PTSD & Trauma: The Functional Medicine Approach
Trauma is not a psychological event. It is a full-body recalibration — a rewiring of the nervous system that changes how you breathe, digest, sleep, and relate to other humans.
PTSD & Trauma: The Functional Medicine Approach
The Body Remembers What the Mind Tries to Forget
Trauma is not a psychological event. It is a full-body recalibration — a rewiring of the nervous system that changes how you breathe, digest, sleep, and relate to other humans. Traditional psychiatry gave us SSRIs and talk therapy. Both help some people some of the time. But when a veteran still flinches at a car backfire after two years of weekly sessions, or a childhood abuse survivor cannot tolerate being touched despite understanding their history intellectually, we need a wider lens.
Functional medicine offers that lens — not as a replacement for trauma therapy, but as the biological foundation that makes psychological healing possible.
What Trauma Does to the Brain
Three brain regions tell the story of PTSD.
The amygdala — your smoke detector — becomes hyperactivated. It fires at stimuli that merely resemble the original threat. A tone of voice. A cologne. The angle of afternoon light. J. Douglas Bremner’s neuroimaging work at Emory University showed that trauma survivors have an amygdala stuck in overdrive, interpreting neutral cues as dangerous.
The hippocampus — your filing cabinet — literally shrinks. Bremner (2006) documented measurable hippocampal volume reduction in PTSD patients. The hippocampus files memories with a timestamp: “This happened then, not now.” When it shrinks, memories lose their timestamps. A flashback is not remembering — it is re-experiencing, because the brain cannot distinguish past from present.
The prefrontal cortex — your wise elder — goes offline. This is the region that says, “That was a car backfire, not a gunshot.” In PTSD, prefrontal activity drops during triggering, leaving the amygdala unchecked. The thinking brain cannot regulate the survival brain.
Beneath all three sits the HPA axis — the hypothalamic-pituitary-adrenal stress cascade. In healthy stress, cortisol rises, handles the threat, and returns to baseline. In PTSD, the axis dysregulates. Some patients show chronically low cortisol (adrenal depletion), others show a flattened diurnal curve with elevated nighttime cortisol. Both patterns drive inflammation, disrupt sleep, and impair immune function.
Polyvagal Theory: The Map of Safety and Danger
Stephen Porges’ polyvagal theory (1994, refined through the 2000s) gave us the most useful clinical map of trauma physiology since the fight-or-flight model. The vagus nerve — the longest cranial nerve — has two branches:
- Ventral vagal (social engagement system): active when you feel safe. Allows eye contact, vocal prosody, co-regulation with others.
- Dorsal vagal (shutdown): activates in life-threatening overwhelm. This is the freeze response — dissociation, collapse, numbness.
Between them sits the sympathetic nervous system: fight or flight.
Porges introduced the concept of neuroception — the nervous system’s below-conscious scanning for safety or danger. Trauma survivors have distorted neuroception. Safe environments feel threatening. Kind people trigger suspicion. The nervous system is not making a cognitive error. It is operating on old data that was once accurate.
The freeze and fawn responses — so common in childhood trauma — are not weakness. They are brilliant survival strategies from a nervous system that correctly assessed that fighting or fleeing would make things worse.
ACEs: The Dose-Response Relationship
In 1998, Vincent Felitti and Robert Anda published the ACE Study — 17,000 Kaiser Permanente patients surveyed about Adverse Childhood Experiences. The categories: physical, emotional, and sexual abuse; physical and emotional neglect; household dysfunction (domestic violence, substance abuse, mental illness, incarceration, parental separation).
The findings were staggering. ACEs showed a graded dose-response relationship to adult disease:
- 4+ ACEs: 460% increase in depression risk
- 4+ ACEs: 1,220% increase in suicide attempts
- 6+ ACEs: 20-year reduction in life expectancy
- ACE scores correlated with heart disease, autoimmunity, cancer, addiction, chronic pain
This was not about “stress.” It was about developmental trauma reshaping the stress response system during critical windows of brain development. The biology of adversity becomes the biology of disease.
The Body Keeps the Score
Bessel van der Kolk’s landmark book (2014) synthesized decades of research into a single message: trauma lives in the body. Unresolved trauma manifests as:
- Chronic pain without clear structural cause
- Irritable bowel syndrome and functional GI disorders
- Autoimmune conditions
- Chronic fatigue
- Fibromyalgia
- Migraines
- Pelvic floor dysfunction
- Unexplained cardiac symptoms
Van der Kolk’s research showed that traumatized individuals often have impaired interoception — the ability to sense and interpret internal body signals. They either cannot feel their bodies or are overwhelmed by body sensations. This disconnect is not pathology. It is protection.
The Functional Medicine Workup for Trauma
Testing should map the biological terrain that trauma has altered:
- DUTCH Complete (Dried Urine Test for Comprehensive Hormones): cortisol awakening response, diurnal cortisol pattern, cortisol metabolites, melatonin. Reveals HPA axis dysregulation with more nuance than serum cortisol.
- Neurotransmitter testing: urinary catecholamines (epinephrine, norepinephrine, dopamine), serotonin metabolites. Controversial in some circles but clinically useful for pattern recognition.
- Inflammatory markers: hs-CRP, IL-6, TNF-alpha, homocysteine. Trauma drives chronic inflammation.
- Heart rate variability (HRV): the single best non-invasive marker of autonomic nervous system health. Low HRV correlates with PTSD severity. Track with wearable devices as a biofeedback tool.
- Nutrient testing: RBC magnesium, omega-3 index, vitamin D, zinc, B12, folate. Trauma depletes nutrients through chronic stress metabolism.
Somatic Therapies: Working with the Body
Somatic Experiencing (SE), developed by Peter Levine, works with the principle that trauma is incomplete survival energy trapped in the body. Rather than retelling the story, SE tracks body sensations — trembling, heat, constriction, expansion — and allows the nervous system to complete the self-protective responses it could not finish during the original event. Levine’s observation of animals in the wild — who shake off threat responses and return to normal — informed this approach.
EMDR (Eye Movement Desensitization and Reprocessing), developed by Francine Shapiro in 1987, uses bilateral stimulation (eye movements, tapping, or auditory tones) while the patient holds a traumatic memory. The mechanism likely involves memory reconsolidation — the brain re-files the memory with a new, less distressing emotional tag. Multiple RCTs and meta-analyses support EMDR for PTSD, and the WHO recommends it as a first-line treatment.
Sensorimotor Psychotherapy, developed by Pat Ogden, integrates body awareness into traditional talk therapy. It works directly with posture, gesture, movement, and sensation as entry points to traumatic material.
Vagal Toning: Rebuilding the Safety Circuit
If the ventral vagal system is the neural platform for safety, then vagal toning is rehabilitation for the safety circuit:
- Cold exposure: cold water on the face activates the dive reflex, stimulating vagal tone. Start with 30-second cold water splashes; progress to cold showers.
- Extended exhale breathing: inhale for 4 counts, exhale for 6-8 counts. The exhale activates vagal braking of the heart rate. Five minutes, twice daily.
- Humming, chanting, and singing: vibrate the vocal cords, which share a nerve pathway with the vagus. Gargling vigorously has a similar effect.
- Safe social engagement: eye contact, prosodic (melodic) voice, co-regulation with trusted others. Porges emphasized that the nervous system heals in relationship, not in isolation.
Psychedelic-Assisted Therapy: The Paradigm Shift
Psilocybin: Alan Davis and colleagues at Johns Hopkins (2021) showed that two psilocybin sessions with therapeutic support produced rapid, large, and sustained decreases in depression scores. The mechanism involves default mode network disruption — temporarily dissolving the rigid patterns of self-referential thinking that maintain PTSD and depression.
MDMA for PTSD: The MAPS Phase 3 trial (Mitchell et al., 2021, Nature Medicine) showed that MDMA-assisted therapy produced PTSD remission in 67% of participants, compared to 32% with therapy alone. MDMA increases oxytocin, reduces amygdala reactivity, and creates a window of safety that allows trauma processing without overwhelming fear. The FDA pathway for approval was underway as of 2024.
Ketamine: Available as IV infusion, intranasal (Spravato/esketamine — FDA-approved for treatment-resistant depression), or sublingual. Ketamine modulates glutamate via NMDA receptor antagonism, promotes BDNF release and rapid synaptogenesis. Effects can begin within hours. Useful as a bridge while slower interventions take hold.
Nutritional Support for Trauma Recovery
- Omega-3 fatty acids: Matsuoka et al. (2010) showed that omega-3 supplementation immediately after trauma reduced PTSD development — one of the few preventive interventions studied. Dose: 2-4g combined EPA/DHA daily.
- Magnesium: modulates the NMDA receptor (same target as ketamine), reduces HPA axis hyperactivity, supports sleep. Magnesium glycinate or threonate, 400-600mg elemental daily.
- N-acetylcysteine (NAC): 1200-2400mg daily. Modulates glutamate via the cystine-glutamate antiporter. Reduces oxidative stress. Evidence in PTSD, addiction, OCD, and depression.
- Probiotics (psychobiotics): Dinan and Cryan’s work (2013 onward) at University College Cork established that specific gut bacteria produce neurotransmitters and modulate the HPA axis. L. rhamnosus, B. longum, and multi-strain formulas show anxiolytic effects.
- Vitamin D: 5000-10,000 IU daily to target serum levels of 50-70 ng/mL. Vitamin D receptors are dense in brain regions involved in mood and stress regulation.
Stellate Ganglion Block (SGB) for PTSD
The stellate ganglion is a sympathetic nerve bundle in the neck. Injecting local anesthetic (bupivacaine) into it — a procedure that takes minutes — can produce rapid, dramatic reduction in PTSD symptoms. Sean Mulvaney’s work with military populations showed response rates of 70-80%, with effects lasting weeks to months.
The proposed mechanism: SGB resets the sympathetic nervous system by temporarily blocking the nerve growth factor (NGF) feedback loop that maintains hyperarousal. It is not a cure, but it can create a biological window for therapy to work.
Movement as Medicine
Yoga for PTSD: Van der Kolk’s 2014 RCT showed that trauma-sensitive yoga was as effective as proven psychotherapies for PTSD. The key is “trauma-sensitive” — invitational language (“you might try…”), no hands-on adjustments, emphasis on interoception and choice. Yoga restores the relationship between awareness and body sensation that trauma severed.
Tai chi and qigong: slow, rhythmic, bilateral movements that activate the ventral vagal system and restore proprioceptive awareness.
Dance/movement therapy: uses the body’s own expressive movement to process and integrate traumatic material.
Safety and Stabilization: The Phased Model
The International Society for Traumatic Stress Studies recommends a phased approach:
- Phase 1: Safety and Stabilization — establish physical safety, teach regulation skills (breathing, grounding, resourcing), stabilize nutrition and sleep, address acute medical needs.
- Phase 2: Processing — work through traumatic material using EMDR, SE, or other evidence-based approaches, only when the nervous system has enough capacity to tolerate it.
- Phase 3: Integration — reconnect with life, relationships, meaning, and purpose.
The functional medicine contribution is primarily in Phase 1 — building the biological foundation that makes Phases 2 and 3 possible. A malnourished, sleep-deprived, inflamed nervous system cannot process trauma safely.
The Invitation
Healing from trauma is not about forgetting what happened. It is about allowing the nervous system to update its map — to learn, in the body, that the danger has passed and that safety is possible now.
If you have been doing all the “right” psychological work and still feel stuck — still hypervigilant, still numb, still unable to sleep — consider this: your nervous system may need biological support before it can accept psychological medicine.
What would change if you treated your trauma not as a story to be understood, but as a physiology to be restored?