Listener Questions: Hair Regrowth, Reducing Covid Stress, Mycotoxins

Die-off, best elemental diet for food sensitivities, gluten and SIBO.

In today’s podcast, I answer listener questions about the connection between gut health and hair regrowth, how increased stress from the COVID crisis could affect gut symptoms, whether immunoglobulins can bind mold and mycotoxins, and other questions about die off reactions, the elemental diet, and soil based probiotics.

In This Episode

Question: Addressing Die Off … 00:03:59
Question: Choosing an Elemental Diet … 00:10:17
Question: Can ISF help people with mold/MCAS? … 00:13:34
Freedom of Choice … 00:19:17
Question: Addressing Hair Loss … 00:23:54
Question: COVID’s impact on GI Health … 00:31:14
Question: Gluten’s effect on SIBO … 00:39:15
Question: Probiotics and SIBO … 00:46:50
Understanding Levels of Evidence … 00:56:11

Listener Questions: Hair Regrowth, Reducing Covid Stress, Mycotoxins -

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DrMichaelRuscio:
Hi everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio again with Erin Ryan, and we’re going to tackle some more listener questions. Hey Erin.

ErinRyan:
Hey, it’s good to be back.

DrMR:
It is good to be back.

ER:
A lot has happened.

DrMR:
Yeah, crazy, crazy time to be alive between COVID and protesting and rioting. I actually had to cancel a podcast the other day because everything was seemingly normal and then all of a sudden helicopters are flying overhead. I hear sirens, I hear chanting, and I just didn’t want to be on a podcast during that. When you’re on a podcast, typically you have all of your focus diverted to the podcast and you’re not paying attention to whether a bad situation is slowly making its way toward you. You’re not thinking “do I need to be prepared to maybe get out of my location”. So yeah, it’s been a wild past few days or few weeks, I should say. Actually several weeks, if you factor in COVID. It’s nice to be connected here with you again, and hopefully we can help people who are trying to get their health as on track, as possible, continue to grapple with the questions that come up. It’s really been interesting answering these questions. One of the things that hope the audience cues in on is while on the superficial layer there are answers, oftentimes what I try to do is to help people think at a more bedrock fundamental level that may be where the questions or the challenges are coming from. This is something we discussed recently in our probiotic webinar.

I’m not sure when this podcast will air relative to the probiotic webinar that we recorded. It laid out a series of beautiful questions that all articulated how easy it is to be mislead if you’re looking at mechanism. This is was about the FUT2 gene and how it has implications for bacterial populations in the gut may skew and/or production of the mucus membrane, if I’m remembering the details correctly. Essentially there was all this hubbub about something that’s highly influential with no good clinical information to support the claim. This obfuscates what we know works for someone with particular symptoms. When someone tries to insert into that a new, interesting tidbit, oftentimes what they do is they divert off of the path of knowing what works for someone with these specific symptoms. And instead move to this highly speculative cliff side, where it’s very easy to tumble off and kind of get lost and lose your footing. Sorry for the long kind of prelude here, but this is one of the things, for me anyway, that I hope is most constructive about these Q and A’s is giving people that deeper philosophical construct with which to analyze this peppering of different claims that the healthcare consumer is going to invariably be confronted with.


Sponsored Resources

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Listener Questions: Hair Regrowth, Reducing Covid Stress, Mycotoxins -
Listener Questions: Hair Regrowth, Reducing Covid Stress, Mycotoxins -
Listener Questions: Hair Regrowth, Reducing Covid Stress, Mycotoxins -

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➕ Resources & Links
➕ 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, please make sure to subscribe in your podcast player. For weekly updates, 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 to your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hi everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio again with Erin Ryan, and we’re going to tackle some more listener questions. Hey Erin.

ErinRyan:

Hey, it’s good to be back.

DrMR:

It is good to be back.

ER:

A lot has happened.

DrMR:

Yeah, crazy, crazy time to be alive between COVID and protesting and rioting. I actually had to cancel a podcast the other day because everything was seemingly normal and then all of a sudden helicopters are flying overhead. I hear sirens, I hear chanting, and I just didn’t want to be on a podcast during that. When you’re on a podcast, typically you have all of your focus diverted to the podcast and you’re not paying attention to whether a bad situation is slowly making its way toward you. You’re not thinking “do I need to be prepared to maybe get out of my location”. So yeah, it’s been a wild past few days or few weeks, I should say. Actually several weeks, if you factor in COVID. It’s nice to be connected here with you again, and hopefully we can help people who are trying to get their health as on track, as possible, continue to grapple with the questions that come up. It’s really been interesting answering these questions. One of the things that hope the audience cues in on is while on the superficial layer there are answers, oftentimes what I try to do is to help people think at a more bedrock fundamental level that may be where the questions or the challenges are coming from. This is something we discussed recently in our probiotic webinar. I’m not sure when this podcast will air relative to the probiotic webinar that we recorded. It laid out a series of beautiful questions that all articulated how easy it is to be mislead if you’re looking at mechanism. This is was about the FUT2 gene and how it has implications for bacterial populations in the gut may skew and/or production of the mucus membrane, if I’m remembering the details correctly. Essentially there was all this hubbub about something that’s highly influential with no good clinical information to support the claim. This obfuscates what we know works for someone with particular symptoms. When someone tries to insert into that a new, interesting tidbit, oftentimes what they do is they divert off of the path of knowing what works for someone with these specific symptoms. And instead move to this highly speculative cliff side, where it’s very easy to tumble off and kind of get lost and lose your footing. Sorry for the long kind of prelude here, but this is one of the things, for me anyway, that I hope is most constructive about these Q and A’s is giving people that deeper philosophical construct with which to analyze this peppering of different claims that the healthcare consumer is going to invariably be confronted with.

ER:

We have a couple of examples of questions that come in similar to that with just inferences that they probably just read something off the internet, hoping and looking for information. So that’s a great point that you brought up because we’ll hear some questions just like that today.

DrMR:

Yup, they are always there.

ER:

Yeah, exactly. All right. You ready to get started?

DrMR:

Let’s do it.

Listener Question – Addresssing Die-Off

ER:

Okay. Here’s an audio question from Christine.

Christine:

Hello. My name is Christine. I started the ….. the special diets. I was even cutting out [foods and] trying to fix my diet earlier. The closer I got to a nice clean diet, the more itching I have. I don’t have any kind of rash. It’s just general itching everywhere. Enough that I can’t sleep at night. So I was just wondering if you could do a broadcast going more into the specific[s] on die-off and how you deal with that instead of just feeling crappy for a week or two or three or four. So, that’s my question. Thank you.

DrMR:

Okay. Good question. So let’s examine first a bit about die-off. On the one hand, I don’t want people to think I’m going to jump on every term people use and kind of try to be overly persnickety about how we’re describing things. However, it is a somewhat prevalent mistake that when people have negative symptoms correlating with a change, in this case a dietary change that those must mean a die-off. In my experience, true die-off reactions are quite rare, quite rare. What happens the majority of the time, I would argue 70, maybe even upwards of 80% of the time, what’s happening is whatever change has been made isn’t a good fit for the individuals system. We do see this even with moving in a healthier dietary direction. The best example of this is the person with compromised gut health, who goes on to a higher fiber, higher vegetable and higher prebiotic diet who then notices they feel worse. That can quite simply be the fact that plant material can be hard to digest. This is not an absolute rule, but there is clearly this observation in the literature that those with sensitive digestion will oftentimes have a harder time digesting fibrous plant stuff. So what may be happening here is the itching may be a byproduct of making a dietary change that isn’t the best for the individual. Now we can get down into all sorts of weeds where maybe eating too much carbohydrate, maybe it’s candida causing the reaction, or maybe you’re eating too much histamine, and maybe it’s a histamine reaction. That kind of detracts from just knowing what to do. In Healthy Gut, Healthy You, we lay out the main dietary changes one should go through. First would be moving toward a Paleo type diet template or said more simply, just an elimination diet where you’re cutting out common culprit foods like dairy and gluten processed food.

DrMR:

From there, one can go to low FODMAP and you can kind of iterate on if some of the Paleo changes helped. For example, let’s say cutting out dairy and you felt better. Maybe you don’t want to go to the standard low FODMAP diet, which does allow some dairy cause you’ve noticed cutting dairy out helps you. So you can kind of nuance from the basic fundamental elimination diet, which is also described as a Paleo diet. You can carry some of those things forward and integrate low FODMAP dieting plus or minus some of the Paleo facets like dairy free. I’m not sure quite where she is on this road. You can go a little bit further and the further we go, the more likely there is a non dietary issue present confounding things, which is really important to keep in mind. So you can go further down the reduction of potential allergens, using that term loosely, to an autoimmune paleo diet, where you cut out pretty much all grains, eggs, nightshade, vegetables, nuts, and seeds. Or you can go even further down the reduction of FODMAP, like foods to the low FODMAP combined with SCD diet. Given that you’re at least at step two of Paleo and low FODMAP, if you’re still having this itching, then yes, there may be an additional dietary culprit there. But also remember what I said a second ago, the further you go down this road the more likely it is that this is a byproduct of the dietary. If you’ve seen the pyramid model we’ve put together with the different diets laid out from the foundational base diets, all the way up through the apex nuanced diets, the further up the pyramid you go, the more likely there is a non dietary issue at play. So this is where going on to the next step of bringing in probiotics may be very helpful. This reduces the reaction to the food by helping to reduce leaky gut, as probiotics have been shown to do as well as helping to quell dysbiosis or SIBO, and helping to reduce inflammation. So it’s hard to give a super specific answer here because we only have some general details, which is totally fine. Hopefully this helps you better navigate what to do next. I think the biggest two things to take away from this answer are 1) don’t assume that a reaction, in this case itching, guarantees that it’s die-off and 2) keep progressing through the protocol. This should help you find the right combination of supports for your gut that resolves the underlying mechanism. Don’t get too obsessed about the mechanism because often this just convolutes the path right in front of you, which is laid out in the Healthy Gut, Healthy You algorithm. It is not a cure all, but it definitely is going to work you through the fundamentals and the best sequence of steps that I can think of after spending half of my weeks for three years ruminating on seven years of clinical experience and trying to map it all out for someone. So there’s my long answer to that question.

Listener Question – Choosing an Elemental Diet

ER:

Yeah, sounds like a good place to start. All right. So our next question is from Sonya. She asks which elemental diet works with someone who is low histamine, low salicylates, soy-free and nut-free.

DrMR:

Hmm. Good question. So I can’t say that there’s one elemental diet, that’s going to be best for someone who’s low histamine, low salicylate, soy-free and nut-free but there are a couple of things to consider when selecting, which one of the elemental formulas to use. Just for our audience, I’m assuming a lot of people have heard of the elemental diets, but essentially picture a protein shake or a meal replacement shake that’s made to be hypoallergenic and very gut friendly because it’s all pre digested. This is what an elemental diet is. We have three different formulas that we’ve created. There’s the traditional Elemental Heal. There is a low carb version and there is a whey protein free version. She didn’t say anything about being low carb or lower carb, so she may not need to worry about that. Also, not sure if she has a problem with whey protein or not. One thing I will say about whey protein is that for a good year or so, there was a little bit of me having to convince patients to try elemental diets. This is when we were using the traditional version, which uses a whey protein. They were concerned that they had a problem with whey because they had a problem maybe with dairy, maybe they used one product in the past that had whey and they had a reaction to it. Bear in mind that both low carb elemental heal and the traditional elemental heal use whey that is lactose and casein free. The formula is also devoid of fillers. If you remember back, this was maybe a couple of years ago, I discussed in the podcast how I was getting post workout bloating. This was because the whey protein I would use post-workout had, I’m assuming, some kind of filler or excipient in it that was irritating my system. I actually thought I had a problem with whey protein. But it was just a result of using a not clean version of a whey protein. So that’s also important to keep in mind. You want to try to be able to find the least doctored up version because the more we have to filter things out or go from whey protein down to just amino acids, the more expensive the formula is to make therefore the more expensive the formula is. So we don’t want to assume that just because some people have a problem with dairy or some people have had a reaction to a whey that that applies to anything with whey in it across the board. So those are a few thoughts to consider when selecting a formula. If you’re really not sure after all of that, I would say start with the traditional because that’s the least expensive and see how that goes. And then if there’s any reaction to that, you may want to consider the whey free next. If you’ve had no indication that you’re at all carb sensitive, then you probably don’t need to try the low carb version, but it’s one that you could try also.

Listener Question: Can ISF help people with mold/MCAS?

ER:

Awesome. So our next question is, is it possible that your ISF product can help bind mycotoxins in the gut for people with mold /MCAS?

DrMR:

Great question. So the ISF is Intestinal Support Formula. It’s our immunoglobulin formula. Just as a quick primer for the audience, immunoglobulins are essentially a supplemental version of the mucus membrane that you have in your gut already. We have immunoglobulin IgA, IgG and IgM in the supplement plus some albumin and that’s what the mucus membrane is made out of in your gut. Secretory, IgG, IgA, and IgM. Part of the function of that membrane is to bind to toxins and prevent them from triggering the immune system. Now to the question of mycotoxins. I was discussing this with a mycotoxin expert and I’m trying to recall who it was. It was the gal who specialized in antiphospholipid antibodies, I apologize that I’m blanking on her name right now. I believe she commented on the air about this, that she’s been experimenting with this. I believe she said thus far she suspects that this may be helpful for those with mycotoxins. I may be mis-recollecting a couple of the details here, but it does seem reasonable. We know that the immunoglobulins, the ISF, the intestinal support formula, has been documented to bind to lipopolysaccharide fragments or essentially the cell membrane of bacteria. That’s really what the immune system tends to predominantly trigger when it reacts. So while I don’t believe there’s anything published that has documented this, it seems a reasonable inference to draw. From both a mechanistic perspective and also at least some preliminary clinical reports maybe suggest benefit here. I don’t want to oversell that case because I think it’s a little bit early to be able to comment on the anecdotal responses trickling in from clinicians.

DrMR:

I will say, in those who are really sensitive, oftentimes we’re expecting mycotoxicity. Although this gets challenging to answer because how we actually quantify mycotoxicity is not straightforward. The labs there are far far from perfect. So some people who seem to have a history and presentation that is the bullseye for mycotoxicity may have a test that comes back negative and vice versa. So a lot of presumptions, and this is why I think just working through an empirical clinical process is usually the best way to go. Again, because many of the labs are not as accurate as we would like them to be in certainly in mycotoxicity assessment that is the case. So it’s a big maybe. I do think it would be worthwhile to experiment. It is really important to remember to follow the two points of assessment. One at about the second to third week, that is when a perceptible improvement should be noticed based on a study by I believe Weinstock. One group did publish a Likert score or a symptom score week by week in patients taking immunoglobulins, and this is where I derived my recommendations from. You really saw the initial kind of upward tick or improvement in symptoms really start to come onto the graph by the second to third week. People kept improving, and that rate of improvement started to plateau around week eight to nine. So those are the two benchmarks you’re looking to clear. Second to third week, you should be noticing something. Then by eighth or ninth week you’re approaching, when you may see your plateau and improvements from that therapeutic. Dose is also important. Some studies have found that the lower dose of 5 grams per day can work as well as a higher dose, 10 grams per day. However, I have seen a few patients that didn’t notice much at 5 and then went to 10 and did notice improvement. I struggle with this one because I’m always trying to find the minimal effective dose, especially knowing that the immunoglobulins are a little bit expensive, so I want the most cost effective approach. But I can’t throw out those few clear observations where the higher dose did work. Now, all that said, as long as you’re following that time interval assessment approach I laid out, you won’t make the mistake of staying on something for six months, never seeing any results and thinking “well it’s a pealing of the onion and eventually I’ll start seeing some response”. So all things considered, within this paradigm of minimal effective dose and being cost effective, whether you use 5 or 10, as long as you’re looking at those checkpoints at two to three weeks and then eight to nine weeks, even if this therapeutic doesn’t offer you much, you should be able to minimizethe financial and time investment. Certainly there is a potential that this could bind to those toxins and help reduce some of the immune activation and inflammation that’s ensuing from that.

Freedom of Choice

ER:

I don’t know if this is helpful, but when I take the intestinal support formula, I noticed a huge difference at first and then I kind of leveled off. Then I decided I was going to stop taking them. I did well for a while and then few months later I was like, I think I’m ready for another bottle of ISF and it helped yet again. So I kind of took a break and then went back to it and it still works pretty good.

DrMR:

That’s great to hear. It makes me feel good that you didn’t go on it, see a positive response and then assume that you needed it forever. That’s the one thing I really think that natural medicine, functional medicine, whatever moniker you want to give it, does poorly for people. It almost leads up this expectation of “if it helped you once you’re going to need it forever” and then people end up on a ton of stuff. So that’s really great to hear. That you tried it, you weaned off, you maintained the benefit for awhile, but then you did another course. If everyone in our audience could have that type of experience, I would feel like I was doing some good in the world. So this is encouraging.

ER:

It’s a little scary. I think originally you were the one that gave me the permission to do that. Because I was like that for a while. You know, one time magnesium helped me and I took magnesium every day for years. Now I’m like, okay, I think I know when I need magnesium and then I try it for a couple of months and then if I see benefit from it, I’ll just kind of wean off of it. I don’t think I ever got the permission to do that until I started working with you. That gives me a lot more flexibility and I don’t feel like I have to like get up and take 35 of my supplements every day. So it feels like freedom.

DrMR:

Good. I mean, that’s what we’re after. Freedom, which is a byproduct of people learning to listen to their own body. We’re doing this within a scientific framework, but you know, once we get into the realm of what the science guides us to do, then the nuances of how we apply these things are very individual. This is where, just like you said, you needed that permission. And hopefully people hearing this will be motivated and have enough confidence to take that liberty upon themselves and just listen to their body and trust that they will be able to tell when they regress. As long as they’re doing a halfway decent job of reducing variables, then it should be pretty easy to connect, change to symptomatic regression and then be able to just go back to whatever it was that was helping you.

ER:

Yeah. And to not panic, whenever you feel symptoms coming back, that’s huge. That took some training for me.

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Listener Question: Addressing Hair Loss

ER:

So our next question is from Dale.

Dale:

Okay. Doctor, I’m curious on your healing journey, you mentioned that you had thinning hair in addition to some other issues, but it looks like now you’ve got the hair thing covered. I’m just wondering if you experienced any regrowth of hair. Once you got your various intestinal infections corrected. I think your audience would like to know if there’s any possibilities in that area and what course of action might might help with that. Thank you.

DrMR:

All right. Well, thank you for the compliment in there also, I appreciate that. This is hard for me to say, because two variables changed at the same time. On the one hand I improved my gut health and on the other hand just started using a cocktail of various haircare supports. But there is a little bit of a lag in the timeline. So I think, and again, this is, it’s hard to fully map this out, but I think that my scalp health definitely improved as I improved the health of my gut. I used to notice I would get itching and dandruff and my hair would feel really dry. That I can fairly confidently say improved as I improved my gut health. Probably a slight improvement in hair falling or hair thickness. There’s likely another avenue here to consider. That is your genetic predisposition to age and/or DHT associated hair loss. So the one track is your gut health and I do think that had an impact again, mainly on my scalp health, dandruff, and having hair that looked a little bit healthier. Maybe a slight impact on decreasing thinning and falling, but to really have that substantial impact in the thinning and falling that’s where using a laser device has been very helpful as we discussed with Dr. Alan Bauman. Using a blend of topical DHT inhibitors plus minoxidil, I use a product called Lipogaine. In addition to that, I do derma-rolling on the scalp. I try to do it once a week. Sometimes I’m lazy and I miss a few weeks in a row. I use saw palmetto and a very low dose of Propecia. Occasionally I also do PRP injections because the other doctor in our office does those. I don’t know if I would have sought those out on my own, because the evidence there, well I think it’s just a little bit too early to really be able to conclude. However, with the other therapies, with the minoxidil, with the DHT blockers and with the laser therapy, all those have clinical trial outcome data showing that they help and they’re far less expensive than PRP. When I started doing those, I noticed my hair looked even better.

DrMR:

It’s funny, this question comes in at this time because I came across somewhere, a photo from the SIBO symposium that I spoke at in 2017, maybe 2018. From then to now, I think my hair clearly looks better. When I looked at that photo I was like, wow, even though this was two or three years ago, my hair looks better now, so some of what I’m doing must be working. So it was a confluence of all of those things. But I do think that if someone is trying to keep their hair as healthy as they can, my view is there is an aspect of this that is divorced from how healthy you are. Perhaps it has to do with the density of DHT receptors distributed in ones scalp. This may be why some men, even if they’re unhealthy, can have good hair. I mean, I’m sure we can find, if we just paid attention, a gentleman who is overweight and smoking and ostensibly very unhealthy who has phenomenal hair. So there is a genetic or familial component to this. I feel it’s important not to ignore that and act as robustly as you can with multiple different hair supports as early as you can, because that seems to be the best way to get the results that are kind of noticeable. I think one of the things that twarts some people as they try one thing, or they try another thing, they try it for a month or two, they don’t see a huge change and they give up and they do another thing. It’s only after a few years that they realize “I’ve got to do these few things together and do them for months until I’ll notice a substantial change”. A different few thoughts there, but hopefully that helps you with navigating this and putting together a protocol for yourself. The protocol should mainly involve on the one hand, all the health fundamentals, including gut health that we harp on, plus see the couple of interviews we do with Dr. Alan Bauman and where we lay out using some kind of oral and separately, some kind of topical DHT blocker along with minoxidil and a laser device. That’s a pretty good protocol to really hit your hair from both angles, both from the genetic side and then also making sure you’re as healthy as possible side.

ER:

Yeah. For females in the audience, I believe we had a guest on who came to talk about female hair loss.

DrMR:

Yep. That was also Dr. Alan Bauman and a lot of this stuff is the same. My apologies, I forgot to mention in my wrap up the Derma rolling on the scalp. A lot of the things are the same for females with the exception of the DHT blockers. You have to be a little more careful with that if you’re going to want to have a child. DHT blocking when pregnant can cause, I don’t believe we can say birth defects, but it can retard the sexual development of the child due to blocking androgens that are necessary for fetal development. So that’s the one caveat. But yes, we did a whole followup podcast with Dr. Bauman on that. There’s a lot that can be done for females also.

ER:

Yeah. Just as a female myself, I actually had some hair loss when I think my gut was probably at its worst. That was the first time in my life I’d ever experienced that. I have a head full of very thick hair, so I didn’t really miss it, but it was really odd to be pulling out like handfuls of hair in the shower. I remember thinking “this doesn’t seem right”. But when my gut started to heal, I didn’t have that anymore. So for me it was just the one element.

DrMR:

That would make sense to me that you’d see that more so in females because they don’t tend to have male pattern baldness, obviously. I mean, some females do if they have high androgens, but it’s much more rare. So I’m glad you made that point and I think in women, the hair loss is tied even more exclusively to their general health and or their gut health.

ER:

It seemed like my nail beds were stronger and healthier and just sort of some of those other connecting things were all the different ways that improving my gut dysbiosis showed itself.

Listener Question: COVID’s impact on GI Health

ER:

Okay. So our next question is from Diana and it is a COVID related question. Good timing for this.

Diana:

Hi, Dr. Ruscio. My name is Diana White. I have an aura ring and it has shown my heart rate has increased dramatically since the Corona virus has permeated our lives. It was in the low fifties for a year and now it is in well into the sixties. This is during sleep. Obviously I’m in fight or flight and I can’t get out and it correlates exactly to my gastric distress. There hasn’t been a formed stool since my heart rate went up. So my question is for a gut that was fine before, but this fight or flight has put it into overdrive, what is the best way to, to combat that? I’ve been using some of your products and it doesn’t seem to make any difference. I think this fight or flight is very powerful. So I’d appreciate knowing what your thoughts are around the stress factor. Thank you.

DrMR:

All right. Well, that’s a great question and as you said Erin, very, very timely. It’s great that you’re wearing an aura ring and it’s cool to see how this is all correlating. Meaning her heart rate is elevated and she probably otherwise, without the aura ring, wouldn’t know that because who’s taking their heart rate while they’re sleeping? She’s obviously under more psychological stress and it’s manifesting digestively. So it makes a few points. One is that there is definitely this stress to gut connection. We’ve discussed this on the podcast, I discuss in the book, some interesting research looking at college students under exam stress who then would see a dwindling of some lactobacillus populations in the gut. So certainly we know that stress has a negative impact on a multitude of areas of the body. Most likely in my opinion, it’s going to manifest wherever that person’s weakest link in the chain of their physiology is. So in this case, I’m assuming you probably had some GI stuff before. Then the stress from everything regarding COVID hit. So I’m glad that you were using some things. I’m assuming maybe probiotics are one of the fundamental pieces there. If not, I would definitely recommend getting on a probiotic. There’s pretty compelling data showing that probiotics can protect against upper respiratory tract infections. Now that doesn’t automatically mean it’s going to help with COVID and COVID related conditions, because usually that tends to be lower respiratory. But it does support that there is this connection between your gut and your lungs and your susceptibility to infection. So, well, I don’t want to overstate that case. I think being on a probiotic, if you’re trying to enhance your resiliency, makes sense. This is not too much of a stretch when we consider that by multiple measures, healthier people seem to do better with COVID.

DrMR:

The main measure is anthropomorphic, meaning if they’re overweight there is less resiliance. Also pre-existing conditions such as diabetes or hypertension are also an issue. So these comorbidities of being unhealthy increase one’s risk of negative complications associated with COVID-19. So it supports the fundamental posit that the healthier you are, the better your outcome is going to be, which again, doesn’t seem like too much of a stretch. Now to your question, what do you do? Well, given that you’ve done a few things for your, your gut health, probiotics, probably the most namely. If that’s not enough to attenuate some of the GI distress that you’re experiencing, then you really may want to consider coming at this more from the stress side of the equation. Now I understand that sometimes it’s easier said than done, but there are some things that can be helpful in this realm. One would be meditation. There are many apps out there there’s Headspace, there’s Calm, there’s Waking Up and you can start doing meditation for 10 or 20 minutes a day. It doesn’t have to be a magical number. It could be nine minutes. It could be 13 minutes, but that is something that may really help by giving you those windows to shift into being parasympathetic. Now you can go a step further and do something like limbic retraining. The Gupta program and DNRS are two other programs that can be really helpful. These are going to be far more robust than regular meditation. Oftentimes they ask you to do about an hour of work per day. Although you can do these for a lesser window. I believe this was Jill Crista, or actually, Dr. Amy Kapadia. She was the mycotoxin expert who I believe she was one who commented that if you have someone do limbic retraining and they can’t do a full hour, it still works. It still helps them. It’s kinda like saying, take four capsules of lacto bifido blend and probiotic per day. If someone can’t and they only take two, chances are they’ll still see some benefit from that. So you have regular meditation using some kind of app. You can go even farther to something like limbic retraining. Also don’t forget about, and depending on how hyperbolically you interpret the social distancing recommendations would influence how comfortable you are or are not with doing this, but going for a walk with a friend in nature. That has been very powerfully documented to help with multiple measures, whether they be fatigue, anxiety, or depression.

DrMR:

So you can combine some of these. So you could get something like the Calm app and start doing at least 10 minutes of meditation per day, and also call every friend, you know in the area. Maybe you have a 20% conversion rate to actually setting up a standing, every Wednesday night walk in the woods. You get a few friends and you get a few of these things scheduled and hopefully you can schedule into your weekly calendar at least two or three days per week, where you’re going for a walk in nature with a friend and you’re getting both social time, you’re getting movement, and you’re also getting that very therapeutic was known as forest bathing experience. Which can be pretty powerful and attenuating things like anxiety, depression, and improving fatigue. All this will help you handle this from the other end, which is combating the stress with more of directly anti-stress remedies.

ER:

Yeah, that’s awesome. I did exactly that. Just about a month ago now, because the first month was just so rough and I was like, nope, I can’t stay like this. This is not for me. So I started planting things in the front yard and that really helped. Then a friend of mine who was struggling with postpartum depression on top of all this COVID stuff, I made her go with me to hunt out places to walk near the water or woods around here and it helped both of us tremendously. So I highly support that.

Listener Question: Gluten’s effect on SIBO

New Speaker:

Our next question is from M. She says, “Is it true that having gluten once in a blue moon, when you have SIBO can set your treatment back up to a month?” So this is kind of what I was talking about beginning of the episode where it’s just seems like that might’ve been something she read somewhere.

DrMR:

And you said this was gluten for SIBO?

ER:

Yeah. Is it true that having gluten once in a blue moon, when you have SIBO can set your treatment back up to a month?

DrMR:

Well, yeah, I’m glad this question is being posed here. It’s one we’ve certainly spoken to on the podcast many a time, but you know this this canard is fairly pervasive on the internet. So I think it would be worthwhile for us to periodically address this question. The general answer is no. Now there is a little bit of a nuance or caveat here. If you are someone with highly reactive gluten intolerance then perhaps. It’s not so much that it’s setting back your SIBO treatment. It’s just that you are exquisitely sensitive to gluten like a Robb Wolf, right? Rob can’t even have chicken grilled on a grill that the stuff before that had some kind of flour on it. That’s how sensitive Robb is. He seems to notice negative effects for days afterwards and I’m assuming it may be a week or maybe even a touch longer until he feels fully normal. So if you have historically noticed this severity of gluten reactivity, then your gut health may be impaired for days or even a week or slightly longer from ingesting gluten. Now that’s going to be the minority of people. What if you’re someone who notices a very mild version or maybe you’re not even really sure it just has kind of a nocebo effect where you’re expecting gluten to be a problem. Every once in a while you have dinner out and you have a little bit of gluten in addition to having wine, maybe being up a little bit late, eating some other foods. And so you’re attribute all that negative effect to gluten. So that would be kind of an erroneous, nocebo, but it definitely exists. So if that’s where you are, then there’s a good likelihood that gluten is not really that problematic. It certainly does not warrant you being fearful or concerned about having a little bit of gluten here and there. Said more simply practice avoidance of gluten to the degree to which you notice an aversion to it. If you’re not sure, try to be a little bit more attentive in making that assessment also while appreciating there’s a really strong nocebo. The nocebo is the opposite of the placebo. Placebo is positive. Nocebo is negative. So if you have an expectation for a negative reaction, you can placebo yourself into that occurring more technically it’s known as nocebo, negative expectation coming to fruition because of your expectation. So that’s really important to factor in. This ties back to the fear piece, because if you are fearful of gluten and have a small amount. That fear in and of itself, similar to the last question, talking about stress and stress causing their gut to regress, just the fear itself may cause your gut to regress.

DrMR:

Then if the messaging that you’re consuming is hyperbolic, like, “anyone who has one thimble full of gluten will set back their SIBO treatment by a month”. That’s a very hyperbolic claim. So if that’s your expectation and you’re fearful and you’re having a normal regression, which almost everyone on the gut health journey has. In fact, any human has. Even me trying to improve my mile run time. There are some days when I just feel like utterly useless and I beat myself up a little bit. It’s like, geez, Mike, you know, what are you doing? So there’s always going to be those ups and downs. That is normal. A temporary downswing may occur, irrespective of anything else that you did, right? And you could do everything perfect. And you could still have a downswing because some of these triggers inside your body may not have a ton of rhyme or reason to them. As your body is healing, they should become less and less and less. So for all these reasons, it’s really important to frame this the right way. Hopefully it’s apparent from my diatribe here. The fear combined with the negative expectation or the nocebo can lead you into a very self-destructive territory where you can make your healing much harder than it has to be. So if we can throw out all the programming and get you just to listen to your own body and tune into it, not have a negative expectation, not have a positive expectation, just be objective. Then we can help you determine what your relationship with gluten should be. While also understanding that ups and downs are part of the game. That if you do have a food reaction, that’s also part of the game. Don’t freak out. Just use the observations constructively to learn what you can have and what you shouldn’t have and what your cheats may be. Let’s say dairy feels fine, then make dairy more of your cheat. If you do notice that really strong aversion to gluten, then you don’t want to make that part of your cheat. So yeah, there’s a lot there. Hopefully I laid it out in such a way where it helps you to frame this more neutrally and understand that you have quite a bit more power than you may think. Again, this comes back to one of these fundamental bedrock principles of listening to your own body.

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ER:

Great. So we’re close to the end of our time. Do you want to do one more or call it?

Listener Question: Spore Based Probiotics and SIBO

DrMR:

Let’s do one more.

ER:

Okay. This question is from Debbie. She says “Are you familiar with spore based probiotics that also produce endospores? How would you treat the SIBO condition caused by them? I have methane SIBO, according to the breath test that occurred right after taking these probiotics, because I didn’t know that they can be pathogenic in vulnerable people. They have not, and apparently cannot be killed by Rifaximin or neomycin because they are spores. Thoughts?”.

DrMR:

Great, great question. So this is something that we’ve looked into and admittedly, we haven’t perhaps checked every published reference on the internet, but we have looked into this and I have not been able to find any reputable information that substantiates that claim. Yes, certain spore based probiotics can be pathogenic and this is why it’s important to have a probiotic that’s made by a quality manufacturer. This way you know the species that you’re getting. But outside of that, I have not been able to find nor has anyone to be able to point me to a reference that shows a group of people who used a probiotic and then they had a sequella after that. They had negative effects after that. What I can point to is a cluster of about 14 studies in the U S showing that people who took an established soil based probiotic saw measurable improvements in their digestive health. Another about another 20 studies in Asia using a similar but different formula also showing benefit. The adverse events in all of these studies was equivalent to if, if not very, very close to that of placebo. So this is another one of those situations where certain soundbites just seem to gain traction on the internet. Um, kind of like the Satish Rao paper that probiotics may cause D-Lactic Acidosis. I really like Satish Rao. I enjoy our conversations. I respect his work predominantly, but this was a real misread and he was very strongly chastised by other researchers and follow ups to that paper that it was an irresponsible claim to make. Due to his studies design, he could conclude that probiotics led to DL, lactic acidosis led to brain fog. This seems to be a similar finding. I’m not sure if maybe, if you want to be conspiratorial about it, maybe some of the big probiotic companies that don’t make soil based probiotics were looking to kind of create a negative campaign against soil based probiotics. I don’t buy that, but if you wanted to paint a conspiracy you could perhaps paint that. But no. This is one of the frustrating things with the internet. Somehow these mistruths gain a lot of traction and visibility. So to say it simply when you look at the research using soil based probiotics, meaning a reputable formula, which most are going to be. Sure, there’s going to be some weird, cheap knockoffs, but as long as you’re buying through a healthcare provider or someone you know and trust and/or if you know enough to look at the quality assurance measures the company goes through, either way, find a way to get to a quality recommendation.

DrMR:

Then you can assume that your experience will be the same as just under 40 clinical trials, all finding either benefit or a neutral effect with the adverse events being about that as there is for placebo. So no. I don’t know where this come from. We have looked and it is something that’s mentioned in some of the research papers, but it’s more kind of part of the discussion section. It says something like “Here’s our clinical trial. We took 45 IBS patients. We gave half this soil based probiotic. The other half we gave a placebo. We saw a measurable improvement in the IBSs measures in the treatment group that was not seen in the placebo group. The adverse events were 0% in the placebo group and they were, you know, 0.8% in the control group, meaning that they were about equivalent or about the same”. Because that 0.8% differential is within the realm of normal variance. Then they get to the discussion, which reads something like “soil based probiotics are found in….” and there is all this narrative and extra information. And then “some species or strains of soil based probiotics can form spores that can be toxic and pathogenic, which is why quality assurance and genetic identification is important for these probiotics”. That’s how we’ve seen this mentioned in the research studies. So how did that Oh, by the way in passing remark gets conflated with this being a truth that’s predominant and important when the majority of the conclusions of these studies show benefit is beyond me. And again, I’m happy to be proven wrong if there’s a reference that supports that, but we’ve pretty much gone through all of these studies. If we’ve gone through all of these studies and looked at the effects and the impact, then again, I can’t say we’ve gone through every single reference on the internet, but we’ve done a pretty darn good review and not seen this.

DrMR:

So now in your case, what could have happened could have been either a reaction to a probiotic or it could have been a coincidence or it could have been both. It could have been, you had a reaction, your gut was already kind of on its way to a regression or these symptoms anyway, and this just could have been a bystander negative reaction you had to the probiotic. So I know there’s kind of a lot there, but it’s frustrating when healthcare consumers read information on the internet and they have a hard time knowing how much or how little has gone into the crafting of this recommendation. This belief or dictum, if you will, doesn’t seem to have any solid evidence. It’s just something that’s mentioned in a handful of the research papers as something to be careful of. It’s almost as if, to paint a simple analogy, if there were certain species of bifidobacterium that were pathogenic, it’s like saying, well, don’t use one of the most popular and clinically effective bifidobacterium probiotics on the market, because there are some types bifidobacterium that can be pathogenic. That’s kind of the equation. Actually a good example of this is E.coli. E. coli Nissle 1917 has many clinical trials showing it to be beneficial. I think it was banned in the US because a separate E. Coli, the pathogenic E. coli that had the spinach scare several, several years back, I think spooked people to look at all E. coli the same way. So yeah, I am in a loss for where this comes from. As long as you’re using a quality formula, then I would not be scared of soil based or spore forming probiotics. Now, all that said, it’s possible that you could have a negative reaction. It’s possible you could have a negative reaction to Saccharomyces boulardii. It’s possible you could have a negative reaction to a lactobacillus and bifidobacterium blend probiotic. But having a negative reaction and causing some sort of serious pathogenic issue in your gut are two very different things. If this, coming back to the issue of framing, is not framed correctly, someone just like the gluten question could very easily fall into thinking that the reaction that they had caused irrevocable harm, and that could lead to a lot of ongoing fear and worry, that would be way more antithetical to someone’s healing then the actual, just negative reaction that they had. So, hopefully that helps and will also help to dissuade some of this runaway thinking around this question about soil based probiotics and them potentially being pathogenic.

Understanding Levels of Evidence

ER:

Come on, internet, do better.

DrMR:

I know that’s why that’s why we’re writing. I’m sure our audience has noticed but if you haven’t, we are writing articles now. Typically the only text on our website used to be transcripts of either videos or podcasts, but now we’re writing articles, in part to try to countervail some of the runaway nonsense on the internet. We need better data out there and I’ll give you one example. In a coming post where we outline levels of evidence and how levels of evidence are important. When you do not understand levels of evidence, one can very easily be led astray. So if you type into Google something along the lines of probiotics and SIBO, the first two entries you will get is “Don’t take probiotics because they can cause SIBO”, which is so unbelievably ridiculous, because as we’ve discussed a meta analysis of 18 clinical trials has found that probiotics can remediate SIBO. Even more important to understand, but more disenchanting to notice is that it’s often said the species of bacteria that often overgrow in SIBO are lactobacillus and bifidobacterium species, so make sure you don’t use a lactobacillus and bifidobacterium probiotic. All the while most of the studies that have shown probiotics can remove SIBO are using lactobacillus and bifidobacterium based probiotics. So this is a hair pullingly frustrating example of when people don’t understand how to read levels of evidence, they should not be educating people on information regarding their healthcare, because this is what you get. You get blogger whoever, or you know, this could even happen with Doctors. In fact, a fairly well known doctor recently had an Instagram post that I saw where she was making the same proclamation. That lactobacillus and bifidobacterium species over grow in SIBO. So don’t use this type of probiotic. Totally missing the fact that the majority of the studies in this 18 clinical trial meta analysis were using probiotics that were a blend of lactobacillus and bifidobacterium.

DrMR:

This can only happen when you do not understand and/or hold yourself disciplined to looking at the highest level of evidence before making a decision. So what happens here, presumably, is they read a research study where a gastroenterologist does a jejunal biopsy of fluid and they find in SIBO patients that the type of bacteria that are overgrowing are strains of lactobacillus and bifidobacterium. Then the doctor or the science writer or the blogger or whoever looks at that, and then jumps right to the inference of, well, if those are overgrown, then we shouldn’t use that probiotic. It is so unbelievably irresponsible. Especially when given that there is actual data out there showing how incorrect of a conclusion that is. That data is either ignored or overlooked because you’re trying to sell a different type of probiotic or whatever. But, yes. These sorts of things are the embers from which the fires of confusion emenate on the internet. I’m so sorry for the passionate monologue here, but these are the mistruths that are motivating me to make sure that we write articles to arm people with more truthful knowledge, because unfortunately, oftentimes these things are way easier than they look, if you just know how to follow the best evidence. It’s almost like if you went into a calculus final, or a physics final and remember when you used to be able to bring in a cue card of formulas? Imagine if you wrote the wrong equations on your card. So if you have the wrong equations and you’re trying to solve the problem, it’s going to be very, it’s going to be pretty much impossible. That’s what’s happening now. People are bringing the wrong equations into the problem and they wonder why they can’t solve it. Well, in this case, the wrong equation is using poor quality evidence. The right equation is a clinical trial data, but unfortunately this is not being brought to the exam of our own personal health endeavors. This is why I think so many people feel like they’re failing. This is why I’m so passionate about trying to continue to arm people with better, more voracious information.

ER:

I just wish that there was a way for Google to catch up to, you know, research articles all over the internet. And when you can look up any pub med research article, but that’s not what comes up when people type in questions. So to me, I’m like, okay, when is that gonna catch up to the algorithm of Google and.

DrMR:

In Google’s defense, it does seem they are trying to weight some of the posts that have more references. So, that’s a step in the right direction. But, there are definitely some lackluster articles out there that still seem to be sitting pretty high up. Hopefully these things are changing.

ER:

Yeah, for sure. Okay. Well that’s all we have for today.

DrMR:

Alright. Well, thank you Erin. Thanks guys. Keep the questions coming.

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