Finding Your Ideal Diet – Episode 22

In this episode of Dr. Ruscio Radio, the doc takes you through his process to find your ideal diet. podcast-artwork newThere are so many diets to choose from and we’re bombarded day in and day out on the Internet and TV on what is good and what is bad. Dr. Ruscio simplifies it so you can find that ideal diet that’s waiting for you.

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Topics:

Episode intro…..1:49
Dr. Ruscio’s story…..5:48
Guidelines to finding your ideal diet…..9:05
When diet alone doesn’t work…..12:22
Reintroduction guidelines…..19:49
Carbohydrate reintroduction…..23:06
Susan’s take on finding your ideal diet…..29:29
Gluten…..34:50

Links:

1. (10:06) Dr. Siebecker’s SIBO Specific Food Guide http://www.siboinfo.com/uploads/5/4/8/4/5484269/sibo_specific_diet_food_guide_sept_2014.pdf
2. (11:00) Digestzymes supplement
https://dr-michael-ruscio.myshopify.com/products/digestzymes
3. (11:10) Probiotic supplement
https://dr-michael-ruscio.myshopify.com/products/therbiotic-complete
4. (38:26) Chris Kresser podcast episode
https://drruscio.com/chris-kresser-dark-side-healthy-episode-16

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 Welcome to Dr. Ruscio Radio, discussing the cutting edge of health, nutrition, and functional medicine. To make sure you’re up today on this and other important topics, visit DrRuscio.com and sign up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.
The following discussion is for educational purposes only, and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking to your doctor.

Now, let’s head to the show!

Dr. Michael Ruscio: Hey, folks. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. I am here with the lovely Susan McCauley. Hey, Susan. How are you?

Susan McCauley: Hey, Dr. R. What’s going on?

DR: Not a whole lot. Just trying to get back on track after the Fourth of July weekend here.

SM: Did you have a good time?

DR: I did. I needed a weekend off.

(laughter)

DR: The previous work week was pretty tough. So, it was nice to have some time to chill and relax and all that good stuff.

SM: Yeah, we did that too. We did a lot of walking. But we didn’t go to fireworks. One of our cats got really scared, and so we stayed home and made sure they didn’t tear the furniture apart and all that stuff.

DR: Yeah, the joy of having a cat i guess, right?

SM: Oh, we have a sick cat right now and a scared cat. So, yeah, I can’t understand how it would be like to have kids. I don’t know how people do it.

DR: Well, I guess the nice thing about kids is they can’t claw the furniture.

SM: Yeah, I don’t know about that.

(laughter)

DR: Kids can throw up on it, but they can’t claw it.

Episode intro

SM: Anyway, we have a great topic I am super passionate about it. So, why don’t you dig right in?
DR: I agree. I think this will be a good topic for people, hopefully; more of an introductory-level episode. I thought we could cover how to find your ideal diet. And do this from a really practical standpoint, but one that is also a reflection of mine, and your, clinical experience, Susan, to help people kind of cut through, ‘OK, I read this, I read that there.’ And maybe we can chime in as clinicians – what we’ve found in application is actually the easiest way to get to the practical diet that would be helpful for somebody.

SM: Yeah, there’s so much noise out there. You know, when we turn the TV on, and we watch, I ddon’t know, people watch Dr. Oz or all the different things out there. There is so much noise about what food is good, what food is bad. Paleo gets a lot of bad press because they aren’t looking at your paleo or my paleo – they are looking at a set of rules that we probably interpret a little bit differently. So, people really don’t know. I had someone say to me, ‘Well, I heard the paleo diet is really bad for you.’ And I was like, ‘Well,’ (laughter)…

DR: To that point, we have a few…I mean, to really look at the science…the challenging thing about getting dietary information from something like Dr. Oz or from a mainstream media outlet is that you really have a lot of advertising or soundbites…

SM: Exactly!

DR: Yeah, there are stereotypes and sponsors, and there are soundbites, and what is going to be appealing, and what’s hot and what’s not. Unfortunately, daytime television is a place where they are going to try to reeducate people on a dietary paradigm. It’s probably just too hard and takes too much time to do that. You know, here’s a snippet about this, and a snippet about that, and some shiny bells and whistles, and ‘oh, ah’, and now a commercial and we’ll be back after this.

(laughter)

DR: I think there are a lot of confines within daytime television. So, in defense of the paleo diet, there have been several randomized control trials looking at the paleo diet, and some of these trials have even compared the paleo diet to other diets, like the Mediterranean diet.

SM: Exactly, yes.

DR: And the paleo diet has performed very well, and even in some studies, outperformed more-traditional diets, like the Mediterranean diet for cardiovascular and insulin resistance and weight-type markers.

So, we certainly have a good amount of scientific evidence. What I want to try to do today is not get into the science too much, but help people with what I see a lot of patients struggling with, which is – ‘Should I be low-carb, should I be high-carb, should I be avoiding all grains, can I have some gluten, no gluten? Should I be low fodmap, should I be GAPS, should I be SCD? Should I be paleo or not paleo? People are just driving themselves nuts with all these different dietary boxes and trying to figure out…I heard (someone say), “These six dietary approaches are good, but how do I comply with all six at once without pulling my hair out.”

SM: Right. And if you do all of them at once, what’s left?

DR: Right, exactly. Some people end up on a diet where they are eating three foods, exactly.

SM: And the stress of that, people, I am telling you will undo all of the good that you are trying to do.

DR: Right, exactly. I think that’s a great initial point to make, which is stressing yourself out about diet is not a good thing to do. That probably does as much or more harm than eating a bad food actually does. Stress has been shown to be a very significant factor in a lot of different disease processes. To the degree in which you’re creating stress over your diet, you are probably, inadvertently, working against your health.

Dr. Ruscio’s story

DR: Maybe I can share my background, because I think my story illustrates an interesting case of these different diets and how they fit together.

So, when I was 23, and I am sure that people have heard my story before, I started feeling really poorly. Eventually, I figured out that I had an intestinal amoeba infection – amoeba histolytica, which is a pretty nasty parasite to have. This is case, amongst other things, damage to the gut lining and leaky gut. So, I had lots of food reactivity. I’d have really bad brain fog, really bad fatigue, bouts of depression, insomnia. And I remember that I would…I mean, I was in college at the time, so I wouldn’t eat if there was a test coming up, because I didn’t know if the food that I was going to eat was going to cause brain fog, and if I would feel like an idiot for the next two hours.

SM: That’s scary when you don’t know what is going to happen when you eat food.

DR: Yeah, it really was unpleasant. And so, I started fooling around with my diet. And I started fooling around with my diet while I was undergoing treatment. Eventually, I started to notice certain foods I did not react well to, and other foods I reacted better to. Eventually I feel into pretty much the autoimmune paleo diet. I didn’t even know about the paleo movement at this time. I knew about gluten-free, and I knew about the common food allergens, but I didn’t know about autoimmune paleo, I didn’t know about low fodmap. Just through my own trial and error, I kind of fell into the autoimmune paleo diet. I was on the autoimmune paleo diet where I was rotating my foods, trying not to eat the same food every day, because I also noticed that I might be able to eat a food a few times, but if I had it every day consistently for days in a row, I stated not to feel well on that food. So, the rotation concept was one I was familiar with. I’ll come back to the philosophy behind rotation in a minute, but I essentially fell into an autoimmune paleo diet where I rotated my foods so I wasn’t eating the same foods every day.

Doing that, in conjunction with clearing the parasitic infection I had, overtime allowed me to regain more dietary tolerance. Now, I can eat pretty much anything – I’ve got a couple little things that I can’t do too much of, but generally speaking, I’m in pretty good shape. Whereas, back then, I was at a good friend’s wedding. We had dinner and then I went into my car and took a nap in the parking lot. I remember thinking to myself, ‘This sucks.’ It’s my friend’s wedding and I am so tired after eating that I am now in my car putting the visors down so no one can see me and bother me..

(laughter)

DR: …and taking a nap! So, I was in a tough place. And I found my way out. So, people listening to this, it’s definitely possible to find your way out. I used the autoimmune paleo diet with a rotation to get there, in conjunction with treating and clearing a parasite that I had.

Guidelines to finding your ideal diet

DR: Here are some of the things people may be faced with. They may have about the paleo or the autoimmune paleo. They may have heard about the low fodmap, SCD, or also the GAPS diet. And they’ve probably heard about something on the range of going lower carb or going higher carb. Here is what I’ve found as a general rule to be very helpful for people – I mean, if you are there with some of this trying to figure out what to do.

The first thing I would do is try a lower-carb version of autoimmune paleo. Give that about 30 days and see how you feel. Now, you may also want to, along with that, try a lower fodmap SCD rendition of this diet. And autoimmune paloe and low fodmap SCD have a lot of overlap, but there are some foods that you want to avoid additionally if you are going to do the low fodmap/SCD restriction. Dr. Allison Siebecker put together a great food list that combines low fodmap with SCD in a paleo-friendly template (1).

SM: I’ll grab that link and put it in the show notes.

DR: OK, thank you. So, I would start with a little bit more low-carb version of either AIP, autoimmune paleo that is – try that first and give it about a month or so. If that works only partially, or doesn’t work at all, I would try low fodmap with the SCD. Give that about three days, and see if that works. Something else you may want to add in with this first phase would be a digestive enzyme supplement. I like a compound called Digestzymes, and I will put a link here (2). And you also may want to try with that a probiotic (3).

So, an enzyme will give you some hydrochloric acid, some pancreatic enzyme, and some bile to help with your acid enzymes and fat absorption. And the probiotic has transient immunomodulatory and anti-inflammatory effects. That’s a really solid starting place. That will probably work for a good majority of people. If there is nothing else going on in the intestines, one of those diets should get you there.

Now, you may not go from zero-to-100-percent improvement in a month. But what you want to look for is a trend – ‘Am I tending better? Am I feeling better this week compared to last week?’ As long as you are trending in the right direction, continue with what you are doing, and give that intervention time to realize it’s full effect. Sometimes it may take three months, four months, five months…for me, it took me well over a year and a half to get back to a really more normal diet – at least a year and a half. But again, it was a slow improvement.

When diet alone doesn’t work

DR: Now, what if that doesn’t work? If that doesn’t work, I really think someone’s best, most efficient next bet would be to find a clinician that is very skilled in functional medicine, and specifically has a lot of familiarity with digestion – not every practitioner is highly trained in digestive disorders. There are a far number of patients that I see in my practice that have been to a couple other providers, and have had what I would consider very rudamentary gut screenings. They’ve may be done one lab; and there are some labs that work better than others out there. The Metametrix 2205 stool profile I’ve found has missed a lot of infections.

SM: Or, really? That’s good to know.

DR: I think Metametrix has some very good testing…

SM: That’s Genova now, right?

DR: Oh, I’m sorry. Now it’s Genova. I think they have some good testing, but I have just repeatedly seen that profile miss infections. And that profile also comes with microbiota analysis, which we really can’t use clinically. It’s based upon a sampling of 100 people that work at that company, which certainly isn’t good science. This is a random sampling of 100 people there used to establish their norms. And there are a number of organisms that have been left out of that profile just based upon what they had access to, in terms of the PCR primer. That test, someone may come in having had done that test, and thinking they’ve closed out the issue of screening for an infection or other inflammatory disorder in the intestines. And you really can’t say that.

The next step would be to to get a thorough gut evaluation. And then treat whatever you find. For me, it took me, boy, probably about eight or nine months to finally clear my infections, because I treated for it once, and was dumb and didn’t…

SM: Didn’t retest?

(laughter)

DR: …didn’t retest. You know I felt a little bit better from the initial treatment. Then after a month or two, I started feeling the way I did previously, and then I started to feel worse, and worse, and worse, and worse, until it got to a point where I went back to – I was actually working with Dr. Kalish – and I really didn’t want to spend the money, to be honest with you.

SM: It can get pricey.

DR: And I was a student. I mean, I didn’t have anything. I had, like, nothing living on a student loan budget. So, it was a big deal for me, but I wish I had done that retest and spent the money on the front end, because the several hundred, maybe even a few thousands of dollars that I spent in the months after that tinkering with my own…trying fish oil and some of these other gut-healing compounds and probiotics and not getting anywhere all because I had an infection and hadn’t cleared it. Right, so it would have been much more finacially and time-efficient for me to let the clinician see their process through.

Finally, I cleared the infection. My improvements were very subtle. This is something I think is important for people to understand, which is I notice there is this compendium of responsiveness when we are working with a gut issue. Some people will respond right away – literally, their first or second week into, let’s say we are doing herbal antimicrobials as a treatment, they will start feeling better. Those people are lucky…

SM: Yeah, they rare.

DR: They just respond rapidly, and I think for them, I speculate there is probably less intestinal damage and less immune disregulation occurring. Once you remove the provoking factor, they just bounce right back.

On the other end of the spectrum, the people I speculate respond more slowly – people like me – probably have more advanced leaky gut, more advanced barrier function compromise, more immune reactivity, more of these secondary or acquired food allergies that have just developed secondary leaky gut. And for these people, sometimes they barely feel any different once they’ve cleared an infection. The conversation I have with them is that the same thing happened to me, where I felt almost imperceptibly better from week-to-week, until about three months passed. Then it kind of hit me; ‘Whoa, I could never have done what I did today three months ago; I just didn’t have the energy, the focus, didn’t have the stamina. For me, the improvement was so imperceptively small, but it built up from week to week to week. When it finally accumulated, I really noticed a difference.

SM: So, we have to have patience and notice the little things. I know I am the same way. Things don’t…supplements and test…all that stuff doesn’t work right away for me. I have to be very, very patient, and just notice the little improvements. I write down a lot of stuff so I can look back and see.

DR: Right. Right, yeah. And that’s also where having an objective measure can be very helpful. If you are that type of person, you don’t have an incredible symptomatic response to use as your gauge. So, you rely more heavily on the objective, the laboratory findings to guide what you are doing. That’s important for the people who go through the dietary changes and then don’t notice they feel much better. So, looking for and treating any kind of infection or inflammatory disorder, like inflammatory bowel disease, are a couple things that I find are most common and most helpful for people.

After you have gone through this initial lower-carb version of autoimmune paleo or the lower-carb version of the paleo-friendly low fodmap/SCD diet, and your starting to feel better, and/or you have treated an infection, and now you are returning to this diet and trying to heal – once you are past Step 1, here is what you do. And are you with me so far, Susan?

SM: Oh yeah. It’s funny, though. When you are done, I will chime in on my clients. But, I go about it a little bit different – a backwards approach than you. But, my clients aren’t sick. They are usually just on a standard American diet.

DR: Right. That will be interesting to get your take to see how you handle it differently. We probably have a spectrum of people listening where I tend to see people that are a bit more progressed.

SM: Oh, yeah. Definitely.

DR: And so, not everyone will need to go to this level of strictness. I’m definitely curious to get your take and your approach in a moment.

Reintroduction guidelines

DR: So, once we’ve gone through those one of two steps, and now you’re trying to go forward and heal, here is the second part of what I find very helpful for people. With time, as you start to feel better and better, and you are getting to a level of improvement that you would consider a win – maybe you are 80-90-100 percent improved, you are happy with where you are, the diet seems to be working or treating the infection and then going on the diet seems to be working. Then with time, we want to open up the boundaries of the diet. The first thing I find is helpful to do is to go through a re-introduction of the non-autoimmune paleo-friendly foods, like eggs, nuts and seeds, beans and legumes, nightshade vegetables, maybe even bringing back some grain, like rice, maybe some gluten-free products. And I would start there, with the foods that are known to be common allergens. And, the general rule here is bring one food back in at a time, and try to have a couple servings a day for a few days in a row. This will allow you to have enough exposure to sniff out a food allergy or an intolerance, if you have one.

Now, there are some cases where people may not notice a reaction for, like, a week later. But I’ve really found that to be the minority of cases. I find most people will know within 30 minutes, or within a day or two.

SM: I think so too. I know for me personally, by the next day or at the very latest, the day after.

DR: Right, right. So, for most people, you give it a few days. You have just a few servings per day for a couple days in a row. You’ll get a sense.

If you have a reaction to a food, it doesn’t mean, in my opinion, you can’t ever have it. It’s just, you may have a certain level of tolerability. Back when my gut was healing, eggs, nuts and beef were foods I had a moderate tolerance to. Meaning, I could have a serving a day, but if I more than one serving a day, or I had it for more than a couple days in a row, anyone of those foods, I would start to notice some reactions. So, that’s where I would start to try to bring in some of the quote/unquote “allergens” back in to see how much leeway you have there. People usually get a sense for the foods the foods they can do and the foods they can’t do. Some people are exquisitely gluten sensitive, if they try to do gluten reintroduction. Other people can tolerate some. Some people do not do well at all. With dairy, some people can do some dairy.

So, I think the process of trial and error will help you get to the diet that’s going to work best for you. After you bring back in these foods, what I would follow that with would be the fodmap foods, if you had a reduced fodmap. Also, if you were going on the SCD-compliant list, I would then bring those foods back in. So first, you start off with the more quote/unquote “allergic” foods. Then you bring back the fodmap or SCD foods, and see how you respond. You may tinker with that over the course of a month or two.

Carbohydrate reintroduction

DR: And then, the final thing I have people do – and some of this is implicit in the step I just mentioned – is try to reintroduce their carbohydrates and figure out if they feel better with some squashes, sweet potato, potato, fruits, maybe taro – you know, some of these starchier vegetables; maybe some rice, maybe even some gluten-free substitutes here and there, if there are certain foods they are really kind of jonesing for.

As people start to bring the carbs slowly back I, they may notice they feel better. Or, they may notice they feel a little bit worse. They may notice they have some bloating. They may notice they feel a little bit tired.

SM: Or they gain a bit of weight.

DR: Definitely, or they gain a little weight. If someone is monitoring their blood work, they may notice that their blood sugar, or hemoglobin A1c, or their cholesterol markers start to change in a unfavorable way. There are varying opinions on the carbohydrate piece. There is this carb renaissance…

(laughter)

DR: …that sometimes I feel are trying to make people that have been doing low-carb feel like idiots – you know, ‘You’re not privy to this new knowledge about how important these things are. I really disagree with that approach because there are different people who fit on different spots on the spectrum. I notice that most of my patient population does better on a moderate-to-lower carbohydrate diet, bit there are some people who clearly do better on a higher carbohydrate diet.

SM: Right. I think it’s really important. If something is working for you, you don’t have to change it just because somebody else says that maybe you should change it.

DR: Right, exactly. And that’s one thing I am hoping to provide a voice of reason for people who have found a diet that is moderate or a little bit lower in carbohydrates that works well for them. I wouldn’t go change your diet in light of some of the recent craze about prebiotics and carbs feeding your gut microbiota. If you want to experiment and see if you can find something that will help you, then great. But don’t feel the need to just do what other people are doing because it seems to be the quote/unquote “right” thing. Because I think with all these things, there is a spectrum. We just have to identify where people fit into the spectrum of food intolerances, and also in carbohydrate content. And everyone is going to be a little bit different with where they fall.

SM: Do you ever look at triglycerides to determine if people are at about their right carbohydrate level? I know I’ve looked at, and I try to look at the 75-100. But, it just depends on the person. That’s kind of, for me, a good guideline to see if their carbohydrate intake level is not too high.

DR: Definitely. Triglycerides, and of course their fasting blood sugar, their hemoglobin A1c. Most people, I find, if those numbers come in high, and we go on a moderate-to-lower-carbohydrate diet – and when I say moderate-to-lower, that may be anywhere from 50-to-150 grams a day of carbs. I’m not big into having people get super diligent with counting, because I don’t think it’s a practical, long-term intervention. Maybe they count for a little while to kind of get a general sense, and then try to eat more by feel than by number. For most people, though, the moderate-to-lower carb will work. Some people will come in on moderate-to-low carb – more so people who are on very low carb, actually. They start having negative changes in their hemoglobin A1c, their cholesterol. And when we increase their carbohydrate, periodically their numbers start to go down – their triglycerides go down, their blood sugar goes down, their hemoglobin A1c goes down after increasing their carbs. I think that’s the smaller subset of people that do not do well on a lower-carbohydrate diet.

SM: OK.

DR: And that’s really the approach. I want to echo what you said a moment ago, Susan, which is: sometimes people come into the office and they are really driving themselves crazy trying to be AIP compliant, trying to be low fodmap compliant, trying to be SCD compliant. They are obsessing over, ‘How do I comply with all of these different diets at the same time?’ I tell people that it doesn’t have to be that strict. These diets are meant to help you tune into foods that you may not do well with. They are not meant to be these rigid plans that you follow blindly, but rather something to bring awareness to foods you may want to pay attention to, and foods you may do better or worse with. It’s a way to get you into the ballpark. From there, we kind of personalize to the person. And I think that’s really important to echo, because I have not found a chronic gastrointestinal case where the issue of going from 90-percent compliant to 100-percent compliant totally was a godsend, a miracle. It’s usually, if people are in the dietary ballpark, and it’s not working for them, then we have to look for some kind of underlying intestinal issue. I just want to echo that. So, if people are really driving themselves crazy with trying to comply with all of these things at once, give yourself some slack. Do your best. Experiment with some different dietary approaches. If you don’t get anywhere after a while, you may want to bring in a clinician.

The other thing I think is important to mention, and I found personally helpful, is the rotation piece. The nice thing about a rotation is it forces to stop eating the same foods every day and get more variety in your diet. In a way, it really pushes you out of being able to fall into one pattern of maybe eating too many fodmaps, or too many SCD foods, because you are having to change what you are eating day-to-day.

Susan’s take on finding your ideal diet
SM: And I think you get more nutrition that way. Say you eat the same thing every day, you are only getting a certain set of micro nutrients. If you change it up, you are getting more of a variety. I would say eat the rainbow; get a variety of different foods in every day.

DR: I absolutely agree.

SM: So, it’s funny because you get people coming to you with digestive distress, sick people, people looking for a solution that they’ve been to, maybe, three, four, five other practitioners. I get the people (who say), “I need to lose weight.” Or, “I just don’t feel good.” Or, “I need you to help me.”

I start from more of a basic…and I kind of baby step them in. I talk to them first a little bit about what type of personality they are – are they a rip-off-the-bandaid type of personality. Most people, I’ve found, are the baby steps. So, one week we will take out sugar and artificial sweeteners. And then the next week we will take out grains. And we will be adding foods back, like eggs, healthy fats, and meats. Sometimes, just by taking out sugar and grains, that sometimes is the magic recipe that people need.

DR: I agree, I agree. When I have someone in the office that is more new to everything – they haven’t really even gone on a diet yet. I’ll just give them a very basic, normal paleo template, where we will just go over ‘Try to minimize or eliminate processed foods, and focus on mostly meat, vegetables, fruits, and foods that you buy and prepare on your own, like fresh, whole foods.

SM: Um-hum, real foods.

DR: Yeah. For a lot of people, that is going to yield remarkable results. Definitely, definitely. If someone is listening to this, and they are on Page 1 of their healthcare story, so to speak, then a simple approach like that will probably be all that you need. Absolutely. I think it’s super important to echo that.

And then if you are someone who is maybe on Page 25, then the approach I outlined is where you want to pick up. But yeah, Susan, I completely agree with you that, when I have the fortune of having a non-paleo-ish, super educated person in the office, and they haven’t heard of any of this, they can be great. We just go over some simple dietary changes. They come back in 30 days and love me.

(laughter)

SM: And they get really fast results. But to get the buy-in, I know a few weeks ago I was teaching a course and we were on the first week, which was taking out sugar. And, at first, the group was like, ‘Yeah, I can do this. I can do this.’ We talked about soda and artificial sweeteners. But when one of the women realized that her coffee creamer, which is full of trans fats to begin with, and then sugar and artificial sweeteners, she just looked…the look in her eyes was like a deer caught in the headlights.

DR: Right, right.

SM: So I said, “OK, finish the creamer you have, and then we can switch to some cocoanut milk or some heavy creme.” Now, a month later, she’s drinking her coffee black.

DR: Yeah.

SM: But sometimes it just takes awhile for it to sink in. Tell people it’s OK. It’s OK if you have that coffee creamer today. Don’t beat yourself up. Don’t stress about it. I couldn’t agree with you more. The approach of having to be super hard nosed about this stuff, I don’t think really helps people. You have to meet people where they are. So, exactly.

Oftentimes, I will tell people, “Sure. If you just got a huge thing of whatever – whatever the questionable food is, or if it seems super daunting to remove that food right now – let’s focus on the foods that you can eliminate, and then come back to this when you feel less overwhelmed.”

SM: Or use half of the amount. That was another thing we did. You put a lot in? Let’s take half of it. Baby steps. Figure out where you are and just make a little change at a time. You’ll realize after awhile that all those little changes add up, and all of a sudden, your diet is just real food, and you are eating vegetables, and you are feeling great.

DR: Exactly, exactly. It’s really important for people to know that it doesn’t have to be this super black or white. The thing I like to tell my patients is, you certainly don’t have to be 100 percent compliant. If you are 100 percent compliant, then you can reap 100 percent of the rewards. And if you are 80 percent compliant, you can reap 80 percent of the rewards. But 80 percent is still pretty good, right?

SM: It’s not all or nothing.

DR: Yeah, if you miss a few things, it’s not like all bets are off and you are going to ruin the program. Definitely, definitely.

SM: And I think that once you get to where you are adding those foods back, and you do notice a reaction, then you can use what I call the ‘Is it worth it?’ So, for me, dairy makes me congested. I love ice cream and I love cheese. I’m not going to not eat those foods 100 percent of the time, but I decide is it worth it today for me to feel like that for the next couple of days? Or, nightshade spices, if I eat too much I have a reaction. So I have to rotate those in and out. You just decide.

Gluten

SM: If gluten sends you to the bathroom running and you don’t want anyone to get in your way, then maybe you do avoid gluten 100 percent of the time.

DR: Right. Gluten is a good one to touch on, because that is the one food of all the foods that I think may have the potential to cause the most detriment to people. The area where people may question this the most is, ‘Well, I’ve heard that if I have gluten, I’m going to accelerate or worsen an autoimmune condition.’ In fact, I remember someone recently – I forget where I heard this – but someone essentially said, ‘Visualize, if you have Hashimoto’s thyroid autoimmunity, and you eat gluten, every time you eat gluten, you distroy a part of your thyroid gland.’

Gosh, there certainly is a lot evidence to support that people who have Hashimoto’s should avoid gluten. I agree with that. In fact, there was even recently a paper published showing that people with non-celiac gluten sensitivity have a higher incidence of autoimmune conditions. So, I think there is some merit to this. I certainly see patients who go off gluten have improvements in their thyroid autoimmunity. But, is it to say that if you have one slip up, you are going to do irreparable damage to your thyroid gland? I really question that. I think the way that people will know is the severity of their reaction. The more severe your reaction, I would speculate – again, I don’t think we really know this for sure – the more severe your reaction, the more likely you are to be doing damage to your thyroid.

Also remember: It’s not what you do as the exception to the rule. It’s what you do as the rule that’s going to have the most impact. If you are day-to-day, getting sleep, you are exercising, you’re managing stress, you are eating a very healthy diet, my opinion on this is the occasional splurge on bad foods is not going to derail all of that progress. In fact, it should make you resilient enough where you can handle some either psychological stress, or sleep stress, or dietary stress. Part of the reason why we do these things is so that we are more resilient and more able to bounce back from any kind of health insult. I just want to throw that out there to prevent people from getting super scared. Unfortunately, some of my patients come in and they are scared to death to eat anything wrong. Again, that can be really damaging. There is some legitimate evidence showing things like high prolactin levels, which can be caused by stress, correlates with an increased incidence of autoimmunity.

So, we want to be careful not to unduly stress people out. And with that, I’ll stop beating that dead horse.

(laughter)

SM: Yeah, stay off the Internet and stay off Facebook groups. You can get scared. You can go down the rabbit hole if you start looking at what other people are doing and what other people are saying. Find your trusted sources, and use those as your go-to. Too many inputs also clouds the…makes it too noisy out there, and you don’t know what to believe. Then, all of a sudden, you feel like you can’t eat anything. And that is a horrible feeling. I’ve been there before. I’ve done autoimmune paleo with low fodmap for 30 days because I had a digestive issue. You know, it is a little stressful trying to figure out what you can eat, and you really eat out too often. So, taking that stress level down is going to help just as much as taking out those foods sometimes.

DR: Yep. And I would refer people back to the episode that Chris Kresser and I…

SM: I was just thinking about that one.

DR: His personal story was a great example of this, where Chris it sounded like he was impeding his own healing because he was so obsessed with his diet. He kept his diet generally healthy, but focused less on diet and more on enjoyment, hobbies, self-expression, and fun, that was the pivotal moment for him in terms of when his healing really began or started to accelerate. Which goes to show you that it’s not all about diet. And if you are sitting home and obsessing about what you are eating, and you’re reading all of these different chat groups, and driving yourself crazy, I would really, really encourage you to stop doing that, and to try to find someone whose advice you trust. Follow that person’s lead instead of spending all of that time on the Internet looking up this stuff. Maybe get outside…

SM: Maybe go for a walk?

DR: Go for a walk. Pick up a hobby, because that will probably yield you a better healing dividend.

SM: Take 10 minutes and meditate.

DR: Absolutely, absolutely.

SM: Well, I think we’re out of time.

DR: Yeah, hopefully we give people something useful. If not, we just wasted 30 minutes of people’s time. Hopefully it was useful.

SM: I don’t think we did. Just remember, everybody, that every body is different. Don’t compare yourself to other people. If something is working for you, stick with it. And, just focus on that.

DR: Absolutely. Well, thank you, Susan. And thanks guys for listening. And hopefully this will help some people out there.

SM: And we will talk to you guys next week.

DR: Take care.

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRusso.com to ask a question for an upcoming podcast. Post comments for today’s show and sign-up to receive weekly updates. That’s D-R-R-U-S-C-I-O.com.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

16 thoughts on “Finding Your Ideal Diet – Episode 22

  1. Dear Dr. Ruscio,

    What do you mean by a gut evaluation if diet isn’t working? I have tried everything and still haven’t been able to start improving. If Genova doen’t work for detecting parasites and infections, what kinds of tests/evalulations do you recommend? Do you mean colonoscopy etc. Will you expound on what steps you would take next (in terms of a gut evaluation? Thank you. Gratefully, Heidi

    1. Hi Heidi,
      Great question and something I am planning on addressing in the near future. Would you mind asking this question in the podcast question audio submission field? This will put some more pressure on me to get this out! Much easier for me to get a podcast on this out before an article, so this would help! More to come!

  2. Dear Dr. Ruscio,

    What do you mean by a gut evaluation if diet isn’t working? I have tried everything and still haven’t been able to start improving. If Genova doen’t work for detecting parasites and infections, what kinds of tests/evalulations do you recommend? Do you mean colonoscopy etc. Will you expound on what steps you would take next (in terms of a gut evaluation? Thank you. Gratefully, Heidi

    1. Hi Heidi,
      Great question and something I am planning on addressing in the near future. Would you mind asking this question in the podcast question audio submission field? This will put some more pressure on me to get this out! Much easier for me to get a podcast on this out before an article, so this would help! More to come!

  3. Thank you for this great podcast! I’ve been on a low carb (30 grams per day of non-starch veggies) Paleo diet for several years to control Type 1 diabetes. HA1C runs 5.6 to 6.0. I also have gastroparesis which makes blood sugar control difficult. Is it safe to stay on this diet long term? I have low cortisol AM, high cortisol PM and have heard the recommendations to increase carbs for this but I don’t want to elevate my HA1C. Also, does your dosing for the Digestzymes differ from the recommendations on the bottle of 1 daily with a meal? I also take Iberogast before meals. I’ve been following you since the Digestion Sessions and I’m very impressed. Lori

  4. Thank you for this great podcast! I’ve been on a low carb (30 grams per day of non-starch veggies) Paleo diet for several years to control Type 1 diabetes. HA1C runs 5.6 to 6.0. I also have gastroparesis which makes blood sugar control difficult. Is it safe to stay on this diet long term? I have low cortisol AM, high cortisol PM and have heard the recommendations to increase carbs for this but I don’t want to elevate my HA1C. Also, does your dosing for the Digestzymes differ from the recommendations on the bottle of 1 daily with a meal? I also take Iberogast before meals. I’ve been following you since the Digestion Sessions and I’m very impressed. Lori

    1. Hi Lori!
      Glad this has helped. Its hard for me to recommend what diet would be best long term in this context but I would follow the guidelines laid out in the finding your ideal diet podcast. https://drruscio.com/finding-ideal-diet-episode-22/

      I use DZ at 1-3 with meals and have patients try to wean off once stabilized for a few months to find the minimal needed dose. Hope this and the other podcast episode helps!

  5. Great podcast! It’s just what I needed to hear. Most blogs stress being 100% compliant to see any benefit, so I was glad to hear your perspective. Also, for me on AIP, I find it incredibly difficult to stay on such a restrictive diet requiring so much work – especially when you’re not seeing dramatic results right away. Every time I listen to one of your podcasts, I am reminded to be patient and trust the process. Thank you for keeping me motivated!

  6. Great podcast! It’s just what I needed to hear. Most blogs stress being 100% compliant to see any benefit, so I was glad to hear your perspective. Also, for me on AIP, I find it incredibly difficult to stay on such a restrictive diet requiring so much work – especially when you’re not seeing dramatic results right away. Every time I listen to one of your podcasts, I am reminded to be patient and trust the process. Thank you for keeping me motivated!

  7. Hi Dr Ruscio,
    I really appreciate all the wonderful work and information you have been sharing and you have inspired me to ‘fact check’ and not assume all of what I read and hear. However searching those databases and reading the papers first hand just chew through time, I don’t know how you do it !

    With regard to finding a diet that works do think as Dr Tom O’Bryan that any tested (say Cyrex) immune reactivity to gluten/ gliadin is detrimental and exclusion of gluten from the diet is a necessity ?
    I can see with may be some of the other food immune reactivity the question of which comes first – the chicken (gut integrity) or the egg (food immune reactivity) becomes a little more grey.

    Thanks again

    1. Hi and thank you Tim,
      I am not a fan of food allergy testing and think the best approach is elimination-reintroduction and then avoiding foods to the degree to which you have an intolerance/reaction to them. We’ve done a few posts where we expand on a reasonable and responsible approach to gluten/gluten free. Search gluten in the search box and you should find them! Hope this helps!

  8. Hi Dr Ruscio,
    I really appreciate all the wonderful work and information you have been sharing and you have inspired me to ‘fact check’ and not assume all of what I read and hear. However searching those databases and reading the papers first hand just chew through time, I don’t know how you do it !

    With regard to finding a diet that works do think as Dr Tom O’Bryan that any tested (say Cyrex) immune reactivity to gluten/ gliadin is detrimental and exclusion of gluten from the diet is a necessity ?
    I can see with may be some of the other food immune reactivity the question of which comes first – the chicken (gut integrity) or the egg (food immune reactivity) becomes a little more grey.

    Thanks again

    1. Hi and thank you Tim,
      I am not a fan of food allergy testing and think the best approach is elimination-reintroduction and then avoiding foods to the degree to which you have an intolerance/reaction to them. We’ve done a few posts where we expand on a reasonable and responsible approach to gluten/gluten free. Search gluten in the search box and you should find them! Hope this helps!

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