health & immunity: a natural perspective for a new …...Health & Immunity: A Natural Perspective for a New Paradigm - Part 2 Dr Silverman: Thanks so much Dr Grisanti. I’m happy

HEALTH & IMMUNITY: A NATURAL PERSPECTIVE FOR A NEW PARADIGM - PT2

FUNCTIONAL MEDICINE UNIVERSITY | ROBERT SILVERMAN DC, DACBN, MS, CNS, CCN, CSCS, CIISN, CKTP, CES, DCBCN, HKC, FKTR

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Health & Immunity: A Natural Perspective for a New Paradigm - Part 2

Dr Silverman: Thanks so much Dr Grisanti. I’m happy to be here and thank

everybody so much for coming back to part 2, we had a great turnout in part 1, we

had a ton of questions, a lot of concerns. Hopefully in the last 2 weeks a lot of people

are getting a better grip on this health pandemic. Once again, you have all my

information here to contact me. I encourage that, I encourage you to contact Dr

Grisanti through FMU, follow us on Facebook, we get a lot of DM questions those

are always very easy.

This is a newly updated presentation. I’m going to share some leading edge natural

approaches to improving ours, our patients’ health, our family and our friends’ health

through immune boosting strategies and much more. I really understand with the

advent of this new research and protocols surrounding this viral pandemic many

practitioners including myself are not seeing patients in person, we are seeing in

telehealth. And I can tell you this conversation piece, these protocols are great.

Nutrition is easy on telehealth and I strongly recommend it. And I’m here to help you

understand the etiology of the health pandemic and possibly the best direction to

take with your patient base now. So without any further delay let’s dig in on it. Like Dr

Grisanti says, I’m not in a rush today so if we go over a few minutes please I thank

you for your patience in advance, we are going to answer all the questions that we

possibly can.

COVID-19 can’t gain entry to our homes or bodies by itself

So I thought this was great, it was an article from the Guardian April 10th, importantly

COVID-19 cannot gain entry into our homes or our bodies by itself, we have to let it

in. So even if it is on our shirt or on our hand as long as it is not pushed into our oral

nasal pharynx we are ok and that is why this breathing and proverbial idea of

physical social distancing is so important. So please the literature since the last time

is even more stacked wear the mask when you are in public, wear your gloves.

Wash your hands for 20 seconds or more as we all talked about that, soap breaks up

that fat bond in the virus, remember a brief overview we covered it in part 1, viruses

are not live they are either activated or inactivated. Washing your hands for 20

seconds or more with soap, soap being a fat breaks the fat bi-layer and inactivates



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the virus as it washes down. Use all your typical antiseptics, again physical

distancing. Many of the stores that you can shop in are doing a great job, if you have

takeout or delivery if you will, wear your gloves, leave it outside, open up what you

need in the food, bring it in, wash the counter down. Just be careful, don’t get

frustrated we are all going to come out of this.

27ft for distancing

So now they are talking about 27 feet for social distancing because when you

sneeze, cough and the such it is a turbulent gas cloud and the pathogen bearing

droplets of all sizes can travel up to 23-27 feet and that is why you want people to

wear a mask because if they have it and they don’t know it they won’t pass it

because the mask will protect you from them.

Underlying conditions among adults hospitalized with COVID-19

So the colors red, blue, and yellow depict different age groups. So interesting, this

was for the month of March, the number 1 reason why people went in in the age

group over 60 was hypertension. From the age groups from 50-64 and 18-49

respective age groups the number 1 reason why they saw or their comorbidity that

led them in was obesity. So when you look at these, you are looking at interesting

cardiovascular disease, diabetes, maybe not or maybe (it is going to be an

interesting conversation that we are going to have at the end) chronic lung disease,

obesity and hypertension. Would it be fair to say that so many of these comorbidities

are wrapped around the theme of lifestyle? So now we know from the last

presentation the different protocols to use for immune boosting. Maybe now we’ve

got to get to lifestyle and maybe now also as I’ll make big point once again, maybe

now lifestyle includes not just exercise and supplements and sleep, maybe it

includes some gut health. Many of these comorbidities can be directly related to

lifestyle faults.

90% of COVID-19 admissions involve comorbidities

The hospitalization rate, 89.3% of patients hospitalised it was a comorbidity, about

90%. And you see the numbers if you are over 65 it is high almost double than 50-

64, and 50-64 is 3 times bigger than 18-49. Please don’t miss, some of these

younger people still inevitably still have to go into the hospital. So with one or more



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underlying conditions or comorbidities virtually everybody who is admitted to the

hospital had more than one, they were sick. Hypertension being the number one

comorbidity 72.6%. CVD slightly over 50% and obesity 41%. Once again, to reiterate

what I said earlier, younger groups number one reason that they are in from 65 or

less is obesity, 65 and older hypertension.

Leading comorbidities among COVID-19 deaths in New York

86.2% of the state’s deaths at that point involved at least one comorbidity, number

one was hypertension. Number two was diabetes. The rate of hospitalisation for

COVID-19 increased with age, not a real surprise we kind of saw the delineation

before but now they took it up to 75-84 and over 85, so the takeaway here is

everyone especially older adults should stay home if you can - physical and social

distance, use face coverings in public settings, wash your hands and start leading a

healthy lifestyle.

COVID-19

On average and this was a little disconcerting when I read this, only 6% of SARS-

CoV-2 infections detected worldwide. The actual number of infections may already

have reached several 10s of millions. Basically we just haven’t tested enough

worldwide to really know how many have been exposed and infected.

Now, between March 22nd and April 4th 2020, a total of 215 pregnant women

delivered infants and it was New York Presbyterian hospital and Columbia

University. All of the women were screened on admission for symptoms of COVID-

19, 4 women which is less than 2%, (1.9), had fever or other symptoms of COVID-19

on admission and all 4 women tested positive for COVID too. Of the 211 women

without symptoms all were afebrile on admission. So nasal pharyngeal swabs were

attained from 210 of the 211 women who did not have symptoms of COVID-19, of

these women 29 which equalled 13.7% were positive for SARS-CoV-2 thus 29 out of

the 33 patients who tested positive for SARS-CoV-2 on admission had no

symptomology of COVID-19 at the time of admission, which is scary when you think

about it. 15% of the women walking in in a hotbed had COVID-19 so always a

concern in transmission to the fetus.



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Now, it should be emphasised this was an early test, however what came out of this

test very simply was if you had a blood group or blood type A you had a higher risk

of acquiring COVID-19 than if you are non-blood group A or blood group O had the

lowest risk compared with everybody else.

Long-term exposure to air pollution vs mortality

This should really lead to the idea of toxins damage our body, toxins make us more

inflamed, toxins damage our gut, toxins damage our liver. So coronavirus patients in

areas that had high levels of air pollution before the pandemic were more likely to die

from infection than patients from cleaner parts of the country. Interesting, the

patients living for decades in a country with high levels of particulate matter, 15%

more likely to die from corona. This was data completed over 17 years from more

than 3000 countries. The particles come from fuel combustion, automobiles,

refineries, power plants and of course tobacco smoke.

Obesity

Obesity, let’s pause and realise when we talk to our patients we can help them with

this lifestyle issue called obesity. 29 out of 50 states already have an obesity rate of

over 50%, they project that all states at our current trajectory will have an obesity

rate over 50% by 2030. Obesity is an important predictor of severe corona virus. The

US has one of the highest rates in the world, younger adults especially are at

particular risk. And then the hypothesis is, people who are obese may already have

a compromised respiratory function prior to infection. Abdominal obesity the beer

belly if you will, which is typically more prominent in men can cause compression to

the diaphragm, lungs and chest cavity. In addition, people who are obese have

chronic low grade inflammation and an increase in those circulating proinflammatory

cytokines those cytokines which build your crescendo to the cytokine storm before

you contract the pathogenic virus or the novel virus have the worst outcomes. As we

talked about in the previous webinar the idea of a glass, nothing in the glass

meaning you have no cytokines. When you add enough water eventually the glass

will overflow. That is an evocative depiction I hope of the cytokine storm. However

the water will be fuller if you are obese because you haven’t filled with the water



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depicting those cytokines and inflammation that you have right now from being

overweight or corpulent you will.

Implication of non-alcoholic fatty liver disease NAFLD in patients with

COVID19

So here we have 202 patients with COVID-19, non-alcoholic fatty liver disease. You

would have never thought however, NAFLD usually occurs from those people who

have not watched their diet. So 50% admission out of that 202, however 75.2% it

went up to that number during the hospitalisation. We all know there’s abundant

ACE2 receptors in the small intestine on the liver. The liver has the largest amount of

macrophages. Once again direct tie gut-liver axis. Gut is the bullseye in your health

and obesity was implicated.

Chest x-ray / COVID-19

It is interesting that a chest x-ray is not very revealing or not very accurate at all. it

was almost 90% normal or mild and it was a substantial number of chest x-rays. So

by the end we are going to have at the end of this webinar a better look-see if you

will into what is a good way to test the patients.

Men

I thought 2 weeks ago men were more susceptible to coronavirus because of

hypertension, because men had more hypertension because of weight - no. The

estrogenic compounds in women have shown to enable them to have a better more

robust immune response to viral challenges than men. Unfortunately in most

instances women usually lose with that estrogenic issue however in this instance

thank you for them that they are able to ward off the viral challenges because of their

estradiol and phytoestrogens.

Immune system

So let’s discuss the idea of immune system. We went into some detail last time but

let’s look at it from a different perspective. There are 3 levels of defence against

disease causing organisms:

1. Barrier - I’m a big proponent of barrier



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- Skin and mucus

- Of course your gut, stomach acid and digestive enzymes

- And of course once again beneficial bacteria that can live in your colon

2. Innate Immunity: Then we get to our regular immune system, that innate vs

acquired or adaptive. The innate immune system is white blood cells called

neutrophils and macrophages and they engulf and destroy these foreign

invaders.

3. Acquired immunity: Then we get to the adaptive and acquired. And I’m not

going get too granular in here in that white blood cells called T cells target and

destroy infected cells, also B cells and plasma cells produce antibodies. So

the antibodies that we are going to talk about testing are summoned by your

acquired adaptive immune system via B cells.

Foundational immune support

What are we talking about foundational immune support - less make it easy, last time

I gave you a plethora of things to consider now we are going to tighten it up a little

bit:

Lifestyle: Let’s look at our lifestyle.

• Diet: Right now who better, when better than to incorporate a good quality

diet. Your typical culprits you want to remove like gluten, dairy, fried food,

sugar, soy. Diet is a critical element. I can’t tell you how many people in the

last month I’ve talked to have said their wife and their husband or their partner

has never been a better cook. I hope when we come out of this that we realize

that home cooking is a positive statement.

• Sleep: Sleep gives your immune system the opportunity to recover. 7-8 good

hours of sleep. Not only that, sleep also detoxifies your brain.

• Hydration: everybody should stay hydrated, now is a critical time. Half your

body weight in water, adding 8 ounces for every 15 minutes that you exercise.

• Exercise: Segwaying into exercise you are going to see a succeeding slide

that talks about exercise and the positive outcomes it can help lead to from

COVID-19.



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As I’ve said before the two things you are allowed walk out of your house for are

food and exercise. Look how essential exercise is.

Intestinal permeability and microbiota balance: Then for lifestyle, I really want to

let it resonate with everybody that intestinal permeability and microbiota balance is at

the forefront.

• Vitamin C: In addition to that vitamin C. Vitamin C is being used so readily,

what I like about vitamin C is that it helps engage immune system function,

decreases viral growth and reduces symptoms from viral onset.

• Vitamin A: As well as vitamin A, starting at 10,000IUs. Its also is great for the

immune system and will reduce symptoms. It doesn’t necessarily decrease

viral growth.

• Vitamin D3 & K2: outstanding vitamin to consume. Enhances immune

system, decreases viral growth and reduces symptoms.

• NAC / Glutathione: NAC a lot of literature showing that NAC is great for

upper respiratory, NAC leading into glutathione, glutathione the master

antioxidant in that it is able to ameliorate more free radicals than anything else

if you will on the market.

• Zinc: a hidden gem, zinc citrate enhances immune system, decreases viral

growth and reduces symptomology of the virus.

• Selenium: I’ll just skip probiotics for moment, selenium’s importance for

human health has been examined and recognised more recently. One aspect

of interest in selenium is the biggest impact it has on immune system and

against viral infections. Our current understanding that we discuss in

functional nutrition is this mineral is a trace mineral and it is one that we don’t

want to be lacking in.

• Probiotics: And what better than probiotics, 80% of your immune cells are in

your gut. Probiotics allow to populate your gut with the proper fuel and

conversation with your blood, your nervous system and your hormonal

system.

• Exercise: And here’s your exercise, we talked about that before, regular

exercise helps prevent and reduce the severity of ARDS, which is acute

respiratory distress syndrome. A single session of exercise increases



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production of a critical antioxidant extracellular superoxide dismutase. A

decrease in that antioxidant has been seen in acute lung disease. Actually a

decrease in that antioxidant has been seen in several diseases, not only

including lung disease but heart disease and kidney failure and has also been

associated with certain chronic conditions like osteoarthritis.

Anti-viral support

So you see I broke it up a little differently and I’m not giving you as many slides

because we really covered in great detail the power of the different nutrients.

• Quercetin is now really coming to the forefront and quercetin you can get in a

lot of different fruits and vegetables and it has a wide range of benefits

including decreasing viral growth, enhancing the immune system and

reducing symptomology.

• EGCG I’ve got a great study on EGCG in a moment.

• Melatonin my goodness, melatonin helps at the gut level for LPS, it helps

with sleep and it diminishes the cytokine storm 20mg of melatonin.

• PEA is interesting in that it helps nerve function but it is also naturally in every

cell of the body and biological response to inflammatory markers. There’s

been over 350 studies, the bottom line is it works through multiple

mechanisms, it attenuates potentially deadly cytokine storms.

• Alpha lipoic acid I’ll have a slide on that.

• Pomegranate again great for immune function.

• omega 3: And we always seem to forget the power of omega 3 fatty acids for

cell membrane health, anti-inflammatory and the biodiversity of the gut.

The viral and cellular membrane

Let’s take a good look at this. Any virus must enter a cell, replicate and damage the

cell escaping to adjacent cells. For viruses there are 3 enzymes that play a critical

role in the sequence, ACE2, furin and 3CL pro. They all can stimulate so here is

what you have, you have your ACE2 going through your furin - this is going to take a

little while to explain - stimulating the NLRP3 inflammasome. So let’s go through this,

give me about 2 minutes to review it.



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The SARS-CoV-2 infects these alveolar cells through the ACE2 receptor. The

destruction of the epithelial cells and increase of cell permeability leads to the

release of the virus. The SARS activates the innate immune system, macrophages

and other innate immune cells that not only capture the virus but also release a large

number of cytokines and chemokines including interleukin 6. Adaptive immunity is

also activated by antigen presenting cells typically dendrite cells in your gut and in

your lung which are your periscope. T and B cells not only play an antiviral role but

they also directly or indirectly promote the secretion of inflammatory cytokines. In

addition under the stimulation of inflammatory factors, a large number of your

inflammatory exudates enter the alveoli resulting in dyspnea and respiratory failure.

As we talked before this spike tropism protein is very powerful in that it sticks to

these ACE2 receptors, it is a sticky protein.

Inside, the uniqueness or presence of furin enzymes on all cell surfaces cleave and

activate the SARS-CoV-2 in a wide range of tissues and organs. Once again it can

damage all these organs at once and it activates and unleashes the NLRP3

inflammasome initiating a flurry of immune reactions that can result in the cytokine

storm. Tropism of the corona virus leads to this furin cleavage in the spike protein. It

is very interesting, this is not present in SARS-CoV-1 or SARS-CoV. Some of the

testing that we’ll get to you’ll see this distinctive difference. The presence of furins on

almost all the cell surfaces allow a dramatically increased ability to fuse to the host

cells so the spike protein and furin activate sites really isn’t the whole story, what we

left out last time was the CL protease, once they’ve entered the human cells corona

viruses produce damage and spread to other cells by creating an enzyme called the

3CL protease. Although several enzymes may be involved in viral replication and

space, the 3CL protease is the most important one of the corona virus family.

ACE2

So here’s your ACE2 which is your host receptor responsible for mediating. This is a

picture everybody uses, I want to share this picture to depict what is going on. The

ACE2, the gut microbiota and cardiovascular, we don’t have to go through the whole

thing, what you are seeing here is ACE2 is common on the lung, the gut, the heart,

liver and the kidney.



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ACE2 is expressed in the heart. Here is what is most interesting I want to share this,

this was a huge takeaway when I came across it, ACE2 cellular distribution in the

human heart is not clearly illuminated. As we all know pericytes with high expression

of ACE2 act as the target cardiac cell. Perictye injury due to virus is the reason you

get the damage, if people are infected by the virus they have a higher risk of heart

attack, it is not the muscle it is actually the pericytes.

Cytokine storm

So here we go with the cytokine storm. So the cytokine storm is interesting in that

pro-inflammatory cytokines defend hosts from invading pathogens but they are also

capable of driving pathological inflammation. So to shorten up the discussion, most

patients with severe COVID-19 exhibit substantially elevated serum levels and pro-

inflammatory cytokines like IL1b and IL6 as well as some others, IL2, IL8, 17 and the

such. In addition also you’ll see a rise in TNF. All of these are characterised there as

the cytokine storm. Also C-reactive protein and d-dimer may be found to be

abnormally high. High levels of pro-inflammatory cytokines may lead to shock and

tissue damage in the heart, liver and kidney as well as respiratory or multiple organ

failure. They also mediate extensive pulmonary pathology leading to this massive

infiltration of neutrophils and macrophages, diffuse alveolar damage with the

formation of hyaline membranes and diffuse thickening of the alveolar wall. They are

bad dudes.

So here is the anatomy and I put this in so that everybody can review this, I’m not

going to read steps 1, 2, 3 and 4, we kind of did that already but I just wanted

everybody to have a picture-word representation of what is going on. Took it believe

it or not from the Wall Street Journal.

Activation of the NLRP3 inflammasome

Here is the activation of the NLRP3 inflammasome. So you get your PAMPS that

stimulate your Toll-like receptor, your TLR speaks to and stimulate NFkB where you

have this release of interleukin and those two interleukins that are released are IL1b

and IL18, in this (it is not depicted clearly) you also get a lot of mitochondrial fatigue

and that is one of the reasons that people feel so tired.



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Decrease NLRP3 Inflammasome

So, what would I do to decrease the NLRP3 inflammasome:

• EGCG green tea is a great choice.

• Quercetin we love, we covered it.

• Resveratrol

• Curcumin

• Ginger - ginger is a flowering plant that has been used in traditional medicine

throughout history as a means of aiding digestion and supporting immune

function.

• Boswellia also works on the 5 hypoxygenase pathway.

• Aloe vera has also shown to decrease the NLRP3 inflammasome.

• Sulforaphane which comes from cruciferous vegetables.

• Omega 3 fatty acids actually may be one of your first choices, probably your

second now behind EGCG and we are going to get to that study in a

moment. Omega 3s actually block certain endotoxins like LPS from clinging

to TLR4.

• Vitamin D bottom line is the former CDC chief Dr Tom Friedman said corona

virus infection may be reduced by vitamin D.

• Melatonin which we talked about decreasing the cytokine storm. And pro-

resolving mediators, these are what fish oils can convert to. They are

resolvins, protectins and maresins, they allow for the resolution of

inflammation and the homeostasis of the initiation and the resolution of

inflammation. Interesting little science titbit, the resolvents are able to pass

the blood brain barrier and cause micro-environment of the brain decreased

inflammation.

The identification of dietary molecules as therapeutic agents to combat

COVID-19 using molecular docking studies

So here is one that we just found last night that is just unreal. The identification of

dietary molecules as therapeutic agents to combat COVID-19 using molecular

docking studies. They checked docking of seven proteins on SARS-CoV-2, they

used 18 compounds that were compared with 2 FDA drugs. Look at those drugs,



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they are the drugs that everybody is talking about, the EGCG was a lead compound

that fit so well into the binding docks the conclusion was green tea EGCG should be

explored as a drug candidate for the treatment of COVID-19. So by getting on the

binding docks they are not allowing other things to bind, the virus can’t get into the

cell.

Vitamin D receptor inhibits NLRP3

Vitamin D receptor inhibits NLRP3 activation, which is fabulous, it physically binds on

the receptor site.

Mechanisms for innate and adaptive immune responses to vitamin D

Here’s some mechanisms for innate and adaptive immune responses and that is a

big takeaway to vitamin D. We can go through this whole slide and all the different

things but I just want to highlight that the mechanism for innate and adaptive immune

responses, vitamin D should be used all the time. There’s some people who said

vitamin D has some negative effects well don’t take 50,000IUs every day, vitamin D3

with K2 5000-10,000IUs has been shown in multiple studies to modulate your

immune system against respiratory viruses in upper respiratory areas.

Evidence that vitamin D supplementation could reduce risk of influenza on

COVID-19 infections and deaths

Here is a study that just came out on April 2nd, in Nutrients 2020, distinct evidence

that vitamin D could reduce the risk of influenza on COVID19 infections and deaths.

To reduce the risk 10,000 IUs per day of D3 for a few weeks then titrate down to

5000, your goal is to raise the concentration to a level of 40-60ng/mL, I like 60-80.

Here is the conclusion of the study, for treatment of COVID19 higher vitamin D would

be useful.

Melatonin

Well I used this slide before but I put in these red arrows, I really wanted to highlight:

1. If you look in the right corner melatonin actually will enable you to get sleep so

you see what it is doing in the lower right corner.



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2. Then when you look in the upper right corner it is stopping the release of ROS

and oxidative enzymes so you are not having the release of your free radicals.

3. And in addition it is actually blunting inflammation that is very typical in the

cytokine storm. Look at that red arrow stopping all the interleukins from being

released.

4. In addition melatonin has many functions. There are anti-excitatory actions,

vasomotor, we talked about sleep, antioxidant, anti-inflammatory. The

takeaway here is melatonin decreases inflammatory cell recruitment, it

decreases pro-inflammatory cytokines, it decreases the incidence of acute

lung oxidative injury and it has an antioxidant protective property.

So melatonin should be in everybody’s toolbox to deal with what is going on.

Methylation vs higher cytokine storm

So this was given to me by somebody who is a gene expert, this was in Lupus, but

what they found out was that if you couldn’t methylate you had a higher incidence of

a release of NFkB and a higher cytokine storm. So for those who have never heard

the term methylation, methyl group is CH3. If you want to make a proper copy you

want to be able to methylate. So think about 2 footsteps and taking a picture, proper

copy. Hypomethylating is removing one methyl group you are only taking a picture of

one step. It is not the same replicability, leading to aberrancy. In addition,

hypermethylation would be like adding 3 footprints. Hypomethylation leads you down

a path in this study to increase the release of NFkB and possibly a cytokine storm,

everybody now should start to consider gene tests in people who are more

susceptible. What leads to hypomethylation, single nucleotide polymorphisms,

histamine, cell biologies are out and producing histamine. Things like that.

Over-expression of IL6

A lot going on in this over-expression and its potential negative consequences on the

viral immune response. So understand that current science evidence supports

different scenarios where the balance of IL6 production after viral infection can affect

viral clearance promoting viral persistence and chronic inflammation. Interesting in

that the overexpression of interleukin 6 can damage that granule TH1, TH2. It also in



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theory with the upregulation of IL6 can increase the virulence and host genetic

background also increasing apoptosis and damaging cytolysis.

Brief introduction of IL6

This is an ad and basically here the takeaway on this study is we are showing the

major functions of IL6, its cell sources, its receptors, its cell targets, and its disease

association. IL6 is an important member of the cytokine network, it plays an essential

role in acute inflammation. It is a multifunctional cytokine which also plays an

important role in human metabolism, autoimmune cell differentiation and cell

treatment and so on and so forth. IL6 being the vast culprit. You can see its disease

association in the 6 points there, you can see its cell target. This is if you will a slide

that we could spend a half hour 45minutes in detailing, you have this please review

this post webinar.

IL6 in severe cases of COVID19

In addition, IL6 in severe cases of COVID19, 9 severe COVID19 patients symptoms

in order: fever, cough, dyspnea, fatigue. So the common comorbidity with the raise in

IL6 was hypertension. IL6 interestingly enough was increased with fever, body

temperature. It was also increased with the expression of C-reactive protein, LDH

and D-Dimer. The conclusion, in March 2020, the dynamic change in IL6 can be

used as a marker for severe COVID19. However, what do we do, what can we do to

inhibit IL6? Well we can stimulate this wonderful antioxidant pathway called the Nrf2.

Stimulate the Nrf2 pathway

What helps stimulate the Nrf2, well let’s take a look at some of these supplements

and lifestyle changes. Again I want the lifestyle changes to now start to resonate with

everybody since we have been home for a while and maybe home for a little bit

longer.

• Fish oil stimulates Nrf2

• Caloric restriction, intermittent fasting, time restricted eating

• Curcumin

• Green tea extract

• Milk thistle



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• Alpha lipoid acid

• Sulforaphane

• Ashwaganda root

• Coffee, of course organic coffee. One little aside to the coffee, remember if it

is not organic coffee it is full of a large amount of pesticides. Organic coffee is

limited as to pesticides.

• One more addition to this, low level laser therapy has shown to really help

stimulate the Nrf2 pathway.

Alpha lipoic acid

Alpha lipoic acid I think it has been overlooked. It is actually a cellular coenzyme, it

works with the water and the fat part of the cell, antioxidant. It increases glutathione

levels and it is shown to attenuate increased susceptibility to human corona virus.

The next big thing ahead vagus nerve

What else would I like to share with you, well I’d like to talk about the vagus nerve I

think the vagus nerve is very much overlooked in that the vagus nerve goes from the

medulla oblongata down through the transverse colon. It is 90% afferent and it

innervates so many different structures in between the medulla oblongata and the

transverse colon. It is on the outside of the transverse colon. And therefore it has to

sense what is going on inside the gut. It does so by sensing the bacteria in the gut

and it also communicates guys are you ready and gals toll-like receptor 4, that’s how

TLR communicates in the gut. Having said that, 90% is afferent because it needs to

be sensory, only 10% efferent.

So just a little review once again of the anatomy:

- The medulla oblongata down through the transverse colon innervating the

neck, thorax, liver, pancreas and intestines. The vagus nerve is sensory and

communicates with the CNS, as we all now know there’s been many

statements about loss of taste and smell actually being a precursor and

diagnostic tool that people are using for corona virus, if you lose your sense of

smell and your taste you have some cranial nerve CNS problems.



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- The vagus nerve also is the captain of the ship of the parasympathetic

nervous system, the rest and digest system.

- It also runs the enteric nervous system, that is why the gut is called your

second brain. The enteric nervous system is the largest accumulation of nerve

cells in the body. It regulates immune response, detecting nutrients and

motility. Therefore the interaction of the enteric nervous system vagus nerve

leads to the bidirectionality between the gut and the brain and the brain and

the gut.

Here is a great picture of the vagus nerve and you see how it innervates everything

and I wish I could circle it is also innervating the lung.

Vagus nerve at the interface of microbiota-gut-brain axis

Low vagal tone, you’ll see a higher incidence of IBS and IBD, a decrease in HCL

secretion, pancreatic enzymes and reduction in bile. Bile is a critical element, it is the

soap to bring specific things in your gut it stimulates something which we will talk

about in a moment the migrating motor complex. So targeting the vagus nerve

through appropriate stimulation would be of interest to restoring the homeostasis

between what I call the 3 way calling, the microbiota-gut-brain axis.

Vagus nerve stimulation – inflammation

When you’re able to stimulate the vagus nerve you will have a dramatic reduction in

inflammation. Stimulating that vagus nerve enables you to have a release of

acetylcholine. Of course we just talked about the reduction in inflammation, improves

outcomes in RA and inhibits cytokine production by 30%.

Vagus nerve stimulation also enhances motor and cognitive recovery, reduces

damage to the blood brain barrier, decreases cerebral edema, and also allows for

neuroprotective effects. Look at vagus nerve’s stimulation effect on the gut,

stimulating the vagus nerve in endotoxin induced tight junction injury [with LPS] so it

had a positive outcome because when this right cervical vagus was stimulated it

ameliorated the damage of the tight junctions. It also inhibited the up regulated

activity of myosin and NFkB. Vagus nerve stimulation in conclusion in this 2013

study, attenuated the disruption of intestinal tight junctions.



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Vagus nerve nutritional support

So here’s your vagus nerve nutritional support. One of the other things I want to say

is the vagus nerve is great because it decreases peripheral inflammation something

we are not looking about. I wanted to expand the mindset when I gave this webinar,

didn’t want it to be just vitamin C, I didn’t want to be just vitamin D. So what do we

want:

• vagally mediated probiotics

• Short chain fatty acids or what I like to call post biotics, butyric acid

• Fibre

• Increase your bile acid flow will increase vagus nerve stimulation

• Omega 3 fatty acids because they increase heart rate variability

• L-citrulline increases HRV

• And of course time restricted eating is a great choice

• Sleep more, you may want to incorporate melatonin in there because it is

great with LPS, it also enables you to sleep more.

• And people have asked me, so I threw a slide in, vagus nerve stimulation I

use a violet light to stimulate the vagus nerve very quickly. Gargling and all

the others is a great method, this is just very quick. I stimulate it with the laser

and then I add the nutritional support to hold the level of tone.

Dr Rob’s Gut Matrix

We saw this slide before, every time I try and tie it back to the gut. So for those who

haven’t seen it before:

Everybody knows what leaky gut is and we’ve all heard that expression of leaky gut.

Our intestinal tract has a percent of our immune cells it is where our macro and

micronutrients are absorbed. Having covered that, understand that the intestinal tract

is made up of the small and large intestine. The small intestine is a misnomer, they

call it small but it is really 90-95% of the length, they call it small because of its

diameter which is one inch in comparison to the large intestine which is 2.5 inches.

In addition it is a single layer epithelial cell whereas the large intestine is a tripe layer

epithelial cell. That small intestine thickness is the thickness of a wet paper towel.

Again when you unravel it the length of a tennis to a basketball court.



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So it should be semipermeable, however when it becomes too permeable from

specifically things like food sensitivities, yeast, fungus, medications, toxins and a

whole plethora of other possible causes including dysbiosis the levelling of good and

bad bacteria which should be to the tune of 85% good, your gut is now too

permeable and undigested food particles, bacteria, yeast, fungus and viruses can

pass your gut into your bloodstream.

75% of your toxins, see the tie in, go from your gut in your bloodstream to your liver.

Liver dysfunction toxic chemical overload, 25% go through the gut to the liver

through the portal vein. You also have a higher incidence of insulin, blood sugar,

prediabetes, obesity and the like. Having a leaky gut if you will damages the tight

junctions, increases your incidence of autoimmunity – thyroid falls in there. In

addition you’ll see more muscular skeletal aches and pains, leaky gut leaky brain,

gut on fire brain on fire, leaky gut leaky lung.

The influence of the microbiota on viral infections

The influence of the microbiota on the viral infections, well your good microbiota has

3 different ways to influence your viral infection outcome:

1. Good bacteria can be very protective because it decreases your

inflammasome response.

2. In addition to that it can have an indirect promotion of health through lymphoid

cell proliferation.

3. Or it can have direct promotion on viruses by using an antiviral immune

response by stimulating a good quality interleukin.

GI tract possible route of viral transmission

Let’s go back we saw these before, 53.4% of the patients that had SARS-CoV-2

RNA in their stool, they were positive for SARS, they were positive for the virus in

their stool. Conversely, 23% of patients tested positive in stool despite testing

negative for the virus in respiratory samples. Now let’s Segway forward and see that

we realise that the GI tract is a possible route of viral transmission, in the bathroom

is one of the ways that people can spread it. And prolonged viral shedding in feces of

paediatric patients with corona virus, essentially the SARS-CoV-2 exhibits in

children’s GI tracts or existed for a longer period of time than the respiratory system.



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Clearance in respiratory tract occurred within 2 weeks after the abatement of fever.

Viral RNA remained detectable in stools longer than 4 weeks. So you have a 2 week

period after respiratory abated fever, everything considers symptomology the

abatement of fever. Here we had 24 COVID19 patients, in those COVID 19 patients

that were discharged, each patient had received 2 consecutive negative throat

swabs and one negative rectal swap. The median viral shedding was 12 days. The

shortest was 4 days the longest was 34 days, another study talked about the median

being 20 days and the longest being 37. So having said all that talking about how the

virus can stay in the gut much longer than symptomology or abatement let’s look at

the gut lung axis which is a bidirectional cross talk that occurs between the gut and

the lung, has been termed the gut lung axis.

Intestinal disturbances have been observed in certain lung diseases which are

shown to be mediated by the gut microbiota and some probiotics have shown

beneficial effects on the lung health in the treatment of respiratory diseases. So it

truly stands to reason that a deeper understanding of the gut microbiota and its role

in respiratory disorders will aid in the design and development of improved treatment

for lung disorders. The gut and lung microflora are clearly linked by nutrition, the

immune system and digestive and respiratory health through mutual communication

linking these very unique integral systems. This is an emerging exciting field of

investigation leading to new ways of thinking about the lung and its disorders.

Gut lung communication

So I find this extremely exciting in that here we have the gut lung communication,

we’ve got the oral pharynx which you’ll get environmental products and bacteria to

affect the gut to the lung and the lung to the gut. Whereas in the blood you’ll see

bacterial fragments, short chain fatty acids and immune cells. And the nerves as we

depicted before signals via vagal nerve afferent invasion.

Pulmonary microbiome in health and critical illness

Now, this is a slide let’s take a real good look at it. Now you are seeing that

translocation of bacteria from the gut increasing your incidence of ARDS acute

respiratory distress syndrome. And also being complicated or combined with oral



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dysbiosis. What a takeaway, the gut’s bacteria adversely effects the lung and you

have a higher incidence of ARDS.

Population based gut microbiome associations with hypertension

So before we get into the gut and hypertension, we are probably going to go over a

few minutes so I thank you for your patience and I am going answer your questions, I

just want to make sure that I gave an action packed informative webinar. So here we

are looking at the gut’s affect on hypertension. So we all know that the gut can be

adversely affected by drugs, food, lifestyle, with a lack of biodiversity can increase

blood pressure profiles. So this gut hypertension it is interesting that 41 patients had

ideal blood pressure, 99 patients had hypertension, 56 patients had pre-

hypertension. Patients with pre or hypertension had a reduction in the bacteria

diversity. Then second phase in this same study scientists transplanted fecal matter

from patients into germ free mice. Mice that received fecal matter from hypertensive

patients then developed hypertension. Researchers conversely also transplanted

feces from mice without hypertension into mice with hypertension, reduction in blood

pressure in mice with hypertension. So what did that say - your bacteria can depict

whether you are going to lose hypertension or gain hypertension depending on the

quality, diversity, and the population of your gut bacteria.

SCFAs – short chain fatty acids

Short chain fatty acids is a direct link from gut to hypertension. Dietary fibre, gut

bacteria produce short chain fatty acids. Bacterial populations patients with higher

blood pressure had lower levels of species that produce short chain fatty acids.

Microbiota – factors

There’s a lot going on in this particular slide but it is a very involving slide in that the

microbiota can be controlled by many factors including diet, physical activity,

genetics and epigenetics. The influence of the gut microbiota on the host may be

partially explained by the generation of short chain fatty acids including acetate

butyrate and propionate and the non-beneficial lactate. These SCFAs acting on cell

surfaces including GPR43 GPR41 and Olfr78 regulate blood pressure whereas the

GPR41 and Olfr78 counter regulate each other. So your microbiota ultimately is

speaking to your body and it is one of the key factors in what your blood pressure is.



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The super 7R action plan

So how do you fix the gut well I didn’t share that with you last time, I’d like to share

that with you today.

1. Reset: The number one thing in my super 7R action plan is you want to reset

your diet, anti-inflammatory, no gluten, no processed food, no dairy, no

nicotine, no artificial sweeteners. Possibly keto, definitely Mediterranean, a

good quality whole food diet that doesn’t have processed foods. Change of

lifestyle start making health a premium point in your life. Exercise, sleep,

hydrate, change your mindset. You don’t have to worry we are going to come

out of this and we are going to be better than we were once we get through it.

All our previous generations have gone through something and they were

better for it as we will.

2. Remove: You want to remove unwanted pathogens. Those pathogens are

like bacteria, viruses and the such. By removing those unwanted pathogens,

we recommend oregano oil for the respiratory, thyme oil to go with it.

Berberine, berberine HCL is a fabulous herb. It is great for your dysbiosis train

wreck patients, remember that berberine b = bowel it removes stuff from the

bowel. In addition I like a lot of garlic at this point. Garlic is shown to your all

natural antibiotic and here’s where I put it for this functional medicine people,

liver detox. Those toxins and pathogens speak back and forth between the

liver and the gut and we’ve always had this conversation gut first or liver first,

let’s do it together here is where we can do a detoxification support.

3. Replace: replace what: digestive enzymes and stomach acid, betaine HCL,

protease, amylase and lipase.

4. Regenerate: repair, heal and seal the damage to the intestinal and mucosal

gut lining. The L-glutamine, okra, NAG, apple pectin, alpha lipoic acid, vitamin

D3, omega 3 fatty acids, are a great choice at this point.

5. Reinoculate: And then we want to reinoculate, reinoculate with what,

probiotics, good quality prebiotics garlic, onions, leek, Jerusalem artichoke. If

you wanted a prebiotic supplement you should consider using XOS,

xylooligosaccharides. That pre feeds the pro. Remember the life of a probiotic

is only about 11 days per se. Dr Bugs will get to me on that because I know



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he is listening. Pre and pro biotic which will ultimately lead to your postbiotic.

Your post biotic is the residue left that is going to determine if you are going to

have a health or bad health signal.

6. Reintroduce certain foods, reintroducing certain foods that you may have

taken out, of course not gluten, dairy and the like, but maybe certain foods

that you are no longer allergic to.

7. Retain: Ultimately you want to retain your health through GI integrity, GI

integrity, good probiotic, omega 3, vitamin D, a multivitamin and quality fruits

and greens drink.

Hypertension susceptibility

So now we can look at some genetic tests. These are just blowing up, people are

interested, you want to know if you have a genetic disposition to injury. So longterm

treatment with ACE inhibitors can cause damage to your body. In these groups they

have a higher taste[?] detection and recognition thresholds. So what I do this is a

cheek swab and in this cheek swab it will tell you if you have specific genes that lead

you down a path that enable you to have hypertensive susceptibility. These are tests

that you can take in your house. So right now every functional medicine, functional

neurologist, functional nutrition practitioner etc., loves the home tests since we can’t

see people in office. Here’s a home test to enable people to see if they have a

genetic predisposition to hypertension. And in addition to certain inflammation - look

at those inflammatory markers, imagine if you have a genetic disposition to

interleukin. So what I did was they knew I was having a webinar so here you can go

to toolbox genomics put in the code DrRob you put that code in they told me for the

webinar and in the future you’ll get a $40 discount on all the genes. So hopefully that

enables you to want to conducer it and I thank toolbox for enabling me to get a

discount for everyone who is attending.

COVID-19 ASSAY

Let’s talk about COVID-19 assay, we did it before. I’ve had two weeks and I’ve had a

100 responses so far in patient and we can talk about that and I’m sure you want to

talk about that in the question section. So COVID-19 here’s the key component,

there’s a lot of labs out there that have to test for COVID-19, the bulk are testing for



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just coronavirus which was previous viruses. We are probably all going to test

positive for that because we’ve been exposed. We want to know if we’ve been

exposed to COVID-19. So the current laboratory diagnostic method is I’m looking for

IgM and IgG.

So what is the difference between IgM and IgG, well for one, antibodies made in

response to viruses persist in the blood acting like sentinels and rouse an immediate

response should the virus try to invade again. The antibodies have unique signatures

we call the different protectors modelled after encountering different viruses so

finding them is a signal of a past contact with a particular virus. It is a distinctive

difference between catching an invader red handed versus going back to the crime

scene and dusting for prints. So let’s talk about the difference between IgM and IgG.

IgM are a class of immunoglobulins that’s composed of this 10 structure pentamer

that is released early in the immune response, it refers to the immunoglobulin M. It is

produced in the early stages, it has no subclasses, it is larger than IgG, it is less

abundant, it is unable to travel through the placenta, it is found in blood and lymph,

and temporary antibodies are replaced by IgG. It provides protection against newly

emerging pathogens in the body and it is responsible for agglutination.

Conversely IgG is a class of immunoglobulins the most abundant type that circulate

in the body, it does refer to immunoglobulin G. It is produced in the late stage of

immune response, it has multiple subclasses, it is smaller than IgM, it is a monomer,

it consists of two antigen binding ells, the most abundant, it does travel through the

placenta from the mother to the child, it is found in all body fluids, it is long lasting, it

is very protective against bacterial and viral functions and it actually activates the

compliment system.

So what you want to do is here’s a graphic representation of understanding the days

of infection. So here we’ve got a typical purple line the shows us SARS-CoV-2 RNA

and the antigen. You are typically asymptomatic to 5.1 days then you typically will

see an onset of symptoms, your body will call its protective mechanisms which are

your immunoglobulins and IgM will become detectable approximately on day 7. IgM

will become detectable and at approximately day 14 IgG will come out. IgG remains

in the blood and provides long term immunity. As there are going to be 4 plausible



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results from this test. You can be negative like me for IgM and IgG, so even though

I’ve been exposed I was not infected. You can also be positive for IgM, negative for

IgG, which would imply that you are in the early stages, so clearly quarantine and

maybe take the PCR test. You could also be IgM positive and IgG positive so you

can see you are in the middle of that 14-21 day period and what you really want to

see is negative IgM and positive IgG which means you have your own vaccine. You

need to be 28 days post regular temperature or abatement of fever to know that you

have the full complement of IgG. It takes a while for IgG to fully cascade. Additionally

be very careful when they’re just doing IgG markers and not IgM and IgG, because a

lot of people again are testing for corona virus. This particular kit, there’s some

updates, I shared with a lot of practitioners many of my patients and many more are

taking the test. Essentially the original go through of the kit was what we’d like to

refer to as sensitivity. The sensitivity in the first go round was 87.3% which meant

that we had less than 13% false positives that number has now increased to 91%. In

the bottom number it is all about the denominator the specificity was 100 it has now

dropped to 99%. So the denominator is still a robust stellar number.

So again I’ll pause for a moment, if you want to get the kit it is available, there’s your

website KBMOdiagnostics.com use the code COVID19/DrRob is my code. The

turnaround time from arriving at the lab is 24-48 hours. Right now it is a serum test,

you should be seeing a finger prick test coming soon. The serum test I know we can

talk about the antibodies in the question and answers, the serum test requires a

phlebotomist to come to your house. We did that so you order the test today you get

it tomorrow the phlebotomist comes on Tuesday you resend it Tuesday to

Wednesday you get the results by Thursday. Again you can bypass the phlebotomist

if and when the finger test does come.

As we get right to the finish line, please keep an eye out my book is coming out

August 2020, it is called Super Highway to Health, 7 Steps to Optimizing the Gut-

Brain Connection. Functional Medicine University said they would support us and I

greatly appreciate Dr. Grisanti. My plug for Dr. Grisanti – he is a very very humble

guy so he brought in this New Yorker and I want to make sure that everybody knows

that enrolment is April 20th. He gave these last two webinars for free with his own

money, and I really want to thank him very much for that. There is not a better online



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learning service than FMU. And if you want to learn more about FMU case studies

ClinicalRounds.com

I always like to end with a quote before we get to the questions, “The mind, once

stretched by a new idea, ever returns to its original dimensions.” Sir Oliver Wendell

Holmes.

If you need to get in touch with me, once again there is my Facebook, Instagram,

there’s my website. And if you are interested in laser and you own one there’s my

mastermind laser Facebook group.

Now without further ado, I can hear Dr. Grisanti, let’s answer any questions you may

have.

[there’s a further 20 minutes question and answer discussion time on the recorded

webinar in the archive, both MP3 audio and MP4 video]

Documents

health & immunity: a natural perspective for a new …...Health & Immunity: A Natural Perspective for a New Paradigm - Part 2 Dr Silverman: Thanks so much Dr Grisanti. I’m happy