Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
Listener questions – symptoms while fasting, elemental diet, traveling, H. Pylori and more.
Today we will cover listener questions from Healthy Gut Healthy You, including…
Diet for microscopic colitis
Stopping antimicrobials and biofilm removers after one month
Symptoms while fasting
Mixing Elemental Heal with other liquids
Traveling out of the country
Great-in-8 and H. Pylori
Is the protocol okay for children
Dr. Michael Ruscio, DC: Hi everyone, welcome back to Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here again with Erin Ryan. We are going to be taking listener questions. Man, it feels like it’s been a while, Erin. It’s good to be picking this back up and digging in to some of these questions.
Episode Intro … 00:00:40 Diet for Microscopic Colitis … 00:02:16 Stopping After One Month of Antimicrobials … 00:08:48 Headache, Other Symptoms When Fasting … 00:16:30 Taking Half Elemental Heal, Half Juice … 00:20:54 How to Treat Gut While Traveling … 00:24:09 H. Pylori Treatment in HGHY … 00:29:53 Reactions to Whey in Elemental Heal? … 00:35:59 Using the Protocol for Children … 00:39:42 Negative Reactions: Normal Part of Process … 00:42:12 Episode Wrap-up … 00:45:35
Hey guys, this is Dr. Ruscio with a huge favor I’d like to ask you. If you could take 15 to 20 seconds and fill out a survey that we’re running to help us better understand you, our audience, I would deeply, deeply appreciate it. If you’re on the go and you’re just listening to the podcast, the link to the survey is conveniently located in the description on your podcast player. It is also, of course, located in the transcript associated with this sphere if you’re reading this. The direct link to the survey is, it’s DrRuscio.com/survey. It’s super short. Five-ish questions will take you 15 to 20 seconds, but it’s very helpful in allowing me to better understand our audience and better serve you guys. So if you would please take just a moment, it will be very helpful for me and I would really appreciate it.
Again, the link is in the podcast description on your players. It’s also embedded on the website with the transcript post, and it’s directly accessible through DrRuscio.com/survey. Okay. Thanks.
Erin Ryan: Yeah! We’re going to focus on questions we received for the book Healthy Gut, Healthy You. I think that all of these are timely and relevant. The book has been out for a while now.
DrMR: About a year and a half.
Diet for Microscopic Colitis
ER: Our first question is from Sophie. It’s a broad question, but I think it will help out some folks with a specific ailment.
“For step one, do you have any advice on the diet for microscopic colitis?”
DrMR: Just to get the audience up to speed, the first step in the program or protocol (even though I don’t love that word) laid out in Healthy Gut, Healthy You has to do with finding the right diet for one’s gut. We really can make a referenced and scientific case that a variety of different diets can be helpful for one’s gut. Rather than me imparting my own bias into the conversation and only citing the research referencing what diet I want to be the best, we lay out a few different options and help guide you to discovering what diet might be best for you and your gut.
In this case, for microscopic colitis, there’s not really a diet that would be the best. I should take a large step back and say, even going on your standard nutritional advice—which many of us wouldn’t maybe find to be the best advice—which includes partially increasing whole grain consumption in the diet (not to say that grains are always a problem, but even dietary advice that basic), upping non-processed grains, fruits, and vegetables, and reducing sugars and processed foods, has been shown to be helpful. So, from nothing to that has been shown to be helpful.
Then, from there, elimination diets like a paleo diet (but not limited to a paleo diet) that cut out things like gluten, dairy, soy, and this handful of other common irritants has also been shown to be helpful. As has a low-FODMAP diet, as has the specific carbohydrate diet, and one study in the autoimmune paleo diet. All of these are codified into the stepwise approach, in step one in Healthy Gut, Healthy You, that helps you determine what the best diet for you should be. So there fortunately is more than one option here.
Now, this person can go through the protocol in the book, and figure out, based upon the signal her body gives her, “I feel no different on this diet,” then move on to trying a different diet. “I feel better on the second diet.” Let’s say the second diet is low FODMAP, great. That tells us that the reduction of FODMAPs which feed bacteria is more important for your gut than the reduction of potential allergens. Not all these foods will be a problem for all people all the time. We go through a short experiment, usually two to four weeks on a given diet, and then reevaluate.
If the needle is moving forward and your symptoms are improving, good. That means that’s a good dietary maneuver for you. Continue. If you notice little to nothing, then try one of the other diets. It’s tempting to think that we’re all, as it’s sometimes termed, unique snowflakes, but we’re really not. Typically all those snowflakes fall into the purview of what the research literature has already discovered, a snowflake type one, type two, type three, or type four. That would correspond to maybe an elimination diet, a low-FODMAP diet, elimination plus low-FODMAP, or elimination plus low-FODMAP plus a nuanced SCD.
If that sounds like a lot, the book just walks you through, “Here’s step one. Do this for two to four weeks from this food list. Reevaluate. If it’s working, continue. If it’s not, move on to this slightly different version and give that a few weeks and then reevaluate again.” That’s pretty much the answer.
I would just close with a little bit of encouragement. It’s typical that people want to think, “Well, if I know I have a SIBO-positive breath test, or if I know I have this diagnosis, does that vastly change the protocol in Healthy Gut, Healthy You?” For the most part, it does not. The protocol, the program, or the process in Healthy Gut, Healthy You is built with all of this in mind.
Again, it’s tempting to think because you have one diagnosis or one piece of lab work, that you’re going to do things vastly differently. Fortunately, when you know enough about how all this works, you can simplify down to the approach in Healthy Gut, Healthy You, which has nuance and personalization built in, and simply follow that protocol. You should end up—in this case with microscopic colitis—with the best combination of interventions for your gut and how to rebalance things, so that you’re devoid of symptoms.
ER: Well said.
DrMR: Let me ask the audience, if you’re enjoying the podcast, if you would do me a huge favor and write a quick review in iTunes. We’ve recently gone from five stars to four-and-a-half stars. I’m assuming that there are maybe a few people who don’t like the fact that I challenge some of the concepts that we consider religious truths in functional medicine.
I will not lie to you. It bothers me. When I saw that our rating went from five stars to four and a half stars, it’s definitely something where I’ll just be walking the street and it will pop in to my head and bother me for 30 seconds. Then I’ll just remind myself that you can’t ever make everyone happy.
Looking at the caliber and rigor that we try to go through with being truthful, evidence-based, and unbiased in this podcast, I really feel that the podcast is more deserving of five stars. If you agree and if you feel like it deserves that ranking, please help turn the tables to move us back to a complete five by leaving us a quick review. I would deeply, deeply appreciate it and will help me sleep better at night also. Haha.
Stopping After One Month of Antimicrobials
ER: Good. With that said, we’ll go on to our next question, which is from step two in the book, the Remove phase. Victoria says,
“After one month in step two, my liver became impacted: high bilirubin, jaundice, etc. Though I suspect the reaction was artemisinin, I stopped all antimicrobials and biofilm removers and opted to not continue with month two. After about three weeks, my liver appeared to have cleared. My digestion system appears to be functioning well. No bloating or diarrhea. During the first month of antimicrobial and biofilm treatment, there seem to have been two die-off episodes.
To support any progress, I continued to eat low FODMAP and continued on my soil-based probiotics. At this point I’m considering starting prokinetics and adding back in Lacto-Bifido and Saccharomyces boulardii. Can you tell me what benefits I may have missed by stopping after one month of antimicrobials and biofilm removers? Given the decision to move on to rebalancing early, does my approach for doing so make some sense or would you recommend other considerations?”
DrMR: Again—for the audience, to contextualize where this question is coming from—in the book, the third step of the program calls for the use of specific herbal antimicrobials. We reserved this for the third step because we spend the first two steps laying the groundwork to encourage your gut to naturally fall into balance. This is why, in my view, people who just go on Rifaximin, an antimicrobial protocol, or an antifungal protocol will oftentimes regress afterwards. They haven’t laid the appropriate groundwork, which is all working to encourage balance in your gut ecosystem and less inflammation. Less inflammation means the growth of healthier bacteria and better nutrient absorption.
When we lay this foundation, we can administer what I term a “nudge” with antimicrobial herbs to help encourage this reset back to healthier equilibrium, which may not be achieved yet because some unsavory players have overgrown. Even though we’ve done all this work to support balance with diet, with probiotics (the first two steps), we still may need to provide a little nudge to push out the unsavory players from their overgrown perch and allow the healthier guys to reestablish an equal footing. Then, once you get back to balance, oftentimes it’s much easier to maintain that balance in the long term.
In this case, it seems that, in that step of antimicrobials, it’s a two-month step. The second step simply caused some reactions. I wouldn’t necessarily overthink this. Sometimes people can have reactions to herbal antimicrobials. Oftentimes, this is quite simple to navigate. Oftentimes, people want to think that it means it’s killing certain organisms instead of others, and they have all these hypotheses. What I’ve noticed in clinical practice is it’s not that specific. It’s not that precise.
We should zoom out and quite simply have someone do a little bit of experimentation to figure out what of the items that are administered into that step—in this case, the second month of the antimicrobials—that are driving the reaction. It very well may have been artemisinin. Simply stop using that one agent, because that agent may be irritating to one individual’s system, and instead carry forward with the things that are tolerated.
Now to the question of, “Do you shortchange your results by doing just one month instead of doing the full two months?” Probably not. It really depends on how much you had in the way of symptoms before starting the antimicrobials, and where you feel you are at after ending the antimicrobials. What you’re looking for is movement in the right direction. When you plateau after that, you should be looking to plateau at least at 80% to 90% improvement overall. What I’ve noticed is, when we get close to perfect, usually with time the body will get the rest of the way there. In the acute phase here, you do the antimicrobials, you observe your body for a few weeks afterward.
You’re looking to see, “Do I seem to be pretty close to where I’d like to be, or am I still a decent way off?” This is all, again, mapped out exactly in the book in terms of what to do. The answer is simply listen to your body, follow the guidelines laid out in the book, which would essentially direct you to repeat the antimicrobials if you did not reach the level of symptomatic improvement that you’re looking to reach, or continue forward with completing the other steps in the protocol. Now if someone has a hard time with one set of antimicrobials, I list a different set that they can consider. You can also consider using the elemental diet if more help is needed.
Now it’s important to clarify that going through every step doesn’t mean you will have the best gut health. You want to use the minimal amount of intervention necessary to get you to a point where your symptoms are gone or close to gone.
Again, a lot of these questions are already answered in the book. I think people just need the confidence of trusting themselves to follow the book protocol. Essentially, the short answer is you would do exactly what the book protocol says. There is not necessarily any problem with doing a shorter course of antimicrobials. Again, it’s extremely context-dependent in terms of how you’re feeling afterwards.
Just refer back to the book and that will continue to walk you through and hopefully these remarks give you a little bit of confidence and clarity in what you’re doing.
ER: I can say, it sounds like she said there are some positive results with the digestive symptoms. There is no bloating or diarrhea. It sounds like she definitely got some benefit from it and didn’t miss out on too much.
I can also say from personal experience that it’s really easy to feel disheartened when you get your bottle of antimicrobials and then some other symptoms occur. What we found in working together was that, I just wasn’t handling a multi-antimicrobial approach very well. We had to take it down to one specific one and then I felt great.
ER: So don’t lose hope.
DrMR: A formula with just one ingredient. That’s exactly what we discuss in the book. This is a good question, in the sense that hopefully it will give you the confidence that you really have the answer right in front of you in the book. Just continue to work through that process and what you’re experiencing. Although it may be a little bit disheartening, there’s nothing that’s really outside of the norm.
Headache, Other Symptoms When Fasting
ER: Next, we have a question, this is also for step two. Jen, age 35, has had moderate-to-severe chronic fatigue syndrome and POTS for the past two and a half years. When she was going through the fasting process on day three, she felt headache-y and tense so she stopped the fast. She noticed that in the time after she did the fast, she had severe POTS reaction to some foods that she didn’t notice previously. She also experienced some symptoms of heart racing and pounding, especially when she was upright. She’s wondering if this had more to do with the fasting or if you have any other ideas on how those symptoms might have been brought on.
DrMR: Again pretty much it comes back to exactly what we speak to in the book protocol: fasting is not for everyone. For some people, it’s too much stress. That sounds exactly like what this reaction was. Again, reactions happen. They’re nothing to worry about. Realize that if you go through a multi-faceted protocol like the book offers, there’s a good chance that something in that multistep, multifaceted protocol is not going to be the right maneuver for you. When I say that, it’s important to understand that the way you discover it’s not the right thing for you is by receiving a bad or negative signal from your body.
Perhaps it would be helpful to know—and I should really consider writing this into a future version of the book whenever we revise it—that these reactions should be looked at in a more constructive way. Because the more of these questions I see, it seems that people have a hard time conceptualizing that they can have a reaction and it doesn’t mean that they’re doing something wrong. That’s really important to understand that. And I get it. When I was new in practice and someone came in saying they felt worse, in my head, I was like, “Oh my God.”
ER: “What’d I do?”
DrMR: Over time, you just realize that no therapy is perfect. Patients will have reactions. Over time, you have enough experience and wisdom to say, “Okay, if you have this kind of reaction, here’s what we do next.” Instead of getting worried about it, you look at it just like data. And you’re calculating based upon that data what to do next. In this case, nothing to worry about. That will happen with some people. You simply do not make fasting a part of your health plan, at least not for right now, because it’s not a good stimulus for your body. It may be too much stress for your body.
Nothing is wrong. Nothing is broken. Just continue to work through the protocol, and realize and remind yourself that these reactions are precious indicators to help you find what you should do and what you shouldn’t do. I’d say, just for everyone, be a little bit less worried about them. Be more mindful that they are actually constructive, in the sense that they, again, help you delineate between what you should do, what you keep in your plan, and what you should not do.
DrMR: Hi everyone. I’d like to thank Just Thrive who helped make this podcast possible, and to tell you about their prebiotic, Precision PREbiotic. This contains a blend of three different prebiotics; galacto-oligosaccharides, fructo-oligosaccharides, and xylo-oligosaccharides. These three prebiotics work together to feed your intestinal bacteria.
Now, patients with impaired digestive health should be cautious with prebiotics, but this does not mean that prebiotics should be avoided. Prebiotics have shown the ability to improve digestive symptoms, encourage growth of healthy bacteria, decrease inflammation, and blood sugar.
So a trial of prebiotics should be included in your gut health plan. This is why I include prebiotics in the Healthy Gut, Healthy You program. If you visit thriveprobiotic.com, you can use the code RUSCIO15, for a 15% off discount, which can be applied to all Just Thrive products. They are also available on Amazon. Check them out.
Taking Half Elemental Heal, Half Juice
ER: Next, we have a question from Cameron. He says,
“I’m currently going through the second month of step three on the antimicrobials. I’m really interested in doing an Elemental Heal fast once I’m finished. Since I’m on a college student budget, would it still be effective to fast on both the Elemental Heal and homemade vegetable juice? Since the Elemental Heal is a little out of my price range, I was thinking of only drinking half the recommended daily intake of shakes and adding one to two glasses of juice.”
DrMR: Yeah, that would be fine. There’s definitely wiggle room with all of these protocols. Now, on the one hand, I recommend that people don’t modify things because once you open up that Pandora’s box, I think it’s easy for people to start modifying things in the wrong way. This is a challenging balance for me to try to strike, understanding that these things are not set in stone and there is wiggle room, but it’s impossible for me to write all the wiggle room into the book. Some minor modifications are okay. Significant modifications, I would try to avoid. It’s hard to, again, impart all the different nuances that one may want to do and one may not want to do.
Now in that vein, there’s no problem with using some bone broth or some vegetable juice to water down or supplement the use of Elemental Heal or an elemental diet. The only problem one may run into is going too low calorie. Now, the longer you’re using an elemental diet, the more of an issue this becomes. In the shorter term, if you’re doing the Elemental Heal for a few days, not a big deal. If you’re doing it for two to three weeks, then that’s when being hypocaloric may cause some issues. Meaning you may be tired, irritable, like what’s just described by the POTS patient.
It’s not to say that will happen. And that could even be beneficial if someone has high blood sugar and high body fat and then going a little bit hypocaloric or low calorie for a few weeks may be a good thing. This is where the nuances start stacking up. But there are some simple things you can look at. The more burnt out you are, especially if you’re underweight and burnt out, then going low calorie… bad idea. But if you fit the profile of someone who may do better on the calorie restriction, like being a little bit overweight, not feeling like you’re burnt out, having decent energy, these things, then you may be a better candidate.
Ultimately, try it. If it seems okay, continue. If you get a negative signal from your body that tells you that you probably want to back off a little bit, you may want to add a bit more solution of the Elemental Heal into your daily routine so that you’re not going hypocaloric.
How to Treat Gut While Traveling
ER: We’ve got an audio question from Elena.
Elena: Hi, Dr. Ruscio. This is Elena. I was diagnosed with Hashimoto’s back in February, but have had gut issues for some time before. These became much more severe after a trip to Sri Lanka last November. I’ve been following the brilliant step-by-step guide in your book and I’m now working my way through step three, which I’ve had to repeat. I’m hoping to soon be ready for step four, but I’m worried that a trip in a couple months to Kenya may upset the balance. What do you recommend I should take in terms of antimicrobials or other supplements in the leadup to the trip and while I’m away? Thank you.
DrMR: Great question. I’m so happy to hear that although she has Hashimoto’s, she’s not overlooking the impact of her gut. In fact, I will be releasing a case study on the website of a firefighter, who was diagnosed with Hashimoto’s and hypothyroid, went on medication, and didn’t see any improvement in how she was feeling. It was only when she went through the protocol in the book that she noticed her symptoms resolved. Really powerfully illustrating that in some cases the symptoms that one thinks are from the thyroid are actually from the gut. That’s great that she’s on the right track. Thank you for the kind words about the book.
Again, in step three, this is where we’ve gone through the preliminary steps one and two. We’re really building this solid health-encouraging foundation, and now we can use antimicrobial herbs to really try to reset the balance in the gut to this healthier equilibrium. Some people may need to repeat that more than one time. That’s what she’s indicating here. To the question of, “How do you travel while you feel like you’re in this precarious situation?” you can quite simply just continue to work through the program. If you’re traveling and you’re worried about eating some bad food or just having a regression because of the stress or exposure to pathogens, antimicrobials should be able to mitigate that.
This hasn’t really been studied. There have been studies with other antimicrobial agents like Rifaximin that have been shown to reduce traveler’s diarrhea and acute gastroenteritis, but the same has also been shown for Saccharomyces boulardii. In fact, there was recently a meta-analysis showing that Saccharomyces boulardii can reduce traveler’s diarrhea. I’m assuming you’re on, hopefully, all three probiotics, our Lacto-Bifido probiotic, our Saccharomyces boulardii probiotic and our soil-based probiotic. If one of those didn’t sit well with your system, then don’t use that one. Assuming you’re all on three, then those function to prevent this acute gastroenteritis and this traveler’s diarrhea.
Thankfully, we have a meta-analysis now with Saccharomyces boulardii substantiating that. And you should see a protective effect from the antimicrobials while being on them. Has that been published? No, it hasn’t been published yet. I don’t know when that study will be published. I’m not sure if there’s any research groups who are saying, “Can oil of oregano prevent traveler’s diarrhea?” but hopefully there will be and that will be published. It seems like a very safe inference knowing that when Rifaximin, which has been shown to reduce traveler’s diarrhea, has been studied against herbal medicines for SIBO treatment, they’ve been shown to have equivalent effectiveness.
So if they’ve been shown to be equivalent in the context of SIBO, I’m assuming they would also be equivalent, perhaps even more beneficial—because the antimicrobials are antibacterial, -fungal and -parasitic—than Rifaximin. Those are the steps I would go through. And you’re in pretty good shape if you’re on the probiotics and antimicrobials while traveling. I wouldn’t worry about it too much, and hopefully, you’ll have a little bit of fun. Hopefully this travel is vacation. That can be a very health-promoting time for people because they’re working less, they’re less stressed, they’re sleeping more.
Hopefully, overall, the travel to Sri Lanka will be enjoyable, you’ll feel good. I’d rest assured that, while you’re not bulletproof, with the probiotics combined with antimicrobials or even one of those alone, you will have some assurances to protect you against the negative effects from travel and/or from exposure to any kind of bugs while you are traveling.
ER: We actually had a guest on recently that was talking about a case study where, I think, he gave someone Rifaximin, and everyone except his patient on the trip got sick. He got out alive because he had his Rifaximin.
DrMR: Yep, and Allison Siebecker saw the same thing using our Intestinal Repair Formula. She and her husband were traveling, I don’t know if it was domestically or abroad, but everyone in the group got sick except for her and her husband. She attributed that to the fact that they were the only two using Intestinal Repair Formula while traveling.
I didn’t mention that in this last comment because I think you’re probably okay with the probiotics and antimicrobial herbs. Just because there have been other reports for other things doesn’t mean we have to do everything. This is where I’m trying to protect people from taking 30 bottles while traveling. But your point is definitely well taken, Erin, which is, there are a number of things that can be helpful. Hopefully, she can travel and not be too worried about it.
H. Pylori Treatment in HGHY
ER: Yeah. Our next question is from Mary. She wants to know how well the Great-in-8 Action Plan treats stubborn H. pylori.
“H. pylori was mentioned very briefly in the removal section. However, most of the natural remedies recommended for H. pylori, like mastic gum, are not found in the Biota-Clears. Can you please elaborate?”
DrMR: This is a great question. I used to give H. pylori-specific agents for H. pylori, like the mastic gum predominantly. What I started doing—in cases that had a low level of motivation or financial resources—was experimenting with only using the Biota-Clears. Because what I used to do is Biota-Clears plus additional specific H. Pylori remedies. I noticed in every one of these cases, they seemed to have the exact same outcome as patients where I was using the Biota-Clears plus a special anti-H. pylori agent. So I don’t think that we need to use those special agents.
This is one of the challenges with trying to be evidence-based. You can have too limiting of a view on things, and you may not be able to think beyond what the evidence is currently showing. It is a balance. We want to be careful, but we know that various antimicrobial agents have antibacterial and antifungal properties and the more we study these various herbs, we see they can work for various organisms like H. pylori. It’s very likely that if a study were done using the Biota-Clear series on H. pylori, we would show a favorable effect, especially when we combine that with probiotics which have been shown to have a synergistic effect with antibiotics for H. pylori.
We don’t have any research studies that have attempted to show, “Do herbal antimicrobials work synergistically with probiotics for H. pylori?” just because those research studies haven’t been done. We do know that if you pair probiotics with something that is antimicrobial, most namely antibiotics, they have a synergistic effect in clearing H. pylori. When we combine probiotics plus the antimicrobials, that tends to work very well, in my clinical experience for H. pylori. You could go a step further and add N-Acetyl-Cysteine which is also laid out in the book protocol, which has been shown in one well-designed study to enhance the clearance effect of H. pylori when it was co-administered with antibiotics.
And what I’ve noticed is most cases are able to clear H. pylori when they use the probiotic protocol in conjunction with antimicrobials, the Biota-Clear. It tends to work very well.
H. pylori in my experience has not been that difficult to get rid of. I think the reason why I’m seeing an increased ability to clear H. pylori… Maybe what you see published in some of the conventional medical studies—and this is just an assumption, but my thinking is—is people who are not taking care of themselves, not eating well. You may have people who are sedentary, drinking soda, and just generally unhealthy, who have this non-responsive H. pylori. We know that all of these healthy factors, like I just mentioned, lay the foundation that encourages balance in your gut microbiota. It would stand to reason that if there is no foundation laid in these general medical cohorts, they would have a harder time clearing H. pylori because they are relying solely on antibiotic therapy.
Whereas if you’re going through the Healthy Gut, Healthy You program, you will have taken steps to get time in the sun, be exercising. You’re reducing your stress. You’ve dialed in your diet, which is a huge step, and you’ve used, amongst other things, probiotics. All these things are stacking the deck heavily in your favor, that you will have a better prognosis than someone who is drinking soda, not sleeping well. Perhaps they’re sedentary, maybe even smoking, and looking for an antibiotic to be the one therapy to clear their H. pylori.
Some of the contemporary literature does suggest that with H. pylori, it’s more an issue of rebalance rather than strict eradication. If we’re looking to rebalance, that means you’re not looking to kill it, but rather you’re looking to get the ecosystem back in balance so that other bacteria will police out or down and hold in check the level of colonization of the H. pylori. For all these reasons, I’ve seen fairly exceptional results with the probiotics and herbals when combined on the foundational pieces for H. pylori.
Again, another one of many a good question that has already been incorporated into the program in Healthy Gut, Healthy You.
ER: Just for listeners who aren’t familiar with what Biota-Clear is specifically, that’s the name of the products that we have in our store that are antimicrobials. If you’re looking for that anywhere else, you can only find it in our store.
DrMR: We may start selling on Amazon at some point, but that’s one of many things I haven’t gotten around to.
ER: That’s why I was thinking Amazon. I just took advantage of the probiotic deal the other day. I was like, “Sweet. Free shipping, great.”
Reactions to Whey Protein in Elemental Heal?
This is more of a general question that came in for the book. Do any of your patients react to the whey protein in the semi-elemental formula that you recommend?
DrMR: This is a great question. This is one that comes up periodically. We should have some answers regarding this on the product page, but the short answer is, for the most part, no.
For the most part, we see pretty excellent tolerability to whey protein. I think what happens is one of two or three conflations that make people have the false assumption that they won’t do well on the whey protein contained in our semi-elemental diet (which is called Elemental Heal).
One, they’ve used whey protein in the past that was not lactose-free. Ours is lactose-free and casein-free. That leads to quite an increased tolerability of the formula. The fact that it’s lactose-free, I think, goes a long way.
Now, the other can be the way the whey protein is processed. Cold processed whey protein is significantly more expensive, but it’s much easier to digest. Essentially, it hasn’t been damaged by heat, which also should have an impact.
Thirdly, I wonder how many people have used whey proteins in the past that had other fillers in them. I actually had this experience with a whey protein. It’s fairly visible if you go to Whole Foods or you go on Amazon or what have you. It’s a fairly visible whey protein that is known to be of halfway decent quality. They have definitely got fillers in there because I would be bloated every time I used that, and I thought I had a problem with whey. And once I started using other clear forms of whey protein, I never had any bloating. The excipients or other fillers in there do make a difference.
For all those reasons, I think people are surprised at how well they could tolerate something that they were suspicious they may not have been able to tolerate historically, whey protein, if it is good quality, if it’s processed the right way, if there’s no other fillers or excipients in there. The answer to the question is, there is a small number of people who may not tolerate it. But for the most part, and this includes a somewhat sensitive subset of patients that I see, that tolerability is pretty darn good.
ER: We have time for one more question, which is from a mother.
“Can you use this diet/protocol on children and/or would anything need to be modified?”
DrMR: This is regarding the entire book protocol?
ER: Yeah, it’s a general question for the book.
DrMR: So the age matters a little bit. But in short, yes. What I typically do—and I don’t know that this has been definitively mapped out in the research literature—if they are a child, usually if they’re somewhere between six and 13, 14, then what I will do is use anywhere from a half of the adult dose to a quarter of the adult dose. And yes, we can go through all of these same steps.
The younger a child is, the more I like to try to start with using the diet, the probiotics. Then if they need more help, trying the prebiotic and fiber first. There’s some evidence showing that children may do better with a gut bacteria supporting approach than adults. That’s more if they’re really young, in terms of what the research literature shows, so if they’re two, three, four. Let’s say they’ve gone through step one of the book, step two of the book, and they’re improving all along the way, but they need to see more improvement. We may try a prebiotic and a fiber experimentally before trying the antimicrobials. If they see a positive response, then great. If they don’t, then we can always use the antimicrobials.
All the therapies are viable, as is the Elemental Heal elemental diet, which has been used in quite a number of studies in children with Crohn’s. Actually, the children in this one study in particular I’m thinking about, which is a two-year followup, the children who were using elemental diets actually saw a better growth and less disease activity than their counterparts who also had Crohn’s disease but were just using healthy diet.
So yes, these can be used in children. Of course, I would check in with your local doctor, their pediatrician, just in case there are things in this case that I’m not familiar with. But for the most part, they do tend to be very well-tolerated and can be used in children.
Negative Reactions: Normal Part of the Process
ER: That’s all we have for Healthy Gut, Healthy You this time.
DrMR: Awesome. Sounds like people are working their way through the protocol here. These are great questions. I just want to encourage people, again, to remember that a negative reaction is not a bad thing. It’s not pleasant, don’t get me wrong. But when you’re experiencing the negative reaction, there’s such a tendency to assume the worst.
And I get that. There have been supplement experiments that I’ve done and they’ve gone wrong. I felt really terrible for a couple of days. Before I connected the dots, I was thinking, “Oh my God, what’s wrong with me?” Your mind goes to the worst possible case scenario. Then I finally figure it out, connect the dots, and then throttle back on whatever experiment that I was running.
Try to keep in mind that those negative reactions should not throw you off. Just make a note of them and return back to the program as laid out in Healthy Gut, Healthy You, and use that to help steer you along the steps. And understand that that’s going to happen. In a fair number of people, a negative reaction is going to happen.
I think a fairly significant dictator, in terms of, can you use something like Healthy Gut, Healthy You successfully or not, has to do with the level of composure you can maintain if you have a negative reaction. If you can not freak out, if you can take a deep breath, try to step away from the minutiae of the situation and just read through the advice in the book objectively, and just make an adjustment like the book outlines, then you should be able to use this book very advantageously.
And that is good, because that saves you the need to spend the money to see a clinician. It’s one of the things I have definitely noticed some patients, they start going through the book protocol, they’re feeling better, they’re feeling better, they hit a speed bump, they hit a reaction, and they just stop and they make an appointment at my office. Oftentimes, I essentially take them through the rest of what the book already outlines. They feel a lot better having me there for my reassurance, which I totally understand. But if I’m trying to put as much power back in your hands as possible, I should mention that you would be surprised how many patients need nothing other than to just go through the book protocol with the caveats that are laid out there.
The book does recommend, “If you have a reaction here, instead do this.” Those are not just throw-away recommendations. Those are what I do in the clinic with patients. Again, while I’m happy to help anyone one-on-one who feels that they need it, I just want to encourage people, you’re probably able to do more than maybe you’re giving yourself credit for.
It helps to understand that those negative reactions aren’t the world coming to an end, even though if you feel like it in the middle of it. Rather they can be an indicator that you should adjust course, make one of the small modifications that are recommended in the book, and then continue forward.
I just want to close with that because I see that becoming this emergent theme, which is great. This is something that will really, I think, help our audience better be able to navigate their own healthcare. Part of this is just being able to weather that storm of having a reaction.
Hopefully, this has been helpful. Please everyone, keep the comments coming. It’s great to hear about how people are seeming to work their way through the protocol and reap some of the benefits. This is great stuff. Please keep it coming.
ER: If I may, I’ll just plug one more time: anytime you want to send questions, it’s really helpful if you can consolidate your question down to a shorter question. We’re not able to include questions that are your full health history and things like that. So we try to pick what we think we can get on the podcast, and we certainly want to help as many people as possible. We can do that by receiving questions that are a little more on the condensed side.
DrMR: Thanks for that reminder, Erin. And I’m sure that the people who are including the detail are probably doing so because they’re trying to give me all the necessary context. It’s one of these tough balances where, in an ideal world where time did not exist, I feel like context would be great. Unfortunately, it’s trying to balance answering more questions and giving a slice of help to a lot of people, rather than one full pie of help to just one person.
DrMR: Cool. Thank you, everyone. We will talk to you next time.
I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!
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