A Better Model of Functional Health

Episode Intro:

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

Dr. Michael Ruscio :

Hey everyone. This is Dr. Ruscio. Welcome back to Dr. Ruscio Radio. Today I have a special treat – although it feels weird to say that about something you made. I took quite a bit of time over the past few months to think about how we can best describe what we’re doing at the clinic in such a way that it arms people with tools to be able to evaluate other healthcare providers; to really ensure they’re not getting pulled into some of the shenanigans in the field and to have a short list of principles. Follow these and that will hopefully help keep you on the best path in functional medicine. And so I created a three part video series. This is going to form an educational mainstay for new patients at the clinic, but it has very broad applicability for anyone who is following the work of gurus, health coaches, doctors, online programs, working with doctors directly, etc.

DrMR:

There is a lot of carryover into how you use these principles to evaluate information; to have a checklist as to whether a provider is giving you advice that is keeping with the paradigm we use at the clinic. So a three- part series – I just want to give you a quick foreshadow/overview here and then we’ll go right to the audio from the videos. We’ll release the audio, obviously, in succession here in the podcast, but you’ll also be able to locate the video in the description for each of the podcast episodes. We’ll release these on Monday, Wednesday, and Friday. I would definitely go to the YouTube versions of the videos.

DrMR:

In the third video, we develop three final operating principles that an order of operations guides decision making – not emotion… not the Google algorithm… not advertising… not industry influenced thinking – that lab results are 1/4 of the data needed to make a healthcare decision, and that weeding out unnecessary tests reduces costs and improves results.

DrMR:

There are also great visual representations here of what a patient path looks like as they navigate through this inverted tree analogy that I’ve been using lately. In this inverted tree, the trunk is the core of our model and is the diet, lifestyle, and gut health foundations model. But as you progress down through the trunk, certain symptoms remain while others have responded. And it’s those remaining symptoms combined with your personal information that helps us dictate what branch items – that we don’t do for everyone – we may want to pursue. So HCL – yes or no? Enzymes – yes or no? Antimicrobial therapy – yes or no? Mold treatment – yes or no? Specialty niche diets like low histamine, abdominal massage, pelvic floor, female hormones, thyroid, limbic, apnea studies — these are all things that are second or third order or level.

DrMR:

I really go through a number of examples of how important it is to look at the evolution of a patient’s symptoms in juxtaposition to their history and their other personal information to then dictate what care someone gets going forward. And I think this is probably one of the most valuable images that we’ve made in a long time. We also tie this all together when looking at a cost comparison between models. You can see what this nets out to in terms of cost. So anyway, I think this hopefully should be one of the more informative video series that we’ve done in a while. I hope you will go through every one, and also share these with someone who is thinking about pursuing functional medicine so they have a better idea of (well, in my opinion and our opinion at the clinic) what functional medicine should look like. I hope you find this series helpful. And please, if you have any feedback, I would love to hear it. All right. Thanks guys. Bye-bye.

The “Dr. Google” Problem

DrMR:

Hey, this is Dr. Ruscio. Let’s discuss a better model of functional and integrative medicine – the approach we use and we advocate for. And just as a little bit of context, a challenge for both doctors and patients is that the Google (or other search engine) algorithms show people more of what is popular, but not necessarily more of what is the cause of their problems, right? This is the ‘Dr. Google” problem. And this becomes even more problematic for those who are trying to perform their own health research. But what we can do – and what we should do – is use biostatistics + prevalence data + patient information in order to make healthcare decisions that are the most likely to help you, thus avoiding the pitfalls of asking your doctor for the drug you saw in a commercial or the contemporary equivalent of asking for a test or treatment you read an article on or heard a podcast about.

DrMR:

When we get this right, it leads to better results in less time and with less cost. Let’s expand on this. Coming back to our operating principles, we’ve covered how the science really informs how to treat people and not labs, how many labs are inaccurate, and how we get far better results when we treat the person and not the labs. Three other principles here to really round this out: An order of operations guides decision making based upon data — not based upon emotion, the Google algorithm, or advertising — and keep in mind that much of what you may read could be advertising masquerading as education.

DrMR:

Fifth principle: Lab results are usually 1/4 of the data needed to make a healthcare decision and we’ll give you some specific outlining of that in a moment. And #6: We’ll show you a side-by-side comparison for how weeding out unnecessary testing reduces costs and improves results.

Order of Operations & The Differentials List

DrMR:

So, an order of operations guides decision making based upon data – not on emotion, not upon the Google algorithm, and not on advertising. Here’s a simple biostats example: Hypothyroidism affects 1% or less than 1% of the population. IBS affects 15% of the population. Either condition can cause fatigue, depression, and/or constipation. However, if you search fatigue, depression, or constipation, and hypothyroidism is a more popular search term, the Google algorithm will show you more articles on hypothyroid than it will on IBS or gut health. (I’m just using IBS as a stand in for gut health.) The idea of thyroid might sound appealing, but this doesn’t mean it’s the root cause. Remember, the prevalence here – hypothyroidism 1% or less of the population… IBS 15%. What we do to circumvent this problem is we organize a list of potential causes from the most common down through the least common. Conventional medicine does this – it’s called a differential or a DDx. And this is something I think conventional medicine does quite well.

The Diet, Lifestyle, and Gut Health Foundations Model

DrMR:

And what we then do is personalize how we proceed through this order of operations, based upon your history, your symptoms, your response to treatment, and your lab values. This is what our model looks like. And I want to try to tie this all together here. We could term the model that we use as the “diet, lifestyle, and gut health foundations model.” Looking at this inverted tree here in the upper right hand corner, the real core (the items that are going to be the most helpful for the highest percentage of people) are these dietary, lifestyle, and gut health foundations. So, a paleo diet or another type of elimination diet… a low FODMAP diet perhaps… some fasting… with lifestyle, exercise – making sure it’s not too much, insufficient, or the wrong type… sleep… emotional health and perspective…

DrMR:

Some patients come in very afraid of food… or inculcated into thinking they are dependent upon supplements… or afraid because they’ve been diagnosed with some erroneous condition based upon a lab that has almost zero validity. With the emotional health piece, just how we frame things (or reframe things) can be quite helpful. Probiotic triple therapy is another mainstay and then some level of integration of elemental dieting. These are all good places to start.

Working Down the Inverted Tree

DrMR:

As we start working down this core, this trunk, we’re then seeing how someone’s symptoms evolve. And it’s that evolution of symptoms that really helps us identify – “What else can we do from some of these branches?” The core of the tree are the items that – from a biostatistic perspective – we know will help the most people. The branch items can also help people, but we need additional context to determine which branch do we navigate.

DrMR:

We don’t want to just give everyone HCL + enzymes + antimicrobials + binders for mold + thyroid support + female hormone support. It’s too much. So outlining a few examples of this, as you start working through the trunk, your clinician will be attentively looking at how your symptoms evolve in juxtaposition to your information, your symptoms, and your history. And let’s take one example of hydrochloric acid. If you have a history of autoimmune conditions, anemia, and you’re older, these are all historical factors that put you at increased risk of low HCL and therefore benefiting from HCL supplementation. And let’s say that you’ve had this treatment response from going through that core of an elimination of bloating and constipation, but you’re still having these symptoms that are non-responsive of heartburn and indigestion. This would make you a real candidate for HCL. It would really strengthen the rationale and increase the likelihood that you would respond.

DrMR:

And by the way, there’s not really a good lab marker for HCL. Now, what about pancreatic enzymes? Let’s say you’ve had a history of pancreatitis, diabetes, and you have these symptoms that have not responded of bloating and loose stools + potentially a lab of low fecal elastase. Again, as you proceed through a few visits initially with your clinician and work down the trunk, your clinician will be analyzing all of this and determining – Is this a branch that we pursue or not? Antimicrobial therapy – oftentimes, this is something that’s thrown out to people I think far too quickly. And we discussed in our last video how the response rate to the antibiotic rifaximin goes from about 50% to about 85% when you use probiotics + the antibiotic. This is all the more reason why we work down the core and then we determine – do we go to the branch of antimicrobials or antibiotics?

DrMR:

Let’s say historical data is tht you have a history of SIBO or maybe H. pylori. Your treatment response has been that your gastrointestinal symptoms are partially improving, but there’s also unresponsive fatigue, brain fog, and sleep issues +/- certain lab findings (maybe a re-testing of SIBO or a re-testing of H. pylori) and all this can be used together to dictate – do we want to go down the branch of antimicrobial therapy? Or what about abdominal massage? There have been some studies that have found that abdominal massage – just self abdominal massage (free, easy, and cheap) – can help people who have otherwise non-responsive constipation. There’s not necessarily a historical finding here, but the symptom of constipation that has been non-responsive to other therapies, and there’s also not a lab finding. If you fit this profile, then a recommendation for abdominal massage could be given out, but keep in mind that many people will see constipation improve when they change their diet, if they start exercising, if they use probiotic triple therapy, and perhaps if they do a reset with elemental dieting. Again, this is so important to articulate — the process of monitoring your symptoms and looking at how your symptoms evolve in juxtaposition to your personal information, helps your clinician determine what branch that we go to.

DrMR:

And female hormones – another good example. If a woman has a history of female symptoms, perhaps some starting post hysterectomy or symptoms starting postmenopausal, and she’s having these symptoms of PMS, cycle irregularities… or hot flashing, fatigue, mood swings, and brain fog. And as you work down the trunk and there’s only been a partial response to other therapies, that’s a good time to pursue female hormone supports. However, we don’t want to jump right to this branch because many cases of female hormone imbalances (or at least the symptoms of them) will resolve once we work through the trunk of our model. At least for the herbal treatments (and you can also make the same argument for low dose bio-identicals) they namely act in a corrective fashion and labs really aren’t required. It doesn’t matter if the estrogen is a bit high or low, or the progesterone is a bit high or low, the herbs tend to be corrective or somewhat adaptogenic. So, another example of the limited utility of labs.

Dr. Ruscio Resources:

Hi, this is Erin Ryan from the Dr. Ruscio team. We get lots of questions about Elemental Heal – our gut supporting meal replacement shake. So, I thought it would be helpful to answer a couple of those questions. Now let’s talk about the investment. Some people wonder – is it worth the cost? What if it doesn’t agree with me? What then? Well, there are a lot of different ways to think about it in terms of offsetting costs. You’re using this shake as a meal replacement, so you’re not paying for food while you’re using it as a meal replacement. That helps with the cost. It could also offset future costs for ongoing therapies. If Elemental Heal is really helping you and you only need to use it in combination with one or two other therapies, you’re offsetting costs of more doctor’s appointments, more testing, and so on. In terms of the sourcing, every ingredient is impeccably sourced by Dr. Ruscio himself. There is nothing in this product that he wouldn’t put in his own body. In terms of the taste, it tastes great! I love the chocolate, but there’s also peach and vanilla. We also have a money back guarantee in case you order too much, or if it doesn’t agree with you. Just let us know and we’ll help you out. There’s a lot more info on the website: DrRuscio.com. There are customer reviews, research, and scientific evidence all about Elemental Heal.

Biostatistics, Personalized Care, and Lab Work

DrMR:

So, those are just a few examples of how this process works. Take the tree, flip it upside down so it’s the trunk and then the branches. That is constructed based upon biostatistics, meaning what are the most common causes of symptoms and then what are also there, but less common. That’s the overall guiding structure and then your history, your symptoms, your response to treatment, and your labs help us to navigate you through this model successfully. This is how we’re able to be very precise, not have a high lab bill, not waste a lot of time, effectively personalize care, and keep the costs low. One thing I’d like to point to from these past examples is that labs were only helpful for a small number of those cases. And this brings us to principle #5: Lab results are usually 1/4 of the data needed to make a healthcare decision.

DrMR:

We personalize care based upon four things predominantly: history, symptoms, treatment response, and lab work. I really hope that helps you see that labs do have a time and a place, but they should not be looked at as the preeminent guiding factor, but rather 1/4 of the information needed (in addition to a lot of information about you as a person) that helps guide clinical decision making. This then leads to the question of – guess what happens when you weed out these unnecessary tests? Better results in less time and with less cost.

Weeding Out Unnecessary Testing = Lower Patient Expense

DrMR:

And that leads to point #6: Weeding out unnecessary testing reduces cost and improves results. As an example, we pulled a few different clinics’ initial lab bills from the internet. And what you see here is that the “treating the test” model… you can see $3,000 to roughly $8,000 of lab testing fees, whereas at our center, we come in at either $0 for some cases or about $900 for others.

DrMR:

And this correlates the average number of supplements. This is more of an estimation from what we hear from our patients, but it’s not unusual to start off with 12 supplements at some clinics, and we start off at three. And then the follow-up testing can be $500 to $2,000, and in our clinic it’s usually $0 to $350.

Episode Wrap-Up:

To recap, these operating principles really guide our clinical model and the care that we provide for you. The scientific literature tells us how to treat people, not numbers. Many labs are inaccurate, even fraudulent, and should not be used. Treating the person leads to far better results. An order of operations guides decision making based upon data, not on emotion, the Google algorithm, or advertising. Lab results are 1/4 of the data needed to make a healthcare decision. And by weeding out unnecessary testing, this reduces the cost and improves the results.

DrMR:

I hope this short series has been helpful for you to understand what we do and why we do it; what the evidentiary basis underlying what we do in the clinic is. I want to really close by leaving you with the fact that as you work through the trunk of the model, the amount of analysis that we are doing on the back end is immense. We have an ongoing list of those potential problems and at each visit, we’re making notes, we’re moving things up the list, we’re moving things down, as your symptoms evolve the treatment. Even though we may not boast the longest follow-up visits, it’s because we’re doing a lot of the crunching pre- and post-visit to continue to personalize the care to you.

DrMR:

This is why I’m so happy with the results that we’ve been getting. And it really does seem to be resonating with both doctors and patients. Again, I hope this outline helps you better understand what we’re doing, why we’re doing it, and really a lot of the hard work that we’re doing behind the scenes so we can come to a visit prepared and best able to help you navigate through the trunk and then to the right branch, if any is needed for you. This is Dr. Ruscio and I hope that helps.

Outro:

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