Answers on Subclinical Hypothyroidism, SIBO, and Sole Water

Introduction:

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.

Erin Ryan:

Hey 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, what is your take on Sole Water, a/k/a Himalayan Salt Water for promoting digestion? Any advice for someone with EoE who has trouble swallowing the supplements needed to improve my gut? This is actually really exciting. We have an all-in-one probiotic powder coming out very soon, maybe by the time this podcast episode airs, so take a look in our store. This is going to be a super simple way to take that three probiotic blend that he talks about so much in just one swoop. You just pour it in your water or whatever you’re drinking and down the hatch. It’s very exciting, keep an eye out for that.

Back to the questions. What is your take on Peptide BPC-157? He had some interesting insights here that kind of made me want to try it, so I’ll keep you guys posted. Next question, I’m throwing a lot at SIBO and can’t seem to digest animal proteins, what should I do? Dr. Ruscio gives some advice here on how to get to the bottom of a tricky situation, like potential pancreatic insufficiency, combined with SIBO and how to deal with that. Next question, do you think Subclinical Hypothyroidism is a spurious diagnosis? One of Dr. Russo’s favorite topics to get into, you’ll have to keep listening to find out his advice on that. Is it counterproductive to take things like Glutamine or Collagen while trying to dissolve bacterial biofilms? Have you come across any drug/probiotic interactions?

Those are your questions for this week, and we hope you enjoy the episode. Oh, and Dr. Ruscio shares his favorite vape pen and why it’s his favorite. If you’d like to submit a question, visit Dr. russo.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. Ruscio:

Hey, everyone. Welcome back to another episode of Dr. Ruscio Radio. This is Dr. Show back again with Erin Ryan, and we are doing more listener questions. Hey, Erin, welcome back.

Erin Ryan:

Howdy.

Dr. Ruscio:

All right, guys. Well, let’s roll into some questions. Actually, before we do, I wanted to say thank you to Crafty for their vape pen that they sent me. If you remember back to the podcast with Jordan Tishler, he is at something, I think it’s cannabis MD or something like that. We had a lengthy discussion on in this case, cannabinoids and how they may enhance intimacy between partners, sexual intimacy, amongst other facets of intimacy. And according to Dr. Tishler, the optimum temperature for vaporizing is 350 degrees, which is what the Crafty vaporizer is preset to. And so, I had been long intending to procure one of these, and I finally got around to getting one and giving it a try.

I actually really like it. I much prefer it to using some sort of, whether it be a pipe or a diffuser or something like that, it’s a ballpark of difference. Knowing that the temperature, again, according to Tishler, is the optimum for extracting medicinal compounds, but not so hot that it may cause any burning. And I guess chemicals that would be secondary to combustion that’s too hot that can be detrimental to health is really nice to know. The company is Crafty, and the store is Storz & Bickel, I believe, or the website is storz-bickel.com. But if you just search for “Crafty Vape Pen” have to say really like it’s very easy to use. And for those of you who are foraying into using cannabinoids medicinally, as I’ve mentioned on the podcast before, I do think there’s something there. There are definitely insights that I routinely am getting after using cannabinoids.

And again, to touch on something I said in the Podcast in the past and not to paint with too broad of a brush here, but I think you will get the most out of the cannabinoids if you’re using them with a bit more intention. So, what I tend to do is cannabis, cardio, and then I go on the sauna. At this point it’s almost become like a spiritual exercise for me. It’s really quite lovely and inspiring and insightful, as opposed to, welp, I’m going to watch a funny movie and order a pizza. Sure, I mean, some of that, we don’t want to be health fanatics, but I think there’s this really interesting application of cannabinoids.

If you’re going to try it using flowers, edibles, is another option of course, but the challenge with edibles is you have to wait 45 minutes to an hour. If your schedule doesn’t fully permit that, you know, the vaporizer is a really nice alternative option. Anyway, I would highly recommend that vaporizer and you can rest assured that this one has been preset to be at the optimum temperature.

Erin Ryan:

Very cool.

Dr. Ruscio:

Yeah. Yeah. Okay, so let’s go to questions. What do we have on the docket?

Erin Ryan:

Our first question is from Chris. He wants to know, what is your take on Sole Water, or drinking salt water in the morning to promote digestion? I have gotten my gut health under control for the most part, but I still lean toward constipated and being irregular. A friend told me that Sole Water helped them immensely.

Dr. Ruscio:

Good question. Sole Water, as you said, is essentially Himalayan salt water, and this wouldn’t be too dissimilar to what some people are doing when using electrolytes, when they’re going low carb. Rob Wolf been on the podcast and in the past have discussed his LMNT Electrolyte, which is something that I personally use, I recommend patients at the clinic use it. It’s a salt-forward electrolyte if does have magnesium and potassium also. There does seem to be this justifiable use of electrolytes, salt-forward electrolytes, in those who want a low carb diet. What about other populations and what about constipation?

I haven’t seen anything showing that salted water or electrolytes would be noteworthy or beneficial for constipation. It is possible, through perhaps the retention of water. Although, as I was thinking through this mechanistically, if the sodium is causing you to retain more water and not pull it into the colon like magnesium or vitamin C, then you may not get more water into the bowel and that may not be any better for constipation. It’s possible it helped your friend for some other reason, could be there’s some mechanism there that I’m not aware of. I don’t know that salted water or a salt-forward electrolyte helps with bowel regularity.

What I can say is there’s been a number of trials finding that probiotics can help with regularity. There is also the obvious magnesium or vitamin C. Magnesium being something that at least reportedly a fair number of people are a bit insufficient in. And then there’s also fiber. So, it’s an option. You can try it. A way to kind of answer this question for yourself is applying a framework of experimentation, let me try this for a week or two. Probably a week is more than sufficient, I would think. Go into it with a neutral expectation, be careful not to placebo yourself, and see if you feel any better. If not try our probiotic Triple Therapy, if that doesn’t help, or if it only helps minimally, you can add in magnesium and or vitamin C. And then finally you can try fiber and that gives you a good kind of sequence of things to try to improve your bowels.

Erin Ryan:

Okay. Good luck with that experiment, Chris. Our next question is from Craig.

Craig:

Hi Dr. Ruscio. I purchased your Several Steps to Healing the Gut, the anti-microbials, digestive enzymes, motility, all the good stuff. Also, I have a complication, which is the Eosinophilic esophagitis, and this makes swallowing some of these pills, very difficult. Just curious for your thoughts for people who have difficulty swallowing pills and yet want to do a program which admittedly involves a lot of pills. What do you recommend they do in that case? Obviously the one way is just to open up the pills and put them in liquid and down it. But things that have a coating and an enteric coating, or even the gel capsules with oil. So, look forward to your feedback and your advice on this matter. Thanks.

Dr. Ruscio:

Alrighty. Great question. So EoE or Eosinophilic esophagitis.

Erin Ryan:

Three times.

Dr. Ruscio:

Yeah, right, I got it on the third there. That definitely has a food trigger component to it. There are a few diets that have been looked at, they’re essentially just different iterations of elimination diets. Four, six, and eight food elimination diets have been used, just justifying the model of taking triggers out, tends to resolve EoE. So, I would definitely be on the lookout for what your food trigger or triggers are. And the book walks you through a good framework for that, but it’s not to say that something like low-FODMAP is going to help you identify every potential nuanced food that may irritate you. I have a touch of EoE from certain foods also, and so I just try to be a little bit more mindful of those triggers and that’s gotten me pretty much to complete resolution when avoiding said trigger.

That should be done in the greater context of improving your gut health as you kind of alluded to, and as how you get healthy, what you provide the framework for which would be personalizing the diet, but also not trying to get all of your healing through just diet alone. Albeit, it is yes, the foundation, there are other things that can remedy problems in the gut that make you more sensitive to foodstuffs, probiotics, enzymes, anti-microbials, elemental dieting, and the like, you’re definitely on the right track.

To your question about what to do with pills. Well, there is some good news here in the sense that we are right about to release an all-in-one probiotic. So, all three of our probiotics, the Lacto-Bifido Blend, the Saccharomyces Boulardii, and the Soil-Based have now been put into one tear stick, kind of like a Crystal Light pack that you just tear open and pour into a glass of water and have been packaged as to be heat stable or shelf stable, so they no longer require refrigeration. Making it very easy to get all three of the probiotics into one serving. You can do one or two sticks per day. So that should make that easier for you.

Then, so some of our other products like Gut Rebuild and the immunoglobulins we have either in capsule form or in powder form, and there are some anti-microbials that are liquid-based. Biocidin® and has a liquid-based anti-microbial as one option, but hopefully you won’t need to go all the way to the antimicrobials if you utilize some of these others. A few things there to try to fine-tune dietarily while working through the Healthy Gut, Healthy You plan, and hopefully having the all-in-one probiotic makes one of the central pieces of that plan, the probiotics a little bit easier for you to apply.

Erin Ryan:

Okay. I can’t wait until that probiotic comes out.

Dr. Ruscio:

Me too. It’s going to make my morning routine a little bit easier.

Erin Ryan:

Me too, because my probiotics get pushed back in the fridge after people have been putting things back in there. And I’m like, “Oh man, I haven’t taken my two probiotics in like three days.”

Dr. Ruscio:

Yeah. And just give a more specific date, by the time this airs, we should be within only a few weeks of that releasing if it had not released already, I believe. That’s something that should be very, very soon around the corner, if not already in the store. And we’ll make a few announcements on the podcast and email also. But yes, I am excited also selfishly.

Erin Ryan:

Yeah, exactly. Also brave to give it a date. I feel like don’t jinx it. Products or…

Dr. Ruscio:

Yeah, we’re just waiting for it to ship.

Erin Ryan:

Oh, okay, okay. I know how that process goes.

Dr. Ruscio:

Yeah, there is some variance there. But the formulation and the quality assurance measures and all that, all the hard work has been done. So thankfully we are just kind of waiting.

Erin Ryan:

Cool, okay. Well, that’s exciting. Our next question is from Sally. She wants to know, are you familiar with BP-157? What are your thoughts on it?

Dr. Ruscio:

BPC-157 it’s a peptide we’ve discussed on the podcast in the past and it’s something that we’ve recommended to some extent in the clinic, it’s not a central recommendation. As the audience probably knows, what I try to do with a new therapeutic, kind of like with immunoglobulin therapy, is use it on patients in quite an intentional way for a period to see what the signal we get from the patient response is. Now with immunoglobulins, that was clear. With BPC-157 it was a little bit clear. So, I’m open to it. It seems a bit more hit or miss. There had been a few studies looking at it, mainly I believe in the model of gastritis. And I believe there’s even been at least one human interventional trial. I may be misrecollecting some of the details, but I believe BPC-157 is one of the few that actually has a human interventional trial documenting the ability to heal the lining of the stomach.

Others use it for kind of general healing anywhere, even for musculoskeletal injuries. There may be something to that. I’m not sure. This is one of the challenges with peptides is a lot of the information is mechanistic or inferential doesn’t mean that it won’t work. It just means if we’re going to position this in a therapeutic hierarchy, we always put the stuff that’s based upon mechanism, inference or theory toward the end of the line. Because the more theoretical you become, the less of the probability of benefit. Also, I think people should be a bit cautious with the placebo effect with peptides, especially if there are any of the administer via injection peptides.

It seems that when people are doing even small subcutaneous pinch of belly fat injections, that is much more prone to placebo-ing people because it’s, oh my God, I’m injecting, it must be stronger.
But as I’ve shared, I believe by the time this podcast is aired, I’ve shared my experience with Tesamorelin leading to seven, 10 pounds of muscle gain, which was shocking to me and irrefutably, not placebo. Now that’s a different peptide for a different purpose, but that got me to open my mind a bit more up regarding peptides.

So, there is something there. You have to be careful with peptides because there’s a lot that’s preclinical. BPC may be helpful, it’s worth a trial if you’ve exhausted the other options. The best thing I can point you to in terms of all those options in a guided path would be Healthy Gut, Healthy You. And then final point here regarding peptides, one of the things I’m working on right now in the background is putting together a optimization program that will be administered through the clinic. It’ll be clinician kind of prescribed or constructed, but health coach administered, and peptides will be part of that.

And what my aim there to do is, help give people kind of the after Healthy Gut, Healthy You, after we get out of the woods of kind of sick and symptom care. What do we do then to help you have better energy, have better cognition, have better sleep? It’s no longer I’m grappling with food or active brain fog, it’s more so there’s maybe some small lingering things, but it’s more about performance and health optimization. And peptides will be, we’ll be kind of brought into that algorithm or sequence. So, BBC-157 worth a trial, be careful do it at the right time and monitor yourself and look for objective improvements. And if you don’t see any, I wouldn’t stay on it beyond maybe a one- or two-month trial.

Erin Ryan:

Okay. Let me know when you’re going to try the peptides out in the way that you described with health coaching because I’ll sign up. I feel like for the last few years, I’m happy to be at 85%, sometimes 90%, but man, I would like to hover between 90 and 100, if possible, but I always feel like there’s just a little bit more I could do to optimize my health.

Dr. Ruscio:

Well, one of the things we haven’t talked much about in the podcast, but for the past, maybe three years, roughly, I mean, now that my health is in good position and I’m not having some of the lingering symptoms I was having and I’m in a pretty good place, I’m just constantly running experiments. Speaking with people who are specialists in different areas of peptides, of exercise training of sleep, of oral airway health, much of this has been showcased on the podcast. But I’m constantly running these experiments that I’m kind of figuring out the best way to kind of put these into our framework because that’s what I really think is missing right now with wellness plans or with much of health coaching. Well, much of health coaching, I think, it’s good, but it’s a bit narrow in its scope. And I don’t think there’s enough that’s brought in definitely regarding sleep, regarding the use of some of these other adjunctive therapies. And it probably is because this needs to be a marriage of health coaching and kind of clinician oversight and direction.

But yes, I’m really incredibly excited about this because I can say for me, and I’ve mentioned in the podcast before, just kind of in passing, there was one point when I was struggling to get three or four workouts in, in a week, and now I’m exercising seven days a week, sometimes two times a day. I’ve been doing that for a while. So, it’s not like I was overextending on my way to a burnout that I haven’t realized yet. That’s kind of my new normal. And that’s an amazing level of energy to have and I really notice it when I interact with my niece and nephew, because I have enough energy to play with a six and an eight-year-old. And I never kind of feel like, oh, I’ve got to sit down, which is very, it makes life really enjoyable.

So yes, for a number of reasons, I’m sorry, without getting too off topic, I’m exceedingly excited about rolling it out. Because these are things that for me have vastly improved my quality of life. Again, beyond step one of how the parasite gut was a mess, I was in disarray. Got over that and then it was kind of like you’re saying, Erin, how do I get to that next…I don’t just want to be healthy, I want to be thriving.

Erin Ryan:

Yes.

Dr. Ruscio:

And that’s what I’m really curious to share with people.

Erin Ryan:

Yeah, and I don’t think I’m alone in saying that it’s just that next level of energy. You hit the nail on the head by saying just like I have this new found energy. Because I don’t know if it’s because I have an 18-month-old and I spend a lot of time chasing him. But I find that I used to work out seven days a week, pretty easily and now, yeah, like you said, it’s like four days a week tops and it takes me like two or three days to recover, which is nuts. That’s never been my deal. So, I could definitely see some, some benefit and trying new things. But okay, so we’ll go onto the next question.

Dr. Ruscio:

We’re in sink Erin, kind of like we normally are.

Erin Ryan:

I know, it’s so weird.

Dr. Ruscio:

It is. For our audience, this is not pre-planned.

Erin Ryan:

No.

Dr. Ruscio:

This is actually… before the call you were saying a few things about aches and pains and I was thinking, she would be a good candidate for a lot of these plans. That’s why we’re such a good team here because we’re, we’re very much in sync.

Erin Ryan:

Yeah. Let me know. I’ll sign up for it.

Dr. Ruscio:

A hundred percent.

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Erin Ryan:

Okay. All right. This question from Kyle.

Kyle:

Hey Dr. Ruscio. I am 23-year-old male. I’m currently dealing with SIBO. I’ve done months of anti-microbials and herbals, and I’ve seen really no sort of improvement in my symptoms. I’m currently, four weeks into Rifaximin treatment and really still have not noticed any improvement. I came across your podcast recently and listened to as many episodes as I could just because the information you put out there just makes a whole lot of sense.

My main symptom is constipation and with that stomach pain, cramping between meals and with meals. I cannot digest any sort of animal protein, whether it be chicken, fish, meat. Even if I just have a little bit with a whole plate of veggies, I find myself extremely constipated the next day and have very bad cramping throughout the day.

I just received your book in the mail and I’m very excited to start reading it, but I wanted to ask you if you’ve ever come across a patient or any sort of situation, similar to this. I take digestive enzymes with bile and HCL, digestive bitters, vitamin C magnesium, you name it, and really nothing seems to help digesting those fats. I would be very thankful if you answered my question. Thank you in advance.

Dr. Ruscio:

This is a great question. A few things, firstly, thank you for the kind words, and I’m glad that you found the book. But the first step would be to go through the plan on Healthy Gut, Healthy You because it takes some of these things…one of the rationales behind the sequence of how they go down with you is it’s hard to evaluate the potential benefit of a therapy until you’ve kind of cleared some of the noise. And so that’s why there’s this kind of sequencing and stepwise process because to get a better read, there’s a little bit of work that has to be done, clearing potential confounding variables and therefore confounding symptoms before you get to whatever step it may be.

What you can think about this is, you want to address diet and lifestyle before addressing dysbiosis because some of the symptomatic manifestations of dysbiosis may not actually be dysbiosis. It may be coming from diet and lifestyle. So, to know if the fatigue and brain fog or in this case, I believe it was bloating constipation, is that coming from dysbiosis, which Rifaximin would address or is it coming from a dietary mismatch? So, we start with diet and lifestyle first, then we graduate to therapeutics that are more centered around dysbiosis. And then after that, that’s when we can have a better read for if someone truly deficient in HCL or does someone potentially have pancreatic insufficiency.

And what you’re describing sounds a little bit like it might be either low HCL or potentially more likely it could be Pancreatic Insufficiency. But it’s hard to read that because the treatment for Pancreatic Insufficiency is kind of this graduated increasing of a dose of a pancreatic enzyme. And in theory, if someone had Pancreatic Insufficiency, but they also still had, let’s say, methane SIBO causing constipation, they may not be able to see or realize the response from the enzyme trial, because the potential benefit from that as being thwarted by the fact that methane CBO is still present. So that’s part of why there’s this sequencing.

That’s one thing that I plan on slightly refining and tweaking in the Healthy Gut, Healthy You protocol is sharpening up that sequencing just a little bit more and putting after the antimicrobial phase, a more thorough visitation of the HCL and enzyme bit. One of the things that’s challenging is, if there are too many steps in the program, people are going to throw up their hands and say, “Oh my God, I can’t do this, it’s too much.” So, you can kind of get there through the protocol because you’re doing the antimicrobials because you’re actually doing the enzymes before the antimicrobial phase, you’re doing the enzymes and HCL in one, and you’re doing that while you’re doing the probiotics.

You may notice the improvement when you go through the wean off. So, when you’re going into the wean is when you may discover this. But if you’re doing it with a clinician, they can be a little bit more precise in how they do this. And what I do in the clinic is I address dysbiosis first and then I circle back to a more targeted trial on things like HCL and EPI. You get there with the Healthy Gut, Healthy You protocol, it’s just, you can, you could in theory, make it a little bit cleaner.

But in any case you’re on the right track work through the Healthy Gut, Healthy You protocol The one thing that you may want to consider is doing the specific enzyme titration for Pancreatic Insufficiency after you’ve gone through the Healthy Gut, Healthy You protocol, and also try just HCL alone and do a titration upward to four caps per meal and see if either one of those remedies things, if the Healthy Gut, Healthy You protocol does not. Make sure you do the Healthy Gut, Healthy You protocol first, and then based upon your symptoms, it does sound potentially like more of a nuanced imbalance in GI secretions may be present.

Erin Ryan:

It’s all about that roadmap.

Dr. Ruscio:

It helps.

Erin Ryan:

It does. It sounds like he’s trying to throw… he sounds like me, I try to throw everything at the problem all at once. Oops. Okay. Good luck, Kyle. Our next question is from Robin. She wants to know, do you think subclinical hypothyroidism is a spurious diagnosis? Even if thyroid medication leads to improvement of symptoms? Is prescribed T3, just masking gut symptoms in this case?

Dr. Ruscio:

Great questions. I think that we’ve, we’ve definitely harped on in the podcast.

Erin Ryan:

It was like, should I put this in here? We talk a lot about this.

Dr. Ruscio:

Yeah, I think this is important because if people are new to the podcast or maybe fully didn’t register this when we had discussed it in the past, it’s always important to kind of keep this in circulation. Because unfortunately yes, one of the most spurious arguments or promises in the functional medicine space is this, your symptoms are caused by this nuanced imbalance in thyroid hormones, which conventional medicine is just ignoring. And we only have the answers here in functional medicine. Which I was practicing for years until we kind of started fact checking this and realizing that so many of these cases are really underlying GI cases. And it’s been sad seeing how some people have really had their care fumbled for one, two, three years until they finally figured this out.

Subclinical hypothyroid is not a fictitious or spurious diagnosis, it’s an accurate diagnosis. The disagreement comes from how do we treat the subclinical hypothyroid? And for our audience, subclinical hypothyroid is when TSH is flagged high and T4 is normal. Now there have been adequate studies that have looked at subclinical hypothyroidism and given these people thyroid medication. And there has been no clear benefit when doing so, so this question’s been answered there. There’s a couple of caveats there.

When the TSH is above 10, that’s when people may benefit, that’s one exception when people may benefit. If someone exhibits a history of infertility and they’re trying to get pregnant, that’s another exception. And/or if you see subclinical hypothyroidism in very young populations. I don’t know if there’s agreement on exactly what that age definition for young is, but I think you can say in their teens or younger, then that’s when you may want to be a bit more careful. Or there may be more of a potential benefit from using thyroid hormone, in someone with subclinical hypothyroid.

Remember that there’s an age associated creep up in the TSH. So, for someone to have a slightly elevated, i.e., subclinical hypothyroid at 60, is much, much more normal than someone at 16. And that’s why there’s this age association to how we interpret subclinical hypothyroid. Now the T3 piece meaning, is prescribed T3, just masking the symptoms? My thinking there is the provider is trying to kind of split the baby, meaning they’re not wanting to treat you for overt subclinical hypothyroid or kind of hypothyroid, so they’re, they’re not giving you the T4 they’re instead just giving you the T3. But T3, it’s more so treating the downstream metabolism of the T4. So, it’s a bit tangential or downstream tangential in a way. What I’ve seen is clinicians will look at downstream imbalances and thyroid hormone and treat that.

The analogy that we’ve used in the past is if you see a male who has low testosterone, and then you give him more testosterone while ignoring the fact that he’s inflamed and therefore aromatizing his testosterone into estrogen. The problem is aromatization it’s mal conversion, it’s not deficiency, then giving T3, is a bit a logical given that. I remain open to the fact that the T3 may help some with symptoms. But I don’t believe it’s accurate to say that the T3 is masking symptoms because they haven’t seen enough patients report they feel demonstrably better from T3.

Now that being said, I’m probably not seeing many of those patients walk in the door. Because for the people who had does it work, they’re probably not motivated to come into our clinic and get a second opinion. However, again, we’ve talked about, there have been trials giving patients, thyroid medication as T4 who are subclinical hypothyroid, and no benefit has been demonstrated other than those exceptional cases or situations that we talked about a second ago. We’ve also gone through an exhaustive review of the literature looking at, does T4 plus T3 work better than T4 alone? Generally speaking, no, except for a small number of people who, and this is 10%, maybe less of individuals who are genetically poor converters.

There was a follow-up question, and this is mainly in our clinicians newsletter, we’ve been discussing this. Well, the reason why your view didn’t find that our ratio of T4 to T3 was beneficial was because you weren’t using the right ratio, or you weren’t looking for the studies that use the right ratio. So, it was a fair question. And we went back and reanalyze all the data, and we found that no, there is no trend in the data finding that a specific ratio of T4 to T3 works best. Here’s just a side note to articulate the maddening nature of my position sometimes. Even after going through that review…we review all the evidence and we write it up in our clinician’s newsletter with the references, someone replies that, “Well, you’re missing this study and I don’t think your analysis is right.” The study she’s referencing is one of the studies that was in our analysis. It was one of maybe two studies that found T3 ratio did matter. Whereas there were essentially eight studies that found the T3 ratio didn’t matter.

This is part of where I get a little bit peeved, because if we’re going to try to argue your position with us, which is fine, I welcome the dialogue and that’s why we went into the secondary analysis to begin with. But when you don’t take enough time to clickthrough and look at what evidence, our case cases, based upon to see that your very study that you’re referencing is in our analysis, it’s like, Jesus, if you want to believe what you already believe, that’s fine. And that’s how you operate when you want to believe what you already believe. Which is you don’t actually read someone’s argument and therefore learn, you just kind of reiterate your preconceived or your current justification.

But the way we’ve learned is we look at someone’s arguments and we compare them to our arguments. So, without getting too off topic here, suffice it to say, we’ve really looked into this issue and it sums out to essentially the following. Most people will not need T4 plus T3, they will be fine with just T4. A small amount of people, 10%, potentially less of the population will do better with T4 plus T3. A specific ratio of T4 plus T3 doesn’t seem to be any better than the standard ratios that most medications are using. And to the question of T3 alone, I am highly, highly suspicious that it offers absolutely no benefit other than placebo, except for the ones in a very, very, very rare occasion, leaving the door open there. Not that I have any data to support that, but just because I like to be acknowledging of what I don’t know, and that a possibility could exist.

So, all that maybe to say that thyroid problems are blamed for symptoms, way more frequently than they should be. And if you look at the fact that, I may be off on some of these numbers here about 4.6% of the population is hypothyroid and functional gastrointestinal disorders affect about 40% of the population. Gut disorders and gut problems are more common than thyroid problems. Although there are some who practice in a very inverted way. So yes, I would be suspicious that the T3 isn’t only masking, but more accurately said is probably just, if anything, giving you a placebo and certainly not impacting the underlying cause.

I think this is a real area where functional medicine is incorrect and is harming patients. And that’s been documented by some of the case studies that we’ve published where real people have come into the clinic and for a year or two had been on thyroid medication, feeling little to no better the entire time in some cases actually feeling even worse. Then we’ve been able to take away years of suffering and a couple months by just doing this the right way. So, it’s not that I’m trying to call anyone out, just because I’m trying to be a contrarian, it’s, it’s disheartening when someone cries during their initial exam because they’re so fed up, but not feeling well. And it’s like, “Oh, you were never hypothyroid and let’s just change this, let’s fix your gut.” And two months later, “Oh my God, I feel better than I felt in two years. No need to cry anymore and have every day of my effing life ruined.” So that is why I get a little bit passionate about this because it’s just, it’s troubling when you see someone in that much pain for that long when they don’t need to be. So my thoughts on T3 and gut.

Erin Ryan:

Alrighty, I was pleased to hear it. So, my cousin who’s very close to me, she was having some issues and her allopathic doctor had said, “Oh, it looks like you’re inching close to subclinical hypothyroidism” but she said, “No, you don’t need to be on hormones or anything like that.” So, I was like, “Oh, good for her. Like, she didn’t try to push that on you.” Because I was like, “Wait, don’t do anything, talk to Dr. Ruscio before you listen to this person.” She was like, “Well, she said, I don’t have to be on hormones.” I was like, “Okay, that sounds right.” Based on like, we cross-check like your numbers from what you said in a podcast to like her numbers. And I was like, “No, I think this is the right track.” So good for her.

Dr. Ruscio:

Yeah. This is one area where I think conventional medicine is doing it right. I mean, they’re doing it, in my opinion, more right than they are wrong. And I think part of what’s happened here is people go to the conventional doctor and the conventional doctor is very kind of, well, you’re not hypothyroid, so sorry. And on the one hand, it’s great that they’re not going to read more into their thyroid lab work than they should. But I think where they fall short is the patient says, “Well, what about my depression? What about my brain fog? What about my dry skin?” And the conventional doctor says, “Well, you’re not hypothyroid.” And so, it’s lackluster in the sense that, well, what else can I do? What else do you have for me?

Erin Ryan:

Yes, yes.

Dr. Ruscio:

But where functional medicine falls flat is now everyone has hypothyroid, and they go way too far in the other direction. So, I think we’re, we’re in the midst of this kind of auto corrective phase where we’re realizing, okay yes, we want to do more, but we don’t want to do more based upon a fallacious argument and ignore what research and conventional medicine has offered us. So, we want to do more, but we don’t necessarily need to invent a diagnosis within thyroid. That’s where I think is going wrong at current or one of the things that’s going wrong.

Erin Ryan:

Okay. So our next question is from Raphael.

Raphael:

Hello, Dr. Ruscio, it’s Raphael from Germany. After reading your book, I came up with the following question. Is it counterproductive to take things like Glutamine or Collagen while trying to dissolve bacterial biofilms with Biota-Dissolve or other products of this category? Thank you so much, your book has been a real gamechanger for me.

Dr. Ruscio:

Awesome. Great question. Thank you. No that is fine. In the clinics, sometimes I do. Sometimes I don’t use some of these kinds of adjunctive supports. The formula I typically use is gut rebuild nutrients, although this is not the only formula or highly unique in what it does, it’s just a combination of various gut supportive nutrients centered around glutamine. The thing that I grapple with and I think any clinician or person putting together their own health plan, is how much is enough and then how much is too much. Because if we give you 15 things, it’s likely you’re going to feel bad. I don’t want to say that that’s always the case, there’s not a direct correlation between more things and feeling better. But part of what you could say is, well, if we give you 15 things, then you’ll likely improve, but could we have gotten that same improvement with four things?

There’s this sweet spot where we don’t want to be so slow where let’s say we give someone one probiotic and then we wait a month and then we give them the second formula probiotic in addition, and then we wait a month, then we give them a third. We can maybe do all three probiotics at once and we can do more than literally only one thing at a time. On the other end of the spectrum, it’s kind of this top-down approach or throw the sink at you and hope something sticks. The optimum is somewhere in the middle, a bit more toward the minimalistic side of the scale. So that’s where I do sometimes use these nutrients at the same time.

We’re going through some of the early phase, sometimes I don’t, it just depends on how robust you want to be really, and how reactive you are. The more reactive you are, the more I would really follow a one thing at a time or only one or two, you’ll be minimalistic at a time step wise and the less reactive you are and the more financial wherewithal you have to dump into more supplements, then I think it makes it more justifiable to use a nutritional or kind of supportive collagen/Glutamine formula while you’re going through some of those steps. So yeah, it’s not a right or wrong. It’s more based upon some other conventional factors, when is the best time?

Ruscio Resources:

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, 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. 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. 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.

Erin Ryan:

Our last question is from Heidi. She says, have you come across any concerns with drug interactions or alterations within the P450 enzymes that may affect a drug’s metabolism with the use of probiotics? What about altering transporter interactions such as PGP or OATPs. Looking forward to hearing your insight?

Dr. Ruscio:

Great. Well, I think, you know how I’m going to categorize this answer, Erin, but it is an important type of question to field. So firstly, I don’t know of any drug/probiotic interactions. There could be some, but in all the papers I’ve read, which has been quite a lot, not a single paper has mentioned this. So at least from my high level of reading in probiotic research, this doesn’t seem to be pressing enough of an issue for it to be brought up. Could there be something I’ve missed? Yes. But again, I haven’t seen this anywhere. But this question categorically is a bit more academic and, in the weeds, than it is clinical. And why that’s important is because if you’re level of analysis is more like a bench researcher looking at kind of the mechanism and the metabolism, you can miss the clinical science, which is more your randomized control trials, which is what the mechanistic conjecture eventually leads to.

Now the hypothesis is ready to be tested in humans in an outcome trial. And I’m assuming that what you really want to do is use a probiotic to remedy some subjective problem, energy, sleep, brain fog, bloating, loose stools, what have you. And that’s where I come back to, well, the best answer to this question is let’s look at what the clinical interventional studies, the randomized control trials can tell us. So, unless you’re trying to solve a problem of a P450 enzyme problem you know that you have, then this question becomes a little bit misdirected.

Typically, the way these things play out is, the mechanism may lead you to a broader question that does have clinical relevance, but sometimes people ask in a very detailed way. It’s almost like saying you’re trying to get to the beach, and you ask people, do you know how to get to…and you give them a latitude and longitude. And they’re like, “Well, I’m not really sure where you’re trying to go there.” And they said, “Well, I’m trying to get to the beach.” It’s like, “Oh, we’ll just take fifth Avenue all the way to the West and then you’ll get to the beach.” It’s like, “Okay.” So, in this case, if there’s some sort of issue with the liver, there had been a number of clinical trials that I have found that probate can lower liver enzymes.

If this question is a specific question, that’s actually trying to ask the broader question of, could the probiotic help with liver health or do need to be careful about taking a probiotic if they have compromised liver and then potentially compromise P450 function? Unlikely. It seems much more likely that the probiotics will help. So good question. A bit of reframing to maybe get you to the level of analysis that’s going to be most productive for improving your own health. Unless you’re a researcher, then this question is a bit more squarely targeted and correct, if you’re kind of an academic research, you’re trying to better understand some of the mechanistic underpinnings of probiotics and how they work. But otherwise, I think those remarks hopefully are salient and will kind of help focus you and direct you in a way to think about the use of probiotics that may help you with what I’m assuming is some kind of underlying health concern.

Erin Ryan:

Okay. Yeah, when I read the question at first, I was like, oh, maybe this is a school question because it was very academic. Then it reminded me of like word math problems and I had PTSD.

Dr. Ruscio:

Those questions. They do have a time and a place.

Erin Ryan:

Sure.

Dr. Ruscio:

Those types of questions, at least for my vantage point in the healthcare field is, how do I use information to improve people’s health? And so those questions are asked by people in certain positions in the healthcare community to eventually then have them readied to then be transferred to a clinical setting of a clinical trial and give us the outcome. And that’s kind of when you picture the evidence-based pyramid, the lower levels, and I don’t mean lower in a derogatory way, it’s important to clarify that. But that’s more where people are looking at mechanisms and then saying, okay, now how do we take this mechanism and look at it? Oh, okay. That should mean then if this mechanism is correct, if we manipulate this, then it should improve that clinical outcome. And now it gets translated upper level to clinical science. The clinical sciences where I’m looking, because it’s a much more efficient vantage point. Again, if you’re a clinician, it’s a much more efficient vantage point because it filters out all of the hypotheses from the lower levels of the pyramid that don’t make its way up to being viable in the clinical wrong of the pyramid.

Erin Ryan:

Okay, well said.

Dr. Ruscio:

Whew! Okay, all right.

Erin Ryan:

Aren’t you glad you got that off your back?

Dr. Ruscio:

Yeah, right? Well, I tried to explain because I don’t want people to think of me dismissive of the questions, but there’s so much information, that unless you have a filtering mechanism, then you get bogged down in inefficient reading and exploration. I’ve learned over the years that I have to apply certain filters to make sure that I’m not getting pulled into hypotheses because I can’t read everything out there.

Erin Ryan:

Right.

Dr. Ruscio:

So there, there has to be some efficiency gaining filter that we use to make sure that we’re focusing on the things that are the most important and relevant to improving people’s health.

Erin Ryan:

Yeah, that makes sense. Well, that was all of our questions for this week.

Dr. Ruscio:

Awesome. Well, thank you, Erin. And thanks guys. Keep the questions coming and we will talk to you next time.

Erin Ryan:

All right, thanks.

Outro:

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