Gut Brain Axis with Dr. Robert Silverman: Rational Wellness Podcast 124

Dr. Robert Silverman discusses the Gut Brain Axis with Dr. Ben Weitz.

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Podcast Highlights

3:17  Dr. Silverman has made the Gut-Brain Axis the focus of his next book, Superhighway to Health, because the gut to brain connection is such an important part of our overall health.  One reason the gut is so important is that 80% of our immune system surrounds our gastrointestinal tract. Your gut is where your macro and micronutrients are absorbed.  The bulk of this absorption is in the small intestine, which is really 90% of the size of our intestinal tract, so it should not be called the “small” intestine. But the small intestine is only a single layer thick, so it is vulnerable to increased permeability if our gut becomes damaged. A damaged, leaky gut then can lead to a cascade of injuries and inflammation and eventually autoimmunity.

3:55  In the Functional Medicine world it’s commonly accepted that the gut is often the root cause of many other health problems, but this concept has not been embraced by the general medical community.  A lot of common medications are adverse to gut health, including antibiotics, opiates, non-steroidal anti-inflammatory medications (NSAIDs), like ibuprofen (Advil) and naproxen (Alleve). The NSAIDs damage the tight junctions, leading to leaky gut. If you have leaky gut, lipopolysaccharide, (LPS), is an endotoxin released by gut bacteria, gets into the blood stream and can lead to systemic inflammation.  If you cut your finger, you put a bandaid on it to protect your barrier.  Because we don’t see our gut lining, we don’t know if we have leaky gut, so we tend to ignore it. 

7:49  There are a myriad of non gut related symptoms, like skin rashes, brain and neurological problems, musculoskeletal pain that can all have their origin in the gut and if you clean up and fix their gut, you ameliorate them.  If you have a leaky gut, LPS and endolethal distending toxin get into systemic inflammation. You get too many toxins feeding through the liver and you damage your liver, you get a higher expression of diabetes, and you get an increase in obesity. You have three times the incidence of having a heart attack. You have more thyroid and other autoimmune problems. 50% of people who have spondyloarthropathies have leaky gut. Leaky gut, leaky brain. Gut on fire, brain on fire.

11:40  The vagus nerve goes from the brain stem, the medulla oblongata, down through the transverse colon. The vagus innervates most of the digestive and abdominal organs (liver, pancreas, intestines, etc.) and it even affects heart rate as well.  The vagus nerve is largely an efferent, meaning sensory, and when it senses dysbiosis, an imbalance of good and bad bacteria in the gut, it stimulates Toll-like receptor-4 and you get a release of LPS. The vagus nerve normally functions as a rest and digest nerve but when it dims, sympathetics go up and parasympathetics go down.  This also affects intestinal motility through the Migrating Motor Complex (MMC). We need nine to 11 peristaltic contractions in our small intestine per day to move our bolus from the small to the large intestine. When we have SIBO, we’re down to three because we have a backlog of the bacteria and it’s not moving through. Many attribute that SIBO to a decrease in vagal nerve stimulation.  Dimming of the vagal nerve may also close the ileocecal valve.  When you have a concussion, you down regulate the vagus nerve, which is why 60% of concussion sufferers get SIBO.  This is why with concussion patients, you need to treat their gut.

14:30  Our modern lifestyle and diet affects our gut-brain axis in a number of ways. Dr. Silverman recommends that we eliminate gluten, dairy, processed foods, sugar, nicotine, artificial sweeteners, and foods that we are allergic to.  We should also eliminate environmental toxins, like BPA, pthalates, food gums, emulsifiers, etc. We also need to manage our stress levels. 

18:45  Pesticides and toxins like glyphosate in Roundup should be avoided, which damage our microvilli and are considered carcinogenics by the Whole Health Organization.  We should eat organic as much as we can.

22:27  Dr. Jeffrey Bland, the founder of Functional Medicine, developed the 4 “R” program for gut healing, but Dr. Silverman has developed the 7 “R” program. 1. Is to Reset your diet and lifestyle.  The best diet should be individualized for each person. It could be it could be a keto, it could be a plant based, or it could be a Mediterranean.  You also need to do some form of exercise and this should include cardio such as walking, some form of resistance training and some form of flexibility work. 2. Remove. Remove toxins. Remove food allergies. Remove bad bacteria with emulsified oregano oil, berberine HCL, garlic, and other antimicrobials. Serum Bovine Immunoglobulins is also very helpful. This should also include some form of detox program.  Bacteriophages can also be helpful, since they can attach to only the bad bacteria and kill them.  3. Replace. Replace stomach acid, pancreatic enzymes, and probiotics, like Saccharomyces boulardi, which is a healthy yeast that functions like a probiotic. 4. Regenerate. Regenerate and repair the gut lining with a plethera of nutrients, including medical foods. Alpha lipoic acid, fish oil, and vitamin D are very helpful for reducing inflammation, promoting biodiversity, and promoting the mucosal lining of the gut. 5. Reinoculate. Use prebiotics and probiotics like Xylooligosaccharide and spore based probiotics like bacillus subtilis.  6. Retest and retain. Dr. Silverman mentioned that he really loves using the Cyrex Tests, including Cyrex Array 2, which tests leaky gut, measuring zonulin and occludin and also measuring LPS. He also likes the Array 22 to diagnose IBS.

33:40  Dr. Silverman treats vagus nerve dysfunction using violet laser light therapy using an Archonia laser for 30 seconds on each side of the vagus nerve from the brainstem down to the colon on both sides.  He also uses a percussor over the ileocecal valve and he will use some performance tape over where the ileocecal valve is.  He also recommends certain nutrients, including omega 3 fatty acids, green tea extract, and 6 or 8 additional nutrients that will be in his new book.

36:54  Dr. Silverman treats concussions with a five part protocol that includes addressing the upper cervical spine with manipulation, including the rectis capitis minor muscle.  He also uses proprioception and balance training. He uses a transcranial laser.  He also uses a nutrient protocol, including Magnesium Threonate, omega 3 fatty acids, turmeric, Specialized pro-resolving mediators (SPMs), and liposomal glutathione.  Dr. Silverman explained that the mechanism of a concussion is the shearing of the brain that leads to tearing of the axons that are involved in brain function.  Women are more susceptible to concussion than men, since they have weaker neck muscles and they don’t respond as well.  One way to test for concussion is to give a Vestibular/Ocular Motor Screen to the patient. Dr. Silverman often runs Cyrex Array 20 to monitor the blood brain barrier, but he also recommends testing for Interleukin 6, Interleukin 8, and C Reactive Protein, which are inflammatory markers. Neurofilament light polypeptide is a new biomarker that can be measured in plasma and is an early marker for Alzheimer’s and other neurological diseases.

42:25  Chronic traumatic encephalitis (CTE) results from brain trauma but there does not need to be a concussion. It can result from a series of sub-concussions that results in structural damage to the brain that doesn’t show up on CT scans. Dr. Silverman recommended Cyrex Array 20 for the Blood Brain barrier and having the patient do a tandem gait test and some cognitive tests are helpful, as well as the protocols that Dr. Silverman just mentioned for concussion.  Players suspected of having CTE should be given a functional MRI to see if there is a decrease in blood flow to part of the brain.


Dr. Robert Silverman is a chiropractic doctor, clinical nutritionist, international speaker and author of, “Inside-Out Health: A Revolutionary Approach to Your Body,” an Amazon No. 1 bestseller in 2016.  Dr. Silverman has a forthcoming book, Superhighway to Health, which is a complete guide to understanding the gut-brain axis and how it impacts overall health.  Dr. Silverman has a full-time private practice in White Plains, NY, where he specializes in the treatment of joint pain with innovative, science-based, nonsurgical approaches and functional medicine. His website is Dr.RobertSilverman.com.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.


Podcast Transcript

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello, Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple podcasts and give us a ratings and a review. That way more people will find out about the Rational Wellness Podcast. Also, you can go to YouTube and watch a video version, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

                                            Today we’re going to talk about the gut-brain axis with Dr. Robert Silverman. The gut brain-axis refers to the bi-directional, both ways, communication that occurs between the gastrointestinal track and the brain and the central nervous system. The gut microbiota communicate with the brain through the vagus nerve through the production of neuropeptides, through the production of neurotransmitters like serotonin and GABA through the immune system and through altered intestinal permeability.   The brain plays an important role in the modulation of gut functions such as motility, secretion of hydrochloric acid, bicarbonates and mucus and the gut immune response. The brain communicates with the gut through the sympathetic and parasympathetic branches of the autonomic nervous system. The brain also communicates with the gut through the hypothalamic pituitary adrenal axis using hormones which are essentially chemical messengers to control the digestive process. The vagus nerve is one of the main pathways for nervous system communication between the brain and the gut.

                                            Dr. Robert Silverman is a chiropractic doctor, clinical nutritionist, international speaker and author of Inside-Out Health: A Revolutionary Approach to Your Body, an Amazon number one bestseller in 2016.  Dr. Silverman has a forthcoming book, Super Highway To Health, which is a complete guide to understanding the gut-brain axis and how it impacts overall health. Dr Robert Silverman has a full time private practice in White Plains, New York, where he specializes in the treatment of joint pain with innovative, science-based, non-surgical approaches and functional medicine. And most important Dr. Robert Silverman is the chosen one.  Rob, thank you so much for joining me today.

Dr. Silverman:                    It’s great to be here today.  Thank you Ben, that was a great intro. Thank you so much. I’m excited about it.

Dr. Weitz:                           Okay, great. Why have you made the gut-brain axis your focus with your new book, Super Highway To Health, which is going to be released in February of next year?

Dr. Silverman:                    For me, I practiced 20 years and I found this may be the key access to our health. I think it was overlooked up to most recent memory and I believe that if we have a strong gut to brain connection that you will see a lot of health conditions quelch. Without question, the gut to brain axis is the topic of 2019 and beyond.

Dr. Weitz:                            In the Functional Medicine world, it’s commonly accepted that the gut is often the root cause of many other health problems, but this is not commonly accepted in the general medical community. Can you explain the impact that gut has on our health?  Can you also explain why the traditional medical community doesn’t seem to appreciate this connection?

Dr. Silverman:                    Let’s go through all the good stuff and then maybe we can get to why they’re not embracing it in the medical field. It’s interesting. Although there are a lot of medical DOs, MDs, DOs that are really coming in and looking at the medicine, functional nutrition model. The gut without question is everybody knows is 80% of our immune cells. I’ll say that again. It’s 80% of our immune cells. What have you done for your guts lately? Do you have the guts to be healthy? Your gut is where your macro and micro nutrients are absorbed. That’s foods, vitamins, and minerals. The bulk of the absorption occurs in a misnomer called the small intestine.  The small intestine is 90% of the size of our intestinal track yet we call it the small intestine. Food, nutrients and water are supposed to be absorbed in the small intestines. A new study just came out that lymph nodes are pointed exactly at that property in the small intestine. Whereas the large intestine, where a lot of bad things can occur, is a much thicker mucosal lining. It’s actually three layers, the mucosal lining in the large intestine. The small intestine is a single layer epithelial cell that if you unraveled it would be the length of a tennis court with the thickness of a paper towel.

                                            What’s most interesting to me is why people don’t look at it. I cut my finger, I put a band-aid on it because I know to protect the barrier. We don’t see the barrier in our gut so we don’t think to protect the barrier. So if our gut is damaged or it becomes leaky, if you will, too permeable, this can send a cascade of injuries, a cascade of inflammatory markers.  And that cascade stimulates and starts outside our gut in our bloodstream. It can be localized inflammation, systemic inflammation, and ultimately leading to, and we’ll go into more detail I’m sure, auto-immunity.

                                             The gut keeps what’s inside your body from actually going outside your body. Everybody right now, the doctors all know this, but every lay person, if you will, think about if your gut is too permeable or leaky, what’s inside your gut is floating around in your bloodstream. Most people when I say that, take a step back and go, “Oh, what do I need to do to keep this healthier?” Now why are the medical fields not taking this? It’s interesting. I went to chiropractic school in 1996 and leaky gut was already coined.  I think that a lot of the medical fields haven’t addressed this because a lot of the medications and a lot their treatments are very adverse to gut health. For instance, antibiotics, opiates. I mean opiates, the word opiate means opium. It has a slight amount of opium in it. Nonsteroid anti-inflammatories like Advil, Ibuprofen, Aleve, all damages the gut. They actually damage something called the tight junctions. Now you and I always use the word tight junctions and they open up and then we call that leaky gut.  Somebody just said … It was actually a patient who said to me, “So those tight junctions open up, I’m going to call them loose junctions.” I’m like, “That’s pretty good. I see you nodding your head.”  I just don’t think they’ve, taken this concept and it’s indisputable about the gut being 80% of the immune cells. For me I’m pausing because it’s so disconcerting, because it’s this constant battle every day. There are actually patients coming in that already say, “Hey, what can I do for my gut?”

Dr. Weitz:                            Right. One of the interesting things is all the myriad of non gut related symptoms that can actually have their origin back in the gut. You can have skin problems, you can have neurological brain problems, you can have a host of other problems that if you clean up and fix the gut, will often ameliorate.

Dr. Silverman:                     Absolutely, I have what they called my Dr. Rob’s gut matrix and it’s one slide and I’ve done a whole weekend on one slide. If your gut is leaky, if your gut is damaged, we can take it to the next step. If LPS, lipopolysaccharide, an endotoxin is expressed, lipopolysaccharide is on the inside of the body holding the outside of the membrane, holding gram negative bacteria there, endolethal distending toxins. If LPS is exposed, it leads to systemic inflammation.

                                            If your gut is too permeable, there’s too many toxins or an excess amount of toxins going into the liver. 75% of the toxins that get fed to your liver gets fed through your bloodstream from your gut. 25% gets fed through your portal vein. Leaky gut, damaged liver, leaky gut, higher incidence of prediabetes, diabetes, obesity because of the inflammation. In addition to that, we’ve also seen three times the incidence of heart attack now, with the expression of LPS. Leaky gut, leaky heart, increased auto-immunity.  Everybody comes in with a thyroid problem, so they think, or some autoimmune problem. Well, let’s trace it back possibly to the gut.  Leaky gut, higher incidence of musculoskeletal pain. 50% of people who have spondyloarthropathies have a leaky gut. You and I started it as chiropractors, we still do chiropractic. People are coming in with back pain, they think I’m nuts. I said, “Hey, I’m going to fix your area of your lower back, your L4-L5, but I got to fix your gut.  The literature is robust on that, in addition, and probably the biggest thing that we talk about is that gut to brain axis. Leaky gut, leaky brain, leaky brain, leaky gut. Gut on fire, brain on fire.  Your gut communicates with your brain within a millisecond.

Dr. Weitz:                            I also think it’s interesting that you were emphasizing the small intestine and in addition to there not being enough focus on the gut, what focus there is has been largely on the large intestine and doing stool samples and analyzing the bacteria there.  But not much has really been focused on the small intestine till all this focus on SIBO started coming in.  But Dr. Pimentel right now is doing a major project to map out the microbiota of the small intestine, which really hasn’t been done to this point.  I think that’s going to be… You will see a lot more focus on understanding the small intestine in the future, or I guess we should probably call it the long intestine instead of the small intestine.

Dr. Silverman:                    The long intestine with loose junctions. Yeah, I mean in a small intestine we know we can have leaky gut and when you think about it, I ask a lot of people, I say, “Where’s your gut leaky?” The question I really ask is, is it leaky in the small, large, or both?  Well, it’s probably both, but it’s probably more so in the small because the large intestine has all these really involved conditions like IBD, IBS, celiac, Crohn’s, ulcerative colitis.  Obviously Crohn’s is all the way through the track. The damage to the large intestine, can also backlog to the small intestine.  But interestingly enough, to get back to the gut to brain axis, if the large intestine is going back to the small intestine, it may be damaging the ileocecal valve, the flap or the doorway between the large and the small intestine. And what controls the ileocecal valve other than what you talked about earlier, the vagus nerve.

Dr. Weitz:                           Right?  What are some of the ways that our brain helps to direct the function of the gut?

Dr. Silverman:                    Well, let’s talk about the vagus nerve you mentioned-

Dr. Weitz:                           Okay.

Dr. Silverman:                    I’m sorry. Let’s do the vagus-

Dr. Weitz:                           Sounds good.

Dr. Silverman:                    There’s three. Now you really talked about the idea of neurotransmitters and everything. 93% of serotonin is your gut without question, those neurotransmitters are a player.  We forget our blood system.  We’re all interconnected, so it’s definitely going to communicate there. But the fastest way and the thing of most interest because everybody’s playing with it so much is without question, once again, that vagus nerve, that cranial nerve, that bi-directional communicator. The vagus nerve goes from the brain stem, the medulla oblongata, down through the transverse colon. It’s on the outside of the transverse colon, but it innervates the larynx, the pharynx, the liver, the pancreas. It does everything in that area down so it has an effect on heart rate. Now the stimulation of the vagus nerve, just as an aside, is really implicated in the increase in heart rate variability.

                                           You increase your heart rate variability. It shows health. Lot of good blood markers go with heart rate variability. The vagus nerve is 80 to 90% efferent. Now that means it’s a sensory nerve that communicates and the reason it’s a sensory nerve, it’s on the outside of the transverse colon and not on the inside. What is it senses: dysbiosis or the unleveling of good and bad bacteria and it does so and it stimulates something called toll-like receptor 4. Toll-like receptor 4, not to get too technical, is actually an innate immune stimulant on your intestinal, inside your intestinal track. And what stimulates toll-like receptor 4, lipopolysaccharide.  When it does that, the vagus nerve actually dims and sympathetics go up, parasympathetics go down, the properties of the vagus nerve no longer function like it is a rest and digest nerve or your wine and dine nerve. It also relates, you talked about motility, the migrating motor complex or the migrating motility complex. We need nine to 11 peristaltic contractions in our small intestine per day to move our bolus from the small to the large intestine. When we have SIBO, we’re down to three because we have a backlog of the bacteria and it’s not moving through. Many attribute that SIBO to a decrease in vagal nerve stimulation.

                                           Then you have the ileocecal valve that may be open so you get the backlog from the large to the small intestine or it may be closed. You can’t get the small intestine to go to the large intestine. One last parting shot on that before we go into more detail, when you have a concussion, it down regulates your vagus nerve. You’ve got to treat the gut.  60% of concussion patients get SIBO.

Dr. Weitz:                           Interesting. What are some of the ways that our modern lifestyle and the standard American diet affect the gut-brain axis?

Dr. Silverman:                    Well, I tell everybody, and this is in my upcoming book, I share it. I tell them this is my thousand dollar nutritional consult. Everybody got ready, GPS and you’re going to laugh, no gluten, no processed food, no sugar. Take care of your DNA, no dairy, no nicotine, no artificial sweeteners. If you want to add one more thing for your lucky seven, anything you’re allergic to, don’t eat.  We can cover the lectins in that seventh morning if you will. We started with all the bad foods, then we’re talking about the environment. Interestingly enough, the environment, BPA and pthalates, it’s very basic stuff. We get these environmental toxins that damage the integrity of our gut, which we want to keep in a pristine condition. And food, look at all the food chemicals, all the food gums, the emulsifiers. They all damage our gut lining. We just talked about drugs, the different kinds of drugs and everything and let’s not forget being a type a personality, how about stress?

Dr. Weitz:                            Absolutely. Increases stress hormones, adrenaline, cortisol.

Dr. Silverman:                    Yeah. That and now you’re getting from that gut to brain axis as you talked about in your intro to the HPA axis, which is that lateral periphery. That gut to brain is the center, it’s the highway. There’s an exit to get on another road, and that’s HPA.

Dr. Weitz:                           You brought up lectins. It’s a little bit of a side path, but should…

Dr. Silverman:                    Here we go.

Dr. Weitz:                           Should we be scared to death about lectins?  If I eat a lectin, am I going to die? If I eat a tomato, if I eat some other… Hey, if I have a legume that has lectins, is that going to harm me?

Dr. Silverman:                    Again, if we take wheat and dairy out, the amount of people that are showing to be allergic to lectins is much less. Do I think that everything’s lectin and just take every lectin out? I would probably say no to that. I would say that…

Dr. Weitz:                           If I get tested for sensitivities to lectins or to foods that have lectins and I don’t show sensitivities and I’m good.

Dr. Silverman:                    Yeah. Basically my position will be if you take wheat and dairy out and you’re not allergic to lectins, kumbaya. That’s going to be my answer. I think that clearly lectins are direct binders. If you’re allergic to them, they will directly bind to a tissue and damage you. However, if you’re not allergic and you took wheat and dairy out, I think you can eat them. They’ve got a lot of food values. At a certain point, if we’re going to be so restrictive, there’s nothing to eat. We’ll go back to what a famous chiropractor called Jack LaLanne. He said, “If man makes it, I won’t eat it.”

Dr. Weitz:                           Right. But tomatoes grow in the ground, man doesn’t make them.

Dr. Silverman:                    I mean, it’s an interesting thing. I’m a Tom Brady fan being an East coast guy, even though I’m from New York. So that it was nightshades and everything like that. But the reason they didn’t like nightshades was that they found out that insects died from chewing on a nightshade because there was a neurotoxin.  I think were a little bigger than the insects.  I’m not so sure that even nightshades are as deleterious as everybody thinks.

Dr. Weitz:                           Right. They’d been part of a healthy diet for a long period of time. I’ve had plenty of patients who eat nightshades regularly and we look for inflammatory factors. We look for… Try to screen them for potential, for chronic health problems. A lot of them don’t show any problems at all from eating lectins. That’s what I’ve seen.

Dr. Silverman:                    Yeah. You know what, I’ll take a tomato that isn’t sprayed versus a tomato sprayed any day.

Dr. Weitz:                           Oh absolutely. Yup.

Dr. Silverman:                    That’s a whole other podcast. But basically I’m a big proponent of organic food or quality farm food and everything. That’s one of our biggest problems. Our food nutrient deficiencies are huge and they are without question damaging and ruining us to our gut to brain axis.

Dr. Weitz:                            Absolutely. Pesticides and chemicals. Let that be the next question is what about toxins and what role does that play in our gut health and the gut-brain axis?

Dr. Silverman:                    The toxins may be one of the worst things. Now when we talk toxins, we already did the gluten and the dairy. Two of them are allergic foods. We ought to also cover the environmental toxins and the things. A great one to make sure everybody doesn’t take is Roundup. I mean they just paid a large amount of money because they’re so damning to everybody’s health. They’ve got glyphosate in it. The World Health Organization has called glyphosate a cancer causing property or cancer causing ingredient. It damages the microvilli, which are these little finger projections in our small intestine to grab all our nutrients and they damage them.

                                           Right then and there, obviously we want to avoid the bad soils. Also, and something that I’ve asked a lot of people in the farms is, is the farm or is there shade? If there’s shade, the water doesn’t hit as hard or if it is an organic farm but there’s no regular soil there? Meaning if it’s a full organic farm it’s fine. But if you have an organic section and a regular section when it rains and it rains without trees, so you get all flooding, there’s something called runoff. You run off all the ingredients from one to the other and even though it’s organic soil, you may be getting the pesticides. These are the type of questions that I like to ask, which farm, where’s it going, et cetera. 

Dr. Weitz:                           The water… Organic farming, in my opinion is better, but it’s certainly not perfect. There’s no way to make it perfect because they’re not using purified water. So even if the water didn’t run off from a regular farm to an organic farm, they’re still using water that they’re getting from the river or… And chances are it has some sort of toxins in it as well.

Dr. Silverman:                    No doubt. Understand that organic is only 95% organic which speaks to the idea of you always have to do the best we can. There are certain supplements that we have to take and there’s certain detox and gut helping programs that we should work on all the time. I just did a LinkedIn and we filmed a video and the video said, “Here’s one of the more commonly asked questions in my office. If I eat well, do I need supplements?” Well one, how many people eat well? Almost nobody. But yes, if you eat well you still may need some supplements and without question you want to make sure the gut to brain axis stays in a very strong integrity and making sure it communicates all the time at optimization.


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                                                Now back to our discussion.


Dr. Weitz:                              Now Dr. Jeffrey Bland, originally developed the Four R Program for healing the gut, but you have expanded it to the Seven R program in your new book. Can you explain what your Seven R program is and how it helps us heal our gut?

Dr. Silverman:                    Absolutely and everybody knows that Dr. Bland is the father of Functional Medicine and I’ve had some personal time with him. We all wouldn’t be here if it wasn’t for his vision. I believe that he’s a visionary, so kudos. I tip my hat to him. The Four R was awhile ago and every time I see him and he sees somebody do a rendition, an expansion of it, there’s a big smile in that man’s face saying, wow, look, here’s the seed and look where the plant’s growing. I’m up to seven right now. Let’s go through the seven. This is all pointed at the gut and the gut to brain axis.

                                           Number one R is to reset, reset your lifestyle. If we did anything, resetting the lifestyle would be without question of the ultimate, utmost importance. Within that resetting lifestyle like a diet like we talked about, it could be a keto, it could be a plant based, it could be a Mediterranean, and we could expand on that if you want a little bit. We have to individualize it for that person. New keto may work for you. Mediterranean may work for me. I’ve got a staff member here and plant-based may work for her. With that being said, we should all exercise, get our steps up, some form of body resistance or weight resistance. We don’t have to squat 900 pounds, but some body resistance, some form of flexibility and now really let’s chill with the blue light and all the technology even though you and I are on our laptops right now. Reset.

                                           Number two would be, remove. This is one of the biggest ones. Remove what? Remove toxins. Remove allergy foods. Now, the real question is, and I don’t know if we can cover it, is do food allergies give us leaky gut or did leaky gut cause the food allergies? Let’s take out the high allergy food as our test at that point. Testing and not guessing is a critical element because that starts our baseline. Now remove. We’re going to remove the bad bacteria very simply by using things like oregano oil and emulsified oregano oil, which removes all the bad bacteria from the upper body and berberine HCL and other things that’ll removed bacteria from the lower body. Garlic’s a great choice. SBI serum, bovine immunoglobulin is a great choice because it actually mops the gut and takes the antigen before it goes through the intestinal tract. My add there is, and it’s a question you and I have talked about multiple times, do we do the gut or do we do detox? Well, I do the detox in the gut. That’s when I do my 10, 15 and 30 day detox, within part two of the removal phase.

                                           Then it’s three, interesting three is to replace. What are we looking to replace? We’re looking to replace stomach acids, pancreatic acids. It’s really pointed at digestion. 60% of the gut is pointed at digestion. Now a lot of people say the next one is reinoculate and I say, “No, that’s not the time to reinoculate because the literature shows that if you have a faulty gut or a torn intestinal track, the good bacteria gets through and your body still attacks any kind of bacteria because your immune system’s on.” At this point from section one, or one through three, I recommend Saccharomyces boulardi. Saccharomyces boulardi is a yeast that functions like a probiotic that helps build the intestinal track. It also decreases your incidence of C. diff.

                                           At this point, our four is to regenerate. Regenerate, repair, or what I like to call heal and seal the gut lining. Use a plethora of nutrients. Some of these are called medical foods, nutrients that enable the gut lining to heal. They do so by promoting a microenvironment that’s anti-inflammatory and specific nutrients that adhere to the mucosal lining and allow it to proliferate and grow. Some other ones asides would be alpha lipoic acid, fish oils. Fish oils are great for the biodiversity in the gut. Fish oils dim the signal of toll-like receptor 4. If you want good gut health, better use fish oils. Vitamin D also helps with the biodiversity.

                                           Number five, obviously then reinoculate and we can go into detail. We can spend all day here talking about the different types of genus, species and strains. Some of the things that I’ve… It’s probiotics and prebiotics. Couple of takeaways that I like is the probiotics, we want diversity. We always want to switch. Some of the hotter ones right now that I like are the endospore bacillus subtilis, it’s an endospore and the prebiotic that I’m leaning towards is not FOS anymore, it’s XOS. XOS has a lot of literature, but the very basic takeaway is XOS feeds the good bacteria, FOS the bad bacteria and the good bacteria.

Dr. Weitz:                           Tell us what XOS is versus FOS.

Dr. Silverman:                    Xylooligosaccharide. It’s a different form of a carbohydrates where we call it fructooligosaccharides. If you guys can spell it, you may be able to beat those 12 year old kids on the spelling bee that got everything right. Good luck. XOS is really the choice right now. Something else that you may want to consider that in a remove phase is something we’re going to hear a lot about this. Bacteriophages, the phages are the choice. 110 years ago or whenever they decided to make antibiotics, antibiotics were made and they decided on it because they were carpet bombers. They killed all bacteria.

                                           The bacteriophages kills one family of bacteria. It’s structure is such that it attaches to the bacteria and it actually goes into the bacteria cell and getting into the bacteria cell, it populates and duplicates and explodes the cell. What it does is, it’s kind of like you have this city with bad guys and it doesn’t kill everybody, it kills all the bad guys and then lets the micro environment of the city, your gut, elevate. Bacteriophages are the thing they’re all going to talk about. There’s a lot of excitement there and they’re used to kill superbugs.

Dr. Weitz:                           I’ve kind of been hearing about that for the last five or 10 years and there’s a few products and then some people say, “Well, look, you can’t just have one product for killing all the different bacteria.” So far not much has really come out of this literature.

Dr. Silverman:                    The literature I’ve seen recently has been really strong, quite robust. It’s something I use. It’s one of my go-tos and like you said, there is no one product.

Dr. Weitz:                           Right. I’ve seen one product, but all it does is affect E. Coli, right?

Dr. Silverman:                    No, there’s a few more. Got a whole bunch now. I’d be happy to share them with you when you’re off the podcast.

Dr. Weitz:                           Okay.

Dr. Silverman:                    Love it. It’s great. I’ve been using them and getting really, really good results. The sixth R is to retain. It’s actually retest and retain. We have to do a baseline, testing is a critical element. We can talk a little about the testing that I recommend and it’s actually retest-

Dr. Weitz:                           What testing do you recommend?

Dr. Silverman:                    I like, you know what, if you’re going to… Without question, you don’t have to put a gun to my head. The tests that I really enjoy are the Cyrex tests. I found them to be quite effective in that they’re great at testing for barrier issues in autoimmunity. The barriers is a problem you want to detect, correct-

Dr. Weitz:                           Explain what you mean by testing the barrier?

Dr. Silverman:                    Okay. Well, there’s specific proteins that you can test for. For instance, let’s take the array 2. The array 2 deals with gut permeability or heightened gut permeability. They’re testing for LPS, which we talked about as an endotoxin. They’re also testing for occludin and zonulin, which are proteins that imply tight junction damage. Then they’re talking back to myosin, which is actually at the intestinal gut level. What they’ve also mixed it with in the real treat is they’re also testing for something called immunoglobulins, IgG, IgA, and IgM. IgG is our most common immunoglobin.  It’s 75% of our immunoglobulins in our body are IgG and it’s the only one that can pass the placenta. IgG implies chronic inflammation.  IgM implies acute inflammation.  IGA implies reactivation.  You’re seeing the damage and the area and the amount of autoimmunity going on. It’s not just showing you damage, it’s also showing you the damage that it can cause because auto immunity is an issue. One aside to the auto immunity is that as a chiro, people still come in for joint pain to me. We all know rheumatoid arthritis is our immunity, osteoarthritis is also, and you need to test the gut.

Dr. Weitz:                           This Cyrex test is a blood test and it’s designed to look for a leaky gut, right?

Dr. Silverman:                    Leaky gut, tight junction damage, that’s array 2 and also damage at the epithelial lining.  People don’t realize that you can have a… Here’s your gut, it’s semipermeable. You have LPS coming through causing a possible systemic inflammation. Interesting thing about LPS is, it doesn’t always have to cause symptomology, gas and bloating. There’s something called now silent leaky gut that Datis Karrhazian has coined brilliantly. He’s talked about, do you have fatigue? Do you have chronic inflammation in your body? Are you getting some forgetfulness? While you may not think it’s attributed to the gut, but it really is. These tests are great markers as a starting point just in the gut. They also have a SIBO versus IBS tests because we know if we have IBS, a lot of people transpose into SIBO and that would be Array 22.

Dr. Weitz:                           What about directly testing the gut by doing stool tests that look for pathogens, look for imbalances, look at, analyze the whole microbiota?

Dr. Silverman:                    I think those tests are great. I think that’s another great test. I know exactly the Genova test that you’re talking about and some other people have other stool tests. The real question is how much testing do we want to do? Do we want to test for food allergies? I’m a big proponent now of testing for genomic markers, trying to see where we are genetically. For instance, can you assimilate fat or do you assimilate carbohydrates? We all know that carbohydrates or improper carbohydrates are not a good choice, but we may assimilate them. We may have to change our macro nutrient content to the individuality of the patient in front of us. So testing, not guessing. That’s actually chapter four in my book.

Dr. Weitz:                           Of course, when you do a good stool test, it should include markers for whether or not you’re breaking down your fats as well because those will come out in a stool undigested.

Dr. Silverman:                    Absolutely. Testing is a critical element without question, even just testing a body fat seeing where somebody has visceral fat that’s indicative of things. I’ve seen visceral fat decrease when we’ve correct the proverbial leaky gut.

Dr. Weitz:                           Yeah. For the stool testing, I prefer the PCR based testing.

Dr. Silverman:                    Okay. I love it.

Dr. Weitz:                           Let’s talk about the vagus nerve.

Dr. Silverman:                    All right. Let’s go into-

Dr. Weitz:                           If there’s communication problems, what can we do about it? Is there a way to fix the vagus nerve and make sure this communication functions properly?

Dr. Silverman:                    Well before I started to really work with the vagus nerve, what I read and it’s still there is to gargle, to cough things like that. I’ve never found them to be speedy or extremely effective. There’s…

Dr. Weitz:                           No, what particular symptoms were you looking at that you expected these to have an effect on?

Dr. Silverman:                    I kind of backed down with no pun intended, I was treating so many concussions and not getting the resolution that I needed until I really started to implement and understand the gut to brain or if you will, the brain to gut axis. When I did that, I realized the vagus nerve was the player and then I started to work real hard, gather literature and try things empirically in my office. The thing I found the best to stimulate the vagus nerve, because the problem is it’s dim, we want to stimulate it, has been a 405 violet laser made by Archonia. I have found about 30 seconds on each side to really stimulate the vagus nerve and upgrade that communication with the brain to gut axis. That’s number one 

Dr. Weitz:                           You do it along the neck where…

Dr. Silverman:                    Yeah. I go from the medulla oblongata at the brainstem, down through the transverse colon, each side. Interestingly enough, vagus nerve left side is satiety, right side is mood and behavior. There are some differences. Yeah, there you go and it communicates really quick. Now-

Dr. Weitz:                           Other than this part of the neck afterwards, it’s deep inside the body cavity, right?

Dr. Silverman:                    It is. It’s exposed going through the jugular foramen. There are three nerves that actually go there other than some vessels, but those nerves are spinal accessory in glosspharyngeal nerve. But the vagus goes through there. I patch it up here and I came down and I go through the whole area. Now I’m at the point where I’m using like a percussor where the ileocecal valve is to create tone or increased tone by the transverse colon. I’m taping the space using a performance tape up here and a tape on the ileocecal valve. We’re getting the vagus nerve to go up and how do we know that?  Heart rate variability. We’re also coming out of my book with a vagus nerve nutritional protocol. There are some nutrients that help stimulate the vagus nerve and feed it. We’ve got about six to eight months of literature on that and I’m very excited to share that with everybody.

Dr. Weitz:                           Interesting. What are a couple of the nutrients that stimulate the vagus nerve?

Dr. Silverman:                    Omega-3 fatty acids, believe it or not, are one of the big ones. No real surprise there. Green tea extract is another one. You know what, I’ll give you those two and if you start with that, you’re really going to get going. But I’ve got like six or eight nutrients that are really going to get the vagus nerve to go. You guys are going to love that. Don’t worry, I’ll post it online when the book comes out. If you don’t buy the book you’ll get the post. I’ll write a blog on it.

Dr. Weitz:                           You mentioning how you treat a lot of concussions, can you talk about that? How do you… What’s your treatment protocol for concussions and what kinds of testing do you do and then what types of nutraceuticals are beneficial after a concussion?

Dr. Silverman:                    All right, so concussion is basically injured more from shearing of the brain. Remember the brain is made of a consistency of jello. That’s right, jello. It’s three pounds. It’s a very small organ. Yet it communicates with all the other organs in our body. The shearing from the moving, that’s where the tearing is, and there are some tearing to brain matter, but the biggest tear is the axons which allow you to communicate.

Dr. Weitz:                           And is one of the key factors that the person loses consciousness during the trauma for a period of time or is that not necessary?

Dr. Silverman:                    The loss of consciousness isn’t really a key determinant. About 9.3%, a little less than 10% of people actually lose consciousness. There are different grades, but they’ve kind of moved away from the grades, they’re are looking at the damage. It’s that shear back and forth. Women are more susceptible to concussion than men. They have weaker neck muscles, more impact, more whip, more shear. They don’t respond as well. We can go through that if you like, but some of the testing, very clear, everything’s in the eye so we use a visual ocular motor screen. You can download that. That’s two to four pages. The blood tests I used the Cyrex blood brain barrier. That is array 20. There’s also some standard blood tests now that you can look at. Some of the standard blood tests are interleukin six, interleukin eight and C reactive protein. They’ll show this tissue inflammation.

                                                In addition it’s something new called Neurofilament light. It’s a protein enzyme that the brain gives out. That’s actually an early marker for Alzheimer’s. It can depict Alzheimer’s, depending on what literature you read, from 16 to 23 years. 80% of people who get a concussion who have the APOE for a Leo in Alzheimer’s increases your incent. Something to look for. Those really cover the tests. The achievement are very interesting. It’s a five-part treatment for me.

                                                Number one, upper cervical. Upper cervical in the occipital ridge, the occipital triangle. You really want to go for those muscles, the muscle that’s most implicated is the rectus capatis posterior minor because it has the strongest myodural ridge. Because it has parallel collagen fibers so it gets whipped back and forth with the head. With that being said, any manual therapists, chiropractor would want to go in there and work on that area.

                                                In addition, we’ve got to start looking at the neck. Most people didn’t realize they all looked at you and didn’t realize the neck was holding the head up. I have torticollis so my neck is crooked but it makes my head look crooked so it’s intertwined. We have to look at the neck. Jim McMahon does a phenomenal 30-30. Remember that quarterback from your Chicago bears and your colored hair, crazy guy and he just stands there now looking with sunglasses in a dark room, having trouble articulating, doing puzzles. He went to a chiropractor in long Island, New York and he said that chiropractor was the first doctor who looked at his neck. So neck is a major thing manually, testing it, possibly adjusting it. Yes, medical doctors adjusting it. The literature is very strong on that. That’s the musculoskeletal chiropractic mode. The other modes are balanced and visual gaze. Balance, training, proprioception. Eight weeks of proprioception have shown to increase the size of the cerebellum where the bulk of posture and nerves are feeding.  That’s a great thing. Proprioception and balance and space between your nervous system and the muscular system. Gaze stabilization is a big deal. Your ability for eye-head movement. Dr. Ted Carrick, a chiropractor’s shown some great literature on that. I think it was in last year’s Frontier of Neurology, if you want to see that study. Laser, I use a lot of transcranial laser, 635 nanometers. The takeaway there is 635 and shown to stop cell apotosis, increase BDNF, brain derived neurotrophic factors which allow for brain neurogenesis. The takeaway here as in we’ve heard Dr. Perlmutter say this multiple times, the brain can now repair itself because we can’t have brain neurogenesis. Remember neuroplasticity, the ability of our plastic brain, plastic allow to grow nerves. I found the laser to be extremely effective for a great microenvironment. And then I use a nutritional protocol.

                                                I’ll give you the five nutrients. I have 15. Let’s give you the five. Magnesium Threonate. Magnesium L-Threonate has really shown to decrease any kind of injury, decreased brain aging, and up-regulate the ability of available magnesium both in the brain and the spinal cord. Omega-3 fatty acids, great for healing the brain, cell membrane. They actually enable you to avoid concussions. Everybody who’s treating teenagers or college kids or somebody who’s in a contact type sport, Omega-3 fatty acids.  Tumeric is always a great choice. We all know that. Pro-resolving mediators, specialized pro-resolving mediators allow for the resolution of inflammation. I’ll make it really easy. L-Glutathione decreases brain tissue damage by 70%. So Liposomal glutathione is my choice. There’s your big five.

Dr. Weitz:                            Cool. You’re talking about concussion, but we’ve learned in the last number of years a lot of football players and other athletes and even apparently people who don’t engage in athletics undergo some brain damage that is not really defined as a concussion. It’s called chronic traumatic encephalitis. It’s structural damage to the brain that can’t be seen on a normal scan. How do we diagnose that and can some of these protocols be beneficial for those patients as well?

Dr. Silverman:                    Yeah. CTE, they did a study of dead NFL players, 110 out of 111 had CTE, there’s damage to the brain. It’s sort of a sub-concussions can equal multiple concussions. Really the best tests are, for me, in here are tandem gait. What an easy thing, tandem gait. You remember you grew up at a similar time to I did, if you couldn’t walk a straight line you had too many back, back too much. I like the tandem gait. You should also test the blood brain barrier and that’s a hidden thing. I go into great detail in my book that the blood brain barrier is made up of the same protein structures as your gut. It’s a single layer organism of the same proteins. The only thing is I call it the bouncer of the brain.

Dr. Weitz:                            Are you saying that using gut-brain barrier tests from Cyrex array 2 is a way to help diagnose CTE?

Dr. Silverman:                    I won’t say CTE, but I test array 20 for the blood brain barrier and I found out if the blood brain barrier… array 20. The only thing that isn’t protect- The blood brain barrier obviously is what it says. It filters blood, 400 miles of blood to the brain. The only thing that really isn’t encased in the brain, in the blood brain barrier is the pituitary because it has to have direct contact with the blood. But once the blood brain barrier’s open, it’s direct access to neuro autoimmunity in the brain and that’s a lot of CTE and other things that we’re talking about. I’m big on that blood brain barrier. Some cognitive tests work really well and the treatments I mentioned before are treatments that you could use virtually mimicking the same treatments I just mentioned for CTE.

Dr. Weitz:                            Are there any other tasks that correlate with CTE?

Dr. Silverman:                    They’re in now some brain scans and MRIs that are being very revealing. So the brain scans are revealing the MRI, the key to the MRI is structure and function. If they have CTE, they have structural damage. But if somebody comes in your office, you want to ask for an MRI. That structure and function, structure is the structure of the brain and function is the blood flow. Obviously one of the biggest things that occur after concussion is lack of blood flow for the first seven to 10 days. You may want to get an MRI to see and reveal what’s going on inside the main organ in your body.

Dr. Weitz:                           But a standard MRI won’t show it.

Dr. Silverman:                    Standard MRI does not show it so you’ve got to ask for that structure and function. I can tell you so many times where I’ve had to ask and I’ve been corrected even if I’ve had to re-ask for it.

Dr. Weitz:                           What exactly is that called? It’s not called a structured function MRI, is it?

Dr. Silverman:                    No. Well, you know what, it’s a funny thing. My MRI place, if I were to walked there, it’s 10 feet away. I tell them that I want the MRI that reveals the vessels and they’re able to do it. That’s how I word it. Just say, I want to see the blood vessels, I want to see the functional movement of the blood. They’re like, “Okay, we know what to do.” Fill out this form.

Dr. Weitz:                           Okay.

Dr. Silverman:                    I can put in the comments section what they’re calling it and everything. It’s sort of like… It becomes rote to me at this point.

Dr. Weitz:                           Right. Good. I think this has been a good discussion. Do you want to give listeners three things that they could start on tomorrow for better gut-brain health?

Dr. Silverman:                    Absolutely. I’m going to make it really easy adhere to my GPS.  I said it before, no gluten, no processed food, no sugar. Take care of my DNA, no dairy, no nicotine or artificial sweetener. And guess what? Get a good night’s sleep.

Dr. Weitz:                           That’s great. How can our listeners get a hold of you and find out about your books and your programs?

Dr. Silverman:                    Well, great, thank you. My website is drrobertsilverman.com. Facebook, LinkedIn, Instagram, Dr. Robert Silverman. I’m very active socially. I’m always posting. I post two to three times a day. It’s a great way to get in touch with me and anybody wants to email me info@drrobertsilverman.com.

Dr. Weitz:                            Awesome. Thank you, Rob.


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