Welcome to the Evolution of Medicine podcast! In this episode, we’re discussing the gut-brain-pain axis with Robert Silverman, DC. As you know, chronic pain is a problem of epidemic proportion, as is dependence on opioids, with deadly consequences. Healthcare needs a new solution to treating chronic pain, and integrative and functional medicine holds the key.

Dr. Silverman is a chiropractic doctor, functional medicine expert, clinical nutritionist, international speaker and author. At his private practice in White Plains, NY, Dr. Silverman specializes in the treatment of joint pain using functional nutrition combined with cutting-edge, science-based, nonsurgical approaches. Our conversation spanned the scientific, when he discussed how the gut and brain communicate, to the practical, when he shared his seven Rs for healing the gut, to the big picture, when he theorized the protocol he would prescribe to address the opioid epidemic. It was a fascinating 30 minutes, and I think you’ll really enjoy it. Highlights include:

  • A deeper understanding of the gut-brain-pain axis, and how it is critical for overall health and addressing chronic pain
  • The three pathways through which the gut and brain communicate
  • The link between the gut-brain axis and intestinal permeability
  • The seven Rs of healing the gut
  • Nutrient recommendations for addressing chronic pain
  • A vision for chronic pain treatment in the future
  • And so much more!

James Maskell: Hello and welcome to the podcast. This week we feature Dr. Rob Silverman. He is a chiropractor and functional medicine expert, nutritionist, lectures all across the country. We had a great conversation here about the gut-brain-pain axis. So, one of the things we talked about was the three ways that the gut and brain communicate. We talked about his seven Rs, if you’ ve heard of the three Rs or the four Rs or the five Rs in functional medicine, now we’ re going to get to the seven Rs here, and he goes through exactly that. We talked about concussion, we talked about a vision for pain centers of the future. Super-interesting half an hour, really tons of great stuff in here. Enjoy!

A warm welcome to the podcast, Dr. Rob Silverman. Welcome, Doc.

Dr. Silverman: Welcome, thanks for having me, James. I’ m excited to be here.

James Maskell: So great to have you here. I’ m really excited actually for you to make your debut on the Evolution of Medicine platform. When I was at the—we met at the Integrative Health Symposium and came to see your talk and it was packed out that day. I had to stand up at the back. So I’ m glad to be able to share this with our community.

Dr. Silverman: I’ m happy you were able to make it, and I’ m happy to be here and share it with everybody. I think what we’ re going to talk about is revolutionary, and it’ s going to change people’ s lives. And that’ s the goal.

James Maskell: Absolutely. So yeah, we’ re on a theme here, the Evolution of Medicine, of chronic pain, and we’ re going to talk about that as we go along. We’ re going to talk about the gut-brain-pain axis, but let’ s start with the gut-brain axis. Because I think this was really coming into front and center just as we started the Functional Forum five years ago. So what was it about the gut brain axis that got you fired up and got you to just dive so deep into this topic?

Dr. Silverman: That’ s a great lead question because I have 20 years of experience. The first 10 was just chiropractic and I added functional medicine to my armamentarium, and you weight loss at the beginning, you do some pain and you get some positive outcomes, but you’ re really looking for the resolution of those kind of outcomes. You’ re really looking for that root cause, if you will. And then really, as I delve deeper and deeper in the literature, came to the realization that the gut to brain axis is critical for not overall health, just overall health, it’ s also critical for chronic pain. And when I applied some of the protocols, growing list of protocols, I found that resolution of systems, but also chronic pain. A lot of things about chronic pain that people don’ t know, we call it chronic because it goes on for a long period of time. But the true concept is it’ s acute pain every day.

James Maskell: Yeah, absolutely. So, get into the mechanism part for the scientists out there, what is the mechanism of the gut-brain axis? How long have we known this, and why do you think it’ s particularly interesting to chiropractors?

Dr. Silverman: Well, I think it’ s particularly interesting to chiropractors because the brain access number one is a bi-directional conversation. So, it’ s usually from the bottom up. So the guts of the brains communicates with each other in a millisecond. There are three ways that it communicates. First vagus nerve, two the bloodstream, and three through hormones. The main communication, the fastest communication, and the one that really resonates most with chiropractors are without question the vagus nerve. The vagus nerve is the largest cranial nerve in the body. It’ s parasympathetic nerve number 10, and we call it the “rest and digest nerve” or some people like to call it the “wine and dine” nerve. The number-one purpose of the vagus nerve is to quell peripheral inflammation. So when the tone is decreased, you have an elevation of sympathetic nervous system and an elevation of a sympathetic nervous system can lead you down a path of pain.

In addition to that, the fact that the vagus nerve is quenched or knocked down, if you will, it also communicates with the central nervous system, the central nervous system being the spinal cord in the brain, kind of home to where the chiropractors are, but it also stimulates inflammation and pain in those systems. So here you literally have somebody who eats a piece of bread, piece of gluten and puts you down on a path of pain. So our patients come in and have headaches, basic thing that a chiropractor will see. If you don’ t take the gluten away for argument’ s sake, you’ re never going to get the clinical medical outcome that’ s needed.

James Maskell: Absolutely. That’ s really powerful, and I’ m glad to have the three ways and it does seem like, you know, I’ ve always said about chiropractors that they probably have to unlearn the least to be effective in functional medicine because a lot of these things are just a part of, you know, as we really understand the science, it becomes clear that everything’ s interconnected and chiropractic education is really based on that philosophy.

Dr. Silverman: Without question, the body is all interconnected and we know that as chiros because the essence of chiropractic is the nervous system. So the nervous system communicates with everything, but as you evolve as a chiropractor, you start looking at all the other systems and see how those up to 14 systems are intertwined. They are perfect candidates for what you just mentioned as functional medicine. And I’ ve always encouraged my brethren to look because we all have to be focused as chiropractors, not having the ability to prescribe drugs to fix the body from the inside out through its natural systems and pathways.

James Maskell: Absolutely. So, I don’ t always read Chiropractic Economics. I used to when I was a sales rep, and I used to sit in offices waiting to speak to doctors, but now I really don’ t every so often. But I did see that recently you were on the cover talking about this exact thing.

One of the things that you said in your article, you talked about the link between the gut-brain axis and that permeability, which obviously is a big factor in a range of chronic illnesses. So, what’ s the mechanism that’ s going on there and how is the body and the system affected by gut permeability?

Dr. Silverman: So we have that increased intestinal permeability, gut permeability and or leaky gut, all things that pertain to the gut to brain axes. So we all know that when the gut is too permeable, undigested food particles, bacteria, they pass, they pass the gut, they go into the bloodstream. Those organisms are called antigens. They start with an antigen antibody effect. It’ s conceivable that antigen antibody of fat goes from local to systemic inflammation and ultimately into autoimmunity. So one thing for chiropractors immediately is we all have to always tell our patients that we all know that rheumatoid arthritis is autoimmunity, but osteoarthritis is also autoimmunity and that’ s a big jump for our patient base. Big jump for chiropractors.

Now that we covered that, with that being said, the gut has a lot of ways of communicating. The gut has a receptor site on called toll-like receptor four. That toll-like receptor four stimulates your own innate immune system. That receptor on the gut actually communicates with the vagus nerve. So that toll-like receptor and the vagus nerve are now communicating via bacteria. Once the vagus nerve is stimulated, or if you will, not stimulated, and the tone goes down, you now have a miscommunication or a slow communication between the gut-to-brain axis. So, at the gut level, you have inflammation in all those times we’ ve talked about all the Rs. I’ m up to seven Rs. I know Dr. Bland and it’ s infancy, the father of functional medicine started with four. Every time we see him, everybody says I’ m up to seven, I’ m up to eight. And he just loves the evolution of it.

But having said that, it’ s not just the evolution of the Rs, it’ s actually the evolution of the communication. And now we’ re seeing the body again through the gut is communicated through those multiple pathways. And chiropractors need to jump on that because one of the biggest downsides to that pathway being compromised is joint dysfunction.

James Maskell: What joint specifically?

Dr. Silverman: Well, a couple of the bigger joints that I always talk about are the spine and the disc. So the disc is fibro cartilage. So when you have a leaky gut, and it becomes permeable, they’ re signaling from the vagus nerve and they’ re signaling through the body and the bloodstream that actually releases cytokines, which are your system of interleukin, which are quite inflammatory, and the release of MNPS is matrix metalloproteinases, which eat fibro cartilage. Your disc is made out of fibro cartilage, but when you really look at the gut, which is what we’ re talking about in the gut to the brain, you realize that the material in the gut, which is a single layer of an organism made up of specific proteins, damages the blood-brain barrier made up of the specific same proteins. So, I call the blood-brain barrier the bouncer to the brain.

When it opens, you open yourself up to neuroimmunity. So now we can get what we call chronic inflammation through the body because our brain isn’ t functioning ,and you and I both know that if you say brain, we have a full house of people who are interested in the conversation.

James Maskell: Yeah, 100%. Well, look, everyone is interested in this conversation too because pain is such a big deal. Before we get into the pain side of things, can you just take us through those seven Rs just so that everyone, let’ s get everyone on the same page because we have a range of practitioners that obviously listen to the show and listen to the podcast, and I think before we get into the pain stuff, I’ d love to just get everyone onto that with your seven Rs.

Dr. Silverman: Sure, I appreciate that. My super seven Rs are quite simple. The first thing you want to do is you want to reset lifestyle. So within that R, or that reset of a lifestyle, you’ re looking to change people’ s dietary habits. So a couple of acronyms I use, which is GPS, no gluten, no processed food, no sugar. Take care of your DNA patients, no dairy, no nicotine, no artificial sweeteners. In addition, I always like to individualize a great diet within a lifestyle for people. So that may be the Mediterranean diet, it may be the ketogenic diet. In some instances, possibly the FODMAP. It could be the Pegan diet that Dr. Hyman speaks about so very much. So we’ re going to pick a specific diet that really fits people’ s genetic markers and get them moving also, 15,000 steps a day, some flexibility, some strength training if at all possible, so reset their lifestyle, and that’ s also an attempt to, as we speak to chronic pain later, rewire their brain.

Number two, real simple. We’ re going to remove, we’ re going remove the bad bacteria. We’ ve heard this before, so in the removal of bad bacteria, clearly the diet is going to be one thing. We’ re going to try and change their environment. Also, I’ m a big proponent of detoxing their liver to remove specific toxins. The BPAs, the phthalates, et cetera. In addition, I use a lot of berberine, berberine HCL to cure and get rid of what we call the dysbiosis in the lower bowel. Oregano oil is also something that’ s real common. There’ s something called serum bovine immunoglobulins that mop up the gut, that take out all these antigens out of the gut, so that would really remove all the bad bacteria. Then we’ ll move into replace, replace stomach acids and pancreatic enzymes.

Jumping to number four, regenerate, regenerate, and repair the gut lining. I like to call it the “heal and seal” time. Heal and seal the gut lining. So we’ ll do that with specific nutrients, usually we have what we call a lot of these options of medical foods. Alpha lipoic acid, omega-3 fatty acids, omega-3 fatty acids, hidden gem for the gut because the omega-3 fatty acids actually dim the expression of toll-like receptor four. Vitamin D, also a great choice within that.

And then we reinoculate. So the fifth step is reinoculate. I’ ll make a little point about that. Reinoculate with good quality bacteria. Now, interestingly enough, in most of the Rs, you’ ll see the reinoculate before the regenerate. I usually give the bacteria after because if the intestinal track is compromised, any bacteria passing stimulates an inflammatory response. So, what I usually use is something like Saccharomyces boulardii at an early stage, which is a yeast that functions as a probiotic, and it’ s really shown to help heal epithelial cell lining and decrease the incidence of C. diff.

So once we reinoculate, which is part number five, I like to retest everybody. Let’ s see where they are, because one of the biggest things that we have to do, and now I’ m speaking of chiropractors, medical doctors always love baseline. Chiropractors sometimes love to go into treatment. So in functional medicine, one of the beauties is that we always establish a baseline, go back to the baseline and retest and see where they are and then reintroduce certain things. Just because you’ re allergic to let’ s say broccoli, doesn’ t mean that you’ re allergic to broccoli after you fix the gut. So it bodes one of those thought provoking questions, do you have food allergies and you get leaky gut or do you have leaky gut and get a food allergy? So hopefully you can reintroduce some foods.

And last but not least, you want to retain your health. So many people think that they had their health, they can go and have pizza pie, like the staff just ate, but I didn’ t see it. You want to retain your house with specific lifestyle changes, and certain multivitamins, fish oils, vitamin D, and the like.

James Maskell: That’ s great. Yeah, really appreciate how clear that is. And obviously this is kind of one of the reasons why people like to come to your seminars because ultimately, it’ s just very clear like, do this in this order. And yeah, I appreciate you sharing that. So I want to get into this chronic pain conversation and the gut-brain-pain axis because ultimately, I think that this is an area where it seems like our medicine, and when I say our medicine, I’ m talking about functional medicine, I’ m talking about chiropractic, I’ m talking about a root cause approach could be solving one of the most vexing problems that we have, which is this huge epidemic of chronic pain. And so let’ s get into it for a moment just from a mechanism point of view with what does the gut-brain axis have to do with, like you said, the acute pain every day?

Dr. Silverman: Well, one, as we all know the gut is the house of the immune system. We all know that 80% of our immune cells are in our gut, it’ s where macro and micro nutrients are absorbed. But it communicates with our brain, as I said early in a millisecond, and our brain is the house for our pain. It’ s all our pain perception is in our brain. So one of the best statements I’ ve ever heard simply put, gut on fire means brain on fire. Brain on fire means gut on fire. So if your brain’ s on fire, it’ s not processing well. And without that processing, you’ re going to have an increase in inflammation. In addition, since your gut is the key for inflammation, increased inflammation elevates people’ s perception of pain. But what’ s maybe most interesting if we get a little technical is when we have that communication between the gut and the brain via that vagus nerve.

So that vagus nerve stimulates the parasympathetic nervous system, and it stimulates something called glial, or microglial cells. These microglial cells are your ability to clean and house your brain. When they become abhorrent or in excess, they actually damage your brain. So one of the biggest things now we’ re concerned about is this abhorrent movement of microglial cells, because they damage something called astrocytes. Astrocytes are the structure for the blood-brain barrier, astrocytes or ability to learn. In addition, these glial cells, when they become abhorrent also stimulate the pain receptors, if you will, in your brain. And you’ re leading yourself down a path of chronic pain. Last, remember as I said earlier, I want to come back, I want to piggyback back that elevation of inflammation from the gut is going to elevate everybody’ s perception of pain. So me as a chiropractic trying to utilize functional medicine, if I don’ t fix the gut, I can’ t utilize and decrease the pain enough over a long duration of time.

James Maskell: Yeah, absolutely. So when you see someone come in and the main thing they’ re finding is chronic pain, what order do you go into deal with the most likely things in that order?

Dr. Silverman: So if someone comes and say, we’ ll take the typical thing, eight out of 10 Americans have lower back. So, of course, after an exam, if I had to take a diagnostic test, there’ s always X-ray and MRI. So usually you’ re correlated and let’ s call it a disc herniation. So clearly everybody’ s coming in and pointing at that region, that disc herniation, the damage of that annulus being torn and the nucleus coming out. What they don’ t understand is that if their inflammation is elevated at that point, their pain is going to be elevated and I’ m never going to be able to resolve the injury if I’ m not able to resolve the inflammation at the gut level. So it’ s that contributory thing.

You know, if I could, if we had a video on, I’ d take a glass of water and in that glass of water would add all this water. That patient before they injured their back would have a full glass of water, pouring a little more water in after they tear their herniated disc and it would be flowing out and a patient comes in and goes, I don’ t know what I did. I don’ t know how I got this injury. I don’ t know why it hurts so much. Sort of like they squeezed the toothpaste out of the tube and didn’ t understand why it was all over there. So that gut is inflammatory marker leading for inflammation, leading you down a path of chronic pain. Disc herniation is an interesting injury but probably most commonly seen in chiropractic offices.

James Maskell: Yeah. What do you do on the intake to get you an idea before you do any other testing? Are there certain things in the history or the intake that give you a sign to say, hey, let’ s not forget about the gut. Maybe let’ s actually just go for the gut straight away.

Dr. Silverman: You know what, that is such a great question and I think that is where the doctors can pick up so many different things in the intake form. So in my intake form I ask about foods, they ask about medicines and when we can jump on the medicines if you’ d like, because I know we all like to try and avoid medicine.

James Maskell: Yeah. Let’ s do that.

Dr. Silverman: And I ask them specific nutrients they’ re taking, the drugs that they’ re taking. Have they had injuries before, and we can write later if they’ ve ever had a concussion. Because if they had a concussion, they have a gut problem now because since the gut and the brain and the brain and the gut are intertwined, if you hit your head, so I’ ll make this statement not to go off-track. For me, a concussion is the window into functional medicine in my office at this point.

So the intake form really reveals a lot. Plus, I have a system intake form. So when you look at the different systems you see a lot of people have gas and bloating and brain fog, you know that gut to brain axis is adverse. And you’ ll also ask them, did they get gas and bloating first? Or, did they have the injury to these musculoskeletal injuries, and they’ ll go, “Well, I just hurt myself but for four years I’ ve had gas and bloating.” And then there’ s also the questions, do you suffer from chronic pain? Because that could be what we now call silent, leaky gut.

So I think we wanted to get into the drugs. So in my genre, two of the things that I see a lot, or in my brother and in the chiropractic offices, we see a lot of people taking pain opiates. And I think enough said, we realize the literature is really bad on pain opiates and it seems like the medical doctors that even the pain doctors have decreased the use of them. But what I see a large use of is non-steroid anti-inflammatories, which are Aleve, Advil, ibuprofen, Tylenol’ s pain and fever, it’ s something different. Non-steroid anti-inflammatories decrease pain, but they impair healing. Nutraceuticals decrease pain but promote healing. So, with that being said, the NSAIDs also don’ t allow for joint cartilage synthesis. They don’ t allow for muscle hypertrophy. They don’ t allow for bones to heal and may cause leaky gut and have shown to damage the blood-brain barrier, both in the gut and the brain.

So you coming with some pain, you take an NASID, you block the pain, but you get into a vicious cycle where nothing heals and everything breaks down. So for me, I don’ t like my patients to take any NSAIDs at all.

James Maskell: Yeah. What about some of the common supplements like boswellia, serrapeptase, pancreatin, that kind of stuff?

Dr. Silverman: All that stuff’ s great. So, my go-tos would clearly be for pain. Some of the ones you just mentioned boswellia, you’ re decreasing the five lipoxygenase. Turmeric, of course, great absorption now on turmeric, turmeric also decreases the NF-kB pathway. It also stimulates the NRF2 pathway, which is a great antioxidant pathway. Omega-3 fatty acids are fabulous in that they help with cell membranes and help with nerve seal. Pro-resolving, specialized pro-resolving mediators are the jam on that and very simply because they allow for the resolution of inflammation and they also allow for the homeostasis between the initiation and the resolution of inflammation. So when you’ re looking at stuff like that, those are great options. You can also knock in your typical glucosamines in black pepper and things like that to help joints heal. But obviously you also wanting to add certain nutrients to help the gut be healthy, and that’ s where your probiotics come in, your L-glutamine, your alpha lipoic acid and such.

James Maskell: Awesome. All right, well look, I want to go on a bit of a different track for the rest of this interview because I know you’ re a big thinker. You think about the way that medicine works right now, the way that maybe it should work. So I want to give you a hypothetical and see where you go with it. So the Surgeon General, obviously he listens to this podcast because he’ s a smart dude, so he calls me up, but he goes, that guy, Dr. Rob Silverman, he seems to know what’ s going on with chronic pain. Dr. Silverman, I want you to make a proposal for what the chronic pain center of the future looks like. How is the care delivered? Who’ s involved, what practitioners do we need and how do we make it affordable for everyone? So give us some of your thoughts there.

Dr. Silverman: I love your idea. I kind of wanted to be president, but I’ ll settle for Surgeon General right out of the gate. He gets organic food. But nevertheless, I think that would be very interesting but it would be a very integrative crew. So, without question, we would have an MD there, we’ d have an MD or DO, we’ d have a naturopath. We would have an acupuncturist, we’ d have a chiropractor and we’ d have some sort of physical therapist. So since you threw me what they call the curve ball, I’ ll tell you that we’ ll have specific things like movement training. So we’ ll teach people how to move better. How to get in and out of a chair. Shocking as that may seem, most people move really poorly. So that puts a mechanical stress on the body, which leads to a biochemical stress. So I’ ll give you an example. Bending at the lumbar spine, which is your lower back, strains your collagen fibers. Straining those collagen fibers releases those cytokines and MMPSs, so they cause that localized injury at the disc level in the lower back. But they also go to systemic inflammation.

So we would teach people how to move. Most common ab exercise, sit-ups, sit-ups are extraordinarily deleterious for your back. It’ s planks now. So, Canada’ s instituted a no sit-up and no crunch rule and they’ re doing planks and side planks. So we teach people how to move. Secondly, wouldn’ t it be great to deal with our soils? Wouldn’ t it be great to get all the pesticides out? So next thing I’ d probably do is try and make everybody drink as simply as organic coffee. It is the third most sprayed item in America behind tobacco and cotton, and it is the most consumed beverage. The average American consumes 3.2 cups of coffee. So if I were able to get the pesticides out of the coffee and give them organic coffee, that would be great.

Go for the soils, try and explain to people what organic is. So, they would get nutrient-dense food verse all this crap. Start doing more, believe it or not, more labeling corrections. So as we know, the number-one calorie that we consume is sugar, and it’ s labeled as high fructose corn syrup. Now we’ re labeled as fructose, having more revealing food label. Also, I know this is pie in the sky, but let’ s be an Alice in Wonderland right now. You and I travel a lot. Correct? You’ re always on the road.

James Maskell: Oh yeah.

Dr. Silverman: Yeah. You come into the hotel with a headache, right?

James Maskell: Yep.

Dr. Silverman: One thing they’ ll offer you is Advil, Aleve and ibuprofen. I always ask them, do you have some fish oil, a little green drink, maybe a probiotic for my headache, if you will. So maybe get those easily attained NSAIDs and those easily attained pain out.

And a more serious note, let’ s start doing some literature on alternatives and working with an integrative system and let’ s really take a look at, as opposed to being in America and being extraordinarily lately reactive. Ouch, it hurts, let me go to the doctor. Why don’ t we be a little bit more proactive? I know you’ re doing something with healthcare that I find great and I’ ll give you a standing ovation except you just can’ t see me right now. I think it’ s awesome that people should be held accountable for their healthcare and understand that health is on them and to start getting themselves healthy through changes in lifestyle. So clearly I would educate people in quality lifestyles.

James Maskell: Awesome. Well, I’ m going to throw out, I agree with everything there, I guess the thing that I think about and, I’ m biased towards this because I’ m going to be advocating for this, I’ ve been advocating it for five years, but I’ m taking it up a level next year. One of the things that I read recently was just the degree to which people subjective reporting of pain was actually a function of yes, physiological things, but also the state and quality of their relationships. And if you are lonely, you would end up reporting a much higher pain score than with the same physiology than if you weren’ t. So in my model, where everyone’ s starting and a basic chronic pain group visit, run by the lowest possible level of practitioner, I mean you could have different people come in. One of the things I like about the group is obviously there’ s a sense of cohesion and you’ re introducing people who want to get healthy to another. But I also love the idea of if you have 20 people in a room and you want to use acupuncture for pain, an acupuncturist’ s time when divided by 20 people starts to look really reasonable in a way that may be an acupuncturist one-on-one is not feasible if you’ re trying to deliver this to, let’ s say, the 50% of poorest people in this country.

Dr. Silverman: Oh, I agree with you. I think the social aspect is outstanding, and I think that’ s part of the education. And you’ re right, I practice in a different area, I practice in Westchester County, so we have a little bit more of an upscale area. But the mental approach, high levels of depression, high levels of social dysfunction, I wholeheartedly agree with you. And I think that goes back, you know, I tell everybody, did you smile today? Can we please be positive, as opposed to negative? Don’ t they say that if you cry it decreases your immune system by four to five hours but your smile, it upgrades it by 24 hours.

James Maskell: That sounds good. So you’ ve got that in your office.

Dr. Silverman: I do. I tell everybody to smile, and certainly when you pay smile twice.

James Maskell: There you go. Well, Doc, look, I really appreciate your coming here and being on the podcast and give us a little bit of an update on where you’ re teaching later this year and next year. Where have you got lined up? Because I know there’ s a lot of ah, Silverman fans listening in.

Dr. Silverman: I appreciate that. Well, I’ m every week somewhere. I’ ll give you a couple of highlights. Like you said, I’ ll be at the Great Lakes in Minnesota from October 25th to 27th keynoting on October 27th. I’ ve got a couple of naturopathic organizations that I’ m doing in Canada with very large, I think it’ s OA&D and BCDA. I’ ve got a couple of those local doctor seminars where we have a hundred people. I’ ve got my own podcast, Proven Health Alternatives, which we have to get you on. So there’ s your invite right now.

James Maskell: All right, let’ s do it.

Dr. Silverman: In February of 2020, I’ ll be at IHS and I will have my book premiere and signing my new book is the Superhighway Health, talking all about the gut-to-brain axis.

James Maskell: Beautiful. Doc, thanks so much for being part of the Evolution of Medicine platform. Super-excited to share this interview. Very concise and clear. And ultimately, yeah, I say at the very beginning of the Functional Forum, I on purpose didn’ t put chiropractic on because from experience what I saw was that, and being in the industry that, I wanted to get doctors. I wanted to get MDs, DOs to functional medicine. I wanted to make it cool. But ultimately, as the science has evolved and has become way more clear that ultimately in this case the vagus nerve is playing such a big role in the gut-brain axis has been such a big role in so many chronic illnesses. We’ ve talked a lot about pain, but I know you’ re passionate about autism as well. And that was in your example here. All of these things are blowing up and we really need practitioners and practitioner teams that are capable of getting to the root cause and dealing with those kinds of things. So I’ m excited to be featuring you and many of your colleagues because ultimately we need a much bigger team than we have now if we’ re going to turn the ship around.

Dr. Silverman: I agree. And I know chiropractors are in, and chiropractors as a general rule have done nutrition, and one parting shard about the vagus nerve, so we can set the standard for all the others who want to talk about its bi-directionality between the gut from the medulla oblongata down through, attaches to the outside of the transverse colon. Remember, it’ s 80 to 90% afferent, which means it’ s up to the brain and it’ s afferent because it’ s basically a sensory nerve that senses the bacteria inside the gut. And one of the biggest things it senses is lipopolysaccharide, and with that being said, in the lipopolysaccharide, it also is again, as I said earlier, “rest and digest” nerve. It has some motor functions and it is the captain of the ship of the parasympathetic system. Overlooked is the enteric nervous system, which has more nerves than any other system in the body. And there’ s your digestive system. So when people say, what have you done for your guts lately? Do you have the guts to be healthy? Gut feeling? They’ re speaking exactly to that bacteria, but that bacteria is communicating with the vagus nerve. So I’ ll leave you with a question. Who is truly in charge?

James Maskell: That’ s a great question and yeah, super exciting to think about. One of the reasons why we started the Functional Forum is unpacking years ago is I just realized when that first research came out about the human microbiome, I was like, this has to change everything and it takes a lot longer than you think, right? We’ re still here, most people still don’ t get it, but putting you on the front lines, and having practitioners like yourself training has been awesome. So check out Dr. Rob Silverman, check out his books. Doc, thanks so much for being part of the Evolution of Medicine podcast. We’ ve been talking about the gut-brain-pain axis. Upcoming on our next functional forum, we’ ll be going deep into the causes of chronic pain and some of the ways to work around it. But in the meantime, I’ m your host James Maskell. Thanks so much for listening. We’ ll see you next time.

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