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Episode 1 – Origin Story, meet Dr. Ashley Mak and Sara Subhani

Ashley: Hello everyone. Thank you so much for tuning in. This is going to be our first episode of the Fix Your Sciatica Podcast. On today’s podcast, I actually have myself as well as Sara Subhani, who is our Nutrition Coach. I’m so excited because we’re starting this podcast from something that we’ve been building over the past year, starting in 2020. We can’t wait to share all of our amazing stories, action steps with you throughout this process. So Sara, go ahead and say hi to the folks. 

Sara: Hey, guys! So my name is Sara Subhani and I am a certified health coach. I was certified by the Institute for Integrative Nutrition back in 2016, and currently I’m going back to become a Registered Dietitian. So I’ll be starting an integrated program at Columbia University this fall, to get My Master’s in Nutrition and Exercise Physiology. So then I can sit with the exam, and then eventually become licensed as a Dietitian. 

A: Awesome! So pretty much, Sara, you’ve had such amazing experiences and success stories working with clients, especially with your background in health coaching. You are now going to be pursuing the highest degree in your field, which is going to be a Registered Dietitian out of Columbia University. So that is so amazing!.

S: Yeah! Definitely my dream school. So that’s awesome!

A: Perfect! We’re really excited to learn all about you, Sara. For those who are tuning in, if you have no idea who I am: My name is Dr. Ashley Mak, I’m a Physical Therapist, I have originated from New Jersey. I started off playing sports, just like the majority of kids in North America. As I’ve evolved as an athlete, I realized that science was something that I really enjoyed, plus I really enjoyed helping people. I eventually got the opportunity to transition into the field of Physical Therapy. Going through my Physical Therapy education, I realized that there were so many ways for us to help people as Physical Therapists. Even from the moment that people are in the hospital where they have their surgeries to even transitioning to working with competitive athletes. I personally specialize in working with people who experience Chronic Low Back Pain and Sciatica. Which is why we have led to this podcast itself which is Fix Your Sciatica. We created this podcast on this platform because prior to this and prior to the 2020 pandemic, we were originally a fitness company. We were Hudson River Fitness. We had a brick and mortar facility in Hoboken, New Jersey. With the rise of the pandemic, we realized that in order for us to be able to help our clients even better, we had to pivot and transition all of our services to online. But once we did that, again we realized that it is important for us to ensure that we are communicating to the people that we can affect the most, and our skill set is particularly dealing with chronic pain. We are so excited to really introduce all this information to you because chronic pain has had a really big impact on our lives, and we want to be able to help others. 

So Sara, could you tell the audience, tell people a little bit more about what has driven you to this point in your life, this point in your career, Nutrition, and how does Nutrition and Chronic Pain fit in together.

S: Right, yeah! So I actually started my career in the Corporate Sector. Like a lot of professionals that you hear about in this space. But I received my Master’s in Accounting from Boston College, and started my career at a big four within Financial Services, so I was just kind of 22, 23 when I was starting my career, and really hungry, really driven. I wanted to be the best at all costs, I wasn’t really taking care of my health, I was chugging lattes, going to happy hours three days a week, going out on weekends, and just working really long stressful hours. So I kind of went from being able to eat whatever I wanted to, just younger. I was always involved in sports, or I was active. All of a sudden, I was just reacting to absolutely everything. So I couldn’t touch dairy anymore, I couldn’t even tolerate gluten, I couldn’t eat a single bite of food without upsetting my stomach and causing so much bloat. So I was just like in this consistent state of being exhausted and having brain fog and being really, really tired. 

So I’ve been seeing doctors for this, I wasn’t really sure what was going on, it had been a couple of years. I was on this regimen of Prilosec and TUMS because I had a bunch of heartburn and acid reflux, and no one was really able to give me any sort of diagnosis or answer. I was tested for ulcers or crohn’s disease, all of these tests were coming back negative, and I was apparently doing all the right things to treat the symptoms but no one could really tell me what was the root cause of it. So I kind of just got sick of it and started researching it myself, I started googling things, trying to read up on it as much as possible. 

But eventually, I came to this article in Harper’s Bazaar and it was talking about this diet, “How you can reset your gut”. And I thought, this is exactly what I need. I’m in my early 20s, I cannot live like this for the rest of my life. So whatever this diet is, I’m just going to follow it to a T. 

I think it resembled most like an elimination diet, where you cut out all your added sugars, like even fruit that was considered too sweet, like a banana for example. Sub that out for blueberries or strawberries instead. Cutting out all gluten, cutting out all dairy, no caffeine, no alcohol, so much water. Then there were even some supplements that they were telling me to take like L-Glutamine for example, which helps rebuild the lining of your digestive walls. So basically, the diet was just eat a lot of vegetables, preferably raw, eat some fruits, eat some really lean high quality proteins, and just stick to this for three months, and all the supplements, all of that. So I did try to stick to it as closely as I could, I mean, I couldn’t really go without my soy lattes at the time, and so those made it in there. But I definitely started to see significant changes even just after a month, and I really couldn’t believe it, so that really made me follow that diet. I mean, I think I followed that one for years. To some extent, I probably wasn’t as stringent with the requirements but just having that happen, and then, on another end of it, I’m like a big runner or used to be a big runner. When winter came, I would just find a gym that had an indoor track, and just run laps in this indoor track. But when I was in Boston, I couldn’t find a gym that had one. So I started to do Pilates instead, and I just noticed that the muscles, I mean it’s the best workout I’ve ever had for my core. So I think that having to do with working out my core a little bit more, which helped with digestion, plus the new diet, I think that was game changing for me. So after a few months of doing that, I felt like I had totally reset everything, and it was such an incredible feeling, and I felt like I had honestly unlocked some sort of secret to life. So I just really wanted to share it with everyone. 

A: So it seems as if this journey that you went through, like many of us, was early, even before we turned 20, so maybe our late teenage years with that work technically kind of reap getting started to ascend to the peak of our health. Because we’re getting stronger, we’re developing, we’re growing, we’re developing into an adult. So we’re in this opportunity where we can kind of eat like whatever we want and move as much as we want because we’re just constantly growing. Then it seems like there was this turning point where it’s like the moment that you became an adult, where you had like all these other responsibilities, things that you did as a kid were no longer relevant. 

S: Right.

A: Your lifestyle and the things that you need to do as an adult.

S: Yeah I totally agree. I think, nobody really prepares you for that, and you just kind of think like, “Oh, it comes with aging. This is supposed to happen. I’m supposed to feel this way. Things are supposed to hurt.” and I think the point is like, no they’re not. You should feel really good into your late, late, late years. I think that’s like the misconception that we’re starting to kind of see through now. 

A: For sure, and one of the big things that affects our health. I mean not only just how we feel from a digestion and energy standpoint. It’s also how pain plays a role in how we function. I remember, even as a college kid, I had the opportunity to swim in college and it was great at the time. Now that i’m a retired swimmer it’s not so great anymore. I’m happy that I lived that life, but we would train three to six hours a day, and we would eat all these delicious foods. But really, one of the most, literally, the one of the most painful times that I had as a college kid was the fact that my back was killing me. When I was in the water, I had no problem. But my back was hurting me so bad that I couldn’t even sit through class or even sit through the library and as a result, my education started to falter. I was like, I needed something to happen. 

Luckily for me, I was one of those few people: According to science, there’s about 75% of people who experience pain or some sort of injury that will actually just spontaneously recover within about 12 weeks without having to do anything, and that’s a really great thing. But it then got me into this discovery and journey of trying to figure out, “Okay, why experience this pain? It was so bad. But then, why did I just recover by doing just like some minimal exercise?”, and then it transitioned. I got the opportunity to go graduate my undergrad a year early, and start physical therapy school, which is a doctorate program. During that time, I’ll be honest. I didn’t really know that much about Physical Therapy, I just knew that Physical Therapy helped people, just rehab from injuries and everything. But going into the Physical Therapy Profession, graduating and working with people over and over again, I’ve realized that pain in itself, limits everything that we do from our overall happiness. But then also it taps into our emotional psyche. There’s a lot of correlation with chronic pain and digestive issues, health issues, chronic issues, and how that impacts our life. 

Graduating and practicing for these past years, I’ve realized that there’s something that we should be doing. Just seeing that huge problem, I realized that, “Why not take on this challenge?”. Which is why I thought it would be so great to focus on specifically, sciatica. Because that is something that often affects a lot of people and it really goes into a lot of different things. 

Now, my background as a Physical Therapist: Movement is my specialty. I find that injuries and pain, I find that the pain that we often feel are caused by a couple different mechanisms. But ultimately, one: it’s gonna be due to a traumatic injury or overuse. That is often influenced by movement and lifestyle. So, I coach people on how to move properly. I got introduced to Sara because with her background nutrition, there’s a very big impact in regards to nutrition and lifestyle and how that influences pain. 

So, Sara, could you tell us a little bit more about how does proper nutrition and proper stress management actually influence pain?

S: Right! So I would probably say the number one way is through inflammation. Our gut produces essential neurotransmitters, I think about 50% of dopamine, 90 to 95% of serotonin. They’re produced in our gut so they both play a critical role in managing pain. Also it houses 70 to 80% of our immune system. If your digestive walls are compromised, if you have leaky gut syndrome, and you have foreign invaders kind of leaking through your gut walls into your bloodstream, your immune system is gonna go into attack mode. It’s going to cause this inflammation, which is a healing process. But if it’s a constant problem and your immune system is constantly activated, that’s what leads to chronic inflammation and then further along the line into autoimmune diseases. So those are two really big parts and then a third one is it activates gene expression. So even though you and I were born with certain genes, that were just naturally predisposed to certain conditions or certain diseases, these genes may never turn on, and that is dictated by your diet and your lifestyle. 

They’re finding through the study, through the field of epigenetics, that our diet and lifestyle plays a significant role in which genes get turned on and off. Some people even hypothesize that 90% of all diseases can be traced back to digestive health. I think nutrition plays a bigger role than all of us kind of even imagined. We always call the gut our second brain. But I think it’s like our first brain. It seems to be the thing that kind of like sparks all the chain reactions, so that’s a huge role. Stress, in general, when you’re in a chronic state of stress, you’re producing certain hormones, certain chemicals that just really influence your immune system, and that triggers inflammation which can just lead to more pain. So there’s a lot of diseases that can be traced to our diet, our lifestyle. They say over 91% of diabetes, over 82% of heart disease, over 70% of cancers, they’re all attributable to preventable changes in our health, in our diet, and our lifestyle. So when you take a look at it from that perspective, you kind of wonder how nutrition and diet and all that hasn’t played a larger role in our education. 

A: It plays a huge role and which brings me to this question. Because I think this is a question that is often brought up by many people, because we hear the word inflammation. But just like the overall information that’s put out there, it’s like inflammation kind of seems like this scary thing. So in your eyes, do you think that inflammation is bad?

S: No! I mean, it’s your body’s natural healing mechanism. I think when you put chronic in front of it, that’s when everything becomes bad, right? Stress is not a bad thing. When it’s chronic stress, we’ve seen that it can actually change the structure of your brain. It’s about finding balance in everything, right? That’s the whole thing like there’s not like good food, there’s no bad food, there’s no good gut bacteria, no bad gut bacteria. It’s all just a balance, and so I think what’s happening is people are just going out of balance and then trying to recalibrate by going to another extreme and we’re just kind of flip-flopping back and forth and not really finding a good medium.

A: And it’s hard, I mean, you’re absolutely right about the aspects of this balance. I think one of the things is because we have so much information that is available to us. It gets really hard and confusing because things aren’t just A or B. It’s a spectrum and being able to be on that spectrum is going to allow us to grow and thrive. You’re absolutely right about the information of inflammatory processes. I mean especially, if you were to bump your or scrape your elbow, you’re gonna have pain. But also there needs to be inflammation in order for those tissues to go there and heal, and allow these tissues to go through. With that being the case, it’s tough because inflammation itself can be influenced by so many factors as you said. To be able to address those things and allow inflammation to happen when it’s needed to facilitate healing, but then also to remove any sort of inflammatory aspects. 

That’s the same thing with movement. The big question that we often get asked as PT’s, it’s like, “Oh, well I should be getting a standing desk”. It’d probably be a great idea. But then the big question that we have to ask ourselves is, “How can we really vary our movements throughout the day and how can we live across the spectrum of being active versus inactive?” which is really key. Now, I think because there’s so much information when it comes to a physical therapy standpoint, then also from a nutrition standpoint. What do you think, with all the information that’s out there, is the biggest misconception about food, lifestyle, and its impact on health and pain?

S: So I mean, I think this one is kind of starting to go away. But kind of like that, all calories are created equally. I think we’re starting to learn that our body metabolizes certain macronutrients and absorbs micronutrients very differently. But then even after that, I think the biggest one is that there’s a formula that works for everybody. And I don’t think people really understand the number of variables that dictate how effective a certain diet will be for people. So there are so many things in play, like your genes for example. Certain people respond better to certain diets because of their genes. The ketogenic diet and the CPT-1A gene are great examples of that. That’s why some people respond well to it and some people don’t. The diversity of your microbiome, that’s another big one. So the more variety of vegetables and fruits and prebiotics that you eat, you want your gut bacteria to be very diverse and flourish. There’s studies that have been done on mice that show that there’s an overpopulation of a specific bacteria in obese mice. And when you take that bacteria and inject it into a lean mouse, those lean mice then develop obesity. Stress levels, another huge one, we know that high levels of stress activate certain hormones and chemicals that promote weight gain. But they also affect where you put on that weight. And like I said chronic stress just kind of changes the structure of everything in your body and your brain. It’s not a fixed diet that’ll work or a fixed regimen that’s the big misconception. It’s a moving target, so something that even worked for you, years ago probably isn’t working for you anymore or might not work for you anymore based on the changes that your body is going through, or the different stressors, or the different lifestyle you have. I think there’s an overarching concept that you can apply to people’s lives. But there is a lot more bio-individuality that goes into it and I think people realize. 

A: So we’re looking at some structure but also some fluidity based on the person. Because we’re human beings and we are a culmination of various different genetic traits. But then also being exposed to various different environmental factors that influence who we are, how we feel, and what we do.

S: Right! Exactly!

A: Right on, and I’m so glad you brought that up, because being involved with the fitness industry, which is one of the big parts of my career, I’ve gone through all those different diets before. I’ve eaten paleo, which is great because I loved eating bacon and loved eating all that stuff. But then also looking at and being able to see like “How does this work?” and I think one of the really interesting things particularly from the lifestyle perspective with nutrition is also how that actually translates over into pain management too. 

One of the many reasons on why I created ifixyoursciatica.com was to be able to debunk those myths and help reduce all that confusion that people have when it comes to managing sciatica and low back pain. Because if you go on the internet and you search how to fix my sciatica, you’re gonna have like 10 articles that are gonna say forward bending is actually really great for your sciatica. You’re gonna have another 10 articles that are gonna say that forward bending is actually really terrible. As a consumer, it gets really challenging because you look at this information whether it be a diet or even just an intervention for your back pain, and you’re saying like, “What do I do?”. I think you provided a really good solid point that is being able to see, “Does it work for you?” and that’s going to be the most important part. That’s a big misconception with Physical Therapy and Pain Management that people feel as if they have this specific diagnosis. Whether that diagnosis was made by their physician, their physical therapist, or even Dr. Google or Dr. Facebook. Where they go in and they’re like, “Okay I think I have this issue” and then they’re trying to treat that specific issue versus trying to treat that specific person. And so, in a way there’s like a formula, some sort of framework for people. But then also we have to recognize that we are human beings and we will respond differently with that. It’s kind of like, you remember? I think it was probably about 10 years ago. They saw, it was a picture on the internet. It was like, “Is this dress blue? or is this dress gold?”

S: Oh my gosh! Yes! 

A: Yeah that was a crazy thing. I think well one, do you remember what it looked like to you? To me, it looked gold. But then a bunch of people said it looked like it was a black dress.

S: Yeah! I think it was gold to me as well. I feel like it was an age thing. Like you were above a certain age, you’re gonna see it somewhere so they were like you could dictate how old you were based on what color you saw. 

A: Interesting. Now that could be an entirely different episode on its own when we talk about the aspect of what pain and perception. Because that in itself is already pretty huge. But going back to the task at hand, I’m just like telling them.

S: Right! Yeah! And that’s one thing I wanted to say about that too. I think a lot of people just kind of see some study or see some article and they don’t really know who’s funding it. They don’t really know what the control groups were, what the variables were, and they just like, take this small piece of information or misinformation and just run with it. They also like to isolate a lot of information. So I feel like in the nutrition world, a lot of micronutrients and macronutrients are getting isolated. And that’s just not how it works, like you can’t just like, up your B Vitamins and up your D Vitamins and all of that kind of stuff. It’s all a balance, they all depend on each other. It all matters how they get absorbed. It’s so, it’s a system in place that people are trying to compartmentalize. And I think that’s what’s not working for people.

A: Ah. yeah! It’s just like taking things out of context. Ultimately, a lot of these scientific studies, I mean you look at the scientific method and the highest quality are randomized clinical trials, right? RCT’s. And what that means is that they’re really trying to control every single condition, aside from this experimental thing that they were providing. So it will work if you, the subject of the person, can create that same exact environment in which that study was created, but it does get pretty challenging. With all this conflicting information that is out there, it can be very overwhelming. I was brought up in a world where the most important thing aside from knowledge is being able to take action. So if there was one, single most important action that someone could take that is feeling overwhelmed and frustrated and confused with all the information out there, with your experience, what would be your biggest recommendations? Like what’s the single most important action step for them to take?

S: So I think that people don’t really realize how much power and knowledge that they actually have over their own health. So if you ask somebody, “What is the single most important thing that you could do today to better your health?” They always have a response. It’s on the tip of their tongue. And so even if it’s something like, “I guess I could limit my alcohol consumption to just the weekends”, or “I binged at night and I can’t stop”, or “I crave unhealthy carbs even when I’m not hungry”, I think people don’t realize that it’s actually small changes that need to be made and practice consistently that get the significant results. Instead, they try to go for these huge overhauls of their lifestyles and their behaviors. Otherwise, they think it’s just too easy, but the hard part is actually the consistency. So I would say, the best thing, the single most important thing, is to pick a really small habit that you can work on and that you will actually stick to. Like drink more water or I’m just gonna incorporate at least two to three servings of vegetables into my day, every single day or three times a week at least. And just practice that habit and then move on to the next thing that you need to fix. So it’s definitely a step-by-step process. But that’s really where all the work is, behavior change. I think everybody has all the knowledge of like, I should eat this and not that. It’s the problem of how to stick with it and how to actually implement it.

A: Cool! So, you might have listed three important things. Which I mean, I think all equally important. But if I were to make sure that I have this succinctly. Ultimately, one of the biggest things is that most people have an understanding in regards to what they should be doing. But the reality is that, regardless of whatever you are going to be pursuing, if you know that it’s gonna be better than what you’re currently doing right now, to be consistent. And be consistent and practice that on a daily basis.

S: Right! So I guess if I could just boil it down to one thing. I would say, ask yourself, “What is the single most important thing that I could be doing to improve my health today?”. Just do that. Just do that one thing, so that’s the one thing.

A: Awesome! I think that’s a very valid and very powerful action step. Because the majority of people don’t understand what healthy eating is. But there’s something that happens that causes them to go and deviate from what they should know. It’s a lot of shoulds, “I should do this, I should do that”. It’s really tough because everyone’s life situation is different. There’s stresses, there’s all these other things and so being able to identify and look within, that’s going to be huge. That’s my biggest action step for people who are experiencing pain from a movement standpoint. Because I can give someone 10 – 15 different stretches. But really, when you are dealing with pain or even chronic pain, because it’s dominating your life, everything that you should be doing should be reducing that pain. And the reality is like, who’s experiencing that pain in the first place? It’s not me, it’s you, the listener. You, the person who is experiencing saying, “How can I fix this?” It’s being able to look and say, identify what makes you feel better. But ultimately, it’s not gonna be the stretches, it’s not going to be the exercises. It’s all going to be understanding that you have to be moving. Let your joints move freely, but then also moving with quality. Ultimately, when we move with quality, like the biggest thing for a movement standpoint and even just from an eating standpoint as well, is that quality matters. You can’t just do something for the sake of doing something. Everything should be having a purpose. That is going to translate over into actually feeling better. Sorry, you have a lot of amazing information and you have an amazing level of knowledge about nutrition, but also about behaviors. I think you’ve touched on a really great spot. So could you tell us a little bit more about what your process is like, when it comes to helping out your clients.

S: Right! So I actually think that my role, more than anything, is to help my clients towards actionable steps. So they can stop giving into things like their cravings, or to prevent them from downward spiraling if they happen to have a bad day. And I think there’s obviously technical aspects that I also help with, like portion sizes and healthy sources of carbs and proteins and all that. But I think the most important thing is to help create sustainable habits for each of my clients. And I want them to succeed. I want them to keep growing and elevating themselves. So hopefully, they don’t need me the same way that they did in month one at month three. Otherwise I’m kind of like, failing at what I did. But I think at the end of the day, like our brains are very lazy. They want to be on autopilot for as many things as possible. So that they can conserve their energy for the really important major life-saving tasks. What I’m really here for is to help people take a step back and take a pause and bring awareness to the habits that have just sort of become autopilot for them. A lot of those habits are no longer serving them. So I help guide them into more beneficial, productive, modified habits that they can actually take with them.

A: Awesome! So you’re kind of like this. Since I moved out to California. I love, I’ve just gotten super into being outdoors. Oh yeah! Listeners, I live in California, it’s amazing. But really, a big part of it is like from a hiking perspective. You’re kind of like that guy right? Like, you’re that guy. Your client is the hiker, and the hiker sees the path. But maybe the path could look really scary. But you’re there to say, “Let’s just take it one step at a time”. You know, “We’ll get snacks on our way there”, guide them through. So that’s amazing, I think, I had a lot of experiences with other different nutrition coaches. I’ve been a client of many nutrition programs before. I feel as if your approach is a very actionable way and also a very sustainable way. Because it’s being able to meet me or meet you at your level. Because my nutritional needs are gonna be very different from the nutritional needs of someone who might not necessarily know that much about healthy eating versus like a super fit athletic person. They’re gonna have various different goals. So I really appreciate that Sara, that’s awesome.

S: Yeah!

A: And one of the biggest things from a process standpoint, here at ifixyoursciatica.com, really the big thing is meeting you at your level. That’s one of the most important things when it comes to pain management. Again, pain is going to be an experience unique to you, and so, when it comes to our process, when it comes to managing pain with movement, is ensuring that every movement that you’re doing is going to provide you pain relief. That’s gonna be important. That’s one of the reasons why you’re on this, listening to this podcast right now, is because you are looking for an answer to fix your pain and solve your pain. And going through one step at a time and identifying that you are in fact, an individual person. Even though us practitioners can use a type of framework which helps organize our thoughts, it is going to be important for us to take all this information and have it make sense for you and have it make it meaningful for you so you can truly experience pain-free living. 

Sara, I mean, thank you so much for this information. It’s really exciting to share your story with the world and share your knowledge. I know that this is not going to be your last presence in this podcast. So it’s really, really, really exciting to have you. If someone is trying to get in touch with you and wants to learn more about nutrition and how it can influence their health, what’s the best way for them to get in touch with you?

S: Sure, so you can just leave me an email. My email address is sara@hudsonriverfitness.net. Otherwise, I’m on Instagram. It’s @sara_subhani actually. So just my first and last name and you can just shoot me a DM.

A: Awesome! Very, very cool, and if you haven’t done so already, please subscribe to our Instagram which is @ifixyoursciatica. And also if you have any other questions, if you want to take bigger steps towards treating your sciatica and chronic low back pain, then visit our website ifixyoursciatica.com, as well as send us an email at info@ifixyoursciatica.com. 

Sara, thank you so much for coming.

S: Yeah! Thanks for having me, it was great.

A: Awesome! See you.

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