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Simple Steps to Wellness with Autoimmunity with Mickey Trescott and Angie Alt

Autoimmunity is a process wherein your immune system attacks healthy tissue and can cause conditions like hypothyroid, rheumatoid arthritis, celiac disease, and type 1 diabetes. Today we speak with Mickey Trescott and Angie Alt to cover simple steps toward healing your autoimmune condition.  We also make an important clarification that autoimmune conditions can often be described with undue fear and help you understand what a healthy perspective on autoimmune conditions is.

Dr. R’s Fast Facts

  • Autoimmune conditions are conditions in which your immune system attacks and damages healthy tissue
  • If you have one autoimmune condition you are at risk for another, however your level of risk has been overstated by many health gurus
  • Early life environment has a large impact on autoimmune diseases later in life
  • ‘Inform and collaborate’ is a process wherein you educate yourself about your condition and build a winning healthcare team to manage an autoimmune condition
  • The autoimmune paleo diet is an approach that is helpful for many autoimmune conditions
  • Connecting with nature is a key aspect in improving your health if you have an autoimmune condition
  • The Autoimmune Wellness Handbook provides a big picture guide for getting starting with improving your autoimmune condition.

If you need help with autoimmunity, click here.

Simple Steps to Wellness with Autoimmunity with Mickey Trescott and Angie Alt - RusioPodcast MTrescott
Episode Intro … 00:00:50
Personal Journeys … 00:02:50
The Main Contributors to Your Healing … 00:07:40
Developing Multiple Conditions … 00:10:28
Overcoming the Fear of a Condition … 00:15:50
Changing Views of Autoimmunity … 00:19:08
Early-Life Environmental Impacting … 00:21:48
‘Inform and Collaborate’ Process … 00:23:32
The Autoimmune Paleo Diet … 00:27:08
The Future of Functional Medicine Review … 00:31:20
Fear of Reintroducing Certain Foods … 00:32:30
Healthy and Positive Lifestyle Adjustments … 00:37:37
Time in Nature … 00:39:06
Avoiding Overwhelm With a Condition … 00:42:35
Episode Wrap Up … 00:45:12

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  2. The Autoimmune Wellness Handbook

Episode Intro

Gianna: Hi. This is Dr. Ruscio’s Radio. And this is Gianna Ruscio.

Dr. Michael Ruscio: Hey, everyone. That very cute introduction was my 4-year-old niece Gianna Ruscio. I was at home visiting family and I couldn’t resist the temptation to get her cute little voice on microphone. So that was her gracing us with an introduction during the Christmas season.

And today, we’re going to be talking about autoimmunity. And we have Mickey Trescott and Angie Alt here to talk about this topic. And these two definitely know a lot about it. So I’m looking forward to getting into some of the nitty gritty. Mickey and Angie, welcome to the show.

Angie Alt: Thank you for having us, Michael. We’re excited to be here.

DrMR: Absolutely.

Mickey Trescott: Yeah, thanks for having us.

DrMR: My pleasure to have you guys here. So for people listening, in case you’re not familiar with autoimmunity—I’m assuming most people are—but just in case, autoimmunity is a condition where your immune system attacks different tissues of your body.

And there are many different types. Autoimmune thyroid, known as Hashimoto’s, is one of the more common ones. There is autoimmunity against joint tissue which can manifest as rheumatoid arthritis. There is celiac disease which is against intestinal tissue.

There’s IBD (inflammatory bowel disease), Crohn’s, and ulcerative colitis where there is autoimmunity against different types of intestinal tissue or commensal, healthy intestinal bacteria.

There is psoriasis and eczema which may be autoimmunity against the skin, although those are not clearly in the autoimmune box yet. There is multiple sclerosis which is nervous tissue autoimmunity. There are many different types of autoimmunity.

And they’re pretty common. In fact, some stats by the NIH have shown that autoimmune diseases are almost as common as cancer and more common than heart disease if we lump them all together.

So just to give us a quick primer on the issue, these are conditions that are fairly prevalent and common. And certainly, we want to do the best we can with natural management strategies to optimize our outcomes.

Personal Journeys

And I know that you guys have had quite a bit of personal experience. So why don’t we start there with your journey with autoimmune disease and what that was like?

Mickey: Yeah, so this is Mickey over here. And if you’re looking for people with personal experience with autoimmune disease, Michael, you definitely picked the right bunch. Angie and I share five autoimmune diagnoses between the two of us. So we’ve been around the block with this stuff.

And my journey started not too long ago, about five or six years ago when I started having symptoms of thyroid disease. And it took me about a year—I’ll spare you guys the long story.

But if any of you guys listening have had symptoms of thyroid disease, especially some of the more subclinical symptoms, that’s actually really common in young people. So at the time I was 26 years old. And medically, a lot of doctors think that’s pretty uncommon.

So it took me a very long time to actually get in front of a doctor who would listen to what I was experiencing which, when I was doing my online research, I really saw the pattern. And I thought that it was due to my thyroid.

And it took me about six doctors to finally find one who would test me for TPO antibodies which are an antibody that attacks a part of the thyroid tissue. And I got my diagnosis of Hashimoto’s disease.

And this doctor actually also tested me for tissue transglutaminase antibodies which is prevalent in celiac disease. So I got two diagnoses in the same appointment. I found out that I had multiple autoimmune diseases, which is actually fairly common. Once you develop one, if you don’t start getting it treated and managed, it’s a very high likelihood that you’re going to develop another one.

And so I got these two diagnoses. But I was told that even though I had debilitating symptoms—at that point I had lost my job. I was barely able to get out of my bed. I just could not function as a regular member of society anymore. I couldn’t even load the dishwasher. I had to ration my trips up the stairs in our house to go to the bedroom. And so things were looking pretty dire.

But my doctor still, even this pretty smart guy who diagnosed with these diseases and was smart enough to test for antibodies, said that my thyroid levels were normal and that I didn’t need any treatment and that a gluten-free diet was all I needed to feel better.

And the three months after that phase, I went on a gluten-free diet. And I got worse. I started experiencing symptoms, neurological symptoms. I had never actually had any gut symptoms from celiac disease, which doctors say isn’t common. But anecdotally, talking to other celiac, a lot of us get neurological issues when we have gluten cross contamination and even other cross reacting foods and other food sensitivities which I’m sure we’ll talk about a little bit.

But I lost feeling on the left side of my body. I had burning nerve pain that was keeping me up at night. I was constantly dizzy and unbalanced. I had horrible vertigo. And I was slurring my speech. So I went out to dinner one night. And I would try to order off the menu. And, “Bleh, bleh” came out. And that’s when my husband was just like, “We really need to dig in and see what we can do about this.”

And at the time, the doctors that I was seeing all said I was likely developing more autoimmune disease, most likely lupus or multiple sclerosis. But I needed to have those symptoms for six months more before they would consider a definitive diagnosis because it came on pretty fast.

So that’s when I got my butt into gear and got online and found out about all of this paleo and ancestral health. I had been vegan for ten years, so no doubt that played a big role in how I was feeling. And it doesn’t tell the whole story, saying that that changed everything in my entire life in a sentence. But that’s how I really started the road to recovery and finding out about diet and lifestyle and what I could do on my own to manage my autoimmunity.

And eventually, I made it through the worst of it. And over the next four or five years, I continued to go upward and feel better to the point where I could work again. I could go back to school.

My background is as a chef, so I wrote a cookbook that I shared with my blog readers. Eventually, it became a print book. Now, Angie and I have a second book out. And really, I have dedicated my life’s work to making it easy for the next person so that they don’t have to go through what I did, trying to figure this stuff out. It was hard.

DrMR: You have such a—I don’t want to say a nice story because it’s not a nice story. But I think it’s a nice illustration of how important self-care is when you receive a diagnosis.

The Main Contributors to Your Healing

And I’m curious. What were the main things that helped you turn the tide? I’m assuming that you needed more than the gluten-free diet. And you needed a diet that’s more akin to the autoimmune paleo diet. And that was probably one of the larger contributing factors. But was there another major contributing factor to your healing?

Mickey: Yeah, so first, it was definitely diet. I had been vegan for a very long time. I had not eaten meat and I was very deficient in very vital nutrients. So things like iron and B12 and vitamin D were very low despite getting tested all the time. I was taking supplements.

And my doctors were like, “The iron is not working. You need to change the kind of iron.” And nothing worked until I literally started eating meat. I actually remember when I started eating liver. Liver is a really, really rich source of iron. It has some co-factors in there, too. For those of you who struggle with anemia, it’s a big deal to have a source like that.

So I started eating it once a week. And within a month, my levels were completely normal, higher than normal. And the doctors were like, “How did you do that? That’s not really possible with supplements.” And that was the moment where I really realized that food was going to play a central role.

Besides that, there was a big slog upward where it was probably about nine months were I did the elimination diet, reintroductions. I made a lot of progress over that time.

But about at the one year mark is when I found a really good doctor. We did some functional medicine testing, looking for those root causes because, as you know, it’s really common for people with autoimmune disease to have some stuff going on that is really not about to be fixed with just diet.

So I found out that I had H. pylori infection. I had a parasite. I had imbalances in my gut flora. And so when I was treated for that—and I actually had some neurotransmitter imbalances—treating all of that and actually adding thyroid hormone as well made the biggest difference. I went from 40% to 80% just with that.

And then in the last couple of years, it has been more of the tweaking the lifestyle. So changing my work habits, changing my screen habits, changing my sleeping habits, my movement habits—the pieces that Angie and I talk a lot about in our book.

Some of them are more difficult. For me, the food is really easy. But actually managing my stress and getting to bed on time is really hard for me. But that is the first thing that will take me down when I’m not minding it. So there are definitely a lot of pieces to that puzzle.

DrMR: All right.

Developing Multiple Conditions

So there are a couple things here that I want to address that I think are incredibly important fundamentally for the entire functional medicine/natural health movement to get on the same page regarding.

And first, I want to say, Mickey, I love everything that you’re doing. I love your first book. I haven’t gotten too deep into your second one yet. But your first book is literally on my desk in my office. And patients flip through it while they’re waiting for me to walk into our exam room.

But there’s something I think we all need to amend which is saying that when someone has one autoimmune condition, they have a high chance of developing another autoimmune condition. Now, I appreciate where that’s coming from. But I don’t think the science supports a high likelihood.

And we’re doing some research right now to flush out some more specifics. And I’m going to very tentatively say I believe for Hashimoto’s to rheumatoid arthritis, there’s a 4% increase of risk. I may be wrong on that. I was just looking over some of the preliminary numbers the other day.

But the reason why I bring this up is, yes, it’s important for us to have an increased awareness of autoimmune conditions. Totally, 100% agree with that. But what I see in the clinic is people come in scared to death because they think they have this ticking time bomb.

And when you actually look at the numbers, having one autoimmune condition, yes, does increase your risk for another. But you don’t have this alarmingly heightened increased risk for another.

So yes, we want to still go through the same recommendations of optimizing our diet, our lifestyle, cleaning up any gut infections like Mickey had mentioned, and the whole allotment of things that we can do for autoimmunity.

But I think it’s important that we start being more discerning in our language as educators how we describe this to our readers or our patients or our friends and family if we’re someone who is educating ourselves because I’m seeing more and more people come in very scared. And sometimes, what I’m seeing is the fear of the disease is actually worse than the disease itself.

So I just want to voice that because, yes, these stats do show increased risk. But it’s not a high risk. It’s actually a moderate to low risk. We still want to go through the same actions. But we just don’t need to be overzealous in how we describe it because, again, I think it creates a little bit of undue fear. But Mickey or Angie, I’m curious to hear what you guys think about that.

Mickey: Yeah, so I get that. And I actually really appreciate having someone who has actually looked at the research and can make that statement based on what they’ve been looking at.

But my research is anecdotally working with hundreds of thousands of people that come through our blog. And the majority of them have had autoimmune symptoms develop at a young age. And then maybe they didn’t know what it was. And then, boom! They got another one.

So I can agree with the statement based on the research. But I would also say I think there might be something going on there that maybe the research isn’t there yet just because the sheer volume of people that I’m in contact with—and Angie might be able to jump in here—where a lot of us have more than one.

And I don’t necessarily—I don’t know. I don’t know how that’s possible. But with the clients that I work with and the people that write in to us through our site, it’s a shocking number of people who have those collections of autoimmune diseases.

But I agree with you that the fear is something that is really troublesome for people. Especially when they get a new diagnosis, the worst thing they can be thinking is ‘then onto the next one.’ So I think you’re right there.

We all need to be really careful how we talk about that and how we talk about that risk. Maybe we are guilty about making feel a little bit of that unnecessary fear before they can actually start making steps to change what they are currently experiencing, if that makes sense.

DrMR: Yeah.

Angie: I think this is something that we touch a lot on in our book (this is Angie) is the empowerment side of this journey. And I hope that we’re doing a better and better job all the time of communicating this through our blog and our social media and with our one-on-one clients and saying to those with autoimmune disease, “The fear doesn’t need to exist. You need to replace that with empowerment.”

It’s not to say that there isn’t a time and a place to go through the emotions of being anxious about your future and what it will hold with an autoimmune disease as part of your picture.

But being empowered and taking the steps that you can in terms of diet and lifestyle is huge. And learning to collaborate with your doctors, getting informed about autoimmune disease so that you can help be an authority in your care, that’s a much more proactive approach than being fearful.

DrMR: I agree. I agree. And I appreciate you guys’ thoughts. And it’s not, again, to take anything away from the importance of treating these things and doing everything we can to optimize one’s health, but exactly. The fear piece is one that I think we need to just be careful in how we’re framing this to patients.

And one other aside I just want to quickly make and then I want to move on to the next point so we don’t get too tangential because I’m sure we could philosophize about this forever.

Overcoming the Fear of A Condition

But we have increasing ability to monitor antibodies. And I think a lot of these newer tests are very contentious because we haven’t established the clinical utility of them. And I’m not going to name any names. But I think people listening may know what some of these highly advanced or in depth autoimmune panels are.

And we had Dr. Carri Drzyzga on here the other day talking about brain antibodies. And I pressed her to comment on, “Well, do these brain antibodies tell us anything differently in terms of what we can do for treatment?” And she said, “No.”

It all really comes back to the same foundational treatment, which I think is important to mention, especially when, again, we look at the context of, as one example, looking at thyroid autoimmunity.

We know that above 30 or 35 for TPO is considered the cut off. So if you’re above 30 or 35, you’re considered positive. However, we have some data quantifying risk and showing that if you’re below 500, you have a very low risk of future progression to actual, overt hypothyroidism if you’re below 500.

Why that’s relevant and how this comes back to this whole fear conversation is if someone is told that their TPO antibodies of 300 is abnormal and they need to be in high alarm and high alert, then that maybe creating undue fear, stress, and pressure in that person’s life. And that fear and stress may actually be more damaging to them than the actual antibodies are.

And the same thing, I think, holds true for some of these newer autoimmune antibody tests. We may not know what true positive predictive value these lab values have.

So we want to use these things to educate ourselves and to increase our health as best we can. But be careful to take the good and try to leave the fear because I think that’s an important thing for people, as I’m sure you guys probably know even better than I do. There can be a lot of fear associated with this. So I guess any comments on that before we move to our next point?

Angie: Yeah, I think that it’s so interesting because I literally just right before the Christmas break had this exact conversation with a client. She got antibody test results back for Hashimoto’s, in fact. And she was diagnosed as positive. And she and her husband and her mother were all kind of freaking out and very afraid, very nervous about what this meant.

But what I emphasized is that this is just a piece of information. And it’s really solid information that her body is talking to her and saying that action needs to be taken. And there are things that can be implemented that can help change the picture and hopefully slow the progression of anything. It doesn’t mean that her life is over and that she needs to live in fear of that antibody lab number forever.

DrMR: Exactly. Well said.

Changing Views of Autoimmunity

Okay, so now that we’ve gotten some of the philosophical constructs around fear and everything out of the way, how do you guys view the way we look at autoimmune diseases changing in the coming years?

Mickey: You want to take this one, Angie?

Angie: I was like, “Who should hit this one?” This is what Mickey and I were talking about almost every day for the last probably year. We’re really excited to see how things are going to begin to change.

I had a really distinct pleasure this year of having the opportunity to work with a GI doctor in San Diego running a clinical trial of the autoimmune protocol, which is a dietary approach to helping manage autoimmune disease that Mickey and I focus on with our work. And I helped her run this with some of her IBD patients.

I’m unable to share everything in detail. But the results so far have been really positive and really very eye opening to the doctor herself. And I think that that’s really exciting and means that in the future along with people like Dr. Terry Wahls and her research and work that we’re hopefully going to start to see more and more doctors recognizing that autoimmunity doesn’t have to be the fearful thing like we were just touching on. It doesn’t have to be the horrible revolving door of medications with horrifying side effects.

There can be this integration of what the patients can do for themselves, dietarily and with lifestyle, along with, if necessary, thoughtful use of medication to have a really great outcome for the patient where they can restore their wellness. And I think that’s what’s up for the future. I don’t know what you would add, Mickey.

Mickey: Yeah, just building that bridge, I think. There’s the whole diet movement. And there’s the whole functional medicine movement. And then there’s the whole conventional medicine. And they’ve been really disconnected in their message and what they claim they can do or can’t do.

And I think that just unifying all of that and putting that power in the hands of the patient to kind of figure out how to navigate all of that stuff and use all of the tools at their disposal to live as healthy as they possibly can.

DrMR: Well said.

Early-Life Environmental Impacting

One of the things that I’d like to add to that—and we’ve talked about this before on the podcast—is how important early life factors are in dictating if you will have increased risk for autoimmunity or not. And this is somewhere where I think we have the most powerful chance to intervene.

Things like the environment one is raised in, antibiotic use early in life, probiotic and prebiotic use early in life, cesarean birth versus vaginal birth, breastfeeding versus non breastfeeding—these things have been documented to have a significant impact on the development of autoimmune conditions later in life.

So this is an area where I think we probably have the opportunity to get most to the root cause of autoimmune conditions which, in large part, not solely, but in large part, the environment is a very important factor.

And it’s really early life where the immune system and the microbiota develop. So this is where I think we have the highest ability to enact change.

There are some things we can’t change. We can’t live in a hunter-gatherer society if we live in the U.S. You could try, I guess. But even if you lived in the dirt and in the forest, we’re still probably missing some exposure due to just the widespread hygienic nature of living in a westernized country.

We can certainly take steps in that direction. But there are some things that we can’t change. But there are a lot of things that we can.

So my two cents on that. But definitely moms and moms-to-be and parents of young children, that’s a really powerful time for you to intervene.

‘Inform and Collaborate’ Process

Now, you guys also mention—and I like this—the ‘inform and collaborate’ aspect is something I’ve heard you speak about. And I’d like to hear your thoughts more on that, because I get what that means. But help the listener understand how you can inform and collaborate to get a better outcome with an autoimmune condition.

Mickey: Yeah, so a lot of people love to jump to the stuff that they can do, like diet and lifestyle. But honestly, the very beginning of the process of learning how to navigate this process is learning about your condition and learning about the testing you need.

And that’s what we cover in the “Inform” chapter of our book. It’s the first chapter. And it basically talks about, “What is autoimmune disease?” A very basic primer on the science. Everyone doesn’t need to understand how T cells work and antibody formation and all that stuff. If they want to, it’s great to know.

But most people should know the basics of an autoimmune disease being an issue with the immune system, not with the organ that’s affected. So with Hashimoto’s, a lot of people think, “Oh, this is a thyroid problem.” It’s actually your immune system. And it’s not as easy as taking out your thyroid or just treating your thyroid. We know there are a lot more things that we could be doing to manage that.

So just learning, and me as a thyroid patient, I see things through that lens. I’m a more informed patient. And I get more done with my doctor with collaboration with them, which I’ll talk about next, when I know the lab tests and I know the basics of what I’m looking for and how the hormones work.

This might be different. If someone has rheumatoid arthritis, they might educate themselves on the different inflammation markers and how that fluctuates and how they can talk to their doctor about that. And that’s really important information.

A lot of our doctors, especially in the conventional system, are really strapped for time. And so if you’re trying to get the most out of your time with them, the more informed you are, the more the level of care that you’re going to get from them.

So if you’re walking into your thyroid appointment, saying, “What the heck is a thyroid,” that little three minute discussion is going to be something you could have figured out on Wikipedia.

But if you say, “Hey, doc, I noticed my free T3 is always low. And I feel like crap. Is there something we can do about this?” That might be something that results in an action on your team’s part. So that’s why we’re a big fan of inform.

Collaborate is just how to find these collaborative practitioners and how to build that relationship that is built on trust and built on getting you better. It’s a very hard step with our current medical system. But there are a lot of tricks to figuring out how to navigate that, how to figure out when a practitioner is working for you, how to find one, and how to get more than one support player into your team.

So as a Hashimoto’s patient, I might need to see an M.D. or an endocrinologist or an N.D. if they can prescribe thyroid medication in my state in addition to some complementary care like Chinese medicine or acupuncture or an herbalist.

We talk about how to put all that together and how to figure out what you need, because you really shouldn’t have to depend on one person for everything. It’s all great sources of information to help you on your wellness journey.

DrMR: Well said. And I really like your point about knowing what a thyroid gland is, because the more you know walking into that visit, the higher the level you can take the dialogue to. And that can definitely be very helpful. So I think that’s an excellent—all those points are excellent actually.

The Autoimmune Paleo Diet

Now, the dietary approach that you guys recommend—of course, your first book was The Autoimmune Paleo Diet book, which I really enjoy. And by the way, I should just maybe mention that.

So before, back when I got ill when I was about 23, there may have been some misinformation out there. But I didn’t have access to The Autoimmune Paleo Diet. But it’s pretty much the exact diet I ended up eating just through my own trial and error. And that’s why it really resonated with me.

When I looked at The Autoimmune Paleo Diet—I think it’s Robb Wolf who first made me aware of it—I said, “Gee, this is exactly the diet that I have fallen into. I don’t eat eggs. I don’t eat nuts. I don’t eat seeds.”

It was pretty dramatic. So I certainly have been a fan of it just through my own healing necessitation. But tell us a little bit more about the diet that you advocate for people with an autoimmune disease.

Angie: So the autoimmune protocol started out as an offshoot of the bigger paleo approach to eating, but over the years has been refined into its own thing with lots of research from people like Sarah Ballantyne. And basically, it’s an elimination and reintroduction diet.

You go through an elimination period where you take out all grains including, of course, the gluten grains, legumes, eggs, nuts and seeds, which include chocolate and coffee, the nightshade vegetables (so for folks who don’t know, the nightshade vegetables are white potatoes, eggplants, tomatoes, and the hot and sweet peppers), and then all dairy.

And so you go through this elimination period. Most people need a minimum of 30 days in that period to kind of clean the slate. For most folks with autoimmune disease, realistically, this is going to take probably somewhere 60 to 90 days at least.

If you don’t see improvement by 90 days on the elimination diet, that’s when you really want to start working with your healthcare team to dig deeper, because there’s a good chance that there’s something underlying that’s preventing progress.

For instance, maybe you have small intestinal bacteria overgrowth. Maybe SIBO is hanging out in there. Maybe you have a parasite. There may be something else going on that’s not really allowing the immune system and the gut to heal the way it needs to.

Then from that point, as you begin to improve and you’ve cleaned the slate enough, for lack of more scientific way to talk about it, as you begin the reintroductions, you can easily tell which foods are going to work for your bio-individual body and which foods are going to be triggers and actually increase autoimmune symptoms.

So you begin this staged approach to reintroduction, starting with foods that are least likely to provoke a reaction and most nutrient dense, and ending with foods that are most likely to provoke a reaction and least nutrient dense. And there are foods in that last stage that most people with autoimmune disease probably never want to bring back into their diet anyway, for instance, the gluten grains.

So you go through that process. And what comes out the other side is this highly individualized diet that works for you and best supports your wellness.

And I think Mickey and I have been at this now for 5+ years. And I think what we’ve learned and what we talk about in our book is that the autoimmune protocol, the dietary side of it, after you’ve had enough time, is basically a way for you to tighten up when you need to, to best support managing your autoimmune disease and then also be able to learn how far you can open up when you’re enjoying great health without taking down the whole ship.

So for instance, over time, you may find that chocolate doesn’t work for you at all, but having an occasional cup of coffee is no problem. And it’s psychologically good. It’s emotionally good to be able to go and connect with a friend and have a cup of coffee. And you don’t totally throw off your whole health that you’ve achieved over that. So it’s a way to learn to talk to your body and help manage your disease.

The Future of Functional Medicine Review

DrMR: Hey, guys. I just wanted to make one quick announcement. If you are a healthcare practitioner, I’m very excited to announce that we just released The Future of Functional Medicine Review. This is a monthly practitioner training tool that will allow you to sharpen your clinical skills and enhance your ability to practice cost-effective functional medicine.

You’ve probably heard me say, like, a thousand times that we need to make functional medicine more cost effective to be able to get better patient outcomes with less time and less money so that we can reach and help more people. Well, this Monthly Review will be a big step in that direction.

It will consist of four sections: a case study, research study reviews, the practitioner question of the month, and the practice tip. And all of this will be very helpful in making you a better clinician and steering you toward practicing a more efficacious and cost-effective functional medicine model. If you head over to, you can see a full sample issue and learn more.

Again, I’m very excited about this, and I think you will find it hopefully very helpful. Okay, back to the show.

Fear of Reintroducing Certain Foods

DrMR: Now, something I’m sure that you guys see is the person who has an autoimmune condition and they’re afraid to eat any non-autoimmune foods because they think it’s going to cause a flare of their autoimmune condition. And I love what you just said, which is essentially to eliminate and then reintroduce to find your own personalized diet.

But what do you say to the people who think that they can never eat any nightshades ever again because they have Hashimoto’s? And they’re fearful about reintroducing them because they think they’re going to flare the condition?

Mickey: Yeah, reintroduction is a part of the process just like elimination. So a lot of these people—and I would say I was probably more in this category when I started—had a really negative view of the foods that I was eliminating. But I think people need to reframe what they’re doing. And what they’re doing is they’re actually, like Angie said—it’s a way of talking to your body.

And when you look at food as potential—so chemical nutrient potential, something that is going to feed your cells and either cause you healing or cause you harm, you realize you’re going to do the best you can to make those choices. But in the end, you can’t control everything. And you can’t go on a diet and never have a flare again.

The reintroduction process is laid out the way it is to minimize people having a horrible reaction. So for instance, you go on the autoimmune protocol, and then you eat a cheese pizza. That’s not what we advocate for. And that person might get really sick. And that might be something to be afraid of because gluten and dairy and tomato sauce are probably in combination going to be really problematic.

But start that reintroduction process with things that are very nutrient dense, like seed-based spices or some other spices or some nuts and seeds, especially if they’re raw, or the cold-pressed oils of them, pastured eggs starting with the yolks. These are foods that we know are very nutritious and very good. And there’s no reason not to include them unless you’re sensitive to them.

So for the people who are really afraid, I like to tell them that the reintroduction is actually a part of what they’re doing. And if they feel great and then they reintroduce a food and they don’t feel so great, well, guess what? You know what got you to feeling great. You know how to recreate that.

You have information. And that information is more important to help you navigate your dietary choices for the rest of your life than just being on a restricted diet with a ton of rules and no information and a lot of fear, if that makes sense.

DrMR: Yeah, it makes complete sense. And I ask that question because I think the answer is something that a lot of people need to hear just to make it okay for them to go through the reintroduction. So I think that that was a great answer.

Mickey: And something to add, too, Michael, is something that we talk about a lot, if people aren’t experiencing success. This is a big reason why a lot of people never get to reintroductions. They think that if they hold out for a year or two years or I’ve even heard of people for three years doing elimination diet with no positive effects.

In 30 to 90 days if you’re not seeing any improvements, you need to work with someone to help you troubleshoot some root causes because there’s probably something going on that just diet-harder-and-more-diet is not going to fix. That’s another really important point.

It’s usually the same type of person who just wants to persevere on a really restricted diet. And maybe they have some eating disorder tendencies, which in that case it’s really important to maybe bring in a therapist who can help you work with the food issues and the restriction, because that can bring up some stuff for a lot of people. And just be mindful about your goals going through that and what you’re doing there and that information that you’re trying to gain.

Angie: This is one thing that Mickey and I talk about and say to people. The point of this process is to help you develop a healthy body, not a burdened heart and mind.

DrMR: Yeah, well said. Well said. It reminds me of the law of diminishing returns. I’ll paraphrase this in a health context. If you’re doing the right treatment, you should see a decent amount of response initially. And then the more you do that, your results diminish. So you get a lot of benefit up front.

And we see this in the clinic a lot with SIBO. When we find the right treatment approach for the SIBO, we see a pretty nice effect. But if a treatment is not the right treatment or not working for the person, if we don’t see at least some effect within the first few weeks to few months, we’ve got to change tact.

And doing the same thing longer and expecting to get a different result is generally not a great approach. And so as you’re saying with diet, I think the same thing holds true for many functional medicine treatments. So give something its fair trial. But if it’s not working, then move on to something else. And don’t keep beating your head against the wall.

Angie: Right. Couldn’t agree more.

Healthy and Positive Lifestyle Adjustments

DrMR: Now, what about some other lifestyle approaches people can hone in on? I know nature is one thing that you guys have talked about. But what are some of the more powerful or more helpful lifestyle practices that you think people should be aware of?

Angie: So in the book, we kind of go on from the dietary steps you can take to start talking about some of the lifestyle adjustments. And we mark them out in the book as rest, breathe, move, and connect.

So rest is about sleep and what you can do to dial in your sleep and help optimize your healing there.

Breathe is all about stress management, which is particularly challenging in our modern day world but a huge factor for those of us with autoimmune disease.

Again, this is probably going back to a little bit of the fear discussion we were having at the beginning. Managing stress and anxiety has a really positive impact on autoimmune wellness.

Then movement, finding that good balance in terms of too much or too little movement. Both of which, being too far on either side of that curve is hard on those with autoimmune disease.

And then finally, connect is about making sure you have not only strong connections with other human beings—over and over, we see studies about how important this is to health—but also connect with nature and finding time to decompress and connect to the natural world. And what a huge impact that can have on the immune system!

Time in Nature

DrMR: And I agree with all those. And the one that I just wanted to add something in on was the piece about time in nature. And we have discussed this on previous podcasts. But we have some pretty powerful data showing that when people spend more time in nature, it may be only 15 minutes that is needed in nature for someone to experience an appreciable increase in their mood, their energy, and a decrease in their fatigue or their anxiety or their depression.

And so that’s pretty powerful. That’s a lot better than any supplement I can think of, except for maybe caffeine which gives you a pretty quick jolt. But it’s not really something you can use all the time to lift you out of a lull without maybe suffering a crash at some point.

And the other part about nature that’s pretty compelling from an evidence-based perspective is that people who live near forests or oceans have a lower, what’s called all-cause mortality and morbidity, meaning death from any cause and impairment of health from any cause.

And it’s not because of exercise, because some of the studies have isolated for maybe people who live near oceans or forests swim or run more, and therefore, the health effect is attributed to that. That has been isolated out. And it’s something about time in nature itself that tends to be very medicinal.

So I always harp on that because it is an essentially free intervention that has some pretty compelling science behind how beneficial it can be and how much better it can make you feel in as little as 15 minutes.

Mickey: Yeah, I could not agree more with you, Michael. And that was actually my favorite part of doing the research for this book, falling into that wormhole of research on shinrin-yoku, which I’m sure you know is the Japanese practice of forest bathing and finding out all of these studies that they’ve done.

And the Japanese know that this works. But they’ve really produced some compelling evidence. And I personally have benefited so much from moving from the city to the countryside. Part of the reason was personal. But also part of it was because I wanted to have that easier connection with nature. And I think it really has impacted my health a lot.

And it’s not to say if you live in a city you can’t get out to see nature, especially if you live in a city that has lots of parks. But it’s becoming more common now with every development, you’ve got to have a park. You’ve got to have a green space.

And even your little backyard, you can go out and, at the end of the day, put your feet in the dirt and have a cup of tea and just spend that time just being with nature. I think it’s incredibly helpful.

DrMR: Yeah, it’s really amazing. I had a call, and I was taking a walk during the call before our podcast recording. And I went a different route. And it took me up this little hill in a neighborhood. And it had a nice view where you see out through the whole town and see the sun setting behind the hills. And it was a little bit misty. So all the rays of sun illuminated the sky.

And a smile just lights up across my face. It’s just amazing how something in nature can just make you feel good [*snaps*] like that. So hopefully, people will be inspired to get outside and enjoy nature because it is such a nice and powerful and free intervention.

Avoiding Overwhelm With a Condition

And speaking of interventions, we’ve gone through a number of them. How can people avoid feeling overwhelmed if they’re thinking, “Okay. I have an autoimmune condition.” We’ve mentioned dietary stuff, lifestyle stuff, checking in with a functional medicine doctor and different treatments with them. How can they prevent overwhelm and get a plan together that makes them feel empowered?

Angie: Well, this is definitely a big issue and something that Mickey and I thought through a lot while we were writing this book, not only from our personal experience of it, because unfortunately there wasn’t a handbook like what we just wrote for us when we were going through the process. So probably our own processes weren’t as methodical and included a lot of overwhelm.

So figuring out how to organize this in a way that was more approachable for people and helps address that overwhelm, because we’ve seen that, again then, later with our clients, it can be really tough to do that.

So in the book, one of the things we do is lay out this whole infographic that helps people answer a few questions for themselves and make decisions about, what’s the next step? Or maybe even have they done the starting point work to begin with?

And then we also have a lifestyle guide that shows them how to, over the course of three months, 12 weeks, how to just very methodically layer on a few minutes a day addressing each of the lifestyle aspects that we were just talking about.

And it gives guidance about slow transitions in terms of the diet because it can be really overwhelming to try to take on the whole elimination portion of the autoimmune protocol at the same time as, “Now, I’m going to start meditating. And I’m going to spend an hour in nature every day. And I’m going to get to bed at eight o’clock.”

DrMR: Right.

Angie: And it’s very hard to put it all into practice with our modern lives. So we have a process to kind of help them slowly layer it on.

And separate of the guidance that’s offered in our book, I think that if a person is really struggling with that overwhelm, a good thing to do might be to consider bringing on somebody who can be their partner, maybe a health coach or a nutritional therapist or even a close friend or family member who can kind of be there for them as they put each piece into play. It’s okay to layer. It’s the tortoise and not the hare who won the race.

Episode Wrap Up

DrMR: Agreed. Agree completely. And your book is The Autoimmune Wellness Handbook. Tell us a little bit more about that and where people could find that book and where people can track you guys down if they want to connect with you.

Mickey: Yeah, so our book is available wherever books are sold. So if you guys have a Barnes and Noble or any bookstore, you should be able to pick up a copy there or on Amazon. We’ve described it a little bit in this podcast, but it’s basically what we wished we knew when we started our journeys.

It’s meant to be very encouraging, very empowering, not overwhelming, to have a lot of action items and tools that you can use, lots of quizzes—how to tell on the spectrum if sleep is an issue for you, for instance, or movement. And you can use it as a guide to hone in on the areas that are maybe a priority for you instead of saying, “Here are all the things ever you should do and you’re really overwhelmed by.” It has a lot of resources to help you gently through that.

And it also has recipes and, like Angie said, the lifestyle guide. So we’ve really put a lot of thought and energy into just making it one of those first steps. It’s not the only step. But informing yourself and educating yourself go a long way in trying to figure out how to navigate the process.

Angie and I can be found at our blog, All of our social media accounts should be @AutoimmuneWellness, except for Instagram, which I think is AutoimmunePaleo.

And we’ve got a free recipe list, meal plan, lots of videos if you sign up for our email list on our website. So if you guys are looking to kind of dip your toes in, we have that. And I think that’s it. Did I miss anything, Angie?

Angie: No, I think you got it all.

DrMR: Well, I know that this is going to be a good resource for people. I thought your first book was very well done. And like you said, I think people need a nice guide, a nice roadmap because, like we talked about earlier, this is an area where you can go pretty deep into the black hole if you don’t have some kind of anchor.

And I think this book will help give people a nice roadmap in terms of, “Okay. Here are the big picture, high priority items. Here’s how I can organize them and start the process of just taking action rather than festering in this fear of what ifs and what have you,” which again, you can get pulled pretty deeply into pretty quickly on the internet.

Now, my final question—I haven’t asked this one in a while, but I think it’s pretty salient for this conversation. What is maybe one of the more fun things that you’ve done lately but also might be the least healthy?

And I ask this with the context of sometimes, again, people hear all this health stuff from these different health gurus we have on the podcast, thinking that we’re all not fallible and never eat off plan or whatever. So I think it’s helpful to show the human side of, yeah, even the people who wrote The Autoimmune Wellness Handbook can go off plan a little bit and have a little bit of fun. So can you guys share maybe one of the least healthy but most fun things you’ve done lately?

Angie: I love this question! I think it’s so important to present ourselves as real human beings. So probably the most fun thing that I’ve done recently was over the holiday, over Christmas, I spent an afternoon with my husband drinking Mexican mules which are a Moscow mule, a ginger beer, with tequila. And we had a few of those together which Mickey introduced me to that drink. Thanks, Mick.

Mickey: Sorry.

Angie: And just had a few drinks together and laughed and enjoyed ourselves and played with our new puppy.

DrMR: Awesome.

Mickey: For me, mine’s food related. I baked stollen, which for anyone who’s German is kind of a traditional Christmas pastry that my grandmother used to make and we’ve always had as a Christmas tradition. And I had everyone over for Christmas.

And I baked it. And it was gluten free. But it was probably not the other things. So it had traditional gluten-free flour and eggs and a bunch of stuff that I don’t usually eat. And I did suffer little health consequences. But just remembering the stollen from my childhood and being able to experience that with my family and see them get behind it and feel that joy was totally worth it.

DrMR: Awesome. Well, thank you, guys, for sharing. And thank you for all the work you’re doing. I think, again, this is a space that can be dicey for people. And it’s great to have people like you who are truly trying to help people, who their hearts are in the right place, and are just trying to guide people through recovering their wellness out there. I think it’s great. So thank you, guys, again for everything that you’re doing and for being on the show.

Mickey: Thank you, Michael. We’re actually also really grateful for practitioners like you who are having conversations with us and trying to move this whole movement forward. We’re really grateful to be here.

DrMR: Thank you. And thank you, everyone, for listening. Until the next time, keep fighting the good fight. And we’ll talk to you guys soon.

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Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.


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