Answers on PCOS, Vertigo, and Chronic Infection Testing

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.

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: What should I do if I think my supplements for hormone balance are causing depression? Is there a connection between vertigo and SIBO? If I see Giardia on a patient’s GI-MAP test, is it worth targeting and treating separate from other gut issues? Where in your hierarchy would you test for chronic infections like Lyme, herpes virus, and Epstein-Barr? Should urine mycotoxin tests be provoked or unprovoked? Is there a risk to staying on the low-FODMAP diet for three to six months? Is it okay to eat nutritional yeast? How should I protect my gut before, during, and after taking an antibiotic? And, does your practice help people with mold?

ER:

Well, thank you everybody who submitted your questions this week. 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 back again with Erin Ryan, and we are going into listener questions. Hey, Erin.

ER:

Hey!

DrMR:

Let’s jump in.

Hormonal Supplements

ER:

Cool. Our first question is from Myra. She says, “I’m 38 and have PCOS. I started taking these hormonal supplements, Estro-Harmony and Progest-Harmony about a month before my cycle, and I noticed it helped some of my PMS symptoms, but I had a major change in my emotional state. I’m not a depressed person, but I can only describe the feelings as very low and depressed. I even had thoughts about not caring if I was alive anymore. It was really scary. Is that a sign of my hormones trying to regulate with the supplement? I stopped taking it for now. I liked that my cramps and bloating weren’t so bad, but the depression part really scared me. Any ideas?

DrMR:

You’ll see this sort of reaction with female hormone support herbs in maybe 5% to 10% of women, in my observation. It’s fairly uncommon, but it definitely does happen where their moods get worse. Now, that could be one of the two formulas, because you started using both Estro-Harmony and Progest-Harmony. So what I’d recommend you do is continue on the path you’re currently on, which is to stop, and then you should see the symptoms abate. Restart them one at a time and see if you can pinpoint where that reaction is coming from. It’s almost for certain not coming from both, but rather one.

DrMR:

Let’s say it was from the Progest-Harmony. I’m not saying one of these is more likely to cause a reaction than the other, but just using that as an example, you could then try single ingredient versions of the ingredients in that formula, because it may just be one of the ingredients that you’re having a negative reaction to. And that’s what we’ll do in the clinic. We’ll oftentimes use some herbal liquid tincture, that single ingredient, in place of a multi-ingredient formula. So no, that’s not abnormal. It happens in a small number of cases. It usually goes away fairly shortly after someone stops using a formula. And it’s either some type of reaction or just the compound agitating your system.

DrMR:

The other thing to keep in mind with PCOS is blood sugar regulation. I’m sure you’ve probably already heard about it, but blood sugar regulation and higher blood sugars is something that can drive PCOS, as is inflammation. You probably know that, but it’s worth mentioning that a reaction then occurs in some people with the herbs. Stop, restart, and see if you can pinpoint. Those can be taken in isolation. They don’t have to be taken together, and that still may move you in the direction of seeing some improvements in your female hormone symptoms. But the fact that you saw some symptoms improve is a good sign and more likely this is just needing to personalize the formula to get around what’s probably some sort of intolerance reaction to one of the specific ingredients.

ER:

Okay, fantastic. I hope that’s helpful, Myra. Our next question is from Kelly.

SIBO and Vertigo

Kelly:

Hi, I have been diagnosed with SIBO and I’ve been trying to manage it for the past couple of years. I wondered if you’ve ever had patients with chronic vertigo as well? It seems like every time I get my SIBO under control, my vertigo gets worse. And of course, being tired all the time doesn’t help vertigo at all. So I just wondered if you have any advice on the topic of vertigo. Thanks.

DrMR:

Yes. A few things here that could be going on. Firstly, it’s helpful for me to know if this is true SIBO or if it is just symptoms that are IBS or IBS-like. I just say this because we want to be careful not to feed into this, “Well, it’s SIBO, it’s H. pylori, it’s candida.” Your gut could just be sensitive. People like to criticize the IBS diagnosis, but it’s actually a helpful constellation of symptoms that tells us that your gut’s sensitive. And there are things that can be done to improve that gut sensitivity.

DrMR:

So it’s partially helpful to know if it’s SIBO or if it’s IBS. And then the follow-up question is, is there something that you’re doing for the SIBO or the IBS, something that improves your symptoms, that leads to worsening vertigo? Meaning, maybe you’re going really low-FODMAP and you’re also inadvertently going low-carb. The vertigo could be more so, depending on how it’s manifesting, this dizziness and lightheadedness secondary to electrolyte insufficiency.

DrMR:

It’s hard to say because I don’t know exactly what’s going on, but that’s one potential scenario that could be playing out. If you’re going really tight dietarily, than something you’re doing dietarily could be provocating the vertigo and/or causing something else that looks like vertigo. Most commonly, it could be an electrolyte insufficiency, and there you could try Robb Wolf’s electrolyte, the LMNT electrolyte.

DrMR:

Also, there could be some post-concussion syndrome occurring, or said more simply, you could have imbalances neurologically from prior head trauma. And actually, you don’t even have to be fully knocked out or concussed to have this post-concussion syndrome. This podcast will air closely to another podcast we had with Dr. Devin Waterman who discussed this as something that he sees in his clinic where you don’t have to be fully knocked out unconscious to have post-concussion syndrome. And I like Titus Chiu’s book, BrainSAVE! that has a self-help protocol that you can do. So if there’s been any head trauma, then I would consider doing an eval, and a simple way to start is to read Titus Chiu’s book BrainSAVE! There’s a self-help plan, and if that resonates and/or the self-help plan helps you or flares you, then that tells you that there’s something here neurologically that could use some attention.

ER:

Okay. That’s pretty cool. I didn’t know that. Can’t wait to hear that episode.

C. Diff and Giardia

ER:

All right. Our next question is from Scott, who I believe is a practitioner. I will do my best on the “science-y” things. You might have to translate for the audience, so let’s see. He asks, “If a patient has high C. diff toxin genes, but zero calprotectin and normal sIgA, then it just doesn’t seem like something worth going after. However, if a patient has Giardia present on qPCR, like GI-MAP, that seems like something worth going after, if I’m not mistaken. Your insight would be appreciated.

DrMR:

So with C. diff I believe the stat is about 50% of people are asymptomatic carriers. So I wouldn’t be so much concerned about the calprotectin, nor the secretory IgA. Secretory IgA isn’t very accurate according to my understanding, which is derivative of Ilana Gurevich’s review of some of these markers in the past. With some of the functional medicine stool tests, I suspect that you see falsely-elevated calprotectin. I don’t really look at the sIgA, but the calprotectin I look at cautiously. And with the C. diff, I’m really looking to see if this person have symptoms. And even if they did, probiotics can help with lots of GI symptoms.

DrMR:

So I guess the take home on that question is that the individual sitting in front of you is far more important than their lab findings. It’s really important just to keep saying this. This is not an exclusive rule, but in many cases, and I would argue in over 50% of cases with functional medicine testing, definitely with stool testing, the patient’s lab values are only one-fourth of the needed data to make a decision.

DrMR:

Now, Giardia is a little different. Giardia is a strict pathogen. So if it’s positive, then it’s something that you want to pursue. But it depends on if this is something that’s flagged as positive, meaning the GI-MAP will report it as high, or there’s just some that’s been detected. The amount that has to be found in the stool to give us a high assurance that it’s causing disease would be what the GI-MAP reports as positive. When there’s some detected, it could or could not be a problem. So if someone has the hallmark symptoms of Giardia, mainly chronic diarrhea and/or intolerance to fat, then it probably is something that [inaudible] if it’s only detected but not flagged positive. But remember that you may be able to get over the hump with probiotics, a good, strong clinical dose of probiotic therapy.

DrMR:

You want to monitor them, and you should be looking for fast resolution of symptoms, but I’d be careful with the interpretation of if there’s detection of Giardia, but not being flagged positive, and you’re seeing that in an individual with little to no symptoms, then you likely don’t need to go guns ablazing with anti-microbial therapy. But the more symptomatic they are, the more you may want to pursue that or look to other causes. So these lab questions are challenging because, again, they’re only about one-fourth of the data. So I appreciate the question and I’m happy to answer it, but I think it’s important to call attention to the fact that the framing of this question is built upon a false supposition, which is that lab testing is something that tells you a definitive direction, and it’s really not.

DrMR:

So those are some of my thoughts, but the most important answer I’d provide here is that a lab marker, in many cases, and definitely in functional medicine GI testing, is about one-fourth of the data needed to make a decision.

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Chronic Infections

ER:

So for the next question, you may have a really similar response in that case, but let’s hear it anyway in case it’s something different.

Scott:

Hi Dr. Ruscio, my name is Scott and my question is, where in your hierarchy of treatment would you put chronic infections? So, looking at herpes virus or chlamydia, pneumonia, Epstein-Barr virus, all those viruses, and looking into Lyme. Do you include those in any of your initial lab workups, or do you find that’s higher up on the hierarchy after you would do gut health and key foundational things? What I’m really curious about is, let’s say you test 100 people and you look for some of these chronic infections in people. How many of them are going to show a positive and how clinically relevant is that if it does show a positive? Also, how clinically validated are those tests if somebody is sick and they have these symptoms and it’s caused by this bacteria or virus? So I’d love your input on that. I know a lot of functional medicine doctors run those types of tests and I’m just unclear of the clinical validity of them. All right. Thank you.

DrMR:

Okay. This is a good question. It’s an important question because there are these chronic infection panels that can be done where you test for, let’s say, 20-some odd organisms. These oftentimes include things like Chlamydia pneumoniae, Klebsiella, Lyme, multiple Lyme co-infections, viruses, many viruses. So let me try to start with what I think is clinically relevant, which is the viral panel. Clinically relevant in the sense that I wouldn’t pursue viruses directly. Most viruses that is. Your Epstein-Barr, your herpes simplex. This is because for a varying degree of the population, anywhere from maybe 20% to 99%, have been exposed to some of these viruses, and it’s not abnormal to have exposure. If people are having herpes simplex, or they suspect Epstein-Barr, it’s usually an issue of the immune system not being strong enough.

DrMR:

The objective there is to get the things out of the way that aren’t allowing their immune system to operate the way it should. Sleep is massively important in this regard, as is diet, lifestyle, exercise, stress, and gut health. There have been studies that have looked at Epstein-Barr virus reactivation and shown, and I’ve discussed this on the podcast many times before, that socio-economic stress directly correlates with the degree of Epstein-Barr virus reactivation, meaning the more stress someone is under the more that virus tends to pop back up. And my clinical experience is, while I’m open to a time and a place on antiviral protocols, and I used them a lot early in practice and I use them very selectively now, they didn’t really hardly ever move the needle.

DrMR:

In fact, I think what I was seeing in the small number of cases where the antiviral protocols did seem to offer benefit was we’re using high-dose resveratrol. And that’s also an antihistamine and mast cell stabilizer. Or quercetin, which helps with leaky gut and with histamine intolerance. So in some of these cases, I think what we were seeing was either the anti-histamine mast cell stabilizing impact of compounds that were also antiviral, or the fact that we may be using a high-dose oregano or other herbs that were antiviral that were also anti-microbial and were improving some of the presumed dysbiosis in the gut.

DrMR:

So for all those reasons, I don’t really test the viruses at all anymore. I don’t really do any treatments for these kinds of chronic viral reactivations. I should also mention that even with Epstein-Barr, how we quantify reactivation is not well-agreed upon. Now, I should mention that it’s been probably four years since I went hunting for an answer on this, but four years ago when I did, I could not find any consensus on what researchers are using in terms of lab criteria. This is for Epstein-Barr specifically, but what is the lab criteria to tell you reactivation?

DrMR:

Now, there is some suggestion that elevation of the early antigen specifically. For people in our audience, for laypeople, when you test for Epstein-Barr, there’s different fractions of Epstein-Barr virus, the virus that causes mononucleosis, that you can test for. One of them is early antigen. There’s also the viral capsid antigen, the nuclear antigen. So some researchers were saying, “Well, it’s elevation of early antigen,” and others said, “Well, it can be a level of viral capsid antigen, but it has to be above ‘X’.” And as I looked at this, there’s not even agreement in terms of what we’re seeing on blood work that tells us that this is normal, that most people have been exposed, and so there’s going to be some residual in the immune system. That’s part of the fact that almost everyone has been exposed to this virus. And so there’s going to be some background noise.

DrMR:

So the ability for researchers to say, “Well, if we find this pattern, it tells us it’s background noise. If we find that pattern, it tells us that there’s activation,” even that wasn’t agreed upon. That was one of the things in my mind that really got me questioning testing, because that was so ambiguous. And it was like, if I’m going to these seminars and people are so confident that it’s Epstein-Barr, why aren’t they saying, “Well, when you do the testing, just keep in mind there’s not general agreement on how we even diagnose this as a positive, so it’s more of a presumption that it could be Epstein-Barr virus. Correlate this clinically with someone having improvements in symptoms within six weeks.” I mean, you just didn’t see that. That was one of the things, as you start putting all of these pieces together, it’s like maybe there’s a lot of Kool-Aid drinking going on.

DrMR:

So with viruses, I don’t really do anything with that. There’s one lab called Medical Diagnostic Laboratories and for a term I was doing these multi-infection panels. I’ve told this story before about, I believe the organism was rickettsia, and I was seeing a bunch of these positives, like one a month. And this is a really rare condition. After a couple of months, I said there has to be some sort of methodological error at this lab, because there is no way I’m seeing this many rickettsia cases. And what do you know, three months later the lab sends out a notice, “We found an error in our lab methodology with the rickettsia marker. We’re no longer using this marker, and we’re updating to methodology ‘Z’.”

DrMR:

That was another example of how these things have to be correlated clinically. We can’t just vacuously be treating lab markers. And I saw a whole bunch of Chlamydia pneumoniae, and I would treat them. I just never really felt that there was a good signal of the sicker individuals having more positives and the healthier individuals having less positives. I didn’t see that. It was just kind of random. A really sick person would have nothing, and a healthy person would have a bunch of positives.

DrMR:

So that started to rouse my suspicion. Then I would treat individuals, and it was really hard to say people were improving. Maybe they were, maybe they weren’t, when you factor in for placebo, I’d say over 50% of people probably noticed no response. And then you factor on top of that when I went fact checking, there was no agreement on how to interpret the virology titers. There was the rickettsia marker that this one lab totally blew and they were misdiagnosing patients for God knows how many months.

DrMR:

So I really just cut all that out of my practice model because I just couldn’t make heads or tails, and I wasn’t getting a clinical signal that it was benefiting patients. I was open to it and I was hoping that it would, but I’m also not going to be a fool and keep pursuing those things if I’m not seeing what I feel to be a positive signal. I don’t mean to insinuate that people who are treating these things are fools, but it’s just how I felt. I felt like I was just following things without seeing results clinically. So I didn’t want to be foolish, not see results, and continue to pursue tests and corresponding therapies.

DrMR:

Now, Lyme and the Lyme co-infections is a little bit of a different story, where there’s more definitive evidence that people with Lyme will not be feeling well, obviously, and treatment can be vastly helpful. But, I suspect that there’s a fair number of people that are being incorrectly diagnosed with Lyme, because there can be some ambiguity in testing when people have Lyme for moderate to longer term. My “spider sense” also suspects that some who are treating Lyme are just seeing desperate patients, and desperate patients tend to get some results just when someone cares and gives them attention. And we also know that antibiotics can be helpful, and I suspect that some of the perceived benefit isn’t the Lyme, but it’s the fact that the antibiotics are probably taking care of things in the gut.

DrMR:

Now again, it’s not to say that there’s nothing to the Lyme piece, but I suspect there’s a fairly marked bit of over-diagnosis and over-treatment in the Lyme camp. Because of that, it’s not something that I’ve engaged in. Maybe at some point we will try to put together a contemporary model of assessment, diagnosis, and treatment for Lyme. But right now, mold is what we’ve been focusing on. Maybe at some point we’ll take that same analytical machine and point it in the direction of Lyme and go after it. But I think there’s something to Lyme. I would make Lyme an end of the line thing that you pursue, unless you have pretty textbook presentation. You know, was feeling good, tick bite, with a rash, started feeling poorly, then that’s a pretty clear scenario that Lyme could be an issue.

DrMR:

If it’s the ambiguous Lyme, I would make that one of the last things that you pursue. And there are Lyme specialists who echo this position that we want to get diet, lifestyle, and GI where it should be first, then pursue Lyme kind of lastly. I have not found viruses to be helpful. And then with some of the myriad of other infection panels that include C. pneumoniae, like you mentioned, I just haven’t been able to see any beneficial signal from that either. So hopefully that helps, but these are things that I’ve looked at. I’d love to say that there’s more benefit there, but unfortunately, at least for me, a lot of that I have not found to be very helpful.

ER:

Okay. Short answer, sounds good.

DrMR:

Short and to the point.

ER:

I almost started laughing because you said Lyme should be the end of the line. And I was going to say, should it be the end of the Lyme? That’s a good way to remember it.

Urine Mycotoxin Tests

ER:

Okay. So our next question is from Paula, and she says, “Should urine mycotoxin tests be provoked or unprovoked? It’s very confusing because the lab itself is very clear in its instructions to not provoke (with lyposomal GSH) but it seems the mycotoxin mold expert doctors like to provoke the test. The concern being if you don’t, you’ll get a false negative. Any ideas?

DrMR:

Great question. I should clarify one or two things on my prior remarks regarding my experience with urine lab testing. I use glutathione on most days, and I wasn’t convinced that I needed to stop using glutathione before doing a mold test. What happens here is that glutathione at least purportedly will help your body better process and flush out toxins. So you’ll liberate the toxins and you’ll see them in the urine. I wanted to keep my glutathione intake constant and do multiple retests because at least in theory, if the glutathione is liberating the toxins, but I’m also doing months and months and months of binders, at some point there shouldn’t be any more in the pool to liberate. But all of my tests have come back elevated.

DrMR:

Now I did have mold in my home, but I want to clarify one thing, I always had the windows open and I never had the AC or the heat on, and I also had two air filters going. So even when we did an ERMI test, the ERMI test came back negative. Now, if we were to do that now that I’ve been out of Austin for a month and we have not yet remediated, and the AC has been running because it’s hot in Austin, I’m sure the ERMI would come back positive. But I just want to clarify that I don’t think there was any skewing of my retesting results because of environmental exposure.

DrMR:

So I have on my list of things to do another, I believe my fifth, urinary microtoxins test and not be on glutathione and see if there’s a difference. So I will have at least one data point to answer that question. And a more direct answer to your question, I would not provocate if the lab is not recommending provocation, because I’m assuming what the lab has done is determined what the normative levels are and their normative levels are not based upon provoked urinalyses. This is an assumption, but what I’m assuming you could be achieving is a true false positive when you provoke and you’re using a test with ranges that are for non-provoked.

DrMR:

Now to your point of the mold experts wanting you to provoke to make sure that you see any that could be in the system, I understand that concept and I’ll have my data point to report at some point, but it’s really kind of theory. My concern with the provocation is that it may be giving you a false positive.

DrMR:

I also have this sneaking suspicion that if someone’s taking probiotics and/or eating fermented foods, that is causing false positives on these urine tests. Now, some have said that there’s at least one study that disproves that. I don’t yet quite buy it. Something we have on our research agenda at the Center is to get a group of 10 or 15 healthy controls with no known exposure and then 10 or 15 people who have as best as we can identify exposure plus symptoms and see if there is a consistent ability for these tests to discriminate between healthy controls and those who have been exposed.

DrMR:

So in my mind, it’s still something where we’re trying to figure out how to use this technology. And I want to make one clarification, I want to credit Dr. Joe with helping me look at these urine tests not as a, “Well, if our study shows that they don’t work, we’re no longer going to use any of these tests and go egg the companies.” But instead, his thinking is that these companies would likely be willing to work with us in attempts to validate how to use them. And that was helpful for me, because no secret here, I think I have become a touch jaded with some of what’s going on in functional medicine testing, but I’m trying to reframe my thinking to giving some of these labs more benefit of the doubt.

DrMR:

Now there are some that I think were clearly doing really questionable things. We’ve talked about the uBiome partially using dog feces to establish the normative ranges of their poop tests for humans. So there’s some sketchy stuff that’s happened, and it makes me protective. It makes me protective of our audience and of our patients. To whatever degree I’m critical and maybe a jerk sometimes, it’s because I’m protective of people, their money, their emotions, and their health. But there might also be this ability to lead and inspire change from within.

DrMR:

And so that’s how I’m trying to frame how we could proceed with Great Plains and RealTime Labs if we are able to produce information that shows that those tests do not successfully identify those with mold as compared to healthy controls. But for right now, I would recommend not doing the provocation because the ranges are set for a non-provocated test. I’d be careful with the provider that is trying to get a positive test no matter what, because unless there’s a study like the self-study that I’m doing, that shows that if you provocate every test and you treat, eventually the provocated tests will go to negative. If that data doesn’t exist, then you run the risk of always having a positive test because the provocating agents are liberating some of the normal mold that is in the environment, because there is mold in the environment normally that people should not be freaked out about.

DrMR:

And so what may be happening is that, or maybe some of the mold in fermented foods, again normal, is getting overly-flushed and producing this false positive. So I would revert to non-provocation as the standard right now, if that is what the labs are calling for, because that’s what to whatever degree they have validated. And we will have more here to report, but I just don’t know when we are going to pursue that directly. So it’s on our agenda, and we’re getting fast at pursuing items on our agenda, it’s just that I don’t know if that’s going to be something we’ll have data to report on in three months or in a year and a half.

DrMR:

So for right now, follow the lab guidelines, do not provoke, and work with the clinician that you trust. Because in my experience, if you’re just following different people, it’s extremely hard to piece this together if you’re not working with someone. And I invite you to reach out to the clinic if you want someone to kind of quarterback this process for you and give you competent advice. So hopefully amidst all that, something is helpful for you.

ER:

All right. I actually know someone who might be a good candidate for your study. A friend of mine is struggling with mold. That would be a good person to test it out.

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Longer-term Low-FODMAP Dieting

ER:

Okay. So our next question is from Marius. We do get this question every so often and because we continue to get it, I just keep bringing it forward because I think people are still wondering about this because there’s misinformation out there. So we’ll revisit this.

Marius:

Hello, Dr. Ruscio. My name is Marius. I live in Romania and I have two questions. I have started incorporating the low-FODMAP diet and I’m currently waiting for my support product. It’s going to take awhile, but anyways, I feel a little better with this diet and I feel I will stay with it for the long-term. I want to ask you, are there any risks to develop any nutritional deficiencies? I stay with this diet longer than three to six months per year because I used to have a large variety of fruits and veggies before. And for my second question, I can not have gluten or dairy, and I recently found I like to add some nutritional yeast on my plate, sometimes when I miss Parmesan. Is there any risk of candida or fungal biome overgrowth by eating nutritional yeast? Thank you.

DrMR:

Alrighty. Yeah, it’s always a good question for us to be speaking to, Erin, so thank you for including this one. Is there any risk that longer-term low-FODMAP dieting can lead to nutritional insufficiencies? And the answer is yes, but it is greatly mitigated against if you reintroduce to tolerance. It’s possible I may have missed anything that’s been published very recently, but the best study here looked at a two-year followup and did not find any significant nutrient deficiencies in those who were following a modified, keyword modified, low-FODMAP diet. But other studies have found some insufficiencies that develop when people are doing more strict low-FODMAP in the longer term. So it’s very important to follow the philosophy that we always try to articulate on the podcast, which is these diets are used shorter term, and then longer term you want to be pushing and broadening the boundaries as much as your individual system will allow while also using other supports, things like probiotics as one example, that can help improve your tolerance to higher-FODMAP and other foods like dairy, if you have lactose intolerance, that you may not be tolerating well.

DrMR:

You can also use something like Cronometer or another app to track the food that you eat over a week or two and look at if that puts you at risk for eating your way into a deficiency. Look at the report and say, “Oh, well, vitamin A is something that I’m day over day insufficient in. I’m not meeting my daily intake requirements.” And you can look up foods higher in vitamin A and ideally build more of those into your diet, or secondarily, you could supplement.

DrMR:

And then onto your question about nutritional yeast and fungal overgrowth. I don’t know of any evidence that suggests you’re going to have a fungal overgrowth from eating nutritional yeast, nor do I know of any studies or any quality data that you can probiotic food your way into small intestinal bacterial overgrowth. So no, I wouldn’t be worried about that either. Great question, just make sure that you don’t follow a short-term elimination diet in the long-term. You can do a modified, but it’s important to move toward a broader diet.

Probiotics and SIBO

ER:

Okay. Our next question is from Kip and he writes, “Any chance you could give a few tips for during and after an antibiotic prescription to heal the gut? How come natural doctors recommend probiotics for SIBO and other doctors don’t? Will there ever be consensus?”

DrMR:

Great question. So for during and after antibiotics, I don’t know what you are using an antibiotic for or what antibiotic you’re using, so check this with your doctor, but probiotics have been shown to synergize with various antibiotics and help improve the clearance of various infections and to reduce the incidents of antibiotic associated side effects like diarrhea. So during and after probiotics would be a good idea. Check that with your doctor.

DrMR:

Why isn’t there a consensus? Well, unfortunately not everyone’s opinion is an opinion that is correspondent to what the evidence shows. When there is ample data and there is also controversy, it’s because some people don’t want to believe data and/or they are just kind of ignoring and/or cherry picking. The data for probiotics and SIBO are irrefutably compelling in that there have now been 24 or more clinical trials showing that SIBO can be addressed successfully with probiotics.

DrMR:

There are one to two papers that are very low-quality and predominantly speculative that suggest that probiotics can cause SIBO. However, narratives can gain momentum, and then even when ample data to correct a narrative has been provided, people do not follow that data. That’s unfortunate, but that is something that permeates human beings, and you will find that wherever you go.

DrMR:

So there is a consensus, it’s just that the consensus of the data doesn’t map onto the consensus of the gurus, which is why it’s important not to take arguments from authority, but to take them from the evidence. That’s why I think the answer here is pretty clear. There are 24 or more clinical trials, and also these have been summarized in meta-analyses, documenting that probiotics can eradicate SIBO. If someone has a counterargument, you want to ask them what is their evidence. And unless they can say something equal to or better than 24 clinical trials and/or meta-analyses, then the consensus so to speak should be pretty evident.

DrMR:

So hopefully when looking into the evidence supporting those saying that probiotics cause SIBO as compared to those saying that probiotics can treat SIBO, you will see fairly evident that one position has ample evidence and the other has a lot of hand-waving and theory and tells you a compelling story about mechanism, but doesn’t ever follow the evidence-based model of citing the best evidence to support the recommendations. So in this case, the best evidence is clinical trials and meta-analyses, and the inferior evidence is hand-waving speculation, mechanism, and storytelling. So hopefully one day there will be consensus, but right now a counternarrative has gained momentum, and it’s a tough ball to slow down and prevent from rolling. So yeah, there you have it.

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 have 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. Health coaching. 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’re a clinician, there is our clinicians’ newsletter, The Future of Functional Medicine Review, which 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 are otherwise considered challenging cases. Everything for these resources can be accessed through DrRuscio.com/resources. Alrighty, back to the show.

Mold

ER:

Okay. We have one more question. Actually, I just threw this one in just now because you alluded to it earlier and I thought it was very fitting. This is from an anonymous person, but they asked, “Does your practice help people with mold as well as serious gut issues?”

DrMR:

Yes, mold is something that Dr. Joe has had himself personally, and I now have had the pleasure of having it in I suspect both places that I’ve lived in Austin. I’m going through remediation now in the condo that I reside in Austin. I’ve been running testing on myself. We’ve been writing about this in our clinicians’ newsletter. There is something here. I don’t think mold is bunk. I do think some of mold is bunk, meaning there’s probably some over speculation, overreaching, and overreading of the tests, but clearly it’s something that exists, causes problems for people, and it’s something that we’re doing progressively more with at the clinic.

DrMR:

So yes, if mold is something that is a problem for you, it’s important to keep in mind that gut health is an important foundational aspect of addressing mold, in my opinion. And remember that some probiotics are actually mold binders, and in my clinical observation as Dr. Joe has also seen, they tend to reduce the immune reactivity to mold. So gut health is an important piece of mold. Unfortunately I’ve gone through this on both the patient side and the doctor side, as has Dr. Joe. This is something that we are treating at our clinic, and we’ll be more than happy to help you with that.

ER:

Okay. I’m nervous having just moved to Austin myself last year. I don’t know. Did you notice something right away? I know you’ve talked about this on one of your other episodes.

DrMR:

Yeah. I think it’s really important. I’m glad you asked this because I don’t want to feed into the, “Ooh, mold!” because there’s a little bit of that which exists with mold. Something that I think is really important to mention is not everyone is sensitive to mold. When I first moved to Austin, I bunked up with a buddy and he had no problem at all where he lived. So just like when certain trees bloom, some people are just wrecked with allergies and I notice nothing, that same thing seems to happen with mold. I am not sensitive to much, but I am sensitive to mold. So I just want to clarify that. My estimation is it’s probably less than 50% of the population. I’m completely guessing here, but it’s maybe 10% to 20% of people who are actually sensitive to mold or allergic to mold.

DrMR:

So I just want to clarify that because I don’t want otherwise healthy, non-allergic people going to warm climates and having this fear in the back of their head. For me, I have noticed historically that I’ve not liked being in places that are all sealed up and where there’s recirculated air running constantly. And that’s probably because I’ve just learned over time and I’ve listened to my body. I didn’t know exactly what, but the reason why I like windows open and fresh air is because you may get some kind of mold buildup according to what some of the IEP consultants have shared with me in about 50% of homes in hot, humid climates.

DrMR:

So I already had an intuitive sense, and that is me as a smaller subset of the population, but it’s not everyone. So Erin, I’m not sure if you’ve observed anything like this in the past where you don’t like AC and you gravitate away from environments like that. I just don’t want people to think that everyone is sensitive to mold. I’m assuming it’s probably less than half, maybe even less than a quarter of individuals.

ER:

Yeah. It’s just that my allergies went absolutely bonkers when I moved here. I think I probably have mold and trees and grass and all kinds of things. So I was just like, “Well, I don’t know.” I think you can have allergens to mold but maybe not be sort of infected with mold or something like that, right?

DrMR:

Well, I question the whole “people are infected with mold.” I know this is something that Jill Crista posited on the podcast. That is not a direction that I’m leaning. My suspicion is that the mold colonization is probably quite, quite rare in someone who’s pretty immunocompromised, really beat up, and has had a whopping level of exposure. So it’s probably an exceptional situation. From doing some reading on mold, one of the things that I’ve come across is, at least according to my understanding, exposure over time can lead to development of seasonal allergies. This is actually something that’s quite common. People will tell me, “I’ve never had allergies until I moved to Austin.”

ER:

I know, I hear that all the time.

DrMR:

Yeah, and another IEP informed me that you’ll see some mold, like I said a moment ago, in about 50% of places, in a climate like Austin. So probably where some of that development of allergies after moving to that sort of climate comes from is from the exposure. So I think there are some real cons to living in that environment, but it’s not something that can’t be handled. If you consult with a good IEP, it could be something like a yearly maintenance check. That’s probably what I’ll be doing going forward. I look at that similar to when I lived in the Northeast and you have to close certain things down for the winter. You take all your chairs off your deck. You have to do all this work. It’s kind of a pain before the snow season comes. I look at that yearly check and work similarly in a climate like Austin.

ER:

Yeah, that makes sense.

DrMR:

So I just reframe it. Let’s not go, “Oh my God, everywhere’s going to have mold,” and get all fearful, which I did at some point. You take a moment, step back, and say there are certain things that I’ll have to do to make this climate work. It’s kind of like your yearly due diligence. Get things checked, make sure there’s no leaks, no drips, no buildup, no humidity. If there are, fix them, and it shouldn’t be too bad of a thing. But just having that knowledge and having a good IEP consultant to work you through the process and have his network of consultants, meaning HVAC specialists, makes this a lot easier.

DrMR:

So hopefully, especially in light of our most recent conversation with Mike Schrantz, people have resources now, so that they’re not just going on the internet, doing a random search, using a random company, and kind of floundering through this.

ER:

Yeah. Well, I know Zyrtec helps. So I think I have a little bit of an understanding. I mean, also I moved out to the wild, from the East Coast to the wild and the lake and everything, so it wouldn’t surprise me if it’s just some allergies. But anyway, good discussion. Those are all our questions for today.

DrMR:

Awesome. Well, thank you Erin, and thanks guys. Keep the questions coming.

ER:

All right. See you next time.

Outro:

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