Recently I joined Tom on Impact Theory to discuss gut health, finding purpose, and why stress may be the real root of your health problems.
Warning: this video occasionally contains strong language (which may be unsuitable for some audiences).
Tom Bilyeu: Hey, everybody! Welcome to Health Theory. Today’s guest is Dr. Michael Ruscio. He is a functional medical practitioner, clinical researcher, and best-selling author of Healthy Gut, Healthy You. And through his amazing podcast and public speaking, he has established himself as one of the most prominent voices in functional and alternative medicine.
And what I want to talk to you about today, as you well know, I found you pretty early in trying to deal with what was happening with my wife. And what I want to know, I know that originally you planned to be a traditional medical doctor and headed down that road. What was it that made you take a hard right and go into functional medicine?
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Dr. R’s Fast Facts Summary
Your gut can influence any other system in the body
- You can have a gut problem that is manifesting solely as non-gut related symptoms
- If symptoms do not improve after taking steps to improve diet and lifestyle, the next step would be to start working to improve the gut
- Start with Paleo or Low FODMAP
- If the change of diet, lifestyle, stress, and sleep does not produce any benefit, then work with your practitioner to seek testing for what might be causing symptoms
- The book Healthy Gut, Healthy You will walk you through the diets and next steps
- Take walks in nature even (as little as 10 minutes a day can still be beneficial)
- Nature is therapeutic
- Get outside – 15 – 20 mins per day of sun exposure is optimal
- Avoiding the sun is detrimental to your health
- Have meaning in your life
- Do not withdrawal from social activities just because of a diet
- It is healthier to connect with people and maintain personal relationships than to potentially eat a few bites of food that may not fall within your gut healing diet guidelines
- Do not withdrawal from social activities just because of a diet
Sometimes diet and lifestyle changes may not be enough
- If diet and lifestyle changes aren’t having a big enough impact, consider dysbiosis as a potential cause and speak with a practitioner about possible testing
Should everyone stop eating gluten?
- The short answer is NO
- If you suspect gluten is an issue, try removing gluten for two weeks to see how you feel
- If you benefit from avoiding gluten and want to cut it out of your diet that is fine
- There is a big connection between stress and gut health
- We know that stress has a negative impact on the gut and can alter the microbiota
- If someone has had emotional trauma when they were younger, they may need to be more mindful when issues with stress come up.
- Helps to facilitate movement of food through the intestinal tract
- Low FODMAP diet can help the density of serotonin cells in the gut become more like that of healthy controls.
- This could be why people have better mood and focus when they start to heal their gut
- People need at least 6-7 hours of sleep per night on average
- Lack of sleep can negatively impact the gut and exacerbate many other health issues
- Taking time to fast between meals can improve gut health
- Modified fasts can be easier, more manageable
- Start with a 2-4 day liquid fast
- Elemental diet can be a great reset
- Can be liquid only for 4 days or simply used as a meal replacement for one or two meals per day eating food for a 3rd meal.
Start with the foundation – Diet and Lifestyle
- Get help with your diet and lifestyle.
- 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. Michael Ruscio, DC: I was pre-med, and I was playing lacrosse. And you’re feeling when you’re 23 in college almost invincible in terms of energy and everything else. And then I started having fatigue, brain fog, insomnia, and was feeling cold, having mood dips all of a sudden. And there was really no good dietary or lifestyle reason for it. I was eating a clean organic diet. I was doing what I loved. I was getting adequate sleep. I was exercising.
And so I went and I saw three different conventional doctors: a GP, an internist, and an endocrinologist. And they all did their workups and said, “You’re healthy.” And I said, “Well, did you hear the part where I just told you that all of a sudden I am waking up like 8 times a night? I can’t fall back to sleep. I’m having these bouts of depression. I’m having fatigue that I have never had before.”
And they said, “Sorry, we don’t see anything. There is nothing that we can do.” And so I turned to alternative medicine. And he told me, “I think you have a parasite.” And I remember thinking at first, this guy is nuts. I really had no digestive symptoms. They were more neurological in my case. But I said, well what do I have to lose?
So I did the stool test. I figured out I had a parasite. And nothing really improved my condition until I improved the health of my gut. And that totally opened my eyes to this whole wonderful field of alternative medicine. It just so happens that now years and years later that I’m in practice for digestive ailments. I really think alternative medicine is the most powerful line of intervention.
TB: It’s really interesting, because when I was growing up, if somebody had said alternative medicine, I would think crystals, and incense.
DrMR: Kooky. It was kooky before. But it’s gotten very scientific. It’s kind of like a contemporary, more science-based application of natural medicine.
TB: And seeing the whole body as one integrated organism versus the more sort of separated and acute way that I think of at least traditional medicine is.
DrMR: We should definitely draw that premise, which is natural and integrative medicine often times are looking to the root cause and how to treat the root cause with the most natural and minimally invasive treatments. And that’s a counterpoint, but a necessary counterpoint to conventional medicine, which may be looking for things that can kill you and things that need to be dealt with in a different, more reductionist treatment model.
So they both definitely have their time and their place. But I think if you have one in the absence of the other, then that really is a disservice to the patient, because they are not going to be getting the full breadth of therapeutic options they have at their disposal.
Your gut can influence any other system in the body
TB: Now one thing that I am really so desperate for our listeners to understand is the importance of the gut. The importance of the gut was introduced to me at a moment of my highest arrogance. So I was running a nutrition company and was insanely successful. I had transformed my own physique. I had gone from 60 pounds heavier down to 6-pack abs. I just thought I had it all dialed in. I thought that I knew everything when it came to nutrition.
And then my wife one day just says, “I’m not feeling well.” And then “I’m not feeling well” turns into projectile vomiting and turns into a year of basically eating 4 ingredients. It was crazy. Her hair started falling out. Her nails were breaking. I was legitimately worried she was going to die. You hear about that all the time that people get dysentery and they basically just die of diarrhea essentially. That was when I realized, okay, I actually don’t know anything. And so I started then researching the microbiome, which I had never even heard the word before. So what is the importance of the gut?
DrMR: Well, I think that there are probably 3 fundamental pillars we should establish to kind of support this conversation so that people don’t get lost. One is that your gut can influence almost any other system or cause any type of symptom in your body, brain fog, fatigue, insomnia, joint pain, thyroid problems, skin conditions, as well as, of course, gas, bloating, reflux, constipation, diarrhea. So that’s one thing that is important to keep in mind.
The other thing that ties in with that is you can have a gut problem that is manifesting solely as non-gut symptoms. So you could have inflammation in your intestines and have brain fog and insomnia like I did. But there are no digestive symptoms happening. So sometimes it eludes people because they go, “Well, I don’t have a digestive problem. My bowels are fine.” Well, it’s not always that simple.
And then thirdly, if people are saying, “Well gosh, there are all these things I read about, thyroid, adrenal, toxins, Lyme, mold, food allergies. What do I do first? How do I sequence this?” After someone has taken reasonable steps to improve their diet and their lifestyle, if they are still not feeling well, the next thing they should do in most cases is take some steps to improve the health of their gut.
This is not a kooky, super progressive, left wing theory anymore. We have contemporary science showing that yes, something like atopic dermatitis, which is a skin condition, or ataxia, which is a neurological condition, can be caused by a gluten reaction in the gut. Yet there are no digestive symptoms occurring at that same time.
TB: Yea, that’s where it gets really crazy. In your book, you really break down how not to get lost in what you read on the internet, or what the current trend is. But how can people go about actually figuring out what’s going wrong?
DrMR: Well, I think following that sequence of first take some reasonable steps to improve your diet. So go on a healthy diet, exercise, get sleep, pursue some meaning in your life, manage stress. And then the next thing I would do is look into your gut health.
And the sequence is important, because you can get lost on the internet. You could go and say, “I have these three symptoms.” Look them up and it says it’s hypothyroid. And then you go chasing down thyroid. But many thyroid symptoms can be caused by a problem in the gut. So looking at this stuff in a sequential order can help guide you to be most efficient.
And then in terms of what to do specifically for the gut, that’s a little bit more challenging. There’s high carb, low carb, high fiber, low FODMAP, probiotics, no probiotics, antimicrobial herbs, low lectin, low sulfur, low histamine, low oxalate. You know, SIBO, Candida, H. pylori, toxoplasmosis, inflammatory bowel.
There are so many things that people have to juggle, that it’s really a paradox of plenty. We have all this information at our fingertips, but people don’t know how to apply it. And I talk about this in the book, the difference between knowledge and wisdom. We can all get knowledge on the internet, but the wisdom for how to use that knowledge is only accrued through study and reflection and time.
And that’s what I wrote into the protocol of the book. Here is how you sequence this stuff, because there are 15 things you could do. But here’s the first thing that you should do. And then we will reevaluate. We’ll check in. And depending on how you’re doing, you’re either done and we go to kind of a maintenance mode. Or we continue to escalate through that sequence that’s kind of this wisdom based protocol.
TB: You have this quote, and I thought that it was really powerful. “There are methods and there are principles. And there are probably a million plus methods that you can go about something, but principles, there only a few. And the person who leads with methods is inevitably going to get lost.”
And that to me is the internet, right? Dr. Ruscio, when I started to trying to research what was going on with my wife, I was like I have never felt more overwhelmed in my life. It was like I had to learn some big topics before. That was crazy. I felt more adrift at sea when I started learning about the microbiome than I did when I started learning about business.
And so it just seemed like everything that I had learned, it spiraled and spiraled. You talk a lot about lifestyle in the book. And there are some really surprising things you bring up, but just at a high level. Like when you say a healthy diet, what does that mean? You mentioned something a minute ago, which I really want to drill into, which is have meaning in your life. That’s so surprising if you don’t know your world.
Start with the foundation – diet and lifestyle
DrMR: Right. I always like to picture these things in a pyramid type model. So you have your foundation of the pyramid, and then you work up. You don’t start with the apex. You don’t start with the most exotic treatment. You start with the foundation.
So the foundation would be diet and lifestyle. Now regarding diet, there are a number of different diets one could start with. I think the two best ones that have the highest probability to help the most people would be either a paleo diet or a low FODMAP diet.
Now a paleo diet does not have to be this CrossFit guy with lots of protein, lots of fat. It can be a very high vegetable, fruit, minimal protein diet. So you can skew the macronutrient breakdown on a paleo diet to fit your preferences and what feels good to you.
But the main tenet of the paleo diet is avoiding inflammatory foods and processed foods. So no grains, dairy, and soy will be the biggest shifts for most people, and nothing processed, of course, and focusing on fruits, vegetables, meats, eggs, nuts, and seeds, and potentially beans and legumes, depending on the version of the paleo diet that you subscribe to.
And you can give that a couple of weeks. And this is the beauty of the dietary piece, back to something that we were talking about before the cameras went on. You can give a diet a 2-3 week trial. And if a diet is working for you, you won’t be healed in 2-3 weeks, but you will be able to say, yes, I’m feeling better. And if you are, ride that wave until you hit your peak level of improvement, and then reevaluate it, exactly like we described in the book.
Now after 2 to 3 weeks, if the paleo diet isn’t helping you, then a low FODMAP diet may be a better maneuver. Now what’s paradoxical about the low FODMAP diet is you reduce some stereotypically healthy foods, broccoli, cauliflower, avocado, because these foods are powerful at feeding intestinal bacteria. That’s not good or bad in isolation, but it depends on the context of the person. If someone has a preexisting bacterial overgrowth, then eating a diet rich in those FODMAP foods will provoke that existing overgrowth.
Some other people also are hypersensitive to gas pressure. And if you feed bacteria as part of your metabolism, just like a car spits out gas in the exhaust pipe, these bacteria release gasses as part of their metabolism. And so some people are hypersensitive to that gas pressure. And so eating a diet that really produces these gasses can be problematic for them also.
And so some people will go on a higher fruit and vegetable diet and feel worse. And they are like, “Ah, why do I feel worse?” Well you inadvertently are eating a high FODMAP diet, and that doesn’t work for your gut. And sometimes just identifying the vegetables and the fruits that are high in FODMAP, avoiding those, and focusing on the ones that are low in FODMAP can do volumes for improving one’s gut health. And you can figure that out in 4-6 weeks. It doesn’t take forever.
And then from a lifestyle perspective, time in nature is very important. We know that people who live near green zones, forests, or blue zones, oceans, have a higher life expectancy and a lower all cause mortality, meaning death from any cause. We also know that if you take two groups of people and one takes a break and takes a walk in a city and the other takes a walk in the forest, it’s only the group that walks in the forest that reports higher levels of subjective well being and lower scores of fatigue, depression, and anxiety. So there is something therapeutic about time in nature.
TB: If you had to guess what that is, what is that?
DrMR: I believe they are known as phyto-cyanides that are part of what makes up the scents from trees that lower blood pressure. So there is something therapeutic about nature.
Some evidence has shown that children who have allergic conditions of the skin tend to grow up in areas where there is less diverse plant life around them. And some of those bacteria from the plants get on the skin. And they find that the more diversity of the plants, the higher diversity of the bacteria on the skin, the lower the amount of inflammation and allergy in the skin. Some of this may literally be a transfer of microbes from the natural environment.
And then sun exposure is another one. You don’t want to burn. But it is clearly being shown that avoiding the sun is as bad for your health as smoking. And we do see that chronic sun avoidance is correlated with a number of health detriments. Constant, chronic low dose exposure to the sun, 15 to 20 minutes on most days, is a pretty reasonable recommendation that has been correlated with decreased all cause mortality, as well as decreased instance of breast cancer, I believe non-Hodgkin lymphoma, a number of things.
And then coming back to the exercise piece, people who have better fitness levels have healthier gut microbiota. And even sedentary people who then change to an active lifestyle, and when we track their microbiota, they become healthier. You are the environment in which these bacteria live.
So if you are doing things that are healthy for the environment, you now harbor the growth of healthy bacteria. And if you are doing things that are unhealthy for the environment, you harbor the growth of unhealthy bacteria. Those are some of the foundational pillars for that first rung on our pyramid of diet and lifestyle.
TB: So talk to me about when you said get meaning in your life. That is so surprising and so in tune with what I know about emotional well being. But I’m surprised that somebody in functional medicine will put such a fine point on it.
DrMR: I was seeing people come in who were so afraid of gluten, and they were so afraid of some other foods, that they were withdrawing from social activities. So I’m not going to the restaurant with the girls on our monthly girls night because there might be gluten in the sauce, and I’ve heard that because I have a thyroid condition, if I have any gluten, that will up regulate inflammation in my thyroid gland for up to 6 months. So I can’t have any. And if there is any in the sauce, I don’t want to go out to dinner.
And so now they become a bit of a recluse. And they spend more time on the internet researching. And by the way, time on the internet is correlated with scores of depression and anxiety. As time on the internet goes up, sense of well being does down. So they are trying to make themselves healthier. But in doing so, they are kind of sabotaging their lifestyle. And it’s a good quote, “Don’t make yourself sick in attempts to be healthy.”
But how this ties in to purpose and meaning is part of our purpose is to have social kind of activity. But one of the things that can make it more difficult to have purposeful social connection or can distract you from what you are doing with your life is getting sucked into this black hole of dietary restrictions that can make your life much more difficult to live.
And just as a final point here, there is some evidence showing, coming back to the smoking analogy, another parallel has been drawn, that loneliness is as bad for your health as smoking. So purpose and activity are very important. And if your diet is unnecessarily restrictive, it makes all those components of your life more difficult.
TB: That’s so fascinating to me. And you talked in the book about something I had never heard before. I loved it the most. But I just got introduced to it, so I want to hear more about it. It’s this whole notion that women need to tend and befriend. So you talked about it in juxtaposition to men who spend a little more time in fight or flight, and women tend to befriend.
And so my wife is doing this new initiative called women of impact. And they had this big dinner here. And it was amazing. And I was hiding downstairs, because I am not a woman of impact. And the night had wrapped, and there were 4 or 5 of them left. And I walked by, and it was a scene so foreign to me, the way that they were on a heightened emotional level. They felt really connected, really safe.
DrMR: It’s a different dynamic than men.
TB: Yes! Like what is it about that?
DrMR: I was seeing that men would come in with problems, and they didn’t seem as psychologically affected. And women came in with the same problems, and they seemed to be more psychologically affected. And then I read Shirley Taylor’s work, which essentially said at times of stress men are more physiologically wired to go into this kind of fight or flight, which is a bit more of an isolation kind of reaction.
Women would go into this more tend and befriend. In times of stress, women more so need that friendship and that kind of activity. It may be mediated by this hormone called oxytocin. And estrogen may potentiate the effect of oxytocin. So it may be hormonally that this is driven. But the travesty is if a woman is going through a health challenge, and she is reading on the internet about dietary restrictions and those are leading her to isolate herself, she may very much so be thwarting her health.
In fact one patient came in with a stack of labs after having not gotten results with her last provider. And it was a very challenging visit, because she came in thinking here’s the expert. We are going to dig into this. It’s going to be complex. It’s going to be cerebral. And what I told her was I don’t think anything is wrong with you. What she wanted from me was this is the problem, you have got to diet harder. We need to fix this.
But when I looked at her case, I could see that she overall was very healthy. But she was self diagnosing with all these things she thought she had from her internet reading. But when we got her to open up her life and enjoy her life a little bit more, she came back 3 weeks later and she said, “Oh my God! I feel so much better!” In 3 weeks! It comes back to the point of not stressing yourself out about diet and making sure you have that time for social activity, because it is so fundamental for healthy existence.
TB: How do you deal with that in your practice?
DrMR: There is another really important layer to this. That is sometimes people try to force a dietary solution to a non-dietary problem. That was me. I had an amoeba infection that was driving all of this inflammation in my intestines. And it didn’t matter how great I ate. If I moved to Nepal and only ate food that was grown by monks under a full moon and it was full organic and biodynamic, it wouldn’t matter.
Because if there is something actively inflaming and damaging your intestines, then diet alone may not be enough to allow someone to heal. So that’s why, again, in the book we moved people through the diets. But if the diet doesn’t work, we don’t beat them over the head with more dietary restrictions, because it’s important to understand there may be another thing present.
And most commonly what’s present is some type of dysbiosis, which is an umbrella term that encapsulates any kind of imbalance in fungus, bacteria, or other like life in your gut. And so for some people, that’s where the big miss is. And if they can address dysbiosis, then they don’t have to be so restrictive with their diet. And then they can eat more. And now they are finally getting back to the person that they were before.
TB: I want to get back to that notion of the zealotry and being overly insane and restrictive and all of that through this exploration process of either somebody who is just trying to avoid getting sick, or somebody who is already sick and is trying to recover. How do you walk people through that? What’s your advice? And then certainly as it relates to the way people talk about gluten for instance.
Should everyone stop eating gluten?
DrMR: We want to act, yes. We want to have someone start off with some dietary restrictions. But I think the fundamental miss is if the dietary restrictions aren’t producing much benefit, then we want to move on to another type of therapy. A lot of the solutions to that problem is just knowing how to get someone well, but also making sure that you coach the dietary recommendations in a non-overzealous fashion.
Because when people feel like they are put in this box and if they don’t eat perfectly, they are making a huge transgression against their health, that creates unneeded fear and stress. And gluten is a great example. Is it clearly a helpful dietary change for people to make? Yes. But some of the media would have you believe 80 to 90% of people should avoid gluten. Would you say that is maybe on the mark?
DrMR: Now I don’t think we have incontrovertible data here yet. And there was recently a study done in Italy that I think was the best one to date on this topic. They looked at 12,225 patients. And a group of physicians came up with a 60 point assessment, lab tests, physical examination, symptoms.
And they wanted to see what was going on with gluten sensitivity. How common was it? What were the symptomatic reactions associated with it? And what were the comorbidities that were encapsulated with this condition.
And they found that 3% of that study population had non-celiac gluten sensitivity. So that’s something. Yes, it is there. But is it 90%? No. That can help us take solace in eating some gluten and not thinking like we are totally sabotaging our health.
Sometimes the argument is made, well, if you are eating gluten, you are fueling this inflammatory process that may not manifest symptomatically for months or years. But they found that 90% of the people who had a reaction to gluten, had a symptomatic reaction within 24 hours. So that shoots a pretty big hole in that theory.
And finally, this same study found that 30% of the people with a problem with gluten were able to eat gluten again if they addressed some underlying imbalance in the gut. So as it pertains to gluten, right there hopefully that can deprogram a lot of people’s fear into thinking that if I am not feeling well, I have to avoid gluten all the time.
We want to heal someone’s gut, get them feeling well, and then quite simply have them reintroduce gluten and see how they do. One final thing here, it’s often said if you have any autoimmune condition, you should never have any gluten. This same study found that of the whole population, 3% were gluten sensitive. Of that 3%, 14% had autoimmune conditions.
So yes, there is a correlation. But is it the majority that the internet would have you believe? No. Why does this matter? Because if we force people or indoctrinate people into thinking that they need to eat more restrictive than they actually do, that makes their life more difficult, psychosocially and emotionally. And so that’s an important thing that if we can wind that back to a more reasonable position, then people will be able to get all the benefit from avoidance with none of the detriment.
TB: Yea, I want to talk about that psychosocial issue, the stress. There is so much stress and pressure and frustration in this process for people. What are the effects of stress?
DrMR: Stress is very bad for your health. I don’t think there are any studies that have looked at the effects of stress relative to whatever they are studying and found a benefit. If anything, it’s always neutral or detrimental.
TB: What I don’t get is how is it impacting the microbiome, though? Like I remember when Lisa was first told you should meditate before you eat. I thought, what? Like honestly, that was one where I was like I just learned my lesson to not be arrogant about this and think that I know something. So hey, yes, let’s try it.
But I was like I really don’t understand. So how are they connected?
DrMR: Well coming back to our earlier point about the health of the host impacts the health of the microbiota, right? It’s really quite as simple as that. Now when we look into some of the mechanisms underlying this, we do know that college students underneath exam stress or exam preparation stress have a skewing of their microbiota.
They see a dwindling of I believe its Bifidobacterium populations and potentially also lactobacillus populations in the gut. So we know that stress has a negative impact on the gut. Just like a circadian shift would when you fly into a different time zone, that also causes a negative impact on the gut. So it’s trying to take as many stressors off the gut as we can.
And a lot of this comes back to simple fundamentals of is this good for the organism as a whole, yes or no? And then if we were to look at what’s happening in the microbiota at the same time, the things that benefit the host tend to benefit the microbiota. And the things that are a detriment to the host tend to be detrimental to the microbiota. So stress falls right into line with that.
TB: What I am trying to piece together is a couple of phenomena. So one, if you are really nervous about something, it can give you diarrhea. Why?
DrMR: Well, there are reactions between your nervous system and your intestinal tract. So we know that some of these things can be psychosomatic, meaning the brain manifests physically. And there are a lot of nerves in the gut. So this is why some people may pee or poop on themselves if there is a highly, highly traumatic event. So there is a connection between your brain, your emotions, your nervous system, and your gut.
And part of this is hard wired, meaning the nerves that directly enervate down. And then some of this is more locally controlled by the enteric nervous system or the nervous system of your gut. And then some of it is hormonally controlled. So there are maybe 3 among other mechanisms that connect stress or psychology to one’s gut.
TB: So where this plays in is, so thinking about my wife and the things that really create problems for her, just trying to really think through every time she has an issue, I think one of the primary things that is driving it is stress. If before she eats we slow her down, get her to meditate, get her to clear her head, get into the parasympathetic nervous system, then she won’t have the issue.
DrMR: Everyone is a little bit different in terms of their history. Some people have had a knee injury in college. And now every few months or couple of years they have got to go back to rehab.
Other people may have had emotional trauma when they were younger. And that sets the tone of their nervous system to very quickly kick into this kind of fight or flight. And so they may have to work a little bit more diligently at managing stress. And so it seems that past traumas in their life can leave us with things that we just have to be mindful of.
And I would put a knee injury and emotional injury on a similar playing field. That means as long as you are doing some therapy, it doesn’t have to be this big esoteric, cathartic thing that is going to dictate your life forever. Sometimes people hear about the things that you did as a child to your gut or to your emotions can affect you later in life. And they go, “Oh my God! I am never going to be able to escape this.”
I would look at it very similar to a knee injury. Okay, you blew out your knee. Right? So now we are going to have to do some rehab every once in a while. Every once in a while it’s going to ache. Is that a huge deal? No. Does it mean anything is wrong or broken with you? No, it is just you had a knee injury and so every once in a while you need some TLC.
But I think also framing like that is very important. That’s because we don’t want to make people think that there is more imbalance with them than there actually is.
And when I talk with doctors, I always tell them, okay, if you are going to have a visit with the patient, and you can’t get it perfect. You can either make them feel like they are more sick or less sick than they are. We want to shoot for making them feel like they are less sick than they are, because one’s sense of their health does have a measurable impact on the health outcome of that person.
TB: Talk to me about the impact of the gut on mood, which seems pretty extreme.
DrMR: Yea. And this is what’s exciting. We are seeing really solid scientific evidence documenting this connection between the gut and the brain or mood or whatever. There was recently a trial published on IBS, irritable bowel syndrome, so gas, abdominal pain, constipation, diarrhea. And they found that those with IBS have higher scores of fatigue, anxiety, and depression.
Now what’s even more impressive is that meta-analyses have been published. So a meta-analysis will look at all the available clinical trials and summarize the data. And there have been two meta-analyses published to date showing that probiotics can alleviate anxiety and depression.
It’s one of the worst symptoms that one can have. We can put you on a yacht in the Bahamas. But if you were depressed, you wouldn’t enjoy it. Anyone who has dealt with mood dips probably understands that in part, it doesn’t matter where you are or what you are doing.
You could be doing the laundry and be super happy, whistling. Or you could have just gotten a huge bonus check from your work and be sad about it. And that’s in a big part the gut-brain connection. It’s very interesting.
TB: So I would love to get down to what’s going on at a neuro-transmitter level. So serotonin is one I always circle back to. So 95% of the body’s serotonin is stored in the gut, not necessarily made in the gut, but stored in the gut. And we are finding out maybe through the lymphatic system that serotonin actually can cross the blood/brain barrier. What’s that? How does dysbiosis or anything affect that?
DrMR: Yea. There’s a lot of nervous activity and a lot of neuro-transmitter production in the gut clearly. Whether it is 95% or 90% or 98%, I am not sure. It clearly clinically impacts the brain. And one thing that I do think is interesting is serotonin helps to facilitate movement of the food through the intestinal tract.
And so that is important, because if food doesn’t move through the intestines at an appropriate pace, if it moves too slow, just like stagnant pond water will foster bacterial growth, stagnant food in the gut lumen can foster bacterial and fungal overgrowth. There is some preliminary evidence showing that a low FODMAP diet can help the density of serotonin cells in the gut become more like that of healthy controls.
So to a degree it seems that healing the gut may actually help with resurrection of serotonin production. And perhaps that’s part of the reason why when one heals their gut, they have better mood, focus, and anxiety.
TB: Wow! That’s just incredible. Like the whole enteric nervous system which until pretty recently I didn’t even understand like how well developed it was, like how many neurons were in it, the whole concept of the second brain. How do think the two work in concert together in terms of directionality of the signal? Like how much is the brain talking to the enteric nervous system and back from the enteric nervous system to your brain?
DrMR: Well, there is clearly a bidirectional relationship. They are cross talking to one another. Which one is more impactful? I don’t think we know. There is some evidence suggesting, but again I don’t think the answer is clear at this point, that the gut to brain may be more powerful than the brain to gut.
But context is important here. Like for someone with prior emotional trauma, then you may need to work harder at the brain to gut connection, because there may be this underlying injury there, for lack of a better term. But I think the more injurious section of these two is the gut.
That is because we know that antibiotic use, cesarean birth, not being breast fed but being formula fed, and just the environment that we live in in the West, being so hygienic, all decrease how well the gut microbiota is colonized. And that throws off the immune system in the gut.
So it may not be which one is more powerful, but which one is more prone to imbalance. And I think our environment isn’t good for either. But I think there are probably more insults on the gut. And so in my mind we can get more out of focusing on the gut.
But we are doing a podcast series, because I want to dig in a little bit more deeply with some people who are experts in the gut to brain connection, so I can try to assess this out. That’s because I haven’t been happy with some of the answers I have gotten. Some of the people who I have come across, in their writings they seem very overzealous.
I believe that dogmatism can only exist in the presence of ignorance. You can only feel so strongly about something if you haven’t read any of the contradictory research. And so there is a difference with speaking with passion, but having an opinion that is dogmatic.
I went through this evolution myself as a clinician. I used to think X. And then all of a sudden I started reading this other data showing that Y was actually true. And then how do you reconcile that? Some people just choose to focus on X. I chose to look at X and Y.
And that’s why the book protocol, using diet as an example, there’s no this one diet is best for everyone. But here are indicators we can use to help people find what dietary camp they should be eating from.
And so back to your question, I’m trying to get a better answer on that. But I think there is a little bit of dogmatism that permeates some of those circles. And we are lining up some guests to come on the podcast to really try to drill down into that to get a good answer for how often do people need to be doing some kind of therapy for their brain if they are having a gut problem?
TB: That is really interesting. That whole concept of being dogmatic only being able to exist in the presence of ignorance, that is so good. And that’s how I know you are one of the people to really listen to, because if you get a new piece of disconfirming evidence and you can see that it is really real that you will change and adopt that new belief, which I think is insanely powerful.
Talk to me about sleep. This is something that when people approach me as an entrepreneur and they hear how much I work, they think my punch line is, well just stop sleeping. Don’t be so weak. And my thing is I prioritize sleep. I make sure I get sleep. Why should people get sleep?
DrMR: This is one of the areas in the book where I was actually really surprised at how much research we have showing so many health conditions will become worse, significantly worse if you don’t get at least 6 to 7 hours of sleep per night on average. Heart disease, cancer, neurological conditions like Alzheimer’s and dementia, obesity, weight gain, depression, high blood pressure, you cannot be optimally healthy if you don’t sleep.
Sure, there may be a short period where you have to grind. But then you have to recover afterwards. You can’t exist on chronically less than 6 to 7 hours of sleep per night. It will negatively impact your health. We know that it has a negative impact on your gut through multiple mechanisms.
One is probably because melatonin is helpful for the gut. This is why you release melatonin when you sleep. Some trials on IBS have shown that we give IBS patients melatonin and their IBS goes away.
The other thing that was really interesting was seeing that people who chronically sleep more than 9 hours of sleep per night also had impaired health. And how we reconcile that is a little bit more difficult. I put forth the hypothesis in my book that perhaps these people have underlying health conditions that are requiring them to need more sleep.
And so it’s not actually the sleep itself, but it’s an artifact of the fact that their hypothyroid is not being treated or whatever, and it’s skewing the relationship. But if you chronically need more than 9 hours, you may want to investigate an underlying health ailment that is driving the need for that much sleep.
TB: All right, one thing that I really want to touch on that we have talked about before on the show, I am really fascinated by it, but I have never heard anybody talk about it like you do, which is fasting, or more specifically to you, modified fasting. And then elemental dieting, which I literally had never heard of until I read your book. What are those? Why are they useful? How can people put them to good use?
DrMR: So part of the step 1 in the book is meal frequency. And there is debate here. You have the body building fitness community, eat every 3 hours, small meals. And for some people that works really well. But we are also learning that fasting, or it’s also known as intermittent fasting, essentially taking time without food, can be health promoting for your gut.
And there is at least 1 trial on inflammatory bowel disease and 1 trial on IBS that have shown you can improve one’s gut health by taking periods without food. Now often times the question is asked, well won’t that slow down your metabolism? So we reviewed this issue. And most of the data shows no change in metabolism. There are a couple of studies that show metabolic benefit. So the data tend to show a neutral effect on metabolism or a slight benefit.
And so what we recommend in the book is a modified fast, where you have essentially bone broth or this cleansing lemonade, so you get some calories in. Because for some people, doing a strict water only fast, it is hard. They are under too much stress in other aspects of their life, so it’s hard to do a strict water fast, although I am totally open to that.
But we give them a little bit of caloric support. And we have them start off with a 2-4 day liquid fast. And for some people, that can be a very powerful reset for the gut. And if someone responds well to that, we have them experiment with larger, less frequent meals, like 2 larger meals a day. And this can also be labeled as intermittent fasting.
Now for some people that doesn’t work, and they eat more frequent meals. But that is such an easy thing, no testing, no supplements to buy, just change your meal frequency. And will it fix everyone? No, but it would be significantly helpful for some definitely.
For people who have failed out of everything else, an elemental diet can be very helpful. And an elemental diet is essentially picture a protein shake. That’s a complete meal replacement. It’s devoid of any colors or fillings. It is hypo-allergenic and gut friendly. And this can be used to both heal the gut and starve overgrowths of bacteria. And people can do this for anywhere from 2 to 4 days, up to 2 to 3 weeks.
Now if someone has severe IBS or severe IBD, then doing a liquid only meal replacement for 2 weeks can be a cathartic change for them. And it’s not actually that hard to do. I’ve done 4 days exclusive on the elemental formula that we put together and I felt great. I had laser like focus. I didn’t have to worry about shopping, cooking, eating, cleaning.
Now some of the elemental diet formulas on the market are horridly bad tasting. And invariably if someone goes on the internet and reads about one of these diets they will hear, yuck, they tasted terrible. This is true for the more antiquated versions. But the version that we recommend and we put together is the Elemental Heal. The Elemental Heal is very palatable.
How many people make a shake, a smoothie in the morning, and just rush their way to work? So it’s not that foreign of a concept really. And for some people that can be very, very helpful for their gut. So I just wanted to make sure I added that in.
TB: I am actually glad that you brought that up. So I was reading your book. I came across that section. I had never heard of it. I dove into it. I actually went and ordered the Elemental Heal. I was super excited to try it. This is in no way a commercial by the way. But the whole notion of digesting food at some point is a stressor. And if you want to give your digestion a break, then give this a shot.
And the reason I wanted to try it, all of a sudden I started breaking out in like a little rash. And what was little at first became gigantic. Everyone was telling me that oh it’s got to be your laundry detergent, or you have come into contact with something. And because I am so obsessed with the microbiome, I was like I am telling you this is something I am eating. But I could not for the life of me figure out what it was.
And so I tried like pulling things out of my diet and reintroducing them. But the sort of mainstays in my diet I thought, well I have been eating them for years, so I didn’t pull them out. Then reading your book, I come across foods that are high in histamines. And one of them is cured meat. And I eat a metric ton of cured meat. I didn’t even know that there was such a thing as a high histamine food.
DrMR: That’s probably one of the things that after you have gone through some of the other foundational pillars, that would be on rung 2 or 3 of the pyramid. But it can be problematic. And essentially histamine is a by-product of fermented and cured foods. And some of these foods, again, are paradoxically healthy, kombucha, sauerkraut, kimchi, avocado, canned tuna or canned salmon.
And you wouldn’t think that they are unhealthy. And they are not unhealthy per se. But we all have a different ability to drain histamine out of our systems. And so if you pouring into the sink faster than the drain can clear, eventually you tip over. And then the tip over symptoms can be neurological–brain fog, insomnia; dermatological–rashes, flushing; rheumatological–joint pain; or gastrointestinal.
TB: Yes, I had those as well.
DrMR: And I had that same problem actually. And this happened to me maybe 4 years ago where I was all of sudden having these moments of cloudiness and irritability. And it was a beautiful sunny day. Everything was going well. I was sitting there at my computer writing an article that I am passionate about doing what I love. And I am just feeling irritable. And I was in a bad mood.
And I figured out I was kind of eating the lazy man’s paleo diet, jerky, avocado, spinach, kombucha, sauerkraut. And all of those things were high in histamine. So I was just inundating myself with high histamine foods. A simple maneuver of just reducing my histamine load and then within like a day, like I felt better.
So sometimes these things aren’t as bad as you might think. You might be having a rash and think, oh my God, what’s wrong with me? And you’re thinking what’s going on? And what could this be? Sometimes it is just a simple dietary observation and tweak that you can make and then you’re fine.
TB: That’s so incredible. I really feel like we’re the transitional generation. It’s like when you live in a dingy apartment, you flick the lights on and the cockroaches suddenly you see them everywhere. It’s like people just all have these problems. It is nuts.
DrMR: Every time people ask me what I do, it’s I have this, or my wife has that, or my cousin has this, or my father has that digestively. It is amazing to me how prevalent these things are.
TB: It’s crazy. And because it’s embarrassing, people don’t want to talk about it. And so that was part of the driver behind the show. Part of what was really bothering Lisa in the beginning was the shame. She just had shame around it. When she finally got over that and was like I’m going to start talking about this openly, then she started really impacting people. And it is so powerful. And I am so excited about the way that you in particular approach this.
And to that point, before I ask my last question, tell these guys where they can follow you online and really engage with you.
DrMR: This stuff is really powerful. So thank you. It is nice to see people appreciating it, because if I can make someone feel better, in my mind that’s the biggest gift I can give to someone. I would love to be able to make you a millionaire. But if I could either have you be rich or feel good, I would rather you feel good first. Then you will have the energy to pursue becoming a millionaire.
But everything can be accessed through DrRuscio.com. The book is Healthy Gut, Healthy You. We have a weekly podcast, video and article. And if you are a healthcare provider, we also have a subscription access monthly clinical training newsletter, where we go into case studies and research studies, if you wanted to try to learn more about this. That’s the long and short of it.
TB: That’s great. And people should definitely follow you.
If you were going to make one recommendation that would have the biggest impact on somebody’s health well being, what recommendation would you make?
DrMR: Well, at the risk of sounding self-aggrandizing, I would read my book. I took 3 years and painstakingly tried to give someone the most complete resource I could give them for improving their gut health. So I would say improve your gut health. Or take steps to optimize your gut health. It’s not a guarantee. It’s not a panacea. But that would, I think, be the most impactful thing people could do.
If it is not health related, I would say make sure you are pursuing a purpose. That Nietzsche quote I shared before, I always love to end with that, which is “He who has a why to live can overcome almost any how.” So if you have that why, that thing that you are doing that you are passionate about, it helps you get through some of the difficulties of not feeling well.
And so make sure not to forget about the life that you are trying to pursue and your mission and your vision at the expense of your health. And keep that north star in your vision.
TB: That is an amazing answer. Dr. Ruscio, thank you so much. It was a pleasure.
What do you think? I would like to hear your thoughts or experience with this.
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