Limbic Retraining Helps Resolve Gut Symptoms - Dr. Michael Ruscio, DNM, DC

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Limbic Retraining Helps Resolve Gut Symptoms

A Patient’s Journey to Physical and Emotional Health

It’s an all-too-common experience in healthcare for patients to feel unheard and unseen by healthcare providers, who can sometimes prioritize lab results over their patient’s experience. And this isn’t limited to conventional medical doctors or specialists. It happens in functional medicine, too. 

And when it happens, the patient is profoundly underserved.

In this video, I speak with Danielle, a former patient who explains how her gut symptoms resolved when all the pieces (including the psychological one) came together in her treatment. It’s an eloquent example of how treating the whole patient leads to optimal results.

In This Episode

Episode Intro … 00:00:45
Danielle: Background & Health History … 00:04:03
The Danger of ‘Treating the Numbers’ … 00:06:51
Moving the Needle: Emotionality & The Paradox of Freedom … 00:16:43
Moving the Needle: Limbic Retraining … 00:22:25
Episode Wrap-Up … 00:24:25

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Hey everyone. Today I spoke with Danielle, a patient at the clinic about her experience in the field of functional and integrative medicine. Unfortunately, there are a few horror stories here to share in terms of how damaging clinical care delivered and contextualized in the wrong way can be. However, we also discuss how pivotally important gut health supports combined with the correct non fear-based narrative around one’s healthcare and limbic retraining could be the difference from someone who had seen multiple doctors and had been struggling with symptoms for years to not having symptoms; to not having food reactivity, not having supplement reactivity, not having fear and also going out and living her life and rediscovering enjoyment instead of constantly ruminating over how she’s feeling and getting pulled deeper and deeper into this obsessive thinking. So, a real case study that looks at not only these gut and physiological parameters, but also the importance of the appropriate handling of various psychological and limited parameters. So with that, we’ll go to the conversation with Danielle.

➕ Full Podcast Transcript

Episode Intro:

Welcome to Dr. Ruscio 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. Michael Ruscio:

Hey everyone. Today I spoke with Danielle, a patient at the clinic about her experience in the field of functional and integrative medicine. Unfortunately, there are a few horror stories here to share in terms of how damaging clinical care delivered and contextualized in the wrong way can be. However, we also discuss how pivotally important gut health supports combined with the correct non fear-based narrative around one’s healthcare and limbic retraining could be the difference from someone who had seen multiple doctors and had been struggling with symptoms for years to not having symptoms; to not having food reactivity, not having supplement reactivity, not having fear and also going out and living her life and rediscovering enjoyment instead of constantly ruminating over how she’s feeling and getting pulled deeper and deeper into this obsessive thinking. So, a real case study that looks at not only these gut and physiological parameters, but also the importance of the appropriate handling of various psychological and limited parameters. So with that, we’ll go to the conversation with Danielle.

DrMR:

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio here with Danielle, who has been working with me at the clinic. Danielle – like I was saying before we got on the call, this is a case study that I think is going to help so many people because you exemplify a few things that I wish more people knew and that I wished many providers would stop doing. I know you know exactly what I’m referring to here. I’m excited to share some of these details with people. Long story short, you were a beautiful case of someone who with the appropriate non-exotic gut support plus limbic retraining was a night and day game changer. These things aren’t always so obvious. It’s much easier when I say, “Well, we did this and that, and it worked.” Right? Looking back in time.

DrMR:

However, when you come in with this worry, stress and this emotionality, and having had seen multiple doctors, doing all these tests and supplements, from the clinician’s perspective it can be very hard to make heads or tails of all of this. This is why I’m really excited to talk through this so both clinicians and patients can better learn how to get people to the interventions that are going to help them and not flounder in this eternal purgatory of tests, supplements, worry, fear, dietary restriction and what have you. But before we go into some of the details, give us a snapshot of what your main symptoms were and what you were doing before we started working together. We worked together many years ago. You were doing pretty well at that point, and then you went off living your life – awesome – as I would want you to. Then, things started to regress a little bit. And this is when you got sucked into the functional medicine vortex of harm. For people listening to this/watching this, you’ll hear from Danielle that my criticisms are not unfounded. You were quite harmed by some other providers, and so I don’t feel my criticisms are unjustifiable. Anyway, we’ll come back to that. Tell us about the snapshot of you. How are you feeling and kind of what was going on?

Danielle: Background & Health History

Danielle:

It began in 2009. I thought everything was fine and I woke up one day. I ate breakfast and my stomach blew up. I mean, it stuck out like I was pregnant. This was a brand new thing – never experienced it, never had any food problems before, didn’t know what was going on. That was the main, big symptom – this pregnancy look. I’m a very thin person, so it really showed. My pants didn’t fit. Then, when I would eat, I would feel a little nauseated. I started getting circles under my eyes. I stopped sleeping well. I started getting constipation… diarrhea. It depended on what I was doing. And I had no one to help me understand what was going on. In fact, at that time, nobody had heard of SIBO or any of that. It was all new. So, I actually went to doctor after doctor trying basically everything – from dietary restrictions to hand light therapy to LED therapy to drinking bleach. I’m not joking – drinking bleach. I don’t think I ever told you about that one.

DrMR:

No, you did not…

Danielle:

Everybody would put me on their program, but their program would be just what it is. So, if you’re the right person for that program and that happened to work, it would be great. If you’re not, which I wasn’t, they would come down on me and tell me I was doing it wrong. And as you know, I don’t do it wrong. I probably overdo it right.

DrMR:

Yes. If anything, you’re too compliant.

Danielle:

So, having a doctor tell me I’m lying… I’m not following the protocol. No, I don’t feel better. I’m actually sick. I had a lot of doctors just really not understand what to do with me, and not being necessarily very nice or kind or positive when they wanted to have work didn’t work.

DrMR:

Yeah. What a tremendous lost opportunity that is. One of the things we talk about in the podcast/on the show is even the things that don’t work are indirectly diagnostic. When we’re going through a clinical visit, we have this summary tab open and their ongoing visit tab open, and we’ll be making notes in their differential or problems list. And if you respond to something, that’s a mark of reinforcement for one of the differentials. Or if you don’t, that may support a different differential and rule out another one. So, that’s why I tell patients the labs are about one fourth because there’s this other data that’s so important to learn from your system over time and hone us in on what to do.

The Danger of ‘Treating the Numbers’

DrMR:

Again, what a lost opportunity when clinicians get mad at you for not responding. Whereas, if they had the right model, I would argue they could use that in a progressively diagnostic fashion to hone you in on what to do. And this does tie in with the other thing I wanted to more centrally loop into this conversation – as best as I was able to tell, you got pulled into this treatment of the tests. And not only was it treatment of the numbers, instead of treatment of the person, it was esoteric, ‘here’s the newest theory.’ That sounds exciting, and I think you learned the novel sounding, cool science-y sounding theory actually doesn’t deliver most of the time; theory is one thing and then tried and true therapeutics is another. Tell us a little bit more about that because there was a lot of this ‘treat the numbers and if you don’t respond to the numbers and corresponding treatment theory, then you’re the problem’ sort of narrative that you were given.

Danielle:

Yeah. We would go through the big test of my gut and I’ve done a lot of testing over the years. Most recently, I think it’s because more people are becoming aware. I think there may even be more tests around than 2009. So, as we get the test, we sit there and we look through each thing and based on each little section determine – “This is a good supplement for you to take… Oh, this one based on this section…” With my most recent doctor, I actually remember sitting there saying, “…but I feel good… why do you want me to take all this?” And then also telling him, “…and I don’t want to spend $800 a month on supplements. I just don’t want to, I don’t feel like I should need to…” That’s absurd – that’s like a mortgage. But, if you go through a test and you look line by line, you come up with a lot of supplements that are supposed to help each of these things, but it wasn’t being factored in. I understand that the test says this, but I am saying, “I feel good.”

DrMR:

That’s the interpretation. There was poor interpretation. And I’m so glad that you say this because just last week in the clinic, there was a patient who was very adamant about going through a line by line analysis of her labs. In defense of the patient perspective, I can understand how you do a lab and you look at the report and you say, “Well, I want to know what each one of these things mean and what we’re going to do about each one because I’m not feeling well. I want to make sure my doctor’s not being lazy and not stuffing all this data.” However, that’s really not how this works. Now, if you think your clinician is lazy, don’t work with them. Right? There’s a caveat here. What’s really important is looking at the most pivotal markers, pattern analysis and correlation to the individual. And that’s why oftentimes at the clinic, our remarks on labs will be very high level. This is just noise. Oftentimes, we’ll see a positive here or a low there. These things in and of themselves are not diagnostic or demonstrative of trend. Or yes – this is a pattern, this is well identified, this means XYZ, and maybe we should do ABC. So yes, it’s very important not to get into this ‘treating the numbers.’ This is exactly what it is – treating the numbers.

Danielle:

But you pulled me back. I kept saying, “…but I want to look at this because I’m being told I’m sick. I want to know.” Regardless of how I felt, we’re taught everything is in the data. It’s all in the data. It’s all in the test.

DrMR:

Yeah. We had a little bit of a dance, and this is where the clinician has to learn how to give a little bit so as to not push you away. We had a little bit of a tango and I may have stepped on your toes and vice versa a few times, but we were able to get through it to the other side.

Danielle:

I trusted you because you never made me feel like I was crazy or I was lying or I wasn’t taking it seriously.

DrMR:

I’m glad you said that, seriously. When you came in the second time, you partially fit this profile of someone who has a limbic imbalance — someone who seems to be very worried, concerned and is highly reactive to food and supplements. This is where – either consciously and/or subconsciously – the limbic system can be on overdrive and therefore the immune system can be hypervigilant. So, you have to be very careful with the language that you use with someone who’s in that position. One of your other doctors (I’ve told this story on the podcast before) said something like, “You’re really sick. You’ve got to take this result seriously.” And the result was a dysbiosis finding from a stool test, which are super gray and non-definitive. So, telling someone they are super sick based upon dysbiosis – which, again, is very gray area in terms of ‘maybe it’s a problem/maybe it’s not a problem’ – is such a huge disservice. I remember you were visibly distraught/audibly distraught when you followed up with me. Tell us a little bit about that.

Danielle:

At that particular meeting, I actually looked at my doctor and I said, “I’m feeling better than I’ve felt in a really long time.” And he’s holding the paper in his hand and he goes, “What did you do? What did you do to feel better? You’re sick. I’m looking at this and you’re sick. What did you do?” He’s a very nice man, but he’s attached (is what I realized) to fixing it. He’s got to figure out the pathway and he’s going to figure it out. So, I can’t be better on my own from something he doesn’t help. Then it made me feel like I was cheating on him – ‘What did I do? I don’t know.’ It was very upsetting. I grew up in a family where I was taught ‘Don’t trust my own feelings and emotions.’ So, I have another person saying, “No, you’re wrong. You’re not better.” And I’m going, “Well, maybe I’m not better. Maybe I don’t feel well.” I do want to go back to something you said about the limbic retraining and how you approached that because you pushed me on that for several times. And I was basically like, “I don’t need that.”

DrMR:

That was our dance. Yeah. I think it was two or three times. One of the things I’ve learned is to pitch it as best you can, but also sometimes you just have to… what’s that old saying? ‘You can lead a horse to water, but you can’t force him to drink.’ So, put it there in your program, have the conversation around it, give you my rationale, support you through it. Knowing in the back of my head, if she just does this, there’s a very high probability it’s going to be game-changing. Then, the next visit comes around and there’s all this chatter about all this other noise, and then “Did you do the limbic retraining?” “No.” And the clinician is going… Grrrr. I swallow that pill, you know? You’re here for her. Let’s come at it again.

DrMR:

And it took two or three recommendations. And thank you for acknowledging that. Yeah, it took a few tries. In your defense, I think at that earlier stage you were still working with me and the other provider and there was just a lot of emotionality to work through. So, our session ended up being part therapy session, just to talk you off of the ledge of “I was feeling better from your recommendations, and then I checked in on the stool test results with the other doctor and he said I’m really sick and I’m not taking this seriously enough.” Again, this was the worst possible thing for someone with your psychological constitution and where you currently were in your healing journey to say. You were in need of a little bit of TLC and hand holding because you were really fighting an uphill battle with your other provider.

Danielle:

I was. I actually left you for a while there to go to that other provider.

DrMR:

I know – broke my heart.

Danielle:

It’s because my primary care physician said. “You can’t get what you need from somebody that you’re never going to see in person.” So I was like, “Oh, okay.” And I left. I remember saying to her, “I actually really like him. I like what we’re doing. It’s working.” She advised me go where you can go in person to somebody more traditional. And so I did because again, I listened to not my gut – I listened to what somebody was telling me different from what felt right to me.

DrMR:

I like to think that at that point in time, you were better. You weren’t fully over the hump, but you had seen some improvement. When someone’s in that position, let them explore around a little bit because they’re partially toward their goal. And hopefully another provider can just give you that little bit of additional push to get you to your goal. That didn’t happen in this case, but this is all part of the learning curve. Right? I don’t think you’re going to make these mistakes again. Sometimes you don’t know until you just try something. Who knows? Maybe there would have been something of merit that could have been discovered with a local hands-on person. I try to be pretty good about telling someone when I think they need to do that – and they need to go see a pelvic floor PT in person… or have a physical assessment for abdominal adhesions… or check-in with their conventional gastro for a colonoscopy or EGD… I’m pretty liberal about – “Yeah, go get the other perspectives.” In defense of your primary care, there are zealots in all facets of medicine, and they may just have a paradigm where they saw a lot of telehealth or alternative zealots so they were just trying to keep you in the conventional paradigm.

Danielle:

For somebody like me who listens to what the doctor says – almost to my detriment – it’s a challenge to go with somebody who’s not going to take into account anything that I’m saying.

Moving the Needle: Emotionality & The Paradox of Freedom

DrMR:

Right. So, let’s go over to the things that really moved the needle. We had to get you out of this fear-based ‘treating the numbers/treating the labs’ paradigm. We got you on the probiotic triple therapy plus the gut rebuild and reparative nutrients, and that led to a notable increase. It wasn’t able to resolve everything, and I do have a note in your chart that at a later date, you came off of those things just to test it. You noticed you regressed a little bit. So, that was a good signal for us. For patients – the lesson – sometimes they freak out when they go off something and they regress. “Oh my God, everything’s going to come crashing down…” No – this is good. We just verified, we established, this line of support was helpful. So, that was good.

DrMR:

But it was really the emotionality and the limbic piece on the heels of that where we fully got you out of the woods. I think part of that was you physiologically needed to do that. Then, the other part of it was you weren’t able to appreciate any progress because of the way you were just hyperfocused on your symptoms even if you were 60% improved. This is a tell for clinicians – if you’re looking over the notes and someone has taken a huge step forward, but they say, “Yeah, but I’m feeling terrible” but four out of your six symptoms are greatly improved… How are you labeling that as I feel terrible still? Oftentimes, that’s someone who is hypervigilant and they’re just focusing on whatever is not right and isn’t appreciating part of what is right.

Danielle:

I was definitely believing that the better I did at the recommendations – minus limbic retraining. We don’t count that because that was me thinking you were telling me I was a hysterical woman. You never said that, but my head went to “It’s not in my head.” If I could do everything really, really well, it was going to help. So, even when I didn’t have a reaction, I was still touching it… looking at it… making sure… documenting it in my head, which never gave me a break. It never gave me a moment where I could go, “That was actually okay” because then it was – That was okay. Why was it okay? What did I do? How can I get back to having more be okay? That’s not very relaxing.

DrMR:

Yes. In that same vein, enjoyment and other stuff in your life to do and pursue and to think about – there was just none of that. That was the other thing that was so wonderful to see as these things fully hit. You were saying, “Oh yeah, I forgot about…” It was a certain symptom or something that you had totally forgotten about. I was like, “Yes, this is exactly what we want.” We want you to be so focused on “I’m doing better in the gym.” I believe it was CrossFit you were doing at the time – or maybe still doing – like, “I’m doing way better at CrossFit.” The you that came in for follow-up visits was talking about other stuff than just health. There wasn’t a lot of it, but that’s really important narrative for the clinician to cue in on. She’s not just thinking about this all the time. She’s now opening up and actually interfacing with the world and living her life. That’s the wind in the sails that I think pulls you the rest of the way in a lot of cases.

Danielle:

It’s also a scary thing because I have been looking around just the past couple of months going – What do I do now? How do I eat? It’s literally living differently that I now have to do because this huge focus is just not there anymore.

DrMR:

Yeah. I think the paradox of freedom, in some cases, can be hard for people. That’s where in some of our follow-up visits, having me to soundboard off of and give you that encouragement like ‘This is good.’ A lot of people get here to where they don’t need a diet plan. I think you, for so long, just had the plan and of having a plan, you’re like, “what do I do?” For clinicians, this is part of the reason why I really harp on – let’s not be beating people over the head with restrictive dietary recommendations because this is what we can inculcate in people. Again, I’m happy you weren’t working with someone who was going to say, “Well, I know you’re feeling better, but that lab test from four years ago found some high elevation of gliadin antibodies and dairy, so make sure you never have any of those… and also you’re MTHFR, so if you’re ever going to the airport, make sure you check the labels… if you ever see folate or folic acid…” These little things do make a difference because someone like you would follow all that, and it would demonstrably impact their quality of life.

Danielle:

Forever!

DrMR:

Exactly.

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Moving the Needle: Limbic Retraining

DrMR:

Well, I think we’ve picked through a lot of the high level points. I mean, there’s so much that we could unpack here, but is there anything else that you want to share with people? Maybe someone in a similar position as yourself – what would you want to say to them?

Danielle:

For me, the limbic retraining was the final key. However, if I had done it two years ago… three years ago, it wasn’t the time. I had to do this other work to get myself to a place where I could even take that in. I wouldn’t have been ready. I wouldn’t have trusted it… I wouldn’t have approached it, but the limbic retraining was the final piece for me. The crazy part about it was… what did I say? In two to three days, I was eating almost anything I wanted and having barely any reactions, which is insane. I don’t have advice for you on how to share about limbic retraining with people in a better way because mine goes to, “Oh, Danielle… you’re too sensitive… you need to stop thinking about it… he’s saying this is all in your head and you’re making it up.” That’s where I went. You didn’t say that. But, I think that’s a place where things just have to be approached so carefully.

DrMR:

It’s always something that we’re trying to find the best wording. The other challenge is we may have at the clinic four to six different ways we can phrase this. You try to predict… “maybe phrasing two is going to go with this patient…” Sometimes it lands and sometimes it doesn’t, and that’s why I think with us, we had to try a few times before it landed. If I’m being totally honest, I think pointing to this case study for people is going to be hugely helpful. We may even say check out Danielle’s conversation about limbic retraining just to give you a person to associate to and get the “I wish I had done this sooner, maybe at month one instead of month three or four.”

Danielle:

Or five or six…

Episode Wrap-Up

DrMR:

Yeah. Also, in keeping with your earlier comment, sometimes you have to make certain mistakes and that’s just part of the learning process. I’m glad you’re sharing about the limbic retraining. That was the main thing plus how poorly some of the conversation was handled with your other providers just so we as a healthcare community can be even more aware of how much weight – especially with certain patients – our words carry; how I understand that you want patients to take things seriously, but there is such a thing as undo weighting given to a lab finding that can carry psychological harm. We have to be careful about how we do this. It’s why I say that if we can’t get it perfect, let’s be a little under, as compared to a little over. I think that’s going to be the most serving to most people. I mean, if you have someone with diabetes frank, and they’re not doing anything, that’s a different conversation. However, I think most of us in functional medicine are not seeing the guy who’s still smoking and drinking a bunch of soda, and we have to rattle the cage a little bit. It’s moreso highly motivated people like yourself who we don’t need to go to that fear and rattling of the cage approach.

Danielle:

I rattle my own cage.

DrMR:

Right. We want to de-rattle.

Danielle:

Yeah, you were de-rattling. I was doing the rattling. I think that was a really cool thing. That’s been the cool thing about working with you. You never actually made me feel like I was crazy or I was overreacting or I shouldn’t be doing something. The way you approached everything was – “Hey, there’s this study. Hey, this is what we’re seeing” vs. “Danielle – you’re sick. You need to do this.” And that type of speech works really well.

DrMR:

Thank you. Actually, thank you very much for saying that because it’s a form of framing, right?

Danielle:

Gestalt…?

DrMR:

Yeah. Gestalt. I know there’s Gestalt therapy. I’m not sure exactly how it’s applied, but perhaps. You’re talking about – here’s what we see help individuals, not you are sick, so you should do this. I really try to avoid wherever I can in saying that because I actually don’t think that’s the case. I remember when I had my own symptoms. I wasn’t thinking, “I am sick.” I was thinking, “What the frick… I got this brain fog… how do I fix it?” If someone is getting pulled into that, you don’t want anyone to identify their self with their symptoms or a disease or a label or a diagnosis. You want to empower them.

DrMR:

This actually brings up one other thing. I gave you some reading in the camp from Wim Hof and some of the associated Scott Carney books about how strong we are; how you could maybe go for a hike in snow in just shorts and do some of these things. I think that really landed for you because it allowed you to tap into your own empowerment. I think that’s something that really can be helpful for people who may drift into this territory of worry and stress and limbic imbalance — they need to feel empowered. That’s where I think some of that work can also be pretty helpful.

Danielle:

You recommending Wim Hof to me – I watched the movie… I started reading the book… I bought the class… my husband has joined it with me… I was doing the cold showers. I stopped at the cold hand in the water – not into that. I could do the cold shower, but ice water on my hand? One of the things he says is CrossFit is a great mentality to have because you push your body and you realize your strength. So, you brought me back to that. I actually went back to CrossFit through you reminding me that I am powerful.

DrMR:

And you are. You legitimately are. This is important to remind people of so that you can be as strong and as empowered as you actually are, and not keep ruminating on the lab finding and wrapping up your identity in that. All around, these are just so many great pearls to be offering people. I can’t thank you enough for sharing your story. I know for a fact this is going to be very helpful for a large swath of people. I want to thank you just for putting up with some of the shortcomings in the field, and I’m so glad you found your way back to me and us at the clinic and we were able to help you.

Danielle:

Thank you for having me. It’s cool to have a positive story to share. So, thank you.

DrMR:

Yeah. Thank you.

Outro:

Thank you for listening to Dr. Ruscio 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.

 

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