Answers on Antifungal Medication, Curcumin, and Hydrogen Sulfide SIBO

Listener questions about chronic eczema, EOE and PPIs, and peptide therapy for gut issues.

On today’s podcast, we will cover listener questions, including… 

  • Will an oral antifungal medication destroy my gut?
  • Do you recommend bismuth thiol biofilm disruptors for hydrogen sulfide SIBO?
  • Does curcumin really help with inflammation in rheumatoid arthritis? Is there enough research to support this? 
  • What should I do if I suffer from burning pain in my stomach, and HCl, apple cider vinegar, and digestive enzymes don’t help?
  • How do I get off of the PPI I’m taking when I have reflux and EOE?
  • My eczema of 10 years cleared up while I was on the modified fast and diet from Healthy Gut, Healthy You, but it’s starting to come back as I add foods back in. What should I do?
  • Do you recommend the peptide BPC-157 for gut issues?

In This Episode

Intro … 00:00:45
Oral Antifungals and Gut Health … 00:05:50
Hydrogen Sulfide SIBO … 00:11:00
Curcumin for Rheumatoid Arthritis … 00:14:36
Gastritis and Gut Health … 00:18:17
EoE or Eosinophilic Esophagitis … 00:27:18
Eczema and Probiotics … 00:32:28
Modified Fasting … 00:38:48
BPC-157 … 00:41:24
Episode Wrap-Up … 00:43:40

Answers on Antifungal Medication, Curcumin, and Hydrogen Sulfide SIBO - Podcast305b ErinRyan

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Hi everyone. This is Erin Ryan from Dr. Ruscio radio. Today on the show, Dr. Ruscio answers your questions. In this week’s episode, you asked: Will an oral antifungal medication destroy my gut? Do you recommend bismuth thiol for hydrogen sulfide SIBO? Does curcumin really help with inflammation and rheumatoid arthritis? What should I do if I suffer from burning pain in my stomach and HCL, apple cider vinegar, and digestive enzymes just don’t work? How do I get off of the PPI I’m taking when I have EoE? My eczema of 10 years cleared up while I was doing the modified diet from your book, Healthy Gut, Healthy You, but when I started to add back in foods, it started to come back. What should I do? Do you use peptide BP-157 for gut issues in your practice? That’s all the questions for this week. I hope you enjoy this episode. If you’d like to submit a question, visit DrRuscio.com/podcast-episodes, and click send us a voicemail. Please speak loud and clear and keep it as concise as you can. Enjoy the show.

➕ Full Podcast Transcript

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. 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.

ErinRyan:

Hi everyone. This is Erin Ryan from Dr. Ruscio radio. Today on the show, Dr. Ruscio answers your questions. In this week’s episode, you asked: Will an oral antifungal medication destroy my gut? Do you recommend bismuth thiol for hydrogen sulfide SIBO? Does curcumin really help with inflammation and rheumatoid arthritis? What should I do if I suffer from burning pain in my stomach and HCL, apple cider vinegar, and digestive enzymes just don’t work? How do I get off of the PPI I’m taking when I have EoE? My eczema of 10 years cleared up while I was doing the modified diet from your book, Healthy Gut, Healthy You, but when I started to add back in foods, it started to come back. What should I do? Do you use peptide BP-157 for gut issues in your practice? That’s all the questions for this week. I hope you enjoy this episode. If you’d like to submit a question, visit DrRuscio.com/podcast-episodes, and click send us a voicemail. Please speak loud and clear and keep it as concise as you can. Enjoy the show.

DrMichaelRuscio:

Hey everyone. Welcome back to Dr. Ruscio radio. This is Dr. Ruscio back again with Erin Ryan, and we are tackling your listener questions. Hey Erin.

ER:

Hey, how’s it going? You want to jump right in?

DrMR:

Yeah, let’s jump right in. I know you made an exception with your babysitter time to fit this in, so I don’t want to make you bump up against that hard stop that you have coming.

Oral Antifungals and Gut Health

ER:

Oh, much appreciated. All right. So our first question is from Adam. He says, “I have a history of bacterial and fungal overgrowth in my gut, so I’m pretty terrified of taking any prescription meds because I never want to go through that again. My doctor is strongly recommending an oral antifungal medicine for nail fungus. We’ve tried all the over-the-counter options and they haven’t worked. Will an antifungal wreak havoc on my gut? How will I know if it’s doing too much damage? I have to take it for at least six weeks.”

DrMR:

Okay, great question. On principle, I would not be concerned. I also would be less concerned if you’ve tried other options, the herbal and probiotic options, remembering that probiotic cells are anti-fungal, and you’re not getting the traction that you want. Now this is when these medications have a time and a place. I haven’t seen anything that has made me concerned about using them in this context. We mentioned this on the podcast before, but we recently had a case that was similar in that they had tried herbals, probiotics, all these different therapeutics, and nothing really had an impact until he used Fluconazole. This prompted us to do a review of the evidence which we have not yet published, but we will publish in our Future of Functional Medicine Review clinicians’ newsletter once that’s finalized.

DrMR:

The review was of the different applications that antifungal medications have been used for, such as chronic toenail and nail fungus and chronic vaginal candidiasis. This boils down to an approach that’s often used, and that we’ve been using in select cases at the Clinic, of a pulsed dosing, where you wouldn’t necessarily take this every day. Of course, this is something you should speak with your doctor on, but your doctor should see this pretty quickly if he or she references the published literature. Every other day or every third day dosing of a lower dose in a longer-term application like this for a few months is often what has been used, and it’s shown good effectiveness.

DrMR:

The only other thing to maybe consider is adding in some type of anti-biofilm agent. Now this hasn’t really been published; we’re in the process of publishing how anti-biofilm agents synergize with herbal antimicrobials in the treatment of SIBO, and there was one paper published finding that the anti-biofilm agent N-acetylcysteine synergizes with H. pylori antibiotics in the clearance of H. pylori. So there’s some evidence, nothing in this exact application to my knowledge, but if the fungus is chronic, and presumably in this case it is, then there may be a biofilm that’s protecting it. You could also use our Biota-Dissolve. That would be an absolutely fine item to pair in with the prescription.

DrMR:

Again of course, clear this with your doctor, because I know nothing other than this. So bounce this off him or her in regards to using the anti-biofilm agent. Be careful that they don’t give you the, “Well, I don’t know what Biota-Dissolve is, so I’m going to say no.” If they give you a reflexive no, say, “Is there anything that you can see in here that would do overt harm to me?” Because sometimes you get, “Well, I haven’t heard of it, so I’m going to play it safe and say no.” So you may want to follow up that response with a more clear question.

DrMR:

So discuss the anti-biofilm agent, and I’m not sure if they’ve recommended the pulsed dosing, but essentially what this bottoms or nets out to is a lower dose used not every day, either every other day or every third day. I mentioned Fluconazole. It wouldn’t have to be Fluconazole; there are other agents. I think what’s more important is the way the agent is used instead of the agent itself. So hopefully that helps get you a little further along on your journey. Also, take probiotics at the same time. Probiotics will likely synergize, and they will also likely help prevent any antifungal associated side effects from the antifungal.

ER:

Cool. And so the pulsing just has the benefit of not harming your gut or not being as intense in terms of side effects?

DrMR:

I can theorize on what the mechanism is. I don’t know, and I also haven’t looked to see if there’s consensus on what exactly is happening. It’s likely one of a couple of things. You’re going to prevent resistance because you’re pulsing, and you may be able to get adequate resolution with pulsing. To your point, it may be more of a Minimal Effective Dose that doesn’t cause more noxiousness or perturbations of the microbiota, and it also doesn’t cause resistance. So it may be really a Minimal Effective Dose in a few different ways.

Hydrogen Sulfide SIBO

ER:

Cool. All right. Next, we’re going to go to an audio question from Dante.

Dante:

I wanted to ask you for someone who has Hydrogen Sulfide SIBO, if you would recommend these people to take the bismuth thiol biofilm disruptor, because I read that it is very potent and is very powerful, but it contains alpha-lipoic acid. And that means it contains sulfur. So I wanted to know if it’s safe for people with this condition.

DrMR:

Okay, good question. This question is a red flag that you are getting way too zoomed in. So I’d like you to go for a walk and legitimately try to reduce the amount of reading that you’re doing, because it is very likely that when you’re at this level of analysis, you’re going to get in your own way and trip over your own feet, and that’s so important to understand. So I would relax a bit and try to find a good clinician to advise you.

DrMR:

Also, there’s another little bit of a red flag here. Have you been diagnosed with Hydrogen Sulfide SIBO, or are you self-diagnosing? Another potential big problem there, if you’re self-diagnosing. I would have zero reservations using bismuth, which is contained in Pepto-Bismol, because there’s evidence, and this is something that Mark Pimentel mentioned on the podcast the last time that he was on, that when the SIBO antibiotic Rifaximin is co-administered with bismuth, it seems to improve outcomes. And that’s what we’re after. Remember we’re after the outcome data, not the mechanism data. So I would have absolutely zero reservation about bismuth regarding the alpha-lipoic acid content.

DrMR:

I’m not even aware of what the alpha-lipoic content is of bismuth, because in this context it doesn’t really matter. What we do know is that bismuth seems to be anti-sulfur, and there is some clinical interventional evidence, at least per Mark Pimentel, who’s one of the developers of the test for Hydrogen Sulfide SIBO, that it will synergize with anti-microbials. So I would relax, be careful not to self-diagnose, get a little bit less zoomed in, look for clinical outcomes, find a good clinician to advise you or go through Healthy Gut, Healthy You, and if you do legitimately have Hydrogen Sulfide SIBO, then using bismuth in conjunction with whatever else you’re doing should be totally fine. Again, normal disclaimer, discuss this with your doctor, but no, I would not have any reservation about using bismuth.

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Curcumin for Rheumatoid Arthritis

ER:

And our next question is from Scott. He says, “I’ve read some of the research about curcumin and its anti-inflammatory effects on the body. Do you feel there’s enough evidence to support this? I was considering curcumin as a natural treatment for rheumatoid arthritis so I can get off of the steroids. The research seems to be using a very pure and high dose of curcumin. Do you recommend any particular dose or brand to take?

DrMR:

Great question. There is a good amount of research with curcumin. In fact, I believe it’s probably one of the most well-studied medicinal spices in existence. So I would have no reservation with using curcumin. In fact, I would use it. I actually do take one or two capsules of curcumin on most days. Moss Nutrition has good curcumin, and Integrative Therapeutics also has good curcumin. I don’t have strong thoughts on the dose, and what I’m assuming would be reasonable is essentially one or two capsules per day. Some people may get a little bit of GI upset if they go too high on the dose. If you’re in more of a compromised position, you may want to try a higher dose in the shorter term. Again, discuss this with whatever doctor or clinician is advising you, but you may want to try double or even triple of the recommended dose for a term and then wean down to find the Minimal Effective Dose.

DrMR:

So yes, curcumin is definitely something worth exploring. Do not forget the importance of your gut health for rheumatoid arthritis. I can’t boast a large number, but what I can boast is that in a very controlled setting, we have had a handful of patients who have been able to get off Humira for RA when using either probiotics or using anti-microbial therapy. That doesn’t mean that you should just do the probiotics for the sake of probiotics or the anti-microbials for the sake of anti-microbials, it’s to point you to the fact that the largest density of immune cells in the entire body resides in your small intestine. To some extent that seems to set the tone for immune function elsewhere in the body. This is why certain foods like nightshades, for example, have been shown to trigger or worsen RA. And by withdrawing nightshades, you can see improvement in RA or in inflammatory arthritis more generally. It’s the gut connection.

DrMR:

Elemental diets have also been shown to be as effective as corticosteroids for rheumatoid arthritis. So you have a number of options at your disposal. Curcumin is absolutely one because it’s anti-inflammatory. So is fish oil and so is vitamin D because it’s immunomodulatory, as are probiotics and elemental dieting. The final thing to consider once you’ve done all of those, hopefully in a step-wise fashion so you can get a sense for the effect or lack of effect of each type of therapy individually, would then be microbials as a final consideration. So you have a lot of fruit on a therapeutic tree that’s low-hanging in front of you. Hopefully this helps you navigate that. I’m pretty confident that if you take the right steps, you can make some nice strides in your RA.

ER:

Well, that’s so cool that elemental heal has that application too. It makes sense. You’re just giving your body a break.

DrMR:

Yeah, absolutely.

Gastritis and Gut Health

ER:

Cool. Okay, this next question is from James. Wow, we’re really plowing through them today. Cool. James’s question is a little bit on the longer side. It’s about two minutes, but I wanted to play his question because I think that a lot of people are in this position where they’ve tried what they might think is everything, and they feel really lost. So that seems to be what most people ask us about.

DrMR:

Yeah, let’s do it.

James:

Hi, Dr. Ruscio, this is James. I had a question about gut health. I don’t have any constipation or diarrhea. According to the stool pictures, I have normal stool, but I have pain when I go to the bathroom, in my stomach area after I go to the bathroom. A lot of GERD or gastritis, especially on an empty stomach or an hour after I eat. I do try to take digestive enzymes, which don’t seem to help much. I have tried HCI, hydrochloric acid, which burned my stomach even more, and apple cider vinegar, which burned it more. I also took the baking soda challenge where you drink a teaspoon of baking soda first thing in the morning and see if you get any burping. I did that and I didn’t get any burping for at least 20 minutes. So I know that too much acid isn’t my issue, but it feels like it because I’m always having this burning. The only time it stops is sometimes when I eat. A lot of pain, a lot of fatigue, a lot of exhaustion.

James:

I have tried the low FODMAP diet, and when I cut the carbs really low, I get really dizzy and shaky and have a rapid heart rate when I stand up. And a lot of anxiety; another issue of mine is anxiety too. But when I eat a few carbs, like some blue organic corn chips, 20 minutes afterwards, I feel a lot better. So I don’t think cutting carbs out completely is good for me. And I try to eat lean protein, some MCT oil, stuff like that. I did try the elemental diet Heal shake, but I seemed to have a reaction to it. I don’t know if it was the whey; I’m not sure. So I’m just curious what are the things that you think it could be in the stomach area that’s causing it? When my stomach is not so inflamed, then I have a lot less anxiety and depression and all that stuff. So I know it’s in the gut. I don’t think it’s SIBO either, but I’m not sure. If you could answer some of that for me. I do have an appointment with you, so hopefully we can get that resolved.

DrMR:

So this sounds like someone at the clinic actually. These are the sort of things that I listen to visit after visit every day. So I definitely hear you, and, don’t despair. There’s certainly a few things that can be done here. So it’s good that you ran the HCL experiment, because those symptoms, the GERD symptoms, can be caused by high or low HCL, as discussed in Healthy Gut, Healthy You. And the fact that you’re younger, at least you sound younger; if you’re older, you sound young, but you sound like you’re maybe in your twenties or early thirties. Being in that age cohort makes it pretty unlikely that you have low HCL. It’s possible, but it’s less likely. And that was corroborated by your experiment. You took the HCL, you took the apple cider vinegar, and you had the elicitation of the burning, which tells you that you’re probably making adequate stomach acid.

DrMR:

But what that could indicate is that there’s a degree of gastritis. Now, I believe you said that the endoscopy was normal. I have this theory that there may either be subclinical gastritis or there could be inflammation in the upper GI that’s not registering as gastritis, but it does throw off the motility of the upper GI, and that’s why you have GERD. Because inflammation does interfere with motility, and you need to have proper motility of things like the esophageal sphincter to prevent GERD. So there could be this gastritis or pseudo-gastritis present. In cases like this, I really favor our Gut Rebuild Nutrients or something like that, a reparative compound that has things like glutamine, aloe, elm, and zinc to soothe and help to repair the lining of the gut.

DrMR:

I would pair that with a paleo like elimination diet. I’m assuming you’ve probably done something like that if you’ve done low FODMAP, but if you haven’t, then the other side of this could be allergenicity or reactivity to foods. Not that they’re fermenting in your gut as in too much FODMAP, but that they’re causing an immune reaction as in antigens or allergens, and this is what the paleo diet does a good job of. But be careful not to inadvertently go low-carb. This depends on what application of the paleo diet you’re going to be reading about. You can pull up our paleo diet. It’s more relaxed, and we’re in the process of releasing a relaxed iteration of the paleo diet that allows things like rice and gluten-free grains. This relaxed paleo diet would be a good mark for you to aim for, where you’re not going low carb. So the Gut Rebuild Nutrients, the relaxed paleo diet, and then get on our probiotic Triple Therapy, because that can definitely help with the inflammation and immune reactivity. That’s where you start; that’s going to help most people.

DrMR:

Now give that some time, and by time I would say give that at least a month, because you have a few different things there to do so you want to give yourself some time to integrate those and listen to your body. And if that’s helping, ride that wave until you plateau. But something else you could consider is reducing the histamine content of your diet. There’s only probably about a 20% probability that you’ll need to do that, but you could also look up our low-histamine diet and aim to just reduce the amount of histamine in your diet. Don’t go crazy. Don’t turn into a histamine zealot and never have one ounce of histamine, but generally try to avoid the high-histamine foods and steer toward the lower-histamine foods. Run that experiment for one week. It’ll either help or it won’t. If it doesn’t, don’t worry about it, move on. If it does help, continue to be mindful of histamine, and then gradually wean yourself back onto more of a normal histamine diet.

DrMR:

Now along with that, you could also try doing a reset with another type of the elemental diet, the whey-free one most namely, just as a consideration. You could also consider herbal antimicrobial therapy, kind of more down the road here, or immunoglobulin therapy with our Intestinal Support Formula. Those would all be viable things to trial.

DrMR:

You said something about feeling better on carbs, so if you do, that’s an important signal to listen to. But if there’s anything here that I didn’t hear correctly, or if at any point in time you think you do better lower-carb, take an electrolyte along with it, because you’re exhibiting signs of being low in electrolytes, and I really like Robb Wolf’s LMNT, which you should be able to find in our store also.

DrMR:

So we have a few things there to navigate, but the real foundation would be Gut Rebuild Nutrients, the relaxed paleo diet with ample carbs, and probiotic Triple Therapy. That’s probably gonna get you most of the way there, but if not, there’s a few other things to keep in your back pocket and to consider applying in a stepwise fashion. I can’t emphasize how important it is not to just do all these things at once. There’s that that military saying, “Slow is smooth and smooth is fast,” I think. So, slow and steady. Be the Tortoise, not the Hare, and I’m pretty confident this will help you get over the finish line.

ER:

The good thing is he’s already tried a lot of stuff, so he’s not starting from complete scratch.

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EoE or Eosinophilic Esophagitis

ER:

Okay, our next question is from Jessica. She says, “I have a 10-year history of reflux being treated by PPI. I’ve had IBS symptoms for five years. I found out recently that I have eosinophilic esophagitis. I’m on a paleo diet, which is helping. I want to get off the PPI, but I’m not sure how to get off of it without it making things worse with the eosinophilic esophagitis.

DrMR:

Okay, good question. I have a touch of EoE, or eosinophilic esophagitis myself, so welcome to the club. It’s really not that big of a deal; it’s only something that bothers me on rare occasion. But I think it’s important just to mention that even for a gut nerd like myself, who considers himself in pretty excellent shape, I have little buzzers on the dashboard that go off here and there. And it’s really important to keep that in mind. No one, I think, is walking around perfect. I would say I feel pretty darn good, and can’t really ask for much more, but there are little things here and there, and I think that’s just important because if your expectation is never not to feel perfect, then you’re likely always going to be upset. If you’re just trying things a little differently, that can help. So just a side comment there.

DrMR:

EOE is predominantly food reactivity related, and that obviously ties into general gut health. You may want to go a little further down the dietary road to an autoimmune paleo diet trial. That may remove some of the additional foods that are bothering you. For a couple more nuances, you could also look up an eight food elimination diet. I don’t recall the eight specifically in this diet and how they differ from the autoimmune paleo. There’s a lot of overlap, except maybe shellfish might be the one, but you’re looking at things that are embodied in paleo and/or autoimmune paleo, like gluten, grains, soy, dairy, spicy foods, nuts, seeds, eggs, and shellfish. And you also have the nightshades with autoimmune paleo. So that is one aspect of this, but if the gut is not in good health, then you’re going to have to eat more restrictive than you need to because a porous gut is going to have more reactivity, therefore you’re going to have to eat a more restrictive diet.

DrMR:

So probiotics is definitely something I would integrate and bring into the mixture. And if you haven’t done the probiotic Triple Therapy, please do that, because that can produce results where one probiotic alone does not. So I would definitely do the probiotic Triple Therapy, using our three different formulas together, and that will hopefully allow you to be able to heal your gut and expand your diet. Now, once you’ve given that some time to see what sort of results you have, in parallel with that, you can do a mini reset with elemental Heal. And what this can do is reduce overgrowths if any are present, and it also reduces antigens or food particles that trigger your immune system because it’s hypoallergenic. Elemental dieting has also been studied in the context of eosinophilic esophagitis. So a lot of the same elements that we use for everyone. It’s just doing this in a step-wise fashion so you can learn what works for you, what doesn’t work for you, and end up at your personalized plan.

DrMR:

But that should be able to get you on the other side for your EoE. One final thing, and tying in the aspect on the PPI, you should see a reduction of the need or an elimination for the need for the PPI as you go through these steps. But if you’re someone who has low stomach acid, then all of these steps may not ever fully get you to the point to where you’re symptom-free while off the PPI. And so make these steps the first thing that you do, or the first few things that you do, but then consider a trial on HCL and phase. Now that you’ve sorted out the food reactivity and the health of the gut, reduced the inflammation and supported the microbiota, then you can get a clear read on needing HCL or not. Because the need for the PPI may be driven by all of the above. If you address all of the above and there is still this need for the PPI, it could be due to low HCL. Perform the HCL trial, max out at four caps per day. Don’t follow the idiotic internet recommendation to take up to 15 or something crazy like that until you feel your stomach burning. Check this with your clinician, but that should hopefully be able to get you to where you’re trying to go.

Eczema and Probiotics

ER:

Our next question is from Lisa.

Lisa:

Hi, this is Lisa. I struggle with chronic eczema on my hands. We’re talking like 10 years of chronic eczema. I’ve been following the Great-in-8 plan. My eczema almost completely cleared up when I was doing the modified fast for about two and a half days, which was amazing that something so chronic cleared up so quickly. As I added in food, following the paleo FODMAP protocol, the eczema slowly started coming back over the four weeks. However, I otherwise felt great on the protocol, like no burping, since I have excessive burping problems, and no bloating. I’ve been taking probiotics, oil of oregano, and grapefruit seed extract to help with balancing bad bacteria. I’m frustrated that these actions have not solved the eczema problem on my hands. Obviously I’m curious what you think, but I suspect it could be the following. H. pylori, which may explain my excessive burping as well. Candida yeast overgrowth, since I still historically have noticed flares in my eczema when I eat high starch or sugar. And I have also taken a few food sensitivity tests and yogurt keeps coming up. Could this be a sensitivity to a probiotic? Really curious what to do next and what your thoughts are with some of the things I’m suspecting. Thank you so much for what you do.

DrMR:

Okay, great question. It’s interesting what runs through my head when I listen to this question, which is is how people tend to think so specifically through the lens of, “It’s going to be X, Y, or Z. Candida or H. pylori.” The longer someone spends in clinical practice, you see that those don’t really change treatment demonstrably in many cases. It’s more about figuring out what treatments help the individual. That’s not to take anything away from the diagnosis of Candida or H. pylori, but the treatment for both of those is very similar. Yes, there is some nuanced difference, but I think that misses the bigger mark, which you’re already on your way to, and a commendation to you for that, for running some of these experiments.

DrMR:

So a few thoughts. If the modified fast was that helpful, you can always integrate more of the modified fasting into your weekly or monthly routine. I advise some patients in the Clinic to do a day of modified fasting per week. Some people prefer to do two days every other week. Some people will do a three-ish day reset with the modified fast once per month. But if we’re getting the signal from your system that it’s helpful, that’s something that can be done more routinely. You may need a little bit longer on the more strict application of the diet and the probiotics until you can expand your diet successfully. I’m assuming you started with probiotics and then the anti-microbials later. But if not, that would definitely be something to visit in that separated stepwise fashion, the full probiotic Triple Therapy, give that some time. Allow it to balance your microbiota and improve the health of your gut, then consider layering in the antimicrobials as is outlined in Healthy Gut, Healthy You.

DrMR:

It’s also possible that you may not be using a high enough dose of the anti-microbials. I believe you said it was oregano and grapefruit seed. So this is where I’d be a little bit careful not to take the algorithm from Healthy Gut, Healthy You, and then you use different products. You can; but the more you deviate, the more you open yourself up to not doing things correctly. So it could be that the dose of the anti-microbials wasn’t enough. Now, had you done the probiotics first and the anti-microbials later, you’d be able to say what the relative impact of the probiotics versus the anti-microbials were. And if you saw a jump of improvement from the anti-microbials, that’s a valuable signal, because that tells us we could push a little bit harder with the antimicrobials if they were helpful.

DrMR:

Again, this is why the step-wise process is so important. Now, elemental dieting is also something that you could consider. This could allow some of the gains that you realize from the modified fast, but give you more calories in a more complete meal replacement. So that’s also something else to consider trialing and integrating in. Vitamin D would be important, as would fish oil, because both of those are anti-inflammatory and immunomodulatory, which obviously for eczema is something to consider. That gives you a lot right there. I think you have the answers; I think you’re missing the execution. And that’s where slowing down a bit and realizing that you’re likely going to get more out of listening to your body’s response and learning from that than you will pursuing certain tests.

DrMR:

Now, I don’t want it to dissuade you from seeing a clinician and having diagnostic testing that you may need, but more likely the win is going to come from executing these things correctly. Because as a clinician who looks at these tests, oftentimes they won’t make a huge change. They do in a small subset of people. And that’s the importance of having that information in the back pocket for maybe this really is that chronic biofilm protected Candida. But that is the minority of people. Unfortunately, people always think that there are the unique snowflake, so they fall into the exceptions rather than the rule. Most of what I do in the Clinic is just getting people to go through the rules, listening to their own body, and not getting pulled into some of these different ways of thinking.

DrMR:

So I think you have most, if not all of what you need right here in front of you. It’s just doing a little bit more of what works, slowing down a little bit to get a better signal on what works and what doesn’t work, and then giving your body a little bit more time. So hopefully that helps, but I think you’re very close. So keep up the good work, and you’re very welcome.

Modified Fasting

ER:

Awesome. And do we want to explain what modified fast means for the audience?

DrMR:

Yes, thank you. So in Healthy Gut, Healthy You, I introduced this concept of modified fasting where you can either make bone broth and essentially subsist just on bone broth for anywhere from one to four days, or you can make this lemonade Master’s Cleanse solution and subsist on that, or a combination of the two. It’s similar to elemental dieting, but it’s not a complete meal replacement. But what’s nice about it is it’s essentially all culinary ingredients and stuff that you have at home or can buy easily. It’s not another supplement to take, and it’s a good starting point. So that’s what modified fasting is. It isn’t a true fast; there is some caloric content of those, and that can be a nice way to give the gut a rest and a chance to heal, as evidenced by her response.

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. 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 have been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s 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 listen 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. Finally, if you’re a clinician, there is our clinicians newsletter. The Future of Functional Medicine Review. I’m very proud to say that we’ve now had doctors who’ve read that newsletter, found challenging cases in their practices, applied what we taught in the newsletter, and have been 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.

BPC-157

ER:

And we’re already at our last question, from Dr. Steve Rudack. I think he mentioned he was also a Functional Medicine practitioner. He wanted to know how you use peptide therapy in your clinic, specifically BP-157 for gut issues.

DrMR:

We’ve had a few cases where we’ve used BPC and I can’t say I’ve seen a great signal. There have been a couple of people who’ve said they feel like the BPC has really helped them. In thinking about this for maybe the past two years, since I initially became aware of BPC, I think two or three people have said it’s really helped them, but none of the people for whom I’ve actively recommended it. We’ve used the oral form; William Seeds’s version and we’ve also used Kent Holtorf’s version. They’re both oral over-the-counter preparations that don’t require a prescription. Seeds’s is commercially available, but with Holtorf’s I believe you have to be a clinician of some sort, but lackluster response on those.

DrMR:

So I suspect that if you are astute and applying the therapeutics that we talk about that have a good evidentiary basis behind them for gut healing, the various dietary changes that can be made, probiotics, most namely Triple Therapy, immunoglobulins, gut rebuild nutrients, anti-microbial therapy, elemental dieting. If you master those things, then I don’t think BPC has much more to offer. I could be wrong, and I’m open to changing my perspective on that, but BPC is one of the many new and interesting things that I think will produce more of a signal of benefit in someone who doesn’t use the existing tools well already, but for those who do, I don’t think it’s any more effective. So I’ve tinkered, I’ve listened, and so far in my limited experience, haven’t seen anything response wise that’s made me want to pursue it further.

Episode Wrap-Up

ER:

All right. Well, that’s our last question for today.

DrMR:

All right. Well, I think I was a bit more succinct. Maybe it’s good for me to go to the gym before we do this. It gives me a little more blood flow to the brain.

ER:

Yeah, we ran through these more quickly this week, for sure.

DrMR:

Great. I also did a podcast right before this, so I might already be a little bit warmed up. But thank you Erin, and thank you guys. Hopefully these listener questions are helping you navigate the landscape and helping other people who maybe have similar questions navigate their landscape too. So, yeah, great stuff guys. Thank you so much, and we will talk to you next time.

Outro:

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