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Do you want to start feeling better?

Yes, Where Do I Start?

Listener Questions – Bloating, Prokinetics, Low Sulfur Diet, Probiotics

Answering your questions about gut symptoms, treatments, and staying hopeful.

Dr. Michael Ruscio: Hi, everyone. Welcome to another episode of Dr. Ruscio Radio. This is Dr. Ruscio. Today, I’m here with Erin Ryan, and we will be going into listener questions. These are really fun, Erin. I’m glad we’ve been doing these. It seems like they are offering quite a bit of help to people who are on their journey, struggling. I’m so excited to get rolling on another listener question episode today.

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In This Episode

Sugar and the Microbiome … 00:01:10
Why are Prokinetics Recommended After Antimicrobials? … 00:08:07
How Long to Trial a Low Sulfur Diet … 00:13:47
Bloated Even When Drinking Water … 00:21:25
Losing Hope in Functional Medicine, What Should I Do? … 00:25:17
Should We Pulse Probiotics? … 00:32:11
The Role of Hunger and Satiety in Digestive Problems … 00:35:50
Episode Wrap-Up … 00:38:15

Erin Ryan: Same here. So, we’re going to get started with Katie’s question. I think this is a question that a couple of people learned something from. So, why not?

DrMR: Great.

ER: Here we go.

Sugar and the Microbiome

Key Takeaways

[Back to Top]

  • Not everyone’s gut is sensitive to the same types of carbohydrates. There is a lot of individual variance here which is why we come back to a simple process of … make a change, listen to your body, and then reevaluate.
  • A trial on the low FODMAP diet or Elemental diet could be helpful

Katie: Hi, Dr. Ruscio. My name is Katie. I have a question for you about diet and its relationship to the gut microbiota. I hear a lot of people say like, “Don’t feed the bad guys,” or, “Sugar feeds the bad guys,” meaning the bad microbes in our gut. But don’t the good and the bad microbes eat sugar? And many of those processed foods that are bad, processed foods that we’re talking about, contain simple sugars that seem like they would be digested in the small intestines further up in the digestive tract. So, are those “bad sugars” even making it all the way down to the colon?

If not, then is it really the sugar molecule itself that is the problem, or is it something else in the processed food like additives and chemicals that are actually causing damage down in the colon? Isn’t a sugar molecule just a sugar molecule? Meaning, how could bacteria know the difference between a sugar molecule from a “bad” carb like a cookie, or one from a “good” carb like a sprouted whole wheat piece of buckwheat bread? Sugar is sugar. Right?

DrMR: Great question. This is definitely something that can be confusing. The reason for this is, it’s easy to think that healthier foods, or foods that are stereotyped to be healthier, are better for you. But that’s not always the case. This is where a low FODMAP diet, which reduces bacterial feeding, can be very helpful for some.

We can go even further and be more relevant to this question when looking at the elemental diet, which has about zero fiber in it, intentionally built to be a low-residue, or a low-fiber, low-prebiotic diet, that uses sugars as the carbohydrate source. One of the confusing points this leads to is people asking, “Well, won’t the elemental diet potentially feed fungal overgrowths because fungus especially feeds off sugar?” Which may, in part, be true. But I think there’s a lot of misinformation in that regard.

Processed junk food might be more prone to causing a problem due to inflammation than would a clean elemental diet that’s predigested and, therefore, you don’t have complex carbohydrates, you have simple sugars, because of how the microbiota can be starved by an elemental diet, or potentially even by certain sugars, and how this can have a reparative effect on the intestines due to the intestines not needing to work hard to digest food. And also, it does seem that, in a number of people, the microbiota gets a little bit out of control and feeding it doesn’t seem to always be the best maneuver.

So, the relationship between food and the microbiota is not a straightforward one. There is still likely much that we don’t understand. Because of that, the best thing to do rather than speculate based upon the mechanism is to look at the outcome. I wouldn’t say “Sugar is more prone to feeding certain bugs,” that’s a theory. I wouldn’t say, “This has been absolutely proven; therefore, we should eat this way.” That’s a theory. But if we look at the outcome, we are much more able to at least infer what has been healthy for the individual.

And this is really where the inception of many of the principles in Healthy Gut, Healthy You comes from. Where the microbiota enthusiasts would always be trying to portray fiber as being so important in the diet, yet especially for IBS and inflammatory bowel disease patients, a high-fiber diet isn’t always a great idea. At least not in the initial healing phases.

So, what we can do is look at the outcome data. We take a number of patients with IBS, SIBO, or inflammatory bowel disease, and we put them on this elemental diet or a low FODMAP diet, and we see improvements. We see less inflammation, less leaky gut, potentially an improvement in the microbiota. Although, it’s much harder to say because the measurement is something that’s inconsistent across many of the studies.

But we see the individual feel better with less inflammation, and less leaky gut, and of course less symptoms that are making them feel better. So, that is probably the best way to read this. Sugar may or may not be a problem. There are some people who will feel volumes better on an elemental diet.

There are other people who are intolerant to almost all types of carbs, including the simple predigested in Elemental Heal, but all the way up through things like sweet potatoes and white rice.

So, it’s all theory until we test it in the individual, and this is why listening to your own body’s biofeedback is so important. There’s a lot of nuance in there. The sugar may not have much of an impact on the SI. Some sugars may. Some sugars may have more of an impact on the colon. If colonic bacteria grow up into the small intestine, then the food substrates that would’ve fed the colonic bacteria now are overfeeding bacteria that have grown their way up into the small intestine. Although, that concept has recently been challenged by research by Richard McCallum, amongst others.

This all gets very confusing, which is why, thankfully, in the clinical community, we are looking at interventional data and outcomes, and we’re not trying to precisely identify every mechanism. Those two communities of research and mechanism and clinical do intersect and overlap. But fortunately, with many of the dietary choices regarding one’s gut, you make an intervention, you listen to your gut, and you proceed accordingly.

Reducing variables is very helpful. Meaning, don’t change too much or do too much at once because it’s very hard to discern cause and effect. This is not an easy question to answer. There seems to be a tremendous amount of individual variance, which is why we come back to, thankfully, a simple process of making a change, listening to your body, and then reevaluating.

Why Are Prokinetics Recommended After Antimicrobials?

Key Takeaways

[Back to Top]

  • Prokinetics help to keep the stream moving so that there is no stagnation and no overgrowth
  • The antimicrobials are treating what the lack of motility causes, the overgrowth. So, you may not need to take both at once
  • Prokinetics tend to lose their effect over time so it’s best to limit use if you don’t need them
  • It may be better to wait until they are best positioned, or most needed post-antimicrobial therapy to use them

ER: Okay. And our next question is from James. He says, “Why are prokinetics recommended only after antimicrobial treatment? Is there harm in taking them at the same time? Some Pimentel interviews I’ve seen recently suggest that prokinetics can be an effective treatment on their own. Why not combine them?”

DrMR: It’s a great question. It’s a fair question. I don’t think there’s any problem with combining them. And when I say “I don’t think,” I have seen no data showing that combining antimicrobial therapy with prokinetic therapy is in any way a problem. Although, you can make the argument that you may not need to administer both at once because the antimicrobials are addressing the problem that is secondary to the lack of motility.

For our audience, prokinetics are agents that help to stimulate movement of food through your intestines to make sure that things don’t move too slowly. If they move too slowly, one risks bacterial or fungal overgrowth. So, prokinetics help to keep the stream moving so that there is no stagnation and no overgrowth.

Now, the antimicrobials are treating what the lack of motility causes, the overgrowth. So, you may not need to do both at once. However, you could. Part of the reason why this is not recommended is, prokinetics tend to lose their effect over time. And so, as to guard against that loss of effectiveness with time, it may be better to wait until they are best positioned, or most needed post-antimicrobial therapy to use them.

Now, all that being said, my opinion is that the utility of prokinetic therapy is very much so overstated. There are definitely some for whom prokinetics are helpful. But in really listening to and experimenting with prokinetics with my patients in the clinic, I don’t think they are the end all be all that are needed for most people.

Short story here is, in the studies — unless there’s some that I’ve missed, and I don’t think that there are — who give patients prokinetics, yes, the prokinetics, after treating SIBO, do extend time in remission. But the patients still ended up going into a relapse. And so, it kind of kicks the can down the road.

Might there be another way to prevent that relapse? Yes. I think probiotics, although this hasn’t been fully documented, can be very helpful here, as may a low dose and repeat use of herbal antimicrobials. As one continues to heal, there tends to be less of a need for the low dose repeat antimicrobials over time. And what this comes down to is, what is the most effective strategy for maintaining harmony in the gut ecosystem? Now, one way would be prokinetics.

Another way would be two pearls of oil of oregano per day. It does seem that there’s better effect from the prescription prokinetics. It does not seem that there’s better effect from the pharmaceutical antibiotics. So, many of my patients prefer, rather than going on something like prucalopride, I always have a hard time saying that one, or Resolor, they’d rather be on two pearls of oil of oregano. I’m open to either. But for all those reasons, I’m not super keen on prokinetics.

Also, when you look at the testing for the autoimmunity that underlies the motility disorders, there’s a number of cases that will not be positive, especially those patients with constipation, which seem to benefit the most from prokinetics therapy. So, there’s still a lot here that hasn’t been sorted out.

I deeply appreciate Pimentel’s work. I think his work may be more relevant for a very narrow subset, and we could be making a mistake of assigning too much importance to motility as another case in point. Again, coming back to Richard McCallum’s work, the gastroenterologist who was on maybe six months ago, he’s finding that it may be more of an issue in SIBO, oral bacteria can grow from the mouth downward, and it might be due to a lack of hydrochloric acid than it truly is a lack of motility where colonic bacteria are refluxing upward into the small intestines, which kind of shoots a hole in the motility-centric theory of SIBO.

So, without getting too into the weeds here, and I hope I’m not putting some people to sleep, I’m very much open to prokinetics. But I think the utility has been overstated. If you come back to a protocol like the one that we recommend in Healthy Gut, Healthy You, the prokinetics are mentioned, but you see there’s a much greater context in which they’re used. And by doing so, I think you have a better probability than if you rely heavily on a prokinetic post-antimicrobial therapy.

ER: Yeah. It’s all about that algorithm, right? Use it when it’s potentially necessary.

DrMR: Yeah. It helps quite a bit.

ER: You guys talked a little bit more about prokinetics in the episode that you did with Allison Siebecker as well. So, if they want to hear more about prokinetics and algorithm, that’s a good place to go.

DrMR: Yup. Thank you.

ER: The next question is from Dora. It’s about the low-sulfur diet.

How Long to Trial a Low Sulfur Diet

Key Takeaways

[Back to Top]

  • Low Sulfur Diet
  • If you have tried a diet for a couple of weeks, notice some benefit but then symptoms return, you may need to move on to a deeper level of intervention like antimicrobials
  • The protocol in Healthy Gut, Healthy You can help with this

Dora: My name is Dora. I ate so much asparagus, and sulfur accumulated in my body and led to very bad, undesirable side effects. I read your article, “The Low Sulfur Diet,” and I followed. Thank you so much for this great information. Actually, it was very difficult, but I tried to continue. It helped a lot. And then, afterward, all the symptoms returned again. I just want to know how long sulfur takes to get out of my body, and what I should do, exactly. That’s it. This is the main question —

DrMR: Okay. So, a few things here. So, a low-sulfur diet — and I’ll see if we can link to our low-sulfur diet here in the transcript. Or, if you just search my name and low-sulfur diet, you should see a handout come up — will remove foods like asparagus. I don’t have all the foods committed to my memory, but there are a number of vegetables that are high in sulfur. Foods like cauliflower, I believe broccoli, also, asparagus. Many meats are also fairly sulfur-dense, so you end up going on, oftentimes, this lower meat and modified vegetables, vegetables that are actually higher in carbohydrates. And this can work well for some patients.

Now, the other thing in here that may be the issue may not be sulfur. It may be the FODMAPs. And so, I would start, first, with a trial on a low FODMAP diet, because it’s more likely that the FODMAPs are the issue and not necessarily the sulfur. Asparagus is high in both sulfur and in FODMAP.

To your question of why your reintroduction of foods didn’t work, it’s because oftentimes diet will not be enough to sufficiently heal the gut. Many times, it will. For the majority of people, diet is likely all that one needs. And I should also mention that your reintroduction may go smoothly if you waited a while longer. We see this quite often with FODMAP introductions where, in my opinion, four weeks for most people is too short of a window to really have a successful FODMAP reintroduction. We want to get there, and it’s important that we set that as a goal.

However, it seems to me that it can take people sometimes a couple of months until they really notice they have an improved tolerance to FODMAPs. But there may be another imbalance present: Small intestinal bacterial overgrowth, or fungal overgrowth, or more likely, just general dysbiosis without necessarily needing to give it a precise label. This is the term I use in the clinic much more regularly now, which is dysbiosis, which might be a better way of even describing small intestinal bacterial overgrowth. It might more so be small intestinal dysbiosis, just meaning a general imbalance that isn’t always hallmarked by an elevation of bacteria.

And so, because that’s present, the diet has been a bit of a crutch so as to not expose the symptoms that are secondary to the dysbiosis. But the diet wasn’t adequate to correct the dysbiosis. And this is where again, Erin, to your point, and to the point earlier about Healthy Gut, Healthy You, having a larger roadmap and an algorithm is so crucially important.

The sad thing about blogs and podcasts is you’re typically given a narrow slice of information. In this case, it sounds like you read something on low sulfur, which is great, and I’m glad that information reached you. However, it’s very important to apply that within this greater context so that you understand how to take the appropriate collaborative interventions, or adjunctive interventions, to allow your gut to truly heal and balance.

So, in this case, going to Healthy Gut, Healthy You, and as you’ll see there, starting with an elimination or a low FODMAP diet. So, for you, the Paleo low FODMAP sounds like a really great starting point, giving that some time, then considering layering in your probiotics. That will likely be enough to really get you over the hump and, subsequently, your reintroduction to go smoothly.

So, in this case, it’s a pretty simple answer. You’re doing the right thing, but you don’t have the sequence there. It may be challenging to get to a point where you can eat more broadly until you go through the appropriate steps.

ER: Okay. Yeah, I’ve definitely experienced that diet as a crutch before. And, yeah, it didn’t go very well afterward. So, I needed a lot more help. It took several months for me to be able to get those foods back in my body and feel okay with them. Some of them I have never reintroduced again because it just never went well. So, I stay far away from broccoli and cauliflower. Just doesn’t work out for me.

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So whether using Elemental Heal as a morning shake meal replacement, or as a mini gut reset for one, two, three or four days, or even all the way through to the application of exclusive or semi-exclusively for two to three weeks, we now have a formula that should fit your needs no matter how you’re using it.

If you go to and into the store, we’re offering 15% off any one of our Elemental Heal formulas. This discount is limited to one per customer and if you use the code, “TryElementalHeal” at checkout, you’ll get that 15% off. Please give them a try and let me know what you think. I believe you will find them to be not only a great tasting but also really friendly on the gut and will help give you a bump and a boost in how you’re feeling.

Bloated Even When Drinking Water

Key Takeaways

[Back to Top]

  • Could be an issue with gastritis, or irritation of the lining of the stomach
  • Putting any expansive stress on the stomach, as it should expand when water or food enters, with the tissues being inflamed, might lead to a bloating response

Okay. So, our next question is from Susan. “I feel uncomfortably bloated from just drinking water on an empty stomach. And it also seems that I become instantly bloated after taking just one bite of food. I’m confused. Do you know what might be going on here?”

DrMR: This is something I’ve seen a few cases of in the clinic. You don’t see a lot of this, but it’s something that definitely sticks out when someone says, “I’m bloated, even when drinking water.” Now, one thing, and most patients, when I ask them this, have already put this practice in place, is making sure you’re drinking filtered water because contaminants in water might be an issue for you, and you might be sensitive to those.

If that’s in place, then my theory on this — I don’t have any science-based answer, but what I do have is my clinical speculation — is that there could be an issue with gastritis or irritation of the lining of the stomach. Which, in my view, can diminish what’s known as gastric accommodation, or the ability of the stomach to expand when food or water arrives. It could also be a temperature issue if the water is too hot or too cold. I think that’s less likely. I think it’s more so just putting any expansile stress on the stomach, as it should expand when water or food enters. With the tissues being inflamed, it might lead to a bloating response.

So, in terms of what you do about that, there’s a number of things that can be done for gastritis. We kind of come back to the same algorithm. I don’t mean to sound like a broken record, but the algorithm is a byproduct of over 10 years of clinical experience and 10 years, day after day, listening to patients, asking questions, treating them, following up with them, reading the research, modifying what I do in the clinic-based upon patients’ biofeedback, based upon what the new studies are showing.

So, a lot goes into this. But you would want to start with the diet and lifestyle basics, things that will irritate the lining of the stomach, as you probably already know, caffeine, alcohol, nonsteroidal anti-inflammatory drugs, and then also certain foods, depending on the individual. You have your typical culprits like gluten, dairy, soy, and processed foods. Also, for some people FODMAPs might be an issue. So, you start there, and then you reevaluate.

Probiotics may also help as kind of a second line of intervention. Also, our Gut Rebuild Nutrients is something that I definitely favor in cases where I suspect gastritis, and that’s a great starting point. That will resolve most cases. It is possible that there’s something present actively causing gastritis like H. pylori, and probiotics will also help to diminish the level of colonization of H. pylori.

Or, you may require subsequent antimicrobial therapy. If your gut’s highly inflamed, you may need to go as far as doing a reset with Elemental Heal. So, there’s, again, a litany of different options. They all have their time and their place. The algorithm or the stepwise way to approach this is codified into Healthy Gut, Healthy You. So, I’d refer you there.

Please do let us know if you find help there, because this is an interesting presentation, bloating upon drinking water, that I’d like to follow up with some patients’ experience. Or, in this case, a reader or a listener experience. So, please do keep us abreast of how you do.

ER: Yeah. Thanks, Susan. We’re looking forward to hearing back from you.

Losing Hope In Functional Medicine, What Should I Do?

Key Takeaways

[Back to Top]

  • Consider working with a more specialized practitioner. Generalists tend to order far more testing and have less tools in their toolkit, so to speak, for specific conditions.
  • Consider following the gut protocol in Healthy Gut, Healthy You
  • Red flags: If practitioners are ordering a ton of expensive testing or trying to talk you into packaged programs that cost hundreds of dollars they might mean well but that indicates they may not be specialized enough to work with you

Okay. This next question is one where I just really felt for this person. There’s not a whole lot of context, but I think it’s an important message to play because there are so many people in this very same situation. So, here we go.

Listener: Hi, Dr. Ruscio. I have a question. I have kind of lost hope in functional medicine. I have been through three functional doctors. $40,000.00 later, and I have felt good at times, but then I seem to crash, and nobody seems to be able to help me. I do not know where to go anymore. I do not know what the future holds, and I wonder if you have any advice for someone like me. Thank you.

DrMR: Okay. Well, when you say you’ve lost hope in functional medicine, I’m kind of there with you

ER: I thought you’d say that.

DrMR: Yeah. I sometimes feel the same way. Three doctors and $40,000.00, it’s a lot of money. Unfortunately, we’ve published video conversations with patients who went to a doctor, and they were given a six to eight-month cure plan for something like $20,000.00. Which, to me, just seems crazy. So, unfortunately, this sort of thing does happen, highly financially inflated functional medicine. 

Of course, there may be some people who are doing something like that that are doing a great job and are working in a cost-effective fashion. But I definitely have some huge red flags that go up when I hear that sort of thing. But it can be expensive. It can be challenging if your needs are complex, and you are working with a series of potentially well-trained and, of course, well-intentioned providers. But they may not have the depth of knowledge correspondent to the level of need that you have.

I definitely see a number of these cases in the clinic where someone’s been to a handful of other doctors, and they haven’t gotten the results that they need. And I think this is where working with a generalist as compared to working with a specialist can make a difference.

Now, it’s hard to know what area of specialty that you do need. I think it’s a great idea to consider a gut specialist, because that is a common, common source of the problem.

The other thing that I observed, and hopefully this will provide some hope, is ups and downs are not uncommon. But, coming back to the generalist versus specialist, at least my observation, it’s hard for me to fully say because I’m not a generalist, so I’m trying to look through the lens of a generalist and based upon what many of my patients have told me, this is the vantage point I think they have, whereas they’re not necessarily highly accustomed to working with more complex cases that the clinician needs to grapple with the ups and the downs, and really have that master algorithm that we discussed that’s laid out in Healthy Gut, Healthy You to navigate.

And why that matters is because what I think happens in a lot of functional medicine is, the generalists will do some testing. The testing will semi-fictitiously point to a couple of different treatments, and the practitioner will have luck or results just because the few treatments that they’re using were able to rectify the situation for the patient. So, it’s not that the testing really helped them. Rather, the testing probably hindered them, and they couldn’t go beyond what the testing suggested.

So, it works for simple cases. You have X, Y, Z finding on the SIBO breath test, or on a stool test. You use probiotics. “Yay, I got better.” And the practitioner pats themselves on the back. “Well, yup, that was because you were low on bacterium on your stool test.” Well, not really. But it lines up because the patient responded. And that’s great when you’re in the generalist model working with a bit more of a simple presentation.

However, when people have reactivity, when they have layers, when they need a more comprehensive, personalized plan, this is where much of the testing actually gets in the way and where, unfortunately, good clinical thinking and decision-making isn’t often done, and why, in my observation, many generalists can struggle with the ups and the downs.

This is a common narrative I have with patients, which is, the ups and the downs will likely continue to occur. But we want to look at you almost like a stock market ticker graph where there’s these ups, downs, ups, downs, ups, downs.

But is the trend line week over week, or month over month? Is that up-down pattern trending upward, horizontally, or worse? And that’s, I think, the difference between the type of care one can get with someone who’s a bit more specialized, is they have a bit more of a long gain view.

And when I say long gain, I don’t mean years, but months. You know, three months, six months, nine months, you should be through a decent amount of the healing process. But sometimes, you really have to work, and you have the personalized therapies, and go way beyond what testing can tell us to do.

So, I hope that provides some solace because cases like yours definitely do exist. And, unfortunately, they can also definitely be fumbled for years, and years, and years before finding the right fit in terms of a practitioner. So, I would not give up hope. I know it’s easier for me to say, but I’ve seen many a case that have been in that similar type of position. And sometimes, it just comes down to finding the right person for you.

I also don’t want to hold myself up like I am able to fix 100% of cases. I am not. But I think I have a very good track record, and also have a referral network for people to refer to and keep the patient moving forward, should I exhaust my toolkit. So, for all those reasons, I think your prognosis is more favorable than you may think. You’ve just got to work a little longer. Try to find that right provider. And once you do, I think you’ll really start to make some improvements. So, hang in there. Don’t give up hope. And hopefully, this lands for you and motivates you to get back on the health horse and keep at it until you get to where you want to be.

ER: Yes, Maria. Don’t give up hope.

Should We Pulse Probiotics?

Key Takeaways

[Back to Top]

  • There is no evidence showing that we need to pulse probiotics

Okay. Our next question is from Henrick. “I’ve heard of other practitioners recommending that patients pulse their probiotics, but I haven’t heard anything as to why they would do this, let alone the timing they recommend. What’s your opinion on this topic?”

DrMR: Pulsing probiotics, I’ve seen no evidence showing that we need to pulse probiotics. And like so many things in functional medicine, there are all these elaborate theories, “Take with food. Take without food. Don’t take with antimicrobials. Take on a full moon.”

Take during the summer solstice,” or pulse, or rotate, or take with fiber, or take these with fiber, take those with that. And when you really look at where we may have any data, looking comparatively, there doesn’t seem to be any real difference in the outcome.

And I should also mention that for the majority of these recommendations, there has been no adequate study to prove any of them are any better than the others. It’s more so just, again, coming back to the fundamental problem of speculation and mechanistic thinking, you can land at all these suggestions without realizing that the group of people who adhere to these as compared to the group that just doses the probiotics, however, is easiest for them, and therefore, they’ll be most consistent, actually do exactly the same.

In fact, I would even go as far to mildly argue that the long-term prognosis for those on a more simplified dosing protocol is probably better because they will be more consistent, and they won’t get burned out with having to carry with them a pill case where they take some in the morning on an empty stomach, then some with lunch, then some two hours after lunch, then some 30 minutes before dinner, then some an hour after dinner. It’s just bonkers.

I’ve tested these hypotheses, and it doesn’t seem to make a big difference. So, I would say start simple, and see if you notice a result. If you don’t, you could always try the more elaborate dosing regime, as long as you’re careful to guard against your own placebo. And if you are noticing you feel better, then sure, you could make that nuanced adjustment. But the starting point should be simple because that is what is more prone to consistency, and that seems to be what is the most conducive to results.

ER: Yeah. And for an elaboration on this, I just have to plug your article about when to take probiotics.

DrMR: Yeah, thank you. That’s why we wrote that article, for that very reason.

ER: So, this will be our last question. Andres. This is about satiety.

The Role of Hunger and Satiety in Digestive Problems

Key Takeaways

[Back to Top]

Couple of theories here:

  • Depending on inflammation or irritation that might be present in the gut, people may lean more towards eating less
  • Some feel better when they don’t eat and may have conditioned themselves to eat less

Listener: Okay. So, here’s my question. I’m wondering about how you, Dr. Ruscio, think about the role of hunger and satiety in digestive problems. For instance, if a patient is hardly ever feeling hungry, even if they go for a full day without eating, or when they’ve eaten a huge meal and they don’t really feel satiated at all, how does this matter to the diagnosis of various digestive issues? Thank you.

DrMR: Great question, and one for which I don’t really have a great answer. A few observations are that some people, depending on the degree of inflammation or irritation that might be present in the gut, may lean more towards eating less. And this is a fairly common observation, “I feel better when I don’t eat.” I think over time, that can lead people into preferring to eat less, almost through this kind of conditioning response.

It could also mean that someone has been at a caloric excess for a while. And as I have gotten better about tracking how much I eat and how hungry I am, and also used fasting to help keep my hunger signals pretty accurate, I noticed that if I have one or two days where I eat a lot, the next couple days, I actually end up skipping one or two meals in a day, even though I wasn’t planning on doing it, because I’m not really that hungry.

So, it would seem logical to infer that if someone has some body fat to lose, that as their metabolism is getting healthier, they may notice they are significantly less hungry as their body is trying to move back to balance.

The other, again, could be due to inflammation in the GI, or just irritation. And then there are some cases where it doesn’t seem to have a whole lot of rhyme or reason, where people may just have a period where they were more hungry or less hungry, and it didn’t seem to track with anything. So, I don’t want to portray this as it always has a high level of meaning when someone has alterations in their satiety.

Episode Wrap-Up

ER: Okay. Well, that’s all we have for this week.

DrMR: Sweet. Well, thank you, Erin.

And for the audience, we’ve probably already announced, you’ve probably seen the new website with the cheesy picture of me on the home page. But if you haven’t been there, check that out. We’re working really hard to get more articles up there. For quite a while, as you know, we only had the podcast and the transcripts of the podcast, and videos and transcripts of those videos. But now, since some projects have been offloaded, I’m able to start writing articles. We have our probiotics starter guide. We have the comprehensive probiotics guide, which, I believe is 43 pages. I wrote a behemoth probiotic article that are kind of narrowed focus, “The Best Time to Take Probiotics,” the use of probiotics with antibiotics.

So, for our listenership, I hope you will keep checking over at the website, because more and more articles are being presented there, some of which, rarely, I will narrate, like the comprehensive probiotic article. But for these shorter, more narrow-focused articles, I won’t be narrating all those. So, I just want to point you there just to make sure you don’t overlook something that could otherwise be helpful.

And thank you guys for the questions. Keep them coming. It feels really great that these snippets of advice seem to be helping people make their way through some of the floundering, which I remember, and it really stunk, and get to the other side of feeling healthy.

So, thank you, guys. I love doing this. I appreciate the questions and feedback. So, again, please keep it all coming.

ER: Yes. Thank you.

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