Listener Questions: Antioxidants, Gene-Tailored Diets, Joint Pain and Gut Health, Hydrogen Sulfide SIBO, Probiotics During a Hospital Stay, and More…

Today we will cover listener questions, which include antioxidants, gene-tailored diets, joint pain and gut health, hydrogen sulfide SIBO, probiotics during a hospital stay, and more…

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Dr. Ruscio Radio Listener Questions: Antioxidants, Gene-Tailored Diets, Joint Pain and Gut Health, Hydrogen Sulfide SIBO, Probiotics During a Hospital Stay, and More…
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Practitioner Questions … 00:00:42
Episode Intro … 00:05:46
Antioxidant Usage … 00:06:40
APOE & Diet … 00:21:50
Heal Gut & Reduce Bacteria … 00:29:20
Lung Cancer … 00:34:42
Antimicrobials with Bismuth for H2S SIBO … 00:38:32
Probiotics Pre-Hospital Stay … 00:43:38
Deadlifting & Squats … 00:46:20
Episode Wrap-up … 00:51:00

Download Episode  (Right click on link and ‘Save As’)


Listener Questions: Antioxidants, Gene-Tailored Diets, Joint Pain and Gut Health, Hydrogen Sulfide SIBO, Probiotics During a Hospital Stay, and More…

Practitioner Questions

Dr. Michael Ruscio: Hey, everyone! Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Let’s start off the show today by answering a few questions that have come in from our practitioner following.

  1. Should we use enzymes in all dysbiotic patients?
  2. Can you use herbal antimicrobials when SIBO breath testing is negative? And also, can you use HCL long term? Or what’s the best way to wean off, if not?
  3. The understanding that low-FODMAP should be avoided in IBS, but what about resistant starch? And then,
  4. Medical cannabis or medical marijuana and autoimmune diseases.

So the full answer to all these questions appears in various editions of the Future of Functional Medicine Review clinical newsletter. One of the components of each monthly edition is the Practitioner Question of the Month, and we get great questions like this.

In short, for the use of enzymes on all dysbiotic patients, for most, yes. But for those with diarrhea, bile may provocate diarrhea. And I expand upon that answer in the newsletter.

Herbal antimicrobials when SIBO breath testing is negative. Yes, can certainly be done. There’s a few caveats and guidelines to consider that are also elaborated.

Use of HCL long term to weaning off. Use of HCL long term, not ideally. Ideally, we don’t want to use it long term. And the wean off is essentially done after we’ve done everything else—diet, lifestyle, treatment of dysbiosis, whether that’s SIBO or candida or H. pylori, or what have you, and someone’s hit their apex level of improvement, been stable in that improvement for a few months—they may go into a wean off. I also go over some of the guidelines into understanding that those with autoimmunity have a higher rate of low stomach acid than the general population.

The understanding that FODMAPs should be avoided in IBS, but what about resistant starch? Again, this is outlined further in the Review. But essentially, FODMAPs and resistant starch are very similar, in my opinion. They both feed bacteria. And one of the things that you don’t want to do too much of, at least initial phase in IBS or while someone is active in IBS, actively symptomatic, is feed bacteria.

Now, there’s exceptions to this rule. Some people respond well to things like fiber, prebiotics, and resistant starch. But usually, you want to limit those things initially, and then try to broaden your diet, which would include the addition of fiber, prebiotics, and resistant starch.

And then finally, medical cannabis or medical marijuana and autoimmune disease. And to answer this question, I essentially just summarized a research study that is a review of the data regarding medical marijuana in the use of autoimmune conditions. There’s definitely some promising research. And I think the best clinical trials—again, these are detailed for you in the write-up—are with IBD and diverticulitis or inflammatory conditions of the bowel. So there’s definitely some promise.

Long story short, medical marijuana is anti-inflammatory. And things that are anti-inflammatory are also partially immunosuppressive. So they can be helpful for conditions of excessive inflammation or immune activation. However, the other side of that coin is too much use can be immunosuppressive and increase the incidence of certain types of infections.

So there’s four practitioner questions that have been answered in the Future of Functional Medicine Review. And again, for the month of July only, what I’ve opened up is you can purchase access, your first full month of access, for only $1.00. This will give you access to all of the publications that have been published to date and allow you to really get a look into the Future of Functional Medicine Review clinical newsletter. I’m sure that everyone will love it. We’ve gotten terrific feedback so far.

And you do not have to be a doctor or a healthcare provider to access it. If you’re a layperson, you’re more than welcome to plug in also. Some of the terminology and some of the content may be a little bit deep, but it’s not written to be over anyone’s head. But it is a bit more clinically focused.

So if you’re new to our audience or if you haven’t jumped in yet, if you sign up during the month of July, you can get your first full month of access for only $100 for the Future of Functional Medicine Review clinical newsletter. To sign up, head over to DrRuscio.com/review. That’s DrRuscio.com/review. All right, guys, let’s head on to the rest of the show. Thanks.

Episode Intro

Hey, everyone! Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. And today, let’s go in to some more listener questions. There’s actually a number that were submitted as audio questions. There is an audio submission form on our website where you can actually speak into your computer, in effect, and leave an audio question. And sometimes, this is easier to leave a little bit more detail and context.

And so there’s been, admittedly, a number that had been sitting in queue for a while. And now that I’m getting into the habit of doing the Monthly Listener Questions, I definitely want to give these their attention. So I’m not going to hit everyone that’s in queue, but I’m going to hit a few. And then, hopefully, by the next round of listener questions, we’ll have all of those pending listener questions that were audio listener questions answered.

Antioxidant Usage

So the first one here, I’m going to play. And I’m doing this in a really high-tech fashion. What I’m doing is playing the clip on my cellphone into my microphone. Also, you may hear an ambulance going by outside, which always happens the moment I turn on my podcast recording. So I’m just going to ignore it, unless I get a bunch of hate mail saying that you can’t stand it, then I’ll shut my window, begrudgingly, because it’s a nice day outside, and I wouldn’t mind some fresh air. So here is question 1.

Lillian: Hi, Dr. Ruscio, this is Lillian. Thank you so much for the podcast. So far, I love the thorough review of the topics that you’ve covered. I would love to hear your take on the use of antioxidants, both in food and as supplements, especially for a person who might either have a higher oxidative load for a variety of reasons or would genetically be predisposed to have a lowered ability to generate endogenous antioxidants, such as glutathione, for example. I’m wondering both about the hormetic effect of foods that we eat, and exercise, and whether any supplemental antioxidant intake should be cycled, depending on whether exercise is part of that day or not. Thank you so much.

DrMR: All right. So great question. And a lot there to pick in to. I should first say, I’m not an expert in antioxidants. And to be truthful, I haven’t found antioxidants to be hugely needed in my clinical practice. I use them. There are some specific applications. I’ll give some details on those in a moment. But to me, antioxidants, outside of a few exceptions, are more so icing on the cake, meaning I don’t see a huge need for them. But again, I’m not an antioxidant expert. But I’m not an antioxidant expert because I pursue the things that I think will produce the most results. And so I have not really given a ton of emphasis to antioxidants.

But I should mention that a couple of high-level things before I launch in. I would not recommend eating for antioxidants. In fact, I wouldn’t recommend eating for a lot of things, because what ends up happening is you start crafting a diet that’s made upon these narrowly-focused objectives of eating for this, eating for that, eating for the other thing. And then, you tend to stop listening to your body, which I think is really the most important practice with diet.

There’s a few broad strokes that we could paint, in terms of avoiding allergens, encompassed by the Paleo diet. Avoiding highly-fermentable foods, if you have a problem with IBS-like symptoms, or digestive symptoms. Or potentially, you have SIBO, or a bacterial overgrowth, or you suspect that so you could eat a lower-FODMAP diet to reduce the amount that you feed your gut bacteria in case that’s a problem for you. The antioxidant piece…Oh, I’m sorry, there’s one other, your carbs. You want to dial in your carb frequency. And that does affect antioxidants.

And then eating specifically for antioxidants, a lot of the foods that are rich in antioxidants are going to be included in a lot of these different diets anyway. It’s not to say one diet’s going to grossly deprive you of antioxidants. So I’m not a huge proponent of eating a diet that’s chiefly focused on including a ton of antioxidants.

Now, the other part is you should really aim to reduce your oxidative load, not eat to increase your antioxidant intake. So what is the best treatment or what’s the best method in reducing oxidation or your oxidative load? Well, removal of allergens and irritants. Again, this is Paleo diet or just a low-allergen diet. And this may also include a lower-FODMAP diet, because remember, for some people, the restriction of FODMAPs actually reduces inflammation, as well as helps them feel better. And the inclusion of more FODMAPs actually provokes symptoms and also increases inflammation.

Again, I had mentioned the low-FODMAP diet frequently. But I don’t want people to think that everyone needs to be on a low-FODMAP diet all the time, forever. And it’s something to try in the short term to see if you can gain symptomatic improvement and then try to gradually perform a reintroduction. So just because it’s something that I mention a lot, I don’t want to paint the picture of being like a low-FODMAP zealot.

Another dietary component that can be helpful is limiting the amount of overly brown or charred food that you eat. And me being Italian, I totally get the art of glycation in terms of when you cook, you want to brown or caramelize foods. And this is something when I cook a pleasure meal, then there will be lots of that. But that’s not necessarily the type of meal that I eat day in and day out, whether it’s lots of caramelization, lots of browning, because that does produce advanced glycation end products, which does contribute to your oxidative load.

Managing insulin is another huge one. Some people may only do well, from a blood-sugar regulation perspective, by eating a lower or a slightly-restricted carb diet. So that’s something to keep in mind. Eating a generally healthy, and as a diverse of a diet that you can, is another easy way of just making sure you have adequate dietary antioxidant intake.

Making sure that you have omega-3s in your diet. I think for most people listening to this, for most who have taken their diet from Standard American garbage to somewhat healthy, are probably getting a decent ratio of omega-3 to omega-6, but that’s something to keep in mind. If you’re not eating any fish, you should be. In fact, as you map hunter-gatherer societies’ native diets, as they go more northerly toward the polar regions and carb intake decreases, but fat intake increases, you see the primary food that increases is fish consumption.

So if you’re eating Paleo, and you’re having bison like 18 times a week, I don’t care if it’s grass-fed and blah, blah, the whole party line, you need to incorporate more fish into your diet, because that’s one of the main things that changes as hunter-gatherer populations go from more equatorial to more northerly. So make sure you’re getting some fish in your diet.

And also, the right carb intake, we’ve already hinted on that. But, as an example, we’ve discussed one study wherein an ad hoc, meaning at your leisure, not super strict, carbohydrate restriction actually was able to reduce thyroid autoimmunity by about 40% to 44%. So that’s, of course, going to limit your oxidative load again. So again, not necessarily eating to optimize antioxidant intake, but eating to limit oxidation.

Lifestyle. Exercise hugely important for being anti-inflammatory and helping with oxidative load and also training your body. Your body is an antioxidant system because exercise produces a large amount of free radicals that then exercises your body’s antioxidant system.

Now, there are techniques for using antioxidants pre- and post-. And I don’t get super into that because, in my opinion, that’s just getting more detailed than you have to. And someone made the argument that potentially by using high doses of antioxidants post-exercise, you’re actually going to thwart or cripple your body’s ability to rebound with a strong antioxidant response, as it normally does during exercise. So that particular issue is not one I’ve got super in to, but I don’t think we need to get super prescriptive with that.

If you’re an athlete trying to get that last couple percentage point gain to improve, if you’re super competitive, then you may want to consult with someone like Ben Greenfield or Mike T. Nelson or Ben House to get some information there to help you get the rest of the way. If you’re not a super competitive athlete, then I wouldn’t worry about it, because the small gain that you may incur, it’s probably not going to be anything that you’re going to notice really, to be truthful.

Now, another area to vastly reduce your oxidative load, guess what that would be? Your gut health, right. Addressing dysbiosis, SIBO, H. pylori blasé, candida; there’s varying evidence that those can increase oxidative stress. And by treating those, they can decrease oxidative stress. A lot of that’s more inferential, where you see people’s symptoms improving and different disease activities decreasing.

Although, there is some information, I believe it’s regarding H. pylori and C-reactive protein. I believe—and I could be wrong here—but I believe there has been a systematic review of the meta-analysis showing there was a slight positive relationship between H. pylori and C-reactive protein, meaning the more H. pylori, the more C-reactive protein. I may be wrong in that though. But certainly, it’s not an egregious statement to say that if you have frank dysbiosis or frank gastrointestinal infection, treating that is going to help reduce your oxidative burden.

Also, periods of intermittent fasting or fasting can also be helpful, because that will give your gut a chance to take a break. And it will actually reduce the oxidation that’s a byproduct of digesting food. And it also allows the body to go into more of a repair state.

Now, there are some supplements that can be helpful. Vitamin D is probably one of the keynotes. But you may also want to get your vitamin D predominantly from the sun, rather than the supplement. And we’ve talked about how there are vitamin D-independent health benefits of sun exposure.

CoQ10, selenium, and magnesium are some others. And those have all, all four of these (D, CoQ10, selenium, magnesium) have all been used in thyroid autoimmunity. So me having an emphasis on thyroid health, that’s where these come into the picture. But I think these are all also pretty reasonable antioxidants that can be used in a shorter to moderate term.

And also, it’s important to mention that some antibiotics have been noted to be anti-inflammatory, potentially coming back to the dysbiosis point I made a moment ago. So not to forget that sometimes you don’t have to actively take antioxidants, you can actually just focus on reducing oxidative burden. In fact, that’s where I think the best interventions really are. The best interventions are not trying to do something, they’re trying to stop something from interfering with the body’s natural process, right, so your body will be healthy if we remove a gut infection. That statement to me makes sense. Your body will be healthy if we give you a bunch of these antioxidant compounds that people need. That to me does not make sense, because what you’re—one is trying to restore the body to its natural equilibrium, the other is trying to force a change that you think should be forced, and I think that’s a much dicier, riskier endeavor.

Now, so there’s been some studies showing that if somebody has preexisting skin cancer, selenium can provocate that. So that’s why I’m not a big fan of selenium in the long term. And we’ve discussed how selenium supplementation probably has its prominent benefit three to six months.

B vitamins can also definitely be helpful in some cases. And there’s a handful of studies showing benefitting different, mostly cognitive, disorders. Probiotics have been shown to reduce inflammation. Vitamin E, some forms of vitamin E have been shown to actually increase, I believe, it’s all-cause mortality.

And there was one review paper…And I did not have a chance to dig this out and go through a comprehensive review on this, so I should probably state that these are my thoughts off the top of my head and this is not based upon an extensive review. But there was one review paper I read a couple of years ago, actually now. But essentially, when you break down the results of the review paper, most supplemental interventions with antioxidants show no change. Some show a slight benefit, and some show a slight detriment. So when you look at it that way, I think it’s hard to make a huge posture that antioxidants are going to be vastly helpful.

So essentially, I guess what I’m saying is that I think the utility of antioxidants have been overstated. I’m open to them. But I think your best bet is to try to engage in interventions or lifestyle and dietary practices that will reduce your exposure to oxidants, rather than trying to optimize for antioxidants, because one is just trying to remove any factors that are interfering with your body’s natural healthy homeostasis, the other is trying to force your body to a healthier state. And I think the latter of those two statements is much less fruitful and much riskier.

And regarding genes, I’m open to genes. But I’m very wary of the gene testing, because if you remember back to having Dr. Kara Fitzgerald on, she was pretty clear in the paper that did the review on the MTHFR, and if that has any clinical significance. And that’s probably the most well-studied, as far as I know, or one of the most well-studied genes. And the paper essentially concluded that there is really no clinical utility of MTHFR testing.

And there’s a few studies coming up that I’ll be discussing in the near future that go into more detail about that. There is one—and this is going to go in to the Future of Functional Medicine Review clinical newsletter for clinicians with all the details, because this is very important.

But essentially, they gave folic acid to a large group of Chinese subjects. Tracked them for years. And they were tracking, I believe it was cardiovascular mortality. And they showed that folic acid, when given to people who are MTHFR positive, actually reduced the measure being tracked, again, which I believe was cardiovascular. Actually, I’m sorry, it was stroke. They were tracking stroke, incidences of stroke. And they found in this large group of MTHFR-positive people that folic acid actually reduced stroke.

Ah, what? How is that possible? Well, because I think some of the MTHFR people, MTHFR-positive people who take folic acids, like giving someone poison, I think that’s been a bit overstated. And this study supported that.

So I’m open to genes. But the gene testing, I think is probably way, way preclinical in most applications. And it may be something—the gene testing that is—that just distracts you from listening to your own body. So I’m totally open to it if the right evidence is provided. But so far, from what I’ve seen, not through a comprehensive review of the literature, but from what I’ve seen here and there, I have not been impressed in any way, shape, or form by the gene-based interventions. Okay.

APO-E & Diet

Kristi: Hi, Dr. Ruscio, I have recently had the APOE gene testing done, and discovered that I am a 3/4. I just finished reading The Perfect Gene Diet by Pamela McDonald, N.P., in which she has specific recommendations for each gene type. For my gene type, she recommends a mostly vegan diet with 20% fat, 25% protein, and 55% carbohydrate. For exercise, she recommends 75% aerobic and 25% anaerobic. Are you familiar with the research behind this gene testing and these recommendations? I’ve been following a lower-carb Paleo diet for the last couple of years, so this new gene diet would be a drastic change for me. I would love to hear your thoughts and maybe suggest this as a future podcast topic. Thank you very much.

DrMR: Okay. So this is a great question. And it is something I’m planning on having a couple different experts on to discuss. It’s just I haven’t had a chance to do that just yet. And also, it hasn’t been pushed to the top of the priority list, because I am already a bit suspect of the utility of the gene-based interventions, because I think it’s probably, like many things in functional medicine unfortunately, very preclinical. And this may be—and I am totally willing to change my opinion if better evidence is brought to my attention. And again, I am making this comment based upon a limited purview of the literature. But my thinking is that this is one of the many things, in functional medicine, that it’s the 50% of not-do’s that you have to be aware of. So that’s just my opinion. I know not everyone will agree with that. And I’m totally willing to change my opinion on that, if I was presented with the right information.

However, I’ve already spoken to this briefly, but there was another study, and this study will also be really heavily detailed in an edition of the Future of Functional Medicine Review clinical newsletter, because I think this is important. But from just a brief look at it the other day, they took a number of patients. And they genotyped them for the APOE-4. And I believe when they said they APOE-4, they were classifying the APOE-4/4. So there’s these different genotypes that may associate a different disease risk and may indicate that you do better or worse with different dietary and lifestyle exercise interventions.

So what this study did was they genotyped people, as either being APOE-4 or not, and then they gave them a diet that was gene-tailored. And they did not find any difference in the people who were APOE-4 positive, gene positive or not positive, in terms of response to the diet. So said more simply, the gene testing didn’t matter.

And I think that’s really important, because it’s important that we do these trials in a way that’s almost like a placebo control to compare, because everyone improved, right. The people who were given the gene-tailored diet or the people who were not given the gene-tailored diet, the people who had the gene and the people who didn’t have the gene, when any of them changed their diet, they improved.

So to have a study that only looks at the gene tailoring, and saying that they improved, doesn’t really tell you anything, right, because if we take a group of people, and they’re on a garbage diet, we test their genes, and now, we say, “Eat this healthy gene diet,” and they improve, we don’t know if the gene testing was meaningful at all, because unless we show another group that did not have the gene testing and did not have the tailored diet, but also went on a healthy diet, unless we show that they improved less, all we have done with the gene testing is introduced a meaningless variable into the equation.

So if you didn’t catch that, essentially what I’m saying is people can improve from going on a healthy diet. And if the healthy diet is slightly tweaked to conform to your genes, the gene testing is only helpful if you’re going to have more benefit from the guidance of the gene testing. And what I’m saying with this most recent study is that gene testing made no difference, in terms of when they put people on a gene-tailored diet, they didn’t get any better than people who were just put on a generally healthy diet.

So I hope that makes sense. If not, there is more to follow on that. But I would again be very suspicious of gene testing because I think it’s preclinical. And it’s probably something that has a greater likelihood of distracting you from what you need to do and from listening to your body.

I would first find a good clinician to address the fundamentals, right, your diet, your lifestyle, your gut health. And then, once you’ve addressed those things, you can better gauge what your response to diet is. Let’s say you do an elimination or a reintroduction or you experiment with your carbs, you can better gauge, once you’ve addressed the fundamentals, your response to different dietary derivations. And you can also better gauge your response to exercise.

Also, there is an interesting study published recently looking at diabetics. And they put diabetics on either sprint training or just traditional cardio training.  And they both showed similar comparative results in terms of improvements in their blood glucose. So sometimes I think we get so wrapped up in the difference between these interventions when either intervention will have a marked and notable positive impact. And the difference between one intervention to another is maybe 3%. So if you did one form of training or one form of diet, there’s a 3% difference between one or the other. But if you did any sort of training or any sort of diet, you have a 60% level of improvement.

So I hope that’s making sense. But the effect size is important with these things. And sometimes we get so wrapped up in these little details, and they’re really frivolous, in my opinion. So Kristi, hopefully, that is helpful for you.

One more, well, a few more questions. But I wanted to just take a quick moment again to ask you, guys, if you’ve been enjoying the podcast, if you’ve been getting a lot out of it, please leave a review over at iTunes. It has such an incredible impact on helping people who are going to iTunes or searching for a podcast to learn about health to find us. So if you can take just a moment, write a short review, I would really, really appreciate that. If you haven’t done it yet, please do me a huge favor and leave us a review. We’ve got a pretty big audience now. And looking at the numbers, of course, not everyone has left a review. I get that we’re all busy, but if this has been helpful to you, do me a huge favor, take a couple of moments and leave a quick review. Okay. Moving on now to the next one.

Heal Gut & Reduce Bacteria

Dr. Ulrich: Hey, Dr. Ruscio, this is Oren Ulrich. I’m a vascular surgeon from Denmark. I have large problems with joint pain, gut pain, diarrhea, and such. I’ve been listening to…First of all, I’ve been going to a lot of the Danish doctors, professors in allergy, rheumatologists, and everything, gastroenterologists, even wise ones with PhDs as M.Ds., and medical degrees. But none have really done anything or said anything clever. And then, I stumbled on your podcast. And it seems that you have huge experience in these kinds of patients.

I’m currently on vancomycin tablets, four times a day, 250 milligrams. And it has a huge effect on me. Reduces symptoms with approximately 80%, but still have very, very, very irritated gut from now to then. Some of my joints, especially the right shoulder, is very irritated. I’m really, really stuck on this curing myself thing. Even though, I’m a doctor, have prescription rights. I’ve tried probiotics, antibiotics, different forms. But I’m still stuck, still sick, can’t run 500 meters.

So if we can Skype, get a conversation, do anything. Or I can come to the States, visit there. I would really like to use some time, money, effort to get myself fixed. And I think I have some good input to where and some things about your treatments, because I have it on myself tried everything. As I said, some things good, some things bad. But if you have time, my email…

DrMR: Okay. So essentially, a smart guy here, vascular surgeon, doctor. He’s been fooling around trying to get himself better and hasn’t really been able to get any noticeable traction. But interestingly, he does notice that he does better when he’s on antibiotics. So that drops us a very important hint that there’s probably a degree of bacterial overgrowth or dysbiosis. Now, since leaving an audio submission, he’s actually come in to the clinic. And we haven’t been working together for too long, but he was off to a good start. Now, I haven’t heard back from him in a few months, which usually means one of two things: they’re either doing really well, and they’re just riding the wave, or he’s regressed and is just trying to get his motivation back up to pick up the process. I’m assuming it’s probably him doing well, because the last time we spoke, and I could be wrong, but I do believe he was off to a pretty good start.

Now, again, the fact that antibiotics help tells you there’s probably some dysbiosis, infection, or overgrowth, very common. The connection between the gut and the joints is pretty profound. So seeing digestive symptoms and joint pain co-present is in no way surprising. Now, he said he tried everything, which again, you hear that a lot. Well, when you’re me you hear that a lot, right, because you see people who’ve done some tinkering and haven’t been able to get there. And so now, it makes sense to seek out a guy like myself.

But oftentimes, this means that there’s either a missing intervention. Or sometimes say they’ve tried everything, and they haven’t. They’ve tried everything that they’ve been able to come across. But no one can know everything all the time. So sometimes, it’s just they haven’t found the right intervention for them. Or sometimes, it’s not the right integration and coordination between interventions. So people will do an antibiotic and then stop. Later, they’ll do a probiotic, and then stop. They’ll change their diet, and then stop. There’s no integration, no customization, no monitoring, no follow through. So that may be the only thing that’s standing between this gentleman and success.

Something else that also comes to mind, and you may have seen this case, when you have diarrhea and you have joint symptoms, that’s also a flag for histamine intolerance. There was one review looking at histamine intolerance, and this paper nicely showed that one of the more common changes that you’ll see, in terms of bowel regularity, is not constipation, but people with histamine intolerance tend to swing much more toward the odd diarrheal presentation.

And so histamine is just a compound that’s found in some foods, and the compound that is also released by bacteria. And so in people that have digestive maladies, they tend to overproduce histamine because they have bacterial overgrowth and their immune system and the gut is overzealous. And so when the immune system activates, it also causes a histamine release. So they have both internally produced histamine from their immune system and from their bacterial overgrowth. So sometimes these people need a low histamine diet to get to the level of improvement that they’re looking to get to.

Lung Cancer

All right, so this is something I wanted to comment on from someone that came in to the office recently. This was a patient that had a history of construction work. And that likely means this person was exposed to some asbestos. And she had acute onset of pulmonary symptoms like labored breathing and asthma.

Now, she had been working with natural doctors for a while. But I also checked in with her medical doctor. And the medical doctor saw a spot on her lungs in imaging and recommended a follow-up CT scan to rule out cancer. This is where I take huge issue. She then went to her natural provider, and the natural provider said, “No, I don’t want you to do that test.” This natural provider then proceeded to do a bioimpedance-type scan that’s based upon acupoints. And said that “You have a fungus in your lungs.”

Now, this patient, as long as I’m understanding the history here correctly, her signs and symptoms pretty much have persisted since treatment with that natural doctor three years ago, which is why she is now seeking me out. So gosh, I appreciate what the natural doctor is trying to do. But holy smokes, it’s terrible when a complementary and alternative medicine provider tells someone not to do something that’s out of their jurisdiction and training, right. If you’re not an oncologist, you shouldn’t really be commenting on whether or not someone should have a follow-up scan.

And I get, in natural medicine, we’re trying to prevent someone from ever needing to see an oncologist. But holy God, guys, if this person ends up having lung cancer and you’ve delayed that diagnosis by three plus years, you’re making the prognosis exponentially worse. So something that we should not do in functional, natural, alternative medicine is turn a blind eye to conventional medicine.

Conventional medicine is good at what it does, for the most part, which is not treat chronic, degenerative disease, which is not, in many cases, finding the underlying cause, which is not give people diet and lifestyle-based interventions to help them be healthy for the rest of their lives. Yeah, I totally get that. But sometimes people have something wrong, something medically wrong that requires a conventional-medicine diagnosis that we hope not to have. But sometimes something needs to be cut out or burnt off or zapped with chemicals. Well, we want to get this person to the right diagnosis.

Now, that diagnosis may be some sort of pulmonary cancer. She could then know that she has that condition and maybe find a natural oncologist and seek out a more natural-type of cancer treatment, but to have someone do a bioelectrical acupoint-type measurement and totally discard that there may be something conventionally that’s there is just so grossly negligent that it’s infuriating. And this is what gives natural medicine a bad name, things like this. So these things really, really need to stop.

So I just want to make that point. I’m not assuming that anyone in our audience is that dogmatic, because I’m hoping that we’re attracting a more reasonable and moderate crowd. But jeez, guys, please don’t ever delay a referral to a conventional provider out of, I don’t know, out of spite for the other side, because that’s really not going to help anybody. Okay.

Antimicrobials with Bismuth for H2S SIBO

So these are two questions that I had not had a chance to answer yet from when I was speaking at the National Association of Nutritional Professionals in Portland. And the first one, “Have you had success using antimicrobials with bismuth for H2S, hydrogen sulfide SIBO?”

So there are two types of SIBO that we can routinely capture on standard breath testing, hydrogen and methane SIBO. There’s a third type, which is hydrogen sulfide, which there is no commercially available test to detect. So the first question to this person is, “How do you know you have hydrogen sulfide SIBO?” Because there’s not a good test for this.

So I would caution you. Sometimes people end up chasing the most elusive diagnosis. But if you’re working with a good clinician, then you don’t necessarily need to be trying to test for hydrogen sulfide SIBO. There’s a urine test you can do that hasn’t been validated. It’s better than nothing, I suppose. But it actually may not be, because if it means nothing, then it may just confuse you more. And you may actually do better if you make your treatment empiric, meaning you treat someone as if they had hydrogen sulfide SIBO, and you use their response as the test, as the gauge, rather than repeating a urine test, which has been shown to have no validity.

And the reason why that’s relevant is if the test is telling you to do something, but the person’s response is telling you to do something else, you always want to use the person’s response. So first question to you would be, “How do you know that you have hydrogen sulfide SIBO?”

Now, granted that you’re working with a clinician who’s reasonable and seems to be piecing this together as best they can, then perhaps this makes sense. I’ve started to experiment with bismuth for hydrogen sulfide SIBO. There’s some limited data published, but it is encouraging. Even though, it is limited. And so it has been something that I have been experimenting with. And I think this is, it’s pretty simple.

You just essentially add bismuth to your standard treatment, whether it be antibiotic or herbal. And it’s not really a big deal. It’s a pretty innocuous compound. It may cause a little bit of constipation, because bismuth is an antidiarrheal or used as an antidiarrheal. So that’s one side effect to look out for.

How much of an impact it has? I’m not really sure. I should mention that in the one study that’s been done, with a breath test for hydrogen sulfide SIBO, they found that hydrogen sulfide SIBO responded very well to standard antibiotic therapy. So an important question to ask is, “Does this additional treatment have a measurable impact,” meaning does it have a clinical meaningful impact?

My clinic was able to show, for the first time, that the addition of anti-biofilm agents has a significant impact on reducing hydrogen SIBO. Do I use that on all hydrogen SIBO? No. And, in fact, I rarely use it, because you can get very good results with standard therapy for hydrogen sulfide SIBO. I’m sorry, with hydrogen SIBO. I use the anti-biofilm agents for cases that are a little bit more resistant because it is helpful. The anti-biofilm agents are helpful for treating hydrogen SIBO. But you don’t need to treat everyone as if they have the most stubborn case.

So the question I ponder is, does the addition of bismuth fall in that same line where you may get—and I’m just going to create arbitrary numbers, but to try to make this easy for people to capture or to grasp—you may see about 50% response or 50% reduction in hydrogen sulfide SIBO with standard antibiotic therapy. The addition of bismuth may add 4%. So yes, you can technically say, “It helps.” But does it help enough to warrant its inclusion in every hydrogen sulfide SIBO treatment case? I don’t know. I’m open to it. Bismuth is cheap. It’s safe. So I wouldn’t have much of a reservation about that.

So in answer to your question, I’ve been experimenting with it. I would like to know how synergistic it is, meaning is it absolutely necessary or not. If someone has diarrhea, then it may be an easier sell. But again, it’s cheap. And it’s fairly innocuous. So I don’t have a lot of reservation against it. But also remember that the key may not be another synergist. The key may just be revisiting, in an appropriate manner, the foundational treatments for SIBO that have already been shown to be effective.

So just be careful about that, because sometimes we get pulled into the exotic at the expense of what’s already been established foundationally. And sometimes, for me, in the clinic, we get results where other doctors have failed because we’re not getting pulling into the exotic and because we’re focusing on the fundamentals.

Probiotics Pre-Hospital Stay

Next question for the two cue cards left over from the NANP. “Do you recommend probiotics before a hospital stay for surgery to avoid infections?” As a general rule, yes. But there are some caveats. Soil-based organisms or soil-based probiotics or spore-forming probiotics, as they’re also called, have been shown to be risky for those with immunosuppression. So I would avoid the soil-based.

Now, Lactobacillus bifidobacterium-based probiotics have been shown safe and effective even for pre-term infants. So I think we can make a pretty strong safety case. And they can also help reduce some of the negative signs and symptoms or negative, just, symptoms in general, associated with antibiotic use like gastrointestinal distress and diarrhea. So you can make a case for using them during the antibiotics, which you’re likely going to be getting at the hospital.

They’ve also been shown to be helpful in the clearance of infections. They’ve been shown to be very synergistic with antibiotics. And there’s some evidence showing that probiotics, I believe, can reduce upper respiratory tract infections, and also, urinary tract and yeast infections, I believe. And probiotics also help the microbiota recover more quickly from perturbations induced by antibiotics. So yes, I think it’s pretty reasonable to recommend that.

Of course, you need to check in with your doc to make sure there’s no flagrant contraindication. And I would be very simple, because what you’re likely to get from your surgeon or your hospital doctor is a “No.” And that’s because they’re trying to just mitigate any risk on their end, which I get, right, because they know that conventional medicine says, “I can do this. And I will be covered legally if I do this. But I got to stay within the box. This patient’s asking about probiotics. I don’t know. And so I’m just going to revert to the safety zone of, you know, doing what the hospital says I can do.”

You want to ask them, “Do you know of any market contraindication for me taking probiotics while I’m here for this procedure or what have you?” Unless, they have a specific answer for you, they’re probably just diverting to the safe answer. And so that would increase the likelihood that you’re probably okay to use a probiotic if they do not have a specific piece of evidence showing the probiotic would be contraindicated.

So check in with your doc, but also read in between the lines on this one. But as a general rule, probiotics, especially the Lactobacillus bifidobacterium blend class, have been shown to be very safe, even for pre-term infants and even in those with somewhat immunosuppression and even those with infections. Okay.

Deadlifting & Squats

And then finally here, I wanted to offer a little advice, based upon my own previous experience. If you’re not deadlifting and squatting—if you’re exercising, firstly, but you’re not deadlifting and squatting, I would absolutely 1,000% make sure that you are. It’s something that I’ve noticed over the past years, a few years, that when I am deadlifting and squatting compared to when I’m not deadlifting and squatting, I feel stronger. I feel like I have better posture. And my core just feels so much more engaged, functional, strong, flat, sexy, whatever you want to call it, it just makes such an immense difference.

And I think the older I get, the more important that is. And I think it’s because there’s some evidence showing that, as hormones decline, one of the first muscle groups or some of the first muscle groups that start to atrophy are your pelvic floor and your abdominal wall. And I think some of the best exercises for exercising your pelvic floor and your abdominal wall are weight-bearing exercises that are compound in nature and put a load through your hip joints. So these are hugely fundamental movements.

And for those of you who are worried about your core, if I’m being really honest, I think some of these things, we’re laying on a pink mat and holding a fuzzy dumbbell and you’re told to engage your core, I think is BS. Unless you’re in the rehab phase and you need to build yourself back up from rehab, from a bad position, maybe post-surgical or post-major injury, then you should be doing exercises that force your core to engage.

Now, I’m not saying go try to squat 315 on day one. But what I am saying is these things like squats and deadlifts put your body in a position where your core has to engage. And I can tell you, I probably feel squats and deadlifts, right now that I have been out of doing them for maybe two months, I feel them more in my core, than I do anywhere else. And this is why I wanted to make this comment is, that’s an area right now I feel like I need to strengthen the most. And I’m trying to increase my sprint speed.

And I’ve been doing what’s known as hex-bar deadlifts. The hex deadlift bar is like a hexagonal bar. You’ve probably seen people. You kind of stand inside of it. And then, you grab the bar. And you do a deadlift. And I caught a great podcast interview with Ryan… I think his name is Ryan Flaherty, who is a speed coach, strengthening conditioning and speed coach. And he was on Tim Ferriss’ show. And he talked about how one of the, or the best predictor of sprint speed in the athletes that he’s trained was their hex-bar deadlift performance. And so he said elite-level athletes are doing 3.2 times their body weight for their one rep max.

So I’m trying to build my way up to that. So that means you need to, for me 210, I need to be doing almost 700 pounds for a one rep. So I’m a far way off. But as I’ve been working up there and doing these heavier lifts, I feel everything in my body that’s been weak is getting strengthened, including my core, but also my upper back, shoulders, from doing this.

So I would highly recommend, and especially if you’re aging, to make sure you’re squatting and deadlifting. You don’t have to be going for the performance that I am where I’m trying to do this maximally heavy lift. But I would highly encourage you to make sure that you’re doing squats and deadlifts.

I’m not one to be super particular about specific exercise programs. I think something is better than nothing at all. But if you can incorporate squats and deadlifts at least once a week, I think it’s going to pay you some huge dividends. And you can look up the hex-bar deadlift. It’s pretty easy. And once you see it, you’ll know exactly what I’m talking about. And you probably have one at your gym. And I actually like that way better than a traditional deadlift. If you’re a novice to lifting, the traditional deadlift will probably seem a little bit weird, because you have to know the mechanics of good lifting. But it’s also weird not to hit the bar against your chins. And with the hex-bar deadlift, you don’t have to worry about that.

So I would definitely recommend, if you’re not deadlifting, deadlift. Check out the hex bar. And if you’re not squatting, I would squat. I would recommend a front squat over a back squat, because I think the way the front squat loads you is a little more relevant to day-to-day movement and giving you translatable strength into the real world. But you may need to start with the back squat if you haven’t been doing anything at all.

Episode Wrap Up

So just a little tip there on exercise that I have found to be hugely helpful. And I wanted to pass along. And that is it for this edition of Listener Questions. I will talk to you guys next time. Thanks. Bye.


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What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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

12 thoughts on “Listener Questions: Antioxidants, Gene-Tailored Diets, Joint Pain and Gut Health, Hydrogen Sulfide SIBO, Probiotics During a Hospital Stay, and More…

  1. Hi Dr Ruscio, I see you as the go to person for interrogating clinical trials on SIBO so hope you can have a look at this and offer your well informed opinion.. I saw this study recently showing improvements in methane dominant SIBO patients who took two capsules of Lactobacillus reuteri DSM 17938 probiotocs daily. Here is the link to the study. It was a small group but do you think there is any clinical significance to this?

    http://www.europeanreview.org/wp/wp-content/uploads/1702-1708-L.-reuteri-in-methane-producer-constipated-patients.pdf

    Also, this particular probiotic is found in BioGaia which is given to babies with colic in a liquid form or can be taken in tablet form as well for adults. Do you think the liquid form is a better delivery mechanism?

    Many Thanks

    Mark

    1. Hi Mark,
      Thank you. This is a great paper, thanks for sharing! Yes, there have been a few clinical trials that have shown probiotics (of various formulations) can lower SIBO gas levels. There are also a number of trials showing improvement in IBS (the symptoms of SIBO, including constipation) using various formulas. I’m not inclined to think delivery form matters. Hope this helps!

  2. Hi Dr., Great advice, deadlift and squatting makes you stronger and sexy! I was doing the Dr. Doug Mcdoug protocol and felt great.

    1. Hence the free weights are preferable, to strengthen the core, always a good advice to keep a good posture and pay attention to the form of the exercise, and very important low speed with controlled movements. Injuries can occur like it happen to me. So be strong an be safe.

  3. Hi Dr. Ruscio
    Thank you so much for answering my listener question about gene based diets! I was so honored that you took the time on your podcast to address my question.
    You mentioned that you are thinking about doing a full podcast on this topic, so I wanted to pass along a resource that I thought might be helpful. Sarah Balentine just wrote a blog post about ApoE and it seems to have a lot of great information. She provides a long list of citations to back up the information in her article. I’d love to hear your thoughts!
    https://www.thepaleomom.com/genes-know-apoe/
    Thanks again for your time. I really enjoy your podcast and I listen to it as soon as it is posted on ITunes. I appreciate your conservative approach and your focus on research. Keep up the good work!

  4. Hi Dr. Ruscio
    Thank you so much for answering my listener question about gene based diets! I was so honored that you took the time on your podcast to address my question.
    You mentioned that you are thinking about doing a full podcast on this topic, so I wanted to pass along a resource that I thought might be helpful. Sarah Balentine just wrote a blog post about ApoE and it seems to have a lot of great information. She provides a long list of citations to back up the information in her article. I’d love to hear your thoughts!
    https://www.thepaleomom.com/genes-know-apoe/
    Thanks again for your time. I really enjoy your podcast and I listen to it as soon as it is posted on ITunes. I appreciate your conservative approach and your focus on research. Keep up the good work!

  5. Hi Dr Ruscio, I see you as the go to person for interrogating clinical trials on SIBO so hope you can have a look at this and offer your well informed opinion.. I saw this study recently showing improvements in methane dominant SIBO patients who took two capsules of Lactobacillus reuteri DSM 17938 probiotocs daily. Here is the link to the study. It was a small group but do you think there is any clinical significance to this?

    http://www.europeanreview.org/wp/wp-content/uploads/1702-1708-L.-reuteri-in-methane-producer-constipated-patients.pdf

    Also, this particular probiotic is found in BioGaia which is given to babies with colic in a liquid form or can be taken in tablet form as well for adults. Do you think the liquid form is a better delivery mechanism?

    Many Thanks

    Mark

    1. Hi Mark,
      Thank you. This is a great paper, thanks for sharing! Yes, there have been a few clinical trials that have shown probiotics (of various formulations) can lower SIBO gas levels. There are also a number of trials showing improvement in IBS (the symptoms of SIBO, including constipation) using various formulas. I’m not inclined to think delivery form matters. Hope this helps!

  6. Hi Dr., Great advice, deadlift and squatting makes you stronger and sexy! I was doing the Dr. Doug Mcdoug protocol and felt great.

    1. Hence the free weights are preferable, to strengthen the core, always a good advice to keep a good posture and pay attention to the form of the exercise, and very important low speed with controlled movements. Injuries can occur like it happen to me. So be strong an be safe.

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