Listener Questions: Food Allergies, Elemental Dieting, Lectins - Dr. Michael Ruscio, DNM, DC

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Listener Questions: Food Allergies, Elemental Dieting, Lectins

Answers on Probiotics for the Post-Surgery Gut, the Problem with Allergy Testing, and the Lectin-Free Diet

Today we cover listener questions. We go over:

  • Why food allergy tests may not accurately reflect your symptoms.
  • Whether Elemental Heal is helpful for histamine intolerance, possible mold illness, and gut problems.
  • The hype around the lectin-free diet—and if it’s warranted. 
  • Reframing your health path to focus on your symptoms, not lab markers.  
  • The difference between the two Intestinal Support Formula formulations.  
  • Why low fecal elastase may be presenting in unexpected ways.

In This Episode

Intro … 00:08
My allergy tests don’t align with my symptoms … 01:47
I have Hashimoto’s, potentially mold exposure, and had pelvic reconstruction. Is the elemental diet a good starting point for my gut issues? … 12:26
What do you think about the lectin-free diet? … 20:25
How do I keep fungal and yeast growth down while also increasing SIGA? … 27:56
What’s the difference between the vegan and non-vegan Intestinal Support Formula? … 36:01
Thoughts on fecal elastase … 41:19
A word on lab testing and at-home testing … 50:06
Close … 57:59

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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 “my food allergy tests don’t match the reactions I’m having. What should I do?”, “Is Elemental Heal helpful for histamine intolerance, possible mold illness, and gut problems?”, “What do you think about the lectin-free diet?”, “How to keep yeast and fungal overgrowth down after having part of my colon removed?”, “Can you explain the difference between vegan and regular Intestinal Support Formula?”, and what do you do for patients with low fecal elastase who also have constipation?” Thank you all for your questions. And listeners, if you’d like to submit a question, you can 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.

➕ Full Podcast Transcript

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 “my food allergy tests don’t match the reactions I’m having. What should I do?”, “Is Elemental Heal helpful for histamine intolerance, possible mold illness, and gut problems?”, “What do you think about the lectin-free diet?”, “How to keep yeast and fungal overgrowth down after having part of my colon removed?”, “Can you explain the difference between vegan and regular Intestinal Support Formula?”, and what do you do for patients with low fecal elastase who also have constipation?” Thank you all for your questions. And listeners, if you’d like to submit a question, you can 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:

Hi everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Michael Ruscio, back again with Erin Ryan to answer more of your questions. Erin, welcome back.

Erin Ryan:

Hi, thank you. So I guess let’s just jump right in. Thanks for submitting questions, everyone. And thank you for keeping them short and sweet. We’re able to get through more questions as you keep them short and sweet. So our first question is, “my skin allergy tests are normal, but I react to foods with bloating, diarrhea, pain. I’m allergic to pet dander and pollen. My allergy test doesn’t show it. My GI doctor says I have an eating disorder, but I know that these are food sensitivities. Dr. Ruscio, I would like to know your opinion.”

Dr Ruscio:

This is a great question. And this is one that partially illustrates why we want to treat people and not numbers. Now, there is a medical explanation, if you will, in that I’m assuming that you have an allergy or intolerance of these foods that will not come up on your traditional/conventional IGE (immunoglobulin E) acute allergy mediated test, and might be revealed on something like a IGG or IGM. Although that gets us into trouble because as we discussed on the podcast in the past, some fairly major bodies in immunology have concluded that it’s not abnormal or somewhat normal to have some degree of IGG reactivity to foods present in the bloodstream. So could it be that these foods that you react to, you have an intolerance regarding being able to break them down or how they interface with your microbiota, meaning something like lactose intolerance or FODMAP or prebiotic intolerance?

Dr Ruscio:

Yes. The point I’m trying to make is getting a piece of paper to quantify what you feel isn’t always possible. And the realm which is probably the least possible is gut healthcare. One thing I’m trying to be a little bit better about distinguishing is, there are some tests that are very well validated. Blood sugar, right? Thyroid, even—though I and we at the clinic disagree quite strongly with some of the generous and outside-of-the-box interpretation that alternative and functional medicine has regarding thyroid. This is one area that conventional medicine really has this right. The traditional conventional ranges for thyroid interpretation would be another example of a reliable lab. Gut health, food allergy tests—it’s much more ethereal or non-definitive or gray. So I do want to draw that one distinction.

Dr Ruscio:

But coming back to your question, it’s definitely possible that you are reacting to these foods for good reason, meaning you’re not psychosomatic or imagining these things and that you don’t have an eating disorder. And improving your gut health is really the way to address the vast majority of food reactivity. And that’s because it’s the health of your gut that really dictates, in large part, your tolerance to foods. So rather than saying or trying to quantify what food specifically, you probably have a pretty good idea. So generally avoid those and then go to work on improving the health of your gut. “Healthy Gut, Healthy You,” is the book that I spent three years pouring everything I have and knew into—so as to give you a resource. There’s also the clinic, of course, if you’re looking for some one-on-one attention with myself or one of the awesome doctors or clinicians on our team.

Dr Ruscio:

The other thing I do want to address is the eating disorder piece. Now how you approach a conversation on diet could make an underlying…Let’s say you’re maybe a little bit of an anxious personality type. You may or you may not be, but just hang with me on this theoretical, because it will speak to and help some people.

Dr Ruscio:

If you’re more prone to worry for your anxiety, it’s very important that we have the right approach/discussion/narrative on diet. And we don’t inculcate you into “well, gluten can cause inflammation and because of inflammation you want to avoid food all the time. Even one bite can cause upregulation of inflammatory peptides and cascades in your gut for six months, according to this one study.” That is the absolute worst way to phrase this, that’s generally untrue, and it clearly does more harm to people than good. So how you approach diet, your relationship with food, and your expectations about your dietary tolerance—incredibly important.

Dr Ruscio:

Also, depending on if you have that personality type, and especially if there’s been trauma (physical or emotional trauma in the past), then this is when people can skew into a degree of limbic imbalance and something like limb retraining can be a key piece of fully regaining a healthy relationship with food and a healthy tolerance to foods.

Dr Ruscio:

So, hopefully that helps. But yes, you should definitely be able to improve your relationship with food, your ability to eat a broader swath of foods with a little bit of advice and the proper counsel, and come out the other side much more tolerant and probably happy and healthy because of that. And again, Healthy Gut, Healthy You” is one resource, as is the clinic. And I really hope this helps because I know the path you’re on is one that is sometimes taken advantage of or abused by some in the field. Probably not intentionally. I just feel so passionately about saving anyone from that fate that we can. So hopefully this lands, it resonates, and it helps.

Erin Ryan:

Yeah, I hope so too. I remember that one of my first visits to a GI doc, that was the end result was they basically said… Because they had asked me if I had eating disorder stuff in the past. And I was like, “yeah, I mean, I was a dancer who as a young developing girl, who’s like looking at herself in the mirror 24/7 dancing, that just kind of comes with the package, unfortunately.” But I made the mistake of admitting to that before the conversation got started about what was going on. And they basically ended up referring me to a psychologist. And I was like, “no, I have issues. Like I can’t eat without feeling bloated. I feel sick all the time. I just can’t eat. I can only eat like five foods.” And so I think they kind of twisted the context of that to say, “well you have a history of this and so it must be this.” But that was really, really frustrating. So I have a lot of empathy for that and just know that it can get so much better. And yeah, I mean, if that’s what [the practitioner’s] conclusion is, just keep moving on until you find the right one. And reach out to the Ruscio Institute for sure, because that’s how I got so much better.

Dr Ruscio:

And one quick thing on top of that is that they may just not have the tools that you need. And this is where I think the patient or the healthcare consumer has to understand that there’s different realms of medicine. And the analogy I’ve used on the podcast in the past is: you’re not going to come to our clinic for a colorectal cancer screening, right? That’s not what we do. We don’t profess to do that. And the GI doctor is likely doing their best, but you have to understand that they have a certain toolkit and it’s not the one-stop-shop for all of your healthcare needs. And I think that can just help patients better understand how to navigate the healthcare system.

Erin Ryan:

Yeah. Even if they’re a gastroenterologist. Because I went in there with a printout of what a SIBO test is and they looked at it and said, “we don’t do this here.” And I was like, “but it’s a gut condition. How can you not do this here?” And they just said, “well, it’s not covered by insurance. We just don’t offer it.” And I was like, “well, I’ll pay cash. I don’t care. This is what I think I have based on like all this research that I did.” And they basically were like, “we can do a camera-swallowing thing and we can do a motility study, but we can’t do that.” And I was like, “well, it’s just a breath test.” I was just trying to tell them [that] you just breathe into some tubes and they’re like, “right, yeah, we don’t do that.” And it was so frustrating because in my mind then—obviously if I knew [then] what I [know now] it would be different—but I was like, who else do you go to besides a gastroenterologist for gut issues? It was really, really disheartening. And I left there just in a pile of tears because I was like, “well then I don’t know what to do.”

Dr Ruscio:

Yep. And this is also one of the, I guess, challenges of the business aspect of medicine and healthcare. And this permeates all realms. So it’s not to say that this is just a conventional medical thing. But you have to have a business model for your clinic for which you can get paid. Right? And so if they’re built around insurance and you’re asking for something that’s non-insurance, it’s like, “well, what do we do? Where do we get this lab? How do we bill this lab? Is it reimbursable? If it’s not reimbursable, how do we do cash? We never do that. We don’t know how to do that. We have to ask our accountant. Is this even legal?” So it’s not always quite so simple. And you also want a clinician, in this GIs defense, who’s doing a lot of what they’re doing and not just saying, “well, I’ve never done it before, but I’ll do it this time.”

Dr Ruscio:

Then you’re going to come back and it’s like, “well, I guess there’s a paper showing Rifaximin can help.” Which it can, but you may get that kind of one-off Rifaximin approach, which will help some definitely, there’s good evidence to support that. But if you are someone who needs more of a layered, personalized approach, you’re going to hit a wall pretty quickly. So yeah, all really salient points. And why you need, like I’ve said many times in the past, in my opinion, for whatever the issue is, you want to have one doctor on the conventional side, one doctor on the alternative side so you have a full purview of the tools available to help you.

Erin Ryan:

Yeah. I completely agree with that. Alright. So our next question is an audio question from Robin.

Listener [Robin]:

My name is Robin. I am 55 years old. Postmenopausal. Hashimoto’s diagnosis in 2011. My TPO is at 107, homocysteine 9.6, CRP is 1.38. I lived with mold for three years, but moved out two years ago. I’m in Florida. I did well on the plant paradox from 2017 to 2020, but I’ve developed histamine issues. I think I have mold toxicity. I underwent a pelvic reconstruction in December 2020 and my gut is now a mess. I’ve put on 15 pounds. Is the Elemental diet a good start for me?

Dr Ruscio:

Okay. Great question. Very representative of a subset of patient that we see at the clinic. And yes, Elemental Heal is definitely an option. It’s a good starting point, especially if done in the context of if your diet and lifestyle are pretty good. They’re never perfect. Right. But pretty good. And yeah, I think this would be a reasonable place to start. I also want to comment that I think your TPO is great. And so I would look at that as a clinical win. And I’m not sure if when you say TPO is 107, if that was at the time of diagnosis in 2011, or if a more recent test has affirmed that. But in my mind, that’s irrelevant Hashimotos, meaning I would even kind of start thinking about yourself as someone who doesn’t really have Hashimotos because the likelihood that there’s going to be any problem is infinitesimally small at a level of 107. At least this is what the best data suggests. And this is just one thing you can get out of your head. And, if you are tying any of your symptoms to that, it’s something you can probably and might do well to let go of.

Dr Ruscio:

Now, what’s interesting is the mold exposure. And it is possible that that’s something that may be problematic. Now, if you’ve been out of the environment for two years, it’s less likely that it is a problem. It’s possible, but it’s less probable. And so that information, if we’re having a new patient intake at the clinic, that helps us determine mold’s on the list but we’re going to slide it to the middle or the bottom of the list due to the fact that you’ve been out of the environment for that extended period of time. Now, what other information do we have about you?

Dr Ruscio:

Well, when you say that your gut became a mess after pelvic reconstruction, that’s a big flag that either there was some dysbiosis ensued by, I’m assuming, the antibiotics that were used at that time during that surgery and/or adhesions or scar tissue could have developed. And so this would take the adhesions piece and put it on your list. And given the timeline—gut became a mess after the reconstructive surgery—it would move it up in your list (the list that we make for every individual), fairly high. Thankfully for something like this, abdominal self massage can be quite helpful. In fact, we recently published a patient conversation video with Dr. Joe Mather and, I believe his name was, Kyle for whom the abdominal self massage was quite helpful. I believe (if I’m remembering all the details of that case correctly) but I’m pretty sure the abdominal self massage was helpful in his case.

Dr Ruscio:

Now the Elemental Heal can get you some similar benefit as self massage. What I think happens in these cases is you could have a piece of scar tissue that’s kind of pushing on the garden hose that is your intestinal tube. And at that point, where you’re kind of pushing or stepping on the garden hose, food tends to get stuck, slow down, and lead to bacterial overgrowth and potentially fungal overgrowth. Now, when you do a liquid elemental diet reset, since it’s liquid, there’s not going to be the same chance of stuff getting stuck at that point in the garden hose because liquid moves through very easily. And also because the elemental diet absorbs very early on in the GI tract. So there’s a good chance that that foot on the hose point won’t even be involved in digestion, because everything will absorb before it gets there. And you’ll truly give that little juncture a chance to clear out any of the stuff that’s built up.

Dr Ruscio:

So, a few thoughts for you there. Depending on how well the elemental diet goes, you very much so may want to consider reaching out to the clinic because there’s a few different paths here. And each path can take a couple months and, depending on what you do, a few or maybe even several hundred dollars to sort of do your therapeutic trial. And if you do the paths in the wrong order, you may end up spending months and a few to several hundred dollars once, twice, or three times that is not really that productive. So try the Elemental Heal. Hopefully the reset is helpful and you’re good. If not, I’d be a little bit wary, with these couple things in your history, to bring in a professional because that can ultimately end up being a cost and a time savings.

Erin Ryan:

Alright. Yeah. I could see someone grabbing onto the mold idea. I mean, “well, let’s go down this mold path first and see,” instead of, like you said, just it being in the correct order. Yeah. I tend to agree with that, having spent lots and lots of money prior to finding the clinic.

Dr Ruscio:

Yeah. Yeah. And this is where really listening to people makes so much difference. Testing in a case like this may be partially helpful, but this is really a case where if we dig into the history and the symptoms, we get a much more accurate filling in of that problems list. And that allows us to do things in the right sequence. And that’s another reason why—I know I say it all the time—but I’m just so proud of what we do at the clinic because it helps fill in these gaps for people. Where otherwise it’s a super testing-heavy approach and the important information about the person (their history and their symptoms) isn’t interpreted and translated correctly. And even though the person spent three grand on labs, they actually didn’t really get to what they needed. So this is a good case where there’s a couple threads here. And the intake process really helps us dive deep into examining those threads and saying something along the lines of “okay, that one thread? Not super relevant. These two threads? Very relevant. We’re going to start here.”

Erin Ryan:

Yeah. And I was thinking of her comment about the histamine issue too. I mean, anytime I sort of have a flare in that area Elemental heal helps a lot. So hopefully it can help with that as well. Yeah.

Dr Ruscio:

Great point.

Sponsor:

Hi everyone. Just a quick announcement regarding the clinic. I am happy to say that I and we at the clinic are now offering a free monthly support call to all current patients. This applies to any patient at the clinic. Even if you’re not working with me directly. This is an opportunity to ask me and our team questions, share feedback, and get support with any challenges you may have. I will be accompanied by Dr. Joe Mather, our medical director, and Morgan Mallador, our clinical health coach. We have emailed details to all of our patients. So check your inboxes and here is Erin with the date and time of our next call. Hope to speak with you there.

Sponsor:

The next call will be Friday, May 13th at 1:45 PM central. That’s Friday, May 13th at 1:45 PM central.

Listener [Carolina]:

Alright. So our next question is from Carolina. Hi Dr Ruscio. I am an ND. And I’m wondering what you think about the lectin-free diet. I have patients try this and they say it helps reverse their GI symptoms. Do you ever consider this for patients?

Dr Ruscio:

Great question. So we’ve had Gundry on the podcast and I was a little bit more warm to the low-lectin diet early on. And then I was preparing to sit on the gut panel. I think this was the first year…No, it wasn’t lockdown. It was the year before lockdown. So I think it was in 2019. May have been 2018. And I knew that Gundry was going to be on the panel and I had heard or seen some unsavory things about the low-lectin diet between the initial podcast and when that panel was approaching. So we, meaning myself and our research team, really did a deeper dive into the evidence behind the low-lectin diet.

Dr Ruscio:

And I was fairly shocked that there is very, very, very little scientific evidence looking at the merits of a low-lectin diet. Now that does not mean it’s not helpful. Right? Lack of evidence does not mean that there’s disproof. So I should mention that there’s a real paucity or real lack of research here. But the first thing my mind says there is then, “okay, well, let’s look at the diet on its merit alone.” And my feeling is that people are doing other healthy things when they go on a low-lectin diet and that is where the vast majority of the improvements come from. I don’t refute people will improve.

Dr Ruscio:

But where I have a refutation is, is that actually coming from the lectins or is it from the fact these people are cutting out grains and they’re oftentimes going to more of a paleo-like approach? More vegetables and some more meats and they’re getting off of a grain-centric diet. And they’re also avoiding nightshade, which can be helpful for some people, and they’re cutting out legumes, which are high in FODMAP. So grains, many are high in FODMAP—not all—and can be problematic. And a lot of them are processed garbage. Not all, but many. So they’re going to go more towards, in most cases, a paleo-type framework—cut out nightshades, which are problematic for a smaller subset of people, and also cut out some heavy hitter FODMAP foods like legumes, beans, and lentils and peanuts, which can be somewhat antigenic and allergenic. And I think this is where the real vast majority of the improvement comes from.

Dr Ruscio:

Now, when we combine that with the fact that Gundry seems to have built up a pretty impressive empire, if you will, and still has been unable to produce one quality study. There was one kind of in-office study from a few years ago that, again, I think was a real small data point. And part of that paucity or a real lacking of evidence [is] because it was so uncontrolled for lectins, that it was really a study of, loosely said, what happens when people go from a crap diet or no diet at all to a paleo-like diet. And then, a tell, in my opinion, when someone is not being fully transparent is when that’s heralded as the proof of the lectin concept. And okay, if that was your first attempt, totally fine. But we’re now, from when that study was published, I’m assuming at least 5 years, if not more like 7 or even 10, and this fairly large operation has not produced any other scientific evidence. At least when I checked about two to three years ago. Maybe something’s been published since then, but you’re still looking at a fairly large and well publicized and marketed diet with one really paltry study and a bunch of story as to why it’s so helpful.

Dr Ruscio:

So that makes me very, very suspicious. And the reason why it makes me suspicious—and I want to give Gundry all benefit of the doubt because he seems like a nice guy from the conversation that we had—but if you’re going to be building a business on this one claim and selling a whole supplement line to boot, along with it, you should have some research supporting that thing.

Dr Ruscio:

Now, in our case, there’s a bunch of research that already exists on the elemental diet and on probiotics. But even in light of that, we are publishing data. I published a paper on SIBO a couple years ago, we are collecting data on our Probiotic Triple Therapy as we speak, and we plan to start doing the same thing once that data collection closes on the Elemental Diet. So we’re not where we want to be, but we’re at least making strides in that direction. And we’re borrowing from a really solid evidence base to begin with. So even with a solid evidence base, we are trying to do more and better that specifically supports, in this case let’s say, Probiotic Triple Therapy. Or at one point soon, this kind of reset-hybrid application of the Elemental Diet that we advocate for.

Dr Ruscio:

Compare that to lectin and it’s like, man, you have this big operation, a whole bunch of products, and a lot of visibility in PR and publicity around your diet, and the one study is this very poorly done, small study from years and years and years ago. [It] makes me think that this was more of a business than it was a honest attempt at science and at helping people. And I also, again, don’t refute that going on that diet helps. But the question is, is it because of the lectins or did you find a better way to market a paleo diet to people and try to capitalize on that niche? And unfortunately I think it’s the latter.

Erin Ryan:

That’s fair. He definitely has a big PR behind him. I was at a Tony Robbins conference and on the last day he was there to speak about lectins and I was like, “oh, wow.” There was like 10,000 people there.

Dr Ruscio:

Yeah. And if you see that size of disparity between publicity and research, in my opinion—I’m going to be a little bit candid with the audience here, I’m not saying this is Gundry specifically, but I’m just saying, theoretically—this is the sort of person that, in my opinion, kind of parasitizes the field. They capitalize on demand or manufacture demand through good storytelling. And then they do nothing to validate that what they’re doing is actually helping. And I look at that as being parasitic—you’re taking, you’re not giving back. You’re not clarifying, you’re not getting better because you’re not doing any science to do so. And I feel this is one of the main things that I and we are trying to rectify with the work that we’re doing, is as we gain popularity or press or what have you, we’re trying to make sure that research that we’re doing grows in tandem with that. But that disparity, in my opinion, is very, very telling.

Erin Ryan:

Yeah. Alright. Our next question is another audio question.

Listener [Philly]:

Hi Dr. Ruscio. Philly Nassau here. As a young girl, I was given years of antibiotics to treat acne. This led to a lifetime of health issues. To compound the situation, in 2010 I had seven inches of my colon and ileocecal valve removed due to cecal volvulus (or a strangulated intestine). How does someone like me keep fungal and yeast overgrowth down while also increasing SIGA (secretory IGA), which is horribly, horribly low in my case? Thanks for any help.

Dr Ruscio:

Alright. This is a great question. And this has two elements to it, the psychological component and then the medical or healthcare component. Let me speak a little bit to each and [give] kind of this interweaving answer. I would be supportive of yourself. The fact that you had acne and antibiotics doesn’t guarantee that you’re going to have health issues. So I think to whatever degree you can, try to reframe your health history not to be this predetermined fate. I think that would be quite helpful.

Dr Ruscio:

And in terms of, what can you do for the situation that you’re currently in? This is where moving to modulate your internal environment can help put your genes in an environment that’s most conducive to health. And I think that’s an important way to look at this in terms of there’s not anything wrong with you, per se. There is likely this mismatch between your genetics, and part of that could have led to this torsion, and your environment, including your internal environment. And if we can get the environment correct, you should be able to be healthy and thrive. And you’re not forever tied to your history.

Dr Ruscio:

Now what can be done? Well, I would throw out the tracking of the secretory IGA. This does not seem to be a helpful marker. Side note, check all of this with your doctor. But we have not found—and this is something I want to thank Dr. Ilana Gurevich again, who I often thank for her review of lab markers, for which she came on the podcast to share—secretary IGA [to be] one of the markers that seemed to have validity or to be accurate. So chasing an inaccurate marker is an exercise in madness. However, we do want to make sure that you stay healthy. So I’m not sure what your symptoms are. And it’s interesting that you’re talking about fungus and yeast and SIGA, but there’s nothing about how you feel, which makes me also think the psychological piece here is an important piece on the board in that you’re talking about markers and diagnoses. Which secretary IGA and fungal testing is not very reliable.

Dr Ruscio:

So if you’re targeting unreliable markers it’s, again, it’s an extremely inefficient path. And there is a path. And I want to try to steer you on that path. That path would be taking the stock of your symptoms and how you’re feeling and using that—the person, how they’re feeling—as the primary barometer. Now, assuming there’s some consolation of GI and non GI symptoms—bloating, abdominal pain, maybe some brain fog, insomnia, loose stools, or maybe there’s constipation—there [are] things that can be done that supports you.

Dr Ruscio:

There are therapies that can be personalized to your system and use your symptomatic response as a primary barometer. Probiotics is one. Probiotics improve immune function in the intestines. They also discourage and are very powerful antifungal and antibacterial. We’ve discussed on the podcast in the past, how evidence has found that probiotics can be as powerful as antibiotics and as antifungal medications. So that is a great place to start.

Dr Ruscio:

Now, due to the torsion and the anatomy, you may be someone for whom overgrowths have a tendency to recur. And again, probiotics may be enough to remedy that. However, you may be someone who does well with antimicrobials or even a repeat course periodically of antimicrobials. Elemental dieting is also very helpful because if there is some type of anatomical issue in the intestines, let’s say where food can get stuck and overgrowth can occur, the elemental diet is a wonderful way to reset this. And additionally, if there has been a surgical intervention, there could be scar tissue. And this is again where abdominal massage can be quite helpful.

Dr Ruscio:

So to round this all out, someone like you, I think is a healthy person that just needs to find the right way to create an internal environment for which your system will thrive. And I don’t mean to take, too much issue with the language, but I want to try to make sure if some of this language has drifted to an unhealthy place, I really, lock arms with you and help pull you onto a better path. So I think someone like you is potentially healthier than she thinks she is. And with the right supports, you can be quite healthy going forward.

Dr Ruscio:

I understand that there’s been some things that have happened in the past that are unfortunate and discouraging, but I have a high degree of confidence [that] with the right support you can have minimal symptoms, just like any other normal person. And when I say normal, I say that somewhat loosely because we all have stuff, right. So I should kind of air quote the normal. Have good health, good function. Will you be bulletproof and invincible? No. But can you have a very healthy existence? I think so. And it just takes some diligent attentiveness to your system to learn what it needs, create that correct internal environment so that you can thrive. So I really hope that helps. Do make sure to check these things with your doctor, of course. But again, hopefully this helps you on your path and you can find your way through this to the health and function that awaits on the other side.

Erin Ryan:

Yeah. And if I can just say, Philly, I hope this is an exercise I have done before, but just talking to that, that young girl who you still remember probably went through some issues on antibiotics. I know I did when I was on Acutane. I don’t know if you took the same thing. I don’t even know if I’m allowed to say what medication it was, but, low and behold. Yes. I had some, some stomach issues to that. Funny enough, when I was going through all my gut stuff, I didn’t even remember that I was on Acutane at one point or else I would’ve carried that in my very heavy backpack of things that were causing me issues. But yeah maybe talk to that younger self and just be like, “I’m sorry you went through that but eventually you healed from that and now this is just a new thing that we’re getting through and you can get through it.” So yeah, just kind of talking to your younger self and just saying, “okay, we’re going to leave that there, and the body does amazing things so let’s just go forward from there.” So that has been a helpful exercise for me.

Dr Ruscio:

Great, great advice. We may have lost our Acutane sponsorship, but otherwise great advice.

Erin Ryan:

They were going to be a really solid sponsor. Alright. So our next question is from Scott.

Listener [Scott]:

I love Elemental Heal. I recently tried the vegan Intestinal Support Formula and I love that too. I read about IgY max and Immunolin, so I understand the basic differences between them, but can you explain the functional clinical differences between the vegan and non vegan ISF?

Dr Ruscio:

Right. So for our audience ISF (AKA Intestinal Support Formula) is a formula that we have. It’s an immunoglobulin. And immunoglobulins essentially, and simply put, they bind to toxins and irritants—including bacterial fragments like LPS (lipopolysaccharide) the wall of bacteria, or membrane I should say—and deactivate them. The way I describe this to patients in the clinic is picture that you chewed and swallow glass. Not good. But if you’re able to take glass shards, dip them in wax, let them cool and then swallow them, a glass shard that could cause a bunch of abrasions and lacerations of your intestines wouldn’t really be a problem because they were deactivated in the sense that they were wrapped or dipped in wax. That’s kind of what immunoglobulins, as Intestinal Support Formula, achieves.

Dr Ruscio:

Now there’s two different versions. There’s the vegetarian and there’s the regular. The regular is a bovine source and the vegetarian are usually egg-derived. In theory, they do the same thing, but they are a different source. So that may impact their efficacy. So we look to the research evidence to tell us is one better than the other. And there’s much more evidence studying and examining the animal source than there is the egg source. So it’s hard to do a comparison because we don’t have apples and apples. We have a fairly big apple when we have a small orange. Now my sense is they probably work equally well but, again, because we don’t have an evidence base to reference, it’s hard to say. I haven’t had anyone who has switched back and forth between the two to be able to say in a somewhat controlled setting, if you will, if one seemed to work better for an individual than the other. We have much more patients in the clinic on the traditional, which is animal-based than we do on the vegetarian, but both do seem to help people.

Dr Ruscio:

So I would lean in the direction of favoring the regular Intestinal Support Formula immunoglobulins, just because there’s more evidence there. If you have any reason for why you’re avoiding animal products, then you have the other version to experiment with and it’s probably going to be sufficient and similar. But again, I don’t have any anecdotal clinical observations to pull from that could successfully answer that question. Nor is there enough research. There is research showing some benefit for both, but it’s a small amount of research for the vegetarian version. And it’s a little bit harder to be confident in the conclusions based upon that. Whereas I’m fairly confident in the conclusions based upon the animal version. But because we’re a non-philosophically rigid office, if you will, we try to have versions of our care and our products that can be used by those who are both omnivorous and vegetarian. So that’s a few thoughts there and hopefully that helps.

Erin Ryan:

Okay, great. It sounds like the important distinction there—because he’s mentioned “vegan” three times in his question—so it’s vegetarian, not vegan because it’s from egg. So that’s probably important for anybody who wants to know about that type of formula.

Dr Ruscio:

Yep. Thank you. Great point.

Dr Ruscio:

Hi, everyone. If you are in need of help, we have a number of resources for 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 the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Erin Ryan:

Alright. I think we have time for one last question. This one’s from a practitioner.

Listener [Practictioner]:

He or she says, “I have seen a few patients with low fecal elastase, less than 100, and they have constipation instead of the expected diarrhea. How do you think about this? As far as I know, low fecal elastase would cause diarrhea. So I’m surprised by the predominant constipation. Thanks.”

Dr Ruscio:

Yeah, this is a great question. This is something that we’ve been giving a lot of thought and observation to in the clinic. And [we’re] not finding elastase to be as helpful as a marker as we originally thought. To the question, typical presentation (meaning those with low elastase) will have diarrhea, abdominal pain, greasy stools, sinking stools. Typical presentation does not mean will-always-present-as. And that’s important to clarify. You will see some hydrogen SIBO cases that are constipated. You will see some methane SIBO cases that have diarrhea. So it is important to draw the distinction that there are these outlier cases. It’s also possible that this could be lab error or there could be a false positive. And with, not that it mounts on this case necessarily, but with diarrhea that can cause a false positive of low elastase, just as one example. And perhaps most salient is that it could also be that we don’t really know what happens or what to expect when we run these full GI panels on those who don’t have the symptoms for which the GI panel was validated. And I think this is an increasingly important concept for, especially those in natural medicine to be aware of.

Dr Ruscio:

And this is why I and we at the clinic are moving away from full GI panels. Ironically, even as a GI-focused clinic, we’re moving away from the full GI panels because we’re just finding more and more there is a disagreement between what we find on the panel and what we find in the individual. And a couple of examples would be seeing pathogenic bacteria or parasites in individuals who don’t have any symptoms that correlate. And oftentimes when retesting you’ll see those things cleared or it could be a false positive. This happens with C. diff. It happens with, E. coli, it’s happened a couple times with E. histo (although it’s a little bit harder to kind of pin down), it’s happened in a number of cases with certain worms.

Dr Ruscio:

And I think that’s because we’re using these as screening tools and they’re not really validated as screening tools. And this really matters because if we’re using testing the wrong way, we are making it harder to get patients well. So when doing and when using elastics as a screening tool, that changes its validity. And that’s not how the tests, at least according to my knowledge and my partial assumption, has been validated. It’s been validated in a patient population that has symptoms that are known to correlate. And then when you see the person has symptoms that suggests X and you test and you find X positive, then you treat and you see response to the treatment. This is how we validate a marker, loosely stated.

Dr Ruscio:

So what may be happening here is we’re seeing what happens when we use a full GI panel as more of a general screening. Now, does that mean that you’re using this always as a general screening? No. I’m sure you’re seeing patients, as you said here, who have some GI symptoms like constipation, but that may not…you may be putting the cart before the horse, diagnostically speaking. And I think what happens here when we do that is we get all these false positives and negatives that don’t make sense. And this is something that we had discussed in the clinic about a year ago regarding calprotectin and lactoferrin. Our suspicion is: there’s two things going on here. There might be methodology error in some of the labs where they report false positives of calprotectin. Or there might be some background level of noise with calprotectin in an IBS cohort or a generally healthy cohort that’s not diagnostic and doesn’t really tell you how to better treat a person.

Dr Ruscio:

And this is something, again, I think is very important. And I think the importance of it has been understated. And with some of these labs, you’ll also see that a certain, and this is one of the real, I think, advantages now of having a multi-doctor clinic where we’re seeing a lot of labs come through, you will see a certain organism like E coli pop up as a false positive in a cluster and then fade away. And it’s not to say it’s correlated with, E coli outbreak. There’s no known reason for this or C diff. Which makes me suspect that there may be some errors in the labs or there may be some natural oscillation in the microbiota that you see that hasn’t been seen before, because we’re using these as more of a screening tool.

Dr Ruscio:

So, all that to say, you can see a presentation on the lab marker not match. And this is why it’s important to treat people, not numbers. And to make the lab tests—especially in GI, this is not an absolute rule, it’s most relevant in GI—but to make lab tests 1/4 of the data that you use to inform a clinical decision. And just one more thing with the elastase, just want to wrap up with this.

Dr Ruscio:

Elastase, I was really excited about the utility of this marker to diagnose pancreatic insufficiency. And the treatment for this is pancreatic enzymes. Now that we’ve been diligently tracking this in the clinic for over a year, you do see some cases for whom this is helpful, but it’s actually a fairly low yield. And so even more evidence that we should look at these lab markers as literally 1/4 of the data we use to make a decision and not a, “oh elastase, got to give enzymes,” or “parasite, got to give antimicrobials or antibiotics.”

Dr Ruscio:

The more astute we become in the clinic, the more we actually do it the opposite way, where we are looking to build a case with four pieces of data: their history, their symptoms, their response to treatment, and their labs. And this is a good question that kind of embodies why we have that framework that we use. So you wouldn’t be alone in seeing this. And hopefully that helps you understand some of the background and the rationale and the thinking behind this. And this is something that we’ll have more discussions on in the podcast going forward, but suffice it to say, we recently decided at the clinic to abridge down further our initial-phase GI testing and be a little bit more choosy and reserve these panels for patients that have gone through more initial-phase care, failed out, and not responded.

Dr Ruscio:

And by the way, that doesn’t mean a chronic case. It doesn’t mean you just start, because you have patients with preexisting symptoms that have seen a few doctors that you’re justified in doing this. That’s what we see. But we want to save this for the patients who have gone through our care—the correct application of/personalization of diet, of probiotics, of elemental dieting, of immunoglobulins as Intestinal Support Formula, of antimicrobials. And if we’re still struggling and thinking, “ah, maybe there’s a true parasite because this patient still has non-responsive diarrhea or maybe they have inflammatory bowel disease. Now we’re going to run the panel.” That’s the shift that we’re making. And I think we’re going to find a much better agreement between presentation and lab values. And we’re also are going to reduce further the lab bills and have less confusing information like this that we’re trying to parse through.

Erin Ryan:

Yeah. I love that. More of that. All clinic settings

Dr Ruscio:

Yeah. I think a lot of this comes from the fact that the natural integrative space wants to be taken seriously. So they order labs to justify their care. But as we discussed in that three-part video series about a better model of functional medicine, it’s actually not what most of the science tells us to do. Most of the science tells us how to apply therapies, personalize to the individual. Most science tells us about personalized medicine. Yay. This is what patients want. Patients don’t want a whole boatload of lab testing. And I think the natural community needs to continue to move in the direction away from copious lab testing and be much more choosy.

Erin Ryan:

Yeah. It was almost like, it seemed like almost an over-correction in that like, definitely people like myself who went to a gastroenterologist who they spent three whole minutes with and, told me I had a eating disorder or whatever, and then the next visit was some other thing or, oh, sorry, you have IBS. And I’m out of there and like five minutes, I think. Yeah. Like you said, the functional natural community. Because I did see a couple of doctors in that space or practitioners in that space and I was happy to have all the info that they showed me and all the testing, but then that also just kind of sent me into a tailspin. So it’s almost like an overcorrection.

Dr Ruscio:

Meeting somewhere in the middle of that would be really good for patients. And still spending that time with them that they don’t get with other doctors. I think that’s the thing that matters the most is just maybe not an hour-long sit down with them, but just hearing them out, and hearing their history. And just that is enough for, I think, so many of us where we don’t feel like we have enough time to be heard.

Dr Ruscio:

Yeah. No fully agree that, if we listen well and it doesn’t always mean talking, I found that a good form is actually more productive because when you put people on the spot—and there was a couple years where I was doing much more of the intake and exam via just Q & A in the room and we get all these emails, “I forgot to mention”, “I wanted to add”, “I wasn’t really clear on…” Right? So we said, “okay, let’s put as much of this as possible up front, give the person time to think through it, where they don’t have me, “so tell me about this,” breathing down their neck. And then I can also review that ahead of time and quiet by myself and look for the patterns much more effectively and then come to the visit much more prepared and be able to say something like, “okay, Mary, so I see that (like one of these cases) I see that you were in the moldy house and then you moved out, did you feel better when you moved out?” And I’m looking for a yes or no there. And, “I also see that you had a surgery and many of your symptoms regressed from there.”

Dr Ruscio:

So I already have all that and I’m coming to the visit with pinpoint questions that are going to be crucial in getting me to that last little bit of clarity. And this I find to be much more effective. It makes the exam visit maybe only 20 minutes of actual discussion between the clinician and the provider. That’s because the patient has done maybe 20/30/40 minutes of documenting all this ahead of time. And then I’ve spent 20 minutes reviewing all that before our visit, then we speak for 20 minutes. And then after the visit, I spend another 20 really doing my final analysis. And then putting on the finishing touches to their problems list and the plan that we make.

Erin Ryan:

Yeah. Which is loads better than filling out the brief family history before the visit, having a five minute visit, and then getting a diagnosis then and there that you’re like, “oh, what.” Yeah, I love that. Yeah. The intake form—I felt like I got to say all I needed to say without the pressure of being in there. And then we could just talk about the important points once we got on the phone. So yeah. I love that methodology too. But definitely an overcorrection to be like, “here’s your stack of labs, now go figure out what all that means.”

Dr Ruscio:

Yeah. And it’s hard. I remember early in practice, I felt like I didn’t get it right. I felt like, “man, I’m looking at all these labs and I’m not feeling like I’m seeing the utility here.” And there’s, obviously within our audience, a growing subset of people who feel that same way and who are just questioning things and improving the model. So, yeah, I think the tide has shifted. People are now better armed with the knowledge that not all labs are validated. Labs are something that patients will buy and doctors will buy and labs have been successfully marketed to patients and clinicians and now we have to have a little bit of a more scrupulous perspective on labs and be choosy. And this includes, like I’ve said so many times on the podcast before, patients also. If you go in demanding the drug, your doctor may start using the drug more. Or the contemporary equivalent of that: demanding the the lab. So yeah, that’s one of the main torches here that we’re trying to carry forward on the podcast.

Erin Ryan:

Yeah. And another flame to add to that torch is—I don’t know if you support me in saying this but—don’t spend your money and get your own gut testing at home. You’re just going to get a bunch of stuff you don’t know what to do with back.

Dr Ruscio:

Definitely. Definitely, don’t do that.

Erin Ryan:

Don’t do it. Just don’t. It’s so tempting, like all the Instagram ads are so tempting. Just don’t do it. It’s not worth the money.

Dr Ruscio:

I would say that, in my experience, [it] clearly does more harm than it does good for patients. Because of what you’re saying. Someone will be walking around two years later describing themselves as a candida patient.

Erin Ryan:

Yeah.

Dr Ruscio:

And did it help you? No. In a lot of cases, no. I mean, in some cases, when people clean up their diet, or maybe they use a probiotic that’s supposed to be this “special” candida probiotic that just got them to use a therapy that helped them, that’s a little bit of a win. But more often you’ll see people avoiding certain foods that they don’t need to, that feel good to them. Or using supplements that they don’t need. Or putting themselves in this diagnostic box that, in a lot of cases, is totally unvalidated. One of our podcast guests said recently, and pardon me for being a little bit vulgar with my language, but he said, “uBiome is literally dog shit.” Because they use dog poop to validate their normative ranges. I mean, that lab got shut down by the FBI. But that’s actually true. And there are other similar tests on the market that, I assume, are of similar quality.

Erin Ryan:

Oh yeah. By the dozen. So, don’t do it. Or the allergy testing. I constantly see food allergy testing on Instagram and I’m like, “oh, that doesn’t work.” So don’t do it. Alright, so the takeaway here today is find a good clinician. Just go do that instead.

Dr Ruscio:

Yeah. 1000%. Given if you’ve got some low-hanging fruit, start there. And that’s understandable. But yeah, I think for our audience and for people who’ve already done some homework and they’ve gotten the basics out of the way, diet, lifestyle, maybe a couple simple supplements. If you’re still struggling, learn the lesson that I didn’t learn early in my career, don’t do the heavy metal test, the adrenal test, all these other things. I’m so thankful I found Kalish, who posed the idea of a GI issue and that was a game-changer for me. So yeah. Invest in competent advice because it will get you over the finish line—usually with less cost and with less time.

Erin Ryan:

Yeah, exactly. Alright. Well, that’s all we have time for today. Thank you.

Dr Ruscio:

Awesome. Thanks, Erin. Thanks guys.

Erin Ryan:

Yeah. Thanks for submitting all your questions.

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