait to look at your MRI and give you a. You know, there's grades of degeneration from 1 to 4.

[Michael Chernow]

Should we just do it right now? Sure, just do it right now because we're on the. We're on the top.

[Dr. Armin Tehrany]

Let's do an MRI consult.

[Michael Chernow]

And I think I, you know, perfect. So.

[Dr. Armin Tehrany]

So basically, depending on whether that extruded fragment that was sitting on your nerve.

Separate it from the mother disc. Sometimes it dictates how quickly your body can chop it up and let it go. Yeah, this is perfect. We should zoom in on this.

If we can, but we can do it later.

Sorry, bring it back. You have a L4.5 disc that's completely degenerated and the other disks are now feeling the, the heat a little bit. But your L4.5 is the problem. It's got a bulge, is almost hitting the nerve still. And yeah, this, that looks, this is a very typical case of what we would operate on. Well, if, if you're miserable, right, like, you know, like, you can't sit, you can't drive, you just did a one or two hour drive. So you tell me, you know, it would, it's all based on your symptoms. It's not based on this.

[Michael Chernow]

Knock on wood. And, and I, I, I will share one thing that has sort of like changed my symptoms for my low back. I love training. I train my ass off. I, oh, I thought that there was like one way that I needed to train when it came to strength and, and weights. And I, and I thought it was heavy. Like, that's what I thought. I was like, okay, heavy is what I got to do. Everybody says the deadlift is like one of the greatest lifts of all time. You got to do heavy deadlifts, heavy squat. Once I removed heavy deadlift and heavy squat. Now that doesn't mean that I don't do RDls and dumbbell RDls where I'm really stretching out my, my hams and my glutes and like, I still do a hinge movement. But as soon as I got rid of heavy deadlifts, conventional heavy deadlifts and heavy squats, my back pain has been, it's gone.

[Dr. Armin Tehrany]

That's very smart. I mean, that's one of the things you recommend is lower weight, more sustainable red fiber training as opposed to big muscle white fiber training. But you need both. We know strength training is extremely important for spinal health. And someone like you, you know, the, the bottom line is you don't have to be miserable. You don't have to be in pain for rest of your life. If you're, if you're hitting, you know, a week where you only have a minor ache one day out of the week, I would not recommend surgery.

[Michael Chernow]

Right.

[Dr. Armin Tehrany]

If you're having a week where you can't drive, you can't lift your children, you know, your workouts are not the same. You're having to really modify and you have a low quality life, you need a disc replacement. And those are two extremes and many people fall in the middle. But decision making is extremely important. And I bet your fragment extruded itself completely away out of the disc space. And even though it was sitting on a nerve and looked very impressive, it lost its hydration from the disc space. And your body just said, we'll take care of this large fragment and your macrophages cells came and just chopped it up. Now it just has this residual disbulge. But if you notice, you also have no shock absorber. You have very little shock absorber left. Between L4 and L5, there is this white signal on your vertebra that we call MOTIC endplate changes. It has to do with bone that's under stress. So bone that's under stress because the shock absorber doesn't work right. So in flexion, you know, when you bend forward, that's when the disc is loading and that's where you probably feel it. So that's why, you know, more, less weight, but more reps and a sustainable workout is a lot more important, as is recovery, recovery, recovery.

[Michael Chernow]

I agree. I want to. Let's get, let's get back to the discs that you were talking about. And, and the, and, and, and like, not necessarily physical trauma, but emotional trauma in the spine.

[Dr. Armin Tehrany]

Yeah. So that's been another one of my really interesting discoveries. From very early on, we knew that discogenic pain, even in training we knew discogenic pain does something to the brain that's completely different than many other spinal problems like arthritis or even nerve pinches from spurs and things of that sort. Discogenic pain has a psychological component and it brings up this hopelessness in many patients. And I always tell my research assistants that to look in the eye of the patient if they look hopeless, that they have discogenic back pain. It's terrible and it really wreaks havoc. I think the opiate crisis was, at least in my patients, was partially due to discogenic pain that just went untreated. And doctors got used to just giving out OxyContin pills instead of realizing the whole person approach, which is everything is part anatomy, which is the disc shock absorber, part physiology, which is hormones, muscle mass, cortisol levels, et cetera, and part psychology. And we've ignored this three pronged approach to spinal care, which I advocate for and I really believe in, because, you know, many people come in, like, if you came into my office, I'd be like, I think your psychology is pretty good. You have a good balance of everything. But if you said, I can't lift my children and it's really affecting me, my relationship is different for my wife, with my wife, and it's just not. My life is not the same anymore. I would also say, what are you doing for your mental health care? What are you doing? So there's things that, you know, I love that you're a creature of habit, but there's things that we can habitually do to enhance our mentation. Exercise definitely helps. Nutritional supplements can help. Sleep quality definitely helps. And also pain control. So what do you do for your pain? Do you have a regimen? Is it all medications or is it breath work or is it cold plunge or is it other means of treating pain? And also insight into psychological pain is very important because people can be dealing with a psychosocial problem that brings out the spinal pain, which is very interesting. Like people can have recurrent sciatica after a divorce or after a real estate deal gone bad, which is like, it literally is. The nerve is getting less of an energy budget because the brain is dealing with, with something completely different and just can't pay attention to that nerve or doesn't want to give it energy. And we're, yeah, we're trying to research this stuff because I think the body budgeting of that sort of axoplasmic flow, which is the flow of electricity through our nervous system is something that we don't quite understand yet, but I see.

[Michael Chernow]

It every day interrupting this episode to share with you that creatures of habit finally launched our protein bar. It's called the Daily Bar. It's made with 20 grams of plant based protein from 3 grams of creatine. Yes, you heard that right. It also has 3 grams of creatine. It is incredibly tasty and clean as a whistle. All clean ingredients. Take this opportunity. Hop over to creaturesofhabit.com that's creaturesofhabit.com with a K and use code K O h p o d 20 at checkout for 20% off your first order back to the pod. I mean I feel like we're, I mean obviously there's a lot that we don't know about the brain. And I'm of the belief that like what is happening in modern day society is actually pushing us further and further from learning about the brain because we're distracted all the time. Right. Like one thing that I have implemented into my life that is I'm like incredibly passionate about for a number of reasons, but ultimately really to take me outside and in Silence and is hunting. And I, I'm, I'm a hunter. I mean I love to hunt. It's hunting season right now and for the last month, every Single morning at 5am Whether I harvest an animal or not. For me it is just an unbelievable practice because I get outside at 5am, I'm by myself in the woods in the dark, listening to the, to the forest, listening to the birds and the squirrels and, and the sounds of the trees and the wind and like I'm in the elements and it's cold and I'm feeling that and I'm alive and I'm like alert and I'm focused and I'm not on my phone. It's like there. I'm learning so much more about myself in those, in those moments because I'm there from 5 to 8:39 in the morning. And then if I don't, if I don't have a crazy afternoon, I'll go back out from four to four to six. And so we don't do that. We just don't do that.

[Dr. Armin Tehrany]

Yeah, I mean time. Just a time commitment. That's a, that's an incredible time commitment that you just.

[Michael Chernow]

And you know what? Another thing that I also have been really interested in sharing more about is like now I've created a life where I'm, I'm able to say, hey, you know what? Between 5 o' clock in the morning and 8:30 in the month of November, I am doing my hunting thing. Like I'm doing it. I'm not taking meetings at 9:00am My wife knows that. Like, hey, this is the one month out of the year that I get to do this thing that I'm so passionate about. But I just use it as an example that like I do believe that technology and modern communication is just the absolute downfall of humankind.

[Dr. Armin Tehrany]

There's, there's good evidence for it actually. I mean everything from the light on our phone to the fact that the first thing we do in the morning is to check messages or something like that, it's definitely has effects on our brain, on the balance of energy in our nervous system and getting up with a routine of breathing, just settling in and just coming into what we call that theta super creative mode of the brain, which happens very early in the morning. It's beautiful. Your ritual is absolutely beautiful. And I think one of the things that we need to do is just promote that more and more and more so more people will realize the benefits of it. Because right now the attention economy is robbing us from robbing yeah, just absolutely robbing us of our lives. And it's going to become more and more prominent. You have young kids, I have young kids. So, you know, and it's easy to say, oh, we're just going to limit device time or something like that. But it's harder to actually say what. Let me capitalize on the early mornings and the late nights first because I think ritualistically, that's when the brain needs its own purging of information and calm transitions more at any other time. So I love that you brought that up. I do definitely believe the early mornings are very powerful.

[Michael Chernow]

Do you have a morning routine?

[Dr. Armin Tehrany]

I do, but I might differ based on. I have two modes. I have clinic mode, I have surgery mode. So clinic mode is a little more relaxed. I get to sometimes take one of the kids to school, so it's a little bit more dad time. And I'm going to the office dressed up to see patients. So it's different. Surgery mode is a lot more.

Habituated, I would say, because training in neurosurgery is almost like a boot camp. So you have to shift gears and just go through that habit of making, making sure that everything's perfect, like a, you know, fighter pilot mentality. And so, yeah, I love, I love even teaching my children about it that, you know, tomorrow's surgery. So I'm not going to see you in the morning. I'm going to. I'm going to be out the door before you even wake up. And I wasn't a morning person, so that was the really interesting thing about neurosurgery. It. It shocked me into becoming a morning person. And now I love it. Now I can't. Now I can't go back, you know, now even on non surgical days I get up early, but I just kind of ease into the day. I do a meditation. Sometimes I do the meditation in an inversion table. So I got all kinds of.

[Michael Chernow]

Wow, you know what? I interviewed probably 200 people on this podcast and people have mentioned meditation. Of course they've mentioned inversion table. No one has done an inverted meditation. I am going to do that, guys. Inverted meditation. I will follow up with you on that one.

[Dr. Armin Tehrany]

Let me know how it goes.

[Michael Chernow]

I love that.

[Dr. Armin Tehrany]

I've definitely enjoyed it.

[Michael Chernow]

That's so cool. So how long do you meditate for inverted?

[Dr. Armin Tehrany]

Usually 10 minutes. Wow. Nothing. Nothing too crazy. But it definitely, I mean, it definitely eases all of the networks and clears me up.

[Michael Chernow]

I just think that there's just something that we're not really clear on with the central Nervous system. I think the central nervous system has a lot more to do with, with our overall health than we're talking about.

[Dr. Armin Tehrany]

I think that I'm so happy you bring that up.

[Michael Chernow]

I think the CNS is like, it's kind of almost you know, like again I have to bring it back to. And it's hunting for me because that's something that I love to do. So it doesn't have to be hunting for you or for anybody listening. But the thing that hunting does for me is it takes me outside in the quiet.

[Dr. Armin Tehrany]

It's a ritual.

[Michael Chernow]

It's a ritual. It takes me outside in the quiet and I have a pretty awesome morning routine when I'm, when it's not hunting season. But I, I just can't help but I feel so good and I feel like my CNS is, is nice and regulated and there's something there that we're just. That I don't like. It's, it's. Someone's got to figure out what it is.

[Dr. Armin Tehrany]

I mean it's just managing, managing the energy of the nervous system is something that every individual is doing every. Anyway all day long. People do it with caffeine, people do it with alcohol, people do it with weightlifting, et cetera. We're constantly energy managing. The problem is attention, economy, doom scrolling, everything we need to get done. And we don't have any ritualistic habits to say I have to do this to balance myself a little bit better because I will be a better doctor, better father, a better person and happier and more connected. So we just have to continue to promote this. I'm really happy you brought up the cns, this kind of like final frontier, this, this mysterious next step for humanity. Because I really believe cognitive fitness needs to be just as important as physical fitness. And we're, you know, we're constantly like yeah, mental health matters and you know, we have these like cliche taglines. But we're going to have an epidemic of crazy disorders that all have to do with some form of neurologic disorder. And the four bandits or Horsemen that I'd like to mention is trauma. Again, trauma. Our veterans, our athletes, the everyday micro trauma of life that affects us emotionally, physically.

Truck drivers going on long hauls with their spine bouncing. All of these are physical trauma to the nervous system, dementia, which is going to happen, it's happening at a very alarming rate more and more and more. And we have mild cognitive dysfunction that we can notice. We also have some preventative measures including weightlifting and strength training.

[Michael Chernow]

What do you think that the Spike in dementia is due to.

[Dr. Armin Tehrany]

I mean, there's many theories on it. I don't think it's as simple as, oh, we're on our devices all the time. I think it has to do with, first of all, we are aging longer. Second of all, I think there is an intestinal component or microbiomes in the Western culture is not as healthy as it can be. And we're dealing with a lot of processed foods, we're dealing with all the.

[Michael Chernow]

Poisons in our system, a lot of environmental toxins.

[Dr. Armin Tehrany]

Yeah. So I feel like the mind gut connection will be where we need to go to unlock that, both for Alzheimer's and Parkinson's. And there is also infectious or low grade infection components that can happen. So the brain's constantly fighting off things. And the brain is a very protected place. It's constantly fighting off insults, environmental toxins, infections, cancer, et cetera. It's constantly getting rid of stuff. And I think as we learn more about things like the glymphatic system, which is like the, what I love to call the rinse cycle of the brain, which happens during sleep, we will be able to learn how we potentiate that system to clear off toxins.

[Michael Chernow]

Can you unpack that a little bit? The glymphatics?

[Dr. Armin Tehrany]

Yeah. So, you know, in the past, I would say 10 to 15 years, the real scientists, which are in the lab doing all the hard work, have figured out that the intestines and the lymphatics, which is a way by which the body just clears its crud, has a direct component in the brain as well, where anatomically, the spinal fluid is rinsing the neurons and trying to get all the toxins out and then give it to its other channels, which are basically lymphatic channels.

[Michael Chernow]

So giving the toxins to the lymphatics to then ultimately clear it out.

[Dr. Armin Tehrany]

And so this concept of spinal fluid that also, by the way, moves during breath work. It's really important to know that.

We'Ve been studying microgravity environments for space travel. And one of the things that doesn't happen in space is that spinal fluid flow than natural rhythmic spinal fluid flow. Because breathing in microgravity is different. So a lot of things we need to unpack. But the glymphatic system is very important for clearing out toxins and crud and metabolic waste from the brain and the central nervous system. And there's specialized cells with very large processes that are literally these, what I call like rinse pods for the supporting cells and neurons.

[Michael Chernow]

This I, when I When I had that, that initial spinal injury.

I ended up going down a pathway of like witch doctors. Really? Really. I was like, okay, I'll do, I'll do anything. I just don't want to get surgery right now if it ends up that I have to get surgery. And I just. Because I can't live like this. But I'm gonna give it everything I got.

[Dr. Armin Tehrany]

Take it to California.

[Michael Chernow]

Well.

There'S enough wackadoos in here. Here in New York, man. I went down to a guy named Master Ho who's like a, in like out of a movie. This guy is like, name is Master Ho. And he basically he works on like a lot of celebrities, but he's like this old Chinese guy that just is a qigong master. And like, you know, like I met. I got introduced to this really interesting.

Chiropractic work called.

Network chiropractic. Have you heard of this?

[Dr. Armin Tehrany]

Not, not that one. Many methods.

[Michael Chernow]

So it's a very interesting style of chiropractic work. They barely touch you. They, they touch your tailbone a little bit. They like will rub you behind the ear. And it's this very light sensation, energetic work. I walked into the office, somebody told me that it cured their back. I was like, I'll do anything. So I walk into the office and it's like eight beds and this one, this one practitioner just walking up and down, like, barely touching people, like moving their, his hands over their head, like he's like putting salt on, like. And these people were wailing, moving their bodies, wailing. And I saw like, he would like work on somebody and he would like, like, if this is their back, like, say this is their back, he'd like pull like this. And I guess they were so intuitive with this guy at us, after a certain amount of time that they would move their, their glutes up. He would, he would do like that and they're face down. It was wild. I was not open to it though. Like, I just wasn't. It was too. I'm an open dude. I will try anything at least twice. But this was just far out. This looked like I was walking into.

[Dr. Armin Tehrany]

Was it effective?

[Michael Chernow]

So the first, the first time he was like, listen, he walks up to me and he's like, look, he's like, I, you, you. You're looking at this and I know what's going through your mind. He's like, think what you want, judge however you'd like. Lie down on the table. Be open minded. Let me see if I can help you. You obviously look like you Someone that can use some help. So he put two pillows under my hips. I got on the table. Nothing, man. Not a thing. No. No screaming, laughing, crying, yelling, moving my body. Nothing. I felt nothing.

[Dr. Armin Tehrany]

And you felt no difference.

[Michael Chernow]

No difference. And I just did not have anywhere near the experience that these other people were having there. So after it was done, I was like. I don't know. I was. I was in my mind. I'm like, he's. Is he paying these people? Like, what's going on here? He was like, look, dude.

Fair enough. Like, you don't want to open yourself up to it, that's fine, no problem. He's like, but here's what I will tell you. Those people in there.

Have an amazing experience in this setting. You look like you need something to shift. So I would just go home and think about it. If you can come back here tomorrow with a completely open mind and ready to receive whatever the body is showing you, meaning if for whatever reason you lie on the table and you actually feel like laughing or you feel like making noise based on a. Some sort of a touch that he's like, just go with it, go with it, go. And he's like, and if you can't, all good, no harm, man. This one's on me. Like, just like, good luck. I went home. I was like, man, like, I just. Anyway, I show back up at the office the next day because I'm like, fuck it, I'm going to do this. I had an outer body experience. An outer body experience and made my back feel so much better. And what it showed to me was like.

Our cognition really has a very powerful impact on manifestation of pain, manifestation of relief in pain. So powerful. That was the first time that I experienced something that I was like, wow, like, we can really use our brains to impact.

Sensation.

[Dr. Armin Tehrany]

I think you should give all my future speeches for me, because that's exactly what I've been trying to tell people in different ways. I use biohacking terms.

I used to use this term called corridors of susceptibility. So everyone's nervous system has a corridor through which we can biohack into it to do beneficial things for their nervous system. And you somehow, by going home and thinking. Thinking through that process, whatever the thinking substrate in your cognitive apparatus did that night opened up a pathway, a metabolic pathway that your brain thought was resistant to it, and it thought it was impossible to get there. You opened that up by whatever your brain was able to open up to. And then that suggestive practice of, hey, this is going to move Your anatomy around in a way that maybe some heat or some energetics are imparted onto the area of the trauma, and something happens. I mean, it looks like magic. I. I've seen it. I've also experienced random orthopedic trauma and pain. I've had many surgeries, and I've gone to energy workers and acupuncturists and chiropractors to investigate because, you know, I don't have an ego. I want my patients to get better no matter what, either with my surgeries or without. Or as part of a sort of like a bag of tricks that we have. There are many other alternative paths. Being a western trained allopathic physician.

[Michael Chernow]

I.

[Dr. Armin Tehrany]

Have a lot of respect for people that can make people better through their skills in many other ways. It's just, unfortunately, the bar of science for those practices.

Has not been met at a level one class one evidence. I don't know what it will take, but I think we should engage it. We should engage that community to say, hey, can we put some scientific value, some P values, some statistical knowledge behind this to see who will it work on? How beneficial will it be? Will it be 75% effective, 99% effective, and actually be able to guide people through this instead of having to go through word of mouth or these things that look like snake oil operations or mill operations? And I think certain acupuncture is a great example. It didn't work on me as well as it could have.

[Michael Chernow]

I think it's never worked on me.

[Dr. Armin Tehrany]

Yeah, it works on many people. And I'm always like, why did it not work on me? Like, I. I tried to be open.

[Michael Chernow]

I.

[Dr. Armin Tehrany]

You know, and I went to a master in Santa Monica who's excellent. I still send patients to Dr. Dow all the time, and it just didn't have the same effect on me. So I feel like that corridor of susceptibility in your nervous system where something is open metabolically shifts the pathways in a way that makes it easy to go from A to C. Your brain is going from A to B all day long. And then you somehow open this A to C pathway, which is by far my absolute favorite research subject, because I want to help my patients do that. But the other two bandits or horsemen that we didn't discuss, other than dementia and trauma, is pain, chronic pain, which is truly a brain problem, not a spine problem. But it happens in the spine a lot to many of my patients, including ones that have been forced into addiction because of the use of narcotics, or at least tolerance, but sometimes Addiction. And that's a whole different, very interesting brain topic for physiology. Brain. Yeah, absolutely.

[Michael Chernow]

I mean I've had a double board certified neurologist and addiction specialist on the podcast. I'm in recovery for the last 21 years. And so it's, it's super interesting to me to understand the addiction thing. But it, but it is. And he has done human clinical studies on addiction in the brain and has pretty much concluded that addiction is a brain disease. Like he, when I was saying that I was, you know, I, I, I, I, I was addicted to drugs, he was like, no, no, no, no, no, you, you weren't addicted to drugs. You, you have addiction. Right. I was like, I never really thought about it that way.

[Dr. Armin Tehrany]

Right.

[Michael Chernow]

And basically saying that like our lipid system fires at like a 10x in comparison to someone who does not have addiction.

[Dr. Armin Tehrany]

Yeah. And we're just learning this, I mean this is, this is amazing because now with functional MRIs and much better clinical and imaging, we're able to look at those networks and be like, oh, this brain is wired differently and it fires at this rate. And the A is talking to Z in this way. And we could infer it based on just psychological intelligence, but we could never put objective data behind it and now we can't. So I'm really happy that you got that as well. And the final of the four is depression. So societal depression is wreaking havoc on us and there's a lot of good reason for it. There's wars and famine and why can't we get it straight? And some of it is social media and isolation and doom scrolling and divisive disinformation that tries to constantly rev up our emotional systems by making us angry and making us, you know, kind of aroused about something that we feel wrong that's going on in society. And because, you know, the goal of social media is engagement, they don't care how they get it. The goal is to just get you to be aroused and keep scrolling or click or you know, something. So, and it's not their fault. They're, they're there to do their job and they are very effective. And you know, the fact that you are also on that social media makes me believe that we can also turn that around to make the consumer more intelligent about what they're consuming. Because nourishment to our brain is not just nutrition, is experience. And that's the most important, I would say, takeaway home from watching people like you were able to somehow make that metabolic shift in their brain. Not every person Dealing with addiction can, and I think realizing that nourishment doesn't just come from what you put in your body, including the chemicals that you're doing to numb some pain, but it comes from community, like you've talked about, and also certain habitual practices that literally change the nervous system, like breath work and things of that sort.

[Michael Chernow]

I'm curious, as someone who works on brains and sees a lot of brains, like, actually, what are your thoughts on psychedelics and the rewiring of the neural pathways through the psychedelic experience? Like, what is your thoughts there?

[Dr. Armin Tehrany]

So I'm actually very open if it's done through a research protocol first, number one. Number two, is that the brain spa, the Neurovella brain spa, which I created for our patients with chronic pain. We actually offer psychedelic assisted therapy now through a company called Mystic Health. So if it's the correct set and setting, so it's not just hanging out.

[Michael Chernow]

With your friends at a rave where.

[Dr. Armin Tehrany]

You know, you go into a dark place and have a bad trip and done that, something terrible happens, you know, and you hear those stories. But in the correct set and setting, when you have support, you're inspired, you're. You illuminate certain dark spaces in your psyche that you haven't been able to deal with, and it can unlock a lot of bad pathways into a very beneficial state. So I am optimistic, cautiously optimistic. I follow Robin Carhart Harris all the time. He's brilliant in the way he's rolled it out. And we've had a great resurgence of bona fide scientific centers studying psychedelics in a way never done before. We lost the opportunity in the late 60s because of the party atmosphere. And I think, you know, for good reason. The governmental bodies and many doctors were like, oh, no, we don't want to go there. That's. That's terrible. But now, it started with ketamine in very low doses for chronic pain and other substances like psilocybin, showing some promise, which is.

[Michael Chernow]

So what do you offer at the. At the spa?

[Dr. Armin Tehrany]

Right now? Just ketamine.

[Michael Chernow]

Okay.

[Dr. Armin Tehrany]

Because that's the only one that's, you know, federally not, you know, regulated at a research level. But we are applying to be a research center. We also have a research institute. They're called ini, which I formed after my father got Alzheimer's. So I had a personal reason to be like, okay, what else can we do to the brain to bring wellness into the community? And it was, what can we do electrically? What can we do chemically? And what can we do through experience? And that's the three things we're working on on the brain spa. So ketamine is a chemical induction of certain brain states that can help unlock old trauma. I wouldn't say it treats dementia or anything like that. So I don't want to make that, make that relationship at all. But for depression, chronic pain and certain forms of trauma, we're also investigating emdr and there's some, some great, great practitioners who offer that. And I've talked to them and I collaborate with them. Basically, I'm, I'm developing a best in class. So a person like you shows up, you don't have to go look for that, you know, snake oil doctor. Be like, no, no, we got someone for you. And they're, you know, being, they're, they're under a scientific umbrella which we're investigating. So it doesn't have to be that you have nowhere to go and it doesn't have to be surgery or, or else you're out. So it can be like, yes, we can take care of you, not just surgically, but through some other means. And many times I feel like, you know, somebody comes in with a disc herniation, they're anxious to get surgery and they're not like you, they're the other way. They're like, I'm going tonight. And I'm like, you don't have nerve damage. You don't have, you know, you have the kind of disc that could get better with a cortisone injection. Let's, let's try cortisone injection. I'm here for you. I'll operate on you next week if your pain doesn't go away. And, and many people's pain gets managed in a way that they can go back to physiotherapy, core strengthening, etc, and they might need a disc replacement in their life. And I try to be a useful partner for them to say, yeah, you, you like. You're a perfect example. You know.

You'Re absolutely a perfect example. I can look at your MRI and.

[Michael Chernow]

Be like, perfect candidate.

[Dr. Armin Tehrany]

Yeah, we need to replace that disc at some point because your, your metabolism may not be able to sustain this, you know, truncal load and the loads that you're, or you want to put it through. I'm a surfer and surfing is a spinal sport and many times after, you know, you go on a surf trip, it's usually three, four hours of surfing and then you try to do it again that afternoon to try to get, get as many sessions as possible. Your spine looks, it feels like it is in severe spasms for a week straight. And many of my colleagues, we make fun now on the way back from a surf trip, we're like, well, we got to line our injections, our cortisone injections and our inversion table and ice. And so after a certain age, you know, you're a dad as well. You, you to be super dad, you have to, you have to have recovery and the mindset of recovery at all times to stay in again.

[Michael Chernow]

Okay, so there's. Before we end, I've got three things that we have to accomplish. A. I need to understand your recovery habits and what you suggest, what you do personally and why. Like, and I would love to hear a little science behind that because there's a lot of people that come on the podcast that are not certified, you know, scientists, doctors, surgeons. Second.

Artificial discs. I've heard that they are great in the cervical spine and not necessarily as potent in the lumbar or, or, or thoracic. So I want to understand that. And then third is. Oh, man, what was I going to, what was the third one? That was really, I really wanted to ask. Well, let's, let's start with.

[Dr. Armin Tehrany]

I think we should go in the second hour. This is, this is too exciting.

[Michael Chernow]

I mean, I could talk to you for days, dude, me too. I mean, I could.

[Dr. Armin Tehrany]

You're totally invited to California, by the way.

[Michael Chernow]

I will take you up on that. I'll be in California in March, so, you know, good. Hopefully not for, hopefully sooner, but so I let, let's just talk about your, your recovery habits as a, as a doctor surgeon that works with people in athletics across the gamut. Like, what have you seen to be actually effective?

[Dr. Armin Tehrany]

Yeah, I mean, I, so what I like to, I like to consider all my patients athletes at, and no matter what their activity of life is. And I deal with patients across older age groups all the way to, you know, I have a 14 year old patient. But I, you know, I think the most important thing is every day of our life can be looked at as either a training day or a recovery day every day. And your initial morning mindset, if you have the option of choosing one, usually tells you what kind of day it is. I mean, I wear an OURA ring. I try to like, put some physiologic markers behind it. But the bottom line is every day is either a training day or recovery day. And as we get older, recovery becomes so much more important than training. Training is very important when you're 20, at 50 or 60, recovery is more important than Training and your training shouldn't cause more injury. Your training should be, I would say if you're injured, go to 25% of your maximum in whatever your strength training habit is. But basically where I start is gentle walking, gentle breath work and gentle spinal movements. We have a group of exercises that we adopted actually with the help of a chiropractic colleague that we call the foundation exercises. They're actually online as well and we offer that to patients and we, it's, it's not complicated. It's certain plank poses, chair poses, squatting type and those are great for spinal health on a recovery day. And if even those are too intense, then you turn one step down, you, you can do massage, gentle physiotherapy, ice, heat, ultrasound, electronic stimulation like when your back was completely out. But no movement creates issues. So we want movement, ice baths or.

[Michael Chernow]

A cold exposure in general. And back pain.

[Dr. Armin Tehrany]

Yep.

[Michael Chernow]

What are your thoughts?

[Dr. Armin Tehrany]

Acute injury, excellent. Chronic injury needs to add heat as well. And sauna and a red light. Sauna is very, very beneficial as well.

[Michael Chernow]

For red light, what is an actual protocol that you would, you know, that you've seen to be successful?

[Dr. Armin Tehrany]

Yeah, I.

[Michael Chernow]

Is the science legit on red light?

[Dr. Armin Tehrany]

There's definitely some science behind it. It's about how long does it treat an acute problem versus a chronic problem is, hasn't been sorted out. But an acute setting and the bottom line is if you, if you overdo all this, your life just becomes you're going from spa to spot a therapist to spa. So you have to be practical. So I always say even if you get in once a week, you know, so it's not, I'm not very prescriptive. You want people's life to go on, but you want them to have a joystick of that life. So when they get up in the morning, they have tools in their armamentarium to ease their day, to ease what they actually need to get done. Because certain people don't have the luxury of saying, oh, this is a, definitely a recovery day, I don't want to work. So you have to use tools like bracing, ice, heat, stand up desks, tools that make the, even the office work environment. You know, one of my favorite things to talk about is tech neck or text neck. Both of them, both of them occur to my patients all the time. I saw my 88 year old mom the other day going like this for, you know, for like quite a long time and I was like, she's going to be sore in like 30 minutes just from that. So we are we are doomed because technology is making our spines have to assume certain positions for a long time and that is abnormal for the spine. The spine likes to move. The spine likes to be in nature and Hunt at 5am and that's what's healthy for it. Movement, walking, gentle, gentle spinal motion. Definitely ice for acute injury, heat for chronic injury. But I think ice at least once a week to just bring the inflammatory markers down in your.

[Michael Chernow]

So cold plunge once a week is, is great.

[Dr. Armin Tehrany]

Fantastic. Yeah.

[Michael Chernow]

And what do you, what are your thoughts on cold plunging multiple times a week?

[Dr. Armin Tehrany]

Yeah, I mean some people do it all the time. I don't have a. Again, I'm not prescriptive about it. I don't think we have enough science to be like, oh, you have to do it for 10 minutes. And we. That science is lacking. It's not there. But I've seen the effects. I have a very inflamed ankle from an old injury, old surfing injury. When I do a cold plunge, it doesn't hurt for the rest of that day. It just feels like I'm a kid again. Just doesn't hurt.

[Michael Chernow]

One other thing that I just want to mention that I think is really interesting.

And like you said, the Western medicine, your Western medicine trained for the most part that is very science focused, if not all science focused. And anything outside of the parameter of that is always going to be questionable. Right. In. In the eyes of the Western, sort of like through the, through the Western lens.

I don't know how much time you've spent in Asia. I haven't spent an enormous amount of time in Asia, but I've been to Asia multiple times. And in the morning when you are in Hong Kong or in Japan or in Thailand and you're walking through, you know, a city or wherever, you will see massive groups of older people doing qigong. Massive. Every. In every region that I've been to in Asia. Every. My favorite thing to do on trap when I travel is I wake up and I go for a run to explore the city before either my wife and I or where I like. I go for like a five, six mile run and I like me, it's the greatest way to see a city or wherever you are. And it was. It's just dawned on me that all of these Asian communities move their arms to move their. And what I'm learning through a friend of mine now who's really sort of taken to qigong is that it's just the most incredible way to get the lymphatic system going right. It keeps the lymphatic system active and it brings that fluid in and out. And so, like, is that something like the 100?

[Dr. Armin Tehrany]

I do. I do. So on clinic days, I try to do a mini yoga session with my kids. You know, they're learning. I'm trying to get them into, like, the practice. So gentle yoga moves. I think Tai chi is so, so profoundly effective. And yeah, there's a lot of wisdom in those cultures. I remember going to a gym in Seoul, Korea, and they had, you know, they had all the usual equipment and then they had a meditation room inside the gym. And it's not a modern. It was. It was an older gym and there were a lot of older guys just relaxing and it was a huge real estate. And I was like, wow, they really dedicate. They're really into that recovery mindset. They realize that the everyday grind requires that. So, yeah, I love that you saw that. You're right. I didn't think specifically about Tai chi and also yoga. I mean, I feel like competitive yoga can injure you. Gentle yoga is the best thing that ever happened to my patients. So I, I highly, I highly recommend it. But I, I want my patients to realize that. I want everyone to realize that respecting your physiology doesn't mean get after it every day. It means get after it when the right energetics exist and help recover when they don't exist. And you should have many tools in your recovery box. I feel like sleep is really underrated and the quality of sleep and it's not just about, oh, I gotta get seven hours. And I'm gonna take as many magnesium tablets as possible to get that. Seven hours really has to do with sleep efficiency, which is also scientifically, you know, very hot topic right now.

[Michael Chernow]

When you go to bed, when you wake up.

[Dr. Armin Tehrany]

Yeah, but how, how your facet. Yeah, yeah. How your brain recovers. And I feel like that's the only time where I feel like fasting is a reasonable idea. And I know you have some opinions about that. Is. Is try to sleep when your, your, your gut is not dealing with a bunch of food. So it has a, it has a light load on it.

[Michael Chernow]

Meaning give yourself two to three hours before bed without food.

[Dr. Armin Tehrany]

It's the only, that's the only essential takeaway piece from that. So. So your gut doesn't is not distracting or stealing energy from your brain's ability to do the glymphatic work that it.

[Michael Chernow]

Needs to do, I think so. You know, you probably are alluding to the, the recent post I did on, on intermittent fasting. Maybe. You know, my thought on intermittent fasting is I actually think it, I totally am an advocate for, for giving your body two to three hours of, of no food prior to bed. It's the, it's the not eating till 12 or 1 o' clock in the afternoon that I think could very well be effective for lots and lots of people. But I think the stress, the mental stress that it puts on people, should I do it? Shouldn't I do it? How long should I do it? When should I eat? What should I eat in the window? When should I stop eating? When should I start eating? Should I intermittent fast today? Ooh, I don't know if I want to eat right now. Oh, like, it's just too much, you know?

[Dr. Armin Tehrany]

And I couldn't agree with you more. And Dean Wilson, if you're watching, he's one of our physician assistants in California who's a really fit guy and really gets after it. And we used to make fun of how hungry he was in the operating room because he was just like, you know, he was just visibly hungry, starving.

[Michael Chernow]

Because he fasted, because he was like.

[Dr. Armin Tehrany]

Trying to make it to 1pm or something like that. So if you're watching, this is for you.

[Michael Chernow]

I really do want to talk about the disc though, in the last few minutes that we have, because of course that's your specialty. And I think I would love to learn more about it because obviously, knowing what I have going on in my lumbar, I'm sure that there's going to be a time, hopefully not anytime soon, soon where, like something if, if the, if the disc replacement is, is there and ready, like, I mean, it would just make sense for me.

[Dr. Armin Tehrany]

So lumbar disc replacement had a false start in early 2000s due to this disc that has yet has been taken off market, called the Charite. Because of that, the initial scientific studies of lumbar disc replacement just weren't that good. Cervical discipline replacement, totally success story. It, it works so well. It's my absolute favorite thing to do for my patients. And we've mastered the technique so much that the patients are like, well, why did you scare me from this surgery? And I tell them because it's neurosurgery and we're near your spinal cord and your carotid artery and your esophagus and a lot of important stuff. We've just gotten so good at it that they feel like they just had a minor tonsillectomy. They just feel, feel really good. The lumbar devices that are approved now have undergone Rigorous testing. I'm talking about 17 to 20 million cycles of fatigue, more than a human lifetime. And the Prodisc L, which is the only disc that's approved at two levels now by the fda, is the one that we use routinely. And it works. It doesn't have the problems that Charite had in the early 2000s, where lumbar artificial disc got a really bad rap and it became sort of an only a New York and LA thing, and the rest of the country quit doing it. We have definitely seen amazing results now with lumbar disc replacements for appropriate candidates. Patient selection is the most important thing. And sometimes hybrid constructs, sometimes we'll fuse the worst level below and put a lumbar disc above. What happens with fusion, after fusion, after fusion is it rigidifies the spine so much that the next level that's still trying to do all the appropriate motion for you to check your blind spot and do your athletic work. That's the problem with the fusion that it begets more and more interventions and operations. That's what we've observed in certain patients. This fusion concept just dominoes. And there's. You know, the latest studies show that natural history of the patient due to arthritis and genetics can also do that, where you just continue to get disc degeneration above. So, yeah, we. Me and my partner at our surgery center do routinely do one, two, all the way up to four disc replacements, which is not usually covered by insurance, by the way. They only cover up to 2 of the lumbar spine with excellent results. So I have to say it's.

[Michael Chernow]

And, like, what. So what is the recovery process on a disc replacement in the lumbar? Like, how long are you back to.

[Dr. Armin Tehrany]

Great that you brought that up. So initially, after surgery, for about two weeks, it's about wound healing. You know, it's about taking care of your incision. So if you go to the gym too early because you feel good and you, you know, tear a suture, that's not great.

[Michael Chernow]

Yeah.

[Dr. Armin Tehrany]

So we sort of put everyone on a leash for anywhere between two to four weeks and then individualize their return to activity, with the goal being 100% at three months. Wow. And that's a. That's a conservative goal. Some people get after it even sooner.

[Michael Chernow]

Wow.

[Dr. Armin Tehrany]

But if you. If you're an athlete, you should be at 100 in three months. Now, what I like to do is to say, okay, if you're a downhill skier or water skier, wakeboarder, I want that season to be a relaxing season for you. Don't get Competitive. Just stay in the most relaxed mode possible. It's hard for skiers because they want to go on the man. They're crazy slow, possible and snowboarders. So I feel like the take, take home message is lumbar disc replacement works in the correct patient. And recovery is about individualizing how quickly you return to activity, at what percentage and what is your baseline activity. And then I usually work with an expert physical therapist and we literally individualize your recovery to say this is what your core is like, this is what your back muscles are like, what your glute eye are doing. Your buttock muscles are very important in lumbar recovery. And what's your activity tolerance? How long were you able to walk or sustain a high level cardiovascular load before the surgery? So I would say it's. I mean, it's. One of my favorite things to do is to replace discs because people are.

[Michael Chernow]

Are our people like, like, is it, is it like.

[Dr. Armin Tehrany]

Well, yeah, you immediately feel like your foundation. You're now sitting on a better foundation.

[Michael Chernow]

You're making me want to get it, man.

[Dr. Armin Tehrany]

I mean, your entire body feel like. Because it's, it's slowly, you know, losing five degrees and five degrees and five degrees and it's losing. So because you're born with the lumbar disc being a little wedge shaped, so you have this natural parenthesis like curvature we call lordosis. So one of the most important things it does, it actually gives your lordosis back. So when you're sitting, you're. The arc of your lower back is. Is normal.

[Michael Chernow]

Wow. Well, I'm so happy that I now know the best surgeon in the world to do it. I mean, I am. I just am. I'm gonna say that selfishly. And the last question. And then we're gonna have a protein bar. And I want you. I know that you created a really cool promotion for our audience for the holidays, which I'm excited for, for you to share. And I also want to talk about axon as well, but.

Piriformis disease, Right?

[Dr. Armin Tehrany]

Yes.

[Michael Chernow]

So there are some people that say this is totally fabricated, does not exist, impossible, that your sciatic nerve is actually being pinched by your piriformis. And maybe, you know, I'm. You're probably way more articulate on what the piriformis is than I am, but I, I just want to know if, like, what is the actual facts around piriformis?

[Dr. Armin Tehrany]

Yeah.

[Michael Chernow]

And sciatica.

[Dr. Armin Tehrany]

I love that you brought that up because it's, it's a truly a controversial topic in spine and you know, most practitioners say, oh, that, you know, that syndrome doesn't exist, etc. But we have a thing called atypical sciatica. And my first job as a doctor, as what I call the Sherlock Holmes of spine, is to figure out what is causing that pain. So that's literally the most important thing I do, is to figure out, is it the sacroiliac joint, is it performance? Is it a typical sciatica from the lumbar spine? Is there a tiny disc that just bulged a little bit more? So I feel like performance syndrome has to do with the chemical or inflammatory milieu around the sciatic nerve. I'll say that in English. You know, what is going on around your sciatic nerve? Is it inflamed for a reason? It doesn't have to do with performance, pinching it like we're so used to. And I have some of these discussions with our French and international colleagues because they're like Americans are so used to saying nerve pinching, nerve pinching. But there's a lot of dynamic physiology that goes around and nerve pain that doesn't have to do with actual mechanical, mechanical compression. But we always look for mechanical compression because that's what surgeons visually, that is.

[Michael Chernow]

Kind of like what you think, right?

[Dr. Armin Tehrany]

Like, I don't think the performance physically pinches it, but I do think there's something about inflammation or in and around the sciatic nerve that has to do with performance. That has nothing to do with a lumbar disc or SI joint. But both those other conditions have to be ruled out first. And sometimes clinical problems like a lumbar disc declare themselves over time. And MRI is very revealing. And sometimes the initial answer is, why don't we do a trigger point to the performance area? And that feels amazing for many patients, just a trigger point injection. So, yes, there is such a thing as a performance related pain. I don't think sectioning the muscle has been as effective as, you know, some of my colleagues that only deal with performance syndrome do that.

[Michael Chernow]

They'll separate the muscle.

[Dr. Armin Tehrany]

Yeah. They'll ligate it or cut some of the fibers, et cetera. I just don't think that's the sort of way to get around the inflammatory environment. I think we have to get to the root cause of inflammation and it happens a lot more often than people think. And I think reconditioning the glutes through appropriate weight training, that's not too much. And recovery at the same time, because as we get older, we also lose muscle mass. So how do you hold on to muscle mass. I think creatine being a speaking part of that.

[Michael Chernow]

What do you want to try? Cookie dough or the chocolate peanut butter?

[Dr. Armin Tehrany]

I'm so torn.

[Michael Chernow]

This is like, let's go chocolate peanut butter, man.

[Dr. Armin Tehrany]

Okay. Yeah. Yep.

[Michael Chernow]

So this is the daily bar.

[Dr. Armin Tehrany]

We just launched it.

[Michael Chernow]

3 grams of creatine, 20 grams of plant based protein, all clean ingredients, substantial. This is like a snack that is going to actually like make you feel satiated between meals.

[Dr. Armin Tehrany]

I'm so excited.

Okay.

[Michael Chernow]

What do you think?

[Dr. Armin Tehrany]

It's really good. It's really good.

[Michael Chernow]

Like if you had to compare it to something.

[Dr. Armin Tehrany]

Oh, I'm a huge enthusiast of these types of bars. So these, this is what I do in the morning before surgery with some supplements, with some vitamins, sometimes a banana. And that's my, that's my morning morning jam before, before getting into action.

[Michael Chernow]

I think what I love most about the bar is that it's it. It. Well, it reminds me of like a Reese's peanut butter cup for, for sure. And, and that's like taste wise texturally and taste. Thank you.

[Dr. Armin Tehrany]

No, it's better. It's got 20 grams of protein, 20.

[Michael Chernow]

Grams of protein, 3 grams of creatine. But also it's like not a bar that you just want to like scarf down right away. It's a bar that you like can, can like take your time with and take a few bites of and like put it back down and take a few bites because it's actually satiating. It's nut butter based. Both bars are nut butter based. Sorry. For the people that have nut allergies.

[Dr. Armin Tehrany]

I see.

[Michael Chernow]

It's a nut butter based bar. So the chocolate peanut butter is obviously peanut butter and the cookie dough is a blend of cashew and sunflower butter.

[Dr. Armin Tehrany]

And plant based.

[Michael Chernow]

And plant based. No seed oils, non GMO gluten free, dairy free.

[Dr. Armin Tehrany]

Incredible.

[Michael Chernow]

We're really excited about it. Thank you, man.

[Dr. Armin Tehrany]

I will be a super user of your, of your bars.

[Michael Chernow]

Thank you.

[Dr. Armin Tehrany]

As well as your meals, you have the Meal One.

[Michael Chernow]

Meal One is our hero skew. It is a high protein overnight oatmeal. I've been eating this for basically 20 years now.

[Dr. Armin Tehrany]

And the reason it's overnight is because it marinates.

[Michael Chernow]

Yeah. So there's a, there's a number of reasons why overnight is, is in my opinion a little bit better. One, the oats absorb the full flavor profile of what we're trying to create.

They, you know, some people struggle with digestibility in oats. So when you soak oats, there is zero digestion issues. Right. They just become soft and very, very easy to metabolize.

And, you know, like, it's almost like sprouting. Right? Like, when you sprout something, it actually offers more nutrients. And so in the soaking overnight process. Process, you're kind of sprouting the ingredients in there. They're absorbing all the flavors. The full flavor profile is really executed well in the overnight process. And so that's why we did it overnight.

[Dr. Armin Tehrany]

Incredible.

[Michael Chernow]

Thanks, man.

[Dr. Armin Tehrany]

I can't wait to try that either.

[Michael Chernow]

You're a legend. I'm, like, so stoked that we met and, you know, so many people struggle with. With. With back issues and. And spine issues.

[Dr. Armin Tehrany]

No, it's truly a privilege to. To be of service. And I do want to offer. Anyone who's watching that wants to have their MRI checked or even do a quick consultation with me, we're going to give you a discount call code called Creatures with a K. Let's go after. After Creatures of Habit. So you're welcome to use that discount code and make a. An official consultation with us at 800-899-0101, Neurosurgical Spine Group in Santa Monica, California. And you. You get your first free consult yourself.

[Michael Chernow]

All right, let's go. I'm going to take you up on that for sure.

[Dr. Armin Tehrany]

Yeah. No, I'm beyond, beyond impressed and honored to see.

The entire community that you've been able to create out of basically creating healthy habits, beating addiction.

Creating a family around this health culture. And also, habits are an essential part of brain function. It just what the brain does. And for whatever reason, we are prone to bad habits a lot. And it's fascinating to me how you have to kind of like, you know, go a little uphill to get a good habit in there. So tell me a little bit about, you know, like, we talk to the. We have Marines and NFL athletes and, you know, veterans as patients. And, you know, they have this funny saying in military called embrace the suck, where, you know, no matter how hard the day is, you just kind of go for it. What triggered the initial like, oh, no, I'm going to turn this Titanic away from the iceberg in you to do that?

[Michael Chernow]

Well, I mean, you know, I say it all the time. Habits will make a make you or break you. Right? And my habits nearly killed me. I flatlined from addiction, from heroin. And I was introduced to a guy who basically told me that your habits don't have to destroy your life. As a matter of fact, the habits that you are very capable of implementing on a daily basis Simply small ones will actually help you build a life way beyond anything you could have ever imagined. And I didn't believe the guy when he said it to me. But after following his footsteps for, you know, 60, 90 days, my whole entire experience of life was different. And that's when I realized that, like, we all have the ability to commit to both good and bad things. When I. My message. Once I saw that, I didn't think that there was a way to get sober. I just didn't think that that was possible for me because of how, like, committed I was to the drugs and the alcohol. Once I saw that I was able to absolutely 100% parlay that ability to commit into a positive thing, I was like, oh, my gosh, I could really help people. Like, I could actually truly put fitness in front of somebody, put nutrition in front of somebody, and give them someone to look up to. Because that's ultimately what it was for me. I found somebody to look up to that I wanted to impress, that I wanted to get a pat on the back from. He introduced me to fitness and putting positive, healthy things into my body, whereas I was, you know, doing the exact opposite. Anti fitness, anti positive, healthy things into my body. He put those two things in front of me and I watched that. Like, I was as obsessed with that as I was with alcohol and drugs. And, you know, look, it's an. It's not.

[Dr. Armin Tehrany]

I love the way you put that. I think one. One of your statements was, I thought my life was going to be church basements. And some. Somehow that something's inspired you to turn that into this, this incredibly positive thing and have the zest and the enthusiasm to want to do it more and more and more. I think that's the key.

[Michael Chernow]

The. Also the other piece is that, like.

We all can do it.

That's the craziest part of it all. Like, every single human.

Barring some physical ailments or some mental ailments potentially in people, every single human on the planet has the decision to. Has the ability to make a choice, and we're delivered, I don't know, thousands of choices to make every single day. What am I going to say? What step am I going to take? What am I going to wear? Am I going to hit the snooze button? Am I going to eat this? Am I going to eat that? Am I going to say this to her? Am I going to judge that person? Am I going to allow that person thoughts of me to make me feel better? You know, like, we have choices all freaking day Long and you know, the more wins you stack in the morning, specifically for me, the more wins I stack in the morning, the better chance I have to make the right decision over the wrong one throughout the rest of the day. And like, that's just the simplicity of it. And I'm not unique. You know.

When people DM me or ask me like, hey, how do I start? You know what the fuck to do. You know exactly how to start. You know exactly what to do. You want to get in shape, you know what to do. You want to stop eating sugar, you know what to do. You want to lift 400 pounds, you know what to do. You want to start a business. You may not know exactly what to do, but you can, you can't be afraid to take a risk because if you're afraid to take a risk, you're going to never be able to take a swing. And you know, like, there's just like, it's, it's a, we, a lot of us know what to do and the.

[Dr. Armin Tehrany]

Hardest part is don't first step sometimes can be a little intimidating. But it's, but it's the most important.

[Michael Chernow]

It's the most important. Right?

[Dr. Armin Tehrany]

Like, to me, I think it's the mindset that I think you, I commend you for that. It's like how, you know, how do we train mindset? And there's, you know, there's a lot of people online talking about that and I think training, mindset, training how to think is the single most important thing that we can do about our ever so growing societal problems is training people how to think. Because we're going to have to deal with AI and disinformation and you know, this could be another two hour podcast that we should have because I want to talk about manifestation and paradox of choice.

[Michael Chernow]

Do you have a podcast and do you.

[Dr. Armin Tehrany]

No, no, we're starting one with our researchers because we have so many of conversations like this. So we're going to do what we call INI Studios, which is Institute of Neuro Innovation. You'll be invited to the events. It's a very exciting group of young and, and seasoned scientists that have conversations like this.

[Michael Chernow]

Well, I think, you know, it would be fun to have you recurring on the show because obviously we have great conversation and I'll be in LA in March, so we should definitely book a studio and, and, and, and have a round two for sure.

[Dr. Armin Tehrany]

Sweet.

[Michael Chernow]

It was wonderful having you on the show, man. For everybody out there, how can they follow along in your journey? What can, where can they Find you.

[Dr. Armin Tehrany]

Yeah, I. By the way, I hope you enjoy the. The.

[Michael Chernow]

Oh, the axons. Yeah, yeah. Let's talk about this real quick. So tell me about axon.

[Dr. Armin Tehrany]

So, yeah, so me and two other co founders came up with nine ingredients to basically give the brain a early morning rinse cycle with clarity, focus and memory. So it's got adaptogens and nootropics. It's got lion's mane, Bacoba, which is an ayurvedic herb, as well as B6, B12, citicoline, phosphatidylserine. These are all like structural parts of an axon. They support synaptic transmission. And I know supplements in general, there's some controversy around them. And creatine is a perfect example. Supplementation with creatine took a long time to get this much evidence behind it. We believe that lion's mane and bacoba and a few other ingredients in this formulation are the same. They're going to be the next generation of. Oh, yes, of course. We need that in the system to enhance nerve function. So that body budget that I'm talking about, the brain and spine, needs certain substrates to maintain optimal function in some people. And if you have normal levels of everything and your intestines work perfectly, then you don't need supplements. But we know, like, your bar is a great nutritional, you know, step to do in the morning. It's got some creatine, it supports muscles. So axon is sort of like our way of saying, how do we support nerve function with three tablets early in the morning, before noon.

[Michael Chernow]

Sweet. Well, I can't wait to see.

[Dr. Armin Tehrany]

I hope you like it.

[Michael Chernow]

Yeah, I'll. I will. I will give you a full recap after doing it for a week. Thank you for these. Of course, Doc, you're awesome, dude.

[Dr. Armin Tehrany]

It's such an honor. It is truly, like, beyond, beyond stoked to be. To be part of your community. And I think, you know, what you've done is like, what I like to study scientifically is what you've done naturally. Like, I'm like, how did he do it? Like, you know, like, because it's. Because, you know, like, I want to empower my patients that are suffering with addiction and opiates and back pain and just can't, can't get out of the draining the circle, which I always say we have to interrupt the circle somehow. And sometimes early surgery is the best thing for them because it gives them like an event zero that we didn't even get to discuss. Like, he gives them, like, this jumpstart because they're under anesthetic and they come out with some part of their body structure fixed, but they have surgical pain. That's a whole. It's a whole different conversation. Well, we'll have it, because that one's even more fascinating about how do we give people an event 0. You had your event 0 when you met your sponsor and when you met the cranial sacral guy, which sounds really cool.

[Michael Chernow]

Obviously, you guys are probably sitting at the edge of your seat just like I am. This was such an incredibly. Just like a wisdom drop. Just like an enormous amount of content that is going to give you something to think about if you struggle with back pain. I am. Like, I am a candidate for a mirror. Like, I am. I mean, you know, like, God willing, I have a bunch of years left in me where I don't have to necessarily get back surgery. But, like, I think any. Any doctor surgeon that would look at my MRI would be like, oh, yeah, like, oh, you're. You're crippled in pain. Like, it makes total sense based on your mri. But luckily, I take good care of myself and, you know, but I know a lot of you listening and just people in general just struggle and battle chronic back pain. And so, you know, we have talked a lot about that here. It's also really amazing to. For me to learn that lumbar artificial disc surgery is actually, like, in a great place and effective and works really well. Anyway, this one really, like, I was just so engaged, so interested. I can't wait to do more, quite frankly. And, you know, if this podcast really moved you, do me a favor. The only rent I ask you to pay is to share this thing. Share it. Share with a friend. Share it with someone in your family. Share with. With. With your social media audience. Just share the podcast that helps us grow. Giving us a five star rating in a review obviously helps us grow. It would mean a lot if you did that. That is. That is really me twisting your arm there. But, you know, I just appreciate you guys for tuning in. I appreciate you guys for tuning in, subscribing to the podcast and being a part of this community. It means the world to me. And, you know the deal. Until the next one, y'.

[Dr. Armin Tehrany]

All.

[Michael Chernow]

Peace.