Natural Approaches to Health & Immunity

Dr. Robert G. Silverman DC, DACBN, MS, CNS, CCN, CSCS, CIISN, CKTP, CES, DCBCN, HKC, FAKTR

www.DrRobertSilverman.com

@drrobsilverman @drrobertsilverman@DrRobertSilverman

You can’t control the virus, but you can control the host

Factors that make us more likely to contract COVID-19• CVD• Diabetes• Obesity• Hypertension • Age • Chronic pulmonary disease • Chronic liver or kidney disease • Radiation therapy • Autoimmune conditions • Chronic neurological diseases

Stats - comorbidities

• 71% of those hospitalized with COVID-19 in the U.S. and 78% of those in intensive care have underlying health conditions like:• Diabetes

• Chronic lung disease

• Heart disease

• 25% of those infected with COVID-19 may not show symptoms

CDC.gov. March 28, 2020

Dr. Robert Redfield, Dir. Of CDC. March 31, 2020

Stats

• 60% of U.S. adults have at least 1 underlying health condition

• 399 patients with at least 1 additional disease had a 79% greater chance of requiring intensive care or respirator or both, or of dying

NYTimes. March 12, 2020

Increased odds of severe COVID-19

• Patients age 50 plus – 2.5 times more likely to progress to severe case of COVID-19

• 53,000 patients Dec. 19 – Feb. 19

Increased odds of severe illness

Male 1.3 x

Smoking 2.5 x

Comorbidities 2-3 x

COPD 2.5-11 x

Kidney issues 2-16 x

NPR, March 22, 2020

Stats

• China:• 3% of cases – 80 years or older

• 87% – 30-79 years

• 8% in their 20s

• 1% in their teens

• 0.9% – 9 years or younger

• Fatality rate:• 2.3%

• 14.8% – 80 years or older

• 1.3% – 50s

• 0.4% – 40s

• 0.2% – 10-39 years

• 58% of cases – male

• 2.8% – male

• 1.7% – female

JAMA. Published online February 24, 2020

Potential effects of coronaviruses on the CV system

Conclusion: COVID-19 associated with high inflammatory burden that can induce vascular inflammation myocarditis and cardiac arrhythmia

Tao G, YongZhen F, Ming C, et al. JAMA Cardiol, Mar 27, 2020 online

Stats

• Loss of smell or taste might be early sign of infection with the pandemic virus

• 30% of patients testing positive

• Many have loss of taste

The Scientist. May 24, 2020

New Study on COVID-19 Estimates 5.1 Days for Incubation Period

Ann Intern Med. Published online March 10, 2020

Johns Hopkins. Published online March 9, 2020

97.5 percent of people develop symptoms of SARS-CoV-2 infection within 11.5 days of exposure

Median incubation period – 5.1 days

Eye ocular abnormalities in COVID-19 patients

• 1/3 sample size had abnormalities involving the eye:

• Conjunctivitis

• Conjunctival hyperemia

• Chemosis

• Epiphora

• Increased secretions

Conclusion: Ocolar abnormalities frequently occurred in patients with more severe COVID-19

Wu P, Duan F, Luo C, et al. Characteristics of Ocular Findings of Patients With Coronavirus Disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. Published online March 31, 2020

The coronavirus isn’t alive. That’s why it’s so hard to kill.• Once inside a cell, a virus can make 10,000 copies of itself in hours

• Within a few days, infected person will carry hundreds o millions of viral particles in every teaspoon of blood

Andrew Pekosz, virologist at Johns Hopkins University:

“They break into your home, eat your food, use your furniture and have 10,000 babies. And then they leave the place trashed.”

The Washington Post, March 23, 2020

Adjusted fatality infection rates by age group

March 17, 2020

Why does SARS-CoV-2 spread so easily?

https://www.medicalnewstoday.com/articles/why-does-sars-cov-2-spread-so-easily

https://www.rndsystems.com/resources/articles/ace-2-sars-receptor-identified

ACE-2 is the host cell receptor

responsible for mediating infection by SARS-CoV-2, the novel coronavirus responsible for coronavirus disease 2019 (COVID-19). Treatment with anti-ACE-2 antibodies disrupts the interaction between virus and receptor.

The science of soap. Here’s how it kills the coronavirus

Support your immune system

• Avoid certain foods: • GPS

• DNA

• Anti-inflammatory diet

• Detect or avoid food sensitivities

Diet for immune resilience

Proper diet = enhanced immunity

vs.

Poor diet = impaired immunity

Support your immune system

• Make clean-eating a priority:• Wild SMASH fish

• Plant-based diet

• Fruits and vegetables

• Grass-fed meats

• High fiber

• Nuts and seeds

• Chicken soup

• Snack - organic dark chocolate

• Herbals - ginger, turmeric

• Bone broth

• Appropriate fluid intake

• Organic coffee, tea

• Oils – EVOO, avocado, macadamia nut

• Mushrooms - shiitake, reishi, chaga, turkey tail, maitake, oyster, lion’s main

• Include nuts, avocado, olive oil in your diet• Oleic acid from these foods stimulate SIRT1 – the defense enzyme

Support your immune system

• Consider a time-restrictive eating (intermittent fasting) - fast for 12-16 hours

• Get sufficient sleep - aim for 7-8 good quality hours

• EVRL Violet light - Erchonia

• Home exercise plan – work with a practitioner online

• Humidity – keep humidity up at home to maintain airway health and mucus

Types of Fasting

Prolonged Fasting (PF)4 or more consecutive days

of fasting• Water Only Fast• Fasting Mimicking

Diet (FMD)

Time Restricted Eating/Feeding

(TRE/TRF)Daily pattern of eating

during a window of 8-12h

Intermittent Fasting (IF)1-3 days of fasting

usually non-consecutive, per week

S M T W T F S S M T W T F S

Proof-of-concept in viral inactivation: virucidal efficacy of 405 nm light

Conclusion: Results provide first proof-of-concept demonstrating that the antimicrobial efficacy of 405 nm light can be extended to medically important virus

Rachael MT, Michelle M, John EC, et al. Food Environ Virol. 2017; 9(2): 159–167

Nutrition support in the time of COVID-19

Immune support supplements

• Vitamin C

• Zinc citrate

• Mixed mushroom complex

• Vitamin D3 with K2

• Probiotics

• Liposomal glutathione

• Beta-glucans

• Omega-3 fatty acid

• Elderberry

The immunomodulatory actions of 1,25(OH)2D against respiratory viruses

Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients. 2015;7(6):4240–4270. Published 2015 May 29

Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta analysis of individual participant data

Conclusions:

Vitamin D supplementation safe and protected against acute respiratory tract infection overall.

Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.

BMJ, Feb 15, 2017;356,i6583

Vitamin D/VDR and microbiome in intestine and other putative organs

Curr Opin Clin Nutr Metab Care. 2018 Nov; 21(6): 471–74

Probiotics

• 12-week study

• Participants had contracted a cold 4X in the past year

Conclusion: Consumption of probiotics significantly reduced incidence of upper respiratory infection and flu-like symptoms. They had increased sIgA in the gut

Hong Z, Chiajung Y, Zonglian J, et al. Synth Syst Biotechnol, June 2018;3(2):113-120. Published online 2018 March 12

Spore probiotic

• Soil-base microorganisms

• Formed from spores

• Found in dirt and vegetation

• Bacillus species delivered as dormant spores

• Endospores encapsulate beneficial bacteria:• Making them stable

• High resistant to stomach acid

• Results in more usable probiotics to the SI

Cuentas, et al. Journal of Probiotics & Health, 2017;5:4Fouad MFE, Namita R, Rohini DG, et al. Front. Microbiol. Aug 10, 2017

Spore probiotic (cont’d)

• Bacillus subtilis (ability to form spores):• Protects microbes from harsh conditions

• Shelf-stable

• Do not require refrigeration

• Resist gastric hydrochloric acid

• Pancreatic enzymes and bile

• Helps adhere to intestinal epithelium

• Propagates bacteria in the large intestine

Cuentas, et al. Journal of Probiotics & Health, 2017;5:4

Fouad MFE, Namita R, Rohini DG, et al. Front. Microbiol. Aug 10, 2017

Kovács, ÁT. Bacillus subtilis. Trends in Microbiology, 2019;27(8):724-25

Beta glucans

• These compounds regulate the function of the innate immune system

• This part of your immune system is the first line of defense against viruses and bacteria

• Helps your white blood cells bind to and kill viruses and bacteria

Akramiene D, Kondrotas A, et al. Medicina (Kaunas), 2007;43(8):597-606

Elderberry

• Contains several functional bioactive compounds:

• Flavonoids

• Phenolic acids

• Phenolic compounds are potent modulators of the immune response – inflammation

• Shown to reduce production:

• IL-16

• IL-6

• TNF-ɑ

• ROS

Putra WE, Rifa’i M. Adv Pharm Bull, 2019 Oct;9(4):619-623

Tiralongo E, Wee SS, Lea RA. Nutrients, 2016 Mar 24;8(4):182

Imagery of a cytokine storm

Jennifer RT, Marcus JK, Cameron PS, et al. Microbiol Mol Rev. 2012 Mar;76(1):16-32

Cytokines – dangerous double-edged sword exploited by coronavirus

Mediators of the cytokine storm and the associated phenotypes with infection outcome

Jennifer RT, Marcus JK, Cameron PS, et al. Microbiol Mol Rev. 2012 Mar;76(1):16-32

Role of ion fluxes in NLRP3 inflammasome activation

Yang, Y., Wang, H., Kouadir, M. et al. Recent advances in the mechanisms of NLRP3 inflammasome activation and its inhibitors. Cell Death Dis, 2019;10:128

Rebecca CC, Caroline LH, Kate S. Cell Research, Oct. 3, 2018. https://doi.org/10.1038/s41422-018-0093-8

LPS-induced Mitochondrial DNA contributes to NLRP3 inflammasome

Modulate the cytokine storm

• Melatonin

• Ascorbic acid (vitamin C)

• Pro-resolving mediators

• Ginger

• Quercetin

• Nitrate oxide

• Curcumin

• Low-level laser

• Stinging nettle

• PEA

Acute respiratory distress syndrome (ARDS)Acute lung injury (ALI)• Accumulation of neutrophils in lungs an increased production of:

• inflammatory cytokines

• chemokines

• ARDS/ALI – dependent upon activation of inflammasome

• ARDS/ALI – from cytokine storm + NLRP3 inflammasome

• Inflammasome – part of our innate immune system IL-1β and IL-18

Main melatonin functions

Silvestri, M., Rossi, G.A. Melatonin: its possible role in the management of viral infections-a brief review. Ital J Pediatr, 3 Oct 2013;39:61

Melatonin in experimental Respiratory Syncytial Virus infection

Silvestri, M., Rossi, G.A. Melatonin: its possible role in the management of viral infections-a brief review. Ital J Pediatr, 3 Oct 2013;39:61

R. Zhang, X. Wang, L. Ni, et al. COVID-19: Melatonin as a potential adjuvant treatment, Life Science, 23 Mar 2020 online

New York hospitals utilizing vitamin C

• COVID-19 intensive care patients immediately receiving 1500 mgs intravenously and re-administer exact amounts 3-4 times/day

“The patients who received vitamin C did significantly better than those who did not get vitamin C. It helps a tremendous amount, but it is not highlighted because it's not a sexy drug. “

Pro-resolving mediators (SPMs)

Conclusion:

• Exogeneous administration of precursors/SPMs decreased proinflammatory cytokine and chemokine expression

• SPMs reductions may drive O3-induced pulmonary inflammation

B. Kilbury-Bas, S. W Reece, M. J Crouch, et al. SPM regulate ozone-induced pulmonary and systemic inflammation. Toxicol Sci. June 2018;163(2):466-477

Adapted from Serhan, CN. FASEB J. 2017;31(4):1273-1288

Induction of 15-LOX promotes

LM class switching

Lipid mediators involved in inflammation initiationLipid mediators involved in inflammation resolution

Inflammation InitiationProtective Response

LIPID MEDIATOR BIOSYNTHESIS

Inflammation ResolutionReturn to homeostasis

Induction of 15-LOX promotes LM class switching

IMPACT OF NSAIDS/COX-2 INHIBITORS ON LIPID MEDIATOR BIOSYNTHESIS

Lipid mediators involved in inflammation initiationLipid mediators involved in inflammation resolution

Curcumin suppression of cytokine release/storm

Results:

• Curcumin block cytokine release, most importantly the key proinflammatory cytokines, IL-1 , IL-6 and TNF-a

• Suppression of cytokine release by curcumin correlates with clinical improvement models of disease conditions where a cytokine storm plays a significant role in mortality

Peter PS, Lawrence H. In Vivo, Jan-Feb 2015;29(1):1-4

Vitamin D deficiency contributes directly to ARDS

Conclusions:

Vitamin D deficiency common in people who develop ARDS. This deficiency appears to contribute to development of the condition. Approaches to correct vitamin D deficiency in patients at risk of ARDS should be developed.

Dancer RCA, Dhruv P, Sian L, et al. Thorax, 2015;70:617-24

Stinging nettle

• Reduces inflammatory cytokine release and reduces inflammatory biomarkers like:

• TNF-a

• IL-1

• IL-6

• hs-CRP

Johnston TA, Sohn J, Inman WD, et al. Phytomedicine, 2013 Jan 15;20(2):143-7

Palmitoylethanolamide (PEA)Pronounced: Pal mit oyl ethanol amide

• PEA – a bioactive lipid that plays a key role in endocannabinoid system (ECS) responsible for promoting balanced systems, including the central nervous system and the peripheral nervous system

• ECS helps promote relaxation and healthy nerve function

• PEA – produced naturally in every cell of the body in biological response to inflammatory markers

WELL RESEARCHED-underappreciated molecule

• With over 350 peer reviewed papers

• Nobel Prize all devoted to PEA and its many indications

• Significantly favorable outcome in 5 of 6 DBPC trials looking at acute respiratory disease/influenza

MULTIPLE MECHANISMS

• Multiple mechanisms associated with PEA:

• Anti-inflammatory: inhibition of TNF-alpha & NFKb

• Immune support: mast cell stabilization and supporting the endocannabinoid system. In influenza – thought that PEA works by attenuating the potentially deadly cytokine storm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771453/

This Photo by Unknown Author is licensed under CC BY

Fecal/oral transmission

• Fecal/oral transmission may be part of COVID-19 clinical picture

• Significant portion of Coronavirus patients experienced diarrhea, nausea, vomiting, and/or abdominal discomfort before onset of respiratory symptoms

• Researchers found – RNA and proteins from SARS-CoV-2 (viral cause of COVID-19) are shed in feces early in infection and persist after respiratory symptoms abate

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online

Fecal/oral transmission (cont’d)

• Mild GI discomfort – diarrhea: 10% of people have GI symptoms

• GI manifestations consistent with distributor of ACE2 receptors which serve as entry points for SARS-CoV-2

• Receptors – most abundant in cell membranes of lung AT2 cells as well as in enterocytes in the ileum and colon

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online

GI track – possible route of viral transmission

• 53.4% of patients had SARS-CoV-2 RNA in stool

• 23% of patients tested positive in stool despite testing negative for the virus in respiratory samples

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online

GI track – possible route of viral transmission (cont’d)

• The small but growing body of clinical evidence indicates digestive system may serve as an alternative route of SARS-CoV-2 infection

• In addition to respiratory track, they stressed adding that clinicians should be careful to promptly identify the patients with initial GI symptoms

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2, Gastroenterology, Feb. 27, 2020 online

THYROIDHashimoto’s diseaseThyroid hormone levels

MUSCULOSKELETALSYSTEMArthritis/Joint painSoft-tissue injuryCytokines, MMPS

BODYCOMPOSITIONObesity

LPS

INSULINBlood sugar problemsInsulin resistancePre-diabetes/diabetes

LIVERLiver dysfunctionToxins/chemical overload

GI TRACTFood sensitivitiesLeaky gut syndromeYeast/FungusDysbiosis ( Good bacteria)

BRAINSatietyInflammatoryNeurodegeneration

Dr. Rob’sGUT MATRIX

THE GUT IS NOT VEGAS.What happens in the gut,

doesn’t stay in The Gut

Zhu X, Han Y, Du J, et al. OncoTarget. 2017 May 10;8(32):53829-53838

GUT-LUNG CONNECTION

Gut-lung communication

Mathieu E, Escribano-Vazquez U, Descamps D, et al. Frontiers in Physiology, 2018;9:1168

Schematic representation to depict assimilation of dietary nutrients by gut microbiome and their impact on distal organs

Anand S, Mande SS. Frontiers in Microbiology, 2018;9:2147

GUT LUNGS BRAIN

Pulmonary microbiome in health and critical illness

Samiran M, Dusan H. Yale J Biol Med, 2018 Jun; 91(2): 143–149

Bidirectional Gut-Lung Axis

Anand S, Mande SS. Frontiers in Microbiology, 2018;9:2147

Inter-kingdom and inter-compartment crosstalks within the gut–lung axis

Enaud R, Prevel R, Ciarlo E, et al. Frontiers in Cellular and Infection Microbiology, 2020;10:9

THE

Reset diet/lifestyle/mindset

Remove unwanted pathogens

Replace needed digestive enzymes and stomach acid

Regenerate damaged intestinal mucosa

Re-inoculate with quality pre and probiotics

Reintroduce certain foods removed in step 2

Retain your health and GI integrity

7(R) ACTION PLAN

Covid-19 Assay

Current Laboratory Diagnostic Methods

Why we test for IgG and IgM?

Result Interpretation

• IgM Positive: Presence of 2 purple bands (T and C) within IgM result window indicates positive for 2019-nCoV IgM antibody

• IgG Positive: Presence of 2 purple bands (T and C) within IgG result window indicates positive for 2019-nCoV IgG antibody

• Negative: Only 1 purple band appearing at control line (C) indicates negative result

• Invalid: If control line (C) fails to appear, no matter whether the T line is visible or not, the test is invalid. Insufficient specimen volume or incorrect procedural techniques are the most likely reasons.

Clinical Data

1) Clinical trial of this product based on the clear diagnosis/ exclusion criteria of the disease identified in the “Novel Coronavirus Pneumonia Diagnosis and Treatment Program”

2) Clinical research conducted in 5 institutions and the total cases were 447

3) Using this kit:a) 110 cases out of 126 clinically confirmed cases are positive, with

the sensitivity of 87.3% b) 62 cases of clinically excluded cases are totally negative with the

specificity of 100%

How to get a C-19 kit

• Serum test is available now via : https://kbmodiagnostics.com/

• Turnaround time is 24-48 hours from arriving at the Lab

• Home-draw offered

Use Code: COVID19/DrRob

Keep an eye out…

Learn more about functional medicine by subscribing to FMU clinical cases studies

www.ClinicalRounds.com

“Take care of your body, it’s the

only place you have to live”.

Jim Rohn

/DrRobertSilverman @DrRobSilverman @DrRobertSilverman

www.DrRobertSilverman.com

facebook.com/groups/mastermindlasergroup

Principle

The kit detects 2019-nCoV IgM and IgG antibodies by immuno- capture method. The nitrocellulose membrane is coated by mouse-anti human monoclonal IgM antibodies, mouse-anti human monoclonal IgG antibodies, and goat-anti-mouse IgG antibodies. The recombinant 2019-nCoV antigen and mouse IgG antibodies are labeled with colloidal gold as a tracer. The antibodies will bind to colloidal gold-coated 2019-nCoV antigens to form compounds, which are further captured by pre-coated mouse-anti human IgM antibodies to form new compounds, and generate purple line (T). The binding of colloidal gold-labeled mouse IgG antibodies with goat-anti-mouse IgG antibodies will present purple line, which is used as the control line(C).

2m tests run in Wuhan to date…

We Offer at Home Phlebotomy Services

• We have over 6000 carefully selected phlebotomists in or database. We cover almost every city in the United States.

The prices for mobile phlebotomy services

• Single draw: $100.00

• Multiple draws; $100.00 for first and $50.00 for each additional at same location

• Hourly draws (3 hour minimum) $100.00 per hr

PLEASE CONTACT the link below to schedule

https://shop.evexiadiagnostics.com/ provide:

Patient Name and address and availability and phone number for the patient

Lungs should be considered an ecosystem with its own microbiota

Mathieu E, Escribano-Vazquez U, Descamps D, et al. Frontiers in Physiology, 2018;9:1168

Conceptual model of the study

Negi S, Pahari S, Bashir H, Agrewala JN. Frontiers in Immunology, 2019;10:1142