Answers on Naltrexone, Improving PMS, Dopamine Deficiency

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. Make sure to subscribe in your podcast player for weekly updates. Visit DrRuscio.com. That’s D R R U S C I O. Dot 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 with your doctor. Now let’s head to the show.

Erin Ryan:

Hey everyone. This is Erin Ryan from Dr. Ruscio radio. Today on the show Dr. Ruscio answers your questions. And this episode you asked is naltrexone a good solution for lowering inflammation while taking thyroid supplements and working on my gut health? In your Healthy Gut, Healthy You protocol, what should I do if the elemental diet hasn’t made the noticeable impact, I thought it would?

ER:

I’m struggling with constipation, insomnia, acne, and more. Doctors have no answers for me. Where do I even begin to heal? I’m desperate to improve extreme symptoms of PMS. Will your Progest-Harmony and Estro-Harmony work for me? I’m curious about dopamine deficiency and how that has a negative effect on adrenal fatigue with someone who struggles with addiction. How can I become a patient at the clinic? Thank you for so many of your questions this week. I hope that we answered them and that it helps everybody out. If you’d like to submit a question, visit DrRuscio.com/podcast-episodes, and click send us a voicemail at the top of the page. Please speak loud and clear and keep it as concise as you can. Enjoy the show.

Dr. Michael Ruscio:

Hey, everyone. Welcome back to Dr. Ruscio radio. This is Dr. Ruscio again with Erin Ryan, and we will be taking your listener questions once again, which are always really insightful. They help keep me on my toes and attune me to the things that you guys are grappling with. So grateful for the questions and for you Erin. Let’s jump into another episode.

ER:

Thanks. After all it is National Women’s Appreciation Day or something like that. So hi everybody. We survived the winter Snowmageddon. So we are on the other side of that.

DrMR:

I’m sorry that we had to clear about a week of patients. I’m sure people saw the news and they understood what was happening, but obviously not something that we ever want to have to do, but in this case, without power or water, it was tough to do. But thankfully, we got through it. There was, there was nothing that was dangerous.

DrMR:

It was in my opinion anyway, inconvenient, and inconvenient enough to be a little bit of fun. Now I don’t have children that I’m tending to. So Erin, I’m sure it was more challenging on your side of the fence, but at least from my vantage point, there was enough disruption to get me out of in front of the computer and have me on this kind of scavenger hunt for food and water. But there was always food and water available. So that’s why I say it was enough disruption to be challenging and a little bit fun, but not ever dire or dangerous, at least for me anyway. And I don’t want to downplay what happened to some people, but fortunately I made it out okay.

ER:

Yeah, yeah, definitely. That was not the case for many people. Yeah, we got lucky. I think we were the lucky ones. Maybe we won’t have that next year or ever again. You’re like “I’m moving to Austin to get all the seasons.”

DrMR:

Yeah. The Austin Winters. Man, they’re just like the Northeast.

TPO Antibody Tests

ER:

They’re really not. That’s the crazy thing why I wanted to move back here, but anyway. So we’ll start in our first question from Michael. A different Michael. Is it the case that numerically small results for TPO antibody lab tests could be serological false positives caused by cross-reactivity or other imperfections of the measurement process? I understand that this is different than a false positive in the sense of a diagnostic interpretation of results.

DrMR:

This is a great question. One of the challenges with antibody testing is you’re kind of diagnosing a fire via visualization of the smoke. You’re not necessarily, in most cases, actually seeing the damage. So an example of seeing the damage in the thyroid and for thyroid auto-immunity would be something like a thyroid ultrasound, where this was known as hypo echogenicity or lack of echo because the tissues have become scarred and therefore denser. It would give you kind of a pseudo visualization of the actual fire, so to speak for the tissue, whereas antibodies are showing you the smoke. I believe this does happen for a degree to TPO antibodies, as it does for most antibodies. Where my knowledge kind of breaks down to the level of granularity needed to answer this question is, is this something that is adequately covered by the reference ranges?

DrMR:

I believe it is. The question is how robust is the validation of the ranges distinguishing how they controls, which may include a degree of normal cross-reactivity from those who have overt thyroid autoimmunity? This is why reference ranges are important, and this is why I’m very cautious about some of the newer age antibody assays that haven’t yet gone through appropriate validation, because we don’t know if a given level of antibody is normal, perhaps due to normal tissue maintenance, because auto immune cells do help clean up damaged and dysfunctional tissue. Or could a new markers range not be valid because not enough sampling has been done and we don’t have a handle on what a normal level of cross-reactivity is? So this would be a way that we delineate between a true positive and a false positive. TPO being an antibody that’s fairly well-researched, I’m assuming that the positive negative cutoff, usually it’s about 35 or 40, has been validated to distinguish those with overt Hashimoto’s from controls.

DrMR:

And I’m assuming how that’s been done is a cohort of patients who had both the antibody test and an ultrasound. They found that the appropriate set point for sensitivity and specificity was that 35 to 40. But we also know that while that likely delineates between normal and those who have Hashimoto’s, more research is at least suggesting that the cutoff of 500 might be when will you go over the cusp of the level of elevation now becoming clinically relevant. An argument you can make here that’s kind of a parallel would be a fasting blood glucose above 99 tells you that there is some aberrancy in glucose handling in the system, but we may not need to worry about clinically intervening until someone gets up to let’s say one 30 or even higher. That same thing, as just a loose parallel, seems to hold for the thyroid antibodies.

DrMR:

So it’s a great question. Yes, there’s likely a degree of cross-reactivity that’s occurring. Yes, that should be covered by the reference range. And that’s probably why the reference range or in part is set where it is set. Although preliminary evidence suggests that the cutoff level of 500 for TPO may best distinguish between those who have ongoing damage, that may lead to what the researchers have termed a moderate risk of hypothyroidism, when people are 500 or above, as compared to a minimal risk when they’re below 500. So hopefully that helps with some of the nuance. Antibody testing, in many cases requires some interpretation like several labs do. Those would be a few thoughts on how to look at TPO antibodies and how to interpret.

ER:

Okay. It sounds rather complicated.

DrMR:

I’m sorry. Let me reiterate that as simply as possible. If you’re above the cutoff, we could say you have Hashimoto’s, but is this Hashimoto’s to a point that puts you at risk for progression to hypothyroidism? It doesn’t seem to be the case until you hit a level of 500 or above. Now that’s not directly answering the question of cross-reactivity, but the more important clinical context to look at that in is when do you intervene because of a given level of antibody. And that may be because some cross-reactivity may be occurring. And so we have to set the cutoff value at the appropriate point where normal levels of cross-reactivity aren’t labeling healthy people as Hashimoto’s.

ER:

Okay, that helps. It was getting a little sticky for me.

DrMR:

That’s why you’re here. To keep me from going too far off the rails into Nerdsville.

ER:

You were getting there. All right, the next question is from Tia.

Hypothyroid Treatments

Tia:

Hi, thank you so much for taking my question. I do you have a question about my thyroid. I’ve been put on a natural desiccated thyroid and a T3 to supplement as well. I do see some improvement, but I’m still finding, I do have some hypothyroid symptoms. I have tried to heal my gut in a number of ways. I’m definitely using your website to select better probiotics and try again. But my doctor has recommended me trying a low dose naltrexone to kind of give me some traction to help me lower the inflammation within my body and especially my gut to help me with that. So is that a good option? Is that something you’ve worked with? Is that something you’ve heard of to have the LDN help me to achieve that? Of course, it’s going to be paired with healthy lifestyle, healthy diet, but it’s just kind of a supplementation to help me gain that traction. So if you could touch on that or expound on that, it would be so appreciated. Thank you so much.

DrMR:

Okay. LDN, or low dose naltrexone, is a consideration. I don’t have any overt or principled opposition to LDN. That being said, LDN is mostly used for attenuating or dampening auto-immunity. So in this case, it sounds to me more like you’re trying to manage symptoms. And if those symptoms are thought to be caused by this hypothyroidism that hasn’t yet been addressed, then it’s less likely that the LDN, because it treats auto-immunity, is going to help. Zooming way out, there’s two tracks with most thyroid cases to look at. One is autoimmunity. The other is the hypothyroidism. Because they’re not one in the same. Now auto-immunity does cause hypothyroidism, but there are two distinct entities.

 

One is autoimmune damage to the gland. That’s Hashimoto’s or autoimmunity. The other is the gland not being able to produce sufficient hormone. So the LDN helps with a former of those with dampening the auto-immunity. And that really has utility when you’re trying to prevent someone from becoming hypothyroid or potentially progressing further hypothyroid, because if the auto-immunity keeps going on and on and coming back to that hypo echogenicity in the thyroid gland that can be found upon ultrasound, the more autoimmunity, the more inflammation, and the more damage to the gland, the less hormone it can make.

DrMR:

So to your comment, it sounds to me like it’s symptoms that are trying to be managed. Now, unless there’s some other autoimmune condition, perhaps like rheumatoid arthritis, where you’re trying to dampen that autoimmune condition that causes direct symptoms of joint pain, then the LDN sounds to me, at least from what I know, like it wouldn’t really be treating the symptom. There’s also a few things here to parse, which is, firstly, are you truly hypothyroid? I would double check that just to be on the safe side. If you didn’t come back with a lab-referenced range high TSH and low T4, then there’s a decent chance that you’re not actually hypothyroid and using desiccated thyroid hormone like Armour or Nature Throid is barking up the wrong tree. It also depends on what your level of antibody elevation is, like we just talked about. If you’re above 500, then LDN is a consideration.

DrMR:

There’s many other therapeutics that have been studied and found to lower the antibodies that are safe and non-drug as LDN is. Selenium, Vitamin D, magnesium CoQ10, certain dietary changes like a paleo diet and perhaps low FODMAP may lower the antibodies and also improve people’s symptoms. So back to my comment a second ago, it’s not that I’m principally oppositioned to LDN. Although in my view, LDN seems to be much more of a end of the line consideration rather than it would be a frontline consideration. You also may be having symptoms that are a by-product of being on a hormone that you don’t actually need. And you’ll see this in patients who are given mostly, it seems to happen with T3, when they’re not truly hypothyroid. This can actually exacerbate fatigue, insomnia, anxiety, and/or racing heart. So if you’re experiencing any of those symptoms it makes even more sense to check if you’re truly hyperthyroid or not.

DrMR:

And also if you are truly hypothyroid, it’s likely better to start, I know this is a heretical thing for me to say, with standard T4, like levothyroxine or Synthroid, and then see how you do. The reason for that is the majority of cases seem to do fine with just T4. There is evidence showing that a pocket of patients, a small subset will only feel optimal when using a combination of T4 and T3. But one of the recurring problems in the field of functional medicine is reaching to what helps a small subset of patients, and then using that for everyone. And it’s well-intentioned, it comes from a good place. But what I don’t think is fully realized is many of these therapeutics that should be reserved for only nonresponsive cases, if you use them too early, you may actually flare someone by giving them a therapeutic that they don’t need.

DrMR:

So said more simply, if you convert T4 to T3 okay, well you’re being given T4 with your desiccated, but you’re also being given T3. So your body’s taking the T4, it’s converting it into T3 at an acceptable pace, but you’re also taking T3. And this is where you see the exacerbation of fatigue, insomnia, racing, heart and anxiety, because you have too much T3. So that’s also something to consider. And I strongly recommend you continue with the recommendations of improving your GI health and some of those dietary and lifestyle foundations. This may sound like a lot, but if you write it out in a list, it’s a fairly straightforward checklist. Are you truly hypothyroid? Yes or no? If you’re not, get off the medication. Again, check that with your doctor. Don’t do that at your own accord. If you’re not sure that your doctor’s giving you a straight answer, get a second opinion.

DrMR:

So are you hypothyroid? Yes or no? If no, get off the medication because that could be making you feel worse. If you are hypothyroid, then consider starting with T4 alone and then reevaluating. You only need a couple months. I figured that out. You may notice the full benefit only within a couple of weeks. If there’s a need to adjust the dose a time or two, it may take a few months to fully figure that out, but you want to start there because using T3 when you don’t need it may cause some of the symptoms that you’re experiencing. Regarding the LDN, this depends on if your antibodies are above 500. If they are, then I would first use things like diet and lifestyle, and also Vitamin D, selenium, magnesium, and CoQ10. Reevaluate; and then if those aren’t getting you below 500, LDN is a consideration.

DrMR:

Again, it sounds like there’s a lot there, but when you put this all into a hierarchy, you have a pretty clear step-wise process to work through. So hopefully that makes you aware of some of these moving parts and allows you to work with your doctor to figure out the best plan that works for you.

SponsoredResources:

This is Dr. Ruscio with a quick note about immunoglobulins. If you haven’t yet tried immunoglobulin therapy, I hope you will try our Intestinal Support Formula, and to make it a little easier for you to do so, we are running a promotion of 10% off. If you go to our website, DrRuscio.com/isf, and you can use the code, Try ISF. Now what’s novel and unique about immunoglobulins is they function in a unique way in so far as they seem to attenuate immune system overzealousness in the gut by glomming onto and kind of deactivating, almost like taking a shard of glass and covering it with wax against toxins and bacterial fragments like LPS. So what ends up happening is instead of these fragments triggering what may be an overzealous immune system, and then this causes inflammation, this exacerbates leaky gut, and then this leads into a whole array of different things. It could be dysbiosis, it could be food reactive brain fog, it could be bloating, that whole cascade is attenuated by the immunoglobulins. And perhaps the best study looking at this was the one by Weinstock that found a 75% response rate, albeit uncontrolled, in patients who did not respond to diet, who did not respond to Rifaximin, who did not respond to antispasmodics. So certainly an exciting and novel therapy. And if it’s not one that you’ve tried, or if you want to try it again, go and check out our Intestinal Support Formula. Use the code, Try ISF for 10% off.

The Elemental Diet

ER:

Let’s see. Our next question is from Brannon. He or she, sorry, I don’t know if that’s a girl or a guy’s name. In the course of the treatment, and he’s referring to the Healthy Gut, Healthy You protocol, it seems to make the assumption that after the elemental diet, in the case of SIBO, you’ll be ready to move on to rebalance. Research suggests that after three weeks on the elemental diet, there’s an 85% success rate. What should someone do if the elemental diet hasn’t noticeably reduced the bacteria. Would it be helpful to revisit the anti-microbials, anti-biofilm agents, et cetera?

DrMR:

Great question. There’s one key assumption here, I want to make sure to clarify, which is are you referring to bacteria or to symptoms? It’s crucial that clinicians and especially patients start using precise language here, because what we don’t want to do is start proclaiming it’s SIBO, when you don’t know if it is SIBO. Because this kind of runs away on you. And what we want to know again is this a breath test positive that has shown bacterial overgrowth? Or are these your symptoms? Now, if the bacteria are improving, meaning a SIBO breath test pre and post, if the bacteria have improved, then you may just need a longer course of the elemental, and likely the best way to achieve that would be to move to the hybrid application, where instead of using it exclusively, which can be helpful but can be difficult to sustain, you replace one to two meals per day with the elemental diet and a longer-term application. You can do this for a month or several months. There have been studies using this for years in Crohn’s children cohorts and showing very good outcomes.

DrMR:

You can also synergize the elemental diet just like is laid out in Healthy Gut, Healthy You with other therapeutics, other supports. Probiotics would be one to make sure to have that on board. In my opinion, before you even consider an elemental diet and trying to get your best diet established. Should you go elimination, paleo lower fermentation, low-FODMAP, both paleo and low-FODMAP, adding probiotics. And then after that, either anti-microbials or elemental dieting are something to consider. And if you’ve done the elemental diet and you need to lower the bacterial load more, than yes, something like anti-microbials could be synergized in as well. This answer is pretty well given in the Healthy Gut, Healthy You protocol exactly, if you just follow the steps. So it’s right there in your hands. However, if your symptoms are not improving, this changes the situation a little bit, because that would tell us that the elements of diet, at least subjectively, systematically, isn’t working for you.

DrMR:

And if that’s the case, then it may not be a good therapeutic option for you. And then you again come back to, well, have you gotten the best diet determined for you, at least as best you’re able? Have you gone on the triple therapy probiotics and given that some time? If so, then you can move on to adding in anti-microbials or perhaps antibiotics like Rifaximin or Xifaxan. At some point you may want to consider anti-biofilm agents. And again, all of that is included in the Healthy Gut, Healthy You protocol. So this is a great question. You’re kind of midstream. It sounds like you’re jumping midway into the protocol. Maybe that’s just because you’re asking a specific question and you’re doing things in sequence, but it is very important to follow that sequence because it’s a real mistake to let’s say, fall in love with a therapeutic meaning, “Oh gosh, this really resonates with me,” and then violating the algorithm or the protocol, because then you tend to spin your wheels. Erin, you’re a great example of that, as someone who kind of pinballed from thing to thing, and then you didn’t really get the traction until there was this methodical stepwise approach.

DrMR:

So, be patient. You have, I think one of the better answers to your questions in Healthy Gut, Healthy You, just slow down, go step by step, trust that you can follow that protocol. And also trust that there’s a fair chance that no one thing is going to fix everything, but you’ll pick up 15% here, 20% there, another 20% here. And as you work through the steps, you’ll get to that 80-ish percent resolution or more. And that’s really what our goal is.

ER:

Yep. Just stay patient and stay on the yellow brick road. You’ll get there, I promise. All right, so the next question is from Safiya.

Digestion Issues

Safiya:

Hi. I recently stopped smoking and before that I had basic chronic diarrhea and now I have constipation and I take something called Laxalon which just makes my stools really watery, and I’m dependent on laxatives to go to the toilet. The doctors don’t know what to do. I’ve been screened and I don’t have IBS. They say I have IBS, but I don’t have any inflammation in my gut. I’ve been tested for everything, basically. I’m a vegan, I eat lots of vegetables and fruits, lots of fiber. I may over eat at night before I sleep, which could cause my constipation. I really don’t want to give up on my vegan diet, but I’m also really tired of this weight gain fatigue, insomnia, and night eating. My skin started breaking out. I just feel really heavy and toxic. So my question is where do I start?

DrMR:

Okay, well, this is a very familiar kind of question. This is the sort of thing that we’ll see at the clinic all the time, and rest assured that there’s a lot that can be done here. Maybe the most foundational, the things that you mentioned would be the meal timing. It is important to not eat too late at night. This is something I recently quantified in moving my meal time a couple hours earlier and looking at what my Oura Ring sleep tracking device was telling me regarding my sleep quality. And there was a noticeable improvement. I went from kind of a C-grade sleeper to a B+-grade sleeper just by moving the mealtime. Now, is that going to solve everything. Very likely, no. But it’s just important to mention that. So what else could be causing the fatigue, the insomnia, the skin issues and this bowel irregularity?

DrMR:

Well, it’s also very likely that you could be eating more FODMAPs in your vegetarian diet than your gut, at least currently, in this current state, which sounds a bit inflamed and irritated, can process. So there, I would point you to our vegetarian low-FODMAP diet. And if you simply search “Dr. Ruscio vegetarian low FODMAP” that should come up. There’s a very good chance that will help correct the aberrancies in your bowels. And what’s interesting about low-FODMAP when it comes to bowels is it will help people with diarrhea, but it can also help people with constipation. So that would be something I would try. You would only need to be on that for a few weeks until you should at least see some improvement. I wouldn’t expect everything to go from zero to 100, but you should see at least a 23% improvement from the diet.

DrMR:

At least this initial inkling that it’s helping. And if it is, continue on, and then I would add in the triple therapy probiotics, this can also help very much so with these irregular bowels. Somewhere along that line, I would check in with whoever’s prescribing the laxative, if this is a prescription. Have the conversation about doing a trial off of that, because the low-FODMAP and the probiotics will likely rectify your bowels. But it sounds like you’re kind of overshooting the mark. This is what happens with some prescription laxatives. It’s hard to get the balance right, where you go from constipation to normality and instead the landing can be overshot, so to speak, and you end up with diarrhea. So you’re moving, but you’re moving too much. It’ll be important as you start to notice your guts feeling better to get rid of the laxative because it’s causing part of the problem, it sounds like.

DrMR:

As you do that, as you come off the laxative, while you’re on the supports of the diet and the probiotics, if you get too slow, remember to give your body some time so you can assess this. Don’t be too quick to judge, but if you’re let’s say three, four, five weeks in, and you’re consistently constipated after making those changes, magnesium is a great place to start for some additional bowel aid. This may sound familiar to our audience. This is essentially the exact sequence that I write about in Healthy Gut, Healthy You. So I’ve given you some of the preliminary steps there, and I would refer you back to Healthy Gut, Healthy You for more of an expansive narrative on how to implement it and to integrate some of these therapeutics. And a final remark about, do you have to abandon your vegetarian diet?

DrMR:

Most likely not. There are some cases that if their gut is really sensitive, the best option may be at least a temporary departure from vegetarian dieting while we work to heal. And then people can resume that. There’s never any pressure from me on that one way or the other. That’s just some of what I’ve seen in the clinic. So the likelihood of you needing to stop vegetarian dieting is pretty low as long as you follow those recommendations that I laid out. Again, see Healthy Gut, Healthy You for a bit more structure where you can see that written out in all of it’s detail.

ER:

All right. We wish you luck Safiya, and I don’t want to blow past the amazing first thing you said, which is that you quit smoking. That is no easy feat and good for you.

DrMR:

Pat on the back.

Estrogen Supplements

ER:

That’s a great place to start health wise, I think. Our next question is from Cecile. She says, after reading your recent article, “Natural Remedies for Menstrual Cramps,” I suspect I have a hormonal imbalance, as I have many of the symptoms listed there. I looked into your Progest-Harmony supplement. Do I need a hormone test in order to take this? Should I start taking this in the days leading up to my cycle or during my cycle? Or is this something that I need to take for months?

DrMR:

This is something that I’m really passionate about. And I’m glad that we’re releasing some articles on this because it’s something that I’ve discussed on the podcast a few times, but I just don’t feel like it gets enough attention. So I’m glad that we’re seeing some questions like this. So no, you don’t need to have a female hormone test in order to use Progest-Harmony and/or Estro-Harmony. And the reason why is because, said loosely, they’re essentially corrective, meaning they bring you back to balance whether high or low. And so it wouldn’t matter if you’re high or low, you would have a restoration of the normative level of your hormones. That’s what’s really nice about these herbs, and many of the adrenal herbs work in the same way where they’re adaptogenic, meaning they help you come back to where we’d like you to be, rather than either pushing you up or pushing you down.

DrMR:

And so now you have to test because if you push too far, you end up going to high or too low. So no testing is required. And you also don’t need to cycle the use of these. The reason why is because they’re corrective and they’re not going to pave over your hormones, meaning with the estrogen, you’re going to take moreso in the front half of your cycle, and the progesterone you’re going to take more in the back half of your cycle. Because if you’re taking an estrogen hormone pill, or a progesterone hormone pill, you’re going to just go up when you take that. It’s not what happens with these. Now, one thing I would be cognizant of is using the Progest-Harmony alone. This is somewhat reflective of where I don’t know that the field has done a adequate job in educating women on estrogen.

DrMR:

And there’s this awareness of what’s known as estrogen dominance or where a woman has too much estrogen, and also how certain plastics and chemicals are known as xenoestrogens, and they increase estrogen essentially, or they trigger the estrogen receptors. This appears to have made women very reticent about using estrogen, and understandably so, but the herbal preparation of Estro-Harmony is corrective. So if you do have too much estrogen, this will actually help to reduce how strongly your estrogen receptors are being stimulated by estrogens. So that really important to mention.

DrMR:

And then also there are some women who need some estrogen, even bio-identical and have all the signs of clearly needing it, and they’ll come into the clinic, bereft of that recommendation for a long time even though they have flagrant hot flashes, and let’s say they fit the stereotypical thin woman in her forties or fifties profile of someone who is more likely to be estrogen deficient. So I don’t know all the details here, but I’m fairly assured of the Estro-Harmony formula in a wide population of women, because it’s an estrogen receptor modulator. So if your levels are too high, it actually makes your receptors less sensitive to estrogen. And if your estrogen is too low, it actually increases the sensitivity to estrogen. And that’s why in the studies that have used some of the ingredients, like Dong Quai, testing hasn’t been done pre/post, but rather women with PMS or hot flashes have just been given the herbs and they’ve seen improvements. So just a few notes there for you to be aware of. No, you don’t require testing, and no, they don’t have to be cycled.

ER:

Okay. So just adding to her question of, does she take it for a few months? Is that something you just take regularly?

DrMR:

Oh, thank you for filling in that gap. So the longer term application of this would be, I would stay on them until you’ve known. This is kind of a method I follow for almost all interventions. We’ll leave someone on an intervention until they’ve hit their peak improvement from it, give them a few months to maintain that peak, and then try to work off and/or find the minimal effective dose. So that’s the way I would handle this. And if you have to be on them for longer term, that’s fine. We have some women who are on these for a year or even two. Depends on how much stress you’re under, what age you are, what else is going on with your body. So that’s just something to follow. Hit your peak levels, improvements, and maintain what you’re doing, until you’ve been at that peak for a couple of months, and then try to find the minimal effective dose.

ER:

Okay. Just to give TMI, I do not take any birth control whatsoever because I get so nauseous from what I think is the estrogen of that. So I’m always like, no estrogen. But it’s interesting that you say that may not be the case with a supplement like this.

DrMR:

Yeah, exactly. And again, it’s understandable because there can be harm from too much estrogen, but it’s kind of a common human mistake of throwing the baby out with the bath water.

ER:

Totally, yeah. All right, our next question is from James.

Dopamine Deficiency and Addictions

James:

Good evening. My name is James and I just wanted to thank you for all the information that can be found in your book and in your podcast. I really hope that I’m working towards healing myself when things really haven’t been working well for the last few years. I do have a question. I was wondering if maybe you could possibly speak on this, if there is anything to this. I was reading in Dr. Kharrazian’s book, I don’t know if you think that might be a book that has led to the epidemic in over-diagnosis thyroid and hypothyroidism, but in his book, he talks about dopamine deficiency and how that can have a negative effect on adrenal and have an effect on adrenal fatigue. I was wondering if you have heard anything or seen anything about that. Particularly in people with addictions and possibly addictions to something like pornography, where you might be constantly draining your dopamine levels and having some type of effect that leads to exacerbation of adrenal fatigue.

DrMR:

Okay. Well, thank you for the question. There’s a few layers to this, so let me do my best in attempting to address all of these. I appreciate Kharrazian’s work in so far as it was likely one of the keystone books that really helped increase the awareness of Hashimoto’s and how Hashimoto’s is the main underlying cause of hypothyroidism. So from that perspective, I’m grateful for his work and appreciative of it. I also don’t feel that he did a good job describing how to handle ideally the auto-immunity. And in his defense, this was so early on that I don’t know that we had the level of evidence to inform decisions that we do now. So it would be easy for me to perhaps criticize some of his comments, although from what evidence base he had when he was really kind of pioneering some of those thoughts, I’m assuming this is about 10 years ago, I’m assuming he was probably doing the best that he could. All that being said, I don’t know that I’ve seen many amendments to some of the initial messaging there to rectify where there may have been some overreaching.

DrMR:

But to play devil’s advocate, I also haven’t been looking super closely to see if amendments in his recommendations have been made. That said, I’m not seeing the over-diagnosis or incorrect diagnosis slowed down at all. So it seems that maybe this snowball irrespective of if attempts to correct it have been made has enough momentum now just to run on its own. To the question of dopamine and how that maps onto adrenal fatigue, a few things here. This is where I think the field really must do a better job of saying something along the lines of, “Well, how is the dopamine deficiency diagnosed?” Or are we just saying, “Well, do you like looking at your cell phone? Do you like looking at pornography? Do you like caffeine? Do you have fatigue? Well, therefore you’re dopamine deficient.” So there there’s many assumptions being made and somewhat loosely.

DrMR:

As an example of why this is important, there was one neurotransmitter testing lab, I believe the name was Neuroscience, that eventually pled guilty to falsifying lab ranges to make people look like they had imbalances in their neurotransmitters, just so they could sell more supplements through their sister company. So there’s been some monkey business going on with neurotransmitter testing. Now you could be someone who is overstimulating themselves, and dopamine is involved in stimulation. The overstimulation irrespective of exactly what’s going on with dopamine could be leading to fatigue. This is possible. The adrenal connection is kind of dubious because, as we’ve discussed on the podcast in the past, the best systematic review that looked at the concept of adrenal fatigue did find that more than half of the time, the adrenal fatigue tests did not match with the symptoms of fatigue.

DrMR:

So one of the challenges in answering a question like this is the question has so many assumptions just built into the language. Dopamine, well, how do we know there’s actually a problem with dopamine? Adrenal fatigue? Is that even something that’s accurately able to be diagnosed? So if we throw a lot of that stuff out, I think what we’re left with here is a couple of core questions of, is it possible that overstimulation partially from pornography is leading to fatigue? And the answer there is yes. Pornography has been shown to be addictive and overviewing has been associated with a few ill-effects of fatigue, and I think, this sexual desensitization. So that is something to consider. If you’re feeling fatigued, then at least in my experience here, this is not something that I know has been published, but I would suspect if I looked I could find something supporting this, when people are fatigued, their behaviors change, and they tend to fall into chasing and looking for stimuli that give them an easy sense of accomplishment.

DrMR:

So if you’re working at your desk, trying to do whatever task is important to you, and you find yourself always directing to social media, to pornography, to phone calls, to, a video game, it may be that your system is so fatigued, it doesn’t have the focus to achieve the tasks that you want to achieve. And so you’re, reverting to these easy to execute tasks, like a quick Facebook message or pornography or whatever it is. I think that is an indication of something internally that needs to be fixed. Now, part of this is just lifestyle. Part of this is if you’re working at your desk, don’t have your cell phone right next to you with the notifications on, so you’re getting interrupted every three minutes or so. Another layer of this is do you have enough energy to stay focused and achieve a harder task that may not have a payout until you’ve done three hours of work or three weeks of work.

DrMR:

And that’s where the principles that we talk about in the podcast that are laid out in Healthy Gut, Healthy You are important to address. Your sleep, your food, your exercise, your gut health are some of the key pillars there to give you enough energy so that you can focus on the tasks that aren’t necessarily easy. They’re sometimes termed as dopamine hits. Instagram and Facebook and porn. And it maybe harder to do, but when you do them, there’s a deeper sense of satisfaction. So the adrenal piece, the dopamine piece, I think those are kind of mechanistic red herrings. What we want to focus on is what you’re doing, how you’re living your life and trying to optimize your health enough so that you don’t fall into this, “Well, I’m tired and I don’t have enough focus to do things that are more meaningful but difficult. So I just kind of wallow in all these meaningless, but quick to satisfaction tasks like social media, video games, pornography, whatever.” So that, at least in how I view it, would be where you want to intervene, and should be the first domino in this cascade, that if you pick that one up, none of the other cascading dominoes will be able to fall.

ER:

Those are building blocks that all of us have to pay attention to, regardless of what’s going on. I feel like it’s just ingrained. We’ve had social media and email for 10 or 12 years now. For those of us in this generation who have grown up with that readily available, I just feel like God, our brain is so trained for that. Let me just answer a quick email so I feel like I got something done. Especially my experience of being a first time mom, where you feel like the world is sort of chaotic around you and I just want to feel like I did something good that day. Because sometimes you feel like it’s just been a bad day. I’ll just run through email, like crazy, or just deleting emails sometimes feels good to me. Seriously, it’s like I did something today because everything else that I had planned went to crap. My boss is one and a half years old. So it’s a crazy thing that as you were talking, I was like, “Whoa, I totally do with email, because it makes me feel like I’ve achieved something.”

DrMR:

It’s something that everyone, myself included, struggles with. I notice that the later in the day that I go, the more likely I am to find myself saying, “Oh, how did I get, um, Facebook when I was working on this important document.” But being aware of it, helps you just catch it because when you catch the drift that tells you either it’s time for a break or maybe I’ve just hit my cognitive ceiling for the day and I can’t do anymore. There’s a good book I’d recommend for anyone in this situation. It’s from Cal Newport and the name of the book is Deep Work. He does an excellent job of outlining how absolutely detrimental it is to have this constant task interruption. And there’s some pretty eloquent experiments that he cites in his book.

DrMR:

Said succinctly, researchers have taken two groups of people and let’s say they maybe have an hour to complete a task. They’re all working on the same task. One group has an interruption midway through, the other group does not. The interruption may only be something as short as a minute, yet the task execution is notably imparted in the interrupted group. And they even found that an interruption on day one could carry over. If the task was something that required, let’s say two or three days to complete, even an interruption on day one carried over to and detracted from task completion on days two and three. So some of the research here is just irrefutable in how detrimental to quality work and completing that work in a timely fashion interruptions are. This is why I now have become much more judicious about when I’m working in my deep work morning blocks where I’m doing researching or writing or clinical system work, there are zero interruptions.

DrMR:

I have nothing scheduled. I have no notifications pinging. And even when I’m getting up from my desk to clear my head, I do not look at my phone. I do not read anything. If I need to be on my phone for some thing, if there are any notifications, they’re all cleared because just reading that message, even if you don’t act on it, maybe something like, “Oh, you know your father’s upset because you didn’t call him back yesterday, and you said you would,” that will be running in the background of your head while you’re working on the task. And it just eats up like 5% of bandwidth. It’s a window open that’s now draining your bandwidth and it’s just not worth the loss. So I try to have a time for all those things, but it’s not when I’m really doing that deep work. So the book Deep Work by Cal Newport is well worth the read. And we’re trying to have him on the podcast, so hopefully we’ll have an interview on that coming.

ER:

Did you read the research about it takes you three minutes or something to get back to focus? I don’t know if that’s just hearsay or if that’s real research, but I read that many years ago and airplane mode is my best friend while I’m working. It drives my family insane, but again, the families are always trying to get at you. But I’ve heard that it takes three to five minutes just for your brain to get back on track. And I’m like, “What a waste.”

DrMR:

Sure. And then on the other side of it, on the family side of it, while you’re with your family, you won’t be checking work. You’re deeply in your work or you’re deeply with your family, but you have partitions. And there is a technique that Newport discusses, I don’t use this, but I just found it interesting. He has this sequence he goes through at the end of his workday and it’s kind of, “Okay, here’s the things I need to make sure to check before I shut off.” And maybe it’s an email check or one or two other things. And then he has mantra he says to himself, which is “Shut down complete.” And that’s when he just knows work function is done, and now I go into being a dad, a family member, whatever it is. I really like having that partitioning. and I think we probably need more of that. Kind of to what you said when you’re with the family, you’re not checking on email or work stuff, you’re really fully there with your family. And that’s part of how I justify, “Okay. Maybe I didn’t get back to my mother, father, brother, sister for a few hours, but when I’m back, I’m really fully there with them.”

ER:

Yeah, I think that’s fair. Next time, I’ll tell them, “Everything else is on airplane mode when I’m with you guys.” I like that. Like, “Shut down complete.” I use something like that as I was trying to heal my gut and sort of take more time between meals. I would say, “Kitchen closed,” after I finished eating lunch or whatever. Because I was such a snacker, but it was not helping things. I was trying to heal my gut, so I would just go, “Okay, kitchen’s closed.” Like it’s a restaurant. I don’t know why, but that really helps me. It’s so cheesy.

DrMR:

I mean, if the mantra works for you, then I think it’s okay to have it because sometimes you need that signifier of that switch being flipped.

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 efficacious functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who have been unable to improve their health, even after seeing numerous doctors, to 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. Health coaching. 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’re a clinician, there is our clinicians newsletter, The Future of Functional Medicine Review, which 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.

Clinic Philosophy

ER:

All right. So I think we have time for one more. This one is from Debra.

Debra:

Hi, my name is Deborah Bergen. I live in the Fort Lauderdale area. I am quite sure that I have SIBO. I am impressed by what you have written about it, and I’m wondering if you are available for telephone visits. Thank you.

DrMR:

Oh, well that’s an easy one. That’s totally fine. Thank you. I appreciate that. I am available. And there’s also a team of clinicians at my clinic who are also available. This maybe gives me a good chance to reiterate that myself and all the clinicians on our team are working in the same model. I think that’s crucially important. This is one of the things that both Doctors Joe and Rob have mentioned on the podcast, that behind the scenes, I’m putting in a lot of time, effort, and attention to making sure that as the clinic grows, we’re all growing using the same model and really working collaboratively. Because one of the things that in my mind would be a failure is if there was this kind of gurudom where I just had a certain way that I did it. And then we hired other clinicians and I didn’t make it a key point to make sure that we all integrated into the same model.

DrMR:

Or that they all had a practice exactly the way I practice, but rather I look at this as let’s get as many smart people together as possible. And sure we have a guiding model that I’ve developed, but over time, we’re going to be looking at all of our data and learning collectively and collaboratively and updating our model over time. Why I think that’s important is because science will help you get to the truth or the best way to help patients feel better. And that shouldn’t be something that only one person can do. It’d be a real failure if there was only one person in an organization who could do that. And it’d be a real success, if let’s say someone who maybe did have some good ideas, like I think that I do, was able to help other people see those ideas. And more importantly, to see the thinking and the system behind those ideas that allows excellent patient outcomes.

DrMR:

So I’d be very confident with you working with any of the clinicians in our office, and I’d even be confident with a family member, to bring family back into this, working with any of the clinicians in the office. That’s kind of one of the rules that I have, which is, would I want one of my family members working with this person? And if the answer is no, then even if we have patient demand for another doctor, I wouldn’t ever bring anyone onto the team who I didn’t have that level of confidence in, because I’m sure as people know, this stuff is really important to me. It’s not about just having more doctors in the clinic, it’s about having more people who can help improve the lives of our patients and get them well. So any of us will be able to help you. Whether it’s me or someone else, I hope that you’ll reach out and work with them because I have every confidence that if you are grappling with especially suspected SIBO, that we’ll definitely be able to help you.

ER:

And you can go to DrRuscio.com or the other link.

DrMR:

The Austin Center for Functional Medicine website has been live for a bit now. And that’s AustinFM.com.

ER:

And you’ll find ways to do the patient form and, and yes. I had the opportunity to work with Dr. Ruscio while I was living in D.C. and his practice was in San Francisco, and guess what it all turned out great.

DrMR:

It’s amazing how much you can do via telehealth. I mean, certainly if we were doing rehab it’d be much more difficult. But as it pertains to issues in the gut and thyroid and female hormones, between good history taking and follow up visits and data organization, and with all the labs now able to be done remotely, we really don’t miss a beat.

ER:

Yeah, and speaking of female hormones, I hope to get questions like that and about what we received earlier, because I don’t know that everyone sort of associates you with that topic, even though you talk about it from time to time. But yeah, ladies, what are your questions? Send us your questions. We’d love to discuss.

DrMR:

I would love to discuss that more. It is something that I see enough to where I wrote a section into Healthy Gut, Healthy You on that. Even though Healthy Gut, Healthy You was about gut health, obviously, there’s a breakout section all on female hormones, just because they’ve seen so much interplay between the two.

ER:

All right. Well, that’s all we have time for today.

DrMR:

Awesome. Well, thanks Erin. Thanks guys. We’ll talk to you soon.

ER:

Thank you for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show and sign up to receive weekly updates. That’s D R R U S C I O.com.

 

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