She’s been looking for answers for four years. Maybe longer.
The elimination diet, held for months. The supplements, sequenced correctly—a costly shelf of them. The sleep hygiene, the magnesium, the protocol she found online, and the protocol her practitioner adjusted. She has been thorough in the way that thorough people are, which means she’s been paying for it with her attention and her evenings and a fair amount of hope.
Yet nothing lands.
Some things help for a while. Most produce a promise, a flicker, and then nothing.
She arrives at her next appointment with a binder, and somewhere in the first twenty minutes she says the sentence I’ve heard hundreds of times: I don’t understand why none of it works for me.
You may know this woman. You may be this woman. Either way, I want to offer an explanation that has nothing to do with discipline.
For fifteen years I taught practitioners a framework built on the idea that the body is a system of systems, and that no part of it can be understood alone. Inside that framework there is one question I taught them to ask, because the answer determines whether the rest of the work has anywhere to land. The question is whether the person in front of them may be living in a sympathetic dominant state. It’s a lens, not a diagnosis, and I’ll say more about that later.
But I’m not writing this for the practitioners I once taught. I’m writing it for you, because it’s your question now.
Today, where direct-to-consumer panels ship to your door and the average primary care visit runs under twenty minutes, you’re the one ordering the panel, choosing the protocol, deciding whether to try the next thing. So I want you to be able to ask a key question as you do—and more than that, to understand why it’s the question that comes first. I don’t want this because I think it’s brave or even empowered to be your own practitioner and take all clinical decisions into your own hands. That’s not my perspective. Care has been handed to you without the training that’s supposed to come with it, and calling that a privilege has been convenient for everyone but you. I want it because knowing the answer to this question is the difference between another four years of things that don’t land, and knowing why they didn’t.
That difference lives in the wiring of the nervous system, so I’ll start there, which brings me back to my question about sympathetic dominance.
Sympathetic is the branch of the autonomic nervous system that runs the emergency. Heart rate goes up. Pupils widen. Blood gets shunted to the limbs. Adrenaline arrives within seconds. Cortisol follows behind it, slower and longer-lasting, mobilizing blood sugar so there’s fuel to fight or flee. Digestion gets suppressed, not just slowed, because a body preparing to run has no patience for lunch.
Your body is an exceptional system and the emergency response is one of the best things about it. It surges, and the recovery is built in. It was never designed to be where you live.
What braced feels like
When you’re in this emergency state for a prolonged period of time, your built-in recovery mechanism doesn’t function well. You’re braced. We can describe this state in sharp physiological detail and still leave a woman with no way to identify it in herself.
Sympathetic dominance feels like the jaw you find clenched at a stoplight and don’t remember clenching. The three a.m. waking, alert, with nothing in particular to solve. The breath that stops somewhere high in the chest and never reaches the bottom of the lungs. The sense of being slightly ahead of yourself all day, already onto the next thing while still standing in this one. The tab you open at eleven at night to google something you already looked up.
I carried a clenched jaw for years and thought of it as a dental issue.
Part of why it’s hard to catch is that it doesn’t necessarily announce itself as stress. Most of the women I’ve worked with wouldn’t describe themselves as stressed on an everyday basis. They’d say they’re busy, or that they’ve always been like this. They may identify as “type A” or a “perfectionist.” There’s no crisis attached to it, no obvious emergency to point at. In fact, it often presents as capability. Productivity. You’re getting things done. You’re on top of it. And the word people use is high-functioning—usually as a compliment.
The tell is disproportion. A text presents like a threat. A small logistical problem takes the whole evening to metabolize. Outwardly you handle it, and handle it well. The response happens at a volume the event doesn’t warrant, and you’re the only one who knows.
None of that shows up on a tracking device or a functional panel. Heart rate variability comes closest, and I’ll come back to what happens when that measure becomes another thing to manage. But a number is not a state. Braced is the state.
How your nervous system works
When someone tells you that you need to regulate your nervous system, they are not usually talking about your nervous system. They mean one branch of one division of it. The whole of your nervous system is considerably broader, and the substitution has consequences. When we mistake a part for the whole, the part often becomes the target. It becomes something with an address, which can be reached directly, by the right device or the right practice, and ignores the territory or conditions.
What the anatomy shows instead is a coordinating layer that touches every system in the body and takes instruction from all of them. Nothing about your nervous system can be addressed in isolation, which is inconvenient for anyone selling access to it.
So let’s look at the basic shape of it, from the outside in.
Your nervous system has two halves.
The central half is the brain and the spinal cord.
The peripheral half is every nerve branching out from the brain and spinal cord to reach the rest of you—twelve pairs coming off the brain, including the longest and most wandering of them, the vagus nerve, and thirty-one pairs coming off the spine.
That peripheral half divides again.
One side is somatic, or voluntary: the muscles you tell to move when you go on a hike or pick up a fork.
The other side is autonomic, or automatic, and it handles everything you never have to think about. Heart rate. Digestion. Blood pressure. Hormone release.
And the automatic side divides again.
The sympathetic portion is the fight or flight, which readies you for action.
The parasympathetic portion is the rest and digest, which brings you back down.
These last two are built to move in and out of each other all day long, hour by hour, meal by meal. The design assumes you'll spend most of your life in the parasympathetic state and visit the sympathetic state only when something requires it.
What a braced body does with what you give it
Digestion doesn’t begin in the stomach, or even in the mouth. Anatomy says it does. Physiology says otherwise. Digestion begins before food arrives—at the sight of it, the smell, and most of all the thought of it. Physiologists call this the cephalic phase. It’s where saliva, stomach acid, and enzymes ready themselves for work that hasn’t yet started. This phase preps the chemical stage of digestion—the breakdown that liberates nutrition for the cells. And it accounts for more than half of the body’s overall response to a meal.
The cephalic phase isn’t a warm-up. It’s a substantial part of the event.
And this phase operates on parasympathetic signaling. In other words, it requires that you not be braced.
Pavlov called it psychic secretion. In a procedure called sham feeding, dogs chewed and swallowed food that could never reach the stomach. The stomach secreted acid and enzymes anyway—the full digestive preparation for a meal that never arrived, on nerve signal alone. He won the Nobel Prize for that work in 1904. Not for the bells.
The detail I find most useful in that story is that thought and taste appear to matter more than sight and smell. So the woman eating lunch at her desk between calls, who experiences indigestion that afternoon, hasn’t just neglected to see her food while she stares at her screen. She’s missed thinking about it. And thinking about it turns out to be the biggest lever she had.
A friend of mine, sick with worry about her daughter’s rash, counts the grams of protein on her plate and yet cannot bring those macros fully into her body. She’s doing everything the literature would ask of her. But her attention is three rooms away, with her child. And her body knows the difference.
What follows compounds it. Stomach acid production drops. Pancreatic enzymes release sluggishly. Blood moves away from the gut and out toward the limbs. And the mucosa, the surface where absorption actually happens in the gut, loses more flow than the organ as a whole. This means less blood flow at exactly the place where nutrients cross.
You don’t need a tiger for this. In one study, healthy subjects had blood flow to the gut measurably fall during mental arithmetic. A math problem, in a lab, with no threat anywhere in the room. The finding isn’t uniform across studies, but what is consistent is that blood flow constricts under sympathetic activation, and the nervous system does not require an actual emergency to produce it. Which means the email does it. So does the unanswered text about her daughter, the pressure from the boss, the unresolved relational problem, the quota not met. The state doesn’t require an emergency, only the sensation of one.
So what about that protein quotient you’re aiming to meet? You’ve researched it, stocked the pantry and the fridge, consumed the recommended grams faithfully at the right time of day to support your muscles, brain, sleep, and metabolism. But if that chicken breast arrives in a stomach with less acid to break it down, meets fewer enzymes to liberate what’s inside, and passes along a gut wall with reduced blood flow to carry anything across to the cells it’s meant to target, the nutrients may not arrive.
The gut-brain axis is not a metaphor. It’s a supply chain. The vagus nerve is the physical route—brainstem to abdomen and back—carrying the signals that tell your digestive organs whether it’s safe to open for business. But when the message is emergency, the line stays closed. And a meaningful portion of what you planned may move through having barely fed you.
I’ll be upfront about what’s established here and what isn’t: Every link in that chain has been studied—the acid, the enzymes, the blood flow, the chemistry of how a nutrient is broken down and makes it from your plate to your cells. What hasn’t been measured is the sum of the parts. Nobody has fed the same woman the same meal—braced and unbraced—and weighed what crossed. So I’m reasoning from mechanism, and I’d rather tell you that. What I won’t do is let the opposite pass as settled—that what you eat is what you get, no matter the state you’re in.
The recommendation didn’t fail. The protein didn’t fail. The counting met a need on paper, and yet the terrain underneath the effort is still braced. And the bracing likely means that the relief is partial and doesn’t hold. The nervous system decides whether everything else you’re doing has anywhere to land.
In short: you can give a body in the state of everyday emergency the finest raw materials available and it will set them down. It has other priorities and they’re all short-term.
Everything is connected. We are all unique. And all things matter.
State matters.
A word about my own vocabulary
Sympathetic dominance is not a formal diagnosis, and it’s not a universally accepted concept. It isn’t a coded pathology—meaning you won’t find it in a diagnostic manual. No lab confirms it and there’s no medical specialty to treat it.
It’s a lens. One I taught for fifteen years, built on physiology that cannot be reduced to a simplistic slogan. In this piece—and in my broader work—I’ve used the phrase sympathetic dominance carefully, and often. The underlying biology is real and that’s what counts for this conversation: chronic sympathetic activation has documented downstream effects on inflammation, metabolism, hormonal signaling, and cognition.
The framework gets shaky in clinical application, where it’s sometimes used as a diagnosis in ways the physiology doesn’t fully support.
In that way, it fits inside the very conversation this piece is about: how words we adopt to describe something real can end up shaping the story more than the biology does. I’m telling you how I use the term so you can hold it lightly. My hope is not that you accept sympathetic dominance as a diagnosis, or something that you “have” or have to “deal with” or “treat.” but that you notice the pattern the word points to—sustained stimulation, incomplete recovery, a nervous system that never quite repairs—and take that pattern seriously in your own body’s terms.
When we give that biology a definition, put it into context, and take a beat, we have a place to look before we reach for the next thing.
What this isn’t
There’s a larger conversation happening right alongside this one, and I don’t want this piece to be mistaken for it.
Trauma-informed work got something right. It established that the body holds history, that safety is a physiological state rather than a mood, and that you can’t reason someone out of a state that’s braced for good reason. Practitioners in that field have restored something medicine had misplaced, and the people I know doing it well are doing careful, humane work. It’s critical and I’m not here to relitigate any of that.
But trauma-informed has also become the water many of us swim in. It’s on the intake form, in the marketing copy, in the workshop title, applied so widely it’s stopped specifying much. And in that trajectory, one question has largely gone unasked—the one that isn’t psychological, or ancestral. It’s not based on our history or our identity.
That question is whether the nutrients we are taking in are being absorbed.
Somatic work asks whether you feel safe. And it’s a very good question. The one I’m pointing to here may be considered narrower—more mechanical. But in the context we’re living in, it’s equally important: given the state you’re in, can your body use what you’re giving it?
Can your body do all that you’re asking of it—today, and across the whole arc of the plan or protocol you may have adopted?
The state is a portion of the whole. It isn’t the whole.
A woman can do years of excellent nervous system work and still be under-absorbing iron, because absorption has more than one gate. Her best friend can be well-regulated by every measure a somatic practitioner would use and still have a gallbladder that isn’t contracting on schedule—because bile responds to more than vagal tone, and because a decade of bracing leaves structure behind. Gallstones don’t dissolve when you calm down.
So the state determines whether what you give the body can be used. It doesn’t account for everything in play, and it doesn’t undo what’s already underway. The nervous system is a primary lever. It’s not necessarily the only one.
Which is why I won’t tell you to regulate your way out of this. You can’t meditate a gallbladder into contracting, and no amount of calm supplies iron that isn’t there. But stay braced and the iron that is there won’t cross. Both are true, and the second one is the one few check first.
I’m not offering you a better version of the work other people are doing. I’m pointing at a physiological precondition that everything else is built on.
You didn’t manufacture this state. You’re living in conditions that produce it—the appointment that ends before you’re finished, the years of not being heard or believed, the caregiving, the work, the information environment engineered to keep you slightly alarmed at all times. Your nervous system is responding correctly to what it’s facing. The problem isn’t insufficient calm. It’s inaccessible calm.
The loop
Here is one of those things I couldn’t stop seeing once I saw it…
In the clinic, one of the most reliable markers of a body living in that sympathetic dominant state isn’t a lab value or a biomarker. It’s a behavior. And that behavior is chronic seeking—the next pill, the next protocol, the next practitioner, the next program, the next test that will finally explain it or finally reveal the answers.
Urgency about our own health that never resolves into rest has become rampant. A person who cannot stop the pursuit is a new archetype.
And that behavior is the wellness industry’s entire revenue model.
Sit with that for a second, because I did, for a long time.
The state that makes healing hardest produces the exact behavior the market depends on.
And the market, in turn, keeps that state fueled: the urgency, the scarcity, the finding you didn’t know to worry about, the sense that you’re one purchase away from relief and also permanently behind.
Then the purchase underperforms, partly because it landed in a body that couldn’t use it. And the underperformance sends you looking again.
It isn’t a circle, exactly. Each pass costs more than the last, and you come back to it with less. Some of it is exploitative, but most of it doesn’t have to be. The loop doesn’t need anyone’s bad intentions to run.
Hot flashes
There’s something else here, and it belongs specifically to the women I’m most likely writing for. Transition is in this room as well.
About three-quarters of women moving through menopause in Western countries have hot flashes, and the explanation we’ve been given is incomplete. Decreases in estrogen are part of the equation, but not the whole of it. Researchers found that estrogen levels don’t necessarily differ between the women who flush and the women who don’t. What differs is what’s called the thermoneutral zone. The thermoneutral zone (TNZ) is the band of core temperatures within which the body holds steady without having to shiver to warm up or sweat to cool down. Inside that band, regulation happens entirely through blood flow to the skin.
In women without flashes that range runs about four-tenths of a degree. In women with them, it’s virtually nonexistent. And in that narrowed band, a tiny rise in temperature can be read as a severe overheating emergency—a reading performed by the hypothalamus in the central nervous system, responsible for regulation.
What diminishes that range is central sympathetic activation (connected to estrogen levels, but not reduced to them).
The order matters. The state I’ve been describing all this time is not simply downstream of the transition. It participates in producing the symptom that gets handed back to us as evidence that the transition is the problem. We are braced. The bracing is part of why we flash and burn. And the burning is what sends us looking for the thing that will “fix” our hormones.
This is not a claim that hot flashes are solely because of stress. That’s exactly the sentence that can get lifted out of context and become a prescription. Hormonal symptoms are not irrelevant. Hormone therapy can be real medicine and it helps a great many women. What I’m saying is that the picture is larger than the explanations we’re being offered, and that the part few are telling us (because it can’t be sold) is the part that both influences the symptom and determines whether the intervention lands.
I remember when I was experiencing hot flashes that the biggest reprieve came from a set bedtime (9:30pm) and carefulness about the content and conversations I engaged in for the hours prior. That’s one woman, and I’m not handing it to you as an answer. A bedtime isn’t equally available—not on shift work, or in a house that doesn’t go quiet when you do, or to a body already waking at three. But it follows from the mechanism rather than around it. And it’s free.
What can be measured (and what can’t)
The newest thing sold into that seeking arrives as generosity. Test everything at once—a hundred markers, two hundred or more, a full panel delivered to your door with no clinician in the room to read it. What comes back is a list of what’s wrong. Flagged values, out-of-range arrows, and a color-coded page of deviation.
What doesn’t come back is sequence. Which of these matters most? Which one is causing the others? Where would a person begin, and what can she safely ignore for now?
You’re handed a catalog of your own supposed brokenness with no order of operations. That can easily become a nervous system problem of its own. A body reading that page is not a body at rest. The panel fails to help, and then does something worse. It becomes another input—an alarm, a reason to brace—while the seeking it produces looks, from the outside, exactly like taking your health seriously and valiantly into your own hands.
The same thing can happen with excessive tracking. When you’re measuring everything, you risk losing the ability to tune into how you feel. You also lose a sense of whether you’re building or optimizing. Those are different projects. Building is what you do when the foundation is thin and the work is slow and unglamorous. Optimizing is refinement, and it only makes sense on top of something already sound. Confuse them and you end up fine-tuning a meal you can’t even digest.
The clearest case is the one I mentioned earlier: HRV.
Heart rate variability is the small variation in time between one heartbeat and the next. It exists mostly because of the vagus nerve, which can change your heart rate almost instantly. The sympathetic side works through slower chemistry and cannot adjust beat to beat. So the number is reading one branch, and it happens to be the calming one. Higher variability generally means the vagal brake is available to you. Lower generally means it’s less so.
That distinction got lost on the way to market. A ratio derived from HRV was sold for years as a measure of “sympathovagal balance”—a single number for how your two branches were getting along. It was never that, and physiologists have said so plainly for more than a decade.
What we wake to when we check our smartwatch each morning is a partial view of one branch, reported to the decimal. It’s still the closest thing we have to a window on the state I’ve spent this piece describing. And for the first time in history, it’s on millions of fingers.
Which means the woman most likely to be living in that sympathetic dominant state now wakes up to a number that grades how poorly she’s recovered.
Consider when in the day that number arrives. She’ll usually read it within the first ten minutes after waking, inside the cortisol response that has already begun scaling to whatever the day is going to ask of her. Before her feet are on the floor she’s been handed evidence, and the evidence says she is already behind.
Then the number does what numbers do without appropriate context. It gets compared, to her age group, to her own last week, to the woman online who says hers has climbed into ranges that aren’t physiologically plausible in her body. HRV naturally declines with age, which means she’ll watch it fall across years unless she does the next thing. HRV also moves with alcohol and illness and sleep position and what time she went to bed, so it can be dismissed on a bad day and believed on a good one. That makes it a reference, not a verdict.
Ironically, the instrument that detects the braced state has become a daily source of it.
My own mornings
For most of two decades I had a morning routine and I was faithful to it. Alarm, before light. The sequence of to-dos, in order. By the time I sat down to work I had done the things that made me able to meet the day.
In November of 2025 I left that work in an unexpected way. And the first thing that went, without my deciding it, was my morning routine.
I couldn’t set the alarm.
I couldn’t run the progression of small activities. I set the alarm the first week and turned it off before it rang. The second week I stopped setting it. It wasn’t discipline that failed. Something in me had put the whole apparatus down and wouldn’t pick it back up.
And what surprised me was how little I missed it, and how much that bothered me. I had come to believe that the routine was the reason I functioned. And in my previous situation, it was.
There’s a piece of physiology that explains what I was doing, and I wish I’d understood it earlier. Cortisol rises sharply in the first half hour after waking. It’s called the cortisol awakening response, and it isn’t a fixed event. It scales to what you expect. Researchers sampled saliva from more than two hundred people across six consecutive days and found the rise was reliably larger on workdays than on weekends, and larger still in people carrying heavy workloads and chronic worry. Competitive dancers show a bigger response on competition mornings than on ordinary ones. You’ve probably experienced the apprehensive wake-up before the alarm on days when you have an early morning flight.
The anticipation begins before you’re conscious of anticipating anything. People with too many duties are already coping with them from the moment they wake.
So my morning routine was never neutral. And it was never simply beneficial. It was scaffolding erected on top of a body that had already started bracing, built to raise me to the level where I could withstand what was coming. It was my daily fortification.
It worked, and I’m not sorry I had it, and yet that routine could not survive the removal of the thing it was fortifying against.
What I have instead now is a slow, unalarmed waking. Tea. Back in bed with my writing.
From the outside that may sound like a morning routine, and someone could sell it as one. From the inside it’s a different physiological event entirely, because there’s no assault underneath it. Same tea, opposite substrate. I didn’t add a practice. I removed a threat, and the practice reorganized itself around the absence.
Which is the whole argument, turned on me: you can’t tell from the outside whether a practice is landing. The state underneath decides.
What can’t be bought
The obvious move now is to tell you to regulate your nervous system. To find the parasympathetic tone to counter the sympathetic dominant state because that hypervigilance is getting in the way of the things you want to land. I’m not going to do that, and the reason is the whole point.
Nervous system regulation has become its own product category. The vagal tone device, the breathwork subscription, the somatic program, the cold plunge, the wearable that scores your recovery and tells you each morning how well you rested. I’ve watched women take on regulation as one more performance to be measured on, one more place to fall short. Which reproduces the state exactly. You cannot purchase your way into the condition that purchasing prevents.
What shifts the state is unsellable.
It’s sleep you stop negotiating with. Blood sugar that doesn’t spike and crash all day. Enough food. Eating sitting down, with attention, which is the cephalic phase asking for almost nothing. Ample movement that serves what your body needs and what you can do on this particular day. Being heard by someone who has time. The company of other people, which your nervous system reads as safety more reliably than any technique. A morning routine that shifts to meet you where you are.
And breath, which is free and always with you and requires nothing from anyone.
Though even here the story turns.
Slow, paced breathing was studied for hot flashes for years. The early laboratory work was encouraging—roughly half the flashes, gone. So it got standardized. The dose: fifteen minutes, twice a day. The rate: six to eight breaths a minute. A device to pace you, a protocol to follow, international recommendations built on top of it.
Then the larger trials came in. In one, two hundred and eighteen women practiced daily for sixteen weeks. They showed no significant difference from the controls. In another, women using the breathing device were compared with women issued an identical-looking device that only played music. The breathing group’s hot flashes dropped 19%. The music group’s dropped 44%.
Curiously, the women listening to music did better.
I don’t read that as breathwork failing. I read it as what happens when something unsellable gets sold. Sitting down for fifteen minutes with something gentle was the intervention. Music. A book. Art. Trees. Laughter. Cuddles.
The instruction to breathe correctly, at the right rate, for the prescribed duration, twice daily, with a device confirming whether you were doing it right—that was just one more thing to be measured on. And it broke the remedy.
Take that in.
Something that benefits us at the deepest levels broke when it became a protocol.
Not breathing. The prescription.
Breath still does what breath does—it’s the only lever in this whole piece you can access without buying anything. What it doesn’t necessarily survive is the thing you buy that measures, times, and scores it.
The pause
I want to come back to the woman with the binder and say the most obvious thing about her. She is seeking because she is sick or tired or unwell or uncomfortable and not getting better.
That is the correct response. A body that hurts and isn’t improving will send a person looking. The woman who stops looking has usually been told no enough times to believe it, and I have never once thought that was the healthier outcome. Seeking is what you do when the thing in front of you hasn’t finished the job. Every practitioner she saw who couldn’t help her made the next search more reasonable, not less.
And yet.
What eventually helps may be subtraction. Half of what’s in the binder. Not because those things are wrong—most of them are reasonable, have good intent, and some of them were even mine at one time—but because the accounting itself has become part of the load. A body reading a twelve-item protocol every morning is not a body at rest either.
A tidy list of what to do and when would undo everything I’ve spent this piece saying.
I used to have a rule against my team using the popular email sign-off “be well.” Before I even understood why, I felt that no one should have to be well before they’re allowed to get well. That would be its own cruelty, and if you’re deep in something serious, the last thing you need is another threshold to clear.
What I’d offer instead is small.
The next time you feel the pull toward the next thing—the order, the protocol, the search at eleven at night—notice the state you’re in as you reach. You don’t need to stop yourself. Just notice. Are you calm and curious right now, or braced, anticipatory, seeking? Is this considered, or is it the reaching?
And the same question, in the morning, of whatever you do first: what is this built on? Are you fortifying against something, or preparing for something? The answer may not change the practice. But it changes what the practice is doing to and for you.
That noticing is the beginning of the way back.
It costs nothing, which is exactly why nobody’s selling it to you.
References:
Digestion and the cephalic phase
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Chronic sympathetic activation
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Hot flashes
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Heart rate variability
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The cortisol awakening response
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What shifts the state
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P.S. A quick note about reading together: the votes are in, and ROAR—our book club for paid subscribers—will read The Red Address Book by Sofia Lundberg for our first gathering on August 27. Thank you to everyone who weighed in. If you'd like to join us, you can find the details here.
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