In this interview on Mind Pump TV, we answer the question “What is the best diet if I’m looking to improve my gut health?”
Sal Di Stefano: Hey, what’s up, everyone? Welcome back. I’m here with Dr. Michael Ruscio, author of Healthy Gut, Healthy You. By the way, there’ll be a link at the end of this where you can actually take a look at this book.
Dr. Ruscio, let’s talk a little bit about gut health or at least the best diets that people can go on or start with to try to improve upon their gut health. What are some good places people can start?
Dr. Michael Ruscio, DC: Well, one concept that’s important to mention as we wade into the conversation on diet is you don’t have to do these diets forever to notice that they’re working or not working. It’s a key differentiation to make because sometimes people may be led to believe you have to be on a diet for months and months and months before you’ll feel—
Try an elimination diet for two to three weeks, if you do not see improvement, try a different diet (it doesn’t have to be an extreme diet)
If you notice that you become symptomatic when you eat certain foods, it’s best to eliminate them for a while then you can try them again to see how you react
Paleo Diet – Great place to start (doesn’t have to be super strict)
Paleo is one of the easier diets to implement – there are many free guides online
Avoid processed food, grains, dairy, and sugar
Focus on healthy meats, fish, vegetables, fruits, nuts, and seeds
Low FODMAP Diet
Good for those that suffer from lots of IBS-like symptoms (gas, bloating, stomach pain, reflux, altered bowel function)
The Low FODMAP diet restricts foods that are high in prebiotics (found mainly in carbohydrates)
Again, try for two to three weeks, if symptoms do not improve try something else. If you feel better on this diet, you may want to stick to some version of this diet until you are able to tolerate other foods.
Some people do better if they eat larger and less frequent meals where others do not
Intermittent Fasting means you wait an extended period of time between meals to give your digestive system a little time to recoup. It can be anywhere from 12 to 72 hours. Some people like doing a 12-16 hr fast overnight where they skip breakfast and others like to take 1-3 days out of the month to fast. There is no hard and fast rule for fasting. Try different variations and see how you feel.
DrMR: It’s like this peeling of the onion. You have to work through all the layers. And I have not found that to be true. And I don’t think the clinical literature supports that. So that’s the good news. That means that you can try a diet for two to three weeks. And if you’re not clearly improving, then you should move on to a different trial.
SD: Oh wow!
DrMR: Now, if you are improving, you may notice, “Okay. I feel, I would say, 60% better at the 3-week mark.” Give yourself some more time because when you get to week five, you may notice you’ve gained all the way to 80%. So even if you’re not fully improved at the two to 3-week mark, give yourself a little bit more time to see where you end up at.
But you do want to look for, “Yes, I’m improved. Or I feel better. Or no, I don’t.” If you don’t feel any better, then you can move on to a different approach.
But the first approach I’d recommend people start with would be with a paleo-like diet. You don’t have to necessarily go super strict paleo, especially if you’re starting from a point of not having a structured diet. But a paleo diet is a good place to start. There are many free guides out there on the internet that you can look at Rob Wolff, Melissa Hartwig. Both have pretty good books on this.
But essentially, you will avoid processed foods, added sugars. And you will focus mostly on healthy meats, fish, vegetables, fruits, nuts, and seeds. And that’s a great place to start. It’s not going to fix 100% of gut cases. But you can get a lot of yardage out of that. And it’s a good place to start.
SD: Do you find that to be the one that you start your patients on where you see the most impact for the most people?
DrMR: Yes, that’s where I start people.
DrMR: It’s one of the simplest to implement. And it seems to be the most broadly applicable.
SD: So no grains in that.
DrMR: No grains.
SD: No legumes?
DrMR: It’s debatable.
DrMR: And that’s why I say a paleo-like because what I want people to do is focus on the big picture items.
SD: Got it.
DrMR: So no grains is going to be—
SD: A big one.
DrMR: A significant shift for a lot of people. No grains and no dairy. That will be the most significant shift. And then no processed foods. Beans and legumes are kind of in the gray area. I would say to be on the safe side and since this is only a short experiment, no beans and legumes for that two to 3-week period.
SD: And then afterward maybe reintroduce those alone—
SD: To see if those work.
DrMR: That’s also a very important dietary concept that you bring up, which is start with an elimination, which is why we say two to three weeks. But then later, reintroduce the foods that you’ve cut out somewhat systematically. Don’t bring in 10 foods all at once.
SD: Yeah, you want to know which ones affect you.
DrMR: Exactly. So you want to determine, “Do I have a problem with dairy or not?” You may have heard people are dairy intolerant. So, “I’m feeling good. I’m at the three-week mark. I’m less bloated. I’m sleeping better. My skin looks better. Let me now start having one or two servings of dairy and give that a couple days and see how I do.”
Some people will notice right out of the gate. They get bloated. And then the next day, their skin is broken out. But if you’re fortunate and you don’t have a reaction to dairy, a few days go by. You notice nothing. Great! Dairy is now something that you can use in your diet. And then you move on to the next food.
And you’ll likely find most foods you’re okay with. But there may be a couple that you have to be careful with. And it’s not necessary to say that you have to avoid them forever. But you may notice, “Okay, when I have dairy, I get a little bit bloated. The next day I break out. So I’m going to save that for rare treats. Not something that I’m going to do other than that.”
SD: Okay. Sure. Sure. Now, what about the low FODMAP diet? Is that another?
DrMR: So for people who have lots of IBS-like symptoms, which are mainly comprised of gas, bloating, abdominal pain, and altered bowel function—this may mean constipation, diarrhea, or even oscillation between the two. When you have these or other digestive symptoms like reflux, also this could be helpful for, or lots of belching, then a low FODMAP diet can be helpful.
And a low FODMAP diet essentially restricts foods that are high in prebiotics which are compounds found mainly in carbohydrates that feed our intestinal bacteria. Now, that is not necessarily a good thing or a bad thing. But some people are hypersensitive to the gas that these bacteria produce. Or they have too much of these bacteria. And so if you have too much of something—
SD: You don’t want to feed it.
DrMR: You don’t want to feed it. Exactly. And there are many low FODMAP handouts out there. I have one that we recommend in our book. You’ll probably find that not every low FODMAP diet 100% agrees. And that’s okay. Just focus on the guide that you have that will help you reduce FODMAPs. And if that’s what your gut needs, you will feel noticeably better after two to three weeks.
SD: Okay. And what about fasting or intermittent fasting? What is the impact of that? I know personally for me I a periodic 48- or 72-hour fast. And I notice significant improvement in my gut health which then benefits my athletic performance as well because obviously if your gut is off you’re not going to perform as well in the gym or on the field or whatever. So fasting has been great for me. But I rarely ever see it as part of a protocol for improved gut health. But you’ve said you’ve utilized it yourself for your patients.
DrMR: Yep, and actually the first step that we go through in the book protocol is diet. And within looking at paleo and low FODMAP, we also talk about meal frequency. And some people do better if they eat larger and less frequent meals. Now, this is a little bit of a contradiction to much of the health and fitness moniker.
SD: The bros like to talk about eating every two or three hours, which is false, by the way.
DrMR: And for some people, that works. But for other people, they do much better, as you’re an example of, when they intermittent fast.
Now, intermittent fasting essentially said simply, means skipping a meal. And some people will do this in a more organized fashion where they will habitually skip breakfast. They may do it every day of the week. And that may be a little too much for many people. Or they may do it three or four days a week. They’ll skip breakfast. And they’ll just have lunch and dinner.
This can be helpful for the gut because it gives the gut a chance to rest. The analogy I like to use is if you sprained your ankle and you were running 3 miles (aka eating three meals every day), how long would it take your ankle to heal?
SD: Forever probably.
DrMR: A lot. So if your gut is a little bit inflamed, a little bit injured, then giving it a chance to rest and take a break can be helpful.
And you can apply intermittent fasting in all different types. You can skip one meal. Some people do full day fasts. There’s not necessarily a right or a wrong. I would just start fooling around with it. Start with one meal. Skip breakfast. See how you do. If that feels really good, wait a day or two more and then try it again. And if you want to be more aggressive, maybe skip breakfast and lunch and have a really big dinner.
There’s no right. There’s no wrong. There’s no guideline that says, “You have to do it this way.” Just tinker with the concept of, “Hey, maybe I’m a hunter-gatherer now. And we don’t have any food. And it’s going to be maybe a day or maybe a few hours.” Skip a meal. Take a period without food. And see how you do.
SD: So the first one to start with, paleo.
SD: And the second one, FODMAP.
DrMR: Low FODMAP.
SD: And then look into fasting as a potential. And you can use that with any diet, with any nutritional application.
DrMR: Yeah, you can use that application with any diet. And regarding fasting, can you have tea or coffee? I would keep that minimal, especially if it’s adding.
SD: That’s good. That’s good. Why not?
DrMR: Especially if you’re adding things because if you’re adding sugar and creamer, then—
SD: That doesn’t count. Now, you’re not fasting anymore.
DrMR: And some people don’t react well to coffee. Some people, it can aggravate their gut a little bit. So the safest thing is probably tea. But I would try to do it, especially if you’re only going to skip one meal, just go with a water fast. You can later introduce tea or coffee once you have a baseline for how you feel on a water fast.
Just try to break these things down into mini chunks so you can say, “Okay, I feel good on a water fast. I tried green tea. That was fine. I tried coffee black. That was fine. I tried coffee with dairy. And I got bloated.” And they may be dairy sensitive because of that.
So break it down into little bits, a series of self-experiments. And you can get a lot of yardage out of that.
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