Beyond Vagal Stimulation-Comprehensive Brain-Based Approach to Mold Healing

Joe Smith, DC

Well, a chiropractic neurologist is a specialty field within chiropractic just like medicine has neurology and cardiology and gastroenterology and all that stuff. So in chiropractic there’s sub-specialties and chiropractic neurology is one of those. It’s a three-year program and then we’re board certified through the American College of Functional Neurology. And so basically it’s based upon Charles Scott Sherrington’s work. He won a Nobel Prize in 1932 for his work on the central integrated state. So his theory is that the brain output is based upon the total sum of excitatory and inhibitory connections in the brain. And so most of those come from our proprioceptive system or different sensory systems like sight hearing, balance or inner ear, et cetera. And so that balance of systems becomes critical for the optimal function of the brain. And so the difference between a medical neurologist and a chiropractic neurologist is first of all, a medical neurologist actually treats neurological conditions with the particular medication or surgery. And so we don’t have that in our scope. 

Like for example, a medical neurologist would take somebody who comes in and they have like the classic posturing where their shoulders up and their hand is flexed and their elbows flexed and they have that circumductive gain. We know pretty classically that that’s a stroke on the left side of the brain. And so then they will work to help that client with rehabilitation. And then when they are able to station is over, basically they get into occupational therapy, and when the occupational therapy is up, whatever function they’ve gained back is basically their function. Functional neurology was born from French researchers and French clinicians who instead of doing occupational therapy to help the client compensate for the injury by making them better with their strong side, they actually did something called restraint therapy which forced them. So they restrained the good side that wasn’t injured and then it forced them to make new connections to start moving their body. 

The philosophy of functional neurology is to say, there are aspects of this that are obvious frank a blade of neurological lesions, but in Sherrington’s paper, he talks about how the central integrated state isn’t all a blade of issues, there’s functional issues. So I might see a client who has a slightly dilated pupil on one side, they might have a high shoulder on that side, they may have a slightly bent elbow on that side, they may have a turnout foot on that side. And that suggestive that the brain on the same side isn’t inhibiting the output of the sympathetic nervous system to the spinal cord and that ends up creating a soft neurological finding, which is not something that a board certified medical neurologist is really concerned about because they’re dealing with more severe life-threatening and fully expressed disease issues where we’re more catching things in between optimal function and you need to see a neurologist for a medication or some sort of neurosurgery. We kinda catch people in the middle. And then if people do have a stroke doing that type of restraint therapy approach can help people get function back that maybe that model with occupational therapy and centered neurology might’ve been missing.

Eric Gordon, M.D.

Yeah, just to kind of restate ’cause you hit a theme that is something that I’ve talked about throughout this series is what I call conventional medicine or what the medicine that you get when you go to your doctor, your average doctor or wind up in the hospital unfortunately is aimed at fixing something that’s broken. And if you have chronic illness, you might’ve had something broken, but you also have a failure of healing. And that is different than the breaking. And what Dr. Smith really working on is in that continuum when something has injured your system or tweaked your system, but hasn’t broken it. It’s like a sprained ankle versus a broken bone. The broken bone is easy, we see it on the x-ray. 

The sprained ankle, if it’s mild, it’s hard to even know it’s there. It hurts when we poke at it, but the pictures aren’t gonna to be abnormal. Maybe an MRI will show a little swelling, but after a while it might look normal. And that’s what we do as functional physicians as integrated physicians or whatever labels we wanna call, is we’re working at restoring full function. And what Dr. Smith is doing is helping restore function through improving communication and basically focusing on what is often the forgotten organ. And when we’re dealing with people’s health, Dr. Smith could have mentioned to me earlier, the most commonly forgotten organ is the brain because in medicine we act as though there’s not much we can do. If the brain is making a little hiccups here and there, well, good luck. 

And we have in this series talks about biofeedback and things like that that can help, but what doctors… What I’m gonna learn more about today. In fact, I said one of the reasons I’m doing this series is I’m getting to learn a lot is to understand how Dr. Smith looks at the brain and some of the tools that he uses to help assess and get us back to normal through the lens of what happens to your brain when you have mold exposure and a little bit of brain fog. So I’m gonna let you take any one of those books and run with them for a while.

Joe Smith, DC

Well, in the instance of mold for example, folks that are struggling with that, we know that a lot of people that have chronic mold exposure and symptoms from that have brain fog and they have depression and they have anxiety and they have insomnia and they have fatigue. Those are all neurological sequelae. But in the standard model it’s often looked at as, “Oh, you are depressed because you have pain or you’re depressed because you aren’t sleeping well.” But is it that you’re not sleeping well because your brain isn’t working and that’s why you’re depressed? Or are you depressed because of it’s the other way around? So there’s actually a way with an exam and a history to determine where to start. 

So, a lot of folks are kind of given this idea that if they can’t find what’s wrong then they just get labeled in this category of depressed and so they get put on depression medication which I know is an attempt to help, but it doesn’t really answer the question, why is that? Because often the brain is actually the primary issue and a lot of cases of chronic mold that I run into that get referred to me, they’ve tried a lot of different biochemistry approaches and it hasn’t worked because they had a severe neurological issue that wasn’t being managed. It was just kinda being seen as the secondary effect of the mold. But what if a person had a developmental issue? Or a whiplash injury? Or they had a psychological trauma, they had an high ACE score when they were a child, or they had a traumatic brain injury? And that brain injury and loss of brain function led to a change in their state of their autonomic nervous system which didn’t allow their immune system to fight off the mold when they got exposed to it.

Eric Gordon, M.D.

And let me just throw in one thing, is that when we talk about traumatic brain injury, we’re not talking necessarily about getting your brain mushed. It can be minor head trauma in the right people can leave parts of your brain that should be modulating you not doing it so well. So just wanna get away from the idea that it’s, that…

Joe Smith, DC

It’s 100% true. It’s like one mile below where you have maybe you fell out of a tree when you’re a kid, maybe you rang your bell falling off your bike. And there’s these cells in the brain, 90% of the brain are made of these cells, they’re called glial cells, and they start out in this octopus like state, they’re called ramified. And then there’s 10 of those for every one neuron that like secretes a serotonin or dopamine. So, people could be depressed because they’re not releasing serotonin or dopamine or they could be depressed because the neurons that tend to the dopamine and serotonin neurons are actually changed in their morphology. So those glial cells, after you hit your head or after a severe size psychological or chemical trauma can actually change shape from this ramified or octopus like state to what’s called a prime state which looks like a fried egg. At that point, they never go back to the ramified state ever, but they can change from prime to activated which is proinflammatory which is the experience of brain fog.

Eric Gordon, M.D.

I think that is something that, again, just a little addition in there. Brain fog happens for lots of different reasons, but the end result is usually inflammation in the brain.-

Joe Smith, DC

Yeah, the least common denominator is these glial cells are primed and then they get activated into what’s called an M1 designation. That’s the technical aspect of that. And that’s the least common denominator. And there’s many triggers. One of the biggest ones is lack of sleep, another one is systemic inflammation from infection or auto-immunity, another one is insulin surges, another one is over-training, alcohol is a big one. So, if you’re that person that has a glass of wine now and goes immediately into brain fog, that’s a really good indication unfortunately that there are a number of activated and primed glial cells in an M1 designation that needed to be pushed back to that M2.

Eric Gordon, M.D.

Okay, how do you do that?

Joe Smith, DC

Well that’s the interesting thing is everybody when they get into, they start hearing about the brain and they get excited about it, they see all the connections, they’re like, “Well, what do we activate? What do we activate? What do we activate?” And the way the brain works is the first step in a neurological rehabilitation program is not to activate, it’s to establish fuel to the neuron. So that’s oxygen and that’s stable glucose. So a person that just goes in and just start stimulating their brain with like PT or even chiropractic or like cranial sacral that has an established good fuel to the brain will crash and burn. And those are the super sensitive clients that when they get work on, instead of feeling better like their friends and loved ones, they actually feel worse. 

That person hasn’t had somebody actually establish healthy fuel to the mitochondria. And then the second step is to make sure that when we do activate the brain, there’s something called metabolic rate. So like some people could go out and run a marathon today, some people have a hard time getting up the stairs. If a person has a de-conditioned brain or not very much mitochondrial capacity, if they have mycotoxins circulating causing this M1 designation to flare up, if they have anemia, if they have thyroid issues, if they have blows to the head or infections in their brain, they’re not gonna respond the same as the person who just bumped their head and has a little brain fog and comes right on of it. 

So it’s really about not making sure as a functional neurologist, we have to go, how many reps of activity for this specific network can this person tolerate before they hit their limit? And then we have to live below that and then gradually bring them up to their capacity where they can function again. And I gotta say, Dr. Gordon, one of the number one stresses for people on the nervous system is gravity. And a lot of people, the hardest people that I work with, they just don’t tolerate gravity and gravity influencing their inner ear, gravity influencing their postural systems is too much for their brain and so they just have to go lay down. Otherwise they just knock out and get brain fog.

Eric Gordon, M.D.

That exertion, we call exertional malaise or post-exertional malaise. And a lot of them… This is something that would be really fun to see over time is how many of the people with that issue can respond if the brain was in a more optimal state.

Joe Smith, DC

It’s really cool. And that can be tested very easily at the bedside. What you do is you take… Everybody do this at home, take your blood pressure on your right arm. Just be carefully, have somebody around you if you get dizzy, but take your blood pressure on your right arm seated, then stand up, wait one minute, test your blood pressure again. It should go up four or 11 millimeters of mercury on the top number. If it drops down, that’s called orthostatic hypotension and that means that one aspect of the cerebellum which regulates gravity or an aspect of the lower brainstem reflexively which regulates gravity isn’t working very well. Sometimes in my office, I’ll put people on something called a tilt table where they’re lying flat on their back and then I will actually passively elevate them. They almost look like they’re sitting on the bride of Frankenstein table. You know what I mean?

Eric Gordon, M.D.

Yeah.

Joe Smith, DC

And then what I do is I just basically slowly elevate them to upright and then we find that degree by which they can no longer tolerate gravity. So their blood pressure and heart rate will go up at a certain angle, and then we do rehab at that angle and we have them lay on the table for like 30 minutes. It’s funny, that’s the treatment sometimes it’s just laying there so that the cerebellum can calibrate gravity and then suddenly they can stand and their body can function normally without going into fight or flight and they get their life back. It’s pretty cool. It can happen very quickly.

Eric Gordon, M.D.

That is amazing because… Again, you’re illustrating two points, very important ones. One is that the difference between the… Or actually the inability of medical doctors to understand the spectrum of function. Because in medicine, failure to raise your blood pressure by 10 millimeters, if your blood pressure doesn’t go up, who cares? If it only goes up a little bit. They don’t understand ’cause they’re looking for the people who are gonna fall down.

Joe Smith, DC

Exactly, exactly.

Eric Gordon, M.D.

And I have plenty of people actually who do fall down who still fail the tests that the cardiologists will do. I shouldn’t say fail. They pass the test, but they shouldn’t have failed.

Joe Smith, DC

That’s just said, you’ll see Dr. Gordon then if you do this on the right side, that’s typically what will happen. You go into the hospital, you get your blood pressure taken in one position on one arm and then if it’s normal, they say, “Great.” But a lot of people that have high blood pressure, say their systolic is like 150 over like 85. When they stand their blood pressure drops 20 points to 130. If they had normal blood pressure at 120 and it dropped 100, they could faint. So the body is adapting by elevating blood pressure until they get that sorted out. But that same person may have normal blood pressure on the right side, if you test their blood pressure on the left side, it’s not doing the right thing. 

So now this person standing, when they stand up, their blood pressure goes up on the right, they have all of the blood in their brain so that establishes step one in a rehab program is getting blood to the mitochondria, but on the left side of the brain, the blood’s running out of their head. And so what happens? The right cortex fires into the right brainstem and it fires it through the right vagus nerve and it regulates heart rhythm, the left cortex fires into the left brain stem which regulates heart rate. So the person with the more blood on the right side of the brain, suddenly they get arrhythmia and they go to the emergency room and they get an EKG and they’re told they’re normal because what? They’re tested in the seated position.

Eric Gordon, M.D.

Or lying down actually.

Joe Smith, DC

Or lying down and then they stand up and they’re walking to the parking lot, and if they’re wearing one of those monitors that actually measures them in all positions, it just starts going off the chart. But then the treatment and the medical model, I’ve seen this is to cauterize aspects of the heart that are asymmetric, which it makes sense. Like if you have arrhythmia or you have tachycardia, you have some of these problems, you can throw a stroke. You don’t want that. But actually rehabbing the brain and re-establishing functionality in these circuits might be something that is a little less invasive than going in and burning out part of the heart.

Eric Gordon, M.D.

Well, I mean, there I… If life were only simple ’cause it would be wonderful to take, I mean to just get 100 people because… Me being a doctor and saying, “Aha, all these people going in and out of atrial fib, you’re gonna fix so easily.” But on the other hand, we don’t know until we look.

Joe Smith, DC

Well, it’s not always easy, it isn’t, but the idea is if we can get the right diagnosis of function, we actually have a chance at restoring optimal function rather than basically decompensating them with an ablative procedure where there’s no chance of getting that back.

Eric Gordon, M.D.

Yeah, it would be really interesting to look at this especially as people age. Do you notice this ’cause when you start off you’re in medical school, you are taught to take the blood pressure in both arms, but people never do.

Joe Smith, DC

Where is time for that?

Eric Gordon, M.D.

I shouldn’t say never, but people rarely do.

Joe Smith, DC

It’s not a common thing.

Eric Gordon, M.D.

It’s not a common thing. How often do you see this differential blood pressure between right and left side?

Joe Smith, DC

I see this more than 80% of the time in chronic illness.

Eric Gordon, M.D.

Wow, okay-

Joe Smith, DC

And very, very, very, very common. And so then they’ll go to get their body work done and they might feel better for a little while and then it just comes right back because their brain is not getting blood and they literally can’t hold the treatment because their brain doesn’t have the capacity to tolerate the stimulus or they’re being treated lying down and standing up is where the issue is.

Eric Gordon, M.D.

Yeah, I think so. So getting back to it, just to generalize what we’re talking about is that, so the things that you really make sure that you look at when you examine people is how they function in multiple, seated, standing and lying down.

Joe Smith, DC

Absolutely, yeah.

Eric Gordon, M.D.

So going back, so let’s say a patient comes in with brain, if they have a mold exposure and they’re cleaning it up, but they still have persistent brain fog. They really kinda feel like, we’re looking at them going, there’s something else happening here because the environment is kind of clean, we don’t think you’re colonized, but the brain fog is persistent. How do you approach them? What are the ways that you look at them?

Joe Smith, DC

The first thing I do is I look at their lifestyle. A lot of people that have persistent brain fog that have resolved their mold infection just having an injury and now the brain needs to be brought back to function. And as they have brain fog, we know that those egg shaped glial cells are morphology shaped forever. And so they’re going to cycle between a smiley face and then feeling really good and having good focus and concentration to this brain fog. So I look at things like, what’s their sleep like? What’s their alcohol intake? Are they getting too many starches? Do they have an unresolved other infection, like a viral infection that’s causing that? Do they have a history of a concussion? 

So when I examine them, the idea is as we identify the networks that are offline, they may have brain fog that they feel, but it’s like only after they drive too long or only after they look at a computer screen or only after they have a conversation with a certain person. So the history will help me determine what network is actually most effected by that glial cell priming. And then one of the best things about functional neurology is we can actually do a specific neurological test for that specific network. And once we identify that specific network, we can give specific input into that system which gives a small amount of oxygen to that area specifically and just that little bit of blood flow can cause the glial cells to turn to that M2 morphology. 

And then the goal is to get them to have a lifestyle that supports that, including like tolerating gravity, not over-training, getting enough sleep, watching the amount of alcohol that they intake, getting their blood sugar under control, dealing with any secondary thyroid effects, helping them understand how relationships are influencing this. And it becomes more of a holistic model than just like, I’m only focusing on the brain. The brain will respond to its environment. And if I miss something in the environment and just go straight to a supplement or a specific neurological treatment, and then they go back to the lifestyle that’s causing brain fog, they’re gonna get nothing out of it and they’re gonna be very underwhelmed with the results.

Eric Gordon, M.D.

Yeah, it’s interesting that you’re describing the pieces of the Bredesen protocol which is basically reinventing everything that you just spoke about.

Joe Smith, DC

Bredesen’s work is amazing and he talks about the aggregate aspect of all of these little things that affect an output of a cognitive domain. So there’s six cognitive domains that we can measure and the idea is Bredesen’s work is to say, “Look, the patient dream and the doctor dream is that we’re gonna do this mold detox and like rainbows and unicorns are gonna come out and your life is gonna come back.” But the reality is like, that probably isn’t gonna happen if the mold isn’t resolved or isn’t addressed, but then there’s all these other systems that integrate with the brain and they all need to be accounted for if there’s going to be a lasting change. And that’s the principle of his work and it really has changed. And it really is in line with the functional model and the functional neurology is a huge part of that.

Eric Gordon, M.D.

Yeah, when you say there are six cognitive domains, tell us a little more.

Joe Smith, DC

So in the world of… How does a person know if they’re just kind of lost a step and they’re aging and they have what’s called subjective cognitive decline, subjective cognitive loss, where they’re like, “Oh, I’m having a little trouble remembering that word, but is that normal for my age?” Versus actual cognitive decline on the way to dementia. And so there’s six domains and there’s a way to test each domain. There’s different tests. Like I like to use Cambridge Brain Sciences as one of my ways to test cognitive domain. It’s a research standardized cognitive testing that can be applied to these different domains, there’s the Montreal Cognitive Assessment, which very specifically measures each cognitive domain. 

And the idea is, as we determine by doing those diagnostics, if they’ve actually progressed from, “Hey, I’m just getting older, but it’s normal brain aging.” To, “Wow, I have an accelerated neurodegenerative process. I’m on my way to a different type of dementia.” Now we know that in dementia, there’s like cerebellar cognitive effect of dementia, there’s Alzheimer’s dementia, there’s dementia due to poor blood flow, ischemic dementia, we know that there’s Lewy body dementia, there’s frontal temporal dementia. There’s all these dementias. They all look differently on a neuro exam. And I can tell you that by doing this assessments, I can determine if a person is on an accelerated ramp to that. And the idea is how expensive is nursing homes and end of life care when you’ve ramped into dementia. And there absolutely is a way to objectively measure where a person is and there’s absolutely a way to determine if they’ve come out of that. 

So let’s say they show up on a scale of four cognitive domains that are in the actual pre dementia category. They still can do activities of daily living, but they haven’t lost activities of daily living, but they’re on their way to dementia, it’s accelerated neurodegeneration. And then we work with their lifestyle, we work with their brain, we give them supplements where needed, we refer them for medicine when needed, and they no longer flag on four, they only flag on one. Well, gosh, that is amazing and that’s the kind of work that is truly preventative. Although you can’t prove prevention, you can say things that we see ahead of disease. That’s what’s in the literature. These are the things that presented, these things are no longer present during the exam, they’re no longer showing any clinical signs of this. They’ve moved out of the actual cognitive decline section to the subject of cognitive loss. And we may have saved them years in quality of life and hundreds of thousands of quarter million dollar in medical expenses plus like all of the stress of family members that have to go through this, amazing.

Eric Gordon, M.D.

That is the amazing work. It’s just that it’s nice to have ways of entering that early.

Joe Smith, DC

Yes.

Eric Gordon, M.D.

And so going back to what you would do with a mold patient. ‘Cause I said, so looking at these cognitive domains, are there particular ones that you see more frequently with mold or mycotoxin issues or is it just more likely the individual’s sensitivity that puts them in place?

Joe Smith, DC

Mycotox, it’s gonna depend on how their brain developed, what their genetics are and then if they had a blow to the head, what they do for a living, if they use one part of their brain more than another part of the brain. So like, all I can tell you is I see a ton of brain fog and loss of cognitive function. The Surviving Mold website, they have a VCS test.

Eric Gordon, M.D.

The visual contrast.

Joe Smith, DC

So what that’s doing is it’s determining, does the occipital lobe, is it able to perceive the visual acuity scale? And so one mechanism by which people flag on that is mycotoxins. So absolutely, mycotoxins can affect anywhere in the brain. The idea is to make it specific to their particular exam and then determine what other things might be contributing to that so that we can be comprehensive in their care plan.

Eric Gordon, M.D.

That’s always been the issue is that like, I think with most toxicity, it gets you there, it causes the mitochondrial stress, it stresses whatever weak spots you have, but I think at this point, it is hard to predict what the trigger is, whether it’s mold, wine, head trauma. Like so many of these things, the end can look the same.

Joe Smith, DC

Yeah, totally. So the end looks the same. The way that I work with that out of my mind is let’s say I find I have a history of somebody and they have a significant mold contribution, they have an Epstein-Barr contribution, they are in menopause and so everything just got much worse when they went into menopause because they no longer could secrete estrogen and the amounts they needed from their adrenals and then that was kind of like fuel to the fire or they had a history of a high ACE score from psychological trauma as a child and had a strep as a child, five times went to graduate schools started gaining weight and losing hair, they developed Hashimoto’s and then had a car accident on the way back from their honeymoon. And then that person’s gonna respond a little bit differently than a person that doesn’t have all of those things going on.

So the idea is we first get a lay of the land. And that’s what my office does is called the Atlas Method. We just take a look at all the different aspects that we can, we try to line them up. We say, “They’re here, they wanna go up here, what’s the route going to be?” And then the way we actually measure progress is, look a lot of folks, they’re not just gonna suddenly wake up and have energy and have their brain fog go away. But if we can show that their exam findings that correlate with their decreased capacity improve at the bedside. So say like, I give an eye movement or I spin them in a chair or do something and their exam proves, then I can say I can help. If I do that type of stuff with them and they don’t respond, then I kind of circle my wagons and I go back to the metabolic aspect and then I might refer them to a place like your office where they go in and they do the IVs and they do the things so that they can get on top of the metabolic piece so that their brain actually responds to what we do at the bedside. And then that’s how our work can relate-

Eric Gordon, M.D.

Yeah, that is kind of a very interesting circle is that we always have to remember that what we’re doing isn’t working, somebody else may have a piece. That’s something that I think doctors need to remember all the time. I find so many of us we do what we do and when it fails, we give you a drug to deal with our failure rather than going wait a minute, this isn’t working, maybe another part of the organism needs to be addressed.

Joe Smith, DC

Not only that, but what’s worse is some doctors will just say, “What’s wrong with you?” You know what I mean? “Why aren’t you responding to this?” They’ll shift the responsibility onto like the client, like they’re broken or something, or they’re just depressed or maybe they’re malingering or they’re being histrionic. And it’s just like, well, no, there’s actually some stuff that requires some attention here.

Eric Gordon, M.D.

Yeah, that is actually the point of this summit and the joy for me at this summit is talking to a wide range of practitioners and just finding all the different ways that people can be served. And everyone doesn’t need everything, but I always believe that somewhere there’s an answer for almost everyone. It’s just a failure of our imagination. And one of the ways that it helps me to figure things out is know more about the tools that you use. Can you just go through some of the… I mean, I see how important basically history and understanding who’s in front of you. I get that, that’s really crucial, but what are some of the more, I guess, tools that are in your domain that you have that you wouldn’t find in another functional doctor’s office?

Joe Smith, DC

Well, there is some things that absolutely I couldn’t practice without. And one of those is what we talked about, just a blood pressure cuff left to right and it tilt table. Literally the tilt table allows me to determine if their blood pressure drops on a passive, basically going from to straight up and down. So a tilt table super important, but I love this, it’s a diagnostic system calls a video nestography, and they’re called relies. And so they’re like ski goggles with little cameras in them. And so there’s so much about the brain that we can learn by looking at eye movements. Neuro ophthalmology is just a really big part of my practice. 

I’m not an ophthalmologist, but I can look at I’m movements and quantify their movements in like pursuits or like looking back and forth and see cods or gaze stability. And that’s a beautiful window into how the brain is functioning in addition to things like balance and vision and hearing and taste and smell. But what’s really cool is I put these goggles on, I take them through a series of tasks where they look at different targets and then we objectively measure what’s happening compared to optimal baseline and then we also make a video of it so they can actually see what their eyes are doing. Now, one of the coolest tests that is out there in that BNG is they’ll look at a dot, I’ll cover their eyes and say, “Now I want you to keep your eyes on that target, but I’m gonna cover your eyes so you no longer can see it.” And what you’ll see as the eyes will start drifting slowly and they’ll develop a nystagmus from that.

Eric Gordon, M.D.

Just to reemphasize. So with these goggles on, they’re looking at your eye even if you’re not seeing anything out in the outer world, the camera’s on the inside watching you.

Joe Smith, DC

Yeah, they have night vision. So they end up being like Frenzel lenses. So they cannot fixate. So when that person can’t fixate, then some of the things that their frontal lobes are compensating for at a brainstem level start to manifest. So you’ll see in stagnant that isn’t primary when their eyes are open, but then the second you cover their eyes and like in a Frenzel lens and they can no longer use their occipital over their frontal lobe to fixate, you start to see in stagnant patterns come out. Now, imagine this, you’re trying to go to sleep at night and your eyes are closed and you’re dark in the room and your eyes are drifting like this. You’re having a right beat nystagmus. Every time your eyes beat or saccade back to the right, you’re getting a little bit of input into your mesencephalon, your midbrain. Well, that’s where the reticular activating system is. 

That’s gonna wake you up. Not only that, but it depletes your body of glucose faster because of the neurons that are sick, that are not stabilizing the eyes are just gobbling up extra glucose. So these people will wake up in the middle of the night, sweating and breathing and their heart might be beating and they cannot fall back asleep. And they’ve tried everything under the sun and nobody really looked at their eyes covered and so nobody really diagnosed the underlying brainstem issue that probably happened developmentally or from an old whiplash injury or head trauma that happened when they were like eight years old or maybe they were dropped on their head when they were a kid and nobody ever really thought anything about it, but it turns out that was the injury or the impetus to this lifelong thing, ’cause we know what happens when you don’t sleep. What happens to your immune cell?

Eric Gordon, M.D.

Yeah, it quickly goes down, but this is fascinating. This is worth the price of admission because that is a common complaint.

Joe Smith, DC

In some it’s almost ubiquitous in chronic cases.

Eric Gordon, M.D.

Yeah, of that difficulty either being either being woken up or having difficulty falling asleep because you can’t. You don’t know why, you’re not feeling stressed. You kind of relax and you’re like done, you close your eyes and-

Joe Smith, DC

Exactly.

Eric Gordon, M.D.

Staying almost awake. What I always say, everything works sometimes we just have to find out when that time is you. And so I wish we could get these things done earlier in the process. That is the sadness of chronic illnesses is people have to go through so many layers. Right there, they would have gone through a lot of supplements and maybe even a few drugs from me before they would have gotten to have a chance of getting to you to find out that wait a minute, the problem with sleep is something much more basic.

Joe Smith, DC

Yeah, and can I talk about supplements and medications just for a second?

Eric Gordon, M.D.

Sure.

Joe Smith, DC

Listen, legally I don’t talk about medications ’cause they’re not in my scope, but let’s talk about supplements. Let’s say you have somebody with insomnia and their eyes are drifting to the left and shooting at the right, and you are a functional medicine doctor and you perfectly evaluated their insulin resistance, you perfectly evaluated their acute phase reactants, their secondary hypothyroidism, and you manage that their MTHFR perfectly, and their inflammation came down, their mitochondria got better, their energy improved, but then their insomnia got worse. Sometimes what happens is you have a maladapted system and then you make it more efficient by helping metabolic aspects. It’s like the mitochondria of that maladapted circuit can get better too.

Eric Gordon, M.D.

When you exercise, it got stronger.

Joe Smith, DC

It got stronger and so now they’re worse because the plasticity becomes stronger and they have a more amplified effect. And so now unfortunately, that’s how I got into neurology was I was seeing these weird things happening and clients that I was doing a lot of labs with and supplements with and one of my colleagues is like, “Hey listen, you gotta get into the brain.” I’m like, “Listen, I’ve been studying so much. I don’t know if I can do anymore.” And he’s like, “You have to get into the brain.” And once I understood how the brain fit into this whole story of the autonomic nervous system and plasticity and it’s the regulator of all these different systems and it’s the most overlooked thing. Once I understood how each one of these networks worked, I could see how every… Like even if I’ve heard of something brand new, I could go, “Okay, what is this therapy intending to do? And then where does that live in the brain?” So that helps me figure out how to prioritize the care plan because I understand where everything fits within this complex hierarchy of systems.

Eric Gordon, M.D.

 One of the things that would be really fun to hear, educational and fun to hear about from you is just a little bit about the reticular activating system and the cerebellum because I’ve spoken on this series and many others about CCI, the craniocervical instability. And I do believe that many of our chronic patients have mild elements of that-

Joe Smith, DC

100%

Eric Gordon, M.D.

Via surgery, but what people don’t understand is what’s happening at this part low in the brain just in the very back there where the cerebellum sits and right in front of it where the reticular activating system is living. So just a few minutes just about on that dance there because so many people have had really no idea. People, we all… Those of us who know what the different parts are think cerebellum balance and no proprioception. I see what you’re saying. Knowing where you are in space, but we forget that it does a lot more. So just take a few minutes to tell us about it.

Joe Smith, DC

The cerebellum has so many different roles and we commonly think of cerebellum as balance or coordinating movement, but the cerebellum also coordinates the immune system. Through the bone marrow, it helps coordinate differentiation of lymphocytes and it can help create a bystander effect of a polarization of T cells, the cerebellum projects to the contralateral mesencephalon in the frontal lobe, the right-

Eric Gordon, M.D.

By just to have the , that means the other side.

Joe Smith, DC

Right, yeah, so the cerebellum on the left will stimulate the right mesencephalon and the right frontal lobe has a little bit of an aspect of TH2 polarization signaling. The left side-

Eric Gordon, M.D.

And just let me say, this is an area of where functional neurology or chiropractic neurology is thinking in terms that, I don’t believe that I know of any medical neurologists who would think in terms of parts of the brain having specific effects on different aspects of the immune system. But that’s something that-

Joe Smith, DC

It’s the literature that’s rife with this. The literature is so full of this. So the application is just there. It’s just there for the taking and you can see it. You can see it when you look at cytokine panels, you can see it when you look at white blood cell differentiation, you can see at and T and B-cell profiles, you can see it on a CBC with differential, you can see it on acute phase reactants. Some clients, the only thing you can do with them if they don’t tolerate supplements, if they don’t tolerate movement, if they can’t really eat anything, they’re reactive to everything. Sometimes the only thing you can do with them is work with them so they tolerate gravity in their environment by working on the brain. And that alone makes these massive changes on their labs.

Eric Gordon, M.D.

And again, I think they wanna emphasize when you say tolerate it’s that their brain is interpreting the information correctly. So you’re not.. Because I think a lot of… Say a little bit more about that.

Joe Smith, DC

One of my favorite tests in my office is a force plate. And people will stand on this force plate and they stand on it with their eyes open and their hands are on their hips, and then they close their eyes and then we look at their center of pressure. And their center of mass should be directly below them. What happens in a lot of people when their brain is going south is their center of pressure moves backwards so their body compensates by leaning forward and you’ll see this on the force plate. And so that’s why as people get older, they kind of start around their shoulders and they start to lean forward. 

That’s the brain going south. And so imagine this, all these… Some of the best research on the brain was in Russia and they looked at the purpose of the brain. The brain is not just a sensory system that receives like sight sound, hearing, touch, and taste and gravity through the vestibular system in the inner ear. It actually has to attach valence to that. So like, if you’re eating something and you taste strawberry, one person might be like, “Oh, that tastes delicious.” Another person might go, “I have an allergy to strawberry, I’m going to die if I don’t spit this out of my mouth.” So that becomes a motor action. So, imagine like your center of pressure is forward and the part of the brain that is basically designed to predict. And so to predict, you have to know where you are, and then you have to know where you wanna go and then you have to be able to plan how you’re gonna get there. 

And as long as your life is on that process, you feel pretty good, that’s your known world. But once that is taken away and you don’t know, then you go into chaos and that chaos, you’re aware of it and that creates a stress on your body, it’s an existential crisis. Imagine you don’t know where you are in space and everything that you see and hear and smell and touch and taste is not actually where your brain perceives it. That person is going to have an increase just as a result of that mismatch in sympathetic tone from the reticular activating system which elevates their blood pressure, it kills natural killer cells. and it polarizes the immune system into a TH2 dominance, which is a perfect breeding ground for mold.

Eric Gordon, M.D.

Yeah and then for allergy. It’s a fascinating description of where many people go with a severe mass cell reactions where they actually will feel deeper. They call it deep. They try to explain it. And I’ve never… Derealization, depersonalization where they just… That sense watching-

Joe Smith, DC

Their sense of self is gone.

Eric Gordon, M.D.

Yeah, and some of them explain as also not knowing where they are in space ’cause it’s a hard concept to sometimes explain to another person. Like I’m not really here, but I know I am, but I don’t feel like I really am.

Joe Smith, DC

They disassociate because these systems are just so mismatched. So literally, you put them on the force plate, you work with them, and suddenly they’re matching their perceived center of pressure as accurate. So we basically recaptured that function in their brain and so now they actually perceive accurately where they are and you just watch their life come back. Like there’s a sense of relief. 

And suddenly they start seeing things again and they start participating and activating their system and they start participating in life and suddenly they’ve found it again. All those therapies were stimulating the brain, but stimulating the brain like, I’m a body worker too but if I don’t first try to establish accurate center of pressure, it’s like shooting buckets on a boat. A wave could come and I’m have the perfect trajectory, but the wave moves the boat and then I air ball. If you’re a body worker and the center of pressure is off, you may air ball. And it’s just like, it’s super inconsistent and it’s just one of my favorite modalities to check.

Eric Gordon, M.D.

I can still see you like basketball. For the rest of us, so you’re missing.

Joe Smith, DC

Yeah, you just totally missed the mark and it’s… As a practitioner you’re thinking you’re doing the perfect thing and you have it all lined up and then you make the perfect shot, the perfect putt and nothing happens and you’re like, “What is going on?”

Eric Gordon, M.D.

So basically we come back again to the brain lets us know where we are in space and time. And when those perceptions are off a little bit, anxiety and OCD behaviors and confusion. That’s the thing.

Joe Smith, DC

Disorientation.

Eric Gordon, M.D.

The confusion, disorientation happens first. How we respond to that psychologically may differ, but if we don’t know where we are in space, life is now no longer that predictable and it gets much harder and a lot more work.

Joe Smith, DC

Way more chaotic, yes, exactly. The chaos takes over

Eric Gordon, M.D.

And chaos takes more energy from the other systems to compensate. I think that’s the important piece here. So, think you might have something small off, but you wind up using a lot of energy to-

Joe Smith, DC

Exactly, exactly. So then you just kind of start withdrawing from life because everything is way harder than it’s supposed to be and you end up isolating and trying to suppress that feeling of chaos and then you suppress your happy emotions and then it’s just a lot of TV watching.

Eric Gordon, M.D.

Yeah, and I can see how it’s… I’m coming back to that theme that you mentioned is the brain is the forgotten organ because we keep looking at it as merely the victim and not realizing how much of a role it’s playing which should, because it’s like when we fall… I always loved that thing when we fall asleep at night, every cell in our bodies decreases energy production by like 25% within seconds. So, when this thing goes off, the whole system changes.

Joe Smith, DC

Have you ever seen those body exhibits where they look at the lymphatic system and they look at the nervous system like we in medicine and in school, we talk about these systems as if they’re separate, but when you look at a brain and a brainstem and the vagus nerve and the enteric nervous system which is the gut, it’s one thing and we treat them like they’re different, but they’re bi-directional, they’re the same thing, they create these vicious cycles. And we have to have a way of identifying where a person is, where they wanna go and then how we’re gonna get them there. I’ve found that my clinical success has gone up when I first diagnosed where they were and then prioritize their care plan based on their capacities rather than just jumping in with the diet or jumping in with the supplement or jumping in with the technique because that was what I’m good at.

Eric Gordon, M.D.

Yeah, that’s something I wanna maybe let you restate or I might butcher it, but to get it to state it again is that time and time again, you can have the right treatment but if you do it at the wrong time or just with the wrong emphasis. That’s what’s hard is that what we depend on in medicine is we expect what we do to work 80% of the time no matter how we do it.

Joe Smith, DC

Yeah.

Eric Gordon, M.D.

And because basically people walk in, they have a complaint and they get a pill and they’re all gonna get pretty much the same pill or one of six pills that are in that same class and hello, goodbye. But when you’re dealing with chronic illness, we’re now in that thing where it’s not about the trigger, it’s not about the disease that equivalent to trigger, it’s about how your body responds to that. And in order to assess how your body responds to it, we really have to assess how you’re responding to the world. And what you’re trying to teach us is that when that brain is responding to the world in a way that’s not reflecting what’s out there, it’s gonna make missteps and miss calls. And even if I brilliantly give you the right magic pill, it still might make you very, very ill because your brain is gonna be confused and send it the wrong place.

Joe Smith, DC

100%, I think you nailed it.

Eric Gordon, M.D.

I know, but as I said, it’s always realizing as people get more and more ill or more and more sensitive, we just have to be more and more sensitive ourselves and how we approach them.

Joe Smith, DC

It’s a tough gig, a complex case and the more things are involved, the harder it is. So, there is this idea that a lot of people just wait until they can’t function before they really seek out help. And I can’t emphasize the importance of a baseline of just a baseline. Like figure out where you are now before you lose function. And it’s so much easier to stay out of trouble than to get out of trouble. And I’m definitely not coming down and folks that are in crisis. We certainly want to help them, but there actually is a way… We are in the information age folks. We actually know enough right now to significantly advise you on how to avoid a lot of missteps as far as health goes and be a health advisor and help you have a basically a Spock life where you live long and prosper, and then we have this idea that like your medical expenses and your quality of life are just not the limiting factor as you age, you can age gracefully.

Eric Gordon, M.D.

The hardest preventative med is true, preventative medicines is what you’re describing beautifully. I think we can sell obviously women will mostly buy it first. They are the bio hackers out there. People who really wanna know what’s best for them, but I I’ve always found like the reason that men aren’t in doctor’s office very often is that we just think that we’re gonna be immortal and it doesn’t matter what we do, it’s gonna work until it doesn’t and then we’ll keep denying it in another way. But then I said, that’s what creates wars ’cause men always think the bullets are gonna hit the other guy not me. Oh, God, human nature. We can’t change that. Only thing we can do is hope that we can get people to pay attention a little bit. Just to wrap up, I just think that what you’ve described for us is a tool that I just wish more doctors and patients were aware of. Because they said, your field is not brand new, but it’s not very well known yet. And I think we gotta get the message out there ’cause-

Joe Smith, DC

Thank you for having me, yeah.

Eric Gordon, M.D.

It’s a pleasure. It’s Joe Smith, DC and his office is at Atlas Neurology, correct?

Joe Smith, DC

Atlas Health in Fairfax just north of San Francisco.

Eric Gordon, M.D.

Atlas Health, I always want you to make it… We’ll surround you. I give people lots of names, but for Dr. Smith, it’s just excellent physician and compassionate and teacher. And I think that’s the other part I wanna visit is that you just don’t treat your patients, you actually are teaching them how to take care of themselves.

Joe Smith, DC

100%, lifestyle is important. I also get the opportunity to teach other clinicians through a company called Apex Energetics. And so I’m very happy to be doing that and giving back to our profession as well that way.

Eric Gordon, M.D.

Yeah, that is great, great service. Because I said, as I was speaking to another physician earlier today is teaching because what all of us are doing is just not well-known enough out there. And so teaching is really, really important. So thank you a pleasure and hopefully we’ll look forward to everyone in our next episode.

Joe Smith, DC

Okay, take care. Thank you Dr. Gordon.