Dr. Michael Ruscio: Gut Health, Stress & Your Microbiome

Are you constantly sanitizing and sterilizing, frantically trying to kill every bug in your mitts?

This increasing obsession with sterilizing everything around us may actually be doing more harm than good.

Returning to the show today is Dr. Michael Ruscio, a bestselling author, Doctor of Natural Medicine, Doctor of Chiropractic, clinical researcher and host of Dr. Ruscio Radio.

On today’s show, we’re talking about:

• The drawbacks of growing up in a long-term sterile environment
• How to feed your body’s ecosystem 
• Tools for healing your gut
• What to do about stress
• And tons more…

Let’s go hang out with Dr. Ruscio.

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Dr. Michael Ruscio: Healthy  Gut, Healthy You

Abel: Chiropractic, clinical researcher and podcast host, Dr. Ruscio’s work has been published in peer reviewed medical journals, and he is a committee member of the Naturopathic Board of Gastroenterology Research Division. 

I can’t believe I just made it through that without totally messing it up. 

But thank you so much for coming back on the show, good sir.

Yeah, it’s a pleasure to be here. Good to see you again.

Abel: Great to see you, too, even if it’s not in person. We should be hugging it out at some dinner in Austin, probably right now. 

But it’s too hot there anyway. 

So, why don’t we start with something that a lot of people are totally obsessed about right now, which is the necessity for sterile environments everywhere. 

And the idea that it’s 100% a good thing.

Yeah. Well, it used to be a much easier conversation to have, reminding people the importance of contact with dirt.

And one of the clarifications I try to make in Healthy Gut, Healthy You is what I call new dirt versus old dirt. So not all dirt is the same.

There’s definitely this observation that you’re alluding to, which is exposure to dirt, animals, bacteria has a training effect on the immune system, much like the pressure of gravity has a strengthening impact on bone or on muscle.

So, thinking that we could protect someone from gravity would be foolish.

No one would think that, but it’s the same parallel to the immune system. It is a system that requires exercise or the stimuli to develop.

So with that said, a public urinal as compared to maybe a farm, that would be new dirt versus old dirt.

A public urinal compared to a farm—that would be new dirt versus old dirt. @DrRuscio Share on X

So we want to be discriminating, at least in my opinion.

Well, there is some data showing that exposure to sewage in Bangladesh leads to more parasitic infection and GI illness, whereas exposure to animals and blood and dirt with, I believe it was the Hadza hunter-gatherers, also led to increased exposure but not accompanied by diarrheal illness.

So, if we can try to frame this as not all dirt is equal.

Because there are some who, “Well, I’m paleo,” and they go do lots of things in a new dirt environment and don’t wash their hands.

Not all dirt is equal. @DrRuscio Share on X

Abel: Right.

I understand the sentiment, but it might be a little bit ill-advised.

Old Dirt vs. New Dirt

But to your point, we want to get that exposure, if you’re in an old dirt environment, a park, the woods, a farm, try not to really wash up too much afterward, because you may want to bring some of those bacteria home.

And there are data, for example, showing that people who live on farms have more bacteria in their bed, and even though that sounds kind of gross, that’s just a continuation of those bacteria which train your immune system, including the immune system on your skin.

But with COVID, and with exposure to public places where there’s a lot of exposure to new dirt, that’s where you may want to be a little bit more discerning and wash up afterwards.

Abel: And that differentiation is so important, the new dirt versus old dirt idea, because there are many farmers… 

And my dad’s side of the family were all farmers.

They grew up on a farm, my brother’s an organic farmer or a no spray, no till farmer, just old school. 

And there are a lot in those communities who just kind of… 

They go full bore and shoot the Moon, in a sense that they want as much exposure to grime and dirt and all of that even involved with animals, because it trains the immune system. 

Yet, if anyone who’s traveled internationally, especially to the other side of the world, or to a third world country knows exactly what happens, when you get there. 

And that’s usually… you get ill to some degree or you get diarrhea or whatever.

And no matter how clean you try to make it, if you’re eating or if you’re drinking water or whatever, to some degree, these new bugs attack us. 

And we don’t stand a chance, compared to these ecosystems that used to have a lot less just throughput of different organisms, especially humans. 

But humans now, being a worldwide creature, we’re tracking bugs all over the world.

And you also make another good point, which I think is important to mention, because when you look at this body of literature, there’s a few confounding factors that are hard to account for at first.

As one example, look at something you lead with the point which is, timing also seems to be important in dictating if a given organism could be pathogenic or commensal for an individual.

And this is where, and reviewing a lot of the research that I kind of compiled into Healthy Gut, Healthy You, you look at H. Pylori or Helicobacter pylori, and when that colonizes an individual at a young age, it may actually be beneficial.

But at an older age of colonization, it may be pathogenic.

And then there’s some nuance in terms of certain strains may be more virulent than others.

But the general trend still stands that early exposure, kind of like in a third world country, to some of these bugs, they may become commensal.

And that is likely because the immune system is still attuning itself to up to about the third year of age.

So if you get that organism exposed in the attunement window, now it’s kind of part of the gang, so to speak.

Abel: Yeah.

But if you first become exposed when you’re 25 or 30, that’s when it may become pathogenic for you.

So, timing is also important and maybe even all the more reason for parents, when their children are young, not to be so sterile-happy.

Again, certain discriminations to make, but yeah, that early exposure seems to really help make it an organism that the immune system kind of calibrates to.

The Early Learning & Early Exposure Window

Abel: That’s really interesting, because when you look at childhood developmental psychology and the early learning window for languages, it seems like that’s kind of built in as well, right? 

If you’re exposed to a half dozen different languages at a young age, then a lot of times you do wind up speaking all of those languages and understanding them to a certain degree that, if you tried to just put those eight years of exposure and development in your 30s, good luck speaking six languages.

Yep, totally. And kind of like you, I’m not sure when you learned how to play those six instruments there behind you, but…

Abel: Pretty young.

Was that earlier in life or did you…

Abel: Pretty young, yeah. 

Well, it was before puberty really hit that I got exposure to and at least played around with most instruments, but instruments of a different kind from each other, if that makes sense. 

So, I played drums and… But I started on woodwind instruments, and then I got really into guitar. 

And those are different enough that I think if you build in those skills or that early exposure, it becomes a lot easier to… 

It’s more like picking it back up instead of starting from scratch later in life, which is a real thing.

If you never were an athlete, if you never exercised really, if you never played a sport, it’s going to be a lot harder to do powerlifting in your 30s. 

You can’t just jump into CrossFit the same way that an ex-footballer would be able to.

Right, yeah. And that was something when I was in college, I did exercise therapy for a while, and it’d be amazing to see two people with similar complaints, similar body composition, but you could tell within 30 seconds, person A had an athletic background, person B clearly did not.

So, yeah, it’s I guess all coming back to this window of the importance of exposure to these various things, whether it be bacteria or a flu early in life, makes it easier to learn or to kind of deal with, I suppose.

Abel: Yeah. And reading through, I really did love going through your book.

Thank you.

Abel: But I wanted to bring up a couple of the passages there. 

One that was really interesting to me is the earlier in life antibiotics are used, the more damaging they are, and that kind of dovetails with what we were just talking about.

Right. Right, yeah.

So, it’s kind of like the inverse observation, where the earlier the exposure to what we would maybe call old dirt, the more beneficial it may be because there may be that developmental window.

And then once you’re out of that window the exposure no longer vectors benefit.

And the inverse seems to apply for antibiotics.

I do try to be really careful in the book to clarify for patients, this is a case-by-case situation.

So, if there’s an infection that could potentially be life-threatening or lead to long-term damage, clearly use an antibiotic.

But if your child has a fever and the doctor is considering using antibiotics to prophylactically to prevent a secondary bacterial infection, then…

Which is really falling out of favor, but if you had an old school doctor and you felt like they were using antibiotics a little bit too indiscriminately, then that is something that…

There have been some allergan studies which have shown the earlier the antibiotics are administered, the more harmful they seem to be. 

And in some cases, a decade later in life; which may manifest as a metabolic disorder later in life.

So there is definitely something there, and it really comes down to the gut and how the gut colonization tunes the immune system and how the immune system leads to either this proinflammatory or, I don’t even want to say anti-inflammatory, just the correct inflammatory response.

Abel: Yeah, but in Western thought, we’re trained to see the body as some sort of furnace that burns one calorie at a time, yet we’re feeding a whole ecosystem for better or worse, especially when you start looking at the gut. 

When you look at what happens to your body from the inside out, the conversation becomes a lot more complex than just of a furnace of some kind.

Sure. And there does seem to be a trendline of caloric intake and body composition.

But within that Gaussian distribution perhaps what accounts for some people doing better or worse on a given caloric intake could be their microbiota.

And there is some inferential data we can use to support that, which is:

Small intestinal bacterial overgrowth has been associated with heavier weights.

So, it hasn’t been as completely demonstrated that treating that leads to weight reduction.

Although one or two studies have found improvements in blood glucose and cholesterol, the impact on weight that’s been published has been nominal.

But it may be that there hasn’t been a large enough sample size, or it could be there’s also no relationship there.

But the observation at least stands that small intestinal bacterial overgrowth does seem to trend with people being at a heavier weight.

And part of that might be due to the fact that the bacteria help to extract more calories from food.

So, there’s this caloric harvesting hypothesis, which…

And not to get too convoluted here, but the studies tie into another theme, which is that sometimes we would go to a hunter-gatherer band, look at their diet and say,

“This diet is what we should be eating here in the west.”

And a lot of this typically follows a, “They’re eating more fiber,” so we eat more fiber.

But actually some of these, like the Hadza hunter-gatherers, have a higher colonization density of one of the SIBO bacteria, Methanobrevibacter smithii.

And in the context of the Hadza, a lower calorie higher fiber diet, it helps them survive because it slows down the speed at which the food moves through the intestine, so more calories can be extracted.

So, they have this really dense diet.

They don’t probably have enough food, so the bacteria are in adaptation, slow the food down, get as much out of it as you can, and it works for them.

But in westerners, that correlates with being overweight and having constipation.

So, you have to be really careful with looking at another culture or a different atmosphere a different diet and saying,

“We can pluck out one facet of their diet, force into a different population and expect the same result.”

Abel: Yeah. One thing we know definitely doesn’t work though is taking indigenous tribes that haven’t been exposed to modern foods and plopping them in a McDonald’s. It leads you to fast say, right?

Yeah.

Abel: That goes horribly, horribly wrong in the sense that they’re even worse adapted, they’re maladapted to…

Great point.

The Difference Between Research and “Science”

Abel: Being exposed to any of these foods.

Where it’s like we were eating junkie cereals and McDonald’s and stuff as kids, and we adapt, is my point, to pretty much whatever life throws at us.

But it’s very important to understand that you can guide these adaptations in a healthful direction, whereas if you just do what everyone else does, well, we know how that’s going. 

So, it’s very important to realize that there’s some degree of education here that needs to happen for everyone who’s eating and just being human, because this is all very real. 

There are different levels of research evidence, which I love that you brought up in the book. 

Maybe you can speak to that a little bit because a lot of people are just throwing the term science around right now, whatever that means.

Yeah, and it actually really is out of hand. I was just reading up on some new probiotic.

Every once in a while, a new probiotic pops into the scene and people ask,

“What do you think about this one? Or what do you think about that one?”

This product has three clinical trials, and you look and no one is a clinical trial, two are just observational pilot studies that are being…

But they’re calling them a clinical trial. Why this matters is because not all evidence is the same.

As a loose parallel, if you wanted to know if McGee’s Irish restaurant, was a good restaurant, and you asked one guy on the street, and he was like,

“Oh yeah, it’s great.”

That’s not the same evidence as 100 Yelp reviews. It’s really simple to see that.

The same parallel holds for scientific evidence.

If it’s one guy on the street that could be one observational trial, or it could be a meta-analysis of all the rigorous clinical trials and a summary of those clinical trials.

So, this is one of the things that if the consumer can understand this, and it’s not too hard to click through on a reference and then look at what you see.

If you see anything about rats in the abstract, it’s probably an animal study.

If you see something about Petri dishes, it’s probably a cell culture study.

Or if you see something like placebo-controlled or randomized-controlled, then you know it’s this higher level of evidence.

And why this matters is because medicine and healthcare are built upon this pyramid structure of evidence where the least assured to be accurate type of evidences is at the bottom.

So animal trials, observational trials, then at the very apex, we have either clinical trials or summaries of several clinical trials.

And really the inception behind why I put this in the book was… And I tell the story last…

Sorry if I told this the last time I was on the show.

Abel: Yeah, it’s all good.

I remember being in the gut health panel about five years ago, Paleo Effects, and I felt like I was crazy because everyone was all about fiber, fiber, fiber, we got a feed bacteria.

And I remember thinking, have these people seen people with IBS and with IBD?

And how fiber and prebiotics may help some of those people, sure yes.

But a fair subset of those patients will be flared and many of these clinical trials have found a significant incidence of adverse events.

And I really thought on it. I was quite frustrated for a while.

And then I realized that the problem was actually one that posed educational opportunity, where many of the people on the panel were citing observational data, like the Africans with the high fiber, high prebiotic diet being so healthy, or mechanism…

Meaning we want more bacteria in the gut, so if we take prebiotics, prebiotics feed bacteria, therefore it should be good for people.

So, that’s kind of observational and mechanistic data which is lower quality.

And I was looking at the clinical trials, which is of a higher quality.

And so I realized the problem here is we’re not all speaking the same language in terms of filtering our advice through the lens of analyzing the quality of the data.

And so that’s the reason why that section is in the book, to arm the reader and the consumer with,

“Okay, I hear different health claims, let me go look at the references.”

And within a couple of minutes, you could click through to the references and look at what kind of evidence are they going to be citing and get a better idea for who is giving you the most disciplined argument.

Because it’s easy to say, “Well, I think this, I’ll find whatever study supports this.

Or “I think this, I will only cite a quality reference that supports this, and if the data is not there, shocker, I’ll change my opinion.”

Although, that unfortunately seems to be seldom that that does occur.

And I don’t mean to be disparaging, but it is frustrating seeing how this game is played, where it’s all, like you’re saying, it’s all science, science, science.

This is true, we are in the science age, so to say there’s a study is no longer good enough.

We really need a quality study as a footnote, not just some obscure animal study.

Abel: Right, and then there’s the issue of who funds those studies, and are there any biases there? 

So when you do… I would encourage everyone out there to learn how to read studies at the very least, to some degree dabble in it because it is something worth pursuing. 

But if you want to draw conclusions with any level of confidence, you have to do the work and it’s a lot of work no matter what subject or rabbit hole you’re talking about.

Right. That’s why I think following people that you trust goes a long way.

For example, in Healthy Gut, Healthy You, there’s just under a thousand references.

And those were actually hugely informative, and I had to confront some of my own biases when I wrote the book.

I came from a much more kind of paleo diet-friendly framework.

But a diet like the low-FODMAP diet, which can be usually helpful for some people, is a bit philosophically antithetical to many of the principles we advocate for in the paleo community.

And so it took me a little bit of kind of internal struggle, and then I realized, well, okay, there’s not one dietary philosophy that’s best.

There’s a few things on the menu, let’s just look at indicators that a given individual may do better with one or the other and be more about guiding someone to what’s indicated for them, rather than just looking for more and more evidence that supports the one narrow view that I have.

The Carnivore Diet & Gut Health

Abel: One thing that’s more popular than ever, it seems, is the carnivore meat only dietary approach. 

I know you have a few takes on that, what would you like to share today?

Yeah. So it’s really kind of a continuation of that same couple of things that I struggled with when coming from the paleo framework, and then being able to see how there are some people with gut issues who need to go low-FODMAP or low fiber.

There’s another diet called the LOFFLEX diet, which is low fat and fiber.

It’s fairly well studied for inflammatory bowel disease.

And I look at the carnivore diet as a continuation of that same trend line where plant foods do seem to be somewhat difficult for the gut to digest.

And so there’s definitely a line of truth there.

And I see the carnivore diet as something that we could endorse as a really kind of robust elimination diet, but if you can never reintroduce foods other than…

You know, or if you can never reintroduce from the carnivore and add in some plant foods, my position is that there is something else wrong with your gut.

Which does tie into one of the themes from Healthy Gut, Healthy You which is, we shouldn’t be trying to force a nutritional or a dietary answer to a non-dietary problem.

And so if you can only go carnivore, then there’s likely some leaky gut, some dysbiosis, something that needs to kind of be remedied.

And I was an example of that also.

I had a parasite, a pathogenic amoeba, and until that was taken care of, my food tolerance was terrible.

So, I ended up going more and more restrictive, but to get beyond that, there was an issue that needed to be fixed in the gut.

So, I’m open to the carnivore. I think it’s a mistake to claim it’s a lifestyle or it’s the healthiest diet.

I just see it being unnecessarily restrictive, and if someone has to eat that way to feel good, then there’s likely something else that we should employ.

We can use, as part of this larger process, start there, and then we can start layering in some of the gut therapeutics and then give someone their life back where they can go to a restaurant and have a salad with their steak and they don’t have to worry about, whatever.

Abel: But the idea that we should just be eating 100% roughage all the time is similar in some ways, but probably…

Agreed.

Abel: Worse. Having been…

Agreed.

The Roughage Myth

Abel: Run some marathons and training as a runner, especially when you do longer events, you know that you don’t want a whole lot of roughage the night before your race for obvious reasons. 

So, maybe you can talk about fiber a little bit.

Because, like you were saying before, a lot of people are very gung-ho, let’s eat 400 grams fiber a day or whatever, like our ancestors did, but that’s really not the whole story.

Yeah. And there… I think there’s this deeper principle that we’re touching on, which is any philosophical construct applied fanatically can be harmful to an individual.

And Paul Chek and I recently discussed this about religion, where religion, if it’s adhered to fanatically, can be detrimental.

You can make an argument that Secularism could… Certain facets of… Anything really… Gluten-free that’s adhered to, maybe you do have a partial problem with gluten.

But as you become a fanatic about it, then you can drive yourself crazy and other people crazy and it could come out unhealthy.

So, I think that’s the principle.

Keep in mind that these value systems can help people, but if they’re adhered to fanatically, they can oft-times become destructive. 

And that same thing applies in the other direction, going to the other end of the scale toward veganism.

Coming from a standard American diet going to a vegan diet shows a lot of benefit, and those are the sites that will be cited.

And, so there’s a truth there and I’m not arguing that there’s no potential gain.

But where I think that misses out on coming at with levels of evidence is when we have comparative trials, looking at a vegan diet next to a Paleo diet.

It doesn’t always tend to skew showing that veganism is better.

Christopher Gardner in some of his earlier work, he’s over at Stanford, he found that there may be a favoring for a low-carb diet over a high-carb diet.

Although to be fully honest, that may have been because the high-carb diet was not the healthiest diet.

It was kind of like your Crapetarian diet where there was processed grains.

So he did a follow-up study and in it…

His follow-up study, called the DIETFITS trial, he constructed and pitted against a healthy low-carb versus healthy high-carb diet, and he found more of an equivalency of the results.

But the general point I’m driving at is…

These diets can all work.

We really have to, I think, cherry-pick data to show one is vastly superior than the others, as long as we’re keeping the content of food quality there.

That said, my clinical perspective has been that more people do better on a omnivorous diet, perhaps leant slightly toward the moderate to lower carb end of the spectrum.

That’s likely a bias that’s a derivative of the patient population that I see, which is mostly SIBO, IBS and IBD, so it’s important that I disclose that.

But then there are also people within that subset who they’ve tried carnivore and they felt terrible and we would put them on, let’s say a vegetarian, low-FODMAP diet they do really well.

So, I don’t… Kind of obfuscate an answer to your question, but I think they can all work.

And if we cherry-pick, we can make a case for one being vastly better than the other.

But I think if they keep their consistent and the constant of food quality there, then we can make a case for most of them, within reason.

Abel: Yeah, that definitely makes sense, and I would agree with that. 

I want to bring up a passage, as well, that was really interesting. 

You say: “Eating to control blood sugar is more important than eating to feed gut bacteria.”

Eating to control blood sugar is more important than eating to feed gut bacteria. @DrRuscio Share on X

Yeah. So one of the other challenges when writing that book was, there was all this hubbub about feeding your gut bacteria.

And then what you would see with some people as they would go on a very high carb diet, and that would cause all sorts of problems because they were focusing more so on feeding gut bacteria and not looking at their individual ability to tolerate some of these plant foods.

So, at least in my mind it seems more reasonable to first make sure you’re eating, not so as to overwhelm your glucose capacity, because that’s the thing where,  “Oh, rice has all the soluble fiber.”

And oftentimes these foods will be accompanied by a fair amount of carbohydrate. Beans is another good example.

And so, what you could have happen is you’re eating to feed your gut bacteria but now you’ve gained 10 pounds, you feel more bloated, you feel more sleepy.

And that’s what happens when we don’t look at food as a whole food but rather…

Well, this one food is high in vitamin C or high in fiber and we look at foods as nutrients rather than foods as, more kind of global or having a more global impact on the body.

There’s No One-Size-Fits-All Diet

Abel: And it seems like there’s a growing focus on bio… 

We’re all individuals in so many different ways, and targeting a one-size-fits-all, top-down-type diet for everyone just seems extremely inappropriate. 

I remember getting IgG and IgE allergy testing for foods back in the early paleo days, and a lot of the ones that came up for me were all… wonder foods, 110% failure. 

Honey, avocado, what else was it? Even turmeric came up. 

A lot of things that I held really dear, I think I was slightly to coconut and a few others that were just in every paleo recipe at the time. 

But it’s so important to recognize that there is no… 

We aren’t furnaces, it’s not some sort of binary system, it’s extremely complex, there’s a lot going on. 

And even if avocado was great for most people, if you’re allergic to it or if you eat a walnut and your tongue swells up, walnuts shouldn’t be in the recipes anymore. 

And sometimes, it’s surprising, but people need to be reminded of that.

Yup, and continuing on your theme, which I completely agree with, the body is more complex, that we currently have the ability to, with laboratory markers, fully, objectively quantify or qualify.

But because many of these tests look scientific and they look more scientific than looking at the individual’s response, we fall into the hubris of looking at somewhat incomplete laboratory work over that of the individual’s response.

And using avocados as an example, someone may have an allergy test, IgG, M, A that tells them that they can eat avocados.

But that person may also be very FODMAP-intolerant.

And so the avocado may elicit a non-allergic, but still an inflammatory and GI response due to the FODMAP content of the food.

And so someone can be needlessly flaring their reflux and bloating and diarrhea, but the test told me I can do it.

Well, again, it’s built upon that hubris of thinking that that one marker tells you everything you need to know.

And this is one of the ultimate frustrations that I battle in the clinic with other doctors and also with patients, is thinking that a lab marker tells you everything that you need.

And one of the things I have repeatedly said is that a lab finding is about 1/4 of the data we need to make a clinical decision.

We need your history, we need your symptoms, we need your response to therapies.

We look at all that together with the lab testing, and we use that to inform the kind of decision that we should make.”

So, it’s one of the biggest mistakes I’m really trying to sound the alarm bell regarding.

Yeah, we have all these cool tests and functional medicine, but we’ve definitely fallen into this vacuous territory of just treating lab markers and not looking at the individual before us, and thinking through how to solve their problems.

Abel: Yeah, and to continue the conversation about blood sugar a little bit and its importance, there are some new technologies that are making it much more convenient to track your glucose. 

But, I wanted to ask you… 

So, there are some, especially in the body-building community who are all about spiking glucose to build muscle, and that sort of thing. 

How do you see that? 

Do we have a glucose quotient? 

Is there a threshold above which it becomes damaging instead of helpful for building muscle and that sort of thing? 

Because it’s a complicated conversation.

Yeah, good question. And I don’t know that I’ve gotten nuanced enough in that area to really be able to comment.

Usually, for me, we’re looking at the general response to an individual’s diet, definitely, partially, through a filter of their gut response.

And then as far as I go with dialing the carbs is we typically start someone a bit lower carb, not keto, but knowing that many plant foods and sometimes, starches can bother people.

Well, oftentimes I start a little bit lower and then try to have them reintroduce carbs and see if they can just feel out where they feel better on a carb spectrum, and it’s built into the protocol in Healthy Gut, Healthy You.

In terms of is there a best post-workout anabolic spike we can get for muscle synthesis and recovery?

That’s something I actually have a CGM here I’m going to be experimenting with soon to see if I can figure out for myself.

And I do think a continuous glucose monitor on an individual basis, even though that’s a lab test, so to speak, but what you’re getting is constant data that’s always driven by your biofeedback, not just one static test.

And now, the next three months are driven by that one static test.

You’re looking at a multitude of different foods, how they impact your glucose, and then hopefully, objectively correlating different blood sugar levels with how you feel, which seems to me a more justifiable way of using a technology.

But in terms of: Is that something I have patients do routinely? And have I seen a certain trend?

I haven’t gotten deep enough in that to be able to offer anything too specific.

Abel: But it’s important to note that there are a lot of people who are having success with dialing their carbs down, not necessarily to keto levels, but dialing them down, starting, going from there.

Yeah, and I definitely don’t think that people need to choose between keto or high carb. There’s a big…

Abel: Yeah, yup.

There’s a big landscape in between there. And also, I don’t know…

One of my suspicions, and this is just my own clinical observation, I can’t say I know of anything published on this, but so much of what we may attribute to low blood sugar or high blood sugar causing the cravings or the fatigue or what have you, in my opinion, may be inflammatory.

And I just… I’ve observed my patients and also myself, when I’m eating things that seem to be inflaming me, I tend to be more tired, have more brain fog, no sleep as well.

And I’ve observed this response where, “Oh, I’m a little bit tired, I must need to eat.”

And actually, I’ve seen this in myself and with some of my patients, once you get them off of that, “Oh, I’m tired, I need to eat, my blood sugar’s low,” or just the cravings that ensue when you’re in one of those tired, “I’m hungry,” sort of downswings, people tend not to eat as much and also have a better handle on their cravings.

So as my light falls, sorry.

I do think there’s something to the blood sugar regulation issue becomes a lot easier once you’re no longer inflamed because a lot of the ups and downs that people experience, I think are a byproduct of inflammation.

And that’s why I like starting with kind of a gut first approach, because it clears out a lot of the,

“Well, is this thyroid, is it adrenal, is it blood sugar?”

And it really kind of gets a lot of the noise out of the signal, so to speak.

Abel: And you go in the direction of liquid only for a lot of patients, right?

Well, yeah, so an elemental diet is one of the things that can be useful or even a modified liquid fast for half a day or a couple of days, just to kind of give the gut that pseudo-fast.

I think if we were living more as hunter-gatherers and only working four hours a day, and spend a lot of time just hanging out, we could probably do a true fast because you just kinda hang out and then you could take a nap and then you go for a walk into the sun and you’ve only worked four hours.

It seems much more difficult, like people to do a couple day water fast are usually in tiptop shape.

So, it doesn’t seem that most people can really do that.

So, this is where a modified liquid fast where there’s some calories coming in, but they’re really easy to digest, because they’re liquid, either as a modified fast or a bone broth fast or elemental dieting, seems to be a nice way to take some pressure off of the gut.

Abel: And it’s incredible, when you see some people… 

Like, there’s this one YouTube channel that I watch that shall remain anonymous, where the guy periodically, he’s not a health guy, but periodically he’ll go on a fast and you can tell within one day, and especially within three, you just see him lose like 15 pounds in two weeks every time. 

It’s incredible, but what it shows me is that there’s something that he’s doing regularly that’s… 

Some food at least that’s not working. That’s the real message here. 

Yeah, yeah, no, I would agree with you.

And I also… I think fasting is a great tool for people to kind of condition themselves up to.

And I think that’s something else that may be important just to mention, where fasting may be like running, where if you go out and you run six miles and you haven’t trained at all, you’re likely going to be really sore.

But if you start with like a 14-hour fast and do that for a few weeks, and then 16 and then 18 and listen to your body, it does seem that that fast machinery needs some exercise to really operate most effectively.

Abel: I would definitely concur with that.

I’ve been doing fasting to some degree for almost 10 years now. 

When I started, it was just about pushing lunch until 11 or 12 instead of eating breakfast at 7:00 to 9:00, whenever it was. 

And that was really hard sometimes.

But after doing that for one or two years, changing the way that I was living and also being in my 30s instead of my 20s, now I’ve been eating pretty much one or one and a half meals a day for many years now, five-seven years, pretty much the whole time. 

And it’s very interesting to notice how your metabolism changes, how your training changes over time, but I would definitely… 

From personal experience only when it comes to running and fasting, those seem to be related. 

When I’m trained in doing kind of endurance events and dipping into my glycogen, maybe hitting a wall, when you start just like dipping into that for a while, it seems like it trains you to fast better. 

And I see these things as very related. 

So when you combine fasting and training, it can get really interesting. 

But it’s not like there’s some solution there, like the gold at the end of the rainbow, it’s not the answer. 

It’s just an interesting thing to try for some people.

Yeah, and I would agree, especially as we’re continuing further down this road of self-development and conditioning fasting.

Just me personally, or fasting combined with cardio and then sauna afterward works, has worked phenomenally well.

But there definitely does seem to be a threshold, and I’ll even include in that…

Because I was also doing the Wim Hof Breathing Bubbles where there’s like 30 hyper-ventilations, and then exhale all the way and hold as long as you can.

And during that hold, I would have ringing in my ears, I would feel like I almost blacked out for a second.

But I had a certain threshold where I was doing it for a week and a half and I felt like Superman, and then I crashed hard. So…

Abel: Interesting.

Coming back to this kind of bio-individuality, we have to pay attention to our threshold for some of these hormetic stressors, fasting, Wim Hof breathing, sauna therapy.

Because I think there’s the propensity towards saying, “Well, this is good for you, so do more and more and more and more and more.”

But there tends to be a threshold for which we can recover.

And I learned that a few times the hard way, I was like, “Man, why am I super tired all of a sudden?”

I was like, “Well, maybe that really intense hypoxia that you’re exposing your body to in a fasting state after a sauna, maybe you’re going a little bit too hard in that direction.”

Abel: Speaking of Austin heat, I had that happen in front of one of the, on South Congress, in front of one of the food truck trailers, just kind of like places where they had a bunch of people hanging out, at picnic tables and stuff like that. 

I was just getting back from a long run, it was over 100 degrees, and I hit the… It was kind of like a little sidewalk and there was a lip on it, and I just kicked it with one of my feet and went straight down in front of everyone.

Oh, geez.

Abel: And I was almost home, but it’s like that’s the closest I’ve ever come to hitting a wall and I may have hit it right then because I was in rough shape, you know. 

But that’s such a good point, you need to train up to these different things, whether it’s fasting or endurance events, or even changing your diet. 

It takes time for our bodies in the ecosystems of our bodies to really catch up.

Yeah, yeah, well said. And yeah, with the Austin heat as I’m learning when it’s 100, I feel like it feels like 110. So…

Abel: Yeah with the humidity?

It’s legit. Yeah.

Abel: It’ll get you. One thing that helped me though, for training outside, it doesn’t help if you just cleaned up for the day and you’re like, you’re all showered or whatever, and you’re sweating, it doesn’t help.

But if you’re out exercising or you’re outside, I imagine that I’m in a sauna. 

And that kind of re-framing of it on a really hot run when you’re struggling and dogging through it, that reframing of it really helped. 

It took me a while to kind of work on that, but once I did, there is some sort of weird Nirvana there that you can achieve mentally even in those really rough conditions. 

But you have to do it safely and you have to be reasonable about all of that. 

And you can’t go after, you can’t do what Whim Hoff does without doing the training that he’s done.

Right, yeah, and that’s probably what I fell victim to, which is just…

Abel: We all do. Yeah.

Jump in… Let me jump in right at the varsity level and I guess as long as you listen to your body and you learn from the lesson, then, okay.

If you over-extend, fine. But just don’t live in that over extension and not be saying, “Why I’m I suffering from insomnia and energy dips and brain fog?”

What to Do When You’re Doing Everything Right

Abel: Now here’s a question for you, you probably have quite a few people coming to you who are just like,

“I’m doing everything right, but it’s not working.” 

What do you look for? Or what are the common patterns that you might find there?

Yeah, it’s definitely a common presentation and it’s interesting because some people will say, “I’m doing everything.”

But coming back to our earlier discussion on diet, everything well within the Paleo diet confines, right?

And so, some of those cases it’s just low-FODMAP.

In fact, just recently I saw one of the most prolific Paleo authors, I saw that person’s sister, and they thought,

“Well, I’m going to be a complex case, I’m doing everything.”

I was like, “Alright, well, let’s just see.”

We put her on a low-FODMAP diet and a probiotic protocol, and this person’s year and a half chronic symptoms were gone in about six weeks.

So I guess it’s easy for me because I’ve really looked at, well we have low-FODMAP, we have low oxalate, we have low histamine, which is another one.

The low histamine can be problematic because it’s a diet that if you’re eating a lot of fermented foods can be a problem for you.

So, you pretty quickly look at someone’s dietary history and you see, well, here’s how you’re eating, here’s what you haven’t tried, here’s your symptoms, and here’s a typical way that a problem with histamine will manifest.

Neurological, hematological, dermatological.

So, likely with you, we need to tweak the histamine levels, and then that may get you 30-50% improvement.

And then I usually presume that there’s some type of dysbiosis in association with that, so imbalances and bacteria and fungus for which a good probiotic protocol can work amazingly well.

And oftentimes dysbiosis is this thing, or SIBO if we put that underneath the rubric of dysbiosis, is proclaimed to be,

“Oh you have SIBO it’s going to be a year to get rid of it,” and I just can’t over-emphasize how wrong that is.

Most of these things, if you get the right dietary tweaks made and we use the right gut interventions, like a good probiotic protocol, that’s going to be a game changer for a really large subset.

But in that simplicity, there is also some complicated assumptions, which is you identify that your Paleo diet wasn’t quite the right thing for you.

And so just one probiotic with not picking a dietary change will not get you there.

We have to have the right dietary change for the individual, and like I said, that may get you 30% to 50%.

Sometimes you’ll see a 100% response home run, but normally it’s like a good step forward, but there’s still something lingering.

And that’s usually the second step where you have a good well-balanced probiotic protocol, and that’s when you achieve that, maybe 70%, 80% of people will see the resolution that they need by that.

But it sounds simple, but there’s a few nuances where if you didn’t get the FODMAP piece dialed in and allow some of those things to rectify, then that 50% of the gain wouldn’t be captured.

So yeah, you’ll see, you’ll oftentimes see people who are eating kind of as strict within their paradigm as possible, somewhat uninformed about other paradigms.

And so a big part of just navigating that.

And then to complement that, there’s a handful of really good supports for the gut, probiotics are probably one of the best, elemental diets are also good or microbials as I’m sure people have heard about things like [folic acid and those can go really far if they’re applied the right way.

Abel: And when it comes to histamines, food sensitivities allergies as a practitioner, you probably see a lot of things pop-up all the time. 

Has that surprised you? Have you said, “Uh, jeez, I better get rid of peanuts because everyone has problems.” 

Or are there any foods like that?

Any foods that are really common culprit foods?

Abel: Yeah.

The most common culprit foods are probably garlic and onions.

Abel: Really? Wow.

Which may seem a little bit ironic, but they are… Garlic, if you think about it.

Actually, one of my patients said this and I was like, “Oh that’s pretty insightful.”

Said, “If you were a hunter gatherer and you bit into a clove of garlic, you’d probably chuck that thing in the woods.”

Abel: Probably so. Yeah.

And I was like, “You know what, that’s actually pretty insightful.”

Because it is somewhat nauseous, but it also does seem to be hormetic.

But I think for those with a really sensitive digestion, outside of all the benefits that one can derive from garlic, that seems to be one of the more common culprits that people have a hard time bringing back.

And now I’m not saying don’t eat garlic, but I’m just…

The point I’m making is, that tends to be… It is one of the… Under the umbrella of high-FODMAPs it’s one of the harder ones that people have a time with when doing their reintroduction.

Abel: So is that raw garlic? Does it matter that much when you cook it in terms of digestibility and how your body reacts?

Good question, I haven’t gotten that level of granularity from the feedback from my patients, I’m assuming some are doing raw.

But most are probably doing cooked, because I think most of my patients know that cooking helps pre-digest and make things a little bit easier to deal with, and I’m assuming that raw is probably going to be the hardest for people to tolerate.

Abel: Yeah, and I’m curious because it seems like with many of our foods, we still have those foods and we consider them foods.

But we don’t do the traditional preparation that all of our ancestors knew that they had to do to make it digestible or to make it safe. 

Now because of industry and cutting corners or just not knowing any better, we present these foods as foods, but they’re highly problematic without that degree of processing.

Yeah, yeah, it’s a great point.

And I also think I was having a conversation with Anthony Gustin from Perfect Keto the other day, and he made a good comment, which was he noticed his vegetable tolerance was much better when he stopped shopping at Whole Foods and he started shopping at local farmers markets.

Abel: Interesting.

Which actually makes sense, because there’s likely, if you’re getting Spring Mix from Whole Foods, just like this whole kind of supply chain, of the same greens, the same exact sub-types of every lettuce leaf or Swiss chard or whatever.

And so borrowing from the concept of acquired intolerances where if we eat the same food too many times, we can become intolerant to it and why eating seasonally is so important.

Well, within that same kind of philosophy, we could say that the local farmers market will give you even more of that, whereas Whole Foods, it’s probably going to be, going to have that same supply chain where it’s the same exact type of a chard.

And so maybe just getting that little bit of a nuanced difference can attenuate some of these potential reactions.

Abel: And freshness too, I would imagine would matter.

Yeah, great point.

Abel: In indigenous cultures, and some today they believe that there’s more spirit in a native food grown on the native land that you eat there. 

And having traveled to different places, it’s certainly a different experience eating the foods there as opposed to when they’re shipped to you here and you’re eating them on your couch, there’s definitely something else going on. 

But we’re coming up on time, so I want to make sure we just cover quickly what to do about stress and adrenal fatigue, because there are a lot of things going on all around us right now. 

And I think we’re all kind of feeling that we might be at full throttle, running out of gas.

Sure. Sure. Yeah. So man, so much to say here, let me try to reach for the most stallion.

I think taking a walk in nature, preferably with a friend, if you can, unless you’re a real introvert and then maybe by yourself.

But there’s this large body of research mainly being pioneered in Asia, showing that leisure time in nature is therapeutic, whereas leisure time in an urban environment doesn’t have that same therapeutic response.

Abel: Interesting.

So there’s definitely something about getting into natural environments, and we know that those who live in green zones or near green zones, forest or blue zones oceans have a longer life expectancy.

There is something therapeutic about nature.

So getting in nature and then walking is also one of the fundamental pieces of health and some have…

I believe there’s a mechanism through walking as exercise the different sides of your body leads to more hemisphere cross-connectivity through the amygdala I believe, which helps attenuate and process stress.

So walking in nature, I think is one of the best things that you can do for your health.

And I’d like to just quickly juxtapose that with getting an adrenal test.

And this is one of the things that we just recently published a case study at our clinic about someone who saw another provider.

His main complaint was quarterly, he goes to Asia for work, and the stress of time zone disruption wears him out.

No other real complaints. The other provider had them do $2300 worth of lab testing, and they did an adrenal test and they gave him…

And I’m going to… It’s going to be a little bit kind of couth about this because I want to be…

But I’m not going to be couth, actually I’m going to be candid.

I wanted to get to the point, which is, they did a bogus adrenal test, which again I’m being a little bit callous, most adrenal tasks are really not clinically helpful, that’s been published a pretty well done criticism of this.

Over 50% of the time they did not correlate with fatigue scores, is what the study essentially found, a systematic review coming back to that apex level of evidence.

So this gentleman spends $2300 in lab testing, he’s told he has adrenal fatigue, to avoid one of his few morning pleasures, coffee, to instead have lemon with maple syrup for six months, take a bunch of supplements, and he felt no better on the six-month plan.

Abel: Oh no.

And he was made to think he had a… I don’t know if I call it a disease, but a condition of adrenal fatigue and had to give up a simple morning pleasure.

We had him, and one of the doctors at our office essentially gave him some simple tips about circadian health.

So making sure you, as you make that shift, you get the natural sun exposure in the morning, you have the dim light exposure at night, gave him a few antioxidants and exercises to help keep him moving and keep him more in alignment after the long period of sitting, did one blood panel just to keep track of a few things for a few hundred dollars, and this gentleman saw almost immediate improvement.

So just because you’re stressed and you’re not feeling well, doesn’t mean some sort of expensive test is going to quantify what you should do.

And I know it’s so simple to think, well, and something patients say all the time, “I’ll do anything to feel better.”

Okay. It doesn’t mean that we have to just blow your money on a bunch of tests. Right?

There’s a time and a place definitely.

But I just share that example of trying to prevent people from falling over the edge of,

“Oh my God, I’m stressed, I must now have adrenal fatigue. Now I have this thing.”

And every time I don’t feel well, I think about, “Oh my God, it’s that thing,” and it builds up in your psyche, that’s so unhealthy for people.

We are all human, we're all amenable to stress, and there are simple things you can do to de-stress your body. @DrRuscio Share on X

It doesn’t mean that you have a thing.

So walking in nature, I think is a phenomenal one, and then time with people and connection is another.

So sorry to be a little bit preachy there, but I just see how people get…

They get fed these you have this condition, and now it’s just as runaway narrative and whenever they feel tired, they kind of go on Google and they look up,

“Oh my God, that’s another set of adrenal fatigue,” and they realize that they had it and that kind of further ensconces them in that belief, and it’s so disempowering.

And that’s why I’m trying to just help push people into a better direction of its normal to have ups and downs.

It doesn’t mean anything is wrong, and there are some simple things that you can do to help with that.

Abel: And it’s important to also recognize that people think science is a 100% there, but when you talk about any test, testing your blood, your saliva or urine, anything. 

Some are highly accurate and many are not, and it’s important to differentiate between those, and especially if you’re trying to get a diagnosis for something that’s going to be your thing, it’s very important not to take on… 

To use your example, adrenal fatigue, when it’s based on something that’s completely bogus. 

So it’s important to recognize that we really have to take responsibility ourselves. 

I think your book, this is a nice segue, is a great resource to have around because people want to think that Dr. Google is reliable, he is not. 

Books tend to be much more reliable especially from trusted sources. 

Where to Find Dr. Michael Ruscio

So before we go, Dr. Ruscio please tell folks where they can find you, your work, your book, and all that.

Thank you for the kind words. I really appreciate that.

That book was about three years into the writing, it was truly a labor of love.

I try to give people just a responsible narrative on this so that they don’t fall into the fear of adrenal fatigue or unfounded fear of gluten, and can just have the options in front of them with some guide posts on how to navigate them as effectively as possible, without dogma.

So yeah, I really, really, really do appreciate that.

The book is Healthy Gut, Healthy You.

My website is DrRuscio.com, and from there you can plug into the podcast, videos, blogs, supplements, and pretty much everything I do is kind of a hub there.

And just really grateful to be able to share that with your audience.

You can also find Dr. Ruscio on iTunes, Google Play, Spotify, Instagram, Facebook, Twitter, and YouTube.

Abel: Right on. Well, doc, you are so knowledgeable. We need your work more than ever. It’s always a pleasure.

Before You Go…

Before we get there, here’s a note that came in from Jen, she wrote…

My husband and I happened to stumble upon your book in a used bookstore. We are at a point in our life that we KNOW we need to get healthy again.

We have gained weight, lead a sedentary life, etc…

We have a special needs child who will most likely live with us for life. So if nothing else but for her, we need to stay as healthy as possible!!!

So there I was, in the bookstore, looking at cookbooks trying to find a good vegetarian or paleo or SOMETHING. And your book stuck out.

I have been reading it and we have changed the way we eat.

We just started two weeks ago (loosely, not yet following your precise meal plan and still substituting a few ingredients) but have already both dropped 10 pounds!!!!

We feel better physically and mentally.

Soooooo excited to begin this new journey.

– Jen

Jen, thank you so much. I’m glad that you’re doing this together.

I’m really happy you found the book in a used bookstore, which people can do internationally, as well. It’s really amazing.

I wrote The Wild Diet back in 2015, 2016. It has a lot of recipes in there.

I wrote it to be as relevant and valid 10 years from the time that I wrote it, 100 years from the time that I wrote it, as it was the day it came out.

So I’m really glad that you’re still enjoying it, and getting some great recipes.

Yes, they’re meant to be templates.

You know all recipes and a hidden dirty secret…

Even though my wife and I are bestselling cookbook authors of many different cookbooks, most of the time, we’re kind of experimenting, especially me.

I’m throwing ingredients together and then we estimate what we did after the fact. And then try to replicate it.

So all of these different recipes are really meant to be templates.

Everyone has different ingredients available to them at different times, and swaps are easy enough to make. Especially if you have dietary restrictions or you’d like to color outside the lines a little bit more.

So that’s good on you, Jen.

And I’m glad that you and your hubby are doing this together.

It’s really important that you don’t try to do this alone. If you have to, then you can for sure.

But it definitely makes it easier when you have other people to make you accountable, that you can rely on, other people to pick up the slack with cooking and that sort of thing. So good on you.

And then as far as taking care of a special needs child, we have a number of people in our close friend group who have a special needs child, and changing the way that you eat as a family can really not only make you accountable, and I’m glad you built that in, but also help you all feel better together and move on that path toward healing.

So young or old, when you prioritize real foods and cut down on industrial oil, sugar, and process junk, your body can finally heal itself.

And you and your husband already shedding 10 pounds in two weeks. That’s not too shabby.

Thanks for checking out the book and giving The Wild Diet a try.

And the trickle effect, keep this in mind too, it often starts with shedding a bit of weight, but also can lead to feeling better in a lot of other ways.

Having more energy to dedicate to other parts of your life and really grow things there, more focus and just more overall gusto for life.

So look forward to that and kudos to you both.

Keep in touch, let us know how it goes.

How about you? If you enjoyed The Wild Diet book, My Diet is Better Than Yours the TV show on ABC that we did years ago now with our friend Shaun T, or you like anything else, and you just want to get in touch.

Drop a comment at the bottom of this post, or sign up for my free newsletter and reply to my email to you.

I respond to as many messages as I can.

If you have a question, if you have a comment or if you’re looking for one-on-one coaching, just shoot me an email.

You can also follow me on social media—Instagram, Twitter, Facebook, and YouTube.

Lately, you know, it’s a double-edged sword, right? But Instagram has been very active, lately, you can find me @fatburningman on Instagram.

And there are some new social channels coming out, and were on some of those, as well.

We’re trying to spread a wide net at used bookstores and reality TV shows, podcasts, relatively unknown social media networks, VR channels, and all the rest of it.

So wherever you are, look us up under Abel James or Fat Burning Man. Sometimes it’s even easier to direct message me on one of those platforms than it is to email.

I try to get back to as many of you as I possibly can. Get in touch. I always love hearing from you.

Now, a quick plug, due to industrial farming practices and the fact that much of our soil has been degraded, most people don’t get enough nutrients from their food alone, this is just one of the reasons why my wife Alyson and I started up Wild Superfoods to make it easy for you to load up on critical nutrients your body needs to thrive in the face of an uncertain future.

One of our favorite ways to support our own microbiome is with our probiotics from Wild Superfoods called Probiotic Spheres. It pairs wonderfully with our bestselling Future Greens.

Now, what does “wild” mean anyway?

Well, we work with the laws of nature, not against them.

We avoid anything artificial, genetically modified or overly processed.

At Wild Superfoods, each of our products is lab tested and formulated according to the latest cutting edge developments in research, science and medicine.

Guaranteed nutrition, no matter where you are.

And right now, you can get a deal on Probiotic Spheres by heading on over to wildsuperfoods.com.

Right now we’re only available in the U.S., but hopefully we’ll be expanding soon enough, so just go to wildsuperfoods.com to check all that out. Thanks for listening. We’ll see you there.

What did you think of this conversation with Dr. Michael Ruscio? Drop a comment below!