How to Improve Gut Health Without Expensive Lab Tests

How valuing Shereen’s symptoms of bloating, hormone imbalances, and frequent, loose stools more than just her test results led to an effective treatment plan—and actual symptom relief.

Like many patients coming into our clinic, Shereen was used to working with functional medicine practitioners who ordered many expensive lab tests immediately to determine her treatment. But the continuous testing didn’t provide symptom relief, prompting her to look to our clinic for additional assistance. 

When she began working with Dr. Ruscio, DC she was surprised to find his recommendations for healing weren’t based on lab markers; they were instead based on her symptoms. Shereen implemented dietary and lifestyle changes recommended by Dr. Ruscio, DC and ultimately found her gut health, workouts, female hormone imbalances, and food reactions improving. 

Listen in to hear how her health journey began and what got her feeling better.

Subscribe for future episodes

• 
• 
• 

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

Intro:

Welcome to Dr. Ruscio’s, DC Radio, providing practical and science-based solutions to feeling your best. To stay up-to-date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.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 with your doctor. Now, let’s head to the show.

Dr. Ruscio, DC:

Hi everyone, this is Dr. Michael Ruscio. I just wanted to make a quick preface that the audio that you’re about to listen to is actually the audio compendium to a video which has appeared both on our YouTube channel and on our Instagram page. For your convenience, we want to always release the audio version of a video here on the podcast. However, it’ll be evident in some videos more so than others that the visual aids may be heavily referenced and leaned on. In some cases, having a depiction of a concept can be very helpful in portraying and making comprehendible that concept. So in any case, if you are listening to this and you want the visual aids, please see our YouTube and/or Instagram page so you can have access to those. Okay. And here we go to the audio for today’s video.

Dr. Ruscio, DC:

Once in a great while, someone at the clinic will say, “If we don’t do tests, how do we know what to do?” And it’s like, there’s just such a…

Shereen:

Your body is telling you so much.

Introducing Shereen’s story + our top clinical pearl

Dr. Ruscio, DC:

Hey everyone, this is Dr. Ruscio, DC and I’m here with Shereen, who has done so, so awesome at the clinic. And Shereen, gosh, there’s so much I want to share, I want to kind of jump right to it. But hi, and thank you for being here.

Shereen:

Hi. Sure, yeah. Thanks for having me.

Dr. Ruscio, DC:

With these cases, there’s usually one pearl that I always want to share. There’s multiple things that we’ll go over with each patient that we work with as part of their road, but there’s oftentimes one thing that really stands out as, “Ah, if there was one lesson I could share, it would be this”. And in your case, it was the apprehension that you had out of the gate with not using a testing-centric or a test-guided model. And I understand that, right? It was, “Well, how do we know we’re doing the right thing?” Totally get that. That’s the one thing I want to share and kind of unpack more. But maybe to start, give us the short background on your symptoms, just so people have some context in terms of what you were struggling with, and then how that mapped onto the perception that we needed tests to figure out how to resolve the symptoms, which have been, I wouldn’t say completely, but we’re, well, well on our way to being resolved without using this really testing heavy model.

Shereen:

Yeah. I’d say my symptoms started maybe about eight years ago. And it took me a while before I finally got in touch with a functional medicine doctor. And right away when I let them know that I was having some GI symptoms, instantly: “Okay, let’s give you some tests.” And so of course that primes me of, okay, this is just the standard of how you assess what’s going on. And this has to be… it was always, these tests have to be done before we can actually treat. And that wasn’t just from one doctor, that was from multiple doctors that I saw. And then even with… and some of the symptoms I had, I’ll share some of that, it was bloating, constant bloating, frequent bowel movements, like constant, and sometimes it would be very loose bowel movements, so it was very uncomfortable. Feeling like I had to just take out so many food groups and still not really noticing much relief. Kind of being told, “You need to be on a low FODMAP diet forever, and this is just how it goes”, which was incredibly hard to hear.

Dr. Ruscio, DC:

Forever. That’s really bad advice actually, even if you look at the research literature, that’s not what’s reported or recommended by the researchers in low FODMAP.

Shereen:

Yeah, right. I mean what was essentially told to me was well, if this diet is treating you well and you feel like you’re responding well to it, then don’t bring in foods that are upsetting you. And so that was kind of how I understood that. Like, okay, so I guess I just need to continue to avoid these foods. And so it felt like, okay, initially I was optimistic because this was all I knew. So, okay, I’ll do these tests, we’ll see what comes up. And sure enough, some things came up, and SIBO specifically was one issue that came up. And so they started me on a course of treatment, and they said, okay, you did the first course of treatment of antimicrobial herbs and probiotics, so let’s retest you and see where your levels are at. Got another… and I also just want to note that these tests are not cheap. They’re not pleasant, right? That’s the other thing, is they’re not pleasant. So if I’m going to do these tests, I want to make sure, okay, this is really the best way to go. And the SIBO tests also are very time intensive, you’ve got to do a whole different diet the day before and it takes up majority of the day, so it’s a really big investment.

Dr. Ruscio, DC:

Yeah. You have to sit there with a timer, so every 20 minutes… and even though you’re only blowing in a tube every 20 minutes, it’s still, like you said, it’s going to kind of tether you to the table to come back every 15 or 20 minutes.

Shereen:

Absolutely. Well, the first time I did a SIBO test, I actually had to drive about an hour away from me, because at the time, I guess that was where my doctor was doing the test. And so I actually had to sit in a waiting room and then go in every 20 minutes to do the test, which was even worse. And the other thing too is it’s also stressful during this test, you know, I’m ridden with these really disruptive, frustrating symptoms, and here I am really hoping that these results bring back something that will then give me the relief that I need. So there’s also some stress and anxiety around the actual test taking. And so after that first round, I did another round of the SIBO test, noticed the SIBO was still there, incredibly discouraging.

Dr. Ruscio, DC:

Had your symptoms improved during that interval?

Shereen:

Slightly.

Dr. Ruscio, DC:

Okay.

Shereen:

Slightly. I noticed some improvement, but the bloat was still there, it was just not maybe quite as intense.

Dr. Ruscio, DC:

So here’s a cool fork in the road just to kind of quickly expound upon this. All the time that you took, probably three weeks, I’m assuming, to four weeks, could have been used to pivot at that follow up visit. Instead of saying, okay, you’re slightly better, let’s learn from that, let’s build on that and make some changes, instead, I’m presuming, it’s keep doing what we’re doing, or kind of do this maintenance, pause, do the tests, wait three to four weeks and then we can move forward. This is one of the main reasons why I’m not super keen on serial SIBO testing. The SIBO test has been validated, like many tests in functional healthcare have not. This is one that has been validated. So it has the scientific merit, but it doesn’t mean that boom, boom, boom, every month or so we have to be retesting this, because we can learn so much more from your symptoms, how do they respond, and continue to modify and personalize the therapies based upon your symptomatic response.

Shereen:

And that being your approach I think was what was really refreshing and why I brought this up to you to begin with, was initially, as I had mentioned to you, I was skeptical <laugh>. When I first met you, I thought, wait a minute. Okay, so he’s giving me these probiotics, and this protocol, well, when is he going to test me? Okay, well when am I going to start this other…

Dr. Ruscio, DC:

It’s commonplace. Yeah. It’s strange that even though we’re actually functioning in a more scientific manner I would argue, because we’re really doing this empirically, which is what most of the science informs, the entirety of the field is doing it in this highly testing-guided fashion, even though it’s much less scientific. But, you know, it’s, what’s that old saying? A mistruth repeated long enough becomes a truth, something to that effect.

Shereen:

Well, and that’s exactly what led me to pursue your clinic was, you know, my symptoms had persisted, and I had began to see another doctor at the time, and when I told her I really needed to address this, I had just had my son, and I was ready to really treat my gut, she said, “Alright, let’s get a SIBO test.” And instantly, I was like, ugh, I need a different approach. And so it felt really good to actually just focus on the symptoms. And as patient as I had to be those first couple of months and being skeptical, like, okay, is this going to work? Whoa, I’m actually noticing way more improvement in my symptoms than I did doing that test protocol previously. And that’s when I really became a true believer of this approach of testing is not everything.

Dr. Ruscio, DC:

Yeah. And we can get there more expeditiously, you know, if we follow up, and it’s shocking to say this, listen to you, and use that to move our treatment forward rather than at every interval having to retest and, like you said earlier, spend more money, have more inconvenience, and then also, like we mentioned a moment ago, delay your care by another month. Like, these things add up, and this would allow us to get you across the finish line as we did, or mostly across the finish line in three-ish months or so. If you add in all that testing, that’s going to double the time at least.

Shereen:

And the amount of money that you spent.

Dr. Ruscio, DC:

Yeah.

Shereen:

Right.

Dr. Ruscio, DC:

Okay. So the symptoms, just kind of zooming way out, there was gas, there was bloating, there was some fatigue also. There were some female hormone imbalance symptoms. And this is important I think to tie in, because I don’t feel the SIBO community oftentimes is looking broadly enough. It’s very SIBO-centric. And this is why in Healthy Gut, Healthy You, I wrote about this connection that I was observing, and this has been partially documented in the research, between one’s gut microbiome and their female hormones. And so we were kind of tracking and are continuing to track both these things.

How we healed Shereen’s gut without lab tests

Dr. Ruscio, DC:

Okay. So that’s kind of the stage that we’ve set. Take us through some of what we did and what you noticed. Because I have all these notes here of course, but it’s always nice to hear it from your perspective, in terms of, maybe you were saying to yourself, like you alluded to a moment ago, “Ruscio, what’s he thinking? You know, why is he just giving me the probiotics without doing a stool test and and quantifying if I’m low in this or high in that?” So tell us a little bit more about your perspective as we start into care, and also what you noticed from what lines of therapy.

Shereen:

Yeah, well initially I was just relieved that I was being given something to begin to take right from the get go, right. Instead of, let’s wait until we get the results. And so that was really nice because when I came to see you, I was desperate. I was like, “I need these symptoms to get better”. So it felt really good to just get something going right off the bat. And, you know, I know that during my course of treatment, maybe about a few weeks in, I remember feeling a little better, and then I got a little stomach bug, which ended up making me feel pretty crappy for a good month. And that’s when I remember contacting you and your team saying, “What’s going on? I’m taking steps back, it’s horrible, I’m back from the beginning.”

Shereen:

And you very calmly just said, “Let’s just keep at it, you know, this gut healing takes time.” And sure enough, I think that’s when… I think in terms of my belief in your approach, that’s really where it turned for me in terms of really becoming a believer, because I did just remain patient, I believed in your approach, and focused on the other things, the other lifestyle things, like making sure I’m managing my stress, meditating, sleeping well, and gradually, my symptoms really did just become a whole lot better, way better than what those other modes of treatment were. And then it just finally started to feel like my gut was really being supported properly. And then, in addition to my hormones being supported properly, which was lovely and I wasn’t expecting that when I first started my treatment, I wasn’t expecting that the hormone and gut treatment were to be going on simultaneously. But I saw how that worked really harmoniously, and it’s been really good.

Dr. Ruscio, DC:

And we did use with you some of those female herbs like the vitex and the dong quai and black cohosh, which we have in the two Estro-Harmony and Progest-Harmony formulas that we use. And this is just another good example of why it’s so important to really pay attention to your symptoms. And say, well, there’s these SIBO-like symptoms, but we know that there’s way more than just treating the tests. We can apply probiotics in a logical fashion and other dietary and lifestyle interventions, but we also want to pay attention to this other cluster of symptoms. And I don’t even think they were the ones that you came in with, like, “I want to get better with this”, you know, they were in the background. But we try to do, again, coming to that broad purview, what does this person look like in their entirety? And not just focus on one cluster, because there’s interplay. And the female hormones in the gut do have this bidirectional relationship. So we want to be paying attention to these things. Almost like this master dashboard, where we’re looking at multiple systems and saying, well, what knobs do we have to kind of adjust together to get to this orchestrated improvement across multiple systems so as to manifest a wide array of symptomatic improvements.

Shereen:

Exactly. Yeah. Yeah. I mean, it really did feel like you took a step back and looked at the whole picture, not just my gut, which you’re right, when I first came in, I said, “Fix my gut, what’s going on there?” But it’s true, the other hormonal stuff was very much going on and was on the back burner for me initially, but you know, I could see how it was impacting everything else.

Dr. Ruscio, DC:

And so we change your diet a little bit, you know, there wasn’t huge changes to your diet, a little bit of low FODMAP modification, and I believe, did we up your carbs also?

Shereen:

We did, yeah.

Dr. Ruscio, DC:

This ties in with the female hormones where oftentimes people, especially women obviously, they’re too restrictive, they go too low carb inadvertently, and then this leads to this kind of metabolic deficiency where it’s almost like someone’s undereating, they’re just undereating carbs. And this can cause problems with sleep, and with sex hormone production. It’s also more fun if you can eat carbohydrates.

Shereen:

Oh, absolutely.

Dr. Ruscio, DC:

And less restrictive.

Shereen:

Yeah. And I think before I came to see you, I was under the impression of like, oh, it’s okay going low carb, just, you know, fill your diet up with healthy fats and good solid protein, and so that was also a really big change. And to make that connection of increasing my carbs and how that could also help my sleep, that was a really big deal.

Dr. Ruscio, DC:

That’s a big one. Because anything that interferes with your sleep is just going to drag you down over time.

Shereen:

Well, and then I think also the important piece of how active I am, you know, in terms of lifting weights and doing high intensity training, I didn’t realize how much I needed to really support my body through those activities as well.

Dr. Ruscio, DC:

And this is another thing that we look at in our initial intake. How much is this person exercising, and what are they doing? Because if you’re just walking your dog once a day for 20 minutes, that’s different than someone like yourself who’s doing high intensity rigorous exercise. Your metabolic needs are going to be different. And so if we’re seeing, well, I’m not sleeping well and I’m fatigued, let’s zoom out, right? What’s this person doing in totality, and how can we shift multiple things to really support them?

Shereen:

Yeah. Yeah, exactly.

Dr. Ruscio, DC:

And did your workouts get better? I’m assuming that they did.

Shereen:

For sure. <laugh> Yes. Oh my gosh. Yeah. I mean, my energy level got a lot better, my workouts, I was able to, you know, get PRs, like personal records in my lifting, which I wasn’t really expecting and wasn’t really a goal of mine. But I mean it made so much sense, and it just made me realize how much I was undereating and then how much that was impacting my sleep, my hormones, my gut, increasing stress, you know? And so, yeah, once I felt like I was actually well nourished, and able to recover from those intense workouts, it was a game changer.

Dr. Ruscio, DC:

So I feel like there’s really two concepts here. One is we don’t need to be testing-centric. And the other is, we need to have the appropriate level of zoom when looking at a case. If we were too zoomed in just on SIBO, or just one nuance of the gut, we could have missed these other simple things. So the appropriate level of zoom, and then not putting too much focus on testing. And I would argue these interplay together. Because if you’re doing a bunch of tests, there’s kind of this tacit obligation on the behalf of the clinician, well, I’ve gotta treat and manage all those markers now. And it leads you further into this treating of the numbers, rather than saying, hmm, she’s doing a lot of high intensity training, she’s also eating low carb, she’s also exhibiting symptoms of being malnourished. You know, maybe I don’t need to test to sort this stuff out.

Shereen:

Yeah, exactly. Well, and I think also from the patient perspective, when you take that approach, I really feel heard, you know. Instead of just looking at data, which is important still too, but instead of just looking at test results, you really paid attention to what I was telling you. And it’s an incredible patient experience when you’re feeling heard in that way.

Dr. Ruscio, DC:

And this I feel is so important to get out to people because once in a great while, someone at the clinic will say, this happened to me last week, it maybe happens once a month, not too often, I think we’re doing a good job of educating people on this, but they’ll come in and they’ll say, “Well, if we don’t do tests, how do we know what to do? And it’s like, it’s such…

Shereen:

Well, and your body is telling you so much.

Dr. Ruscio, DC:

Exactly. And it’s also such an admonition regarding how impactful lab companies have been in skewing education and functional medicine.

Shereen:

Yeah, yeah. Really good advertising.

Dr. Ruscio, DC:

Yeah, exactly. And this is where the clinicians have to be the gatekeeper in terms of, you can go to the seminars, but you have to understand if it’s a seminar funded by a lab company and a supplement company, you have to be able to filter the claims and use them appropriately. And I think we haven’t quite gotten that balance right just yet in the field.

Shereen:

Right, right. But to your point, I know a lot of people are very well intentioned, right. They want to do what’s right by their patient, but…

Dr. Ruscio, DC:

Yeah, it’s all well intentioned. I just think the problem is there’s not enough questioning. I think people will question pharmaceutical funded seminars, but that hasn’t carried over to the natural and integrative space yet. Because it’s like, you know, natural, everyone’s good, and the supplements and these things can’t be bad. Well, you know, it needs to be reexamined I feel.

Shereen:

Yeah, yeah. Absolutely.

How Shereen is doing now

Dr. Ruscio, DC:

So how are you feeling now? I know we’ve alluded to this, you know, because I don’t want to paint everything super rosy, like it was all on a dime. I’m really happy with how you’ve improved, but give us kind of the current day, and how are you feeling?

Shereen:

Yeah, I mean, for the most part I’d say, well, the biggest improvement from everything that we’ve done is my gut, for sure. You know, I haven’t had kind of like what I call an episode of intense bloat in a long time, I can’t even remember the last time. So that’s feeling really good. I’m able to eat a lot more of a variety of foods without feeling nervous of what it’s going to do, which is great.

Dr. Ruscio, DC:

Awesome. Lifestyle gain.

Shereen:

Yeah. I mean, I think since our last meeting, I think maybe my hormones are still… there’s still some stuff maybe going on there, my sleep isn’t 100% where I want it to be, so I think that there’s still some room for improvement there. But besides that, and I think some of that stuff is probably stress induced too, if I were to be honest. So it’s also a constant kind of managing of that. But yeah, I mean, when I think about where I was when I first started meeting with you, which was back in April or March, around then, I feel like I was kind of a different person.

Dr. Ruscio, DC:

Yeah. And in the about three months that we’ve been working together, I’m extremely happy with these improvements. And to your point, yup, we have a few things that we’re still making some dial adjustments, like we mentioned a second ago for the female hormones specifically.

Shereen:

Yeah.

Dr. Ruscio, DC:

But also just, and I know you know this, but more so for the audience, Rome wasn’t built in a day, right? We want to look macro level, are we seeing month over month improvements? And we are. And that’s an excellent sign, and we’ll continue to have that momentum going forward.

Shereen:

Absolutely. Yeah. I mean, because even though I’m saying like, my sleep, say isn’t exactly where I want it to be, it’s still significantly better than where it was. So, yeah. It’s a huge plus.

Dr. Ruscio, DC:

Awesome. Well again, you’ve done so well. Anything else that you want to kind of leave people with?

Shereen:

I think some things that I would’ve told myself several months ago when I was in the thick of it… be patient, I think that was a big one. And also, you know, one thing that I found really valuable was, you know, doing your due diligence and your research and finding the right person for you and for what your goals are, so that you feel like you’re in good hands. And I think once I did that, it was a game changer for me.

Dr. Ruscio, DC:

Awesome. Well again, you have done so, so well. Thank you for sharing this, because those two concepts I think will help so many people, because it really is contending with a lot of the messaging that’s commonplace in the field. So again, thank you so much.

Shereen:

Thank you.

Outro:

Thank you for listening to Dr. Ruscio, DC Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s DrRuscio.com.