Listener Questions: Acid Reflux, SIBO, and the Paleo Diet - Dr. Michael Ruscio, DNM, DC

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Listener Questions: Acid Reflux, SIBO, and the Paleo Diet

Answers on natural healing remedies for dysbiosis, gastric issues, sound sensitivity, burning stomach pain, and more

Many gut health related questions came in from listeners, which prompted responses about the benefits of triple therapy probiotics, limbic retraining, digestive enzymes, and Elemental Heal for acid reflux, small intestinal bacterial overgrowth (SIBO), gastritis, and other gastrointestinal conditions. Outside of the gut health discussions, a few other questions were asked:  

  • How does dysbiosis affect bladder health?
  • If stevia is an irritant, what’s another healthy sweetener to use? 
  • Is there a connection between hydrogen SIBO and sound sensitivity? 

Tune in to hear the answers and learn more.

In This Episode

Intro… 00:08
How dysbiosis affects bladder health… 02:08
Advice for SIBO with hydrogen at 101… 06:34
Stevia in Elemental Heal… 14:23
Treating reflux after the gut protocol for SIBO… 19:42
The connection between SIBO and sound sensitivity… 26:13
Eating fish with AMAG… 34:19
Treating post-dinner gut pain… 39:52
Close… 44:27

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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. That’s 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.

Erin Ryan:

Hey everyone. This is Erin Ryan from Dr. Ruscio radio. Today on the show, Dr. Ruscio answers your questions. In this week’s episode, you asked how dysbiosis affects bladder health, how to treat the 17-year-old with hydrogen SIBO, is stevia in the elemental diet, what to do about acid reflux at night, what’s the connection between sound sensitivity and SIBO, what’s the best diet for an AMAG diagnosis, [and] what to do about burning pain in the gut after meals. Thank you to everyone who submitted your questions. And if you’d like to submit a question, visit DrRuscio.com/podcast-episodes and click “send us a voicemail” at the top of the page. Please speak loud and clear and keep it as concise as you can. Enjoy the show.

Dr Ruscio:

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Michael Ruscio, back again with Erin Ryan and here to answer your questions. Hey, Erin.

Erin Ryan:

Hey, good to be back.

Dr Ruscio:

Yeah, it’s been a while, I feel like. I think we missed a month. We do this once a month. So when we missed one, it feels like a long time, but yeah, we are back and happy that we’re able to be answering more questions.

Erin Ryan:

Yep. That’s right. And we’re already scheduled to do one for next month too, so we won’t leave you guys hanging. There’s lots of questions in the queue, so we’ll try to get to as many as we can.

How dysbiosis affects bladder health

Erin Ryan:

Okay. The first question is from Brianna, she says, “Can you discuss how dysbiosis affects bladder health?”

Dr Ruscio:

Yeah. So this is a area where there’s some interesting outcome data. Probiotics have been shown to reduce the recurrence rate of UTIs (urinary tract infections), and also to be helpful for bacterial vaginosis. And I didn’t check on this recently, but I’m pretty sure there’s probably also studies finding that probiotics are helpful for vaginal candidiasis. So that’s not necessarily bladder, I mean partially bladder, UTIs, but it’s in that region. There’s also theory—and I’m assuming there’s some studies that have kind of mapped this out, but I haven’t looked at the primary literature on this—but the theory is that the motility in the gut is also connected to the motility of the bladder. And this might be part of the reason why we see at least some anecdotes and the data with UTI may have an impact on the bladder vis-a-vis improving the motility or the contractile function of the bladder.

Dr Ruscio:

So there’s some connection here between gut motility and bladder motility, and some evidence in terms of clinical trials that at least in the model of UTIs probiotics can be helpful. So there’s some connection here. I can’t say this is something we see a lot of in the clinic, but there are some cases, in fact, a couple cases I’m working with right now. And we’ve made some good headway, actually, with either burning or incontinence. So there does seem to be something here, even though this is not something I’ll see a case of or a couple of cases of per day, let’s say like issues with thyroid or SIBO.

Dr Ruscio:

There’s also this issue to just have on your radar screen of the pelvic floor. This is something that we discussed in the past with Jandra Mueller, who is a pelvic floor PT. And it’s important to keep in mind here that there are some symptoms—chronic itching or burning or even incontinence—that may not be due to an infection or something of that like, but could be due to dysfunction the pelvic floor. One of the ways this plays out in some cases is a hyper contracture of the muscles seem to be able to irritate some of the nerves and create a feeling like you have to pee, or like you have an infection or something like that. So also something to keep in mind in terms of what could be affecting bladdered health. In terms of if there’s incontinence or this feeling like you have a UTI, but every time you go get checked out, nothing comes back. So, yeah, that’s a few thoughts on how the bladder connects into the gut.

Dr Ruscio:

And obviously to just make sure I tie this together for you, the gut dysbiosis would be tied in with motility. If we treat the gut holistically and we address someone’s gut symptoms, we usually address dysbiosis and we usually improve motility kind of all at the same time. So the dysbiosis in the gut can affect the bladder. And there may also be, just to make sure I’m not leaving out, if you’re asking about bladder dysbiosis specifically, that probably follows some of the same rules as we would see with gut dysbiosis. If we support the person holistically, meaning things like probiotics and rectifying the dysbiosis there, and also healthy diet, healthy lifestyle practices, potentially pelvic floor, we should see gut dysbiosis improve and presumably also bladder dysbiosis. Especially if that’s one of the things that’s underlying things like incontinence or burning or urinary pain. So yeah, hopefully that helps give you a few things to consider and improve your bladder health and whatever symptoms are derivative of the bladder health that you’re likely grappling with.

Advice for SIBO with hydrogen at 101

Erin Ryan:

All right. Our next question is from Alyssa. She says, “Hi thanks to you and listening to your podcast I asked my son’s doctor about SIBO. He is 17, has had gastric issues for 2 years. He tested positive for SIBO. His hydrogen is at 101. Any advice would be great, I am hoping this is his answer to challenges like going to the bathroom a lot, having gas, and just all around stomach issues.”

Dr Ruscio:

Well, certainly SIBO can cause those very symptoms like frequent bowel movements or loose bowel movements, or even on the other end constipation and certainly gas. And like you said, all around just kind of consolation of gut symptoms. Yes. You know, it is important maybe just to clarify one or two things because sometimes these lab findings and syndromes like SIBO can get away from you and/or be a little bit embellished. So the 101 is high, but it also depends on when you’re seeing that level of 101, because remember the cutoff time is 90 minutes. So when you’re looking at the test, you should see down at the bottom on the X access (the axis goes from left to right) time points, time point 0, time point 20 minutes, 40 minutes, 60 minutes, 80 minutes. Or sometimes they skew the timeline a little bit, but you should be able to pretty much get a mark for 80 or 90 minutes. And it’s at that interval at which you don’t really want to read beyond that.


Dr Ruscio:

The reason why this is relevant is if you’re seeing a 101 value at 120 minutes in, then we shouldn’t be saying he has a SIBO of 101. We should be looking at what value does he hit at the 80/90 minute cutoff point or before? And that just matters because you don’t want to think the SIBO is worse than it is. You don’t want to over-treat. What do you do in terms of supporting this? Well, these are the things that I wrote about in “Healthy Gut, Healthy You” that we use in the clinic and we talk about on the podcast all the time, a basic elimination diet is a great place to start. Now, if he’s 17, buy in there may be challenging. So I would say do the best that you can with a diet, but also pick your battles.

Dr Ruscio:

I wouldn’t come at him with, well, we’re going to go hardcore paleo or hardcore low FODMAP if he’s not someone who seems to enjoy doing those things. When I was 17, that was maybe I was 18, I just started to kind of get into diet. And so for a 17 year old like myself, I probably would’ve been on board because at a early age I seemed to care about health and diet and fitness. But if you’re a 17-year-old who doesn’t care at all, you kind of want to read the room a little bit. So be careful not to push too hard with diet if he’s not motivated. And if he is motivated, then I would start with a paleo diet just as a kind of relaxed template. You don’t have to be super strict on it. Just get into the realm of reducing processed food, eating healthy meat, fish, and vegetables and fruit. Start there, give that a few weeks. If that’s helping, great, continue. If not, then try 2-3 weeks on the low FODMAP diet and you’ll get a sense for which one works the best.

Dr Ruscio:

Now, if you go paleo and it’s helpful, but you’re feeling like there could be more help, then you might want to try the combination diet that we created, the paleo-low FODMAP diet, which combines both together. And within six weeks you should have found what of those diets works the best and continue forward with that diet. Again, be careful not to be super strict. And then again, just like we talk about in the podcast, like is laid out in the book, reevaluate. If he’s doing fantastic, awesome, you’re done. Don’t worry about anything. You know, within reason, broaden the diet and let him not think too much about his health. And certainly don’t keep bringing up SIBO all the time, because we don’t want to kind of put this in his head.

Dr Ruscio:

If he has improved but not near the goal that you want him to be at, that’s when you can consider probiotic therapy. And you can use our triple therapy probiotic, which combines three different formulas into one.(As soon as we’re back in stock. Sorry guys, we were not anticipating those to sell so quickly. So we have more on the way, but takes a little while to get these all kind of put together and back on the shelves.) You could also just give him the three different bottles of the Lactobacillus bifidobacterium plus a bottle of saccharomyces plus a bottle of soil-based probiotics. Now again, read the room. That would be the Cadillac probiotic protocol, the three formulas. Strong, very effective, but if compliance is minimal, just give him one.

Dr Ruscio:

In this case, I would start, it really doesn’t matter which one you start with, but I think the lactobacillus-bifidobacterium blend is just as good of a starting place than any of the others. And if he’s not going to take three different bottles of supplements, start with just the one that has a pretty high probability for a 17 year old to be a home run. Now, if you hit a point where you’re saying, “well, I’ve done all this and we’re at 50% improvement,” so yay, we’re kind of happy, we’re better than we where we were, but we’re not where we want to be at this 90ish percent improvement, then there’s two other options that you can consider.

Dr Ruscio:

There’s the elemental diet and doing a reset. So that would be exclusive or mostly meal replacement shakes for anywhere from 2-4 days and then replacing one meal per day with the elemental diet. If that’s not going to fly with him, right, this is where we have other options. And this is where either herbal antimicrobial therapy or refaximin, the antibiotic. Now why do I put Rifaximin on the table? Well, it depends if this is a 17 year old, knowing that this age group can be challenging in terms of their compliance. Okay. I think philosophically I’d rather start with herbals, but that’s going to be double the amount of pills and take twice as long. It’s great in terms of, I think the herbals have much to offer in the way of they combat SIBO plus fungus plus protozoa. So you’ll oftentimes end up helping with dysbiosis that could be in different organism types, bacteria, fungus, protozoa, and you won’t get that necessarily with Rifaximin. But again, Rifaximin will be two weeks, it’ll be less pills.

Dr Ruscio:

And so again, pick the therapy, that’s going to be best for the individual. And that gives you a pretty good roadmap to help resolve SIBO, but more importantly, his symptoms, as you put it, his gastric issues. The more important thing for you to focus on is what do you do that helps him feel better? Yeah, so that’s a good starting point. There’s more that can be done, certainly. And if you go through that and you’re stuck, feel free to reach out to the clinic and we’ll be happy to pick up from where you guys left off and get him the rest of the way there, but good luck and please keep us posted.

Erin Ryan:

Awesome. That was like concierge-level answer. Alyssa, all you got to do is follow that advice.

Stevia in Elemental Heal

Erin Ryan:

All right. So the next question is from Paul, “I just learned from a Dr. Pimentel source, that Stevia, which is in Elemental Heal, of which I’ve bought a lot, interferes with the Migrating Motor Complex. Your view?”

Dr Ruscio:

Yeah. Great question. So this is one of the many things that I would say is a interesting academic tidbit, but clinically irrelevant. We know that elemental diets work very, very well for SIBO. And the clinical signal in terms of myself and our team of doctors at the clinic using elemental diet provides fairly incontrovertible proof that an elemental diet works very well. And the nuances of the formulation don’t tend to matter. And this is reinforced by not only our clinical observation, but also the fact that semi-elemental diets, which will have only semi digested food stuffs work just as well as fully elemental. Well, why does that matter? How does it impact motility? Because the more food-like something is the more it will interfere with motility, right? Because when you’re fasting, you feed motility and or you spur motility and when you are eating foods, that slows motility.

Dr Ruscio:

So if the elemental diet is most digested and the semi elemental diet is somewhat food-like, therefore slows down motility a little bit, but it’s still able to work just as well for SIBO, that tells us that interesting while it may be, the tidbit on stevia does not have enough of an effect size to impact the clinical outcome that we’re concerned with, which is: will it resolve SIBO? Will it resolve IBS? Will it resolve IBD? So it’s a great question, but we have to be extremely careful not to let academic bits and bites, which are more observation and theory and bottom of the evidence-based pyramid, to get in the way of the pinnacle, which are interventional trials that have found favorable outcomes.

Dr Ruscio:

So in this case again, interesting, but in no way, invalidates the therapy of the elemental diet plus or minus stevia being able to help people. Now with all that being said, and completely unrelated to this, we are considering switching the sweetener to monk fruit instead of stevia. I don’t really have strong feelings about this one way or the other, but it’s a discussion that we’re having internally and something that we’re thinking about doing. So if people do have feedback, I would love to hear it on our social media, or I guess wherever you can track me down, send me a smoke signal and let me know. But that’s something that we’re currently thinking about.

Erin Ryan:

You’ll have to let me know when, because I need to taste that. Elemental Heal’s a very important part of my life. I just bought some more today. I need to taste that because you can’t change up my formula, man. I love it.

Dr Ruscio:

We will. Yeah. I’m pretty anal about any new formula. Obviously we have to check all the boxes in terms of the ingredients and the viability, but then when we get around finally to here’s the sample to try, I’m pretty anal about it. And, and so yeah, I will make sure that this is going to be something that tastes really good. And pretty much the aim would be to have a negligible impact on the flavor. And just switch to a sweetener that people tend to prefer. And you know, there’s a small, small, small subset of people that don’t tolerate stevia. There’s also a small subset of people that don’t tolerate vitamin D, right? So I don’t want to paint stevia as problematic.

Erin Ryan:

Yeah.

Dr Ruscio:

But again, the internal conversation we’re having is within the most, most, most sensitive grouping of people might monk fruit be more tolerated than stevia. So that’s something we’re discussing.

Erin Ryan:

All right. I’ll allow it. okay.


Sponsored Resources

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Treating reflux after the gut protocol for SIBO

Erin Ryan:

Our next question is from Virginia. She said, “Went through your gut protocol for SIBO two years ago. I’ve been way better ever since. Lately I have had acid reflux at night, I’ve pushed dinner up to 4:30 most days and I take tums and pepcid just so I can sleep. I thought it was a short term thing but it’s been a month. I’m a healthy and fit 40-yr-old otherwise. No SIBO symptoms, just the reflux. At this point I can’t eat past lunch or else I have acid reflux all night and my sleep is greatly affected. What should I do?”

Dr Ruscio:

Ah, well, this sounds like a huge pain in the butt. So I’m sorry to hear about it. Especially anything that impacts sleep. As someone who had sleep issues myself, I feel your pain and yes. So let’s unpack this and get you on the road here to optimum. The first thing is I would try HCl. Now, you’re 40. So, that’s on this borderline where HCL might be helpful. You may have tried the HCl back when going through the protocol, that is written into the protocol. But if you had responded very well to that protocol, you may not have drilled all the way down into the trial specifically of a straight or pure HCl supplement. So with this situation of all the symptoms are gone, except for reflux, one of the first things I think about is a HCl insufficiency. Now the older you are, the more likely that is to be helpful.

Dr Ruscio:

And also if you’ve had any prior anemia or any autoimmune condition, that also increases the probability, but those being absent are not disqualifiers. The nice thing about the HCL protocol is you’ll know, within 3-5 days, if it’s helping. Grab our HCL formula, it’s the digestive acid HCL. It’s just straight HCL without any enzymes or bile. And work up starting at one pill per meal, give that a day or two, see how it goes. Then go up to two pills per meal. You’re going to go all the way up to four. You’ll notice one of three things: Nothing? You don’t need it. Reflux gets worse? You definitely don’t need it. Or reflux and GERD get better? You need it. It should be clear. So if you’re saying yourself, “eh, it might be helping.” No, it should be yes. Look at Mason’s patient conversation from a couple years back, it was almost like a light switch. So don’t do for too long. You should be able to get in and out of this within days, maybe max two weeks or less, depending on how that goes.

Dr Ruscio:

If that does not help, you may want to simply repeat the protocol. It could be that dysbiosis or SIBO, whatever imbalances are kind of underlying that symptom have returned. And so start with the reset, go through the diet, eventually go back on the probiotic triple therapy. Consider the antimicrobials, consider an elemental reset. Just go through the protocol that worked before, because it could be that the only symptom that’s now manifesting is the reflux.

Dr Ruscio:

Well, I should also mention that, do an appraisal of your diet just to make sure nothing’s changed and there’s not any food triggers. Given the fact that you’re saying you’re healthy and fit and you’ve gone through the protocol, I’m assuming you’re probably fairly dialed in and you’re paying attention and you haven’t started eating, let’s say nuts, and you’re having nuts every day and this is a trigger that you haven’t connected. But just to make sure to put that out there, do an audit of your diet to see if anything’s changed in case there’s a low hanging fruit food trigger that could cut out.

Dr Ruscio:

Now, you can also think about this through the lens of muscle weakness. There’s a device called I Quoro, they don’t sell to the US, I don’t know why, but if you have a friend outside of the US, have them purchase this and then send it to you. It’s a hundred bucks or a couple hundred bucks for this mouth guard-like muscular trainer that will help train the swallowing muscles because in some cases of reflux it can be due to muscular weakness.

Dr Ruscio:

Now, an easier on ramp there would be the EMST, the expiration muscle strength training device. The EMST 150 that we’ve discussed in the podcast in the past, and this is essentially 50 bucks. You blow into it, but this helps to train some of the muscles in the palette and throat that may help with reflux. If you snore or you notice you have a dry mouth in the morning or drool on your pillow, either one of these would be much more likely to help you. So keep that context in mind.

Dr Ruscio:

And then finally you’ve likely heard of a wedge, a wedge pillow that can help keep you propped up a little bit. That can also help with nocturnal reflux. It’s probably the least appealing option because it doesn’t seem to be causal. So I would say consider that as something to be an adjunctive support while you’re exploring these other options. You can also do what I do, which is I have three pillows and I sleep on a little bit of an incline. I just like it. I prefer it. And it keeps me, instead of lying totally flat with just a little pillow under your head, it kind of supports my mid-back, shoulders, and head and has me on a slight incline. So that might be something that you want to try also.

Dr Ruscio:

But yeah, that’s a pretty good overview of what you want to think about for this reflux. And I think if you go through this diligently, you should be able to find what’s driving the reflux, be able to sleep, and hopefully be back at your full level of performance so you can be an even healthier, more fit 40-year-old. So good luck. And also please feel free to let us know how it goes.

The connection between SIBO and sound sensitivity

Erin Ryan:

Awesome. All right. Our next question is from Mark. He says, “Hi, I suffer from a post drug condition called Post Finasteride Syndrome. I have been diagnosed with hydrogen sulfide SIBO (streptococcus), as well as a methylation block. My worst symptom is crippling sound sensitivity. I saw in your article that hydrogen sulfide SIBO can lead to sound intolerance, but the article doesn’t specify how. I was wondering what’s the connection between SIBO and sound sensitivity. I haven’t found anything online.”

Dr Ruscio:

Okay, great question. Let me just start by addressing the post finasteride syndrome piece. I am not an expert here, but I’ve done some research and I want to share those thoughts with you. And a lot of this comes from some private conversations I’ve had back and forth with urologist Paul Turek. He may not be a bad person to counsel regarding the post syndrome. He’s a well revered, published urologist in San Francisco, but he also does telehealth consulting. When I looked at some of this data, the percentage of people who came away with post finasteride syndrome was quite small. And when you combine that with the fact that we know that nocebo (negative expectation) has a powerful impact. In fact, there was recently a study published on placebo (the positive expectation) when people knew they were being given a placebo, they still reported benefit.

Dr Ruscio:

So a doctor said, “Hey, this is your sugar pill. Take it.” And the person came back weeks later and said, I feel better. So the same thing happens in the opposite direction with nocebo, a negative expectation. Why does this matter? I’m not trying to invalidate your suffering. I’m trying to help you. Maybe not latch onto a diagnosis that may not be doing anything for you. It may be creating this kind of false cause. And also it might be leading you to think that you’re worse than you are, right. I want to try to get you to a point of empowerment. And I have some concerns here that the post finasteride syndrome diagnosis, especially if you’re not feeling well, you go on message boards, you read other people who are not feeling well, this can really strengthen that negative expectation, that nocebo effect.

Dr Ruscio:

So, when speaking with Turek on this, he felt like a lot of this was psychosomatic in terms of men had either stress, prior abuse, or other life factors that seem to have made the person amenable to the post finasteride syndrome diagnosis. So I’m not sure if this is resonating. And if you were in the clinic, I would support you however you wanted to go. But I also want to share this with you, just to give you a different perspective and hopefully a more empowering perspective. If this does resonate, consider checking in with Paul Turek. And also it’s the Turek clinic, and also consider going through the Gupta limbic retraining program. Because if there is some degree of fear, anxiousness rumination about this, the limbic retraining program as the Gupta program can be very helpful coming to your primary question.

Dr Ruscio:

How does H2S (hydrogen sulfide SIBO) map onto sound sensitivity? There is speculation regarding this handful of symptoms that associate to hydrogen sulfide SIBO. As we’ve been doing some enhanced data collection on our patients we have them fill out a short questionnaire that asks them if they have these symptoms that are theoretically attributed to hydrogen sulfide SIBO. Now going into this, I haven’t really seen a lot and some of the other clinicians I’ve spoken with are not really convinced that there’s a lot here. It’s possible that that it is, and the signal is so faint that we’re not seeing it, but my suspicion is that the hydrogen sulfide symptoms are more theory than they are actual. But we’re trying to figure this out. I don’t know if we’ll have clear enough data to actually publish something useful here, but we’re tracking and we’re trying to get a sense on this.

Dr Ruscio:

So will treatment of the SIBO help? I’m not sure, but why wouldn’t you? Right. I would obviously recommend that if you’re not feeling well and you have truly positive SIBO—be careful you have a good interpretation of the test like we talked about earlier this, you know, you can look at these and use incorrect diagnostic criteria—but given that it is a positive, then yes, treat the SIBO and hope for the best. And I wouldn’t be surprised if it did have a positive impact. It’s just, I can’t say that there’s anything published here or any solid anecdotes that have been shared in terms of multiple practitioners have echoed the observation.

Dr Ruscio:

There was also a study, I believe this was animal data that found vitamin A insufficiency may lead to hyper sensitivity regarding hearing. So something there to perhaps look into. But zooming us way out, two things: make sure that you’re getting some competent counsel regarding the post finasteride syndrome, consider Turek, consider Gupta, and then also move on improving your gut health because we know that multiple symptoms and systems of the body can be negatively impacted by what’s going on in your gut. And I really hope that as you do, you will see the hearing sensitivity improve. So a lot there, but I think if you go through this step-by-step and hopefully explore both these options, you won’t have the hearing sensitivity any longer.

Erin Ryan:

Oh, that’s super interesting the way that’s all connected. Who would’ve thought?

Dr Ruscio:

Yeah, the body’s amazing.

Erin Ryan:

Yeah.


Sponsor:

Hi, everyone. If case you are in need of help, or would like to learn more, I wanted to quickly point out what resources are available to you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is always the clinic and myself or any one of our doctors would be more than happy to help you. And as a quick aside there, we just had accepted for peer review a six-part case series where in we demonstrated the gut-thyroid connection and how crucially important it is to make sure you are not overlooking someone’s gut health as it pertains to thyroid health and thyroid symptoms more broadly. Through the clinic we also offer health coaching and, independent of the clinic, if you’re reading the book or need some general advice, we offer health coaching also. There’s our store where you can find our Elemental Diet line, our probiotic line, and other health and gut-supportive supplements. And finally, there is our clinician’s newsletter, the FFMR, AKA the Future of Functional Medicine Review database with research reviews, case studies, and other helpful resources for healthcare providers. Everything for any of these resources can be found at the overview page DrRuscio.com/resources. That’s DrRuscio.com/resources.


Erin Ryan:

This next one has AMAG in it. Do you know what that means before I say it?

Dr Ruscio:

Autoimmune metastatic atrophic gastritis.

Erin Ryan:

Oh, that’s right. Yeah.

Dr Ruscio:

Yep, yep.

Eating fish with AMAG

Erin Ryan:

I just wanted to make sure we said it and I didn’t just say the letters. Okay. Sammy says, “I was diagnosed with AMAG last week and I am extremely scared of the complications of AMAG. Is PALEO diet the answer? But then, you also mentioned the list of foods that cause inflammation and fish is listed on that list (I love fish). So, fish or no fish?”

Dr Ruscio:

Okay. So the AMAG is essentially just autoimmune gastritis. I don’t want to say autoimmune, meaning it doesn’t have any weight or bearing, but just to clarify the acronym. I also want to cue in on one of the first things that you said, which was extremely scared or concerned and I just want to be careful that you don’t go too far in the direction of building this up to be something that is, how do I say this, you don’t want to make this out to be more than it is right now. The nuances of how atrophic gastritis leads to other manifestations, I’m not super clear. This is not something I’ve dug deeply into. But at least in a primary lens of analysis with the atrophic gastritis that will damage the paral cells in the lining of your stomach that produce hydrochloric acid and will lead you to have low hydrochloric acid levels. Is that the worst thing in the world? No. Can you do things to improve your immune system and reduce the likelihood that you’ll have other tissues that are eventually a target of autoimmunity? You absolutely can.

Dr Ruscio:

And this is where the dietary basics of just going from a processed food diet to healthy whole fresh foods. And you have many different diets on offer, as long as you’re nailing food quality first. That’s the first, most important step. Along with that, you might want to try a paleo template as one elimination diet to consider. I’m not sure what you’re referring to regarding fish. And sometimes what happens is when we get into really granular medical research, you’ll see these associations that I think don’t zoom out very well, meaning there may have been one study that found fish intake was associated with AMAG, but they didn’t clarify the main fish that was tracked was canned tuna. And it’s actually some of the either bisphenol A or whatever in the lining of the can that led to the gastritis.

Dr Ruscio:

And so this is why I try to be careful about staying moored by an ancestral framework, right? We know that a hunter-gatherers in a certain way. And even though we can’t eat exactly that way today, it provides us a template of, okay, fish, good, meat, good, vegetables, good, beyond meat? I’m suspicious, right? Because this is new, this is processed. This is not something that’s naturally occurring. So that’s what I would offer you in terms of the best diet look for high food quality. And this is going to go pretty far. And I would not be worried about fish. Again, check this with your doctor. Maybe there’s something here I don’t understand, but I’ve never seen anything credible suggesting that fish is bad for gastritis.

Dr Ruscio:

There was one study and then a follow-up study by a group of researchers, I believe, in Japan who found that vitamin B12 injections actually silenced parietal cell autoimmunity. So they, they silenced this APA (anti-parietal cell antibodies) that lead to the gastritis. So you may want to try B12 injections or even a high dose of oral or pill form B12. H pylori has also been implicated to a greater or lesser extent with gastritis. And so that’s also something to look at. And then coming back to the fear for a moment, depending on how concerned you are, the Gupta retraining program is also an excellent tool to help with fear and anxiousness regarding your health. I would find a good provider if doing this based upon my few recommendations and what you spackle together on the internet doesn’t appeal to you, find a good doctor because the thing a good provider can do is help you not read your way into thinking things are worse than they are and may be going on some sort of diet that you know is based upon speculation or what have you. So I think you have some low hanging fruit you can start with. And then from there, consider a clinician and also don’t forget about the importance of mindset.

Erin Ryan:

Okay. Oh, actually we have one more question. I was going to say we are all done, but we’ve got one more. Do you have time for one more?

Dr Ruscio:

Yeah, let’s do it.

Treating post-dinner gut pain

Erin Ryan:

Okay. This is from Wendy. She says, “I am 66 yrs old, after eating my evening meal I get burning pain in my gut. Can you explain why please? I have underactive thyroid and no gallbladder and a head hand tremor/dystonia, I exercise weekly, I am overweight at 178 lbs and 5 ft 2 in. Any help would be appreciated, I don’t eat much dairy or bread. I take a probiotic daily. Many thanks.”

Dr Ruscio:

Okay. Well, like we touched on earlier, one of the things that becomes more likely to be beneficial when you get up to 60/65 years of age or older is hydrochloric acid, but I would not start there. So this is something we’re going to put on your radar screen. We’re going to make this list just that we do at the clinic. Maybe one down through five, let’s say just arbitrarily. And we’re going to put the HCL or the trial of the acid at position five or six. Not the first thing, something on the list. We want to prioritize it appropriately.

Dr Ruscio:

One of the first things that you could do is try the paleo-low FODMAP diet. You can find that pretty easily, just search paleo-low FODMAP and my name and it should come right up. This will combine some of the rules from the paleo diet along with reducing FODMAPs. And there’s some evidence that has found that this burning or reflux or GERD, however we want to describe it can be improved from a regular elimination diet, like the paleo diet encapsulates. Other evidence that the same thing can be improved or the same improvements can be effectuated by a low FODMAP diet. So if we combine paleo plus low FODMAP, we give you the highest probability of hitting that quick improvement. You won’t do that forever. Do it for about a month. Also remember you don’t have to be anal about it. So if there’s going to be a social event or travel, relax, you know, make it livable. You don’t have to be perfect. 80/20 here applies. But after that month, see how you’re doing. And one of two things: yay, I’m feeling awesome? Then, great you don’t have to worry about anything else. Gradually reintroduce foods, feel out what works for you/what doesn’t work for you and broaden your diet as much as you can.

Dr Ruscio:

If you partially improve but not fully, then trial our triple therapy probiotics. This is our all-in-one sticks, which if/or when they get back in stock, we essentially took three different bottles and put them into one single serving tear sticks. So just one stick in the morning, tear it open, mix it with water. If those are not in stock when you’re listening to this, then you can buy the three different bottles, the lactobifido blend, the saccharomyces boulardii, and the soil-based. And just like Phyllis’s case study that we published from a couple years ago—you can find it probably pretty easily on YouTube if you just searched Phyllis and Dr. Ruscio—she had used probiotics prior and it wasn’t until she went on the triple therapy that you really saw the needle move in terms of the gastrointestinal symptoms she was suffering with.

Dr Ruscio:

So that’s the next thing you trial. Hopefully, yay, that works and we had a home run and symptoms are totally resolved. But if not, or if only partially, so now we come to that list item five or six, the HCL. And I outlined how to do this a moment ago on the podcast. So I’ll just refer you there, but follow that same stepwise dosing protocol. And again, it’s either going to help, it’s not going to help, or it’s going to make you worse. And of course, if it doesn’t help or it makes you worse, stop. If it does help, then that tells you that your body isn’t producing quite enough hydrochloric acid and continue with the supplement. Over time do try to wean yourself off and see if your body has kind of kickstarted its HCL production natively. But if you have to be on HCL long term, that’s totally fine. And that gives you a really good roadmap, if I do say so myself, for how to resolve some of these lingering burning and pain symptoms that you’re having.

Close

Erin Ryan:

Okay, well, that’s all we had for today. And I just want to thank everybody again for sending in your questions. And if you want to send in an audio question, you certainly can, we’ll have a button for that on our podcast page front and center pretty soon. So yeah. Thanks for sending in questions and keeping ’em short and to the point.

Dr Ruscio:

Yep. Thank you, Erin. And thanks, guys.

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