Listener Questions About Hunger, Satiety, Pea Protein, DHEA - Dr. Michael Ruscio, DNM, DC

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Listener Questions About Hunger, Satiety, Pea Protein, DHEA

Answers on Probiotics and Immunotherapy, Elemental Diet and Gastritis, Nausea, and HCL Risks

Today we will cover listener questions including:

  • What is the role of hunger and satiety in digestive problems?
  • Do elemental diets help gastritis or ulcers?
  • What are your thoughts about taking probiotics while doing immunotherapy cancer treatment?
  • Is pea protein ok on a low sulfur diet?
  • Does frequent nausea mean I have gut issues?
  • What is a good starting dose for DHEA?
  • Does taking HCL stop normal acid production?

In This Episode

Episode Intro … 00:00:45
Question 1: Hunger & Satiety … 00:02:08
Question 2: Gastritis & Elemental Diets … 00:07:54
Question 3: Probiotics & Immunotherapy … 00:12:43
Question 4: Pea Protein & Low Sulfur Diets … 00:22:26
Question 5: Nausea & Gut Issues … 00:31:49
Question 6: Postmenopausal Women & DHEA … 00:34:57
Question 7: Supplemental HCL … 00:39:11
Episode Wrap-Up … 00:46:04

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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: What is the role of hunger and satiety in digestive problems? Do elemental diets help gastritis or ulcers? What are your thoughts about taking probiotics while doing immunotherapy cancer treatment? Is pea protein okay on a low sulfur diet? Does frequent nausea mean I have gut issues? What is a good starting dose for DHEA? Does taking HCL stop normal acid production? Thank you to everyone who submitted your questions. Now, if you’d like to submit a question, visit drruscio.com/podcast-episodes, and click “Send us a Voicemail” at the top of the page. Please speak loud and clear and keep it as concise as you can. Enjoy the show!

➕ Full Podcast Transcript

Episode 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. 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.

ErinRyan:

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: What is the role of hunger and satiety in digestive problems? Do elemental diets help gastritis or ulcers? What are your thoughts about taking probiotics while doing immunotherapy cancer treatment? Is pea protein okay on a low sulfur diet? Does frequent nausea mean I have gut issues? What is a good starting dose for DHEA? Does taking HCL stop normal acid production? Thank you to everyone who submitted your questions. Now, if you’d like to submit a question, visit drruscio.com/podcast-episodes, and click “Send us a Voicemail” at the top of the page. Please speak loud and clear and keep it as concise as you can. Enjoy the show!

DrMichaelRuscio:

Hey, everyone. Welcome back to another episode of Dr. Ruscio Radio. This is Dr. Ruscio here again with Erin Ryan to tackle more of your listener questions. Hey Erin – welcome back.

ER:

Hello.

DrMR:

Looking forward to jumping in here. Let’s see what kind of curve balls you have for me today.

ER:

So, our first question is from Andres and this is an audio question they sent in. So, let’s hear that.

Question 1: Hunger & Satiety

Andres:

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

DrMR:

Good question. Well, not to be overly persnickety about language, it wouldn’t be diagnostic. It might be suggestive. It could be suggestive of some good things or maybe some bad things. So, running through these in no particular order of importance – hunger in and of itself doesn’t map onto gut health, but people who have inflamed and irritated digestive tracts may notice that they’re less hungry. This is kind of obvious, right? If you’re feeling bloated or if you’re having nausea, you may not want to eat. Some people, when they feel constipated remarked they don’t feel hungry because of being backed up. Certainly there is some connection between gut symptoms and suppressed appetite, and we could probably draw a somewhat safe inferential line all the way to silent gut inflammation – meaning there is some problem in the gut, some inflammation in the gut – but it’s not manifesting as digestive symptoms, but it is causing them to have less hunger… maybe. I wouldn’t make that the only observation that led you to that conclusion, but it could be one of a number of observations that could reinforce the conclusion that there could be something going on in the gut. It’s also possible if someone is in a metabolic excess, that they’re less hungry because of that excess. And part of that could be due to if someone is overweight and their satiation signaling is still working well, they may be less hungry. And what could happen in some cases is as your metabolism is improving and your satiation feedback loops are improving, you may be less hungry on your way to achieving a better body weight. And you may see this in someone who has insulin and leptin resistance, and they’re coming off of eating a lot of hyper-palatable foods and overeating, and they go through a term where they’re notably less hungry. You’ll hear this reported when people switch to a whole foods based diet – a paleo diet is one example – or even perhaps more commonly, although not necessarily, but when switching to a lower carb diet. It does seem that for some people, carbs can be like quicksand and they have some, and then they have more and more and more and more.

DrMR:

So part of this could be a byproduct of metabolism improving… vitality improving… and being able to stay and/or flip into the fasted state of physiology more easily, or for a prolonged amount of time. It could also be if someone is undergoing less activity. A good example – with Eric Trexler when he was on the podcast, PhD researcher in metabolism and energy regulation – he remarked that it’s pretty clear cut that an overwhelming amount of what looks like age associated weight gain is actually due to a decrease in movement and activity as people age. And it’s not necessarily age. It’s just how we go from, let’s say, college, or even high school, walking between classes, lots of walking, lots of movement. And then we go to the workforce and we’re moving less. And perhaps right after college, we’re doing more activity because we’re working out and maybe we’re in a pick up league for basketball or softball or what have you.

DrMR:

But as the years go on, let’s say people have kids or they get more ensconced in professional endeavors, they’re more tied to their desk and their activity level drops. So, there could be a number of things that cause this. I’m not concerned when someone remarks that “I can go all day without eating and I’m not hungry.” I would look at a number of those contextual factors to see how you read that. And you know, I would consider that there may be a degree of irritation in the gut, but you’d need some other form of evidence to really support that. I myself can say that as I’ve been doing more with fasting, I notice that I can go most of the day without eating. I can fairly easily do one meal per day. I’ll have a little bit of electrolytes and maybe some protein powder, maybe a little bit of green juice, but I’m pretty well able to go the entire day, whereas I remember back in college, I would be quite hungry first thing in the morning. Depending on how you frame that, that could be concerning or not. I think part of that is my diet is different and I’ve pushed into and done more fasting so that my body can more easily get into that state. So, it may or may not mean something is going on in the gut. Look at other contextual factors to either reinforce or rule that out, and then adjust accordingly.

Question 2: Gastritis & Elemental Diets

ER:

Our next question is: Do elemental diets help gastritis or ulcers?

DrMR:

Maybe. This one could really go either way. What you’ll see in some cases of ulcers or gastritis is the individual feels worse if they have an empty stomach. Now, an elemental diet wouldn’t really give you an empty stomach, but it may not be enough to buffer the acid that could be irritating the gastritis or the ulcer. What’s likely happening in these cases is the food is eating up some of the acidity. And so when people have an empty stomach, there’s not that food to eat up the acidity, they feel the acidity more, and that flares their gastritis or their ulcers. This is why you’ll hear people with gastritis or ulcers or nausea or reflux report that they feel better if they eat something. Now again, the elemental diet is some form of food, but it’s not super robust. It’s very light and it’s pre-digested and you’re sipping on it slowly and gradually throughout the day.

DrMR:

So, if that were to be what was going on, then the elemental diet may make you feel worse. Now, it wouldn’t do any damage. It’s totally worthwhile to run the experiment, but I’d make that one note. Now, conversely, some of gastritis or ulcers may be due to foods that are triggering the body to produce more acid. And this is where people have likely heard that certain foods are known to flare things like reflux, not to say that reflux and gastritis or reflux and ulcers are the same thing, but if they come back to this commonality of hyper acidity, then we know certain foods like caffeine, alcohol, spicy foods, higher histamine foods can all flare (or increase) the level of stomach acid and then flare some of these symptoms. And histamine is actually one of the mediators to signal stomach acid release. Remember, there’s this Histamine H2-receptor antagonist (or blockers like Pepcid) that will lower stomach acid via decreasing histamine levels.

DrMR:

So, foods can flare these issues – can flare acid and can flare these tissues – that are irritated by excess acid. And in this situation, the elemental diet could pose a lot of relief for someone very quickly. So, this is one of those things where you can run the experiment, see how you do, and then adjust accordingly. Clinically, it’s rare that I’ll see someone with gastritis or ulcers be flared by the elemental diet. So, I think the odds are probably in that cohort of individuals favor, but it’s just important to know this. And the reason why it’s important to know this (this being the elemental diet is not a cure all and it may not be the right move for someone with gastritis or ulcers) is so that you don’t just keep doing it and think it’s a die-off or it’s a healing crisis or something like that, which I hope people who listen to the podcast have been tuning into that I don’t see die-off reactions. They’re actually quite rare.

DrMR:

I call attention to this because I’ve seen a lot of people who think any negative reaction is a die-off and they needlessly suffer. And I think that really needs to be re-examined. You want to keep that in mind. You should not see a die-off from elemental dieting, maybe a little bit of turbulence as your body is adjusting. Perhaps a little bit of constipation because there’s not a lot of stuff to come through and out the other side, which we consider normal. But if you’re noticing a flare of stomach pain or indigestion or reflux with the elemental diet that persists for more than maybe a day or two, then I would assume that’s not the right fit for you. Maybe try a different formula – maybe try the whey-free version – although the whey seems to be very well tolerated, so I have a minimal concern about that, but there’s a small subset of people who don’t do well with whey. So, run the experiment, give it a couple days, maybe try different formula, and if it’s still not working for you, then probably not the right fit for you at this time, and you’ll need to pivot to diet… probiotics… all the other stuff that we discuss. Gut rebuild nutrients, I think, is a really good move for people with upper GI presentations like ulcers and gastritis. That gives you a few starting points to work through to try to resolve the gastritis or the ulcers.

ER:

Sounds good to me. Let’s see. Our next question is from Sherry.

Question 3: Probiotics & Immunotherapy

Cheryl:

Hi, Dr. Ruscio. I’m a long time listener of your podcast from when you very first started. Hey- question for you. My name is Sherry, by the way. What is your thought about probiotics for cancer patients using immunotherapy? My husband is at Johns Hopkins doing a clinical trial and they say that studies show that people do worse with immunotherapy and probiotics, but I’m very skeptical about this. I can’t find the study they cite, but I did find one article, but you know what? I just don’t trust it. And it’s so counterintuitive since 70% of the immune system is in the gut. I know you’re much more studied than what I could come up with and just wanted to know your thoughts. Thank you so much. Take care. Bye-bye.

DrMR:

Well, thank you for your long term listenership. Sorry to hear about the situation that leads to the question, but happy to offer whatever insights that I can. I share your suspicion – I’m doubtful that probiotics would make immunotherapy worse. Now, it’s possible that it could, but if you’re unable to locate the reference, then that increases my level of suspicion. And I would ask whoever you’re corresponding with – could you please send me the reference supporting your statement that probiotics make immunotherapy less effective and see if there’s evidence for their case. What I think ends up happening in a lot of these situations is when a conventional doctor does not know whether or not a natural therapy will enhance or will be antagonizing of the primary conventional therapy, they revert to the ‘I don’t know so I’m going to say do nothing.’

DrMR:

They revert to the cautious negative, and that’s not necessarily a bad thing, but to your point (which is an excellent one), looking at this overwhelmingly positive body of evidence that probiotics are beneficial for synergizing with antibiotics, for reducing brain fog and depression, for improving cognition, for reducing antibiotic associated side effects, for reducing reflux, for improving thyroid hormone absorption (at least according to one study), for IBS, for SIBO, for inflammatory bowel disease, for infants in the NICU… all this research showing benefit. I would be hard pressed to think that probiotics would somehow undo what immunotherapy is trying to do. That being said, I don’t know. I haven’t seen any research on this one way or the other and you may want to reach out to Dwight McKee who was on the podcast. He was the integrative oncologist that I thought was really the most well versed.

ER:

That was a great episode. I heard that. I just remember thinking if anyone I know ever is diagnosed with cancer anytime soon – I flagged that episode – go to this guy. He knows what he’s talking about.

DrMR:

If you’re not able to either determine that your doctor at Johns Hopkins is hoodwinking you a little bit sadly and saying there’s evidence when there’s not, which by the way I find detestable, and if they can’t produce a reference, and you do want to have a second opinion, Dwight McKee may be the guy. Or if they produce a reference and you’re still not sure how compelling of a reference that is, I’m not sure if Dwight McKee does consulting still, but he was the guy who I was really the most impressed with.

DrMR:

I’d point you to him for an answer because this is outside of my niche. And although I do really follow quite intensely the probiotic literature, this is very niche. And I haven’t seen the study that you’re referring to either, but I also don’t want to mislead you. So, I share your suspicion. See if your Johns Hopkins doctor can produce evidence. If he can’t, then maybe you press a little harder and say – “Is there actually evidence or is this something that you’re inferring?” And just have that pro/con conversation with them and see if he’ll relent a little bit and/or reach out to Dwight McKee for a second opinion. Sorry not to have more of a definitive answer for you on that, but that is one that’s a little bit outside of my area of focus.

ER:

I had one other thought. I actually used to work in pharmaceutical studies – phase one and phase three pharmaceutical as they’re developing drugs and things like that. She mentioned that her husband was in a clinical trial. When we screened people, we really didn’t want them to be taking (or I should say the FDA, rather) didn’t want them to be taking anything really unless it was something that would be fine with the drug we were testing. But I wonder if that’s also their excuse – that they just don’t want anything to impede or interfere. It’s pretty important that she does whatever she can do for her husband, obviously. But I’m just thinking maybe because of the nature of the situation – it being a clinical trial – they’re just like, “Nah.”

DrMR:

I agree, especially when you’re doing a clinical trial, there’s really an effort and I can speak to this in terms of what we’re doing with the hydrogen sulfide SIBO study at the clinic. We’re trying to really select for individuals who have minimal other therapies that they’re doing. That just helps you reduce the noise. That being said, I ran another search. I did a search while we were on the line here, and then I did another one just now as you were speaking, Erin. There is a Healthline article that claims that probiotics or a poor diet worsen response to immunotherapy. From the article here, researchers found that patients using probiotic supplements were 70% less likely to respond to this type of immunotherapy in a study by Christine Spencer. {https://www.healthline.com/health-news/probiotics-linked-to-poorer-response-to-cancer-immunotherapy-in-skin-cancer-patients}

DrMR:

I would pull that up and give that a closer look. There are a few findings here and I’m not sure how robust those findings are. You strike me as someone who is going to make this decision based upon evidence, and you just want to see the evidence and if there is evidence and that makes what you’re thinking. So, this has gotten me to open my mind, but I’d have to drill down to the study a little more deeply just to see how tenable of a conclusion that is. I’m confident that if you give that study a look, bring some questions to your doctor at Johns Hopkins, and have an open and honest discussion about that, you’ll be able to find whatever route makes the most sense.

ER:

It’d be really interesting to hear. I know you don’t have a ton of time on your hands, but I’d be interested to hear what the outcome is… if what they’re saying is true.

DrMR:

I’m going to give it a look once we end the conversation here, Erin. The one challenge is that my knowledge of immunotherapy is very shallow. If there’s an easy way to show that this is a conflatious argument, then sure. But that’s the other thing that makes this challenging nor is there anyone on our team who is really savvy with immunotherapy. If I have any other updates, I’ll include them in the show notes, but otherwise I’ll provide the link to the Healthline article and Dwight McKee (someone who really knows this area) as a reference. And I think that’ll give you a good path forward so you can get a solid answer on this, one way or the other.

ER:

Good luck. And sorry I called you Cheryl – your name is Sherry.

Dr Ruscio Resources:

Hi everyone. Just a quick announcement regarding the clinic. I’m 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 Molidor, 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. The next call will be Friday, January 14th @ 1:45 PM central.

Question 4: Pea Protein & Low Sulfur Diets

ER:

Our next question is: If peas are on the no veggies list for a low sulfur diet, can I still have protein powder for my morning smoothies that contain pea protein?

DrMR:

This is a good question. This is something we see on a recurring basis and I think it’s always helpful to field these types of questions that articulate there’s wiggle room in most healthcare recommendations, definitely including most dietary recommendations. The purpose of many diets is to reduce the amount of whatever it is you’re trying to factor out. So, that may be dairy. It may be gluten. It may be carbs. It may be sulfur. It may be histamine. Unless perhaps you are exquisitely gluten sensitive where there does seem to be a cohort (but it’s a small group) who are very, very sensitive and even a little bit of gluten will cause quite a reaction. I’m even starting to question how true that is because a lot of that is self-reported.

DrMR:

And if you look at what happens when people don’t quite have their gut health over the hump, they’re still floundering with these reactions. I’m remembering back to Robb Wolf saying if someone cooked on a grill that had a sauce with gluten on it before he cooked on it, and then he cooked on it right afterwards, he’d have problems. But I also know Robb has said that he’s felt like it has taken him a long time to get his gut health all the way to where he’d like it to be. And so I wonder if when a person doesn’t have a reason why, gluten is an easy scapegoat, and it may lead to this runaway narrative where gluten is this boogeyman that’s responsible for what might just be… like at that meal, you just had a whole bunch of FODMAPs. And the individual may not have made the FODMAP connection yet, or they just may be still in the throws of IBS or IBD that has this oscillatory pattern.

DrMR:

So even with the gluten, I want to be careful because I don’t want to feed into people being neurotic about gluten. Now, that being said, coming back to your question about veggies, peas, and sulfur. Definitely with a low sulfur diet and a low histamine diet and a low FODMAP diet, it’s more about reducing the total exposure, total load, of things like FODMAPs, sulfur, and histamine, and not having to be ardently avoidant of every little bit. And we have to weigh that against – How helpful is the pea protein? Does it sit well with you? Do you feel good on it? Does it give you an easy morning shake? Whenever you’re having the pea protein, is that something that’s really helpful for you? If so, it’s much more justifiable to try to keep that in your diet and pay attention to ‘Do I have a problem with this?,’ but more likely you just need to reduce your sulfur intake and not get rid of literally everything that is high sulfur.

DrMR:

So, I would keep that in mind and also keep in mind that (at least from my observation), the low sulfur diet is not something that takes a long time to notice the benefit from nor do people have to be on it forever. Also, when we get into the low sulfur realm, I suspect that there’s still something in the gut that’s being missed, that needs to be remedied, to improve dietary tolerance. So, continue on the diet. If it’s serving you, just be careful that you’re not getting persuaded to thinking that diet is what you need to be on absent anti-symptomatic improvement after the first week or two. And if you are confident that the diet is helpful, continue on it and try your pea protein again. I’m doubtful it’s going to be a problem, but listen to your body. And remember that it’s not about complete exclusion for many of the diets. It’s about reduction of your total load.

ER:

That’s very hard for someone like me who is a rule follower – in certain aspects. If there’s a yes and no list of what I can and can’t have, I’m going to obey every single one of those.

DrMR:

I totally get it. And especially if you’re having these periods where you don’t feel well, then that’s frustrating and it can also lead to some fear. Not feeling well – it’s really unpleasant, and especially if you felt good for a little bit, and now you’re regressing, it’s easier for this fear to come roaring up from down below and it can really skew objective thinking. And so that’s why I think these questions are always so important to answer because it hopefully provides people a lifeline for not letting fear whisper in their ear. It could be the FODMAPs… it could be the histamine… it could be the oxalates… Yes, we want to pay attention, but we want to be careful not to get so zoomed in. We can actually make ourselves worse by going so restrictive. And that may have been something that just would’ve taken care of itself all on its own within a few days or a few weeks. So, it’s a delicate balance. I also want to be sensitive to how anyone is feeling, but threading that needle is really important. Erin – I think you can attest far better than me, how cutting and how damaging it can be when you get too zoomed in on diet.

ER:

Oh yeah, for sure. There’s so much liberation in my life now. The fact that I can say – I know I’m going to make tacos with guacamole tonight. So, that’s a lot of avocado. Maybe I just choose avocado for today, and I don’t go nuts on dark chocolate or other high histamine foods, but it’s so liberating just to be like, “okay, I can just choose.” It’s not a yes or no type of thing. That’s been just mind blowing and life changing. It frees you up to do a lot of things in terms of being able to go out to eat with your friends again and not living like a hermit. There are so many great things that happen. You helped me let go of that fear that I was clenching so tightly to. And you’re right – it was like a fear of ‘How am I going to feel tomorrow?’ ‘How do I plan my day for how I’m going to feel tomorrow?’

DrMR:

I’m also hoping that we’re going to see progressively going forward, that whenever you listen to a podcast or read an article or read a book about a given diet or set of dietary restrictions, that whoever the author is, is going to be building in some of this caution to how they describe the diet. In defense of anyone talking about diet anywhere, I wasn’t really aware of this too keenly maybe five plus years ago, but now that I’ve had enough interactions in the clinic and I’ve really been able to pinpoint this (and the whole clinical team at the office is also seeing the same thing), I think it’s evident now that we have to be a bit more careful with how we talk about diets. Hopefully what I’m saying is as the blogosphere and such overturns and we have the updated cast of blogs and what have you, that more of this caution will be built in to give people some guardrails from going over the deep end.

ER:

Yeah. And not to take this too far off the topic, but 50% of (I don’t know what the real percentage is) humans are women. And just the word diet is triggering to us. Maybe some men, too, but mostly women from the age of nine or 10. It’s also important for women to go – ‘Hey, this isn’t that kind of a diet… this is not a lose weight diet… this is not for social acceptance… this is for my health.’ And I don’t need to be strict on it and I can be easy on myself. Diets are very triggering to me, so that’s why I’ll go black and white – I’ll either do it or I don’t. And now I’m just like, “screw it all.” I’m not doing any more diets unless I need to pull back on FODMAPs or low histamine. I don’t even really use the word diet in my verbiage when I talk about it. I just think it’s something to think about because women are super triggered by that.

DrMR:

That’s a great point. And even good for me to hear in terms of trying to not even use the framing that I think has this confining nature that people associate to diet. Moreso, here is an eating plan to help guide you to what’s going to feel good and not feel good and not this rigid boundary of outlines (“You have to be inside of this and you can’t go outside of that.”) You’re right. It is a little bit of a loaded term. All good things for the healthcare community collectively just to have in mind.

Question 5: Nausea & Gut Issues

ER:

Our next question is from Carrie.

Carrie:

I’ve experienced frequent nausea and wanted to know if that’s considered a digestive symptom that indicates a problem in the gut? Or is it possible that I just have a sensitive stomach?

DrMR:

Those are pretty much the same thing. Nausea and a sensitive stomach are the same underlying thing. Now, your symptomatic indicator light sounds like it’s nausea and that’s telling you that something is awry in the gut, whether it be inflammation or gastritis or whatever it is underneath the hood that’s causing the nausea. Usually nausea is an upper GI phenomena, meaning it’s the stomach or the small intestine. It’s the fact that there’s something there that’s suboptimal that’s causing the sensitive stomach or the frequency of the reactions. Here’s the good news – keeping with the theme from our last question – this doesn’t mean that there’s something “wrong,” but there just may be some things that are ideal for your system that you’re not currently doing. So yes, frequent nausea does mean there’s likely something awry in the gut.

DrMR:

Another way of framing that is you may be eating a food somewhat frequently that doesn’t agree with you. And that may be causing the nausea. For some people, dairy or gluten can be common triggers… or maybe it’s spicy food or caffeine. So, the solution to the sensitive stomach could be something as simple as determining what your food triggers are. It’s also possible that there could be something like gastritis or ulcers. The good news there is that there are many therapeutics available to support that – probiotics being one. In fact, there was one study recently that found that the ulcers that can be caused by chronic aspirin use could be greatly reduced by using probiotics, just as one example illustrating how probiotics (amongst many other therapies) are such an easy starting point that they’re one I often point people to. They could help with what might be the underlying cause of the sensitive stomach. So yes, that’s an indicator light – pay attention to it, don’t obsess over it, and that’s an opportunity to figure out what are you doing/not doing that you could that would allow your stomach to have optimum function and for you to have nausea only rarely. I don’t think it’s a reasonable goal to say I’ll never ever in my life have any nausea, but that should be something that’s rare and the frequent nausea should go away. And hopefully when that does, you also may observe you have better energy or mental clarity or sleep.

Question 6: Postmenopausal Women & DHEA

ER:

Our next question is: What is a good starting dose for oral DHEA for extremely exhausted postmenopausal women with very low levels of DHEA in their blood work?

DrMR:

So, DHEA is definitely a supplement that I’m a fan of, and there’s a few different ways to dose this. You can do a pill version. You can do anywhere from five to 25 milligrams per day. I personally use 25 milligrams per day as a capsule. There’s also sublingual drops that you can drop under your tongue and the dose there, (I don’t know off the top of my head) but pretty standard to use anywhere for maybe five drops, two or three times per day, is a decent starting point for the DHEA drops. DHEA can definitely be helpful. I would be careful not to chase numbers on your blood work because if you’re postmenopausal and extremely exhausted, there are a few other things that you may want to look at.

DrMR:

Most foundationally, do you have any gut symptoms? If you do, that may be what is causing your fatigue. Also, this could be a byproduct of being postmenopausal and having low levels of estrogen and progesterone, which thankfully there are some natural agents that can help with this – like the Estro-Harmony and Progest-Harmony – which are herbal blends that help to balance female hormones. And you can actually use those together, even postmenopausally. Iron is something else to think about. So yes, DHEA can help, but if you’re extremely exhausted, I don’t think that DHEA monotherapy is probably going to get you all the way there. I would expect maybe a bump. Joe Mather and I were having a conversation on this in a podcast that probably published only a few weeks ago, in terms of DHEA being helpful, but not as helpful as we were hoping it was going to be.

DrMR:

Now that being said, I still use it, but every time you start bringing new therapy into the clinic, you’re waiting to see when you follow up with a patient and ask – How was the DHEA? You’re waiting to see what the response is? Are you getting lots of – yeah, it was alright… or are you getting lots of – wow, it was really helpful… a little murmur of ‘maybe it helped’ or an ecstatic ‘that was a game changer!’ The DHEA falls somewhere in between, but closer to the murmur of potential benefit than this real game changer. So, it’s not to dissuade you. I think there’s good evidence that DHEA has health benefits and it’s something that you can use. Be careful not to chase the number on your lab work and think that that, because it’s on a piece of paper, is the primary driver of the fatigue. Consider your gut, consider your hormones, and if you didn’t have ferritin looked at, ferritin may not be a bad idea to look at also if that’s flagged low, that could help, too.

Dr Ruscio Resources:

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. We also offer health coaching independent of the clinic, for those perhaps reading the book and/or looking for guidance with diet, supplementation, et cetera. 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.

Question 7: Supplemental HCL

ER:

So, we’re running a little low on time. Do you want to talk about HCL next? What to take in place of Prescript-Assist? Or NMN?

DrMR:

Let’s do the HCL and we can leave the other two for our next chat.

Listener:

There is some evidence that taking HCL will cause the body to gradually produce less of its own HCL, requiring the patient to take more HCL to achieve the same benefit. The theory is that the body has a feedback mechanism to know when there’s a correct amount of digestive fluid. And when that’s been altered by an external influence, including the food itself, it will compensate and produce different amounts as it feels is important for your health. So therefore, the question is: Is it in your knowledge or experience, that taking HCL will affect the body’s ability to maintain HCL on its own? Thank you.

DrMR:

So, good question. In short, I haven’t seen anything that has demonstrated that supplemental HCL or hydrochloric acid will inhibit, especially lead to any kind of long-term inhibition or dependency. Perhaps there’s something there that I’ve missed. However, this is something, especially when writing Healthy Gut, Healthy You, I did quite robust fact checking. And there’s actually not much evidence at all regarding HCL supplementation. Knowing that perhaps the main cause of low HCL is this autoimmunity to the parietal cells and the lining of the stomach, that to my knowledge is not reversible. There are things that can be done that may arrest the antibodies, but I don’t know of any research that has ever found that that can be undone. My thinking is that as long as you’re qualifying and using it in people who need it as compared to those who don’t need it, then it’s kind of a moot point if there will be any dependency. Now, that being said, I haven’t seen anyone who has seemed to have formed dependency. And if anything, my hazy clinical read would be that people may need less HCL over time. Now, that could be confounded by the fact that there is some placebo effect and as people heal and improve and have less symptoms, they’re able to come off supplements and realize that they don’t need them. So, what I may be interpreting as the body healing and therefore needing less HCL may just be the natural evolution of people weaning down only supplements that clearly benefit them. You can also argue that when there’s inflammation that throws off some of these signaling cascades like HCL (and this has been demonstrated for pancreatic enzymes and for motility) certain signaling intermediaries like cholecystokinin kinase is interfered with by inflammation, which is why there seems to be some research connecting inflammation in the gut and gallbladder stones. The contracting of the gallbladder is interfered with because those signaling molecules are deranged by inflammation.

DrMR:

So, if that’s true, perhaps when there’s less inflammation, people need less HCL. If the HCL as an intervention helped to heal and improve someone’s condition, that may actually lead to them needing less HCL in the long term, but this is all speculative. I haven’t seen anything really definitive one way or the other. So, the way I would approach HCL is first not seeing any evidence that shows we have to be highly cautious with this because it’s habit forming. Second, using it and really using it once you’ve gotten through some of the earlier phase interventions like diet, probiotics, elemental dieting, antimicrobials, so you’ve gotten rid of as much noise as possible and you have the clearest opportunity to see – Is there a signal of benefit or not from HCL supplementation? And if there is, continue and if there’s not, discontinue. In my observation, HCL supplementation is overly relied upon in the integrative medical field.

DrMR:

And you combine that with placebo and the fact that it’s often done with many other interventions and that providers don’t seem to be super keen on getting people off of supplements, it leads to multiple points of assumption where people need to be on HCL where they probably don’t. When people do, it’s pretty evident. And it’s easy for me to say that, but I’ve been able to see that as we’ve really continued to do only one or two interventions at a time. We’ve released a few case studies – Mason’s case study is such a choice example of HCL really being quite helpful. And remember, that there are risk factors – those who are over 65, those who’ve had a history of anemia, and those who have any documented autoimmune conditions. They are at increased risk for the need for HCL.

DrMR:

So, if you combine your baseline risk factors along with a trial of HCL at the right time, once you’ve done much of the other stuff that we just discussed, and then you trial on the HCL, you’re looking for clear benefit and if not, you don’t need it. And then, in keeping with most of the recommendations that we make, over time try to wean off and see if you’re able to maintain benefits without being on the HCL. I think that’s a touch less likely given the pathophysiology of low HCL, which is this autoimmunity. You could almost draw a parallel to hypothyroidism, meaning when someone’s frankly hypothyroid, they likely won’t be able to come off the medication because their body is unable to produce an adequate amount on their own. So, those are a few thoughts for you regarding HCL, and how to navigate that and personalize that to you.

Episode Wrap-Up

ER:

That’s all we have time for today.

DrMR:

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

ER:

Alright. Bye

DrMR:

Bye-bye.

Outro:

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