Answers on Mycotoxin Support, Low FODMAP, Hashimoto’s, & More

Intro:

Welcome to Dr. Ruscio radio providing practical and science-based solutions to feeling your best. To stay up-to-date on the latest topics as well as all of our prior episodes, please make sure to subscribe in your podcast player. For weekly updates, DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor. Now let’s head to the show.

ErinRyan:

Hey everyone. This is Erin Ryan from Dr. Ruscio radio. Today on the show, Dr. Ruscio answers your questions. You asked “Can intestinal support formula help bind mycotoxins in the gut for people with mold and MCAS?” and “Can it be used in the treatment of SIBO, even if your immunoglobulin count is normal?” What to do about diet when you already have so many restrictions and you aren’t feeling better yet. What to do when hormone therapy is not working for Hashimoto’s. Now we hear this question often. So Dr. Ruscio elaborates on what else you can try and when to get a second opinion. Dr. Ruscio shares some interesting findings from his own research about biofilm agents and whether or not the clinical benefit is enough to make it a blanket recommendation. Finally, we went off on a bit of a tangent discussing the importance of mindset and why it can be just as critical to your healing as other therapies. If you’d like to submit a question, visit DrRuscio.com/listener-questions and click “send us a voicemail” please speak nice and loud and clear and keep it as concise as you can. Enjoy the show.

DrMichaelRuscio:

Hey everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio. I am back again with Erin Ryan, and we will be going into another episode of listener questions. Hey Erin.

Intestinal Support Formula

ER:

Hey. All right. So we have a couple of questions about Intestinal Support Formula, which is one of the formulas that you can get on our website in the shop. Our first question is from Matt. He asks “Is it possible that your ISF (Intestinal Support Formula) product can help bind mycotoxins in the gut for people with mold/MCAS?”

MR:

Great question. Theoretically, yes. To my knowledge, this has not yet been demonstrated. It is something that we’ve been discussing at the clinic. Let me lead first with the concise answer. Theoretically, Yes. Has it been demonstrated? No. Has anyone studied it, proving that it can’t? No. It just hasn’t been studied in this application yet. It does bind to a wide array of bacterial LPS fragments, so it’s likely that it could. Should someone use this for mycotoxin treatment? Maybe. This is something that we’ve kind of been evaluating over at the clinic in terms of, do we want to do this? There’s a pro and there’s a con. The major con is the cost. There are other options that are less expensive such as charcoal, various clays and acetylcysteine, various fibers. Most of these are significantly cheaper than immunoglobulins. Now, if someone had both mycotoxins and a number of gastrointestinal symptoms, then this may be more befitting. I would also recommend that someone does a fair amount of foundational work to improve their gut health first, so that they have minimal amount of digestive symptoms.

MR:

If someone satisfied those kind of qualifying steps and they still had GI symptoms and they were looking to help quell those symptoms, as well as bind mycotoxins, then in theory, it could be worthwhile. Again, it hasn’t yet been demonstrated. So you’d want to retest at probably a three-month interval and see if you can correlate that to improvements in the mycotoxins that you’re seeing on a urine test. It’s a big maybe, and depending on what else you have going on may or may not be justifiable when looking at the cost.

ER:

Okay. Let’s hear Raphael’s question about ISF.

Raphael:

Hello, Dr. Ruscio. It’s Raphael from Brazil. I would like to know if the [Intestinal Repair Formula] would be helpful for me, since I have SIBO. I tried diets, probiotics, and even two rounds of Rifaximin. Both my blood and urine levels show normal immunoglobulins. IgG, IgA are completely normal. I would like to know if this is relevant. Comparing to IgG levels in the small intestine or intestines. I would like to know if Intestinal Repair Formula would be helpful for me since I have good immune globulin levels in the blood. Thank you so much.

MR:

Okay. So a good question there. To recap, I believe he has SIBO or he believes he has SIBO. He’s gone through dietary changes, probiotic therapy, Rifaximin, and still has not improved from those. I believe he said that his blood immunoglobulin levels were normal. Should he still use, or do a trial on immunoglobulin therapy? You certainly could. It’s important to not make the use of a therapeutic more complicated than we have to. This is something that is a balance between trying to use mechanism and laboratory data to predict who will respond to a therapy, but also not making it unnecessarily hard to go through the exercises of a simple, empirical trial. To my knowledge, none of the studies that have used immunoglobulin therapy have done immunoglobulin testing levels prior to try to predict if someone would better respond, whether it be blood or fecal. You can look at these in both mediums.

MR:

So if baseline testing would predict someone’s response, that’s a very interesting theory. It hasn’t been studied yet, so we don’t know if there’s going to be any bearing at all. It’s a great question. Unfortunately, there’s no data to answer that question. So I wouldn’t insert that into the evaluation as to whether or not you should or should not use immunoglobulin therapy. What we do know, and what has been studied can be found in the Weinstock study. I feel that this is the one with the best design, which is why I cite it the most. The subjects fit the exact profile you’re describing, people who had changed their diets. I don’t believe Weinstock used probiotics, but they use Rifaximin and antispasmodic agents. So they used various treatments. Patients were nonresponsive to all these therapeutics, but they did note a 75% response rate in those using immunoglobulins.

MR:

This is not blinded. So we have to probably cut that response rate about in half because the placebo effect, even in RCTs averages out at about 45%. So that’s important to disclose. That being said, in a cohort of individuals, similar to yourself, they experienced symptomatic improvement from using immunoglobulins. So the relevancy of your testing has yet to be demonstrated. Because of that, and because you fit the presentation type of people who seem to do well on immunoglobulins, it’s worth giving them a trial. Remember you’re looking for two evaluation points. There was one study that did serial Likert scores over, I believe it was a three month period. When looking at the graph, you see an initial improvement in symptoms around the second or third week, and then a rough leveling off around week eight or nine, or at least a real deceleration of the rate of improvement.

MR:

So you’re looking for milestone one second or third week: I’m improving yes or no, not I’m fully recovered, but I’m improving. Yes or no. Then around the eighth or ninth week, you’ll likely be getting close to your plateau point. From there, I would recommend maintaining what you’re doing, whether you’re doing the five grams per day or 10 grams per day for a couple months to make sure that those improvements are consistent, then go to the exercise of weaning off / finding the minimal effective dose. So yes, it’s a viable therapy for someone with the grouping of symptoms that you’re describing. It’s not known at least to my knowledge and after reading pretty much every study on immunoglobulins, if there’s any prediction with blood or stool immunoglobulin levels for who will or will not respond to the therapy. So I would give it a trial purely based upon your symptoms. It’s an excellent question.

ER:

It’s interesting. I’m someone who has relapses of gut stuff from time to time and any time I take the Intestinal Support Formula. I notice definitely by week two, I’m feeling better. Then after a couple of weeks, I forget and stop taking it, which means I’m feeling better. I don’t even know if I’ve gone all the way to week eight. I’m just like, Oh yeah, I forgot I was taking that because I feel good. It’s such a weird thing because it’s very unlike a headache. With a headache, when it goes away you’re like “Oh my God, I feel so much better”, I can function 15 minutes after the Tylenol has kicked in. With your gut, it can take a few weeks and all of a sudden you’re feeling better and then you notice you’re feeling better and you’re like “that’s awesome”.

MR:

Yeah. It can be subtle. You also make a good point, which is there are going to be some people who respond really quickly and they may need a shorter course, which is why I always try to remind people of finding the minimal effective dose. For some people they may need a longer course than for other people. Hopefully, especially if they’re doing all the hard work with their diet and their lifestyle, foundational practices, they may need a shorter course. It’s also definitely important for people to realize that sometimes you don’t realize improvements. I remember when I was recovering from my parasite, I didn’t notice improvements until two or three months later. All of a sudden I looked back and said, wow, you know, I was needing two naps a day and for the past week, I’ve just been hammering through school all day and then the gym afterwards, and then studying all night and I haven’t even taken a nap. I just finally registered the fact that I had notably improved my health. It happened so slowly that you can kind of overlook it sometimes. So yeah, it’s a great reminder to be patient and attentive.

Elemental Diet

ER:

It’s so fascinating that the brain doesn’t alert you to that, but if you have like an ankle injury or something, it’s pretty clear when it’s hurting and not hurting. So it’s really fascinating. Okay. So our next question is from Sonya. This is probably a pretty popular question in people’s minds. She asks “Which elemental diet works with someone who is low histamine, low salicylates, soy-free and nut-free?”

MR:

Okay. Low histamine, low salicylates, soy-free and nut-free. It’s a little bit of a mixed bag. What I would do is I would reframe this question toward needing to just try them and see which one you do best with, because we don’t know what of those are the most impactful for a given individual. So I try not to pigeon hole. Let’s take one example. I wouldn’t tell an individual to only follow a SIBO diet if they have SIBO, because they may discover that they do fine on higher FODMAP foods. It’s definitely important not to let these items limit your thinking. Now, there are some obvious things that you can think about histamine shouldn’t really be a problem. Although the cocoa powder in the chocolate for a small number of individuals has aggravated them. I almost cringe in saying that because I’m not clear if that was really histamine or just something else in terms of an ingredient that they reacted negatively to that wasn’t actually the histamine.

MR:

The elemental diet should have a pretty strong net anti-histamine effect. So what I don’t want to do is play into the thinking that there’s cocoa powder in this cocoa powder has some histamine in it. I had a reaction to it. Therefore I have a really bad histamine intolerance. It could have been the maltodextrin. It could have been someone drank it too quickly and they had a blood sugar spike. So in terms of the question, probably the safest place to start would be the whey-free vanilla. You really should just go through the process of trying these yourself again, because with that level of dietary restriction, it’s very likely there are some false observations being drawn. When someone is symptomatic, there’s this kind of constant up and down with their symptoms and it can be incredibly challenging to accurately connect a certain food or supplement to a reaction. Sometimes it’s obvious, yes.

MR:

Just the other night I was looking back through some of my notes and it was an absolute mess of tangled wires. There was always this up and down, up and down, up and down. With that level of reactivity, there’s likely some gut healing that still needs to be achieved to help you get over the hump. The reason why I pose this thought is because once we get past a certain level of dietary avoidance, we almost can make the problem worse because now we’re micromanaging our diet driving ourselves crazy. We’re missing the fact that there is some other issue that hasn’t been resolved that is leading to this high level of reactivity. You’re still chasing these symptoms and it can be quite maddening. So I’m not sure if this is fully relevant to the individual, but it may be helpful just to take a step back, make sure you’re going through some of the bigger picture, gut health thinking that is codified in Healthy Gut, Healthy You and also not getting too micro in your analysis. Kind of having that agreement with yourself.

MR:

There are going to be some ups and downs. I’m not going to look at the micro trend. I’m gonna look at the macro trend. Not what happened in the three-day interval, but rather the three week interval. To your question, the whey-free vanilla is probably the best place to start, but again, you really want to be careful and just try the different formulas and see which one works best for you.

ER:

Are they all soy-free and nut-free? I thought they were, I was trying to look at the website real quick.

MR:

I believe there’s soy lecithin. I actually have to check on this as we are currently going through a couple of formula tweaks, but soy lecithin is not something that will elicit a reaction in someone who is soy-free. So that should be discounted, but otherwise the histamine content should be low. I don’t know offhand the salicylate content. So that’s a good question. Once we start going past paleo low-FODMAP, AIP and we get into the combination of low oxalate, low histamine elect, what I’m finding is that it’s rare where the diet tends to be the factor that solves. Going further down dietary restrictions doesn’t tend to really help people. I have some strong suspicions that things are so up and down that people are just looking for something to kind of believe in. I’ve seen a number of patients who maybe came across a low lectin and three weeks later, they were jazzed about low lectin. Next time we saw them, they were back to normal and they said they thought low lectin really gonna be helpful, but it wasn’t. It was most likely placebo. It’s important to factor that in. I could be wrong. There could be a nuance that I’m missing, but big picture, there’s a certain cusp of dietary restriction, once we go beyond it, I’m not convinced that going any further with restrictions is really helpful outside of an incredibly rare exception.

ER:

If it’s any consolation Sonya, I rely on Elemental Heal when I’m having really high histamine weeks, which happens often for me. I rely on it because it kicks me out of that high histamine space and I’m able to function a little if I’m just having Elemental Heal for a couple of meals. So hopefully that helps.

MR:

Yeah. Maybe something I’ll share. I recently overextended with my exercise training. We had a podcast. I’m not sure when this podcast is releasing in relation to the podcast with Mike Nelson on cold exposure therapy. I talk about how I’ve really gone at cold exposure therapy. Essentially I have a freezer chest full of water, and it’s at 40 degrees and I’ll go in there for anywhere from one to four minutes per day, plus doing the Wim Hof breathing, which is a prolonged breath hold upon exhalation, which really takes a lot of sympathetic drive to not breathe when your body is gasping for air. Plus exercising, in some cases two times per day, plus doing walks outside when it’s maybe about 40 degrees, just in a pair of shorts. Being an idiot, doing extended breath holds while walking until the point where I get dizzy and almost fall over.

MR:

So I definitely overloaded my system and last week I kind of had a crash. What’s interesting is, for me, I’ll get a little bit of what I’m presuming is eosinophilic esophagitis. It’s just a feeling like you have something stuck in your throat. I notice that when I kind of burn myself out, I get more of that. That is very likely a quite histamine mediated condition, but I don’t change anything histamine related. I do notice when I’m under recovered or my lifestyle factors in this case, just too much training and overdoing it are not where they should be I’ll start to see a resurgence of some of these histamine symptoms. So it’s just a reminder that there’s multiple ways in which one can resolve items in the gut. And maybe just a reminder for people that if you’re not looking at your sleep and your exercise either too much or not enough, don’t forget about those things, how they can tie into histamine or histamine related symptoms.

ER:

Okay. Cold exposure therapy and Wim Hoff. Good for you.

MR:

It will wake you up.

ER:

Yeah, I’ve done both of those on different occasions, but it’s not a daily thing. Wow.

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Treating Hashimoto’s

ER:

Okay. Our next question is Jean. I think her name is okay.

Jean:

I have Hashimoto thyroid disorder and no matter what the thyroid medication I take, nothing seems to make any difference at all. Is there anything that I can take that would help?

MR:

Okay. So obviously a question I’m quite passionate about. There are a few things here that we don’t know. So I’ll give kind of a couple of scenario answers. Someone who has Hashimoto’s and no matter what, I’m assuming thyroid hormone medication, she takes levothyroxine or Synthroid, WP thyroid, Nature Throid, she’s not improving. It would be helpful to know if this is Hashimoto’s with normal thyroid hormone levels, or if this is Hashimoto’s also with hypothyroid. These are two separate things just as a quick refresher. Hashimoto’s is the autoimmune process. It can cause hypothyroidism. It’s very important to mention that the best study, which was a prospective study in Iran found that only between nine and 19% of people with Hashimoto’s ever became full blown hypothyroid. So an important thing for this individual to do would be to look at her lab work and see if her TSH was flagged as high.

MR:

And her T4 was flagged as low. Not what your provider wrote in, because unfortunately, and we’ve even documented this in our clinicians newsletter where the TSH and T4 will be normal yet the thyroid guru will write in “hypothyroid, call for your prescription”. So it can be quite alarming. So you can’t go based upon what your doctor writes in as an assurance. Obviously double-check all of this with your doctor, but there are some doctors who are, in my opinion, overzealous with this. So you can look to if it’s Lab Corp or Quest or whatever the lab, the lab report should flag a high or a low value. So if you’re seeing TSH flagged high paired with T4 flagged low, that would tell you that you’re hypothyroid. If you don’t see that, it means you’re not hypothyroid. If you’re not hypothyroid, the chances that you are going to benefit from thyroid hormone replacement therapy are very close to zero.

MR:

If you are hypothyroid, then there could be a couple of things going on. One. You could be someone who has both hypothyroidism and has a problem in the gut causing the symptoms that you’re attributing to the hypothyroidism. Let’s say fatigue, depression, and brain fog. We released a video about this shortly or a little while ago, entitled The Truth About Functional Medicine, where I lay out that hypothyroidism affects 4.6% of the population. Whereas with gastrointestinal disorders, IBS affects 10 to 15%, digestive disorders more broadly affect about 40%. So gut problems are three to 10 times more likely, but unfortunately this is often overlooked by providers. So what you could have is something going on in the gut causing fatigue, depression, and brain fog. Hormone Replacement Therapy will not solve those. If you are hypothyroid, you’ll need to be on the medication, but you may need to be on the medication in conjunction with taking some steps to improve your gut health.

MR:

We’ve published a number of case studies that substantiate that, where people were on hormone and they weren’t fully improving until an issue with their gut health was resolved. It’s also possible that you could be malabsorbing your medication. This is where a gel tab of thyroid hormone instead of a tablet can be helpful. This is where Tirosint could be used. Once you’ve done all that, that’s the time and place where maybe five to 10% of people would then need to be on some type of combination hormone where it’s Armour, Nature Throid or another type of desiccated hormone, or just taking your levothyroxine or Synthroid and combining it with something like Tirosint. High level, you first need to double-check if you are true hypothyroid or not. If you are hypothyroid, you’ll need medication. If you’re not hypothyroid, you will not need medication. If the doctor you’re working with makes you unsure about the diagnosis, get a second opinion. It’s not very hard to do, bring the labs that diagnosed you with you and they should very easily be able to tell you yes, you are hypothyroid and you require medication or no, you’re not hypothyroid, you don’t.

MR:

Now, if you’re hypothyroid and on medication, the next thing you should do is tend your gut health. That gives you a 90% plus probability, roughly speaking, that you’ll see resolution of your symptoms. That might be a high estimation, but some of the evidence does show that only 10% of people on thyroid hormone medication don’t optimally respond and benefit from combination therapy. So that’s where I’m taking that 90% from. In any case, that’s where you would start. It’s a great question. You’ll probably need to get a second opinion if you’re not sure, because, unfortunately these things aren’t always very clearly explained to patients. If you follow those few steps, there’s an extremely high probability you can resolve your symptoms. It’s just having to suss out yes or no you’re hypothyroid, and then also using the appropriate supports for your digestive health. That being the most likely culprit that’s causing you to have non-responsiveness to the medications.

ER:

Okay. So some light homework for Jean. Good luck. All right. Our next question is from Henrik. He wants to know your opinion on digestive bitters?

Digestive Bitters

MR:

Great question. I haven’t actually done a review of the literature on digestive bitters. Now I’ve done it for HCL and for enzymes. You’ve probably heard my perspective on HCL,reporting what the evidence has found, which is that up to 50% of people with an autoimmune condition, a history of anemia and/ or who are over 65 may benefit from and require some type of therapy to acidify their stomach. One of which could be supplemental HCL. Another is these bitters which purportedly stimulate the lining of the stomach to release more acid. I don’t know if any quality research has looked at these. I do have some concerns, even though I appreciate and gravitate toward the perspective of herbal medicine. I have some questions about how effective they could be because in those who have a diminished ability to release stomach acid, this is usually due to, said loosely, “parietal cell poop out”, or where the parietal cells of the body will have autoimmunity against them, which can be assessed via an anti-parietal cell antibody test.

MR:

That is the tie in to auto-immunity. Those with let’s say Hashimoto’s have a 20 to 40% chance of also having auto-immunity against their stomach tissue. When those parietal cells are damaged, they can secrete less acid. So the main question I have is are bitters strong enough in stimulating these damaged parietal cells to get adequate HCL output? I don’t know. A good trial would tell us that. I don’t know if that trial has been done. One of the other things that some of these herbs do, is they also act as either prokinetics or as anti-inflammatory agents. So the perceived benefit where someone says, “well, I took bitters and I felt better” might be due to the prokinetic or promotility activity of these agents, or it could be due to if they have any anti-inflammatory impact.

MR:

I believe ginger satisfies both of those, but I’m not positive on ginger as an HCL stimulant, but I think it does. What’s challenging is I’m trying to suss out between anecdote and what has been robustly studied. So all that to say, try bitters. If they help you, great. I wouldn’t be overly assumptive that if they help you, it’s purely because of the HCL impact. But if they do help you, then that’s really the clinical end point we’re trying to hit, which is an improvement in symptoms. If anyone has a good reference where bitters have been used in a clinical trial, I’d love to see it. Haven’t got around to reviewing that evidence yet, but certainly something I’m open to.

ER:

Next question is from Sarah.

MS, SIBO and Histamine Sensitivity

Sarah:

Hey, Dr. Ruscio, this is Sarah. I am calling to ask a couple of questions. I have multiple sclerosis. I also have histamine intolerance and SIBO. I just tested. The methane based SIBO results came back above three, all of my results. So I’m starting to treat for that and I’m wondering what diet I should follow for that. I am so restricted as it is. I follow the Wahls protocol and a low histamine diet. Wondering if I should also try to somehow incorporate low FODMAP. I would love your thoughts on that to make sure I don’t get SIBO again after I treat with these antibiotics. Also, I seem to have MS attacks in the summer every other summer. Because I have such a histamine sensitivity, I have a lack of the Dao enzyme in my body genetically. So I’m wondering, because I do get MS attacks every other summer in August. It’s right around my birthday. It’s a weird thing, but it happens. I’m wondering, if I should take an anti-histamine for the summer. I listened to both of your podcasts, well, I listened to all of them, but specifically the one where you had the histamine MCAS expert and it seemed he recommended antihistamines, but I obviously don’t want to go on that for my whole life. I’m wondering maybe I should just do that during the summer to kind of keep those issues, the MS issues at bay. Would love to hear your thoughts on that. Thanks so much. Bye.

MR:

Ok. A lot there to unpack. MS, histamine, SIBO. Should she be doing low FODMAP in addition to her Wahls protocol. Terry and I had a discussion about this recently, and one of the things that she’s finding helps improve the tolerability of the Wahls diet for those with sensitive GIs is making things into broths or soups, or just highly cooking your vegetables. That’s also something I discussed in Healthy Gut, Healthy You. I think it’s a good practice to help people who do have sensitive digestion to be able to better digest the food that they’re eating. So you could try a low FODMAP, but to your point, if you’re already on the Wahls and low histamine, low FODMAP could be a lot to add to it. If you do things right with your SIBO and make sure also not to pigeonhole yourself to only treating as if you had SIBO.

MR:

As an example, probiotics could be a very helpful adjunct that may enhance the effectiveness of the Rifaximin. There have been two trials published that found that Rifaximin with probiotics was more effective than Rifaximin alone as an example. If you get things in the gut right, your histamine tolerance should be improved and your FODMAP tolerance should be improved. So do you have to go low FODMAP right now? Maybe. Do you have a lot of FODMAPs in your diet? If you’re doing Wahls, probably. Do you have a lot of GI symptoms? If so, consider a week or two beta test on lower FODMAP. Also consider a week or two beta test on cooking your vegetables more to see if that will remedy any of the reactivity that you’re having to your foods. Don’t forget about some of these other interventions that can help with SIBO. Mindset, just to make sure that you don’t get too pulled into kind of the despair of SIBO-ville that seems to be somewhat prevalent.

MR:

Mindset, meditation or breath work, exercise, time in nature. Probiotics are another important adjunct and a bit of elemental dieting may be a way to kind of offload both histamine and FODMAP content. So those things can all potentially congeal together to really turn the tide and help ensure that you have the best possible post Rifaximin experience that you can. That should all help lower your histamine load. Now perhaps there is some type of environmental allergen in August that you’re reacting to. It’s much more difficult to say. Would an anti-histamine be viable? Sure. I mean, you want to check this with your doctor. I don’t know what medications you’re taking. There’s an array of anti-histamines all the way from quercetin in vitamin C as natural agent examples, all the way through your over the counter remedies like Benadryl and Claritin. I would have no reservation with someone using an anti-histamine kind of prophylactically, especially if you’re noticing one month in particular.

MR:

Certainly there are lots of people who will take an anti-histamine during a certain blooming month where their allergies kick up. That seems to be generally well tolerated. Remember, if you get things in the gut right, that does have a fairly powerful ability to dampen histamine load. Evidenced as one example by the number of clinical trials that have found probiotics improve histamine mediated conditions included, including I believe seasonal allergy and reactive rhinitis. So there’s multiple feed ins to the histamine situation in your body. I would start with the ones centered around your gut and your diet and your lifestyle, but wouldn’t be too concerned, especially using natural anti-histamines nor over the counter histamines. Just check that with your doctor and be attentive to your symptoms. I’m sure with some experimentation and objective oversight of those symptoms, you’ll find a personalized approach that works well for you.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

ER:

This question is from Kelly. She said, I just learned about digestive plaque. Is this something that you see in your practice? What do you think about it?

Digestive Plaque

MR:

Digestive plaque. I’m assuming she means biofilms and that’s kind of an AKA for biofilms. If not that I’ve never heard of another type of plaque. We are actually in the process now of finally submitting our biofilm data for publication, which, like I had mentioned on a podcast a few weeks ago, that data was sitting there kind of collecting dust, but we were able to demonstrate that when administering herbal antimicrobial therapy for SIBO plus administering anti-biofilm agents, we documented a better outcome for hydrogen SIBO with the addition of the antibiofilm agents. So there does seem to be something to that. I’m not convinced that there’s a clinically significant impact of doing so though. There may be. So to add something like N-acetyl cysteine or a multi ingredient formula for biofilms in somewhat resistant cases, that seems justifiable. I still have questions in terms of, will you have a clinical success or failure if you do, or don’t use biofilms?

MR:

That’s where I more so think that the impact of anti-biofilm therapy is more of a minor than it is a major. You can consider these things in kind of a step up approach where if you respond to antimicrobial therapy, but you have a tendency to relapse afterwards, then in a future course of antimicrobial therapy, you may want to use the anti-biofilm agents along with it. Be careful not to overlook things like your diet, your lifestyle and your mindset. Allison Siebecker and I had a conversation about this the other day, where I think we’re both becoming more of the opinion that in the more chronic cases, it’s oftentimes not due to a lack of anti-biofilm agents or the right herbal antimicrobial cocktail, but rather there’s usually other lifestyle factors that are not in place that are thwarting the individual from responding.

MR:

So yes, it’s something to consider. I would not put all of my eggs in that basket. I should also say, and I want to give myself a little bit of a pat on the back here, I was so fixated on this study’s biofilm results that I forgot to mention that we are the second study in existence documenting that herbal antimicrobial therapy can remedy SIBO. So fixated on the anti-biofilm group that I forgot that there was another control group that we had with just antimicrobials and they saw a significant reduction in their SIBO. So this is the second time outside of the Jerry Mullin / Johns Hopkins paper that has been documented that herbal therapy can combat SIBO. Anti-biofilm agents make the antimicrobials even more effective from a numeric perspective. I’m not sure if clinically it has such a big impact. So think about it, consider it, don’t put all your eggs in that basket.

The Importance of Mindset

ER:

All right. I just want to echo the mindset piece, because if you’ve listened to the listener questions type of podcasts, before that we do you know that I’ve struggled with SIBO off and on and just general gut things off and on for a very, very, very long time since I was like 12 years old. I’m old now. So I don’t think that it ever fully improved until I added in those mindset pieces where I got a therapist. I came out of my dark cave and started calling my friends again. Even though I didn’t feel good enough to go anywhere or leave my house I had them come over or go for a walk with me. I started getting out in the sunshine more. This was like at the peak horribleness of this SIBO stuff. I really sort of lost everything about my life.

ER:

Everything functional about my life was, was gone. It was extremely depressing. What made it even more depressing? Obviously you’re feeling bad, but what makes it even more depressing is sort of watching the rest of your life slip away. So if you’re listening to this and you don’t feel good enough to do anything, make yourself do something. I started making myself watch only shows that were funny to make me laugh, just so I could have a different mood. I’d go outside. If I just felt like walking a block, then I would give myself a pat on the back for at least walking that block outside in the sun and getting some vitamin D. Talking to a therapist about how awful this was and how I was feeling remorse for my life pre-gut symptoms. What has my life become? I’m not singing or dancing or doing any of the things that I normally do.

ER:

Who am I now? A lot of things happen and it becomes very dark. I don’t mean to go too deep into this, but I had written a blog post on Medium to say what my experience was because I didn’t want other people to give up. I wanted people to know that there’s hope. I wrote that in 2017 and today I still get at least 10 emails a week from people. Last week I had two people say they wanted to commit suicide in an email to me and I just burst into tears. I was like, wait, typing them back, I will FaceTime with you, I’m not a doctor, but I have resources. I can send you places. I’m sending them all to you, Dr. Ruscio. So you’ll meet some of these people from all around the world, like someone from London last week emailed me. So just please don’t give up and please, please remember that this mindset piece is just as important as the diet and everything else, all the other pieces that are in play.

MR:

Yeah. Well, thank you for sharing that, Erin. Very well said. It’s an important to reminder. If you feel like you’re really zoomed in on your health, then limbic retraining, EMDR, and/or a therapist (the conventional type) are all good starting points. Just cultivating a bit more of the f-it attitude. One of the things I think is good about being a risk taker is when you’re not feeling well, if expert guru, gluten zealot XYZ tells you about how you can’t have gluten, if you have that other rebel side of you, and you’re just like, you know what, I’m going to go out and do this tonight and not care. That actually can serve you quite a bit. Unfortunately sometimes it’s the people who are the most prone to following the rules, who follow all the zealots rules. At some point they just need to kind of say F it. I’m just going to go forward and kind of do what I want to do. Just a few things there to throw out that maybe will resonate with and help people.

ER:

Do you know how much diatomaceous earth mixed with water I drank for months on end, because I read about that helps with biofilms. Why didn’t I talk to you sooner? You’re the first person that said it’s okay to cheat and have something off of the diet. That’s where your social life just sort of rapidly disappears is that you can’t go out to eat anymore because there’s nothing for you with a low FODMAP diet. It’s virtually impossible. Unless you just go and order a chicken breast. It’s okay to cheat and live your life a little bit.

Episode Wrap-Up

MR:

Yeah. That’s exactly one of the reasons why wanting me to give people dietary advice in the clinic and in Healthy Gut, Healthy You and everywhere on the platform here, the recommendation is do your best be generally compliant, but don’t aim for 100% because to hit that, you’ve got to go into nun mode and have almost no life. The social spiritual loss is not worth it in the net calculation. Yes. So true.

ER:

All right. Well, that’s all we have for today. I hope everyone has this happy, happy, happy holiday, even in spite of the pandemic, just whoever you’re with and whoever you get to spend time with. Just have a good one.

MR:

Awesome, great words to close on Erin. Thank you so much.

Outro:

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