All Things Gut Health, Plus a Few Laughs with the Mind Pump Crew

I recently went back on the Mind Pump podcast and we had an informative and entertaining discussion regarding all things gut health.

In This Episode

Episode Intro … 00:00:39
Who Is The Book For? … 00:01:00
What Is The Book About? … 00:03:00
What’s Best? Organic/Non-GMO? Frozen/Fresh? … 00:15:00
What’s The Deal With Gluten … 00:19:40
Psychological Factors To Gut Health … 00:31:11
Carnivore Diet … 00:33:00
Helminths … 00:39:00
What To Feed Kids … 00:41:30
Gut-Brain Connection … 00:44:20
Fasting … 00:55:40
Episode Wrap-up … 41:24

Subscribe for future episodes

• 
• 
• 

Download this Episode (right click link and ‘Save As’)

Episode Intro

Hi everyone. We wanted to share a recent interview with Dr. Ruscio with you. If you’d like to read the transcript or learn more, head over to the website. We hope you enjoy it.

Mind Pump: Now, when you were writing this, who was it in mind? Who did you have in mind when you were writing this book. Now, obviously, because it’s a gut health book, it’s for everybody. But when you were putting it together, who did you think, “This is who is going to be purchasing and reading this the most.” What were you thinking?

Dr. Michael Ruscio: You know, I pictured patients in my clinic. People who were motivated to improve their gut health. Not necessarily someone who has never even heard of a probiotic. Because I wanted to give them something to do after you did the first two or three things that stereotypically come to mind when you think gut health. Which would be a patient in my clinic. “I improved my diet, I’m still floundering. I took a probiotic, I’m still floundering.”

I hear all the questions that patients ask. Patients come in. They’re scared to death of gluten. “My mother had Hashimoto’s, and I’ve read that if you have a family history of autoimmunity, you can never have one bite of gluten so I haven’t been having any gluten.” And this person is now under weight. They’ve lost like 15 pounds they shouldn’t have lost because they’re not eating enough food. They’re super fearful. They come in with all this unnecessary indoctrinated baggage and confusion.

“I read about paleo. I read about autoimmune paleo. I read about low-FODMAP. I read that you shouldn’t take probiotics if you have SIBO. I think I have SIBO. But then I read that breath-testing is inaccurate. You should rather do a urine.” And they come in, and they’re just being crippled by fear and questions and all the what-abouts. “What about this? What about that?”

What Is The Book About

So I wanted to write them a book that would teach them the important information they needed to know and then walk them through, “Ok. Now what do we do with all of that? Not, let’s do everything at once. But where do we start? Then we reevaluate? Then where do we go from there?”

MP:  Just how individual is it when you’re working with someone for further gut health? In other words, there’s a lot of general information out there to improve your gut health. But I feel like it’s like anything else. We know that there are certain exercises that are good for you, but that doesn’t mean you have a good program. And it doesn’t mean that that program will work for you. And it doesn’t mean that it will work for you all the time. How true is that for people’s gut health?

DrMR: It’s very true. I think there’s two ways to look at this. It’s good to have an algorithm to walk people through. And the algorithm almost stays the same because an algorithm is kind of like a changing formula, right? So you have a set algorithm, but then how you navigate the algorithm depends on the individual’s response.

So the algorithm is painstakingly crafted from looking at the medical literature and trying to identify, here are the treatments that are under the umbrella of what I would organize first. Meaning, the least expensive, the least invasive, and the most effective. So, diet would fall into that camp. And you start people with the diets that are the most effective. And you even organize the couple dietary trials in order of the diet that’s the simplest to implement and will be effective for the most people, firstly. And if that doesn’t help them, you tweak the diet. So you may start with paleo, and if paleo doesn’t work you may go to low-FODMAP.

The big picture is somewhat, I guess you could say pre-programmed. But not everyone is going to go through the same program as everybody else. Because you build into the process this very personalized series of checkpoints. Go on the paleo diet for two weeks. Are you feeling clearly improved, or not? If yes, continue through to maintenance. If no, we’ll tweak now to low-FODMAP. And then you go into the probiotic protocol, and it’s the same kind of thing. We try the few available probiotics, if that provides relief then we go right into maintenance. If it doesn’t provide relief, we build on that further.

So it’s a combination of using the wonder of all this medical literature that we have and then some common sense in terms of how you implement that. And that’s really a key aspect. Because I’ve observed that people tend to go right to the most invasive, most exotic treatments. Everyone thinks they need, using gluten-free dieting as an example.

People think if they have a problem with gluten, they have to eat like they have celiac. But that’s like saying if you have a blood sugar of 103, you have to eat like you’re an end-stage diabetic. You don’t have to go to that level of rigor. If you want to, fine. If you want to, I’m not going to say that you shouldn’t. But for a lot of people, the extra effort it takes to go from eating a gluten-reduced diet to a fully 100% gluten-free diet, there’s a big chasm there of effort and mental anguish, and social stress.

So it’s important to understand some of that nuance in terms of, “Ok, do you have to go all the way to full-blown eating like you’re celiac and never having any gluten? Or can you get away with some from time to time?” And I’m not saying make it a staple. But if you’re out with friends and you want to have a beer or a slice of pizza, you can potentially have that.

MP2: A little flexibility still.

MP: You sound a lot like somebody who has worked with a lot of people. And the reason why I’m saying that, as trainers, when people ask us what’s the most effective workout. What should I do to lose weight, or whatever. We know that there’s that other component of, “Is this individual going to adhere to this advice? Does it work with their lifestyle?” And everybody is a little bit different. Whereas people who have no experience working with other people will say something like, “Here’s your workout. Here’s your plan.”

MP2: Eliminate all of this.

MP: Exactly.

MP2: Or this is what the research says is best. Like, “This is what’s best. This is what’s studied. Do this.”

MP: Without taking into account.

MP2: All the other variables.

MP: All the other variables. So I really like the way you’re talking. I have to ask you, because I follow some of the gut health literature that’s coming out. I like to read about it quite a bit. I’ve had my own issues in the past. And it seems like the past few years, the research has exploded. Or at least the results of a lot of research is exploding. And it’s becoming more and more accepted mainstream. They’re finding now gut health connected to everything. Your moods, even.

You’ve been doing this for a long time. How long have you been practicing in this particular specialty?

DrMR: Almost 8 years.

MP: So 8 years ago, nobody was really talking about this kind of stuff.

DrMR: Much less so, yeah.

MP: It would have been very difficult to find a specialist. A gut health specialist 8 years ago.

DrMR: Outside of, of course, a gastroenterologist. Someone like myself who is in the integrative medicine camp, yeah. There was much less specialization. And I think that’s because you’re seeing the field really grow. Where now there is so much information that we, in my opinion, need to be specializing to a degree. Even with the natural therapies.

And the natural therapies all kind of emanate from this philosophical trunk, if you will, of diet and lifestyle. So there’s always going to be that commonality. But then when you get to someone who goes deep into Lyme disease, or mast cell activation syndrome, compared to someone in gut health. That’s where understanding the nuance is really important.

And don’t get me wrong, a natural, let’s just say, general practitioner, for lack of a better term. The equivalent of a natural general practitioner, will get you pretty far. But there are always going to be those cases where the GP, the natural GP doesn’t have in their tool kit what is needed to ameliorate the problem of the person presenting.

So yes, there’s more that we’re learning. So we’re having to specialize. And I think that’s where natural medicine is going to continue to go, is into this realm of somewhat specialization.

MP: And that’s exciting. But the question I was going to ask you, what made you decide?… Eight years ago, there wasn’t a whole lot of people doing what you’re doing. Why did you choose that? Why did you go in that direction?

DrMR: Firstly, there was my experience. And we talked about this the last time I was on. But in college, I went from feeling great to feeling pretty terrible. And it turned out that I had a parasite that was causing that problem. But before I found that out, I went on the internet. I read about all my symptoms. I thought I had low testosterone. I thought I had low thyroid. I thought I had heavy metal toxicity. I thought I had adrenal fatigue.

So I did what I see a lot of people doing, another reason why I wrote the book in the fashion that I did: try to save people from putting the cart before the horse, so to speak. And I spun my wheels with all these self-diagnoses and self-treatments. And it wasn’t until I fixed my gut that I really saw improvement.

I carried that forward with me. And in practice, I’ve kept doing more of what has worked the best. And out of all of the things I’ve looked into, I’ve done training in Lyme. I’ve done training in heavy metal detox. I’ve done training in thyroid. The two things that produce the most consistent and marked improvements in patients are optimizing their digestive health. There are other things that can be helpful. Definitely. But the most impactful, by far and away in my mind, was the therapies that were directed at gut health.

And now we’re seeing, to your earlier point, all these studies pouring in showing that probiotics can help reduce brain fog. And dietary changes can help reduce immune activation. And fixing one’s gut can help with thyroid autoimmunity. There’s a litany of examples that we could cite. And yeah, it’s exciting to see the interest and this boom in research going in the direction that I’m positioned. And I feel really fortunate to be there. But in direct answer to your question, the gut therapies were just the most effective.

MP: Do you think our guts are worse today than they were 10, 20, 30 years ago?

MP2: Yeah, it seems like it’s going crazy.

DrMR: I think our general health is on a decline. It’s tough, because I don’t want to paint an overly pessimistic picture. But it does seem that as we’ve changed our environment to be more hygienic, and experienced some of the benefits that come because of that. Reduced infantile death, and prolonged life span. As we’ve come farther away from some of these dirt and germs in a more ancestral or hunter-gatherer type lifestyle, there’s been a biological trade off. And the con of that trade off is we’re seeing more inflammatory and immune diseases that are a byproduct of that.

So it’s great when we can save a child through an emergency cesarean birth. But that does increase their probability of inflammatory and immune conditions later in their life. Because they miss out on that inoculation of bacteria as they pass through the vaginal canal. So I don’t want to paint it as a criticism of medicine, or the western lifestyle. We’re making a decision, and there’s a pro and con we have to calculate.

MP: Speaking of pros and cons, talk a little bit more on that controversial topic that you just went over right there, with C-sections. Because I see that a lot. And I just had a good friend of mine that had it. What do you say to somebody who is even considering potentially having a C-section.

DrMR: Well, this is getting outside of my area of specialty, so I don’t want to speak too far away from the body of literature that I’m familiar with. But I did recently interview a nurse-midwife on my podcast. And she made a pretty compelling case for the fact that C-sections may be a bit overly done. And I think there’s a case there to be made.

Now, I choose my language very carefully. That’s why I said emergency C-section. That’s really where you’re contenting with potentially death. There’s, in my mind, very little of an argument you can make against an emergency C-section. A proactive, or elected C-section, there’s nuance there that I’m not familiar with all the details regarding. But this midwife did make the case that it seems that they’re being overly done, and now there may be a pullback from doing it that much.

Or another method is they’re doing vaginal swabs now, and coating the children in the mother’s vaginal bacteria. So that may be a way to counteract that. But I do think there’s evidence that supports they’re being done in excess.

MP: From what I’ve read on that whole process, it’s the process of coming into the hospital, being put on Pitocin. Which makes the birthing process more painful. Then they give you an epidural, because it’s more painful. But now you have to be on your back, which makes birthing more difficult. And then boom, C-section becomes more. I think some hospitals it’s like half.

DrMR: Yeah, it’s a cascade that seems to be initiated when you go to the hospital. Whereas working with a doula or midwife, you don’t start as quickly down that cascade of epidurals and numbing agents and being restricted to bedrest. And she also makes, this gal that I interviewed, also made a good point that oftentimes, people aren’t given the education ahead of time.

So they go into the hospital, and they’re thinking all these things are mandatory. And they don’t understand that nothing bad may happen if I don’t elect to do this. It’s just the way that they do it. But because you’re in a hospital, and there’s people buzzing in and out. And bells going off. You’re in a very deleveraged and kind of fearful position.

MP: So this leads me to a question where I’ve read that we inherit quite a bit of our microbiome fingerprint if you will from our mothers. So my question, you’re talking about how western societies in particular are hyperclean. And we may be reaping some of the benefits but also some of the unintended consequences of that. They call it the clean hypothesis or something like that.

DrMR: The hygiene hypothesis.

MP: Hygiene hypothesis.

DrMR: Or the “old friends”, it’s also known as.

MP: Yeah. So, things are so clean and now we’re getting autoimmune issues and we’re getting gut issues as a result of our immune system not being exposed to certain things. But it seems like it’s getting worse faster. Is this because mother’s pass on their microbiome, and because now mothers have maybe less diversity that it’s just compounding.

DrMR: It seems to compound from generation to generation. But it’s not the only factor. There’s pollution, there’s food quality, there’s stress. There’s our more isolated type lifestyle that we’re living. I think it’s multifactorial. And if we’re speaking about the insult on the microbiome specifically, that also seems to be getting worse. Because there used to be more farmers, and more contact with farm.

I was just home visiting my family in Massachusetts, and I took my niece and nephew for a walk around the block. And there was one point where there’s this cul-de-sac, and at the end of that cul-de-sac there used to be all these woods. Now it’s all houses. And so the natural environment where we derive some of these bacteria that have an impact on our microbiota and our immune systems are drying up. So it’s not only compounding biologically, but I think it’s also compounding environmentally.

Sponsored Resources

DrMR: Hey, everyone. I just wanted to say thank you to Biocidin, who has helped make this podcast possible. If you’re not familiar with Biocidin, they have a quality line of products, including anti-microbials, a soil-based probiotic, and a gut detox formula, amongst other things.

And how I came to learn about Biocidin was actually after a few patients of mine—who had been reacting to all other forms of anti-microbials—went out, did some experimentation, and actually found the only anti-microbial formula that they did not negatively react to was Biocidin. So this got me to open my eyes and give them a further look.

And they have a few products I think are worth mentioning. One is their anti-microbial Biocidin, which comes in a few different forms. They also have Proflora®4R, which is one of the few soil-based probiotics that I recommend. And also they have Dentalcidin, which is their Biocidin in the toothpaste form. And this may actually help with the removal of oral biofilms.

Now, if you go to Biocidin.com and you use the code RUSCIO, they will give you free shipping and a free bottle of Dentalcidin when you purchase their comprehensive cleansing program. They do have wholesale pricing available for licensed healthcare practitioners if you email [email protected]

So Biocidin definitely has some helpful products for improving your gut health. And I would definitely recommend checking out Biocidin for more information on a few of these tools that can help you in optimizing your gut health.

What’s Best? Organic/Non-GMO? Frozen/Fresh?

MP: What role do modern inventions like glyphosates that are sprayed on GMOs. What role do you think that plays in some of that stuff? Do you tell patients to avoid GMO foods? Does it make a big difference?

DrMR: You ask a good question. This is something I talk about in the book to try to give people an answer to this question. Because sometimes people are struggling for an adequate solution to the kind of gordian knot of, “Do I start first with organic? Or would be better off having an organic TV dinner? Or fresh vegetables that are non-organic.”

So, the first thing I recommend people do is eat the right foods. Rather than worrying about it being organic, I’d rather you eat fresh. And foods that are, for lack of a better term, in alignment with the paleo diet, or whatever diet plan we chose for them as we’re going through the diet protocol aspect of the book.

MP: Whole foods.

DrMR: Whole foods first that are compliant with the diet plan that you’re going to be on. Then second would be organic foods. Now, in an ideal world, to your earlier point, we would do all of them. But experience teaches us that not everyone has the resources financially or mentally or logistically to implement everything at once. You know, throw out all your Teflon. Get a water filter. Get an air filter. All organic, pasture raised. That’s a tall order to go from if you’re just trying to stop eating as much bread and eat more vegetables and fish.

MP: Yeah, eating fast food twice a day for the last 10 years.

DrMR: Exactly. So we do lay out a hierarchy. But first you want to have whole foods. Then after that you can opt for either organic or locally grown. And I look at those in a similar kind of footing. So if you can only invest in one thing, I would get the right foods. Fresh, whole foods. Worry about organic and pasture raised and all those things later as you feel like, “Ok. Now I have these dietary changes down. They feel doable. They’re somewhat habituated. What next challenge would I like to try to integrate?”

MP: Now that being said, you do notice that glyphosates have an effect on people’s guts? Are you seeing that? Based off your experience.

DrMR: It’s really hard to say. Because when do I have someone coming in saying, “I had this wheat that’s been sprayed with glyphosate compared to this one that hasn’t.” I was attempting for a little while there to do a review of the literature to try to compare observed rates of celiac in countries with higher to lower use of these certain insecticides, or herbicides. But I don’t know if we have a robust enough body of literature to answer that.

So it is something that I had on my list. And I may try to tackle that again. And if anyone listening is affiliated with the university and thinks they have an interest to do that, I’d be happy to kind of pool our resources. But when I initially reached out to one of the universities that I work with that’s assisted me in publishing another, we haven’t published it yet but we essentially got IRB approval for another study and we’ll be initiating that soon. We’ve been delayed because of an incredibly hard time obtaining placebos, but that’s another story. When we started digging into some of the details, it didn’t seem we had enough of a dataset to answer that question.

So that’s why I try to be very careful in the language that I use. Because I see the problem occurring where people make inflated, and I’m not saying you’re doing this. But people in general making these inflated claims, and then what ends up happening is people get a far worse picture of the way things actually are because no one is trying to really be conservative and discerning in the language that they use. And celiac disease is a good example of that.

What’s The Deal With Gluten

MP: That’s one of the things I like about you, you’re very calculated, and as you’re saying, very careful with how you say just because you want to be very accurate. And I really appreciate that. What are some of the biggest problems that people are finding with food? Like, single things. Is it gluten? You’ve mentioned gluten a couple of times.

DrMR: Yeah, let’s tackle that.

MP: Yeah, because that’s a big one, right? I read an article. People love to send me this kind of (stuff), where they’ll send me a study that says, “Gluten intolerance doesn’t exist.” Or, “This study shows that it isn’t a gluten intolerance, it’s not real except for celiac.” I know that’s false, because I’m one of those people that reacts to gluten, but I don’t have celiac. What’s the deal with gluten?

DrMR: Well. That’s a long answer, but I’ll give you a few of the most relevant strokes. When you hear people say that gluten intolerance is not a thing, they’re probably citing this one study that found that it was actually a FODMAP intolerance that attributed.

MP: That is the one.

DrMR: The causative factor for the reaction and not the gluten itself. Now, we also review this in the book. There have essentially been, and this may have changed since about a year ago, because the body of literature here is evolving quite quickly. But there have been five randomized control trials looking to establish, is non-celiac gluten sensitivity an issue or not? And that’s a condition where you don’t have celiac, but you think you have a problem with gluten. I get bloated, I get headaches, I get joint pain, whatever.

Four of those five studies in a placebo controlled, double-blinded fashion did find that it was, in fact, the gluten that caused the reaction. One study did find that it was not the gluten, but it was the FODMAPs. So this is why being careful in your language is important. Because you could misrepresent those studies, that one low-FODMAP study, if you didn’t look in context of the greater body of literature, you could potentially become confused in terms of what that means.

So it means that both of these things are an issue. And let me tie this to another study. There was a multicenter study in Italy that looked at 12,225 patients. And you had a group of gastroenterologist who are really trying to answer this question. And they comprised a 60-point assessment, including questionnaires, lab tests, and physical examination to try to assess what was the prevalence and what were the symptoms and associated conditions that occur with non-celiac gluten sensitivity. Essentially what they found was a 3% occurrence in that population of non-celiac gluten sensitivity.

Now, 12,000 patients is a good sample size, but it was in Italy. And there may, I don’t know this to be true. There may be less glyphosate use in Europe than there is in the US. I’ve heard that, I have not fact-checked it. And unless I’ve fact checked it, I do not believe it. Because you just can’t believe what you hear. You have to check these things.

MP: Have you heard it from other patients, too? Because I’ve heard clients will be like, “I can’t eat bread in America or pasta.”

DrMR: I’m getting to that. My suspicion is that people have been indoctrinated, not everyone. Not everyone. But I think there’s a fair proportion of the population in the US that have been indoctrinated into thinking you can’t have any gluten. But in Europe, it’s different, and you can. They’ve never adequately tested it in the US. And when they go to Europe, they’re actually discovering they don’t have as much of a problem with gluten as they thought they did, A. Or B, they’re on vacation. They’re less stressed. They’re sleeping more, and having fun, and you’re seeing the lifestyle component reflect.

And I see that quite a bit where patients come into my clinic afraid of food, and finally someone in a position of authority says, “You can eat some gluten. You can expand your diet.” And they go, {gasp}!

MP: Just the stress causes them to react.

DrMR: “Oh my god! I stopped stressing out about food. I’m eating more. And I’m feeling so much better.” So, I don’t know if I fully buy that. I’m open to that. And that’s the question I wanted to answer with my previous inquiry into this issue, but it didn’t seem like there was an adequate dataset to answer it.

But continuing on with this one study. 3% were found to have non-celiac gluten sensitivity. Estimates in the US range from 0.6 to 6%. So there could be more of this in the US. But I don’t know if we have an adequate dataset to fully answer that question. But 3% to 6% isn’t a huge change. It tells you that non-celiac gluten sensitivity is an issue. But is it an issue that affects 90% of the population, as some people would probably have you believe? No. It’s probably more so the minority than it is the majority. So I think that’s really important to keep in mind.

They also looked at autoimmune conditions. Because one of the first things that comes up is, “I’ve heard if you have an autoimmune condition, you should never have gluten.” Well, is that really true? They found that 14% of the people with non-celiac gluten sensitivity. So it’s 14% of that 3%. It’s not 14% of the entire population. 3% were found to have non-celiac gluten sensitivity. Of that 3%, 14% had autoimmune conditions. So that’s not a lot. But it is documented, and it is legitimate. So you need to see both sides of it.

Of that, about 9% of that 14% had autoimmune thyroid. So some people say, “I’ve heard if you have autoimmune thyroid you can never have any gluten.” There is an association between thyroid autoimmunity and celiac disease. And I think it’s the most common autoimmune condition next to celiac disease in terms of the relation. And thyroid autoimmunity is the most prevalent autoimmune condition. So yes, it is an issue. But should you blindly avoid gluten if you have thyroid autoimmunity without ever doing some elimination/reintroduction to see what your relationship is? No. You should figure this out through your own experience.

Now, there are two other things here that are really key. One, it was found. Let me take a step back and just frame this. People often say, “I’ve heard if I eat gluten that could fuel this autoimmune process that may not cause any symptoms for months or years.” Have you guys heard that?

MP: So if I start eating gluten now, three years from now I’m going to have a higher chance.

DrMR: Right. You’re fueling this underlying inflammatory process that won’t manifest symptomatically for years. Ok, that may be true. And I’m open to that, if we prove that. But in my clinical experience, and also with this study finding, I don’t think that’s fully supported. At least not for the vast majority of patients.

In the same study with the 12,225 patients, of which 3% noticed they had non-celiac gluten sensitivity, over 90% of the people who reacted to gluten reacted within 24 hours. So that tells you…

MP: That you’d know pretty quick.

DrMR: And it makes sense that if you were fueling active damage to your body, you would feel, most likely, you would feel some kind of symptom associated with that. Now, the symptoms can be very diverse. For some people it could be a skin reaction. For some people it could be a neurological reaction, like feeling uncoordinated. A bit ataxic or feeling like they have brain fog or slurred speech. For other people it may be constipation or diarrhea or fatigue or joint pain.

So there’s not a symptom, but if you notice all of a sudden you’re having a symptom pop up within 24 hours of your gluten reintroduction, then it’s pretty safe to say you should be avoiding gluten.

MP: Now, can someone not have an intolerance to a food, then develop an intolerance. And through working through it, it go away?

DrMR: Yeah. That’s actually a great transition to the final point I wanted to make from this study. This same study found that 30% of people had their reaction to gluten that was attributable to something else. Meaning small intestine bacterial overgrowth, FODMAP intolerance, or some other problem in the gut that was causing them to be reactive to the gluten in the first place.

MP: So when they get rid of that…

DrMR: So when they fixed their gut, 30% of patients who had a reaction to the gluten, as we label non-celiac gluten sensitivity, were able to then eat gluten and be devoid of symptoms.

MP: Whoa, that’s very interesting.

DrMR: I see quite a bit of that. So I think more people can eat gluten than think they can. Now I want to be careful in saying, because I will hear the gluten-free zealots getting angry. I’m not saying that some people do not derive enormous benefit from going gluten-free. But you’re not seeing what I’m seeing. Which are people coming into the clinic, decimated by fear regarding gluten. Because they’re trying to live a 100% gluten-free lifestyle. So I think for the majority of people, a gluten-reduced diet is probably a pretty safe place to be.

MP: Well you’re not even saying that you wouldn’t pick that as one of the few things to look into right away. I imagine that’s still one of the major culprits.

DrMR: It’s one of the first things I start people off with.

MP: Right. So it’s just that I think people take it to an extreme level, like they do with everything.

DrMR: Because if you had to guess, what percentage of people would you guess, based upon what you hear. The ethos of opinion in natural medicine, would be the percentage of people who can’t eat gluten? It would be high, right?

MP: Very high.

MP2: Well one of the first things that people go one when they’re trying to fix their gut health is a grain-free, typically, diet. Not just gluten-free, but grain-free.

DrMR: Which I support. I support that. But what we want to do on the tail-end of that is then go into a reintroduction to find what your personal diet should be. Some people will have the short end of the stick there. And they’ll have to be very careful to avoid gluten. But other people will have the ability to take some liberty. And want those people not to be encumbered by any unnecessary dietary restrictions. That’s all I’m driving at.

MP: Something you said that was really interesting was how you could have an underlying condition that is fueling or driving a particular food intolerance. And it makes me wonder how many people out there are managing an issue that they don’t know the root of. They’re managing it by eliminating all these foods, and are like, “Well I can no longer eat those foods.” Not knowing they have SIBO or something else that is driving that. Is that common?

DrMR: I think, yeah, it’s fairly common. That’s why in the action plan in my book we start off with diet. But we essentially walk through a reevaluation at the end of the dietary step. And we say, “Yes or no, do you feel like you are at least 70% improved?” And if you are not, we’re going to move forward. Because what can end up happening is people can try to force, to your point, a dietary solution to a non-dietary problem.

If you have SIBO, again, it’s not all about SIBO. It’s just a very commonly discussed topic right now, so I’m using that as one of our proxies for gut imbalances. But there are types of dysbiosis or imbalances in the life of your gut that can occur. But if you have significant SIBO, you can eat around that. You can eat a strict low-FODMAP diet. And you can do fairly well with that.

But, there’s a chance that you won’t have to eat as strict of a low-FODMAP diet, or a paleo diet, or whatever it is that’s providing relief, if you clean up other problems in your gut. So that’s why we have our step one, diet and lifestyle. And if at the end of that you’re not feeling like you have at least improved by 70%, then we keep working through the steps.

Psychological Factors To Gut Health

MP: Have you had a lot of patients come in that you just know there’s a lot of psychological factors that contribute to, you’re trying to address things in their diet, but at the same time you can pretty much tell that a lot of it is derived from their state.

DrMR: Oh yeah. And that’s why I’m so, as you can probably tell, passionate about giving people accurate and very well thought out advice. Because I think we’ve gotten to a tipping point now where people are not being responsible with the language that they use and the accuracy of the recommendations that they’re making. And it’s making people think they have problems when they don’t have problems.

So you’re absolutely right. I see more of that than I’d like to admit that I see. And that’s why I try to have written into the tapestry of the book this message that is empowering and not indoctrinating. I don’t want people to walk away from the book feeling afraid of food, or dependent on supplements. Because you shouldn’t be.

But when someone writes a book, and this is not a dig on anyone who has done this. But when someone writes a book with 101 reasons why gluten is bad, and a plan to avoid gluten, and they don’t give you this broader context, then people walk away thinking, “I can never have gluten.” But three months later, they read about how if you have bacterial overgrowth, which they think they have because they heard a symptom of bacterial overgrowth is bloating, then you shouldn’t eat FODMAPs. So now they’re gluten free and low-FODMAP.

Then, 6 months later they read about the autoimmune paleo diet and how they can’t have any nightshades because that may fuel their autoimmune condition. And they have thyroid autoimmunity. So now…

MP: They have two foods left. Now they’re eating the cardboard diet.

DrMR: Yeah. They keep accruing all these dietary restrictions, and no one has ever given the context of saying, “Here’s the plan we’re going to go through. And we’re going to reevaluate at the end of every step. And as part of this plan, we’re going to try to broaden your diet as much as we can and get your off all supplemental support to try to find the minimum amount of supplemental support and the maximum amount of food you can include in your diet.”

MP: Well, that just sounds like responsible doctoring.

MP2: Right. Integrity.

Carnivore Diet

MP: I’ve got a question for you. We’ve had a couple of guests on the show who eat a carnivore diet. I’ve seen this all over social media now, where people literally only eat meat. No vegetables, no fruits, no nuts, no nothing. And they get improvements in health. Now, I don’t think it’s because the diet is a healthy diet. I personally think they have immune issues with lots of different foods or maybe some other gut stuff. What do you think is going on? Do you think I’m on the right track, or do you think there’s something to the carnivore diet?

DrMR: I think the carnivore diet is an untenable dietary recommendation to make in the long-term. I’m open to it as a short-term diet to allow one to give the gut a chance to heal. To reduce the consumption of some of these food stuffs that may be more noxious to the gut. And it does seem that plant matter can be noxious to the gut. There are compounds in plants, perhaps more so than any other type of food, that are noxious or can be noxious to the gut.

MP: Like what? What are some of these compounds?

DrMR: Well, you have things like lectins and saponins. And even things that aren’t designed by the plant to be noxious can irritate people with sensitive guts. Like those with SIBO, IBS, and FODMAPs.

So I think if you improve someone’s gut health, then they won’t need the carnivore diet in the long-term. If you look at the anthropological data, the best study that I know of that was a world-wide assessment of hunter-gatherer diets did find that, yes. Maybe 50, as high as 60% of calories came from animal products. But that’s 50 to 60%. That’s not 100%.

Now, I’m also open to the occasional exception. The 1% of the population that may have such progressed immune problems that they can’t eat anything else. But I would be suspicious if someone like that may have something akin, well, firstly. Foundationally, make sure they don’t have something like SIBO, H. pylori, dysbiosis, and just aren’t in need of a gut healing protocol. Second to that, an FMT I think may be very helpful for someone who has gone through and not responded fully to all the other foundational therapies. So not putting FMT first, putting that more toward the end of the list. Or undergoing treatment for mast cell activation syndrome where people have very, very overzealous immune systems and may need direct immune therapy. Or even using something like helminth therapy, which is more experimental.

MP: Ugh. That’s where people give themselves parasites?

DrMR: Mm-hmm. It’s much more experimental. But if we’re looking at someone who can only eat meat, something is wrong there. Right? Something is in need of rectification. So that’s where these other therapies, I think, would be good to look at.

Helminths

MP: Is the helminth therapy, is that becoming more of a thing now? I read a book on that maybe three or four years ago, and it was really fascinating. The people that were doing it were people with really bad, like Crohn’s disease. Really, really bad autoimmunity.

DrMR: Yeah, you don’t do this if you’re just a little bit bloated.

MP: Is there new science coming out on this? So for the audience who doesn’t know what I’m talking about. This is where they give people parasites. And through that process, the body’s immune system…

DrMR: We should clarify that term, though. There are things that may have been stereotypically labeled as parasites. But they may not actually be parasitic.

MP: Interesting.

DrMR: Because we’re noticing that some of these worms. And worms are really the lifeform in question here. They may have developed a symbiotic relationship with the host, not dissimilar to some bacteria. Where they cause a localized immunosuppression so that they can live. But we may have evolved requiring some degree of immunosuppression in the gut to prevent overly zealous immune attacking.

MP: Wow.

DrMR: So they may not function as parasites. They may be things that we used to label as parasites, but they may now be better classified as symbionts.

MP2: That’s interesting. They’re beneficial.

DrMR: Yeah.

MP: We need them, in other words? So is there any new research on this to show that it’s…

DrMR: There’s not a ton of research here. Because as you can imagine, the ability to get approval for these studies …

MP: You’ve got to go to Mexico.

DrMR: But we did have…I’m blanking on his name now. We interviewed three worm specialists on our podcast. There was a researcher from Duke, William. Gosh, I’m blanking on his name. William Parker, from Duke. And he did what I thought was one of the more interesting studies. Where they did an assessment of patients who were self-treating with worms. And they did find, there is a documentable clinical effect for these people. But it’s challenging, because there are different types of worms, just like there are different types of probiotics.

We interviewed another, I guess you could say worm specialist. I think his name was Garin Aglietti. And he’s in Mexico. He’s very passionate about worm therapy, but also very passionate that worms are as individual as people. So how we use those is fairly individualized. So there’s a lot here to learn. And I don’t profess to know everything because there’s not a lot of clinical literature to pull from.

I have had a handful of patients who have elected to do their own self-experimentation. Because unfortunately…

MP: Where the hell do they get the worms?

DrMR: I can’t advise anyone to do anything because of the legal environment around it.

MP2: Local bait store?

DrMR: So there are two places you can obtain HDC through a website known as biome restoration.

MP: Wow you can buy worms online?

DrMR: I’ve actually done two inoculations myself.

MP: Wait a minute. Hold on a second. Rewind. You bought worms online, and ate them?

MP2: Yeah, how do they come? Are they in capsules?

DrMR: It’s very similar to a probiotic. I’m sorry, Nancy O’Hara is a pediatrician we also had on our podcast who I thought gave the best iteration of clinical guidelines. She uses these in her pediatrics practice, and she sees about a 50% response rate.

MP: Whoa! 50%?

DrMR: In a select population.

MP: So you took these? What happened to you?

DrMR: The first time I took them, I took a dose that was probably higher than I should have. I didn’t understand all the nuance until I had a chance to interview Dr. O’Hara. And this is why it’s important not to talk on a topic that you don’t have clinical familiarity with. But I wasn’t advising anyone on this.

MP: I would never do that.

MP2: It’s got like tentacles coming out of you.

DrMR: I was just doing my own self-experimentation. But she starts people with a lower dose and gradually stairsteps them up. I did 30 units of the HDC helminth, which is a medical term for worm. And what can happen, if you take too high of a dose. Or you have an immune system that’s very ramped up, is you can have a histamine reaction when you first take it.

MP: Oh, you mean an allergic reaction?

DrMR: And so, I had irritability, and brain fog, and fatigue. I took an antihistamine, and I took an Advil, and it went away within 10 minutes and never came back since. I don’t really have a lot of symptoms. I have little things that we all deal with, but nothing that I felt like it was a good gauge to say this is working or this is not working. So I ended up doing two inoculations. And then there were other things I wanted to experiment with, and so I jumped ship.

About 6 months ago, I did one additional inoculation of 10 units, and I felt nothing. I felt no histamine response. But according to Dr. O’Hara, those who have the most wound up immune systems tend to have the most histamine reactions out of the gate.

So without getting to far field into an area of therapy that isn’t really going to provide people much relief, I think there’s something interesting there. There are these other therapies for people, for example, who can only tolerate meat. I would say an FMT, working with a provider that can guide you through helminthic therapy, or mast cell activation treatments. Which essentially start with over the counter antihistamine agents can be very helpful. But this is going to a class of people that is the vast minority. There’s a lot more entry level steps that will give people quite a bit of benefit.

MP: Wow.

What to Feed Kids

MP2: How often do you get questions about kids? Raising kids today with all the processed foods, and sugar, and the (stuff) that we have out there. Do you get a lot of parents that as you, “What am I supposed to feed my kids?”

DrMR: I don’t get as many parents asking what to feed their kids as I do parents saying, “I have a child with IBS. I have a child with behavioral issues.” And for those children, the same things that happen to adults happen to children.

One of the things I’ve seen happen with children that’s different in adults is, and I see this in a population of children with behavioral disorders. Where their parents read about the GAPS diet. Have you heard of that?

MP: Mm-hmm.

DrMR: So essentially the GAPS diet is a diet that is very heavy in fermented foods. It’s gut and psychology syndrome, I believe it stands for. Natasha Campbell, I believe is the author. It’s a healthy diet. It’s like a paleo diet combined with a lot of fermented foods. And that can be very helpful for some people.

However, in fermented foods, you have d and l-lactate. Which are these compounds which are a byproduct of bacterial fermentation. Children have a much more difficult time metabolizing d and l-lactate than adults do. Why is that relevant? Because d-lactate, when it builds up, can cause brain fog, irritability, alterations of mood.

And if you combine that with someone who also has small intestine bacterial overgrowth, which will itself, we think, release d-l-lactate then you can fall into the syndrome of these kids just being saturated in these compounds that can cause irritability, brain fog, and tantrums, and what have you.

So by getting them off of fermented food. And if they also have it, treating their dysbiosis and/or bacterial overgrowth, we’ve seen some pretty remarkable improvements in behaviors in some of these children.

MP: Yeah, I was going to say. Are parents bringing their kids in, thinking they have ADHD, change their diet, gets better, goes away, stuff like that?

DrMR: Sometimes what happens is it gets better for a little while and then it starts to get worse. If they’re use the GAPS diet specifically. Because at first, I think the probiotics on the GAPS diet help to support and correct any dysbiosis. But then they hit the other part of the U…

MP: The threshold where they get too much.

DrMR: And now they start building up this d-l-lactate, and probably also histamine. And now they’re just saturated. And they need to stop the intake of that for a while, and let these things drain out of their system.

Gut-Brain Connection

MP: Whoa. What is some of the cutting-edge research? Because the last thing that I read that was really mind blowing to me is all this research coming out on how our gut health affects our mental state? And then they discovered that there’s basically a direct connection between the gut and the brain where we thought it was always separated by the blood-brain barrier. But I guess there’s a direct highway now through the lymphatic system. What is some of the newest research coming out? What is it looking like?

DrMR: Well, I can’t say I’m on the forefront of every nuance there. Because there’s an important clarifying remark to make even in that regard. Which is, there’s a difference between clinical studies that exhibit some kind of gut-brain connection and mechanistic findings. Does that kind of make sense?

MP: Explain deeper. So we could see that there’s a connection, it doesn’t mean that there’s actually…

DrMR: Yeah, it’s one thing to be able to say that when someone has this type of bacterial overgrowth, we see an expression change in this pathway in the brain. Or we see an upregulation of this gene transcription. Or we see more of this compound being released. That’s probably some of the most cutting edge, which is just starting to piece together some of these mechanisms. Meaning when this is going on in the gut, counterpoint what is happening in the brain?

That I’m not up to snuff on, because I’m looking at, here we have a group of patients with IBS who also had depression. And we treated them with this, and here is what happened. And this is where I focus on… Because I’ve learned that as interesting as these mechanistic observations are, and as important as they are for advancing the science, they don’t give me anything to do differently tomorrow in the clinic.

And I would also caution that if you do too much treatment in drawing inferences from what we see in mechanism studies, the probability that you may hurt someone is high because until we’ve run that experiment in humans, we don’t know what’s going to happen. And I think people with IBS or other gut issues who are given lots of prebiotics or high-prebiotic diets because in theory that should have helped them and then the majority of patients that tends to flare them, is a glaring example.

MP: I’m one of those. They’ll say, “Eat lots of prebiotics,” which are the starches and stuff.

DrMR: Last time I was here, we talked about that.

MP: Yeah. And I’ll eat that, and that will jack me up.

DrMR: Exactly. So that’s why, I get it. As a patient, it’s attractive to say, “Oh my God, there was more of this compound that’s anti-inflammatory.” Like there are when you eat prebiotics, right? “I’m going to go out and do that.” And I’ve had plenty of patients who have gone out and done that, and they’ve felt terrible after doing so. There are some patients that that will be helpful for. But the point I’m making is we want to look at human clinical trials or at least outcome studies before we start intervening.

Now, to the point of intervening, I have seen low histamine diets be very helpful for people with otherwise non-responsive neurological symptoms. Brain fog, including insomnia. Word search, irritability, fatigue. All are symptoms of many, but of histamine overload. And what can be problematic there is sometimes people inadvertently go onto a higher histamine diet when they go paleo. Especially if they go paleo low-carb.

MP: Is that from all the high histamine containing foods? Like…

DrMR: Like avocado, tuna, any kind of jerky, spinach, kombuchas. Anything fermented. Cured meats. Right? So it’s possible that you could be eating a lot of this. And in fact, I had a period where…

MP2: Sounds like Sal’s diet.

MP: It does.

DrMR: I had a period where I was having brain fog and irritability for no reason. And I just remember, I’d been sitting at my desk, on a beautiful sunny day, and all of a sudden half an hour after I eat I feel irritable and fatigued and foggy. And I’m just like, what the heck is going on? This morning I had two eggs, avocado, sauerkraut, and I just was sipping on a kombucha. I didn’t realize it at the time, but I was just saturating myself in histamine. Because every meal had a high histamine food.

So that’s one thing that can be very effective. It only takes a week or less to run a low histamine diet experiment. And by the way, in Healthy Gut, Healthy You, we talk about the low histamine diet and we also link to a low histamine diet guide. So we have bases covered there for an easy, do this for one week. If you feel better, then just be mindful to restrict or reduce your dietary histamine intake. It doesn’t mean you have to be crazy and can never have any histamine. It’s just like pouring water into a sink. You can’t pour the water in faster than the sink can drain. So you can’t eat more histamine than your body can clear.

MP: What about an antihistamine? Would that benefit somebody in that particular situation? If they took Claritin?

DrMR: By the way, I’m saying this as someone who has been a little bit histamine sensitive sipping on a kombucha, right?

MP2: I was just going to say, you’re drinking our Brew Doctor right now. How often would you recommend somebody drink something like that? Because I know you can overdo that, too.

DrMR: I used to eat a high-histamine food at every meal. And when I took a dietary assessment of what I was eating, I discovered that I was eating a high histamine food at every meal. Because it’s kind of like the lazy man’s paleo. Tuna, avocado, cured meats, jerky, spinach.

So now I just simply try to not do that. Literally all I had to do. There was no complicated math involved. And that made a huge difference. So everyone will have to find their own threshold. Also, your intestinal lining secretes enzymes to help you break down histamine. So the healthier your gut, the better you are at metabolizing histamine. So to our earlier point, if you improve someone’s gut health, they’ll have less dietary restrictions that they’ll have to worry about.

But regarding histamine specifically, I think the easiest way to figure that out is to have someone do a low-histamine diet for a week and then do a reintroduction to see where their threshold is. But in the context of also working through a broader program to improve their gut health. Because if you have an active inflammatory burden in your intestines that’s damaging your villi that secrete the enzymes that help you break down histamine, you’re never going to be able to eat that much histamine until you get rid of that inflammatory factor damaging your intestines, lowering your ability to break down histamine.

Dr. Ruscio Resources

DrMR: Hey, everyone. This is Dr. Ruscio. I quickly wanted to fill you in on the three main resources that are available to you in case you need help or would like to learn more. Of course, I see patients, both via telemedicine via Skype, and also at my physical practice in Walnut Creek, California. There is, of course, my book, Healthy Gut Healthy You, which gives you what I think is one of the best self-help protocols for optimizing your gut health. And of course, understanding why your gut is so important and so massively impactful on your overall health.

And then finally, if you’re a clinician trying to learn more about my functional medicine approach, there is the Future of Functional Medicine Review, which is a monthly newsletter, which is a training took to help sharpen clinical skills. All of the information for all three of these is available at the URL DrRuscio.com/resources. In case you are on the go, that link is available in the description on all of your podcast players. Back to the show.

MP: So that seemed like a really complicated answer to, maybe not drink a kombucha every single day? Or just not having…

DrMR: Yeah, sorry. Coming back to the brain thing, there’s also been one meta-analysis. And a meta-analysis is essentially one study that summarizes the result of the existing clinical trials. Very, very high level of scientific evidence that found that probiotics have a measurable positive impact on both anxiety and depression. So these are the types of things that I think are important.

Looking at the mechanism is very interesting, but that’s for researchers to then say, “OK, here’s a consistent relationship that we’re seeing.” And a way that we could intervene is by then setting up a clinical trial giving an agent that lowers this, increases that, modulates this. Then they have the clinical trial. And if that clinical trial works, someone like me is watching the clinical trial outcomes and saying, “Ah! Now we can bring this into the clinic and use it.”

MP: What about the histamine blocker or antihistamine drugs I asked earlier? Would that help in that particular situation?

DrMR: Yes. They may. They wouldn’t be the first place I would go, because again, someone may just be eating too much dietary histamine. If someone has something like small intestine bacterial overgrowth, or leaky gut, or damage to their gut, then that may be causing them to not do a good job of clearing it themselves.

But as we go on the continuum of people with mild health conditions toward more severe, some people may need ongoing antihistamine medications. Like cetirizine or loratadine. Benadryl, Zyrtec, things like that. And that’s when I mentioned mast cell activation syndrome earlier. For some of these patients who are exquisitely sensitive, then they may need to work with a specialist, of which we’ve had on two times now. Dr. Lawrence Afrin, who is a pioneer in this work, who would essentially build for them a custom protocol of either antihistamine agents, which can be over the counter, or mast cell stabilizing agents, which are mostly prescription, that can help calm down their overzealous immune system.

So yes, someone could start with an easy protocol of just experimenting with an over the counter antihistamine, and that may help them. But I would do that only in the context of first trying to improve your gut health more broadly. And then there are protocols that have been developed for how to use these antihistamines in a more precise manner in the longer term if someone still has these immune type reactions every time they eat. Or just kind of all the time.

MP: Otherwise, it’s a Band-Aid, right? If you don’t fix the root, then it’s just a Band-Aid.

DrMR: Right. And some people will need a Band-Aid. Even after fixing the root, they’ll need that Band-Aid. And that’s ok. That’s the other thing that sometimes throws people a challenge. Where they feel better on a drug, but philosophically they don’t want to be on a drug. But if you’ve addressed the root, there are some people that will need that additional support. And for some people, you just have to say, I’m ok with it. And not prevent yourself from undergoing a treatment that may help you just because you have this philosophical preference not to ever use drugs.

Fasting

MP: Of course. One of the best things I’ve ever done more recently for the health of my gut is I do a prolonged fast every month now. I do a 48 or 72-hour fast, and it’s one of the best things I’ve ever done personally for myself. Why is that helping me so much? Have you used fasting with your patients?

DrMR: Yep.

MP: What seems to be the deal with that? Is it just because it gives me a break? The way I figure it is I’m killing off old cells. Stem cells get stimulated when I refeed those stem cells get turned into new cells, which tend to be less autoimmune, or less prone to be autoimmune. But that’s just my own speculation.

DrMR: I’m sure there’s a degree of that happening. I don’t know if we know what one mechanism predominates, the benefit that is derived from fasting. But they’re probably multifold. And I should mention, I want to try to give the listener the context here. As part of step one in the Healthy Gut, Healthy You protocol, we talk about meal frequency and fasting. Because that would be a foundational issue, right? Just like you said. You derive huge benefit from periodic fasting.

So before we have someone do, say, herbal antimicrobials to kill SIBO, let’s make sure it’s not just a lack of fasting that’s holding them back.

MP2: You’re oversaturating yourself all the time. How about just back off a little bit!

DrMR: Exactly. Now on the other side of the coin, some people need to eat more frequent meals. Because some people fast too much. And they start getting irritable. They start being fatigued, and not sleeping well, and having insomnia because they’re drinking a ton of caffeine and they’re fasting a ton. So there’s a balance to be struck.

But we do have one clinical trial, it may not be a clinical trial, it may be more so an observation. But we have documented evidence showing a favorable impact with fasting and IBS. And in IBD. And we have data showing because there’s the question embedded in this topic, which is, “Doesn’t skipping a meal damage your metabolism?”

The majority of the data has found no impact on metabolism. But some of the data suggests a slight benefit. So if you look at all of the data at large, the majority of the data show a negligible benefit. There are some studies showing a metabolic benefit. So we can say, for your metabolism, fasting is neutral to beneficial, but it does not seem to be supported that it’s detrimental.

But why it works is likely, like you said, stimulation of the apoptosis and stem cell stimulation. There’s also likely a partial mechanism of not being exposed to food stuff that may be irritating your gut.

MP: Mm-hmm. It’s like giving it a break.

DrMR: Right, giving it a break. Those are probably the two predominant. You may also make the argument that if someone has something like a fungal or bacterial overgrowth, you’re depriving those the food they need to proliferate. That could be another argument. A fourth could be that fasting stimulates motility, which helps sweep out bacterial and fungal overgrowths. It stimulates essentially this peristaltic wave known as a migratory motor complex where the intestines contract, and as they contract it just kind of sweeps any of the leftover debris.

MP: This is probably why the first meal after a long fast you get the, basically, diarrhea. It comes out real quick.

MP2: Do we consider the digestive process an actual stress on the body? Do we consider that, or no?

DrMR: That’s a good question.

MP2: The reason why I ask that is I feel like it’s so much simpler than that. When you look at all the systems of the body, if you’re constantly stressing it all the time, it’s constantly having to work, then it would be the most obvious thing to me to give it a break every once in a while just like every other system in the body for it to be most optimal.

DrMR: Good question. I had never really thought about, is digestion a stressor. But yeah, I would think it’s a healthy stressor, just like exercise.

MP2: Right, but…

DrMR: Or even breathing. Oxidation is a byproduct of breathing. Oxygen can be, for lack of a better term, inflammatory because it’s oxidizing. So yeah. We know that you need to burn more calories when you digest food because of the energy that is utilized. So I guess you could make the argument that digestion is a stressor. If someone’s gut is overly stressed, you can take some stress off of the gut by fasting.

MP2: Which seems to me that in the day and age that we live in is more common than not, because most Americans.

MP: Yeah, nobody fasts.

MP2: Right. Most Americans are over-consuming, and sitting down, and having food delivered to them. You know what I’m saying? I just feel like it seems that simple to me that it would be that beneficial.

DrMR: Especially the body-building community. Because this was a tough pill for me to swallow initially. Because I came, I don’t want to say I came from a body building background. But that’s where…

MP2: You come from the eat every 2 hours.

DrMR: Right, eat every 2 to 3 hours kind of camp. Which worked very well for me. But I think when I was going through my gut problems, if I knew about fasting, and some of these other things, I would have been able to heal so much more quickly.

MP2: Right. I 100% agree. If you look at the book right now, what is the most powerful. If I had to pick one chapter in that book, what do you think is the most powerful and impactful chapter you have in your book.

DrMR: Jeeze. That’s like asking to choose your kids, which kid do you like most.

MP2: Right? I know it’s full of all kind of stuff. But think from a practical standpoint when you were writing it, what do you feel like, “Everybody needs to read this piece right here.”

DrMR: Let me answer that with maybe three. I’m going to break it down. 1a, 1b, 1c.

MP2: That’s fine.

DrMR: If someone is still working on their diet, read the chapter on diet. If someone has already done paleo, and they’ve already maybe done low-FODMAP, then I would read the chapter on step 2. Step 1 is all on diet. Step 2 is all the therapies that would do after diet, like probiotics and enzymes. And if someone has already done diet and probiotics, then I would read the chapter on step 3, which is the next escalation of therapy. Which are antimicrobial therapies to help correct any kind of dysbiosis.

MP2: So it’s even written, in your opinion, chronologically, for how someone should actually go about it.

DrMR: Exactly. The whole book, first we go through explaining all these things. Like, if you haven’t heard of these diets, here they are. If you haven’t heard of probiotics, here they are. If you haven’t heard of antimicrobials, here they are. Here’s what they do, here’s how they can help. And then we organize all that at the end into this action plan called the great in 8. And it’s 8 steps, but not everyone has to go through all 8.

MP2: Got it.

DrMR: Let’s say you’re in generally good health, but you’re a little bit bloated. You may only need to go through step 1, and then you go right to maintenance, which is step 6. But if someone has very progressed IBS, they may have to go through step 1, step 2, step 3, step 4, step 5, and then into maintenance, which is 6. So it’s meant to be a book that can help someone with mild symptoms all the way through severe. And it steers you along the process.

So not everyone does all 8, because that would be wasteful. For you, it would be wasteful if you were doing the same amount of stuff as someone with severe colitis. So it’s individualized where we check in with you at the end of each step and we say, “Ok. If you’re feeling this way, go here. If you’re feeling that way, go there.”

MP2: Do you plan on attaching coaching and online sort of accountability through this book? This book is the vessel that kind of opens that up?

DrMR: That’s a great question. No. Because I do not have the time or the bandwidth to do that. I know there are a number of health coaches, and even doctors, who are now using this book with their patients. Which is pretty awesome to be able to say. We do have a forum on our website for every step of the 8 steps where you can ask questions.

And I think at some point, but it’s a year or two away, I’ll probably roll out a clinical training course for doctors and health care providers to be able to use this work with people. I’d love to have that accountability piece, but the next thing I want to tackle is trying to get a few more research studies published showing the validity of some of the approach that’s recommended in the book.

MP2: I kind of think I know the answer, but I would like to hear you articulate it. Do you believe that it’s important that somebody learns all this information, even if you feel 100% healthy. I’ve got no issues, I feel fine. I eat the way I want to eat and I don’t have any problems.

DrMR: I think this book is one that someone in that position, that fortunate position, could read. And it could give them some ideals to strive for if they wanted to be preventative in nature, yes. But I make that recommendation very cautiously. Because I would hate to take someone who is healthy and then pull them into this sickness of health indoctrination and just put that negative into their psyche. This book will not do that, because this book was written to be empowering rather than fear mongering.

I would say, if you’re someone who is healthy, I’d be very cautious with what you read. Because the last thing you need to do is fear yourself into feeling like you’re not sick when you are. And that happens more than you would think. So that’s why I make that very careful answer. Because I’d hate to see a healthy person think they were sick, even when they really weren’t.

MP2: Right. I just like to think that there’s probably people out there that feel fine. I think of myself when I was 25. I would have loved to have met you back when I was 25 years old, but if you would have asked me I would have said, “I’m fine.” And I was eating Jack in the Box every once in a while. I hardly ever ate any vegetables. I didn’t eat a lot of fermented foods. Because I didn’t really understand the importance of that. And I think understanding that, even if I didn’t have problems, would have set me into the right track earlier on as far as better food choices and things like that.

DrMR: Yep. And exactly that in the sense that I also wouldn’t want to make you someone who is now a health nut. You go out to a restaurant, and you ask the waiter, “Was that cooked in a Teflon pan? None for me.”

MP: Create a bunch of orthorexics.

DrMR: I wouldn’t want to turn you into that. And again, I’m not saying that it’s healthy to use Teflon. But you want to be discerning in the way we count…

MP: There’s bigger rocks. I tell people the same thing when they ask us detailed questions about supplements. It’s like, “If I take this at this time.” It’s like, bro. You’re not even paying attention to what you’re eating the rest of the day and you’re asking me about some supplement is going to give you 1% more of the edge. It’s like, let’s handle the big rocks, first.

And I think that’s one of the things that we all connected when we all first met and have become friends. I think you’re very responsible with the information that you provide. Like what we try and do, too. Listen, I’m not saying that’s a good thing or a bad thing. It’s just that there are probably other things that you should probably be putting a lot more effort into before you’re worried about Teflon.

DrMR: Pick your battles. Yeah, exactly.

MP2: What are some other not so common issues that people have that can be related to poor gut. Because obviously if you have constipation, bloating, diarrhea, anything that has to do with that, people know, my gut is off. But what are some other symptoms that can be related to your gut that people don’t necessarily realize?

DrMR: It’s a really important question because you can have a non-digestive symptoms that’s caused by a digestive problem. And that was actually me. I had an amoeba, but I didn’t have diarrhea, or bloating, or abdominal pain. All I had was fatigue, very bad insomnia, brain fog, and I was feeling cold often.

So you can have a problem in the gut that manifests solely as pimples and rashes. Or solely as insomnia. Or solely as fatigue. Or solely as brain fog. Or solely as irritability. Or solely as joint pain. Or solely as hypothyroid-like symptoms. Saying hypothyroidism I think would be a little bit of a stretch. But there’s definitely, especially a SIBO-thyroid, and H. pylori-thyroid connection. So it’s definitely possible.

We have, at very least observations, if not clinical treatment data showing that treating these imbalances in the gut will improve the skin, the joints, the brain fog, the thyroid. So I don’t say these things lightly. Again, being careful in the language that we use. But we do know that it is very possible to have no digestive symptoms but your symptoms are being caused by a problem in the gut.

MP: And it can be a lot of things.

DrMR: It can be a wide array of symptoms.

Episode Wrap-Up

MP: That’s what makes it difficult. Well man, I’m glad you wrote this book. We’ve been recommending it to people. How’s the response been so far?

DrMR: It’s been awesome. People are literally sending in testimonials. I don’t want to say testimonials. But just thank you’s on Instagram. “I haven’t pooped normally in 10 years. This is the first time I’ve been pooping normally.”

MP2: Oh, wow.

DrMR: Literally.

MP: That’s a big deal.

DrMR: Yeah.

MP2: Deserves a celebration.

DrMR: Another gal, “I owe you my life.” So it’s really cool to never have met these people because I see that kind of thing in the clinic, which is great. But to have never even met someone.

MP: Right. To be doing it all over the world now has got to be really cool.

DrMR: It’s a really cool feeling, yeah.

MP: Well, and I’m really excited, just for everyone that’s listening too. I already tied Mike down that we’re going to start having him drop in our forum on occasion.  So he’ll be in the private forum, and we’ll set it up to where you guys could ask him some questions, spend about an hour on there to be able to talk to you guys. So that’s something to look forward to in the future.

MP2: Excellent. And the name of the book is Healthy Gut, Healthy You. And you can find that anywhere, right?

MP: Amazon.

MP2: Amazon.

MP: We’ll also have links in the bio. We’ll have all kinds of stuff with that. Plus we’ll do a nice intro for Mike before we start the show.

MP2: Excellent. If you want to find him on Instagram, what’s your Instagram handle?

DrMR: I believe it’s DrRuscio.

MP2: Thanks, brother. I appreciate you coming on.

DrMR: Thanks for having me, guys. Always fun.