The Future Adjustment Podcast Episode 2: Dr. Robert Silverman & Functional Medicine

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Dr Robert Silverman Chiropractic Podcast

Audio Transcription Below

Daniel: Welcome to the “Future Adjustment,” Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the editor in chief of “Chiropractic Economics.” And our guest today is Robert Silverman, DC and diplomate of the American Clinical Board of Nutrition. He teaches seminars nationwide and in Canada and has a successful sports injury and performance practice in West Chester County, New York. And we’ve asked him to join us here today to discuss his new book “Inside-Out Health.” So, Dr. Silverman, you’ve been traveling and talking about your book, and I’d like to start by asking how did you come to write it in the first place? What need were you trying to fill?

Dr. Silverman: Well, you know, Dan, when you first become a doctor, it’s probably because, at least it was for me, somebody changed my life, and I wanted to change other people’s life the way my life was changed. Then as you alluded to before, I do a lot of lectures. And then you want to really spread the word within those lectures to other doctors so they can understand your experiences and share in your knowledge in a give-and-take situation and get to the patients that way. The final piece to the puzzle, to spreading the message and trying to get everybody in the boat together on this healthcare revolution, is to write a book because the book will stay for perpetuity. So I really wanted to put it all down on a piece of paper. And there’s something I know as an editor you appreciate. Sometimes the written word is the sacred word.

Daniel: Yes. And as I’ve often told budding authors, the closest a man will ever know of the pain of giving birth is to actually try to publish a book.

Dr. Silverman: They are a lot of work.

Daniel: So I noticed that nutrition plays a large role in your practice. And could you tell me kinda how do you see the intersection of nutrition and chiropractic?

Dr. Silverman: Yeah, I mean I think it’s a clear…and intersection is a great word. I think it’s a very clear intersection because I think chiropractic is all about fixing the body from the inside out, and nutrition is a component that every chiropractor should consider. Just when you think of foods, the food aspect of nutrition, foods are energy. That’s where we get our nutrients. Our absorption of our foods are the key components.

Foods also can be a perpetrator for inflammation. And inflammation is something that most chiropractors deal with on a daily basis because inflammation or too much inflammation is extraordinarily deleterious to the musculoskeletal system. So I’m a big proponent of nutrition, lifestyle, and proper supplements to aid patient care into a chiropractic and musculoskeletal patient care.

Daniel: Yes, indeed, the cardiovascular community was really stricken by the results of what was called the “Jupiter study” where they found that a biomarker, high-sensitivity C-reactive protein was directly resulting from systemic inflammation. And as a result of further studies in that area, we’re starting to see that when it comes to chronic illness and disease, all roads do lead back to inflammation. And nutrition plays a big role in that. You know, going back to your book, “Inside-Out Health”, I wanted to ask you is that book directed more towards the general reader, the patient, or is it more directed toward the chiropractor?

Dr. Silverman: You know, I tried to walk the tightrope, and I’ve got some really favorable responses. The doctors seemed to enjoy it, and the patients and/or the layperson seems to enjoy it so much so that many of my doctors said that they enjoyed it after reading it are now are carrying it in their office so they too can share it with their patient as a nice prelude to the things that we in chiropractic manual therapy can do for our patients and the topics and subject matter that the conversation should ensue within the office.

Daniel: Yeah, that was the impression I got from reading it myself, that the doctor might read it first and get a sense of kinda how he might adjust his practice or how she might adjust her practice to incorporate some of the precepts of the book and, in addition, hand it out to patients so that they could better understand what their chiropractors are doing with them and how they can take a more active role in maintaining their own health. So, you know…and when I was reading that text, I thought to myself, “You know, this is kind of sounding familiar to me. It’s similar to the approach taken by functional medicine practitioners.” Was that part of your inspiration for writing it?

Dr. Silverman: Absolutely. I consider myself a functional medicine practitioner. I’ve done a lot of training. I also like to really call it functional medicine, but for us, chiropractors, it’s more functional nutrition. So for me, functional medicine is a very synergistic approach to put in a chiropractic office in that I’m a big proponent of functional medicine because I believe it looks at systems, and not symptoms, just like chiropractors do, always trying to get to what we call root cause resolution, just like chiropractors are trying to do.

A good way that I try to explain what functional medicine is, a good doctor will give you a mirror image of where you are right now via postural assessment, visual assessment, patient history, X-ray, MRI, blood tests, and the like. The functional medicine doctor explains why you have that reflection and tells you how they can change the reflection. And that’s a big idea. So, basically, functional medicine is systems, not symptoms, trying to individualize, personalize results to get your optimum genetic component. So the key component really is that personalization, that individualization. Ultimately, and I know this will resonate with our chiropractic brethren, it’s a collaboration between the doctor and the patient. And I think that’s one of the ways that chiropractors always win because we’re always looking for collaborations with the patients.

Daniel: Yeah, the functional medicine approach, does that require a slightly more lengthy and involved intake process in patient history gathering?

Dr. Silverman: Absolutely. So, you know, you have your normal chiropractic. Now, mind you, when I do it, I integrate both together. But, yes, to do the functional medicine, there is additional forms. There’s symptomology forms. There’s dietary things to look at. You may do specific blood tests. Not just generic blood tests, we may be looking at tests, leading edge tests to see your gut absorbability, your genetic predisposition towards certain things. So it is more lengthy, but it’s very much more worthwhile. And since it is chiropractic economics, there is no insurance code to cover that. All nutritional consults are fee for service.

Daniel: Okay. And would it make sense for a chiropractor to team up with a nutritionist or a registered dietitian if they were to try to incorporate some of these ideas in their own practice?

Dr. Silverman: Well, we have those two options. A busy chiropractor has seen a lot of musculoskeletal who doesn’t have the time to implement that. That would be a great deal. I always suggest to all my chiropractors who specialize in musculoskeletal to incorporate some additional supplementation or consideration within that. You know, supplementation may be as simple as glucosamine and chondroitin or probiotic or fish oil and the like. However, if they don’t have the time, then, clearly, a dietician or a staff member could handle it. Whereas, for me, every patient walking in, we’re talking chiropractic, we’re talking posture, we’re talking movement, and we’re talking nutrition. Now, my intakes and my sessions with patients are a little longer, so you have to adjust your practice management accordingly.

Daniel: Gotcha. You know, one thing I really liked in the book, kind of sprinkled throughout the text, are what you call Dr. Robert. You know, one of them is “Nutrition is like shoes. There’s no one size fits all.” And another one is “You’re never alone in life because you always have your bacteria to talk to.” And you actually begin the book talking about the microbiome in the gut and probiotics. And that’s an area of special interest of mine because it seems like every day we’re getting more and more evidence that the gut is more than just part of the digestive process. It plays the role in the immune system. And, increasingly, we’re learning that the microbiome is part of the cognitive system. And could you tell me a little bit about your thinking on that subject?

Dr. Silverman: Absolutely. I mean, without question, the microbiome and gut health is the conversation of 2017, and it will continue. In reference to the bacteria, yes, they outnumber us 10 to 1, and they are live. So when you come visit me in New York and I take you down to the city for a good sushi meal and the people are talking to themselves, they’re probably not talking to themselves, Dan. They are talking to their bacteria.

So to really expand on that, you’re not gonna get good musculoskeletal health without a quality microbiome. So many things have now been attributed… They’ve done studies, let’s just say, for weight loss. And they found out that if you took a thin mouse and put a fat mouse’s microbiome or bacteria in their gut, they will become fat. They did the reverse, and [inaudible 00:10:20] true. They split twins up, mice twins. Both were thin, and one got a thin microbiome from somebody else, and someone got a heavy microbiome from another. And, obviously, the thin microbiome kept the mouse thin. The fat mocrobiome made the thin mouse fat.

They’re doing that in humans now. So they’re finding out that a key component, just in this example for weight loss, your gut, your bacteria, the health of your gut is a key component. Seventy percent of your immune cells are in your gut. It’s the house for where your macro, your foods, and micro, your vitamins and minerals, nutrients get absorbed. So the real question I ask all my patients, “When it comes to the microbiome, do you have the guts to be healthy?”

So if you really want it expanded out in a chiropractic setting, if your gut microbiome or your bacteria is on unleveled, something that we call dysbiosis, you’re gonna have an increase in musculoskeletal failure because you have increased inflammation, increased things called cytokines and MMPs, which damage cartilage and muscle. If you have leaky gut, this microbiome problem where too many things pass, and your gut is not in its pristine condition, you have a higher propensity, as I said before, to obesity, diabetes, insulin resistance, too many toxins go into your liver. And, ultimately, gut to brain and brain to gut interaction is a key component. They have now found out that Alzheimer’s, depression, and ALS all have a direct correlation to the microbiome in your gut.

Daniel: Yeah, it was really striking to me. As recently as about two years ago, I saw a television commercial that was set…the setting was on an airplane. And the stewardess was walking down the aisle, and she was tossing out little bags of probiotics to the passengers seated in the rows like they were peanuts. And that’s where I began to see that this subject is really permeating the American consumer. You’re not gonna have a, you know, a long uphill road to make that connection for them because I think that this is becoming more widely-known. In addition to probiotics that you might find on the shelf at a drug store or the like, and I know there’s various professional brands that are popular with DCs, I’ve also been reading that fermented foods can play a really important role there in the diet. Is that something that you’d recommend to your patients?

Dr. Silverman: Yeah, fermented foods are a great addition to anybody’s diet. These fermented foods are prebiotics, and these prebiotics feed the bacteria in your gut. And that’s a needed component because even if you have good bacteria and they’re not fed, at a certain point when they get hungry, they’ll turn around and start eating your intestinal tract. So these fermented foods…these prebiotics are critical elements. They also make something called short-chain fatty acids. And those short-chain fatty acids have a very, very helpful effect on overall gut health.

Daniel: All right. And speaking of your text, for any listeners who’d like to take a look at it or order a copy for themselves, where can they find a copy online?

Dr. Silverman: Absolutely,, “Inside-Out Health: A Revolutionary Approach to Your Body,” Dr. Robert Silverman. You also can go to my Facebook, big on social media, like it, share, please, drrobertsilverman. And the same thing with my website, drrobertsilverman, has the book there. Stay in touch. Let’s communicate. We’re never too far with all this virtual…like we’re doing now in social, we can also communicate and, you know, any questions you have, feel free. I will answer them.

Daniel: Okay. Well, that sounds great. And, Dr. Silverman, I’d like to thank you personally for spending some time with us today. This has been a really informative talk. And you’ve given us an inside-out look at the “Future Adjustment.” I’m Dan Sosnoski, and we’ll see you next time.

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