Newsletter

Dr. M’s SPA Newsletter Volume 15 Issue 31 – Poly Vagal Theory, Stephen Porges, PhD

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I think that this is an important time to pause and relook at Polyvagal Theory before continuing with Beyond Behaviors.

Polyvagal Theory: Current Status, Clinical Applications, and Future Directions (Porges, S. 2025)

“Social behavior and the capacity to manage challenge are dependent on the neural regulation of physiological state.” S. Porges


When I dove into Stephen Porges’s 2025 review of the Polyvagal Theory (PVT), I felt like I’d stepped into a crossroads where neurobiology, clinical practice, trauma science, and human experience collide. This paper isn’t merely a summary of three decades of work (all of which I have read); it’s a spirited defense of a paradigm that’s been both celebrated (by me) and contested (by others). What follows is an honest appraisal of what the article teaches us, where it sparks real insight, and where it may fall short, especially through the lens of evidence-based medicine and developmental neurophysiology. (I also went deeper into his 2022 paper in Frontiers in Integrative Neuroscience for the biophysiology of the ANS)

At its heart, the article argues that the autonomic nervous system (ANS), through a set of hierarchically organized circuits centered on the vagus nerve, is not just a background player in stress and homeostasis, but a core regulator of social engagement, physiological flexibility, and behavior. Dr. Porges situates his theory as an alternative and expansion to classical views that treat sympathetic (fight/flight) and parasympathetic (rest/digest) branches as functional opposites. Instead, he proposes a three-component hierarchy: the ventral vagal complex (VVC) supporting social engagement, a mobilization circuit mediated by the sympathetic nervous system or fight or flight state, and a dorsal vagal circuit that facilitates shutdown or immobilization under extreme threat…..

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 30 – Beyond Behaviors Part 2, Mona Delahooke, PhD

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Review of Chapter 2 of Beyond Behaviors
by Mona Delahooke, PhD


“Social behavior and the capacity to manage challenge are dependent on the neural regulation of physiological state.” S. Porges

Top Down or Bottom Up?

“Before We Respond to Behavior, We Need to Understand Its Origin.”

With a deceptively simple observation, Dr. Delahooke reshapes the entire field of behavioral intervention: children’s actions come from two very different places in the brain. Some behaviors are top-down, intentional, planned, thoughtful. But many, especially the ones adults find most perplexing, arise bottom-up from stress responses generated by the body’s autonomic nervous system. We often think of this state in terms of fight or flight, however, it is not that simplistic. It is truly any significant response to the outside environment that leads to a neuroceptive reaction that is not governed by the neocortex, top down. If we don’t distinguish the source, our interventions are guesswork at best and often counterproductive at worst.

She illustrates this through a case, a child whose impulsive, disruptive behaviors were treated as failures of will or desire. School teachers and teams repeatedly urged him to “use his words,” as though language were a faucet he simply refused to turn on. What no one stopped to ask was the foundational question: Was his nervous system regulated enough to access language at all? Was he gated at the level of the amygdala blocking the ability to use his mind consciously and even have the opportunity to respond to a meaningful request? Is he capable of the ask, not in terms of willingness, but in terms of physiological access to the skill itself?
….. and more

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 29 – Beyond Behaviors, Mona Delahooke, PhD


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Review of Chapter 1 of Beyond Behaviors
by Mona Delahooke, PhD


“When we see a behavior that is problematic or confusing, the first question we should ask isn’t “How do we get rid of it?” but rather “What is this telling us about the child?” (MD 2019)


The opening chapter sets the stage for a quiet revolution in how we understand children who struggle. Dr. Mona Delahooke invites us to take a step back from the culturally and medically ingrained belief that children’s outward actions are reliable windows into their inner intentions – or what they really mean and want based on their actions. Instead, she asks, nay implores, us to adopt a more biologically accurate, compassionate, and clinically effective lens from which to view each child as they present themselves. Their behavior is communication from a developing nervous system striving for regulation and often stuck somewhere else, either frozen or in flight…..
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 28 – Feeding Infants


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Food in Infancy
What do we know?

“Humans are the only mammals who feed our young special complementary foods before weaning and we are the only primates that wean our young before they can forage independently. There appears to be a sensitive period in the first several months of life when infants readily accept a wide variety of tastes and this period overlaps with a critical window for oral tolerance. As a result, infants should be exposed to a wide variety of flavors while mother is pregnant, while mother is nursing and beginning at an early age. There also appears to be a sensitive period between 4 and 9 months when infants are most receptive to different food textures. There remains debate about when it is best to begin introducing solid foods into an infant’s diet however, the available evidence suggests that provided the water and food supply are free of contamination, and the infant is provided adequate nutrition, there are no clear contraindications to feeding infants complementary foods at any age. There is emerging evidence that introduction of solid foods into an infant’s diet by 4 months may increase their willingness to eat a variety of fruits and vegetables later in life, decrease their risk of having feeding problems later in life, and decrease their risk of developing food allergies, and the early introduction of solid foods into an infant’s diet does not appear to increase their risk of obesity later in childhood.” (Borowitz S. 2021)

Food Introductions — What’s the best way to approach it?

As infants begin the shift from exclusive milk feeding to solid foods, a range of opinions inevitably emerge on how to navigate that transition. It’s tempting to get lost in modern guidelines, but an anthropological lens is often more revealing. Long before the age of purées in jars and puffed snacks in canisters, human infants ate what their parents ate. It was delivered in whole-food form and mechanically softened by chewing, cooking, or crushing. These early first foods carried important evolutionary advantages…Plus a piece on Hell Yeh or No by Derek Sivers

Enjoy,
Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue Thanksgiving


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THANKSGIVING THOUGHTS

Every year, as the leaves turn and the air gets that crisp bite, I’m pulled back to 1621 in Plymouth, Massachusetts where a group of English Pilgrims, religious refugees who had crossed an ocean to breathe free, and their Wampanoag neighbors sat down together for three days of feasting. No treaties, no agendas, just gratitude for a successful harvest and the simple miracle that two very different peoples could share a meal in peace. Food and friendship. That was the entire point. At least, that is what history tells us.

Fast-forward two centuries and Abraham Lincoln, in the middle of the bloodiest war this country has ever known, paused on October 3, 1863 to proclaim a national day of Thanksgiving.

His words still ring true: “The year that is drawing towards its close, has been filled with the blessings of fruitful fields and healthful skies. To these bounties, which are so constantly enjoyed that we are prone to forget the source from which they come, others have been added, which are of so extraordinary a nature, that they cannot fail to penetrate and soften even the heart which is habitually insensible to the ever watchful providence of Almighty God….

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 27 – Immune Aging

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The Evolutionary Tug-of-War – Inflammation’s Double-Edged Sword

“Environmental factors, particularly infections, have fundamentally shaped human evolution by selecting for protective inflammatory response mechanisms that enhance survival. This evolutionary pressure has created a core biological paradox: inflammation is indispensable for host defense, yet its dysregulation significantly heightens disease and mortality risk. This fundamental tension raises three fundamental questions about human aging and immunity: (1) How have selective pressures driven the evolution of mechanisms to balance inflammation’s protective benefits against its harmful consequences? (2) Why does substantial variability in healthspan persist despite historically stable rates of aging? (3) Does evolutionary prioritization of reproductive fitness inherently limit longevity?” (Manoharan et. al. 2025)

Let’s talk about the fire inside us. Inflammation is our body’s 911 system: lightning-fast, life-saving when a bug invades or a thorn rips skin. But leave that alarm blaring 24/7 and the fire torches the house.

Evolution faced this paradox: crank the immune dial high enough to survive infection and childbirth, yet install brakes so we don’t self-destruct by 40. Manoharan’s team just mapped those brakes in 17,500 humans and called it immune resilience (IR) or the ability to fight hard, clean up fast, and stay cool afterward… and linguistic aging associations…

Dr. M

Dr. M’s SPA Newsletter Volume 15 Issue 26 – Back To Sleep

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Back to Sleep and Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS) is defined as “the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including a complete autopsy, examination of the death scene, and review of the clinical history.”

During my time at the University of Virginia, I trained under neonatologist Dr. John Kattwinkel, a champion for newborn health and one of the leading figures in shaping national safe sleep policies. In the early 1990s, he chaired the American Academy of Pediatrics (AAP) Task Force on Infant Sleep Position and SIDS, which laid the foundation for the landmark Back to Sleep campaign.

At that time, SIDS claimed roughly 14 infants per 10,000 live births in 1988. Following the campaign’s launch in 1994, the rate plummeted by over 60%, reaching about 5 deaths per 10,000 live births by 2006. Despite this dramatic improvement, recent data suggest that the decline has plateaued…..

Dr. M

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