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Jeff English is a trauma-focused clinical counselor with extensive experience working with adults, teens, families, and groups across various settings, including career counseling, life coaching, addiction recovery, professional workshops, and private practice. In this episode, Jeff shares insights from his work as a trauma therapist, exploring how moments of perceived helplessness shape behaviors and how adaptive strategies can become maladaptive over time. He discusses the concept of the “trauma tree,” examining its roots (causes) and branches (consequences), and highlights a powerful framework used at the Bridge to Recovery, a residential workshop where Jeff serves as an outreach specialist. Jeff reflects on the transformative power of group therapy, the role of vulnerability in fostering connection, and the challenges of letting go of control. He also offers practical advice on finding a great trauma therapist, balancing personal growth within relationships, and recognizing when it’s time to seek help.

We discuss:

• Defining trauma—a loaded word [3:00];
• The therapeutic process at The Bridge to Recovery: confronting discomfort, embracing vulnerability, and reframing one’s story [5:45];
• The roots of the trauma tree: the foundational wounding experiences that shape adaptive survival behaviors [11:30];
• The branches of the trauma tree: how trauma manifests through co-dependency, addictive patterns, insecure attachments, and more [17:30];
• The connection between trauma manifestations and underlying wounding experiences, trauma triggers, and the importance of surrender in the healing process [24:00];
• How surrendering control, eliminating distractions, and practicing vulnerability are essential components of the healing process [32:45];
• How adaptive behaviors developed during childhood in response to trauma can become maladaptive in adulthood [43:30];
• The difference between shame and guilt, and recognizing and addressing toxic shame and shame-driven behaviors [49:15];
• The unique rules at The Bridge to Recovery that support the healing process [53:15];
• Internal resistance to healing due to the fear of losing positive traits associated with trauma [58:15];
• The structured storytelling process at The Bridge, and the role of peer feedback in healing [1:05:00];
• The differences between immersive residential therapy and individual therapy, and how to determine the right approach for different individuals [1:09:30];
• Jeff’s personal journey as a client and therapist at The Bridge [1:22:00];
• The generational transmission of trauma, and breaking the cycle [1:25:45];
• The challenge of addressing socially acceptable maladaptive behaviors like workaholism, perfectionism, and overachievement [1:28:45];
• How to determine whether struggles stem from deep-seated trauma or just bad habits, and how rewiring maladaptive behaviors requires addressing the underlying emotional wounds [1:32:30];
• Breakthroughs that shatter beliefs and allows change to occur, and the process that creates this opportunity [1:39:15];
• Jeff’s advice on finding a therapist for trauma work [1:46:45];
• The importance of connection and vulnerability [1:52:45];
• How to encourage a resistant partner to seek healing [1:57:30];
• Jeff’s advice for those facing emotional struggles [1:59:15]; and
• More.

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In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions on diverse topics such as aerobic efficiency and VO2 max with Olav Aleksander Bu; insulin resistance with Ralph DeFronzo; economics of the US healthcare system and cost-saving strategies with Saum Sutaria; diagnosis and treatment of autism, ADHD, and anxiety in children with Trenna Sutcliffe; and strength training with Mike Israetel. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these fascinating discussions.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #338 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• Overview of topics to be discussed [2:00];
• Olav Aleksander Bu Pt.2 episode: metrics to track aerobic efficiency and insights about VO2 max, and the ability of increased carbohydrate consumption to boost performance [4:30];
• The best practices for performing a VO2 max test, the differences between VO2 max training and all-out efforts, and the role of energy intake in endurance performance [14:45];
• Ralph DeFronzo episode: the pathophysiology of insulin resistance and type 2 diabetes—how they impact different organs, flaws in conventional diabetes treatment, and more [24:30];
• Understanding type 2 diabetes beyond the traditional triumvirate of features: the “ominous octet” describes changes in other organs [31:45];
• Pharmacological treatments for insulin resistance and type 2 diabetes [41:30];
• The importance of early detection and intervention in insulin resistance [50:30];
• Saum Sutaria episode: the economic and systemic drivers of high healthcare costs in the U.S. [54:00];
• Reducing health care costs: redefining health insurance, lowering drug prices while maintaining innovation, leveraging AI for efficiency, and more [1:07:15];
• Trenna Sutcliffe episode: insights on autism, ADHD, and anxiety in children—definitions and diagnosis [1:11:45];
• Exploring the rising prevalence of autism spectrum disorder [1:17:15];
• Trenna’s views on caring for children with autism [1:21:15];
• Misconceptions around vaccines and autism [1:26:00];
• Mike Israetel episode: insights about strength training, minimum effective dose, troubleshooting plateaus, tips for beginners, and more [1:28:15];
• Topics Peter is interested in exploring in future podcasts [1:40:15]; and
• More.

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Ralph DeFronzo is a distinguished diabetes researcher and clinician whose groundbreaking work on insulin resistance has reshaped the understanding and treatment of type 2 diabetes. In this episode, Ralph shares insights from his five decades of research, including his pivotal role in bringing metformin to the U.S. and developing SGLT2 inhibitors. Ralph explores the impacts of insulin resistance on specific organs, the pharmacologic interventions available, and the gold-standard euglycemic clamp method for measuring insulin resistance. This episode is a masterclass in the pathophysiology and treatment of type 2 diabetes, featuring an in-depth discussion of GLP-1 receptor agonists, metformin, and a lesser-known class of drugs that opened Peter’s eyes to new possibilities in diabetes care.

We discuss:

• Metabolic disease as a foundational driver of chronic illness [4:00];
• Defining insulin resistance: effects on glucose, fat, and protein metabolism, and how it varies between healthy, obese, and diabetic individuals [8:15];
• The historical significance of the development of the euglycemic clamp technique for measuring insulin resistance [11:45];
• How insulin affects different tissues: liver, muscle, and fat cells [15:00];
• The different ways insulin resistance manifests in various tissues: Alzheimer’s disease, cardiovascular disease, and more [25:00];
• The dangers of hyperinsulinemia, and the importance of keeping insulin levels within a physiological range [29:00];
• The challenges of identifying the genetic basis of insulin resistance and type 2 diabetes [37:00];
• The “ominous octet”—a more comprehensive model of type 2 diabetes than the traditional triumvirate [45:45];
• The kidneys’ unexpected role in worsening diabetes, and how SGLT2 inhibitors were developed to treat diabetes [55:45];
• How insulin resistance in the brain and neurocircuitry dysfunction contribute to overeating and metabolic disease [1:04:15];
• Lipotoxicity: how overeating fuels insulin resistance and mitochondrial dysfunction [1:07:30];
• Pioglitazone: an underappreciated and misunderstood treatment for insulin resistance [1:10:15];
• Metformin: debunking the misconception that it is an insulin sensitizer and explaining its true mechanism of action [1:19:15];
• Treating diabetes with triple therapy vs. the ADA approach: a better path for diabetes management [1:24:00];
• GLP-1 agonists, the Qatar study, and rethinking diabetes treatment [1:31:30];
• Using a hyperglycemic clamp to look for genes that cause diabetes [1:45:15];
• The superiority of measuring C-peptide instead of insulin to assess beta-cell function [1:46:45];
• How GLP-1-induced weight loss affects muscle mass, the benefits and risks of myostatin inhibitors, and the need for better methods of evaluating functional outcomes of increased muscle mass [1:51:30];
• The growing crisis of childhood obesity and challenges in treating it [2:02:15];
• The environmental and neurological factors driving the obesity epidemic [2:07:30];
• The role of genetics, insulin signaling defects, and lipotoxicity in insulin resistance and diabetes treatment challenges [2:11:00];
• The oral glucose tolerance test (OGTT): detecting early insulin resistance and beta cell dysfunction [2:18:30]; and
• More.

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