Dr. Ruscio Releases “The Future of Functional Medicine” Review

Topics:
Episode Intro … 00:42
The Four FM Review Sections … 03:11
Deeper Understanding & Focus … 06:00
Mastering the Gut … 08:05
Clinically Relevant Testing & Treatment … 10:30
Sample Case-Study … 11:20
Sample Research … 18:36
Sample Studies … 25:00
Sections Summary… 28:56
Episode Wrap Up … 31:00

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Links:

1. www.DrRuscio.com/Review

Episode Intro

Dr. Michael Ruscio: Hey, everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio flying solo again today, but I am extremely excited to inform you about something that will be released as of February 1. I’m calling it the “Future of Functional Medicine Review,” and it is a training tool for healthcare practitioners. If you’re a layperson and you’re really interested in health and you want to take a deeper dive, we’re allowing it, at least at the start anyway, to be accessible by laypeople also. But it is made as a training tool for practitioners.

I think many of you are used to me having an opinion that may fall a little bit different than the standard party line for functional medicine. And I’ve received a lot of requests for when I’m going to be doing my next clinical training, weekend seminar, workshop, or what have you. And it’s something I’ve had on my mind for a while, and I’ve been working at for a little while. And it’s finally here.

So, I’ll get into the specifics in a moment, but the reason behind this is really because functional medicine needs to improve. It’s a terrific field, I love it; but again, as the audience is probably accustomed to hearing me say, there are a lot of things in functional medicine that need to be improved.

The most so is probably the cost and effective nature of functional medicine. This over-reliance on testing and the inability to see what’s really clinically necessary compared to what is just academic marketing fluff, right? So, it really comes down to how to get patients better in less time and with less money. That’s really the main underpinning in what this all drives at.

So, I’ve put together something that is a monthly review, and in this review, there will be four sections that will really help any type of healthcare practitioner become much more effective as a functional medicine provider. So, I’m going to attempt to give you a description and then hit some highlights.

Now, if you want to see a sample, we do have a free sample version available on our website. If you go to drruscio.com/review, you can plug in to access this report I’m going to tell you about, the first one that will be free to access. After that it is a paid monthly access service, and I think, for what you pay, the value you get is at least ten times in excess of that.

Section #1 (Case-Study)

So, there are a few sections to this. The first section is a case study. And so, this essentially walks you through a patient that I’ve seen and gives you an insight into exactly how do I look at the patient history and presentation and figure out from that what our differential diagnosis might be. And also, how do I then transition that into a line of recommended testing. And I think people are going to be shocked that the testing is pretty curtailed. More importantly, how do we then look at the test results and interpret those to dictate what treatment we should do. And then further yet still, probably the most important—maybe the most important—how do we look at a patient’s response to treatment and use that to dictate the changes that we’re going to make.

Section #2 (Research)

So, the first section’s a case study. Then after that, there is a research section. And there are three to five studies that I essentially summarize for you in a series of bullet points and give you my interpretation and give you my clinical takeaways. I can’t emphasize how important this is. Again, you’ve likely heard me say things that are different than what you hear elsewhere, and I’d love to say that these are all ideas of my own, but a lot of these are just simple realizations one can come to when you look at the right type of scientific evidence.

And as you’ve probably heard me say—and maybe you’re sick of hearing me say—when you get lost in this speculative mechanism, animal data, in vitro data, you can get so lost. But if you can cut through that and look for clinical trials and pull out the clinical takeaways, you can vastly enhance the effectiveness of your practice.

And we’ll go over a few examples of exactly what I mean. But this research essentially is stuff that will change the way you practice immediately upon reading it. It’s very important stuff, and it’s just the research I spend hours and hours a week reading. I take the most clinically relevant and impactful studies, summarize the bullet points for you—here’s what it means, here’s what you should do—to make it very easy.

Section #3 (Monthly Practitioner Question)

The next section is the Practitioner Question of the Month. And we’ll essentially be looking at the comments section associated with this review and then answering the most common or the most salient questions in the subsequent episode or edition.

Section #4 (Practice Tip)

And then the final section is a practice tip. And this might be review of a test, a helpful office tool, a product review, something like that. So, those are the sections. And again, why this can help is because it can help you become more cost-effective in your functional medicine approach.

Deeper Level of Understanding

Another thing that I think is really nice about the way we’re framing this is this is not going to be about giving you a protocol and say, “Here, follow this, see you later.”

We try to help you get to a deeper level of understanding so you don’t have to follow gurus or jump from protocol to protocol, which was something I used to do earlier in my career. And now that I’m not doing that, it is one of the most liberating and freeing processes, especially because when you stop doing that, you start reflecting on the patient experiences you see right in front of you, and you learn an immense amount from that.

So, when you’re not shackled to trying to follow someone else’s recommendations and you can kind of think through these things conceptually, you start learning so much more, because you actually use your own brain to analyze these things. And you’d be amazed at how many connections you can make when you focus like that.

Better Focus

Another way this can help—and I think this is implicit in what I’ve been saying—is that more testing and treatment does not equate to better results. I think that’s a really important point to make. It’s a common mistake I think we all make. We all want to help people, so we’re thinking, “Hey, let’s do all the testing we can. Let’s be aggressive in our treatment.” But I have found actually the opposite.

Remember, we talked a second ago about reflecting on the patient experiences right in front of you and you can learn an immense amount from that? Well, part of that is contingent upon not trying to juggle and interpret the results of ten different tests and five different lines of treatment. When you can focus on the things that are most clinically relevant—kind of in the hierarchy that we’ve been discussing over the months—you do less and you actually achieve more and you actually learn more, because you’re more focused.

It’s kind of like a computer screen. If you have 15 windows open, the computer starts to run slowly, because it doesn’t have the processing capability to process all that data. Same thing with the human brain and clinical observation. If you’re doing too much, it’s very hard to spot trends, to learn from those trends, and then become better.

So, in short, it’s really a functional medicine model that is much more enjoyable to practice, both on the patient end and on the doctor end. And I can say that just by the experience I’ve seen in the clinic. I’m asking patients to do less, to spend less, and they’re getting better more quickly. And they’re thrilled about that, and I’m happy to be part of it.

Mastering the Gut

So, a question that comes up is, “How can you essentially do less but achieve more?” And I think many of you are already getting this based upon many of our previous podcasts, but mastering the gut is a massive piece of this. And you would be surprised at how often mastering the gut is not achieved. In fact, just yesterday in the clinic, one of our patients is a medical doctor—in fact, we have a lot of medical doctor patients and P.A.s and M.P.s, and I think it’s because they appreciate the evidence-based approach that we take—but we have a medical doctor in the practice we’ve been seeing for a few months. He’s also been working with probably one of the most highly regarded functional medicine providers that you can name.

And he’s been working with us both kind of at the same time. He started with the other provider a little bit before me, and I think he started getting the sense that it was a little bit elaborate, so he came into my office. Now, this other provider did in excess of $6000 worth of testing. He brought in a stack of papers. I was shocked. Again, I try to give everyone the benefit of the doubt, but, man! He has a rare peripheral nerve hyperexcitability syndrome that is immune mediated. He also has chronically elevated liver enzymes, some digestive symptoms—IBS-like digestive symptoms—and also some rosacea and seborrheic dermatitis.

Anyway, we spent, I think, $800–$900 on testing. We found some dysbiotic problems, including SIBO [small intestinal bacterial overgrowth]—but not limited to SIBO—that the other clinician apparently had some initial inkling with, based upon their labs. But I think the problem with the other clinician was there was all this other stuff, and they were kind of trying to treat everything at once.

So, they missed the gut problem or didn’t fully address the gut problem. This patient did a lot of testing, did a lot of treatment, and got nowhere. In my third visit with this patient, he was feeling better than he’s felt in years, and we are $800–$900 worth of testing in, and two or three months of treatment in. So, he said to me, “I hear all your podcasts, and you’re always talking about how we can achieve better results with less testing,” and he says, “I’m just amazed at how true that is looking at my own experience.” So, this is real stuff, guys. This can really impact the effectiveness that you have in the clinic.

Clinically Relevant Testing & Treatment

So, mastering the gut is one. And then the other is understanding what clinically relevant testing and treatment is. And some of the research I’ll share with you in a second—based upon the first sample of this review—illustrates that beautifully. There is a lot of testing and treatment that is not relevant, and I’m proud and happy to be providing this review now. Because on a monthly basis you’ll see, I’ll be reviewing this research to help keep you grounded with, “Here is what’s relevant, here’s what’s not relevant.”

In the first case study, I make a few comments that we could have done a lot more testing in this gal’s case, but we didn’t, because we didn’t need to do that yet. So, mastering the gut, understanding what is clinically relevant is one of the main underpinnings as to how you can achieve better results in less time and with less money and with less treatment.

Sample Case-Study (Histamine and SIBO)

So, let’s get into some of the specifics of the first sample report. And, gosh, I’m probably going to do a terrible job with this. I’m going to try to pick out a few pieces of the case study. I feel like it’s very difficult to convey the full breadth of what you can learn from reading through this write-up. So, I would definitely recommend you go to drruscio.com/review, and then you can just plug in and read through this point by point. So, I’m going to try to do my best here to do this justice.

Essentially, a 46-year old female patient presented with a previous diagnosis of GURD, SIBO, tachycardia, and esophageal stricture. And esophageal stricture is just likely caused from prolonged inflammation in the esophagus. And this forms kind of like a little band of scar tissue or like a scab. And that stricture starts to occlude the esophageal lumen. And it can cause things like the feeling of things being stuck in the throat, for example.

So, sometimes when people say they have a thyroid problem, because of all the crazy thyroid stuff you read on the Internet—not to say that this is not true—but in some of these cases, it can just be an esophageal stricture from inflammation, or what’s known as eosinophilic esophagitis, which is an inflammatory, immune-mediated condition in the esophagus that usually happens secondary to food allergies. And food allergy testing is not really needed. It’s been well documented that six to eight food-elimination diets are very successful for eosinophilic esophagitis.

Anyway, coming back to this gal, Mary, the 46-year-old female. She complains of indigestion, heartburn—no surprise there, because that’s probably what’s causing the esophageal stricture—bloating, nausea, alternation loose stools, diarrhea, brain fog, emotional instability, and cycle abnormalities. So, she presented with a history of SIBO, of course, so that’s something that’s pretty high on the list.

So, we’re thinking SIBO. And we’re thinking reflux, heartburn. We’re thinking HCL, but she responded negatively to HCL. Which—don’t tell many people in functional medicine—but sometimes people actually need an acid-reducing intervention and not just to take more hydrochloric acid. So, clearly, she had done that experimentation with HCL, responded negatively, which further reinforces some type of gastritis, ulceration, or hyperacidity.

She was managing her symptoms decently with a low FODMAP/fast-track combination diet, and few supplements like glutamine and enzymes. But her bowel regularity consistency became worse after treating SIBO. She did both a course of herbal antibiotics and a course of rifaximine. So, she seemed to get worse from that.

So, Mary comes in and had SIBO, previously had treated it, but still has bowel problems—they probably even got worse—has some issues with HCL, meaning she can’t tolerate HCL, and she has some indications that she may actually have hyperacidity. So, our initial workup includes a SIBO breath test, two stool tests, and a blood panel looking at basic markers like a CBC, a CMP, a lipid panel, thyroid-stimulating hormone T3, and H. pylori breath antibodies. We got the H. pylori in the stool with the stool test. Nope, didn’t do an elaborate thyroid panel on this one; I don’t think we really needed it.

So, her labs all come back normal. Not a thing is found on any of her labs. So, this can be a great exercise in getting a clinician or pushing a clinician to start thinking about not relying on lab tests. So, to me, this is not a big deal, but I think this case study will be helpful for people who feel like they have to treat based upon tests.

So, we have her try a modified fast to see if fasting-type intervention would help. We have her go on a few basic nutritional supports like curcumin. There’s some evidence that curcumin may help with the oxidative stress associated with esophageal reflux disease. We also had her go on an herbal tincture for balancing female hormones, probably due to her emotional instability and cycle abnormalities. And we had her start on a natural prokinetic, some probiotics, and a natural acid-lowering compound that included melatonin.

And when we saw her back a number of weeks later, we clearly noted she did not respond well to fasting, and that’s an even bigger tipoff that someone has high acid or gastritis or ulcerations. And she also noticed that, probably with the probiotics, her heartburn improved slightly after she got past the fast.

Unfortunately, she couldn’t tolerate the acid-lowering formula containing the melatonin, which some people don’t. So, we continued forward, and we had her make a few minor recommendations of continuing the program, essentially, but stopping the acid-lowering medication. Because at that point, she was experiencing some nice symptomatic improvement globally. A few things that had flared, but globally, she was doing well.

So, we made a few minor modifications—sorry, I’m going to gloss over those. But I want to get to the big point here. Following a few weeks later, she’s still doing generally well, but she starts noticing that she’s having a runny nose—even though she’s not sick—abdominal pain, nausea, anxiety, palpitations.

And she also reported—and this is a key connecting piece—that too much fermented food consumption seemed to make some of this flare. So, this is a bulls-eye for histaminova, or histamine intolerance. So, we transitioned her into a low-histamine diet, and we had her discontinue all probiotics. And this was really the main thing that made the difference for her.

After doing this, she started seeing very nice symptomatic improvement within a few weeks. We had her maintain on that program and then followed up a few months later. She was still maintaining all of her improvements; she was thrilled with her overall symptomatic response. We’re going to have her follow up a few months later, and then we’re going to start to curtail her off some of the items that we have her on, like the curcumin, the upper GI prokinetic, the female hormone support herbs.

And so, in my write-up I go into some more thoughts and rationale, but we performed about four tests, and these, I think, added to under $1000, definitely. We could’ve gotten pulled into many things that are show to correlate with mast cell activation disorder, female hormone panels. We could’ve maybe even referred her out for an endoscopy. We didn’t; we kept it really simple, and we got great results. I do make a recommendation here in her write-up that she should continue to follow up with her gastroenterologist to keep tabs on the esophageal histology to see if there’s any progression or regression of the stricture. Because esophageal damage can lead to Barret’s esophagitis, which can be cancerous.

So, we don’t want to turn a blind eye to the other side of the fence, here. Conventional medicine, hopefully with what we’ve done, she will not need to have any biopsy ever done of her esophageal tissue, but we don’t want to be irresponsible there. So, that’s a really quick overview of a much more thorough write-up that appears.

Sample Research (TPO Antibodies Considered Pathogenic)

Let me transition now to the research, because here’s a few things that are really important. Gosh, let me start with the first. I’m not going to be able to get through all of these, but let me start with, I think, the most clinically meaningful out of these.

So, this study is entitled “Antithyroid Peroxidase Antibody Levels over 500 Indicate a Moderate Risk for Developing Hypothyroid and Autoimmune Thyroiditis.” So, essentially, this study wanted to quantify something that I think needed to be quantified, which was what level of thyroid autoimmunity actually is pathogenic. And what level is considered “abnormal,” but non-pathogenic.

You’ve probably heard me say before that in my observation, when patients reach a TPO—a thyroid peroxidase level—of between 1–300, they appear to be at minimal risk. And I make that assessment based upon the fact that any other comorbidity or symptom seems to improve. They sleep better, they need less thyroid hormone medication dose, their skin feels better, they have better energy, they have better mood, they have better gastrointestinal function, in many cases.

So, that level of antibody seems to correlate with a globally healthy presentation. When you see someone with—and I’ve said this before—between 700–1400 on their TPO antibodies, that usually correlates with a much sicker looking patient. So, it was my speculative, clinical observation that between 100 and 300 was a level that we could consider a clinical win and left the person at minimal risk and did not need to be further treated for the autoimmunity.

This paper essentially found—and all the bullet points in the write-up are there for you—but they essentially found that when people have a TPO over 500, this was associated with a risk of progression of hypothyroidism. But if they were not above 500, the risk was minimal. And so, this, I think, is really important, because this can change the way that we frame autoimmunity with our autoimmune thyroid patients. Meaning, if you’re Mary Sue, and when you’re first diagnosed, your antibodies were 1100, and now you’ve been on a gluten-free diet—or at least most of the time gluten-free diet—you’ve taken some steps with other aspects of your diet, with your lifestyle, you’re sleeping, you’re exercising, you’re maybe taking a probiotic, you’ve investigated some underlying gastrointestinal dysbiosis and addressed that, and you’re feeling great.

But your antibody levels are now 325. You don’t have to keep coming back to the doctor’s office, choking down selenium, trying to do these heavy metal detox protocols, trying to treat this ambiguous dysbiosis you found on a non-validated stool test with crazy probiotic and prebiotic regimens. You can stop. You can just maintain a healthy diet and lifestyle, and you don’t need to treat the bejeezus out of yourself to try to get your TPO antibodies below 30–35.

And I can’t tell you how much patients appreciate this dialog I’ve been having with them based upon reading this study over the past few months. Most patients, I think, intuitively are feeling, “Hey, I’m feeling really good. I don’t really get why I have to keep doing more. It doesn’t intuitively feel right that I have to keep doing more just because this lab marker is where it is.” So, this is a great study that reinforces that.

Now, there was a leg of this follow up that looked at a little bit longer of a term, and I should mention—and I may screw this up slightly, so go to the read-up for the exact details—but the group with the TPO antibodies above 500 only saw an increase in TSH [thyroid stimulating hormone] of 0.5 every six years. So, even the group with the high TPO that was at moderate risk—using the researcher’s descriptor, not my own—they only saw their TSH increase 0.5% every six years. So, if you do some of the math on that, it would take a while for the TSH to travel upward to a direction that someone would become truly hypothyroid.

Remember that with sub-clinical hypothyroid, where TSH is elevated, conventionally, and T4 is normal, conventionally, there’s not consistent recommendation to start treating that until the TSH goes above 10. And we’ve reviewed that elsewhere. We’ve review sub-clinical hypothyroid treatment elsewhere. But essentially, if someone has a TSH of 4.5, 5, 6, 7, those people don’t necessarily even need to be treated with thyroid hormone. So, there’s not even overtly hypothyroid, given that their T4 is normal along with that. So, why this is important is because by the time someone is going up by 0.5 TSH points every six years, it would take a very long time, if ever, for them to get to point where they’re actually truly hypothyroid, to the point where they need thyroid hormone medication.

This is important because we just have to stop fearing people into thinking they need more treatment than they do. We want to be able to have an honest conversation about here are the basics, here is what we can do, and not try to treat people to this level of perfection that’s not even needed, really. We don’t need to really strive for that. I hope this is making sense. Essentially, TPO antibodies below 500, probably a clinical win. Even if you’re above that, the risk of progression is minimal.

We should still do everything we can foundationally to improve someone’s overall health and their autoimmunity. It’s just, if someone’s below 500, we don’t have to really beat them over the head with it anymore. If they’re above 500, we want to keep doing work, but we don’t want to make them scared, highly scared, like they’re going to die in three years if they don’t take action. So, just some important things for you as a clinician to understand when tracking thyroid autoimmunity and how to steer the ship, depending on what the levels look like.

Sample Study (Gut-To-Brain / Brain-To-Gut)

Ok, let’s see here. There’s another study here. There are a couple. There’s one looking at gut-to-brain and brain-to-gut, and in a sense, what they showed in this study—not every study reinforces this—but what they showed in this study is that two thirds of patients with depression will form IBS before their depression. So, two thirds of people will form IBS and then depression. Whereas only one third forms depression and then IBS. So, this study essentially found that the gut-to-brain connection is more powerful than the brain-to-gut.

Sample Study (Low FODMAP vs. Prebiotics in IBS)

There’s another study here—and I’m really just going to gloss through this one, because, I don’t know if you’re asleep on the other end or still enjoying this dialog—but this was looking at a low FODMAP diet compared to prebiotic supplementation in a group of patients with IBS. So, everyone had IBS, half of the patients went on low FODMAP, the other half supplemented with 16 grams a day of fructooligosaccharides, FOS. And there are some really interesting details in the write-up on this, but essentially, what they found was there was a reduction of inflammatory cytokines on the low FODMAP diet, but the low FODMAP diet also caused what might be negative changes. There were less short-chain fatty acids, and the microbiota became more “dysbiotic.”

The other interesting point here is that of those on the low FODMAP diet, 85% of those people saw improvement. So, when you compare that to only 30% of people who went on the fructooligosaccharides saw improvement: 85% saw improvement on the low FODMAP, 30% improvement on the FOS. And then we see that cytokines improve on the low FODMAP, yet the microbiota and short-chain fatty acids actually look worse on the low FODMAP diet, even though people felt better.

It tells us a few things. One, we probably don’t know what a healthy microbiota is. Duh, I’ve been saying that for a while. The other is—and this is in my interpretation of the study—what’s very likely happening, in my opinion, but this is based upon research, people on IBS have an immune system that attacks their microbiota. So, when you feed the microbiota in these people, you’re feeding the thing the immune system is attacking. So, people feel worse. It makes sense.

Now, the microbiotas are different, but I’m thinking that the microbiota differences are probably in adaptation to protect the host, rather than the causative driver of all this. And we see this when we try to feed the microbiota: people tend to get worse. People go on high FODMAP diets, they get worse; people go on prebiotics, they get worse; people go on low FODMAP diets, they get better. It’s probably because these people don’t have great immune programming, and they can’t handle a super robust microbiota.

People have made criticisms that once you’re healthy, you can then tolerate these things. I’m all for that. I think we should go on a restrictive diet and then try to open up the boundaries definitely. We always want to be working toward the broadest diet we can, including prebiotics and fiber. But if you don’t tolerate that, then don’t try to beat your head against that wall. There’s one study in quiescence—“quiescent” is another term for “in remission”—for Crohn’s disease. And when they went on a high FODMAP diet, they all got worse. So, it kind of shoot-a-hole in that theory of re-balance the gut microbiota and then you’ll be able to do well on the African-type high-prebiotic diet.

Sections Summary

So, let’s see here, we’re about 28 minutes in. I think you guys have probably had enough, but in this report, I’ll just give you the summary. There’s a case study: “Histamine Overload That Initially Presents as What Looks Like a SIBO Relapse: Research Low FODMAP Versus Prebiotics and IBS, a Head-to-Head Trial.” Second study: “What Level of TPO Antibodies Should Be Considered Pathogenic?” We already went over that, those first two studies. “The Gut-Brain or Brain-Gut Connection: Which Is More Important?” Here’s another one I didn’t even have time to get into that’s really fascinating: “Using SIBO Breath Testing to Predict Response to Antibiotics in Patients with IBS.” Really, really interesting study.

And then there’s also an evidence-based thyroid questionnaire. If your thyroid questionnaire is something you got from a weekend seminar, it’s probably crap. Just going to be really, really honest with you. This is actually a thyroid questionnaire from a research group, and there are 13 markers; and if three of these 13 are present, especially a certain three that we include in the write-up, then that greatly increases the probably of hypothyroidism.

So, I make a recommendation to make these 13 questions your thyroid questionnaire. Make the first three that are the most important your top three, and then when you look at your intake paperwork, you have an evidence-based assessment of, “Is this person going to by hypothyroid or not?” Not a questionnaire that was cooked up by some guy who now works for a supplement company. And, I’m sorry, but that’s what happens a lot of times.

And then, finally, the practitioner question of the month—didn’t even have a chance to get to this—“Do Antimicrobial Herbs Work for SIFO?” (small intestinal fungal overgrowth). The final section, the practice tip, is an easy tool for creating online HIPAA compliant forms. So, if you haven’t transitioned your intake paperwork online—if you haven’t done it maybe because you’re scared of the whole HIPAA thing—it’s a cheap and easy, very easy to use way to create your own custom forms that are HIPAA compliant. This was a really nice thing for use in our practice. It took some worry off of us in terms of making sure that we’re compliant with HIPAA, and it also made our paperwork so much smoother.

Episode Wrap Up (February Discount Deal)

So, anyway, this is the Future of Functional Medicine Review. It’s going to have those components to it: case study, research, question of the month, and practice tips. And, like I said a moment ago, I am exceedingly excited about this, because I think it’s really going to be a force for good in terms of steering function medicine in a better direction. I think people need more information about how to practice a better model.

The podcasts and the articles give you some tips, but those things aren’t built as a training tool for practitioners. This is. So, it takes all that stuff to the next level. I’ve sent this report, before it was published, to a number of people in the field. The feedback I’ve gotten has been spectacular, guys. And I think you are absolutely going to love it.

The final thing I want to make you aware of, because I really appreciate the audience that we have, and especially the strong practitioner following—I mean, I appreciate everyone’s patronage, but for the purposes of this, the practitioner following that has built up for the podcast and for the website has been great, and I wanted to thank everyone for that—so what we’re doing for the month of February is we’re only releasing this to our audience, and we’re going to give a discount to our audience.

So, if you register in the month of February, you can lock in a discount, kind of as my way of saying to you, “Thanks for your support.” Because it’s your support that allows me to do what I love, which is combat all the BS in functional medicine of people trying to teach you what to do based upon getting you to buy something. Or teach you what to do because they can’t be a clinician, and just decided to start teaching—even though they never figured out how to be a successful clinician, and now they’re trying to teach you.

I love the Brian Tracy quote, “Never get your education from someone who makes a living off selling education.” I don’t mean to be too curt with that, but, you know, every once in a while, I want to tell you how I think it is. And it’s unfortunate that sometimes people who can’t be good clinicians decide to teach other clinicians how to be a clinician. And I think the people teaching have only the best intentions. I want to be very clear in saying that. I think they’re trying to help people, but if you never figured out how to play soccer, and you never even played a game, it’s going to be difficult to be a coach, right? There are exceptions to that rule—totally, definitely. I’m not saying this is a general rule, but it’s something that I think really needs to be changed in the field.

So, this is my way of hoping to help steer the field in a positive direction. I think you guys are going to love it. I think you’re going to get a lot of value out of it. I think it’s going to allow you to do lot less testing and get better results in less time with less money and have better conversations with your patients. Where you’re not scaring them with autoimmunity, but rather being on the cutting edge of thyroid and digestive conversations. And being able to help people cut through all the confusing fear-mongering excessive stuff they read on the Internet, and be a real voice of reason and practicality for all the patients that you interface with.

So, I apologize if this was a bit of ramble. There’s so much here that I wanted to try to showcase, and not nearly enough time to do it in. But, head over to the page, which is drruscio.com/review, and you can have a look at that first free sample edition. Check it out, and if you like it, please sign up. I’d love to have as many people over there learning from this as possible, so we start a movement of people who can make functional medicine better and be able to reach more patients and help more patients.

So, thank you guys so much for your support thus far. Please let me know what you think of the report. I will be listening, and we will be making modifications based on what people are getting the most out of. All right, guys, talk to you next time. Thanks, bye.

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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.