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Episode 58: How Nerves In Your Gut Can Help (or Hurt) Your Health

Episode 58: How Nerves In Your Gut Can Help (or Hurt) Your Health

Many of you will be familiar with the therapeutic benefits of massage: relief of tight muscles, stress relief and improved circulation to name just a few. Fewer people, however, are aware of the benefits of targeted abdominal massage -- also called visceral manipulation. 

On this episode, Andrea talks to Dr. Bob Griesse about how the nerves of the gut become desensitized, leading to an array of health problems from chronic constipation to acid reflux, IBS, SIBO and more. 

Much like therapeutic massage works for scar mobility and sensitivity after a surgery, visceral manipulation can be used to help reawaken the nerves of the gut, stretch compressed tissue and reactivate the vagus nerve, one of the key highways of communication between the gut and the brain. 

Dr. Bob shares stories from his chiropractic patients and gives actionable tips for getting started with visceral manipulation, including how to stimulate the vagus nerve in an easy, accessible way, and some suggestions on how to find a practitioner in your area. 

Connect with Dr. Bob on Instagram, YouTube and Facebook @healthsourcefairlawn. For those in the Akron/Cleveland area, Dr. Bob is offering listeners a free laser session on the day of evaluation when you mention “The Microbiome Report.” Schedule your appointment here

Questions? Ideas? Email us at or reach out on Instagram @DreEats or @BIOHMHealth.

Approximate Timestamps: 

  • What is visceral manipulation (VM)? (2:06)
  • Nerve desensitization
  • The main methods of VM (13:31)
  • Deep pressure stretching (15:05)
  • The Rebound Technique (20:29)
  • What can someone expect from this treatment? (21:21)
  • The importance of the vagus nerve (22:30)
  • Ways to stimulate the vagus nerve (27:08)
  • The insular cortex (29:56)
  • How to find a practitioner in your area (33:54)

Mentioned On This Show:

ultimate gut health guide


Andrea Wien: Welcome. I am your host, Andrea Wien and you are listening to the Microbiome Report powered by BIOHM Health. On this episode, I'm talking with doctor of chiropractic, Dr. Bob Griesse about something that will be new to many people, visceral manipulation. This is essentially how external techniques can lead to internal changes in our gut health, including constipation, IBS, SIBO, diarrhea, acid reflux, you name it, this technique may be able to help.

On this show, we get into the different techniques that practitioners can apply that make a huge difference in system recovery, plus dive into the science around the vagus nerve, a nerve that affects 90% of the functioning of the gut. You heard that right, nine zero. It's very, very important. Plus, we talk about what you can do at home to send this nerve to the gym, so to speak. We talk about that on the episode and how to bolster its performance. I also want to remind everyone that BIOHM is offering 10% off any product on their website to podcast listeners with the code BIOHM10, again, it's B-I-O-H-M, the number one and zero. That means you can score some prebiotics, probiotics, greens powder, even a gut testing kit at a 10% discount. Now, without further ado, let's get to the show.

Dr. Bob, welcome to the show.

Dr. Bob Griesse: Thanks. I appreciate it, Andrea. I'm excited to be a part of it today.

Andrea Wien: Yeah. This is something that I feel like I say this on every show, which is why I love doing these, but this is something we haven't talked about on the show. And I think it's something that a lot of people have never heard about and don't know where to start with if they do hear about it. I think this'll be a good laying the groundwork episode about just the physical body and how the external, we can really kind of manipulate things on the external to influence what's going on internally. Let's just give an overview of what visceral manipulation is, because that sounds a little scary if you're just hearing it.

Dr. Bob Griesse: Yeah, absolutely. Most people aren't even used to hearing the word visceral. Not to be silly with the words, but the word visceral almost creates a visceral reaction. You hear it and you're like, ugh, it's kind of like when people hear the word moist, it has just a strange feeling to it. But the idea is that we're using different forms of manual therapy on the abdomen and the organs to influence their function. And there's actually a lot of research now that's starting to show that it also has an impact on the function of the brain and its relationship with the gut.

Andrea Wien: This is different. You work as a chiropractor, so this is different than what people are used to in terms of adjustments, getting things popped and cracked and joints and bones back in place. This is, we're talking about something different, right?

Dr. Bob Griesse: Oh yeah, absolutely. The techniques that we're using when we do visceral manipulation is more similar to things that you might experience during the massage or if a chiropractor or physical therapist has used other manual therapy techniques on you, it'd be more similar to that than it is the cracking and popping that you might feel or hear during a standard adjustment.

Andrea Wien: Now, are they complimentary though?

Dr. Bob Griesse: Do they assist one another? Absolutely. Yeah. Yeah. I find that patients get better results when they're getting both of them together. A perfect example and we'll probably touch on this case right now, because it's actually one I'm working through at the moment. I have a patient that has some digestive issues where we're doing both at the same time and I really think that even if a patient comes into my office with purely visceral complaints, that we're not going to get away from using one without the other.

Andrea Wien: Yeah. We actually just had Dr. Kogan on who's a biological dentist.

Dr. Bob Griesse: Nice.

Andrea Wien: And he was talking about how important posture is for teeth. And he sees a lot of issues with people who are hunched over, TMJ, all of these things can be related to postural issues. And so when you start to put all these pieces together, when we look at things from a functional lens, chiropractic adjustments, getting the body in alignment and then visceral manipulation is affecting the oral health, the oral health is affecting the gut health. It's everything is so tied together and cyclical.

Dr. Bob Griesse: Absolutely. It's an ecosystem. It's not just one part here, one part here, like a robot.

Andrea Wien: Exactly. Okay. Let's talk more about why it is useful.

Dr. Bob Griesse: Okay. Probably the easiest way to illustrate that for people is in the mechanical, because some of this other stuff is going to be a little abstract. The easiest way or the most straightforward way for a patient to see this from a mechanical perspective would be something called a hiatal hernia. And some of your patients might have heard of this before, but it's a process by which the diaphragm, which is at the top of the abdomen and separates your organs from your thoracic cavity, where your lungs and ribs are and things like that. It's where the stomach has actually started to slide up through the hole in the diaphragm.

And so I have a case like that, that I'm working on right now. And an easy way for us to assist that case is just by gently hooking the fingers onto the area where there's a J shape in the stomach and gently pulling it down and away from that area. Allows them to breathe easier. It can help with some reflux and things like that. That's probably the most straightforward way to see it, but there's a number of other ways that this can be used as a tool to help people's digestive system.

Andrea Wien: Typically when someone is coming to you, what are some of the symptoms that they would exhibit that you would say, "Oh, this is something we need to look into potentially doing some visceral manipulation?"

Dr. Bob Griesse: Sure. Yeah. I would say really any digestive symptom that has been treated with standard measures of changing the diet, making sure they're hydrated, they're sleeping, things like that. And then we haven't touched on this as a tool before. It's something that supports a lot of those other measures. But if someone comes to me and they're saying that they're constipated, I'm not starting with visceral manipulation, I'm starting with saying, "Hey, what's your hydration like? What's your diet like?" Things like that. And if some of those things have been addressed and we're not quite getting there, this is often an area that's at play because inflammation in the digestive system can cause a breakdown in the surface level nerves that control the movement of your digestive tract. And this can help to re-stimulate those and help those nerves to heal properly once we've gotten the inflammation out.

Andrea Wien: Talk about that a little bit. I think people have this understanding from listening to our show that there is a strong connection between the gut brain access. And historically, we've talked about that in terms of how the microbiota are talking to each other and to the neurons and all these different pieces and parts, hormones. But when we're actually talking about the nerves may have for lack of a better term, deadened or desensitized, how are you working with that? And how does that tie into this discussion?

Dr. Bob Griesse: That's a great question. I think it's often forgotten that the inside of our intestines and our digestive tract in many ways is similar to the surface of our skin. It's rich with blood vessels and rich with nerves. And what happens is when the digestive tract becomes inflamed, those blood vessels are going to pull away from that surface layer of the skin. Just like when we have inflammation or irritation on the surface of our skin, at first, the area can redden or become inflamed and then after chronic irritation, the blood vessels will pull away or even be broken off or the nerves can be broken off or dead in a way exactly like you're talking about. And the first way that we have to heal that is by obviously stopping the inflammation. But if we don't then stimulate those nerves to help them to heal and regrow, which is relatively new perspective in science, then they're not going to do it. Similar to the way that a muscle works. If we just let it lay there, it will atrophy on its own.

Andrea Wien: And I think, correct me if I'm wrong, but how I think about it sometimes is how you're talking about these nerve endings deadening or dying off and not having that same sensation and therefore not being able to send those messages could be like when we have a bad scar or we get surgery.

Dr. Bob Griesse: Absolutely.

Andrea Wien: And that toe or finger arm or whatever it is, feels a little weird. It just has that weird sensation. Is that similar to what's happening internally?

Dr. Bob Griesse: Yeah, absolutely. We even have, it's funny that you bring up scars. We even have tools that we can use and many doctors are familiar with this, not just chiropractors, but tools that we can assess how sensitive the skin is in areas like that. And what you often see with a scar is that it's much less sensitive or it perceives sensations a lot differently than other areas. And it seems that the science and the clinical experience of practitioners is showing us that the same thing can happen in the gut. And so some people become constipated over time because they've had years of inflammation going on in their digestive tract and they change it and the guts starting to heal and things like that, but nerves heal incredibly slowly. And so that takes time combined with good health and stimulating those nerves so that they can regrow through that process and get working again the way that they should.

Andrea Wien: Now, will those nerves regrow without some of these techniques? Or is this just, that will happen automatically, but these techniques are a way to increase the speed of which that healing happens?

Dr. Bob Griesse: Yeah. When I was in chiropractic school, I took some courses to help specialize and understanding of the nervous system. And the thing that they said is that all cells in our body, but particularly nerve cells need three things. They need oxygen, they need glucose and they need activation. And so a lot of people in that field and I would align myself with this and probably most osteopaths and chiropractors would as well, in saying that without the stimulation, it's possible that it may never change.

Andrea Wien: Interesting. Okay. Let's take a step back and talk more directly about where in the body this is used, we've kind of broadly said the digestive tract, but there are really some big players that kind of come into play when we're talking about this. Can you talk through each of those?

Dr. Bob Griesse: Yeah. The main areas that I will frequently treat would be related to the stomach. The epigastric area, close to the diaphragm. We'll work on stretching the diaphragm. We can work on assisting the liver and gallbladder to process bile out into the digestive system. And then there are valves in between our small and our large intestine and then a valve in between our large intestine and our rectum. And so those I would say are the main ones that we focus on treating at least in my office. And then there's a general one that we can talk about as well, that can benefit a lot of people.

Andrea Wien: Yeah. It's funny, so that valve that connects the small and large intestine called the ileocecal valve and it's something that is almost like a fun party trick. Sometimes it can get stuck open or it's just kind of wedged a little bit pretty frequently. And so I've had people say, "Oh, I have this pain here." And I'll kind of go in and do a palpation and release that and it's mind blowing for people. But I think the idea that we can impact something that we can't see so clearly is new to a lot of people.

Dr. Bob Griesse: Yeah. And in a sense, especially with my own profession, because there's people that specialize in different areas, it can be controversial to make that statement that, hey, we're influencing this thing, even though it's deep to surface layer skin, fat muscle and then some lymphatic tissue that surrounds the organs. But the evidence really strongly supports it. And like you were saying, an ileocecal valve is a really good way to see that illustration. I've had patients receive colonoscopies where even after the colonoscopy, they can't control their bowels. You work on the ileocecal valve and the symptoms disappear. And that's not to say that this is some magic thing that works for everybody. I don't believe in panaceas like that, but in the right case, this thing can work really, really well as a tool.

Andrea Wien: And it can be so simple. I think too, if I look at other cultures, I've gotten massaged, I've been lucky enough to get massaged in multiple places around the world, so India, Morocco, Vietnam. And all of those cultures focus on the gut. I think getting a massage in America is maybe one of the only places where they're not doing abdominal massage, where they're not really trying to move some of these things around and get that organ system working better because they understand how important it is to the health of the rest of the body. It's really, it might seem weird for people to think I'm going to go to my chiropractor and they're going to be poking around in my gut, but for most of the world, this is pretty normal.

Dr. Bob Griesse: Yeah. Yeah, absolutely. I think one of the beautiful things about the United States is that it's a melting pot, but one of the dangers that we fall into is that we've lost some of the ancient wisdom that our ancestors brought here and that other people's ancestors brought with them. We neglect this awesome history of nutrient dense foods and techniques to help heal ourselves and things like that. And there are benefits to it, but there are certainly drawbacks to losing things like that.

Andrea Wien: Let's talk about the main methods that you use when you're doing work with this tissue.

Dr. Bob Griesse: Yeah, yeah, absolutely. I would say that we'll start with the most general and then we can work into some of those specific ones. There are different manual therapy techniques that we use. The easiest one for people to wrap their head around was kind of like that one I was talking about with the stomach, but the most general can sound a little bit strange to people. We use manual therapy tools because our hands can get tired and things like that so I try to use tools to assist me as much as I can. And some of them can be really specialized to help things. And there's a technique that in osteopathic medicine and occupational therapy, they call dry brushing. We have a tool that looks similar to a comb that I use, but in outpatient settings in other specialties, you'll see different sorts of tools.

And what it does is you take this tool and you gently stroke across the surface of the skin in the abdomen. It helps stimulate nerves that are called free nerve endings and helps calm down pain. The other cool thing that it does is you can often see a patient get goosebumps from it. And that's a sign that it's actually stimulating the vagus nerve and the vagus nerve controls 90% of the function of the gut so you know that you're actually through this neurological loop directly influencing the abdomen. And that's a really easy way, just like, hey, we don't necessarily know what's going on with this patient. Or maybe they're just stressed and it's starting to affect their digestion. Hey, let's work on calming down the body through this vagus nerve and this dry brushing technique to help get things to move along properly.

Andrea Wien: Okay. We've talked about that one, we'd talked a little bit about deep pressure stretching, but can you get into that one a bit more?

Dr. Bob Griesse: Yeah, absolutely. I think one of the most interesting ones for that one is delivering gall bladder techniques. I've been exposed to some different techniques from other chiropractors who have wide ranging knowledge basis. And so often I'm just gently, but deeply, getting pressure into the liver and gallbladder and helping that organ, which it's important for us to understand that organs work totally different than the rest of our body. They don't perceive like pinching or burning sensations like the surface of our skin. They actually really respond well to stretch. It's great that you mentioned that as one of the words that you used in the question, because what we have to do is get in there and physically stretch the organ to help it perceive that it needs to do something. I'll get in there with the ends of my fingertips, get in deep under the rib cage and help to put pressure in that area.

The other thing that we can do with the liver and gallbladder that's really fun way to approach it. I know it sounds strange to say fun, but is compressed the rib cage. And so what I'll have patients do is they'll take a big deep breath in and as they let it out, I'll compress the ribs some because they have a lot of pliability. And then they'll take another one, we'll go deeper. And then on one of the inhalations I'll actually release and what that'll do is help the liver to gently shift in multiple different directions because it has seven ligaments that attach to it. And so it needs to work itself around in multiple different directions, stimulate the nerves that live in those ligaments to help get it moving.

Andrea Wien: I can just see some type of nerdy, nutrition, chiropractic comic book, where it's the ligaments of the liver and you're really painting the picture for us. That's so helpful.

Dr. Bob Griesse: Oh good, I'm glad. I think that's a weird thing for people to visualize, but when we can give that type of illustration, that helps them to see that this is something that can be good for them and doesn't have to be as strange as it might sound.

Andrea Wien: Absolutely. And I think we kind of think of all of these organs that are in our body as just being there and being stagnant, doing their job and working how they're supposed to without any help from the outside. And so even in something as simple as posture when you're eating. I have so many clients that have come to me and I'll say, "Well, how are you eating? Are you hunched over your desk? Are you compressing all of your digestive organs as you're trying to eat? Are you immediately going and laying down or curling up in the fetal position or slouching on the couch?" Allowing your body to be tall and long when you're digesting can be really helpful for people and these small, small changes can make a big difference.

Dr. Bob Griesse: Yeah. Well, what you described is actually in my opinion, the simplest form of visceral manipulation and massage, is sitting up tall and diaphragmatically breathing because what happens during that process is our diaphragm is shaped like an arc and when we breathe in deeply like that and drop a diaphragm down, it'll compress the organs, push them up against one another. We're not built with a whole lot of space inside there. Get them moving, get them pressing up against one another and then as the diaphragm comes back up, when we exhale, all of a sudden they've got more space to move around in there or vice versa, depending on the manner in which the patient's breathing.

Andrea Wien: Yeah, I think about this too, in terms of the lymph system. We have the circulatory system that the heart is constantly pumping blood and oxygen through the body. The lymph system doesn't have that type of pump.

Dr. Bob Griesse: No valves, yeah.

Andrea Wien: In order to get that moving, you have to move your body, exercise. Yoga could be a really good way. There are certain types of massage that can be really helpful for lymph drainage. And I know the first time I went to get a lymph massage, I was blown away by how gentle it was because you can't really go very hard or else you go past the lymph. There's all these kinds of techniques that people I think need to know about when they're dealing with some type of disease state or just even trying to keep their bodies in healthy conditions that we have so much control just in the way that we move and hold and treat our bodies in how these systems work.

Dr. Bob Griesse: Oh yeah, absolutely. And it's interesting that you brought up lymph because just a few years ago, there was this article that got kind of spread all throughout the internet, especially on Facebook, where they said, "Scientists have discovered this new organ, the mesentery." Well, it's not that this organ showed up out of nowhere. It's just that they identified that a part of the lymphatic system that lives in the digestive tract is so crucial to the function of the digestive tract that they decided to call it a different organ. It was always there, but that proposes one hypothesis about how visceral manipulation and massage can be so effective, is that it's actually allowing the drainage and movement of lymphatic fluid in the abdomen to work well. And then we know that if we drain the lymphatic fluid, then we're getting excess toxins and byproducts of movement and digestion out of that area and we can bring new fluid in there so that these things can do their job.

Andrea Wien: The Microbiome Report is brought to you by BIOHM Health. Want to take action to improve your gut, but don't know where to start? Take the first step with BIOHM's Gut Report. You'll receive a full measurement of the bacteria and fungi in your gut, as well as actionable recommendations on exactly how to optimize your gut health from BIOHM's team of microbiome trained nutritionists.

We had one other method that you use, you mentioned rebound techniques.

Dr. Bob Griesse: Yeah. That rebound technique is what I was talking about with the liver. You've got those deep stretching and pressure techniques. You've got surface layer techniques that which primarily work through the avenue of the vagus nerve and then that rebounding technique that works really well on the liver because it has so many different attachments and so many opportunities to cause that movement to occur. But another one happens in the lungs too, which it's interesting with everything going on in our country today and really around the world that we're talking about the lungs now, because I learned a technique from a mentor in school about using that and I've suffered with lung issues in the past. And there's a really cool rebounding technique that can be used for the lungs.

Andrea Wien: Okay. I can see people thinking, okay, great. This sounds like it would be pretty uncomfortable.

Dr. Bob Griesse: It can be uncomfortable, that's for sure.

Andrea Wien: What can people kind of expect from this treatment? Is it a short or long term solution? How long does it typically take to see results? How uncomfortable are we talking about?

Dr. Bob Griesse: Yeah, I think that's a complicated question. If we're talking about how quickly patients can expect to receive results, if it's something as simple as I had a colonoscopy and things are moving too quickly or too slowly afterward, it's often that I only treat that patient for one session and then symptoms return to normal. But other people who are suffering from an issue of SIBO with constipation and it's been an issue ongoing for years and they're healing their leaky gut and working through bacterial changes and stuff. And then you throw in this on top of it, that's a process that takes time. Like I mentioned before, nerves take time to heal. They're not the fastest thing to heal in our body. That's for sure.

Andrea Wien: Okay. Maybe if people are just experiencing mild symptoms, a session or two might be able to handle it. But again, like anything we talk about, it's part of a healing plan where you're working on diet, lifestyle and this is just one more tool in the toolbox.

Dr. Bob Griesse: Absolutely. Absolutely.

Andrea Wien: You made a pretty big statement earlier. We kind of phased past it about the vagus nerve and how it really affects 90% of functioning in the gut. And that's another topic that we've touched on briefly on the show, but I would love to just dig into the vagal nerve and vagal stimulation and what that means, because I think just now maybe some savvy listeners have heard these terms, but the majority of people have no idea what we're talking about. Can you talk about the vagus nerve and speak to its importance in the body and in gut health?

Dr. Bob Griesse: Yeah, absolutely. The vagus nerve is one of the cranial nerves, which means it comes out of the brainstem and there's a lot of value that it's treated with and respect that it's treated with within my profession, because it's so powerful. When it comes out of the brainstem, it actually comes down and wraps around the first cervical vertebrae in the top of your neck, just behind your jaw, below that bony part behind your ears. And so there are chiropractors who actually specialize in only treating this area because what they find is that when we change the mechanics of the upper cervical spine, it stimulates the vagus nerve so powerfully that it can change a lot of issues going on in our body all at once, which is pretty cool. Then from that area in the neck, it migrates down and affects every single one of our organs in both direct and indirect ways.

We like to use that as an avenue to approach this because when the vagus nerve isn't healthy, it's kind of like the old saying, if mama ain't happy, nobody's happy. If the vagus nerve ain't happy, nobody's happy. And I actually worked with a patient probably three or four years ago now that had their vagus nerve ablated. Surgically they went in there and burned the vagus nerve because there was some neurological dysfunction going on there and you can't do something like that without affecting everything else. It's so powerful.

Andrea Wien: What kind of repercussions did that have that you saw?

Dr. Bob Griesse: Oh my gosh. Every single organ would have signs. Difficulty digesting fats coming from the liver and gallbladder, constipation because the vagus nerve goes down and it stimulates our motor system. What your listeners may understand is that there's a smooth muscle system, that means it's not voluntary in our digestive tract. We don't have to tell our intestines to move our stool along. But the vagus nerve is who does that. If we turn that system off and the only thing we're relying on is the mechanical pressure telling the muscles to move things along, and so that's an imperfect system. That's why we have that backup plan and that master control with the vagus nerve. I like to use it as a tool by adjusting the upper neck, by using these surface level techniques like dry brushing, because it's so impactful, it can change a lot of things, but that can also be the reason that people might feel emotional when they receive these types of massages or manipulations or even get big adjustments when they go to their chiropractor.

Andrea Wien: And I think we can tie this back to what we were talking about before, in terms of just like the nerves on our skin, if we get an injury or in our digestive tract, if we're dealing with long term constipation or something like that, the vagus nerve can also lose its tone. And for lack of a better word become floppy and out of shape. Using some of these techniques that you're talking about can really help to almost send the vagus nerve to the gym, right?

Dr. Bob Griesse: Oh 100%. And I would argue just based, purely on experience with patients that the vast majority of people, their vagus nerve is way out of shape. Our fight or flight response as 21st century Americans is on all the time. We were designed to live in a world where a saber tooth tiger chased us every once in a while. And so you freak out for the 15 minutes that it takes you to either die or survive and then things go back to normal and you're eating with your little commune and working hard to get whatever food that you can. And then stresses come along intermittently like that. Versus the majority of us are facing stress from family situations, work situations, pandemics, economic issues, political issues, every single day. And so it never really shuts off, which means that the vagus nerve never really has an opportunity to turn all the way on and for us to recover and heal the way that our bodies are designed to.

Andrea Wien: Now, there are some pretty random and interesting ways that we can stimulate the vagus nerve, send it to the gym ourselves. Can you speak to some of those?

Dr. Bob Griesse: Yeah. The techniques that we use first and foremost would be breathing. I tell patients that they need to work on their breathing all the time. It would be rare that I would pass a day that I haven't talked to a patient about their breathing. But because the vagus nerve is so intricately involved in things of the digestive system, we talk a lot about techniques that involve the throat and the digestive system to stimulate it. To take it to the gym, like you said.

The methods that I use most commonly involve humming because that involves a deep contraction of the throat muscles. Self gagging and I know that one's usually the weirdo in the group. What I'll tell patients to do is when they brush their teeth, I'll have them brush their tongue at the end, which is not uncommon, but I'll tell them to do it until they gag enough to tear up because the tearing up sensation and what's happening in our face involves other cranial nerves in that area. We've done enough to really hyper stimulate that vagus nerve it's gagged to that point. Now people with a strong gag reflex, that should not be their technique, but I'll teach them to dry brush themselves on their abdomen, to sing loudly or to gargle water because all of those involve the motor functions of that vagus nerve.

Andrea Wien: Now from a chiropractic standpoint and from your view as a practitioner, are you seeing people improve just based on their symptoms alone? Or are there other touch points and things in the body where you can tell if these techniques are working?

Dr. Bob Griesse: Yeah. Going back to the gag reflex, that's actually a really good way to measure it, although not very fun so I don't use it often. But what you can do is patients who struggle with an imbalance in their gag reflex, they're showing you for certain that they have a vagal issue. And so what you can do is use a tongue depressor and this is what I've done in the past. Use a tongue depressor on the tongue and determine where on the tongue we trigger a gag reflex. And so the most common situations are either two thirds back on the tongue and that's normal or we can get it just to the tip of the tongue and then they start to gag, you know that's unhealthy. And then all the way back to the back of the throat and we know that that is also unhealthy. In either of those cases, I'm definitely going to be assigning that as work for the patient. Usually that patient comes in knowing they have something off about the way that their throat works and their gag reflex.

Andrea Wien: That's so interesting. And it's such a simple tool to be able to not diagnose of course, but just to be able to do at home again, a fun party trick.

Dr. Bob Griesse: Right. That's exactly right. That's exactly right.

Andrea Wien: Okay. Let's move on and talk about another concept that I don't think many people have heard of and this is something that even I still work to get my head around a bit is the insular cortex. Can you talk about what the insular cortex is?

Dr. Bob Griesse: Yeah. The insular cortex is a part of our brain that's deep inside. It's even sometimes referred to as the insular lobe and it's located, like I said, kind of deep within the brain. What it does functionally is that it represents an area of our brain that helps us process emotions. But interestingly enough, it also houses the map of our organ systems. Our brain, a lot of it is devoted to a series of maps, maps of where our body is in space, maps of our world, helping us so that if God forbid, we close our eyes or became blind overnight, we would be able to survive. We would know that our left arm is still attached to our body. We would be able to reach out and touch a countertop to figure out where we are in our home. But we also have that for our organ systems so that our body from an unconscious perspective can control it.

When we work on doing visceral manipulation or other techniques to help our digestive system, it's a hypothesis of mine that were influencing this area of the brain and then that area of the brain can better control and understand what's going on in there. But even deeper than that, when you learn about in school, we learn a lot about this area of the brain that's the map of our extremities, like arms and legs. It's called the homunculus. And when we don't use a part of our body for an extended period of time, like say we have an injury, the quality of the map goes down and the brain will often do this thing that is now referred to as homuncular smudging or somatotopic smudging, which means that it'll replace that part of the map with information about pain so that at least it'll have some information coming from that area.

And there are a lot of people that go undiagnosed and have organ pain and bloating and things like that all the time and it's been my experience that some of this is at play in their case. And when we start working on that and their body starts to become better aware of what's going on within its own system, within its own digestive track, then they can control it better and they feel better. And then it influences their emotions. And you're like, holy cow. But it also makes sense because we say all the time, we have phrases in our own language about butterflies in the stomach or a nervous tummy or I have a gut feeling, things like that. And so we know intuitively that that's involved. And I think it, again goes back to what we were talking about, about losing ancestral wisdom is that we know, we don't need a textbook to tell us that this is a thing. They work in harmony with one another.

Andrea Wien: Again, stop me if I'm wrong, but the way I'm about this is for example, if a veteran came back from war and has lost a limb, oftentimes they'll have phantom pains where their left arm used to be. Even though that arm is not there so the brain should not be perceiving that there is pain and there's some interesting therapy then where if you actually can show them their arm in a mirror and massage it, the brain registers that as relief. Similarly in conditions like leaky gut, SIBO, IBS, that's kind of what you're talking about here. It's just a little bit harder to wrap our heads around because we can't see that happening.

Dr. Bob Griesse: Exactly. And in this case, it's not that that part of our body has been removed or damaged that far gone or things like that. We still have those body parts, but the quality of the map has diminished in the same way, just not to the same extent of what you're talking about. I really like that analogy. That's great.

Andrea Wien: It's on 3G, not 5G. Okay. If someone is looking for a practitioner to do this, I don't think it's common to go to a chiropractor even and have them offer this service. What kinds of questions should people be asking? Or what kinds of practitioners should they be looking for?

Dr. Bob Griesse: Yeah, I think that there's an inherent difficulty in it because a lot of people don't do this as their primary treatment method so there's nothing listed on my website that I do this. It's often by word of mouth that patients find out that this is something that I work with. And I'm not aware of any central practitioner locating information. However, as holistic and functional medicine and manual medicine evolve, many providers are becoming better connected to one another. And knowing kind of who does what and so if you've got a chiropractor, massage therapist, osteopath, even your primary care physician may be aware of, but it's definitely going to be more so those of us who operate in what is often referred to as the alternative medicine world that are going to be able to find you a naturopath. Find you someone that you can work alongside.

Andrea Wien: Okay, great. I guess just to end, I would love to just hear a story. I think bringing it home about proper alignment of the body, visceral manipulation, how it's so critical for digestion and gut health. We so often think what's going into the body, so supplements, diet, stress reduction techniques, obviously external, but still fairly unseen. Alignment and posture and chiropractic care is right there. We can see what's happening. We can feel what's being moved around. Why is that so important for digestion?

Dr. Bob Griesse: All the nerves that come out and control that part of our body come from the central nervous system, the brain and spinal cord and what houses the central nervous system? Your skull and your vertebrae. If we're not addressing the protective mechanism that surrounds it and influences it, then we're not really taking the treatment of that central nervous system to its full capacity. In chiropractic, we call the central nervous system, the master control center. It tells everything what to do with few exceptions. The heart operates on an electrical system and things like that. But for the most part, brain and spinal cord, they're in charge. And if people don't start listening to it, if your body's not listening to it, then things go out of whack. Adjustments and other therapy techniques that work to facilitate a healthy function of the nervous system, they're how we can make dramatic change in our bodies.

Andrea Wien: Do you have a story of a patient where even you have been surprised by the results?

Dr. Bob Griesse: I tend not to be surprised anymore. Typically I'm surprised when things don't respond the way that they should. I'll go back to the fun one that I'm working with right now. Easy, low hanging fruit would be the ones where they have complete loss of bowel control after having a colonoscopy and you do one treatment on them. My own mom has been through that, where you do one treatment and all of a sudden bowels are back to normal. It blows people's mind because they're like, "Doc, I've been having new stools for five days since this colonoscopy." You do one treatment and it's gone.

But this one that I'm working on right now is particularly interesting. The patient has been suffering with a hiatal hernia for probably decades, was relatively recently diagnosed and they've been suffering from esophageal reflux. And so it's been a process of not just working with them, but also educating them on the why behind it. But there's two different kinds of hiatal hernias and most people don't know that. There are what are called sliding and rolling hiatal hernias and rolling ones are the ones that typically need to go to surgery. And I think that's what most people are familiar with, with treating that type of reflux, but sliding can actually be tractioned down. In this case, it's not just a matter of influencing the nervous system, but physically moving the stomach down. And that can be an unpleasant one. This patient is responding really well though. We're just a few treatments in and they're already 40% better and they've had no improvement with any of the other acid reflux medications they've been taking.

Andrea Wien: Well, thank you so much for coming on to talk to us about all of this. If people want to find you, learn more about your practice and just keep up to date with you, where can they do that?

Dr. Bob Griesse: Yeah, so our practice is on social media. If they look for us on Facebook or Instagram or even on YouTube, we're just HealthSource of Fairlawn, pretty easy to find. And then our website is

Andrea Wien: Perfect, great. And we will link to all of that in the show notes at Dr. Bob, thank you so much for coming on to chat with us. It's always a pleasure and we'll hope to speak to you soon.

Dr. Bob Griesse: Likewise. Thank you, Andrea.

Andrea Wien: Thanks so much for listening. As always, you can find show notes for this and all episodes at And if you enjoy what we're doing in this space, please consider leaving us a rating and review. I've included a clickable link in the show description to make it very easy for you to do so. I'm Andrea Wien and I'll catch you next time.


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