My Answers: Functional Health, My Morning Routine, and More

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.

DrMichaelRuscio:

Hey everyone, this is Dr. Ruscio. Today I was interviewed by Dr. Joe Mather. He wanted to come on the podcast to interview me, so we have some audience questions. Also, this was a discussion where we go into the deeper level of thinking that motivates and underlies many of the actions that both I and we, collectively as an operation, are taking. So it does depend on what your interests are, but in my opinion, there’s a more superficial layer of actions that is oftentimes informed by a deeper level of thinking, analysis, or what have you. There’s a fair amount of that which Joe wanted to probe into during this podcast. What’s the analytical nature that underlies and allows exposure of weak points in the field, or the ability to optimize systems or help rally and presumably unite and motivate a team of people towards a collective goal?

DrMR:

For me, these are some of the most important conversations, again, because if you can address and optimize a root issue, then like the analogy I often use in the clinic, there are a few root issues that underlie many branching symptoms. But that directionality also applies in a few healthy and effective root thought processes. Those underlie a branching of beneficial interventions, actions, insights, systems, et cetera. So there’s a decent amount of that which we discuss in this podcast. So I hope you’ll enjoy it; I hope no one falls asleep. And with that, we will now go to me being interviewed by Dr. Joe.

DrJoeMather:

Hello, welcome to the Dr. Ruscio radio show. This is Dr. Joe Mather here with my buddy and colleague Michael Ruscio, turning the tables on him. We are in sunny, pleasant, San Diego, and we’re taking a few days to unplug a little bit and think high-level on how to continue to improve our clinic and patient outcomes. And with that, we thought it would be a lot of fun to interview Michael. So, Michael, I know it’s going to be fun. What the listeners should know is that behind the scenes, we’ve had our ACFM team ping our social media audience, patients, and clinical staff, and come up with some questions. So I’m going to work through some questions with you, Michael. Are you ready?

DrMR:

I’m ready, yeah. Thanks for having me. It’s a pleasure to be here. Let’s launch it.

DrJM:

Maybe I’ll have you back if you behave yourself. We’ll see how you do. I have a list of questions here.

DrMR:

All right, let’s run through them.

Morning Routine

DrJM:

Ok, so in no particular order, there were a few questions on your morning routine. We don’t have two hours to go through every single piece of your morning routine, so I will ask you what would be a bigger hit to your daily performance, if I take away Hans Zimmer Spotify radio station, or your quadruple espresso?

DrMR:

That’s a tough one to answer. I’m going to assume since the effect of caffeine is going to be longer than the short-term stimulation you get from a Hans Zimmer soundtrack, that the withdrawal of caffeine would probably be more of a short-term detriment.

DrJM:

Doesn’t the Hans Zimmer heroic impulse just get embedded into your…

DrMR:

It does, that’s why I say it’s a hard choice. Maybe to give a really quick framing for people on that, because I do think there’s a few things in my morning routine that have been really helpful. I promise it won’t be two hours. Close, maybe. There’s a few things that I’ve found to be very helpful. One is caffeine. I’ll oscillate between a double espresso and a quad espresso, which actually isn’t as much caffeine as it sounds like. It’s 70-ish milligrams per espresso. Also, going for a walk before starting work. I’ll listen to Brain.FM, Hans Zimmer, or Phil Glass. I don’t look at any texts, I don’t look at any emails. I used to podcast in the morning, now I don’t podcast. Especially during that morning walk, what I find is that with getting outside and moving, your brain just goes to work in the background on solving all the things that are really important. I’ll just be walking and will get hit with a key insight, and then get hit with another key insight.

DrMR:

And so then when I come to my desk, I feel like I’ve already gotten a jumpstart on thinking deeply and thinking forward, and not necessarily getting pulled into focusing on that one thing that sometimes happens at the desk. Even though focusing on that one thing might be really valid, important, deep work, you can sometimes be a little bit myopically focused on one problem rather than looking at how all the gear wheels fit together. Not that you asked this question, but I should throw this out there. I think one of the things that is a really key asset to achieving higher and higher outcomes is thinking about everything that you do and trying to have as much synergy as possible. We do all these things in a given day, how can you structure what you’re doing so that all those things are building toward synergy with one another, and get this compounding effect? A lot of that’s a by-product of that morning routine — walking outside, some caffeine, some good music, and not necessarily jumping right in with emails, texts, or what have you.

DrJM:

Would you say that there’s a difference in how you prepare your day if you know you’re going to go right into a very focused, deep work block, versus, you know that you have to nail out 10 things in the next three hours?

DrMR:

I pretty much only start my days with deep work, because now, thankfully, there’s a great team that I work with that helps with a lot more of those task execution bits. The only exception for that would be a patient day, but I still kind of look at that as deep work. So no, I don’t like ever starting a day with rapid task execution because I feel like the greatest asset I have is that high-level thinking and problem solving. And so I usually put those quick tasks to the second half of the day, because they don’t require that deep thought.

Advice to Functional Medicine Beginners

DrJM:

Excellent, excellent. Okay, we’ll move on. One other question would be, what piece of advice would you have if you could say one thing to someone just starting out in Functional Medicine?

DrMR:

Highly consider that everything that you learn is wrong, everything that you think is wrong, and constantly be challenging every belief, every treatment that you vector. That auto-correct mechanism will prevent you from being the person who is 15 years in the practice and still wondering why they have subpar clinical outcomes, systems exposure, what have you.

DrJM:

Would you give any guidance to young practitioners on how do you determine what’s right?

DrMR:

That’s a great question. I think confirmation bias is something to really be on the lookout for. We were just talking about this theory of long-term antifungals and mold treatments. You’re speaking about a certain observation, and one of my follow-ups was, “Could that have been confounded by improved remediation or environmental exposure?,” which you said it could. So it was a productive dialogue, but the point is not ever being too excited about any one thing, and really asking yourself, “Am I sure this is what’s improving things? Am I projecting bias?” Let’s say someone comes in saying they feel a little bit better. If someone says that when they’re seeing a doctor that they have confidence in, if you’re factoring out the placebo effect, “a little bit better” to me is a zero.

DrJM:

I agree.

DrMR:

So a little bit better means this treatment that I’m jazzed about may not be working. Let me continue to make that observation. And then also if they are improving, maybe people are doing other things at the same time. Maybe I’m telling people to change their diet, to go to bed earlier, and do treatment “X” that I’m excited about. So how confident can I be that it’s actually treatment “X” that’s vectoring the benefit? I think that’s one way of trying to prevent yourself from seeing what’s right or helpful as compared to what’s not.

DrJM:

So maybe one way to restate that answer would be, to a doctor just starting out in Functional Medicine, do one thing at a time with a patient and observe what happens. If you’re a young doctor, you hopefully have more time with your patients, so you can take a group of patients and just put them on a paleo diet. You could just give them probiotics. You could just tweak their sleep, and then you have the luxury of more time. So instead of saying, “Okay, do that for two months,” you might say, “Just fix your sleep for two weeks, then come back in.”

DrMR:

That’s a great comment, especially because I think it’s really dissonant too, the pressure that new doctors feel, which is wanting to do everything they can to help the individual. I felt this pressure myself. In fact, we were talking about this last night. When I started doing less, I almost felt a little bit nervous. Like if I don’t give adrenal support and vitamin D and antioxidants, they may not feel better. And that’s understandable; that comes from a good place, but in my opinion it’s actually very antithetical to becoming a better clinician. To this whole point, doing one thing at a time gives you a better ability to register what’s helpful and what’s not helpful, and if over a year and a half, you’ve been able to suss out half a dozen things that are helpful, and cut out half a dozen things that aren’t helpful, you are now much more clinically proficient than your competition. But you have to take that leap of faith that more is not better. More testing is not better; more treatment is not better. People generally don’t tend to be upset when you do less, especially if you explain that you’re going to work through this methodically. I think that’s a really important thing for new doctors to take away, which is don’t try to just shotgun you’re way into results.

Unhealthiest Things

DrJM:

Great. All right, next question. What is the most unhealthy thing you’ve done in the last week?

DrMR:

It may have been last night.

DrJM:

I was going to say, I think I was there.

DrMR:

Not that it was supremely unhealthy, but we went out and had a few drinks. We were probably up until about 1:30, so I would consider that a “worth it.” There were a few deep belly laughs, and I think the medicinal benefit of that unbridled laughter is really important, and were minimally disruptive to the day today.

DrJM:

Hopefully we’re coherent right now.

DrMR:

Yeah, yeah.

DrJM:

All right, good. Got it.

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Functional Medicine’s Future

DrJM:

So a big picture question. In five years, do you think conventional medicine will look more like Functional Medicine, or do you think Functional Medicine will become more conventionalized?

DrMR:

Great question. I think conventional medicine will probably continue somewhat on the path that it’s currently on. I just don’t see there being enough incentives for the system to fundamentally change, nor do I know that it needs to. I think conventional medicine does a certain host of things, and that functional and integrative alternative medicine do other things. I think the best strategy would be to allow both of those fields to continue to develop in their own spheres, but to have more collaboration between the two. I don’t think that functional and alternative medicine will look more like conventional medicine. My fear is that it actually continues to evolve into this kind of heresy, this field where there’s just a hellacious lack of thinking critically, questioning if things actually work, treating lab markers instead of patients, and treating theories instead of actually looking for reinforcement that the theory holds vis-a-vis someone actually having some dramatic improvement.

DrMR:

My fear is that there’s going to be a further de-evolution into that, and even worse yet still that regulatory bodies have stepped in more and shut down certain realms of alternative medicine. We’ve seen this in the wake of COVID, which is one of the reasons why irrespective of what you think about COVID-19 and what your feelings are, the more we allow agencies to regulate if you can say anti-vaccine things, or if you can’t say them, we allow things like the Weston A. Price foundation to be taken off of Facebook. My fear is that this continues to run away and the other realm of opinions regarding healthcare outside of conventional medicine gets regulated and shut down. That does a huge disservice to individuals. Now sure, there’s benefit in shutting down some heretics, but I think the net outcome would be one that’s very, very dire in that only the most conventional paradigm of information is allowed to circulate on the internet, and it really holds people back from accessing the information that they need.

DrMR:

So that would be my fear that as our community doesn’t bridle itself it goes more in the wrong direction, and we’re going to put more of a bullseye on our back where it becomes so egregious that it’s not just a couple of bad apples. It’s like there’s a growing cohort of bad apples, so much so to the point of impact where we now have to step in and regulate. That’s one of the reasons why I think providers need to be much more mindful of what they’re doing and what they’re saying.

Functional Medicine Pet Peeves

DrJM:

I was going to ask as one of the questions, what is your biggest qualm with Functional Medicine? I think that’s probably it.

DrMR:

Yeah, I think there’s really just…

DrJM:

Just irresponsible claims?

DrMR:

There’s such a pervasive lack of thinking and people just trusting what they’re being told is correct. A friend of mine just sent me her stool test and said, “My doctor says that I need enzymes and HCL and this or that.” This is a person who has zero symptoms, who is in excellent health, and she had a slightly-elevated fecal fat on her stool test. The over-read of some of these tests is just unbelievable. People have to really start thinking critically about building a case, and I’m hoping one thing that we can really put a dent in is arming people with a different way of thinking rather than just this gurudom of just following the labs, following the protocol, and then providing a way of thinking that you can apply to anything. I think it’s well-intentioned, but man, the amount of people who are just vacuously treating labs and following guru protocols, it’s not right.

DrJM:

And that’s the majority, the vast majority.

DrMR:

We are smarter than this. I think this is partially an extension of the academic system. It’s just rote memorization and regurgitation, and I don’t think people are being equipped enough with critical thinking skills.

DrJM:

It seems to me that high-level, you have a lot of patients who are disserved by the conventional physicians that they’ve seen. The physicians are really well-equipped to rule out the big problem conditions, and that’s where the majority of conventional training is going. So you see a doctor, and that’s why they’re very quick to dismiss, “Oh, well, there’s nothing to worry about with the bloating,” because they’re thinking, “I don’t have to workup for colon cancer with this person. This person doesn’t have malignant mesothelioma,” or whatever. But then the patient is left still not feeling better. So the natural next step is to go to alternative medicine, and when a convincing alternative medicine practitioner throws a boatload of tests that conventional medicine doesn’t know about, it’s very appealing to think that those are all the answers.

DrMR:

And corresponding diagnoses.

DrJM:

The trap is that those diagnostic tests may not be as black and white as doctors and patients hope.

DrMR:

And have been led to believe.

DrJM:

And have been led to believe. So Michael, what is the solution to that?

DrMR:

Well, I think the solution is in part just realizing that. It took me a while to figure that out because no one really says this. No one really says, “Hey, be wary of labs.” Especially progressive labs that are a little bit ahead of maybe where the science is. This is one of the things when you’re on the cutting edge, there’s a pro and a con of the cutting edge. It’s often, “We’re on the cutting edge!” It sounds great, but you don’t want to be the first patient to go through a protocol. I think that’s one of the biggest mistakes that patients make, saying, “I want this to be totally customized to me.” Sometimes the term “cookie cutter” is thrown out as a derogatory term.

DrJM:

I have a few patients who will say, “I’d like to be a Guinea pig for that.”

DrMR:

Right, right. What you want a provider to say is, “Yes, this fits a pattern that I typically see. It responds very well to ‘XYZ.’” But for some people and for some providers, they want this “everyone’s a unique snowflake” approach. Well, that stinks, because you’re starting from square one every single time, and that’s not good. That’s not what you want. Even as, let’s say, a skilled physical therapist, if you go in there and you have a sore hip, do you want them saying they’ve never seen this before? You want them to say, “This looks like sacroiliitis, oftentimes caused by this. Let’s see how your strength is there. Oh, yep, it’s weak there. So typical pattern that I see. Responds really well to ‘XYZ.’” Awesome, that’s exactly what I wanted to hear.

DrMR:

So yeah, I think the reason why people aren’t better is because of these unbeknownst things that all these labs will tell us. It puts the onus on the labs and not on the clinician to just think critically through, “Okay, well, let’s look at this person. They’re having fatigue, brain fog, and bloating. Let’s look at their diet. They’re eating paleo and they’re eating tons of fiber. They’re going to bed at 12:30 and they’re exercising once per week.” Maybe we can get a lot out of that. And then maybe everything goes away but the bloating. Do we need a test, or is there a boatload of research on probiotics for bloating or elemental dieting for bloating?

DrJM:

If only there was a clinic that took this sort of thing seriously and built that into their model.

DrMR:

Yeah. So I think you get a lot further with thinking about what therapeutic interventions have been shown to be helpful. How can we use certain markers, meaning historical or symptomatic markers from the patient, to steer them toward whatever treatment, hence an algorithm? That is vastly more effective than treating lab markers, within some exceptions. There are some things that are clear-cut. Depending on who you ask, but according to our evidence-based paradigm, it’s pretty straightforward when someone’s hypothyroid and when someone’s not. So that would be an exception where the labs are fairly clear-cut, but oftentimes when it comes to GI and some of these symptoms that are vague, like joint pain, fatigue, insomnia, and brain fog, you could find so many, like if they have MTHFR and they have COMT and their adrenal ratio is a little bit off and their T3 is a little bit low. There’s not great data showing that. Has there been a trial of 50 people with low T3 who also had insomnia and brain fog who were given T3 and we saw an acceptable resolution rate?

DrMR:

No. There’s just theory from the gurus. “Well, you’re on a cellular level. Your cells are starved for metabolic stimulus if they don’t have enough T3, therefore…” And that’s the jump that’s kind of killing us. If we can instead just say, “What interventions have been shown to be helpful for these symptoms?” How can we look at the person and what we know and be able to say what could be an option for them, and then layer that with what have they already done to refine that even further? That’s the basis of our clinical model, and it works really well.

DrJM:

We’re really proud that it lets us keep the cost for patients much lower than the average Functional Medicine practitioner. It’s just night and day, and we feel that we get better results, because when you start with those lifestyle principles, you often see quicker resolution. So that really should be the basis of where patients start. Okay, let’s see if I can get you off of your Functional Medicine pet peeve list.

DrMR:

Yeah, don’t get me started on that one.

DrJM:

We only have an hour, Michael.

DrMR:

I know.

Impactful Reading

DrMR:

Has there been one book, mentor, or idea that has been most impactful for you as an entrepreneur in business?

DrMR:

There’s been a couple. Deep Work by Cal Newport, which I think I’ve mentioned on the podcast a couple of times, has been really reaffirming. One of the things that I’ve fallen my way into is, like we just discussed a moment ago, those deep work blocks where there’s no distractions. Someone in my position has a lot of people I’m co-working with on our team, so without really being vigilant about preventing my deep work from being interrupted, I could just constantly be servicing WhatsApps, Slack messages, text messages, emails, phone calls, and meeting. I haven’t done that; and to whatever degree I’ve been successful, I think that’s been a key reason for that success. When I read Cal Newport’s book Deep Work maybe three months ago or so, many of his concepts were the same things I was doing.

DrJM:

I’ve seen you systematize it, and I’ve seen you double down on that approach. I think that helps keep at least the clinic and the podcast pretty high-level and focused on where it’s supposed to be.

DrMR:

Thank you. So Deep Work by Cal Newport would be one, because for most people, if you’re in the field of knowledge work, the most valuable asset you have is your thinking. It’s not just emailing and little ticky-tack problem solving things, it’s really trying to do this grand goal that I have. Usually things of substance aren’t easy to do, and they require a lot of problem solving and strategic thinking. I don’t see any way to get to that outcome if you’re not partitioning yourself away from all the interruptions and then thinking deeply. So that would be one.

DrJM:

It’s harder to do these days with more and more invasive technology, but probably more important, and you get more of an advantage to the degree that you’re able to successfully do it.

DrMR:

There’s this interesting effect called the Matthew effect. I believe it’s taken from that Leviticus passage that paraphrases down to, “To he who has all shall be given, and to he who has not all shall be taken away.” I think technology will allow people who are capable to do more, and people who are incapable to be further distracted by cat videos on Instagram. I see it as a serious problem where people who don’t do this well, there’s just this abyss of distraction that they can wallow in. And then people who are using technology the right way, man, they can just dial up their efficiency.

DrMR:

Tying into what you said a second ago about systemization, one more that I think is really worth mentioning is Principles by Ray Dalio. It was an excellent read. He uses this analogy that again was something that I found I had been doing, and just hearing someone else talk about it made me even more confident in doing it. It was looking at an operation as a complex machine that you sit atop of, and you’re tweaking gears and you’re tweaking all these different gear wheels as they fit together. You’re smiling because I always use the gear wheel analogy. I probably took it from Dalio.

DrMR:

The other thing along with that is looking at your operation as a complex machine, and therefore if your machine isn’t working, you don’t get mad at the machine. So I don’t get mad at the people in the organization; I fix the process. You fix the gear wheel. So I think that really helps you step outside of the operation and look at it as something to be fixed and tended rather than demanded of. But the other that was key for me was looking at what you do that you think only you can do and challenging yourself to find a way to take that out of your head and teach it to other people.

DrMR:

The FFMR Plus research briefs is a great example of something I thought only I could do, just going through the PubMed email alerts thread, throwing out what didn’t matter, keeping what did, and then even going through what did matter and making summary points of the facets of that article that did have an impact. But it’s interesting to say, “Okay, let me just continually monitor what I’m doing.” When you’re continually monitoring the thought processes you’re going through when you’re doing that work that you think only you can do, you figure out that there’s a certain decision algorithm or decision tree I’m following. There’s the title of the paper, do I click or do I not click? There’s the abstract, do I read or do I not read? Now I’m reading, do I know or do I not know? And so I broke all those out, and I’ve taught those to Gavin, and it takes some time and oversight where, coming back to the machine and the gear wheels, you’ve got to calibrate and refine, calibrate and refine, calibrate and refine. But then when it works, you’ve taken that algorithm out of your head, and now that algorithm can be given to one, two, three, four, five people and so on. And so now you could have a team of people doing what you thought only you could do before.

DrMR:

This ties in with another book, The Psychology of Achievement by Brian Tracy. He talks about The Law of Integrative Complexity, which essentially states that he who can assimilate and integrate the most knowledge in a group of people will eventually come to dominate the others in the group. Now I don’t like the word dominate, but it gets across the expression of if we’re competing to be the best clinic for people, if we can assimilate and integrate the most information, we will eventually rise to the top as the best clinic to help people. And so that example of Gavin holds there, where now Gavin’s giving us and all the doctors in the office and all the FFMR Plus subscribers those research briefs, and those really help keep you on the cutting edge.

DrJM:

It’s really good, everybody. If you haven’t signed up, you really should.

DrMR:

It’s been just phenomenally helpful. And so imagine when we said, “Okay, we want to also build out more in the realm of cardiovascular care.” Now we could even have an FFMR Plus GI Thyroid, or an FFMR Plus Cardiovascular, and all those things can grow because it’s not dependent upon the one person who was good at it. It’s just get the process, teach others, and now we can really have more of an impact collectively.

DrJM:

That is so cool.

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Importance of Meditation

DrJM:

All right. Because I’m taking over your show, you said something that I want to double down on. You said you have to look at your thinking. Maybe five or seven years into my Functional Medicine practice, I took a class on mindfulness-based stress reduction and learned how to meditate for the first time. One of the pieces of advice I may have for practitioners just starting out is to learn to meditate. Get good enough so that you can routinely observe your own thought patterns, because that’s what gives you the purchase to be able to check yourself, to check and understand your own biases and the biases of others. So having that leverage to be able to see your own thoughts, not all the time, but enough, I think is a really important skill to develop. So if you don’t know how to meditate, you probably should learn. It’s one of those things that you can practice. It’s an achievable skill and very well worthwhile. There’s my soap box.

DrMR:

It is hard to learn how to look at your thoughts, but it’s really valuable because it carries over to something else that we were talking about earlier and I think is worth just echoing. If you can catch yourself when you’re thinking something biased and hear that voice in your head say, “Oh man, this is super helpful.” And then another voice can say, “Are you sure it’s helpful?” The first voice says, “Well, I know it’s helpful because they’re feeling better.” And the other voice says, “Yeah, but they also changed their diet.” And the other voice says, “Oh, you’re right.” If you can have that ability to see your thoughts as another person in your head, I suppose, and have that bandying back and forth, that can help you not have a biased thought pattern.

DrJM:

It’s actually not that hard to achieve. My friend Dan teaches the MBSR courses and he tells me that it’s an eight week course and upwards of 75% of people who complete the course gain that ability.

DrMR:

I think it’s difficult at first if people are not used to doing that, but once you start doing that, I see that as a gift that helps you as a clinician, as a business owner, as a husband, wife, father, friend, because that auto-correct mechanism will then permeate all of your thinking. It’s not partitioned to one area of the brain or one realm of thinking. So that is a tremendous gift that will just pay huge dividends.

DrJM:

What a fun topic. All right, so moving on to the next question. In your opinion, what is better for patients? A high-dose thyroid hormone, or a high-dose methylation?

Thyroid Treatment

DrMR:

Oh jeez, I love this false choice. I see them both being damaging. For obvious reasons, I think the high-dose thyroid is more damaging by causing insomnia, ironically fatigue, and anxiety. And just as a reminder for our audience, this is something that we’re probably finding at least one case per doctor. I don’t want to speak too far out outside of my observation, but I’m assuming yours is pretty similar to mine, Joe, as is Rob’s, we’re finding about one case per week who has either been incorrectly diagnosed as hypothyroid or they’re just way over-treated for thyroid.

DrJM:

I’m working every Tuesday at the ACFM, and I’ll take on average two new patients. And typically with one, I’m either questioning if they’re on too much thyroid, or it’s pretty clear that they’re on too much thyroid.

DrMR:

It’s amazing how prevalent this is.

DrJM:

So maybe it ends up being one out of four or one out of five patients who enter Functional Medicine. What do you think, is that about right?

DrMR:

Yeah, and that correlates with two data points that reinforce this observation. There is the Luvatis paper from Journal of Thyroid 2018 where he took patients who had ambiguous diagnosis and took them off their thyroid hormone. They retested six to eight weeks later and 60% of them were not hypothyroid. To Dr. Rob’s credit, he found a meta-analysis, and this is a meta-analysis not just one paper, that shows up to 30% of patients can successfully come off of thyroid hormone and remain totally normal with their thyroid function. It wasn’t 30%, but it was up to 30%. So that’s 30% just in a clean slice of patients. And then Luvatis’ paper is probably more squarely representative of Functional Medicine, because it’s the ambiguous shoehorning you into the thyroid diagnosis. It’s unbelievable to make this claim, but we could say anywhere between one-third and two-thirds of patients may be incorrectly diagnosed with a disease that has lifelong thyroid hormone medication as a treatment. That is egregious in my opinion. I think in anyone’s opinion that’s egregious.

DrMR:

Now where it breaks down is, “Well, what you’re not seeing is they’re fatigued because they may not be true hypothyroid, but their cells are starved for T3,” but there’s never any good evidence for this. Credit to the FFMR Plus, this is something that I just came across while brushing my teeth one morning as I’m listening to the audio read of the notes. It was a Danish cohort study. I believe it was 400 individuals with subclinical hypothyroidism. So this means they have flagged high TSH and somewhat normal T4, although I’m sure some of those people had functionally low T4, but they were in the conventional normal range paired with flagged high TSH. And there was no difference in symptoms between those people versus healthy controls. So upon scrutiny, this claim that thyroid is the root cause of all these symptoms doesn’t hold.

DrJM:

You would expect to see outcome data, and there’s plenty of studies on cardiovascular mortality in treating subclinical hypothyroidism. The claims just don’t hold out. This has kind of been beaten to death. So we’re going to stop beating to death; we’re going to leave that one alone.

DrMR:

So just to tie it up, we should see some signal there. The only support I’ve seen is that it’s all theoretical. It’s cellular level, it’s mechanistic, the thyroid gland releases it.

DrJM:

My suspicion is that a lot of the benefit that practitioners are seeing is simply placebo. “Hey, John, I know you’re feeling so fatigued, but look at this. Your doctor has missed it that your free T3 is 2.5, and I really, really think that you’re going to feel so much better if I just get this up to three. Most of my patients are coming in feeling awful, but when I get them up to 3.0, man, they feel great.” It’s very hard for a patient not to internalize this. This is one of the problems I think that clinicians need to be aware of, their own effect on patients.

DrMR:

This is where all these gear wheels fit together. If you start questioning your clinical observations, such as that could be placebo, which is an excellent point, and you start questioning that what you’ve been told is incorrect, and maybe you fact-checked your references and you see that the references are low-quality references. This is how if you shift your paradigm, you’ll find your way out of some of these fallacious practices.

DrJM:

Fantastic, fantastic. Well, as a listener this is fun because these are the kind of questions that, I would have liked to hear. And I’ve got more here, but I was going through Dr. Ruscio radio on Spotify, and you’ve been going since at least 2015, so there’s a lot of episodes here. But the Spotify actually says the first podcast was like 1970, so I think they might have the date wrong.

DrMR:

No, for a short term, it was really expensive to keep it up, I had a time machine, but the upkeep was not worth it. The plutonium driver was, my Russian connection fell through.

Advice for Patients

DrJM:

All right, here’s a a fun one. If you could wave a wand and have every single one of our patients at the Austin Center for Functional Medicine do one of three things, what would it be? You could either have them walk 20 minutes a day, do a 24-hour fast once weekly, or you could get them to sleep 30 minutes more a day. So waving a wand, all of our patients across the board, this gets added onto whatever else they’re doing.

DrMR:

I’m going to assume for most people it’s going to be sleep. Those are all very challenging, but sleep seems to be the one thing that I’ll feel the biggest difference from.

DrJM:

And then what’s number two, the 24-hour fast or walking 20 minutes a day?

DrMR:

Probably the walking.

DrJM:

Probably the walking? I think this is one of those questions where it might depend on the patient’s subtype, but we’re waving a wand here, we’re not subtyping.

DrMR:

Yeah, because if someone’s already getting a fair amount of activity, then obviously walking is less important. But foundationally, I would say the movement would probably be more important than the fasting.

Personal Pet Peeves

DrJM:

Okay. What is your biggest personal pet peeve?

DrMR:

With myself, or just?

DrJM:

Sure.

DrMR:

Probably having a hard time stopping working. It’s something that I’m so passionate about and believe so strongly in what we’re doing, that it’s easy for work to push other stuff out. I’m continually trying to work toward being able to have a large and substantial impact via working less hours, but things keep popping up. Like right now, I’ve been pretty locked in on growing the clinic, meaning making sure that our clinical systems and standards are exquisitely high. And as Hannah and Omar have onboarded, making sure that their training and our communication as a team is just exceptional. Why I’m just so focused on that is because if done the right way, we become better as a team rather than the clinic drifting into being disorganized and not as effective.

DrMR:

As an example of that, because we’re all using the same systems now, the ability of a patient to work with me, and then you, or Hannah, and then Rob, it’s exquisitely high because we’re all building out our DDX, our differential diagnosis or our problems list, and our treatment hierarchy, our note-taking, our data hubbing, and our dashboard exactly the same. And so when I go into someone else’s chart, it’s all in the same structure. And so you don’t really miss a beat, and why that is so appealing is because it allows us to grow effectively, and probably even grow better, because now we can data mine really easily from all those files. But to tie that into your question, I haven’t responded to more than like three emails in the past two months. I just don’t email anymore because I don’t care. This is just too important. And if people on the team need me, they know how to reach me for important things.

DrMR:

My playing piano has totally gone by the wayside, which I’m sad to announce, but I also feel good about it in terms of this being such important work that I’m okay with a short-term sacrifice for a longer-term game. Because this isn’t work that has to be done in perpetuity, it’s work that establishes systems and then those systems should be able to self-perpetuate. So my one gripe with myself would be probably working a bit too much, and being able to turn it off because it taps into a deep vein of meaning and purpose. And I see these people coming who’ve been just so harmed that it’s hard to just cut out 20 minutes early. Because again, it’s just really deep and meaningful work.

DrJM:

That is fantastic. The one thing I just want to say is that Dr. Hannah and Dr. Omar are going to be rock stars, and they are so sharp. If you’re a listener and you’re looking for help, we are working very hard, and Hannah and Omar have just melded in so tightly. They are such a huge benefit to us already, and they’re just getting started. So if you’ve been thinking about joining our clinic, please come in and work with us. We’re ready and growing. The more people that we bring in, I think the more diverse opinions and views will get in. It won’t just be Michael and Rob and my ideas in a vacuum. We’re going to be building a system where lots of ideas will compete and win, and we think patients are going to be the beneficiary. So if you’ve been thinking, man, now’s the time.

Personal Drive and Motivation

DrJM:

All right. So let’s see, what do I want to harass you about next? Let’s just stay on that drive for a minute. People who’ve listened to the podcast have probably figured out that you’re a pretty driven, intense guy. But the more I get to know you, Michael, you’re also very thoughtful. Most people who tend to be as driven as you are, are not reflective. They’re pretty much just charging blindly into traffic. So my friend, where do you think that drive comes from? Given that you do reflect on this, do you have an idea?

DrMR:

I do. I think we touched on this briefly, but to whatever extent I can say this without sounding self-aggrandizing, I’ve always seen inefficiencies in thinking and in systems. I remember being like 15 years old, working at the insurance company my father was a higher up at, and he got me a summer job at the mail room carrying mail or something like that. I’m reporting to a guy who’s probably 40-something, and I remember after a few days, I’m thinking, “This could double in efficiency if we did that. This is inefficient; that delivery route is inefficient. This filing system is inefficient.” And when I was a lifeguard working at a country club in high school and college, I just remember seeing all these things that were just unbelievably inefficient and poor management.

DrJM:

They must’ve hated you as a lifeguard.

DrMR:

Well, I had to learn where to say things and where not. And you learn pretty quickly that some people are so insecure that they can’t. It was actually funny to see that the more successful operations I was involved in, the more those observations were fostered, and the less successful operations, less successful people, the more they were shunned because people were too insecure to act upon them. So as I’ve gotten older and into healthcare and done the same thing with those ideas, I just can’t let bad ideas win. And I guess for me, if I’m being totally candid, looking around and just seeing some of the C-R-A-P that’s being peddled in the field, and how some of these people have big platforms and lots of influence, I can’t die feeling like I didn’t provide a very solid refutation to that work, or to those wrongs.

DrMR:

I may have told us on the podcast before, so sorry to our audience if this is trite, but when I was doing psilocybin recently, I had a deeper level connection of where some of that comes from. I went to the botanical garden at Tilden Park in the Berkeley, California area. I’m walking in the botanical garden, and as I’m walking the psilocybin kicks in. One of the things they report about psilocybin that’s definitely true is that you kind of have this pseudo out of body experience, meaning you kind of see yourself almost like you’re a stranger watching yourself walk by. I remember looking at myself and being like, “Man, you’re a goon.” I’m like 6’1″, 215, fairly muscular. I’m walking like dum, dum, dum, like Shrek just like walking through those gardens. But the follow-up afterthought was, “You kind of have the build of a soldier.” So if we were way back in time, I’m pretty sure I’d be a soldier and not like a potter or something like that. Like the king would be like, “Yeah, you’re going to fight.”

DrJM:

No, I will reorganize the lifeguard schedule, our king.

DrMR:

Too many interests, yeah. But I remember then connecting with being here to fight the battle for people’s health and for people’s thoughts. So the battle that I’m fighting as a warrior isn’t necessarily one with swords and shields, but it’s for the thoughts and the well-being of individuals, and I’m fighting against the charlatans and the snake oil salesmen who are trying to dupe them, or in some cases just have bad ideas and bad thought processes.

DrJM:

I think that you have to separate between the people who maybe have been taught incorrectly or are misguided versus the practitioners out there who are fleecing patients to the tune of tens of thousands of dollars.

DrMR:

Yes, one hundred percent. And that’s why I’m trying to give the benefit of the doubt where some people may be doing what they think is best, but it’s not actually.

DrJM:

That’s probably the vast majority.

DrMR:

I would agree. But when I’m in this kind of spiritual realization state, it’s much more black and white. When I come up and cognize through it, those things all filter through, but at the root level, there’s forces in the world that are hurting people. And this is the person who’s been on thyroid hormone for two years by Dr. Guru so-and-so, and every three months they change the formula and she feels crappy and the whole way. Then they come into our clinic and two months later she feels fine and breaks down crying because she says, “I want that two years of my life back.”

DrJM:

It’s so hard to hear that.

DrMR:

Yeah, and so it’s that which really forges me into that warrior archetype. It’s like fighting on behalf of people for people, and that’s why I think the Hans Zimmer music and some of the superhero themed music are having so much more appeal because I really feel that there’s a war being fought, and one of my strongest archetypes is that of a warrior. And that’s where a lot of the drive comes from.

DrJM:

That is awesome. That is awesome.

RuscioResources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/Resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of. The fact that we deliver, cost-effective, simple, but highly efficacious, Functional Medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health-supportive supplements. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one, or are reading about a product and you need some help with how or when to use, or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you are a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review. I’m very proud to say, we’ve now had doctors who’ve read that newsletter, find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/Resources. Alrighty, back to the show.

DrJM:

Are you up for one or two more questions?

DrMR:

Yeah, we’ve got some protein, some greens, some water, some espresso. We’re pretty much set up.

DrJM:

We’re pretty caffeinated right now.

DrMR:

We just need a catheter.

DrJM:

Oh yeah, well we didn’t didn’t bring that.

DrMR:

Try the greens, that green is really good.

DrJM:

The beet juice was very gingery.

DrMR:

Give a little shake.

DrJM:

Yeah, we are outdoors recording this podcast and it is wonderful.

DrMR:

This new podcast setup is nice because you can sit outside. I mean the background noise should be mostly filtered out by this headset system.

DrJM:

Hopefully this helps people understand the Michael behind the curtain.

DrMR:

Without thinking I’m too nuts here, we’ll have to look at the social media comments carefully.

Favorite Childhood Memories

DrJM:

So do you have a favorite childhood memory?

DrMR:

Good question. There’s one that just pops in my head reflexively. See how much of a guido I am, I was at my Uncle Mario’s house. I think at this point it was at Virginia Beach and man, everyone from the family was there and we were cooking a bunch of food. There were so many people in the kitchen that it was almost like being on a subway, and everyone’s talking and laughing and handing stuff over each other and alongside people and food’s moving all over the place. They’re talking and they’re laughing and it’s like this loud, jovial, Italian family. I remember having one of those, looking at that situation from the outside looking in, and saying, “My goodness, this is just such a wonderful, warm, engaged, funny family experience.” So that’s what pops. The kitchen was like a subway. It was amazing.

DrJM:

Probably smelled pretty good in there too. It’s got to be nice to have that security of that family around. That’s pretty important.

DrMR:

I do think that it’s been really helpful in allowing me to take risks and just start off on good footing, just having a really loving, supportive family. There were times when I was first starting my practice that I had asked my parents to cover my rent for a month here and a month there, because when you’re starting a clinic from scratch, that doesn’t happen easily and you take on expenses of overhead and limited staff, but some staff. And then marketing, it’s a lot of expense to take on, which is why as the clinic has grown, we’ll take on a new doctor and they book out so quickly. It’s just like, I am so overwhelmed with gratitude, because coming from a spot where it took years to get two days in the clinic booked out, and now we can book out a clinic day for a new physician in the office in a couple months. It really makes me appreciate that.

DrJM:

It’s a privilege. It’s great. It’s been a long time coming, but that’s awesome. That is fantastic. I just want to make a plug for the Gupta program with that childhood experience of a stable family unit. I had much the same. I had a big, large, Catholic family and very vivid memories of lots of cousins and my grandma and everybody packed in watching Notre Dame football. I’m a big Notre Dame fan. I remember that feeling as well. Many of our patients did not have that stable of an upbringing, and that causes changes to your physiology and to your body. And for those patients, if there’s been trauma, neglect, abuse, limbic system repair, the Gupta program, or Annie Hopper’s work, DNRS, has just been a game changer. And so, again, some of the deepest underlying causes are things that we can fix. These limbic things can be changed.

DrMR:

It’s really important to mention that.

DrJM:

Sorry to derail, but it’s so, so important for patients, particularly the more complicated people who’ve been traumatized by Functional Medicine. These are patients who’ve had been traumatized in multiple ways, and I think being financially abused or treated inappropriately is another form of trauma. I think one of the things that we can do is acknowledge that and tell them that there’s a way out. Hopefully we’re contributing to that, but people are traumatized by too much medical care sometimes. It’s not just the conventional hospitals that are traumatizing people.

DrMR:

To shift gears back to your other question, because there was the dry piece, and then there was the thoughtfulness piece. There’s one thing I just want to tie in to whatever degree any clinicians or business owners who are listening to this may benefit. I’ve really found that the more you take care of and care about people in your organization, the better the performance you will get is. I think it’s something hard to wrap your head around at first, especially if you feel like someone’s not doing a good job or frustrating you in some way, there’s kind of this, “Why aren’t you doing a good job? They must not care, or they must not respect me.” Now, you have to qualify that you’ve selected the right individual, but given that you have, if you’re having those feelings, it’s usually a process problem, a communication problem, or a lack of support for that individual.

DrMR:

I’ve just really found that to do substantially impactful work on a level of scale, you must have people. And if you can’t figure out how to support people and get people to work together, you can’t have much impact, because one person alone will never out-compete a team of six or 12 all working together. So that caring is just a reflection of valuing the contributions that people are making and valuing that I can’t do what I want to do without other people. Like, I can’t work any more right now, so any more that I want to do is fully dependent upon other people. So that puts me in a situation of you being an extension of me, and if my performance isn’t good when “XYZ,” nor will yours be. So it’s intelligent for me to make those a focus and make sure that you’re as tuned up as a person as you can be, so now we’re both rowing the ship, and you’re healthy and you’re strong, and I’m healthy and we’re strong, so together we’re going to move. And I don’t think that perspective is embodied enough.

DrMR:

Now, the one other thing that this holds hands with and is crucial for is that you have to have a good selection process for new people in your organization so that you’re confident that the person you’re considering, you’re working with, and you’re trying to develop has the skills and has the aptitude. Part of that is just refining a screening process for new employees, but if you’re confident in the person, then if you’re not getting the performance that you want, there’s usually a systems communication or support issue that hasn’t been fully given to that individual, for whatever it’s worth.

DrJM:

Got it. Michael, this has been fun.

DrMR:

It’s been great. Hopefully the audience hasn’t fallen asleep.

DrJM:

Well, the nice thing about podcasts, they could just skip forward through the boring parts, right?

DrMR:

Yeah. Well, thank you, Joe. I appreciate you interviewing me and all your growing contributions to the team. You’ve really stepped up and I think you’ve really taken to a lot of these concepts very, very quickly. It’s been exciting just to see how effective the clinic team can be, because it’s a newer thing for me, being in a clinic team setting, where it was just me in solo practice before. I wasn’t sure at the outset how this is going to go, and now I’m seeing how, my goodness, this is going even better than I thought it was going to go. A big part of that is credit to you and Rob with the ACFM 1.0, and just saying holy smokes, whatever concerns I had about this getting tumultuous with a team instead of one person are totally allayed. I’m actually quite excited because as we grow, things are just getting better and better. So I just want to give you the just hat tip for your work in that direction.

DrJM:

Well thank you. It’s been fun, and I think it’s going to keep getting funner. Love it. Well, I think we need a bathroom break and probably more coffee.

DrMR:

All right, well thank you, Joe, and thank you everyone.

DrJM:

All right, bye.

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 D R R U S C I O dot com.

 

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