Managing the gut-brain axis in health and disease

Start looking at your gut, said Robert Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FA, founder and CEO of the Westchester Integrative Health Center, at the 2019 Integrative Healthcare Symposium in New York City.

The gut is 80 percent of your immune cells. It’s a bidirectional system between the gut and the brain and affects every aspect of our health, said Silverman, presenting on microbiota and the gut-brain axis in health and disease.

Patients are sicker than ever before, Silverman said. The average American consumes about 160 pounds of sugar per year, 146 pounds per year, and 142 pounds of caloric sweeteners. There is a rise in “diabesity,” Silverman said, and it’s because so-called experts claimed carbohydrates were good and fats were back. Chronic pain, nonsteroidal anti-inflammatory drugs and medication use, toxin exposure, and stress are on the rise, as is neurodegenerative disease.  

“We should be talking more about the gut, especially as it relates to the brain.” said Silverman. “If you have a leaky gut, you have a decrease in satiety and an increase in neurodegenerative disease.”

According to the Mayo Clinic, “with leaky gut, damaged cells in your intestines don’t produce the enzymes needed for proper digestion. As a result, your body cannot absorb essential nutrients, which can lead to hormone imbalances and a weakened immune system.”

The gut is affected by several factors, including stress, gut microbiota composition, toxic chemicals, medications, inflammatory cytokines, undigested food molecules, lectins and agglutinins, food coloring, and gums, said Silverman.

The chemicals in the gut can shape the human brain’s structure because it speaks to it, according to a 2017 study published in the journal Microbiome. Researchers have also found that chronic intestinal inflammation alters hippocampal neurogenesis.

The gut speaks to the brain, with 400 times the number of messages from gut to brain than the brain to the rest of the body. There are over 1,000 species, three pounds, and trillions of bacteria in the gut. There are 20 million bacteria genes, where by comparison there are 2,000 genes in humans. There are more bacteria than cells in our body, said Silverman. The gut contains more neurotransmitters than the brain.

The mechanism of the bidirectionality in gut to brain microbiota axis, from the gut to the brain, includes production, expression, and turnover of neurotransmitters, such as serotonin and GABA, and neurotrophic factor (BDNF); production of intestinal barrier and tight junction integrity; modulation of enteric sensory afferents; bacterial metabolites; and mucosal immune regulation.

From the brain to the gut, alteration in mucus and biofilm production; alteration in motility; alteration of intestinal permeability; and alteration in immune function, Silverman said.

The gut produces vitamins, digests food, regulates hormones, excretes toxins, and produces healing compounds. To treat the brain, you must remove cause of inflammation, such as leaky gut, Silverman said.

To assess for leaky gut, get a baseline with patients, Silverman said. He recommends an Intestinal Antigenic Permeability Screen to detect and try to remove triggers and repair barriers. Assess antigenic intestinal permeability, including lipopolysaccharides, actomyosim, serum antibodies, and occluding and zonulin, he said. 

“When the gut on fire, that means the brain is on fire,” said Silverman. “Since there are no pain receptors in the brain, that’s why you get brain fog.”

We need to get to the root of the problem, said Silverman. This starts by healing the gut.

“No gluten, no processed food, no sugar, no dairy, no nicotine, no artificial sweeteners,” said Silverman. “Let’s not make it so difficult.”

Silverman suggests a seven-step action plan for practitioners:

  1. Reset diet/lifestyle/mindset
  2. Remove unwanted pathogens
  3. Replace needed digestive enzymes and stomach acid
  4. Regenerate damaged intestinal mucosa
  5. Re-inoculate with quality pre and probiotics
  6. Reintroduce certain foods removed in step 2
  7. Retain your health and GI integrity

“Do you have the guts to be healthy?” said Silverman.