Listener Questions: Weight Loss, SIBO, Hormones, Mold Toxicity

Intro:

Welcome to Dr. Ruscio, DC radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Erin Ryan:

Hey everyone. This is Erin Ryan from Dr. Ruscio radio. Today on the show, Dr. Ruscio answers your questions. In this week’s episode you asked, “I have trouble losing weight. I’ve fixed my gut, I eat a raw vegan diet, and I’ve tried juicing. What else could I try?”, “Can SIBO lower T3 and sex hormones?”, “What to take as a precaution against food poisoning?”, “Is hair mineral testing accurate?”, [and] “I’m struggling with acute throat tightening reactions to random foods. What could it be?” Thank you to everyone who submitted your questions. 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.

Dr Ruscio:

Hi everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio, back with Erin Ryan, and we are taking your listener questions yet again. Hey Erin. Welcome back.

Erin Ryan:

Hey, thank you. So lots of questions that we’ve gotten in the last couple months were back. So hopefully we can get through some of those today. Should I just jump right in?

Dr Ruscio :

Yeah, let’s jump in.

Erin Ryan:

Okay. I don’t have a name for this person, but here we go. “After several juice cleanses, and now eating a wholesome, mostly raw vegan diet, I resolved my digestive issues. And I’m working out regularly, but I still find it’s impossible to lose weight when it used to be very easy. Is it a metabolism issue? A burdened liver? I’m completely lost here.”

Dr Ruscio :

Okay. Well, glad to hear that your GI issues have been sorted out. That makes it less likely that the inability to lose weight is driven by your GI, which can happen. I wouldn’t say it’s something that happens super often, but there’s definitely been cases where the weight loss has been fairly significant after improving their GI health. So we can check that box off. It is important to clarify between body weight and body composition. Sometimes when people, especially if they’re doing weight training and they’re gaining muscle, they may actually be gaining weight but losing body fat. You’re probably not happy with the way you look, I’m assuming, so this is probably not very salient, but worth at least mentioning a few things that seem to be the most helpful here. And full disclosure, this is not something I do a lot with. There are some patients at the clinic where we work through attempting to improve their metabolism. But I can’t say it’s something like GI or thyroid, [which] is a situation I’m dealing with multiple times per day, everyday I’m in the clinic.

Dr Ruscio :

But from what I’ve garnered in speaking with some who have metabolism and body composition as their primary clinical focus, increasing protein intake seems to be one factor that most agree upon as one of the easier and more effective methods you can deploy. In addition to increasing the amount that you’re fasting. Now, there is a limit to which fasting can start to become problematic, but certainly start fasting a bit more and see if that helps. You may want to try intermittent fasting, if you’re doing no fasting. If you’re doing some intermittent fasting, you may want to try something like an OMAD (one meal per day).

Dr Ruscio :

And I like having people start here doing that OMAD one day per week. I personally find this helps reset my hunger cravings. So start there and maybe then try doing the OMAD twice per week. In parallel to this, your sleep and your stress are important to check in on. Your bedtime can be potentially pretty impactful here. And if you are having any fatigue or cognitive challenges or aches and pains or high blood pressure or cholesterol, these are all flags for some type of apnea. So depending on that and/or if you have family history and/or if you snore or have dry mouth in the morning, drool on your pillow—these are all things that may flag an apnea can be present. There’s some evidence showing that HIITs training may have a slight advantage over cardio or weights as it pertains to body composition. So that’s something else for you to consider.

Dr Ruscio :

And there is (in my opinion, to some extent) a hormone component to this. So, depending on if you’re having any hormonal symptoms, that may be something to look into. And yes, coming back to your question about metabolism, there’s almost for certain something with metabolism. What I outlined are a number of factors that may help with the metabolism. And a burdened liver? Maybe. It’s less likely if your GI is no longer symptomatic. Although a course on probiotics, some fasting, [and] sauna can help with this. You may want to try a course on something like modified citrus pectin, which has been shown to be a pretty interesting binder of toxins to help with detox. Although, I wouldn’t put too much probability on that. But I mean buying a bottle of probiotics and trying a six week trial on that, purchasing a canister of modified citrus pectin, trying 4-6 weeks on that (after the other items) wouldn’t be bad ideas. So there’s a number of things to consider and hopefully that gets you to the point that you’re looking to achieve.

Erin Ryan:

Cool. Well, there’s some good options there. I might try some of that. I haven’t done enough sauna. I feel like since I moved to Texas, I just don’t want to be in a sauna.

Dr Ruscio :

Yeah. You’re kind of in one already.

Erin Ryan:

Exactly. And in February too, like the last two days have been 83 degrees. Alright. Our next question: “Can SIBO lower T3 and sex hormones? I’m a 39-year-old female currently working through your treatment protocol for SIBO. And my GI issues are starting to improve. The lab work shows low free T3, but other thyroid hormone hormones are normal. Estrogen and progesterone are both low, causing menstrual cycle irregularities. Am I correct in thinking that SIBO is the root cause?”

Dr Ruscio :

Potentially. Yeah. I think it’s important to present these potential causative factors in relation to probabilities and not a “it is or it is not.” Because that leads people into absolutist thinking. It’s less attractive, right? People want to hear, “it’s this thing” and rally behind a simple message. But usually in clinical practice, you’re just trying to assess what [out] of a list of underlying causes is most probably causing a person’s symptoms. So in this case, it is possible that a problem in the GI (let’s say SIBO) could be causing perturbations of your hormones. And certainly the more important observation I bring to the table here is: in working with people who have symptoms of female hormone imbalances—PMS, menstrual irregularities, hot flashes (just to name a few)—there seems to be a fairly clear signal that those symptoms improve as we improve one’s gut health.

Dr Ruscio :

So fairly clearly for female hormone mediated symptoms, yes. As it pertains to T3, I’m not doing enough T3 testing and retesting to be able to say, and this is because I look at T3 as secondary. What happens to T3 is almost always secondary to stress, sleep, calories, carbs, also gut health inflammation in the gut. And also the gut itself helps with conversion of T4 to T3. So yes, it is possible that what’s going on in the gut (including SIBO, [but] I wouldn’t limit it to just SIBO) could be impacting conversion of T4 to T3. [It] could also be impacting your female hormones. So I would just keep working through the protocol and using your symptoms to help you determine if you’ve hit the appropriate endpoint.

Dr Ruscio :

Once you’ve gotten your GI symptoms—not SIBO test results, but symptoms—improved, then reevaluate and see if your female hormone symptoms have improved. And if they haven’t, that’s when you may want to either look more at lifestyle factors that can stress the body and thwart healthy production of female steroid hormones (like estrogen and progesterone). Or consider some herbal blends that help to encourage balance—like our Estro-Harmony and Progest-Harmony. Or, after all that, potentially a low dose of bioidentical HRT. The T3 I wouldn’t bother tracking. It really is not going to tell you how to do anything differently to improve your symptoms and tends to be a marker that does more to distract people than to inform what they should do. So you’re on the right track. Keep it up. And there’s a few things to consider mid-to-end phase with the hormones, if those hormone-mediated symptoms haven’t improved.

Erin Ryan:

Okay. Our next question, “I’m a 10-year post-infectious IBS patient who is interested in switching from taking half Xifaxan a day—as a precaution against food poisoning—to your intestinal support formula. While Dr. Siebecker recommends taking 2,000 to 4,000 milligrams of ISF in food-poisoning-prone destinations, what do you recommend for ISF dosage to prevent food poisoning in regular, everyday life in the US?”

Dr Ruscio :

Okay. Yeah. I know Allison had some really nice response, personally, when using ISF. And I think that dose is reasonable. However, I wouldn’t (actually, it may sound sort of ironic) recommend using ISF in that application. It’s not that you can’t do it or there’s any harm in doing it, but it’s not the first therapy I would use.

Dr Ruscio :

What’s saddening to me is that the SIBO community hasn’t acknowledged the meta-analyses (which are summaries of clinical trials) which have concluded that probiotics (most namely Saccharomyces boulardii, but not limited to Saccharomyces boulardii) are effective in the prevention of travelers diarrhea. In fact, we’ve discussed on the podcast, other evidence that has showcased [that] probiotics can be as effective as either antibiotics or antifungal agents. So if we had no other options, would rifaximin be acceptable? Sure. That’s better than nothing.

Dr Ruscio :

If we have probiotics, that is better than antibiotics. And we’ll link for you here too two meta-analysis. But one is entitled “Meta-Analysis of Probiotics for the Prevention of Travelers Diarrhea.” And they essentially conclude [that] several probiotics—Saccharomyces boulardii or a mixture of Lactobacillus and Bifidobacterium—had significant efficacy. So does that category system sound kind of familiar? So you partially see where I get the three formulas that we use. And important to also mention that this study comments: “No serious adverse reactions were reported in the 12 clinical trials that constituted this meta-analysis. Probiotics may offer a safe and effective method for prevention of travelers diarrhea.”

Dr Ruscio :

So I know that Siebecker doesn’t seem to be big into probiotics, nor does Pimentel, and I think this has skewed the field. And I respect the ability for us to have cordial differences of opinion, but it’s really quite important to mention that there is good evidence finding that probiotics can prevent travelers diarrhea. So we just want to make sure that you’re aware of that. And because of that, I don’t look at ISF as what should be used for prevention.

Dr Ruscio :

Now, perhaps you had a negative reaction to probiotics in the past. [It] wouldn’t be a bad idea to retrial them if you did, because I’m assuming you’re healthier now than you were then. Or I’m thinking, more likely, you’ve been scared off of probiotics based upon what other clinicians have told you. The other important thing here to mention is (again, clinicians can have differences of opinion) but there should be less debate or differences of opinion when we have adequate data to answer a question. And this is a case where we do have adequate data, we have meta-analyses, which are the pinnacle of scientific evidence. That all being said, if for whatever reason, you’re still uncomfortable, that’s fine. I’m never going to force anyone to do something. And thankfully we have multiple options. And the intestinal support formula at a dose of 2-4 grams per day, I think is reasonable.

Dr Ruscio :

The clinical trials have used 5-10 grams, but this is in a little bit of a different application. So 2-4 [grams], I think is fine. The one drawback to the intestinal support formula (again, as it pertains to probiotics or in addition to what I outlined a second ago) is it’s a touch more expensive. But it can be used. So if that’s the only thing that you’re comfortable with, 2-4 grams per day seems fine. And I like that over using Rifaximin longterm, even though I have nothing positionally against Rifaximin. And by the way, 200 to 400 milligrams is the same as 2-4 grams. Okay. So hopefully that helps. And really consider probiotics. If they’re not something that you’re using, then just don’t forget about how simple, safe, and able to benefit multiple systems probiotics are.

Erin Ryan:

Cool. And I want to add to that, that your triple therapy probiotics are super easy for traveling too. I know that she was asking for stuff in the US, but if anybody’s listening to this and thinking about traveling, he has these amazing teeny tiny little travel packs that are just so easy to throw in your bag. So you don’t have to take multiple pills or multiple bottles of anything when you’re traveling. So it’s actually pretty well-built for traveling. Although I think we’re sold out at the moment, but we should get more any day now, right?

Dr Ruscio :

Yeah, we are. I think it’ll be another—depending on this podcast airs—probably any day now, that they’ll be back in stock. They also do not require refrigeration, making them quite easy for travel.

Dr Ruscio :

The other thing I wanted to mention is the way that you’re self-labeling yourself as “a 10-year post-infectious IBS patient,” you know, my concern there is that you’re assigning too much of your identity to this diagnosis. And my concern there is that the way that you’re framing you, who you are, and how you identify may not be as healthy or as optimal as it could be. And I have a little bit of a different take on these things. Well, actually, no. I think my take is probably the same as someone like Allison or Mark, but it’s not always maybe so obvious.

Dr Ruscio :

When doctors are talking to doctors and discussing research, we use labels like this to help us understand the context of a patient. When a human being is communicating with another human being, this is not the optimum way to communicate because it pathologizes people. And it turns people into a historical finding or a diagnosis. And that’s really not the aim. That’s helpful, again, when we’re trying to create a packet of data that represents a person, but that shouldn’t be used to create their identity. And this ends up, I think, leading to people having unhealthy identities. And if we acknowledge the importance of the placebo or the high level of impact that placebo has, as does nocebo (which is the inverse, a negative expectation), we can see how now someone who’s walking around 10 years after having food poisoning and who also developed IBS could be incorrectly labeling themselves in a self-limiting way. And now every time they have symptoms, they further ingrain that label.

Dr Ruscio :

Whereas I think a healthier way of looking at this is almost akin to someone who had the ankle sprain, as I’ve described so many times on the podcast. And we do some rehab, get you back to full function. Maybe every once in a while your ankle gets a little bit sore and you go, “oh yeah, maybe I should do some of my stretches again, not a big deal.” And you wouldn’t say, “I’m a 10-year post-ankle-sprain survivor,” or whatever you want to term it. So for some reason, I think (again, because in the medical literature these trends have been observed) they’re communicated as such, sometime by doctors when speaking to lay people. But I don’t think any doctor would want a patient walking around describing themselves as a 10-year post-infectious IBS patient. I think they’d want them describing themselves as, “I’m Mary Sue and I like to do X.” Right? Something that’s not related to a diagnosis.

Dr Ruscio :

So for whatever it’s worth, I’d really consider throwing that perspective out and looking at yourself as a whole healthy individual who had some stuff in the past (and that’s all fine, most people do have some stuff at some point). And now you have a fresh, clean slate and can move forward as someone who’s going to have days where you feel not great and days where you feel great, like anyone else. But you’re not going to keep assigning or tying every time you don’t feel good back to that diagnosis from 10 years ago. And I’m fairly certain, any clinician who was asked that point-blank would say the same thing. Again, remember we use those packets of data to be able to communicate with other doctors in terms of the context of the individual, but it’s not something that we should tie in to someone’s identity.

Erin Ryan:

Yeah. I like that. It’s not a rock you have to carry in your backpack anymore. You can lighten the load. Leave it somewhere.

Dr Ruscio :

Exactly. And I include myself in this. I don’t describe myself when talking to other doctors or what have you, as a post-amoeba-histolytica patient, even though it really F’d me up quite badly. I have moved on. Right? And I don’t want to think about that stuff anymore. And sure, there’s times when I don’t feel well and it’s annoying. And I go, “oh God, okay, one more problem to solve, one more thing to figure out.” But I guess that the difference in mentality is, one is looking forward and one is looking backward. And so for whatever it’s worth, consider reframing and orienting yourself forward rather than backward.

Erin Ryan:

Cool.

Sponsor :

Hi everyone. If you are in need of help, we have a number of resources for you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Erin Ryan:

Our next question is from Anna: “I’ve been diving a little more into the world of mold sickness, and I’ve observed that many practitioners recommend hair mineral testing. I’m assuming to track mineral loss associated with using binders. I have always understood that HMT was unreliable, and I was interested in your thoughts on using it when working with mold. Are there better alternatives? Thank you for all that you do. Anna.”

Dr Ruscio :

Great question. I agree, I don’t see the hair mineral testing as being accurate and I wouldn’t recommend using it. We’re not using it in clinical practice. And we did just go through a review of the evidence of the best methods to test for nutrient or micronutrient insufficiencies. And, thankfully, in keeping with our philosophy, a subjective assessment or a symptom inventory seems to be the best way to handle this. So a symptom inventory, along with an individual’s history or information about them, seems to be what’s helpful in the majority of instances, with some testing. But really the testing is minimal in terms of how much utility it offers.

Dr Ruscio :

One of the side projects that I have, and something that we’ve been working to also integrate into the clinic, is coming up with a simple short form, if you will, that asks the historical or context data along with the symptomatic presentation that could indicate a deficiency in iron, in B12, in B6, etc. So we have a standardized assessment process that we can go through and then a clinician could examine that and really then be able to identify if someone has micronutrient deficiencies.

Dr Ruscio :

If you’re concerned about binders leading to micronutrient loss, then I would do two things: 1) consider a broad spectrum quality multivitamin (potentially also with a B complex if you really wanted to cover your bases) and [2] focus on trying to eat the most nutrient-dense diet. And fill in the gaps that most people are deficient in, like foods high in vitamin K2 (like fermented foods). And then foods that are high in things like vitamin B12 and copper. And this would be things like organ meats. And we had a good podcast with Marty, I believe his last name was Kendall, and we’re going to be doing a part two with him also, on how to really dial in your diet to be most nutrient dense.

Dr Ruscio :

And that’s probably going to be the best way to start. I say that also knowing that there are a couple courses on the internet and without wanting to throw anyone under the bus, but also trying to give you the most fair opinion on this… To say it flatly, there are some people out there who are just so caught in the academic weeds [that] their clinical recommendations are disastrous, in my opinion. They are almost purely theoretical or mechanism based. And that is so fraught with errors. So I just want to flag for you [that] there are some courses out there that claim to be the ultimate guide to determining your micronutrient insufficiencies. And you could ask yourself: “Well, how is it that Ruscio and Co has just gone through a review and they’re saying that the patient’s history plus symptoms is what the evidence says is the best methodology for determining insufficiencies, but some other person online is saying that their guide is and when I go over and look at their guide, there seems to be a bunch of science supporting their guide’s positions?” Well, the difference is the levels of evidence that we’re citing.

Dr Ruscio :

We only make an argument for you guys based upon the highest quality data. And that data is the most likely to be right and correct. You can have a bunch of references that are low quality. Hence the mechanism, the theory. Those are still linkable in PubMed, but they could be even something like animal data, right? These rats who were deprived of whatever in their diet then showed insufficiencies based upon X, Y, Z marker. But obviously, you’re not a rat. So we have to be very careful how much we pull from that lower quality data.

Dr Ruscio :

So again, focus on the nutrient density of your diet, a multivitamin (potentially a B complex) to cover some of your bases and then be on the lookout for that guide that I’m hoping we’ll be able to get out within the next few months. It’s just [that] there’s a lot that we are up to. And so it may be sooner than later. It may be more later than later. So keep your eyes out. But I think you probably have a pretty good protocol. Again, if you focus on nutrient density and multivitamin, plus or minus B complex.

Erin Ryan:

Awesome. Well, we’re almost out of time, but I want to get to one that I think sounds a little more urgent. See if we can squeeze that in really quick. This question says: “I’m a 62-year-old male. I recently had an event where my throat tightened up to where I couldn’t breathe while eating deli ham, which I’ve had many times. I used two EpiPens to try and breathe. The first one didn’t work. My throat felt like it was almost closed. So I tried a second one. Paramedics gave me another shot and I could finally breathe, but they said it wasn’t anaphylaxis from a food allergy, which is why my EpiPens didn’t work. After that event, it happened again when eating meat, carrots, [and] banana. It felt like the food got caught in my throat. I was able to vomit those up and the tightening stopped. I switched to liquids for a few days and slowly added foods back in, but I’m terrified it might happen again. If I’m alone I wouldn’t be able to call for help. My gastro did an endoscopy [and] said I had a bit of inflammation in my esophagus and put me on nexium, but I hear that’s dangerous or cancerous long-term, isn’t it?”

Dr Ruscio :

Okay, good question. I wouldn’t be opposed to you trying the nexium and seeing if it helps. Patients sometimes get caught up in this, and I absolutely understand where they’re coming from, but just remember to trial a therapy doesn’t mean you’re committing to lifelong therapy. Right? And sometimes the trial just tells us, “okay, I’ve responded to acid suppression. How can I fix the cause of this high acid?” So again, you can look at it as a therapeutic trial or a test, not necessarily a commitment to lifelong therapy. This could be a sort of peculiar food allergy (using the term ‘allergy’ loosely) reaction. It wouldn’t be an anaphylactic IgG response of course, but it could be an idiosyncratic manifestation of something like an IgG or an IgM. Or it could be some other type of reaction that may not be food allergy related at all. But by going through the model that we recommend in “Healthy Gut, Healthy You,” or if you want some more personalized care, you can come see us at the clinic.

Dr Ruscio :

That’s probably the best starting point here. And sometimes these peculiar presentations lead one away from the fundamentals. But I think it’s really important to start with the fundamentals because they tend to work for a wide swath of presentations. So I would want to mention that, just to make sure you work through some of actually what you’ve already done and seen beneficial. Right? Liquid dieting. That’s one of the first steps in, “Healthy Gut, Healthy You” is the modified fast. So even right there, reinforcement for my comment. It’s also possible that this could be some type of eosinophilic esophagitis, which leads to this inflammatory response in the throat, causing the feeling of something being stuck in the throat, plus or minus gastroparesis, which can cause a feeling like food is stuck in the stomach, not the throat, but it can also lead to a vomiting response.

Dr Ruscio :

So I’m not sure if when you vomited that was self-induced to try to move things. Or if that vomiting occurred secondary to this sort of reaction. This won’t, to my knowledge, show up on an EGD. Specifically, the gastroparesis won’t show. The eosinophilic esophagitis would show up, but I believe that would have to be confirmed by biopsy. You’d see probably some evidence of inflammation, but to see the actual eosinophils, I believe that requires a biopsy. I could be wrong if methodologies here have changed (and hopefully they have) and this can help be garnered just from the endoscopy (aka EGD). But I’m somewhat confident that you need to do a biopsy to determine that. So this, meaning the EOE (eosinophil esophagitis) plus or minus the gastroparesis, probably would not be assessed or captured via the endoscopy. You’d need a biopsy and a motility study.

Dr Ruscio :

Now that doesn’t necessarily tell you how to solve this problem any better. And seeing both EOE and gastroparesis at the clinic (albeit not a high number of cases), I can say that the model that we work through— both in “Healthy Gut, Healthy You” and at the clinic itself—should be able to help with this. So continue working through the protocol of healing your gut, so to speak. I would also keep your local GI doctor in the loop because there may be some items there, like the EOE or the gastroparesis that may benefit from something like a prokinetic.

Dr Ruscio :

So this would be a good example of where you want to have some good advice from both sides of the spectrum, both conventional and alternative medicine. And again, you have the book or the clinic as a resource for you regarding the alternative or functional perspective, and then keep working with your local GI. And it’s likely you’ll be able to resolve this. I’m sorry that you’re having such acute presentation, but you know, early in my career, I was intimidated by cases like this. And the more I worked with cases, I realized that these individuals respond very well [compared] to someone with different symptoms like bloating. And this is likely because we’re working to really heal and repair the gut itself. And there’s a myriad of symptomatic manifestations that can be an outgrowth of what’s going on in the gut.

Dr Ruscio :

So just want to make sure you don’t jump to the most exotic treatments because you have peculiar presentations. And continue to work through the foundation’s approach that we recommend, while also keeping your local GI doc in the loop.

Erin Ryan:

Okay. Well, that’s all we have time for for this episode, but we’ll be answering more of your questions next time.

Dr Ruscio :

Awesome. Thanks guys. Thanks, Erin. We’ll talk to you soon.

Erin Ryan:

Yep.

Outro:

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates. That’s DRRUSCIO.com.

 

• Dr. Ruscio’s, DC Resources