Recently, I was interviewed by Aliky Kouroupis for the Healthy Gut Experts Summit 2.0 and I wanted to share it with you. During the summit, we talked about what you need to know about healing your digestion, living better, and feeling your absolute best in your body, every day.
Aliky Kouroupis: Hi! Good morning! Good afternoon! Good evening! Wherever you are. This is Aliky from the Healthy Gut Experts Summit. And today, I’m enthused to introduce you to Dr. Michael Ruscio. Welcome, Michael.
Dr. Michael Ruscio, DC: Thanks for having me.
Dr. R’s Fast Facts Summary
When facing chronic conditions, the most logical place to start is evaluating the gut and take steps to optimize your gut health first.
What steps should people take first when they are struggling with chronic symptoms?
- In the book Healthy Gut, Healthy You there are specific steps to follow depending on the severity of symptoms – from mild symptoms to severe Crohn’s disease.
Efficiency in Gut Healing
- Have a protocol that adapts. You don’t have to go to extremes right away with diet.
- Use a diet sequence to guide you. Try a diet for 2-3 weeks to see if it is working for you or if you need to take it a step further. The diets laid out in Healthy Gut, Healthy You can guide you.
- Do your best to stick to the diets and notice what your body is telling you. This is not meant to be a stressful or fear mongering process.
Diets and Lifestyle
- For diet – see notes above on using the book Healthy Gut, Healthy You as a guide
- Important lifestyle shifts – Reduce stress, Reduce fear of food, Increase time outside, Increase sun exposure (refer to guidelines in the book for sun exposure recommendations)
- Exercise – studies have shown that fitness has a favorable impact on gut bacteria
- Some evidence has shown that improving gut health can improve thyroid autoimmunity
- One trial shows that treatment of H. pylori can reduce thyroid autoimmunity
- Another study shows the same after treating Blastocystis hominis
- The most commonly associated factor when someone has SIBO is Hypothyroid
- If you are struggling with your thyroid, make sure to go through a good gut protocol, you may see thyroid symptoms improve
- Some may be able to reduce thyroid medication because the gut can absorb it more effectively
What to think about with recurring SIBO
- If you have a flare up in digestive symptoms it does not always mean a regression of SIBO
- Digestive symptoms can flare with stress and eating a poor diet
- Make sure to eat the right diet that works for you and that healthy lifestyle factors are in place
- Consider prokinetic therapy – keep food moving so it doesn’t stagnate
- Herbal medicines like oregano oil can be helpful
- Consider probiotics to help clean out bacterial overgrowth
- Be careful what you read on the internet, often times the people with the worst cases are the most vocal.
- He who has a why to live can overcome almost any how – Nietzsche
- Don’t stop doing the things that bring you joy, stay social and connected.
- Get help using this information to become healthier.
- Get your personalized plan for optimizing your gut health with my new book.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
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AK: Oh, it’s awesome to have you and share a little bit about not only your personal journey but how you help tens of thousands all around the world with your amazing work no matter where you’re at. And that’s what I want for you as the listener and viewer to pay great attention to, particularly if you’ve been in our community for a while.
I really like how Michael breaks down a lot of what you can do to have a great lifestyle and thriving health on so many levels, really at the root of the digestion as well.
So with that being said, I’d love to introduce Dr. Michael to you all briefly. He’s a doctor, researcher, author, and health enthusiast. And he also practices functional medicine with an emphasis on natural and nutritional solutions. And he also works a lot with smart, busy people who are suffering from symptoms of chronic illness and helps them create the steps and strategies so they can get on with their lives. And I love that.
Now, with your background, you’ve got functional medicine, anti-aging medicine. Listen up, ladies! It’s awesome. And then, of course, he’s got some background in research and defeating autism now, which is a beautiful service. And then, of course, he’s got a doctor in chiropractic from Life Chiropractic College West, which by the way I considered going to, Michael, because I lived in the Bay Area for a long time.
DrMR: Oh, cool! Cool.
AK: Yeah! And I seriously did. I went and applied and everything. And he’s also got a background in exercise science, which a lot of you have asked us about that, too. So with that being said, let’s hand over to Dr. Michael.
How did this beautiful mission and book, Healthy Gut, Healthy You, transpire for you?
DrMR: Well, I’ll give you the short version of the story. When I was in college, I went from feeling—I guess you could say almost invincible. I was 23. And at that age, you can drink whatever you want, eat whatever you want. Many 23-year-olds can. And I was playing college lacrosse. I happened to be eating very healthy, living a very healthy lifestyle. I was very into health and fitness. So I was taking good care of myself and also feeling fantastic.
And then all of a sudden without any known cause, I started having brain fog, insomnia—very, very bad insomnia. And if you’ve had insomnia, you know how maddening insomnia can be. Depression. I was feeling cold for the first time. Bouts of fatigue. And I didn’t know why.
So I went to a few doctors. And they all ran their tests and said, “Everything looks good. You have an athletic physique. You have low body fat. Your cholesterol looks good. Your triglycerides look good. Your thyroid hormones look good. Everything’s fine.” And clearly, they weren’t piecing together that there was definitely something wrong. And that’s when I turned to and found functional medicine.
But I should also mention that before I turned to functional medicine, I went on the internet. And I self-diagnosed with hypothyroid with adrenal fatigue with leaky gut, with all these things. And I tried the leaky gut healing protocol. And I tried the thyroid support protocol and the adrenal support protocol.
I saw some benefit but nothing really long lasting because I didn’t identify that I had an infection in my gut that really needed more than glutamine. I said I did some gut support. But you can have a problem in your gut that won’t be fixed by gut repair nutrients. And the thyroid support didn’t work.
Nothing really worked until I got to the core of the issue which was an infection that I had in my intestines. And that was the only treatment that allowed me to see marked and lasting improvements in how I was feeling.
Flash forward now. I go through my training. And I find my patients and even clinicians are doing the same thing. They’re chasing hypothyroid symptoms. They’re chasing adrenal fatigue symptoms, which clearly have their time and their place. But if there’s a problem in the gut, it can manifest as symptoms that look like adrenal fatigue, hypothyroid, metal toxicity, whatever it is.
And I don’t want to paint one’s gut as a therapeutic panacea. But if we’re going to proceed in a logical sequence, then it’s very important to make sure you have an evaluation for and take steps to optimize your gut health first because there’s a good chance that the other symptoms that you’re pursuing are actually being driven by a problem in the gut.
And that’s now what I do, not only in my clinical practice but also with my writings and with the teaching that I do to clinicians and pretty much everything else.
Steps For Gut Healing
AK: It’s amazing. And I was reading a little bit more. And it’s a brief book from Dr. Michael’s website, Start with Your Gut, where you can get healthier faster by taking this one step, by attending to your gut first. I learned a little bit about that from you, too, by identifying the infection initially.
So how can we, if we have all these symptoms, really ask for the right thing when we’re working with a functional medicine doctor—because you do work with clinicians, too, and traditional doctors. What do we ask for to ensure we’ve explored all options to see if there is an infection?
DrMR: Well, I think I have a better answer because that was one of the challenges I was coming up against, which is—how do I pass a piece of information to a patient and then have them successfully reiterate that to their doctor in such a way that would get the doctor to comply?
But then also, let’s say you do a test, for example. There are a few different things that could be found on that test. Then the doctor needs to know how to treat the test results and follow-up retests. So if you don’t have someone who really knows how to do this first hand, the likelihood that asking for X, Y, or Z is going to get you very far is very minimal.
So that’s why I wrote my full print book which is about 330 pages, Healthy Gut, Healthy You, because it walks you through the exact sequence of steps that I take with patients in the clinic. And it’s adaptable. If you’re someone with very mild symptoms, you will likely have an easier protocol to go through. If you’re someone with severe IBS or severe Crohn’s disease, then the good news is that you have a protocol that will adapt to get you to your level of response and can conform to your growing needs.
So I don’t want to be overly, I guess, self-promotional here. But it was three years of work, just under a thousand medical references, and the best attempt I could construct in order to give someone, “Take this. And that has the highest probability of helping to get you well.”
AK: Yeah, and I like that, too—helping get you well for the long haul. That’s what I got from what you said and shared in the book, too, because a lot of the clients that will come in, you’ll also treat them around digestion protocols, like obviously stopping some sort of clearing out whatever and the repairing protocol. You said repair. Don’t just go to repair first until you know what’s going on. But that seems to have all the other symptoms somewhat subside but give them the longer-term strategy. And that’s why I love how you’ve categorized what you do on your website and in the book, too. Thanks for sharing that.
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AK: So you said here, simple solution is like, “Duh!” Being efficient, effective, and empowering you. Can you run us through a little bit about how that comes to play in someone’s life?
DrMR: Absolutely. Yeah, absolutely. One thing—efficient, empowering, and effective—it’s important to be efficient because sometimes people end up taking 15 supplements at once and going on overly restrictive diets.
And it’s also important to be empowered. Some people feel dependent upon supplements or afraid of food. And I didn’t want any of that. And I saw that first hand from the patients I worked with in the clinic. They come in thinking they have to be on supplements forever or that they can never eat X, Y, or Z.
Gluten as an example, they can never have any gluten ever. And that’s not true for many people. For some, yes. But for many people, they don’t have to go to an absolute zero consumption of gluten. They can get away with a little bit here and there when they’re out, when they’re social, what have you.
Efficiency for Gut Healing
So all these things are important. The efficiency can be achieved by having a protocol that adapts meaning, okay, let’s with diet. Diet as an example. First of all, let’s not have a dietary conversation couched in extremes, meaning if gluten is a problem, it doesn’t mean we have to slide all the way to the extreme of saying, “Okay, so no one can ever have any gluten.” That’s going too far. Gluten reduction can be all that’s needed for many people. And they can get away with some. So couching these things in non-extreme methods.
And then in addition to that, having a sequence that you can use. So there’s a diet level one. And we talk about this in the book. There’s diet level one. And for many people, we start them off with a paleo-like diet that removes processed foods and many of the grains and things like dairy and soy that can be inflammatory and problematic. And we give that a short two-to-three-week trial. And if it’s not working after that two to three weeks, then we move on.
And there are a couple different ways you can modify your diet to conform to different guts’ needs. And we make those small modifications. And sometimes, that’s all that’s needed—just being able to quickly navigate through a couple different derivations on diet. And then you can efficiently get to feeling better. And you’ve also done that, understanding diet in a non-extreme and dogmatic way so that you don’t feel a fear if you’re not complying with that diet here or there on occasion.
AK: Yeah, I love what you just said there. For anyone listening or taking notes or tuning in to this, it’s like I got the sense of a fear of failure because you want to set yourself up for success and not fail up front or feel that, too. So you become more empowered about which direction you’re going and getting feedback from yourself. And that’s really important.
DrMR: Yeah. Yeah, absolutely.
AK: I love that. Thank you for explaining that, too. Now, you also mentioned about what you can do to get results. And you talked about a couple weeks and months and whatever. But I know you’ve shared a lot about, no matter where you are on the spectrum, you could be way in the autoimmune category or just having some initial digestive, like gas or bloating or things that are symptomatic. Can you help us understand a little bit about how your process maybe applies to that?
DrMR: Sure. It’s important to be able to meet people where they are. So there may be someone listening to this or watching this who they’ve gone paleo and didn’t feel any better. There may be someone who has gone paleo. They’ve tried the low FODMAP diet. They’ve tried the autoimmune paleo diet. They’ve tried VSL#3 probiotic. They’ve tried digestive enzymes. They’ve tried a detox. And they’re still not feeling any better.
So we want to be able to help both of these people. But we’re not going to start them at the same spot. It’d be foolish to start the person back in the beginning and have them go through all those steps again.
And it’s not hard to do. In the book with the Great in Eight Plan, we lay out these eight steps. And we personalize them to each individual. And we check in at the end of each step. And we say, “Okay, if you’re better, go here. If you’re not, go there.” And that’s how you can have a lot of options but allow each person to only take as many steps into those options as needed for them.
So I hope I’m answering your question there. But that’s how we try to make this the easiest process for people that we can.
AK: I love it, too, because you’ve got lots of case studies, lots of case studies and clients that this has worked with—small to extreme cases as well. So that’s really helpful. Thank you.
So what else would you recommend to someone starting out—or rather, not starting out, but someone who has tried everything? And they come. They finally discover your book and the protocol. What can someone like that do to shift into hope and potentiality versus—
DrMR: You’d be surprised because the definition of everything can vary widely from person to person. And it really depends on how much you know in a given field.
So if you’ve been tinkering with your health for a couple years and you’ve done some reading and some observations and attended some summits and listened to some podcasts, then your everything will be a certain amount.
If you’ve been in clinical practice for ten years, exhaustively researching everything you could to do with gut health, then your everything is going to be quite a bit more broad.
So just because someone has done everything that they know, it doesn’t mean that they’ve done everything that’s on the table.
The other thing that’s really important is there’s a difference between knowing about a tool, like a probiotic, and knowing how to use it. If your car broke down and we let you into the machine shop, would you be able to fix your car with the mechanic’s tools? Not likely unless you have the training of a mechanic.
So just because you’ve heard about the different tools doesn’t mean that one understands the appropriate sequence and the appropriate technique for applying those.
So if you have done everything, I hope you take some solace in knowing that there are many people that I work with who’ve tried a lot. But they haven’t had the right tools in the right sequence or in the right application.
And that’s really, in my mind, the difference between knowledge and wisdom. It’s easy to gain knowledge on the internet with an internet search. But the wisdom of how to use that knowledge is accrued after years and years of practice and reflection and refinement.
AK: Thank you. Thank you for sharing that. And I hope for some of you listening and tuning in that that went deep. That’s awesome! Appreciate that very much.
Diet and Lifestyle
Tell us a little bit about Healthy Gut Diet lifestyle.
DrMR: Well, there are a few different diets for people to consider. A paleo diet is one. There’s also a modification that can be made, known as a low FODMAP diet. And for some people, they’ll go on a paleo-type diet which is really high in fruits and vegetables, as an example. And they may actually even feel worse because they may be eating more of these high FODMAP foods.
And high FODMAP foods are just foods that contain a lot of compounds that feed bacteria. And for some people, especially if they have too much bacteria built up in their small intestine and if they then go eat a lot of broccoli and asparagus and cauliflower, saying, “Oh, these are healthy foods, aren’t they?”
Well, it’s not that they’re unhealthy. But your gut may need a different type of diet because those foods are very rich in compounds that feed bacteria. And if your gut has an overgrowth of bacteria, that could make the underlying problem worse. So just some of that basic knowledge can be very helpful.
When we bridge into the topic of lifestyle, then things like not having fear around food is important because stress is a very important aspect of a healthy lifestyle.
Time outside is another important aspect. And we discussed in the book some research in Asia where they call this forest bathing, where they show that taking a walk in nature has a measurable, therapeutic benefit. And so it seems almost too simple to be able to cause a substantial effect. But we know that something happens when you walk in nature that does lead to reduced anxiety, increased energy, vigor, and a sense of subjective well-being.
And there’s also exposure to sun. We know that sun exposure specifically—not supplementation with vitamin D, although that’s also advised. But there is something unique that you acquire from sun exposure that’s protective to your health that you cannot obtain from just supplementing with vitamin D.
Until we lay out some guidelines for what are reasonable exposure guidelines for obtaining sun, we’re not saying, “Slather yourself up in baby oil and spend an hour outside in the sun every day.” But there is a high level of gain you can achieve from routine, safe sun exposure. So those are a few things regarding diet and lifestyle.
AK: They’re powerful. They’re actually really powerful. Yeah, nature. Forest bathing, I love that, too. And breathing fresh air. And gosh! And then of course grounding, being barefoot outside is really important. A lot of us, I know, having worked in and out of office buildings, in and out of airplanes, there could be days when your feet literally don’t touch the earth.
Let alone being indoors a lot, especially if you’re—like us, we’re no longer in summer. We’re in the opposite seasons to you actually. We’re in winter now. And so it’s daylight savings time. So it’s very dark soon. So unless you get out, you’re missing that sun exposure. So I think that’s really beautiful.
And you’ve got a background in sports science, too. So where do some of the physical aspects come in as well to maintaining health?
DrMR: Sure. Sure. Well, I’m sure I don’t have to sell people on the concept of exercise being good for. But as it pertains to gut health specifically, we know that exercise and fitness actually has a favorable impact on your gut bacteria.
Sometimes there’s this erroneous thinking that you have to eat foods like fiber that are good for gut bacteria, so you feed the gut bacteria. But we’re learning it’s not that simple. And in fact, like I mentioned a moment ago, some people will not do well with an approach that feeds gut bacteria. But they may need to utilize other factors to improve the health of themselves as a host because we are a host. And bacteria live inside us.
And so things that we can do to improve our health improve our internal environment, thus allowing healthier bacteria to live. So they’ve shown studies where they look at athletes. Most namely, there was a study in rugby players compared to age and sex-matched controls that weren’t exercising. Even after controlling for diet, there was something about being fit, as in these rugby players, that had a direct impact on the health of their intestinal bacteria.
And there have been other studies that have shown that your cardiorespiratory fitness predicts the health of your intestinal microbiota (or all the bacteria in your gut). So sometimes you think, “Oh, healthy gut interventions have to be food and herbs and vitamins and probiotics.” Not necessarily. Sometimes, you do something to improve your health globally like exercise, and that actually creates a healthier internal environment, thus allowing healthier bacteria to grow.
Thyroid Gut Connection
AK: Thank you. That’s awesome. I love this. Okay, beautiful. Can we talk about the gut-thyroid connection a little bit?
DrMR: Sure. There’s a substantial connection there. Some evidence has shown that improving one’s gut health can improve thyroid autoimmunity. Most namely, if someone has H. pylori, there has been one trial showing that the treatment of H. pylori can reduce thyroid autoimmunity, one case study showing the same after treating Blastocystis hominis, and another study showing that the most commonly associated factor when someone has small intestinal bacterial overgrowth is hypothyroid. So there’s definitely a high association between thyroid and the gut.
And in my clinical practice, I certainly see people who think they have hypothyroidism still. Let’s say they’re on a thyroid medication. And they’re still experiencing symptoms. And they keep chasing down thyroid, thinking that the problem is the thyroid. They come into our office. And we talk a little bit more about their mild level of bloating and their insomnia, which they didn’t realize was being driven by a problem in the gut.
And it was the problem in the gut that was causing the hypothyroid-like symptoms. And they actually weren’t thyroid symptoms. They were actually gut symptoms that were manifesting as depression, fatigue, weight gain, constipation. All these things can be attributable to thyroid.
And not only that, but you will sometimes see—and this is not a rare occurrence—people who need less thyroid medication after improving the health of their gut. And that’s likely because they’re absorbing the medication more effectively. And so they have less of a need for it.
So yes, there’s definitely this connection between gut and thyroid. We’re learning a lot more about it. But what I’d offer in simple iteration is, if you’re struggling with your thyroid, make sure you do a good gut check or go through a good gut protocol because there’s a fairly high probability that by doing that you’ll see the thyroid symptom or conditions improve.
AK: Thank you. And you referred to SIBO basically as well just then as well, small intestinal bacterial overgrowth. And I noticed there’s a blog article on your website, too, about recurring SIBO. What are some of the measures if someone is in this predicament so that the SIBO is—well, not recurring, but they’re in more of the long pull for health, long-term.
DrMR: Sure. Sure. So this is another thing that we detail as part of the protocol in Healthy Gut, Healthy You. There are a couple things that are foundational like diet, making sure that you’re eating the right diet, and you have the right lifestyle factors in place.
And how this is relevant is sometimes people attribute the symptoms of IBS to being caused by SIBO. And sometimes we’re too loose in our language where we use SIBO as this catch-all for any kind of gut flare. So, “Oh, I’m bloated. And I have loose stools. It’s my SIBO flaring.” But there’s no documentation. People are just using the language loosely.
We know that digestive symptoms can flare with stress, with eating a poor diet. But there are also techniques, like using prokinetic therapy. And prokinetics just help things in the intestines keep moving so that there’s not a stagnation point where food stops or gets stuck and then bacteria can overgrow.
And then we also know that certain herbal medicines can be helpful. Every once in a while, someone may need to do a little bit of housekeeping with something like oregano oil which can be antibacterial. And probiotics, I think, haven’t gotten the recognition that they deserve as an anti-SIBO therapy. And we do have some high-level evidence showing that probiotics can clean out bacterial overgrowth from the small intestine.
So there’s a lot that can be done. But one thing I would say, depending on the audience member and what level they’re coming into this conversation, be careful not to get swept up into the “attributing every time you have a little flare of digestive symptoms to having a true SIBO regression” because those are vastly different things.
It takes, oftentimes, weeks and weeks and months for bacteria to substantially regrow. But you can eat one off-plan thing or have one stressful day and see your digestive symptoms kick up a little bit. But that does not mean that there’s a regression of something like SIBO, per se.
Episode Wrap Up
AK: Thank you for clarifying that. I appreciate that very much. And for you listening, I’d love to hear from you in our Facebook group. Let us know what you liked from our conversation with Dr. Michael and when you’re going to get his book.
And I want to hear how you go with the protocols, too, because it’s very, very helpful. And I love how you break it down, like I said before we started recording here. I love, like you said also before, going in the forest or sun. But the profound simplicity of what Dr. Michael has helped share with us in this book and in this conversation is being consistent with it. And I really love how he has broken it down for us and given us a plan.
So there’s the Great in Eight process that goes through the whole protocol, so anyone can start no matter where they’re at, and get to the end state but for the long haul of having your thriving health.
So Dr. Michael, any other words of wisdom that you want to impart to us today based on all the amazing research and travels and everything you’ve experienced today?
DrMR: Sure. I would say two things. One, make sure to stay hopeful. Oftentimes, I notice that what people read on the internet often portrays something to be far worse than it actually is. And SIBO is one example. The narrative that you’ll come away from the internet regarding SIBO with is far worse than SIBO actually is for most people.
And this is likely a selection bias, meaning the people who have the most challenging cases of SIBO are the most vocal on the internet. They keep coming back to websites. They keep posting. They keep discussing things in chat rooms and forums. The people who are better, oftentimes, are as my motto is. They got healthy, and they got back to their life. So they’re not hanging out as much.
So you see an aggregation of the worst cases on the internet oftentimes. So don’t let that give you a misrepresented picture of something like SIBO or dysbiosis or improving your gut health.
The other would be not to forget your why. I love the quote by Nietzsche. “He who has a why to live can overcome almost any how.” So you have to have that why in your life to get back to as you get healthier. So don’t lose sight of your family members that you love or your friends or your hobbies or your life purpose. Make sure not to let your health overtake everything in your life and maintain that what you’re doing with your life outside of health because that why will be important to pull you through what can sometimes be challenging when you’re trying to improve your health. So those would be the two things that I would offer people.
AK: Thank you very much for sharing that. And when you say the why, it really does happen like that. Even if someone is lacking a little hope at the moment, if you think into the why as well and you couple that with the hope, people, places, things, and resources and books like what Dr. Michael has written show up in your face.
DrMR: Right. Good point.
AK: Take this as an opportunity to give. And that’s exactly how it works. Be open. And I think that’s beautiful.
Dr. Michael, thanks for spending time with us today. I really enjoyed learning so much more for our viewers and listeners. Thank you for being with us.
DrMR: Been a pleasure. Thank you.
What do you think? I would like to hear your thoughts or experience with this.
- Get help using this information to become healthier.
- Get your personalized plan for optimizing your gut health with my new book.
- Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.
Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.