Dr. Michael Ruscio: How to Dodge Keto Hype and Upgrade Gut Health with Probiotics, Prebiotics & Real Food

Did you know your gut is responsible for producing about 90% of your serotonin, one of the leading neurotransmitters that can help generate (or negate) happy thoughts? In fact, some researchers now call our gut our “second brain.”

There’s a lot going on in that gut of yours.

Today we’re here with Dr. Michael Ruscio, a clinical researcher and bestselling author whose work in the world of gut health has been published in peer reviewed medical journals.

Even though we’d met before, I was re-introduced to Michael by our mutual friend, Robb Wolf, who says, “Mike is one of, if not the most knowledgeable practitioner in the world on the topic of gut health, both what the research says (and does not say) as well as the clinical applications.”

On this show with Dr. Ruscio, you’ll learn:

• How to treat the root cause and not the symptoms of ill health
• The true function of prebiotics and probiotics
• What the research says and doesn’t say about gut health
• How to dodge keto hype
• And so much more…

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Dr. Michael Ruscio: How To Improve The Ecosystem of Your Gut

Abel: How are you?

I’m doing great. I’m happy to be here and glad we had a chance to finally reconnect after our first connection a number of years ago while we were at PaleoFX.

Abel: Yah man. And you just released a solid book, about gut health, which many people will be excited about because that’s probably one of the most confusing areas of health these days.

There’s so much information, misinformation, lack of information, confusing information, about what to do as it relates to our bodies.

But there are a bunch of things that you say in your book that we’ll get into, like the idea that you can’t micromanage an ecosystem.

But before we get there, why don’t we start with how you got into this, because it wasn’t necessarily just like a beautiful career choice where everything went perfectly.

You had to go through a bit of suffering as I understand.

I did, I did. I was in college and I was on par to go into conventional medicine, and I then started feeling fairly ill. I was having insomnia and brain fog.

Both of those symptoms, I can’t overstate how impactful they are.

Insomnia, if anyone’s ever suffered with it—it just halts your life. It’s the worst.

Abel: You’re waking up at like 2:00AM and you can’t get back to sleep, right?

Right, and sometimes I even had cravings. I would get in the car and drive to the gas station to buy a Kit Kat bar.

All the while, the other side of my brain is like, “What are you doing?”

But there was just something going on that was so out of whack physiologically that I just couldn’t sleep, I was craving sugar at night.

And then during the day, I would have these bouts of brain fog where I would just feel like an idiot.

I couldn’t think of words, I felt like I was throwing my speech, I was having bouts of depression.

Just really clearly not the person I was a few months ago, and I figured, “Well, ok, I’ll go see my internist, my GP, and an endocrinologist, just to be the super overachiever I am.”

So I did an over-achiever evaluation at three different doctors and none of them found anything.

They all even remarked, “Well, you have very good cholesterol, and blood sugar, and triglyceride. You have a low body fat, and a good body composition. So you know, it must be stress. There’s nothing wrong with you. There’s nothing that we can do.”

And they were well intentioned, I have no quell at all with medicine, but there was nothing that they saw that they could remedy.

So I went on the internet and I read a bunch. I thought I had adrenal fatigue, hypothyroid (or at least impaired thyroid conversion), and heavy metal toxicity.

I did all these protocols I found on the internet and got little bits of improvement, but nothing substantial and nothing that lasted.

I eventually found a doctor who told me that he thought I had a parasite, and I remember thinking to myself, “This guy’s off his rocker. A parasite?”

If I had gone to Mexico, had food poisoning, came home and then this started, I would have understood. But I had never left the country up until that point.

I don’t think I’d ever even had food poisoning in my life, and I had no digestive symptoms.

This is actually a key principle that’s really important for the audience, which is:  You can have a digestive problem causing symptoms in other areas of the body, and causing no digestive symptoms.

That’s why gut health can be so important and overlooked.

People can be chasing down something like skin rashes, fatigue and depression, and thinking, “Oh, it’s got to be something else,” but it could be emanating from your gut. And I was a perfect case of that.

When I did end up doing the testing, I was found to have an amoebic infection, quite pathogenic amoeba, and this was causing all sorts of problems in my intestines.

Ironically, it was not manifesting as diarrhea and abdominal pain, as it often does, but rather it was manifesting more neurologically. In my case, brain fog, insomnia, fatigue, and depression.

The experience in treating that parasite was the only thing that really helped me to get better. I diverted my path into alternative medicine.

I felt like there was some areas where people in alternative medicine were just way too happy to be doling out very restrictive dietary recommendations and very expensive tests. I would have really appreciated a little bit more conservatism and rigor with some of the thinking there.

So that led me to start performing some of the research in our clinic. Some of the data from our clinic has been published in peer review journals, and we have a couple of more papers that will be published soon.

We have a randomized placebo-controlled trial that we’ll be starting in a few months. That took a long time to get that off the ground.

And I wrote the book, of course, which has just under a thousand medical references to support the approach. It tries to give people that optimal balance between being conservative, cautious and data driven, while also being progressive.

So people can get well and have options, but not feel like they’re being given these excessive dietary recommendations, or testing recommendations that just cripple them because of the expense.

Abel: That’s terrifying and a little bit surprising, that it turns out you were infested with parasites the whole time. Do you know how common that sort of thing is, especially amongst people who haven’t left the country?

In terms of how long it was going on, probably only a matter of months because I had somewhat of an acute downturn. It wasn’t like a slow, gradual slide down. Probably between three to six months prior to hitting the bottom point.

And then in terms of how common, they are not very common. I see maybe one or two cases of this amoeba in my office per year. So, it’s not very common.

But what is actually more common and sometimes overlooked, is what we could term dysbiosis.

Dysbiosis is this umbrella term, but we can organize underneath it: SIBO, candida, fungus, Yersinia, toxoplasmosis, Blastocystis hominis, H. Pylori, parasites.

So, all these things that people hear about can really be organized under this umbrella term of dysbiosis.

Much of dysbiosis isn’t an actual parasite, but something native to your body that overgrows. It can cause some of these same problems.

And actually, in the minority of cases, it isn’t some creepy crawly worm thing that gets in and is causing problems, but rather your own ecosystem is out of balance and that’s churning up inflammation and causing problems.

Abel: Right. Because at any given time, we have pounds of things inside of us that are good and bad.  

You mentioned this in your book, it’s less about getting rid of that one thing, that one evil bacterium or amoeba, or what have you, and it’s more about getting the whole system back in check, right?

Exactly. This is actually a key concept that can help people navigate this terrain more effectively.

At first, it’s tempting for the healthcare consumer to want to perform a test.

“I’ll do the test and I’ll figure out exactly what’s wrong, and that’ll tell me exactly what to do.”

But that’s not really how it plays out, and I don’t think everyone has fully come to realize that yet. Even some of the functional medicine educators, I don’t think have realized that yet.

Me saying that may be a little bit controversial, but I’ve also put in the time to look at this issue, and I rarely make strong statements. But I think it’s a very tenable statement to make that the utility of testing is there, but it’s been grossly overstated. And that’s because people think there’s this one thing they have to figure out.

My case was probably a bit of an anomaly. And actually, even with my case, it was probably a year until I felt better because it was more of a monotherapy to blast out that parasite. I was also histamine intolerant, probably a bit sulfur intolerant, and could’ve used some other strategies to heal my gut.

I still suffered with symptoms that slowly went away over a course of another year, and I probably could have had that all gone in six weeks had I taken a more holistic approach for my gut health.

And that’s the same analogy we develop in the book. It’s not about just blasting out this one thing, but rather like being a gardener, looking at the health of the soil and trying to find the environmental factors that can really make the soil healthy. Tthose are usually multifold.

Abel: I love that example because I think it makes it concrete for a lot of people who’ve had their fingers in the dirt.

It’s hard to conceptualize what’s going on in our gut. Where is the gut even? It’s hard to think about that.

But in terms of an ecosystem, a lot of people know that my brother is an organic farmer and he’s had a lot of issues this past year. A lot of it because it’s been so warm up there, unseasonably warm up in upstate New York. They’re having to deal with a whole bunch of different pests that they haven’t dealt with before.

And it’s usually not a matter of that one pest. It’s looking at the soil, it’s looking at the tiny little tweaks we can make here and there. It’s not like taking napalm to that one bug, it’s really not.

Right, exactly. And people have probably heard of the microbiota, which is this world of bacteria that live in your gut, and it’s not just bacteria, there’s also fungus, protozoa, and archaea.

So, there’s this community of life that lives in your gut, and we do know that the health of the host impacts the health of this community of life.

And so just to think one thing would be enough to cause a measurable impact, it’s a bit reductionistic and it’s a bit naive.

Now, we can use these different tools in concert, but just thinking like, “Oh, it’s got to be that candida and it’s all about the candida.” And this is what I see patients come in with this paradigm of, “It’s SIBO. It’s candida,” and they start even internalizing it. “Oh, my candida flared,” or “My SIBO is back.”

And I appreciate the fact that they’ve educated themselves, and they’ve gone from not knowing anything about the gut to now understanding what SIBO is. But the problem is, when you start tunnel visioning all of your therapeutics around SIBO, you sometimes miss the other signals that your body is giving you, telling you what’s working for your system and what’s not working for your system.

There are a plethora of examples that show that things that we do to improve the health of the host will not only reduce symptoms, but will also improve the life in the gut. And a low FODMAP diet is just a good, quick example of that.

A low FODMAP diet is essentially a diet low in prebiotics, which are compounds that feed bacteria. Probiotic is the bacteria, and prebiotics are compounds that feed the bacteria.

So, a low FODMAP diet is a low prebiotic diet.

Now, many would lead you to believe that you have these healthy bacteria in your gut, and if you eat lots of prebiotics, you feed those healthy bacteria. Healthy bacteria, healthy host.

But that’s not actually how it plays out in the majority of cases.

There’s data that contradicts this, but when we look at the totality of the data, or the trend in the data, we see that especially the more symptomatic someone is, the more problematic it actually may be to feed this community of bacteria in the gut.

And what may be happening here, coming back to the holistic idea, is that the immune system that nestles up against the bacteria, they don’t get along. And so if someone has an overzealous immune system and you feed the bacteria, for which the immune system is trying to hold in check even though they are, “good bacteria,” that can cause the immune system to react.

And we do see the research showing that people who go on a lower FODMAP diet, just this one example, not the only therapeutic tool but this is one example, we’ll see a reduction in leaky gut, a reduction in inflammatory markers, and a reduction in signaling molecules of the immune system in addition to a reduction of symptoms.

So this is why it’s important to look holistically and not just say, “Well there’s this microbiotic craze, everyone needs to feed their good bugs.”

It’s not true for everyone.

In fact, for some people, feeding the good bugs will cause more damage, and understanding that maybe the immune system is a more important part of that environmental symphony that needs to be taken in consideration.

Using a lower FODMAP diet and in effect causing potentially a slight starvation effect will actually be the key maneuver that creates harmony in the ecosystem and finally gets a symptomatic response that a person’s looking for.

Abel: And then it kind of cascades after that?

Yah, and then it can cascade in a good direction, or a bad direction, that’s always the thing.

If you’re doing things right, you’ll start seeing improvements and then you can build upon those improvements.

And I think one of the things that really eludes people, developing the same example, is they listen to what they read or watch on the internet and they don’t listen to the cues that their body is giving them.

That’s what I think is helpful about the protocol in my book, Healthy Gut, Healthy You, which is at the end of each step we reassess symptomatically and use those cues to inform what direction we go.

The protocol is not one linear protocol, it adapts based upon the individual’s response. Because those cues are your body’s way of telling you if you’re doing the right thing or if you’re doing the wrong thing.

Abel: How many people are doing the wrong thing, or in the wrong state?

That’s really hard to say. I probably get a skewed read on this because in the clinic it’s just every day someone who’s not able to figure it out on their own.

It also likely has to do with where someone is on the severity spectrum. People who have very mild involvement in their gut can probably see marked benefit from any number of preliminary therapies.

Mediterranean diet, Paleo diet, even a clean vegetarian diet, a low-carb diet, all these things will probably help someone who has only mild imbalances move in a better direction. Or they keep their diet somewhat constant and they find a good probiotic formula, and they feel great.

So people who have the mild, easy cases will respond very well to many different things. But as you slide down the spectrum to moderate or severe, this is when it becomes more challenging.

And you won’t find just the one thing that fixes everything. It’s those people who really suffer because they read about the one thing in Vogue that’s hot at the moment, and then they do that and it’s very haphazard.

Abel: “Give me a fecal transplant now.” 

Right, exactly. We would be putting the cart way before the horse.

But again, coming back to the analogy of a step-wise process, they might see 25% improvement from diet, and then another 20% from the right probiotic protocol.

And they may get another 20% from a well-crafted antimicrobial approach.

So yah, the further you go down the spectrum, the harder it is for someone to figure this out, and rightfully so.

An analogy I think I use in the book also is, “If you were being sued, you wouldn’t want to represent yourself as an attorney. You’d want an attorney who understands how to use the law effectively.”

Just because you have access to protocols doesn’t necessarily mean you know how to use those protocols effectively.

Abel: Right. And it’s a highly individualized thing as you mentioned.

You need to, throughout this whole process, keep your intuition intact. Build the natural senses that you have or like, “How am I doing? How am I feeling right now?”

Because a lot of people are quite disconnected from their guts especially. It’s not something that we’ve been trained to think a whole lot about. 

So what are some of the things that everyone, or that most people, can do to make a slight improvement, whether it’s kicking certain foods or habits out or putting something in. What are the easy wins for people?

I think the lowest hanging fruit would be making sure you’re exercising, at least a few days a week. And if you really want to maximize that, exercise in nature with a friend.

Because then you get 3 things, you exercise, you get social connectivity, and you get time in nature, all which have been shown to have measurable therapeutic benefit.

And it’s important because sometimes you think, “Well, oh, this is the most exotic adrenal formula. And I’m looking at all the marketing for it, it has all these pathways.”

I think it’s fairly safe to say that taking a walk in nature with a friend will have a more drastic improvement on your energy and self-perceived sense of well-being than even the best adrenal support formula on the market.

And sometimes it’s important not to contextualize that as such, because people want to go right to the new cool thing, which may have it’s time and it’s place.

But that would be one, walking or exercising in nature with a friend. That’s a really nice trifecta, from a lifestyle perspective.

Making sure you’re getting time in the sun is also important. These are things people have probably heard in one way or another.

From a dietary perspective a Paleo diet is a good place to start, but if people have gone on a Paleo diet and, I think, two to four weeks is all you really need to at least get an initial assessment of moving in the right direction.

If you can’t clearly say that you’re moving in the right direction after 2 or 3 weeks, then it’s probably not the right diet for you.

Now I wouldn’t say that you will achieve all of your improvement in that two to three weeks, but again, you’re looking for that key indicator from your body that, ok, something here is clearly better than it was 2 to 3 weeks ago.

But for some people, ironically, they go on a Paleo diet, and they feel a little bit worse.

Some people feel no change, some people even feel worse, and these people may be the subset that are FODMAP sensitive.

If  you have an inkling that the non-Paleo foods, like dairy and gluten, are problematic for you, you can then do the Paleo low FODMAP diet, which is a union of Paleo and low FODMAP.

But there are other people who, especially people who are underweight and have other known foods, that they don’t tolerate well, like for some people they’re very sensitive to many vegetables, but seem to do okay on grains.

This subset also tends to be more underweight, then they can go on the standard low FODMAP diet, which allows certain dairy and certain grains.

We will be publishing a case on our website soon, for some people, like they come in underweight, and very afraid of grains and that’s exactly what they need to be eating, because their gut isn’t healthy enough yet to process vegetables.

Then we’re about to publish a case study with this gentleman named Randy who was literally having a hard time walking up stairs.

And in the back of my head I’m thinking, “Boy, could this be early progress MS, or something really more cardiovascular that’s serious in nature.”

And when we significantly upped his carb intake to have him eat more grains and some gluten, he gained 5 to 10 pounds in 3 to 4 weeks, and he power washed his entire deck.

Abel: You’re kidding.

Literally. And he goes, “My wife’s thrilled, and I’m happy.”

So for him, he just needed to have that shift in his macros, he was still a little bit sensitive to vegetables. Grains seemed to really sit well with him.

And we didn’t say, “Eat gluten containing grains.” But we didn’t say don’t have any of those.

So he had gluten containing grains sometimes, and didn’t notice negative reactions to those, and overall was feeling much better.

So sometimes if we can just excise the dogma of the dietary recommendations, and again use someone’s cues from their body, we can really help get them to the diet that can be the most serving for them.

Abel: Right. Because if you look at each individual over the course of time, it’s a moving target.

Absolutely.

The Psychology of Healing

Abel: If you’re going on a low FODMAP, that’s not necessarily a lifetime choice, that’s more of a stepping stone to get healthy.

You make such a good point.

This is something that we talk about in the re-introduction step, which comes a little bit later in the book protocol.

And I set this expectation that people will be able to eat more foods, and that’s actually a very important setting.

That expectation is actually very important in randomized controlled trials with IBS.

In randomized controlled trials you’re specifically trying to design the placebo effect out of the study design. Yet it remains  45% on average in randomized placebo-controlled trials in IBS.

So, your thoughts about food have a powerful impact on the manifestation. And this is one of the reasons why—and I’m sure you picked this up from the book—there is no dogmatism. There is no fear mongering.

There is no overzealousness about things like gluten or dairy, saying that’s going to up regulate inflammatory peptides for six months, and you can never ever have it at any point.

Because that does not, in my opinion, help people. Nor does the best scientific evidence that we have to date support the need for that level of restriction.

So yes, we want to get people to the point of the broadest diet in the long term, and that legitimately can happen.

We do see  in many studies that people who are more sensitive to foods, as they heal their gut and things rebalance, they become less sensitive to foods.

So, if we’re going to use the placebo effect, let’s use it accurately based upon what the literature says. And let’s use it to help someone feel healthier.

And this is the conversation that I have whenever I do any kind of training for clinicians.

I ask the audience a question, “If you couldn’t get it perfect. If you had to either overshoot or undershoot in terms of how healthy or sick you made someone feel at the end of a consult with them, would you want to make them feel more sick or more healthy than they actually are?”

If you can’t get it perfect, we always want to shoot for the side of making them feel healthier than they are because that will have a measurable impact on their health.

And so that’s a concept to try to carry into the book, of trying to showcase the empowering side of diet rather than the fearful damaging side of diet. Because that will manifest in someone’s worldview.

And I do see that in the clinic where people come in and they’re afraid of food and part of their illness is literally psychosomatic. They’re expecting to feel sick if they ever eat any of these foods, and it becomes this kind of placebo-driven, self-fulfilling prophecy.

Abel: Right. So you’re kind of creating your own anxious gut in that. That can’t handle food anymore.

It’s fascinating that the placebo effect accounts for up to 45% of the results. That’s astonishing.

And I totally agree with you, we should be harnessing that for good as much as we possibly can.

Because clearly, we don’t understand everything there is to know about the body, how it works, and all of that. Yet, the placebo effect is something that doesn’t really go away.

That makes it sound like eating is almost more of an emotional thing and a psychological thing, than even a scientific one.

For some people it is.

And there’s another case study that we’re writing up right now, that we’ll publish on our website, with this brilliant psychotherapist came into the office and was very well researched, knew quite the breadth of data regarding gut health.

And she had seen a number of providers before and she wasn’t really able to get the traction that she was looking to get.

And she came in with this air of, this is the expert, we’re going to dig into this, and kind of rolling her sleeves up mentality.

And I could clearly see that there was very little wrong with her and that what she had done was she had far overshot the landing. And she was now treating herself like someone who was really sick, in terms of how she was eating and what she was thinking, what she was doing, and what she was taking.

What she needed to do was kind of throttle that back and move into the maintenance and enjoyment phase of her life, and of the healing journey.

And when she did that, and it was very tense, I remember leaving that visit, feeling it wasn’t what she wanted. I could tell that what I said was not what she wanted to hear.

But when she came back a month later she said, “I cannot thank you enough. I feel better than I felt in years.”

And what had she been doing? Having a drink every once in a while, eating some off-plan foods, and just letting go a little bit, and enjoying her life.

Now that’s not every case. The majority of people probably need to fix the problems. But for some people, the emotional psychological aspect, if not addressed will be the thing that thwarts them from achieving what they’re looking to achieve.

Abel: Yah. I think you can’t really emphasize that point enough these days.

With the internet, with being so plugged in to social media, and everyone’s chattering about how this thing’s horrible for you, and this thing is good for you. It is easier than ever to overthink something.

And I’m sure you have a unique take on this as well, as a doctor, but the idea of being able to look up whatever you think your problem might be on your phone or on your computer and get who knows what kind of information back.

That’s a big problem, isn’t it? And I’m talking mostly about psychology at this point.

That’s a fantastic point. There’s a post I’ve been thinking about writing which kind of walks through why patients could be more prone to get diseases that they research, than their doctors do.

And I think part of that reason why is because doctors, or at least well-informed clinicians at large, will understand not only the science and symptoms, but also the prevalence. And the prevalence is important.

Using non-celiac gluten sensitivity as an example, I believe this is a study that is very important for the audience to be aware of.

So, non-celiac gluten sensitivity is essentially, you don’t have celiac, but you clearly have this reaction to gluten. In the research, it’s called non-celiac gluten sensitivity.

It’s a legitimate clinical entity where there had been at least four, maybe now five clinical trials substantiating this concept.

So yes, we do see scientific validation for the concept that there are people who are not celiac but who will have a problem with gluten.

Abel: Is inflammation thing that’s the problem?

It may be inflammation, it may be kind of immune system inflammation. Part of it may also be the FODMAP content.

So, of these trials, four out of the five show that it was actually something to do with the gluten itself, and it was not the prebiotic rich FODMAP component of the gluten. But one trial did find that.

So for some people it might be the prebiotics, for other people it might be the immune system.

And at least the initial data says it might be the immune system for more people, but I don’t know that we have fully answered that question just yet.

But in this study, it was in Italy and they looked at 12,225 patients, and they found that the prevalence, and I should mention this is a group of gastroenterologist, a multi-center study that put together a 60 point evaluation to really try to dig in and figure out what the symptoms were, what the associated comorbidities were, what lab markers might be useful.

And they found a 3% prevalence of non-celiac gluten sensitivity in the population that they studied.

And they studied other data from the U.S. because the glyco-phate used, or the Roundup used in the U.S. and Europe is different.

So, that’s one contentious point which I think is totally reasonable.

So, they cited data in that study showing that the United States has found a 0.6% to a 6% prevalence.

So it might be more in the U.S. Yes, totally open to that argument. I think there’s a possibility there.

But again, let’s look at what the data shows when people try to honestly answer this question. And it looks at that 6%, at least according to the best data available is a prevalence in the US.

And now when I make people aware of this, one of two things usually happens. People find that encouraging, or people try to argue with me about that.

And I don’t think it’s something that we should be arguing over because the recommendation, I think, is a highly tenable recommendation, which is: Eliminate gluten for a term, and then reintroduce it in, and avoid gluten to tolerance.

I think it’s hard to argue with that, because then you will find where you fall in that spectrum.

Sometimes the argument is made that, “Well, you’ll be feeling inflammation in your body that will not manifest symptomatically for weeks or months or years.”

Ok, I’m open to that concept or we’re going to need to have some kind of data to support that concept.

And again, what this study found was that over 90% of the participants that had non-celiac gluten sensitivity reported a considerable reaction within 24 hours.

Over 90% of people with non-celiac gluten sensitivity report a reaction within 24 hours. Click To Tweet

Abel: 90% you said?

Over 90%.

So there were some that had this delayed reaction, but the vast, vast majority noticed either a neurological, or dermatological, or a rheumatological, or a digestive reaction within 24 hours.

So it kind of refutes that argument that you have to avoid gluten on blind faith, which I don’t think is accurate.

And the last point on this study, they found that 30% of the people with a problem with gluten, could have gluten once they addressed another underlying problem in the gut like bacterial overgrowth or FODMAP sensitivities.

So there’s a lot of hope here.

Gluten can be something that can be used to help people get healthier, but we want to wield that informational sword very carefully.

Because if we are overzealous with it, then I think we end up creating more harm in someone than we do good.

And it may not be that you have to avoid gluten forever. But eliminate, heal your gut, re-introduce, and then avoid it to the level that you’re intolerant.

Strong reactions, strong avoidance. No reaction or mild reaction, then mild avoidance.

Abel: I think it’s also worth bringing up that we tend to over-simplify things, like gluten. It’s just a thing, except it’s not really when you look more closely at what you’re actually eating.

I’ll use myself as an example. Before I ate this way and I was eating more like a vegetarian, I was very physically active, I was running a lot. I was eating a whole grain bread from the store and I didn’t have a whole lot of money, so I’m sure it wasn’t the best that I could buy.

Now, that wasn’t necessarily whole grain, in the way that we’d like to define it. It was also packed with all sorts of different additives. Sulfates are one that my mother has had problems with, I believe I do as well. There are so many things that are in that, certainly gluten.

But I would imagine a different kind of gluten than, for example, what’s in the most recent loaf of sourdough that my wife Alison made from organic spelt and rye. Both of which are gluten grains.

But it’s a sourdough.

And we’ve been working on that starter for over a year now. It’s been eaten by that starter over the course of time, we cooked it kind of low and slow, we didn’t add any sulfates or preservatives, or extra gluten to make it extra poofy or anything.

Those are fundamentally different things.

So the idea that you can or can’t eat gluten just seems like such a over-simplification.

It’s one of those examples of trying to use the napalm on that one little bug. It’s less about that and more about thinking at a higher level, right?

The food quality matters, the preparation matters. Absolutely.

And maybe to play devil’s advocate on that point, even though I agree with it. The other thing I’d like for people to be able to have, and this is coming back to Randy and we discuss this in the video that we’re going to publish with him.

When I said you can have some gluten, I was mainly thinking, “I want this guy to start eating more carbs because he is deathly ill and fatigued.”

I don’t want him to be at a work function and the only thing he can eat that has carbohydrate in it contains gluten and then therefore he does not eat.

So sometimes I think it’s just allowing people a little bit of leeway to maybe eat something that’s not the healthiest thing, but let them find their own level of reactivity and if they’re okay with that.

We don’t want to make it a staple, but if they can have leeway on occasion, we want them to be able to have that leeway so that they just don’t feel any additional encumbrances from their diet than they have to.

The aim will always be the best quality food, but if someone falls short, we don’t want them to go into the internal stress response about, “On my God, what did I just do”.

Especially, if they haven’t qualified that symptomatically they can’t have that poor quality food, even if they noticed that when they have that poor quality food, they have a problem.

We will learn from those bodily cues and adjust accordingly, going forward.

But if they can have a little bit of leeway, I want them to have that leeway to prevent that fear response.

Thoughts on the Keto Hype

Abel: Right. Now to shift gears just a little bit. In the past year or two, it seems that Keto has even eclipsed Paleo in terms of a way of eating in terms of hype, and all of that sort of thing.

But the way that most people are doing Keto is more like, it reminds me of Atkins.

I remember my driver’s ed instructor when I was learning how to drive, would have me drive him to McDonalds to get three hamburgers because he was on Atkins.

He’d take off the buns and just eat the burgers.

Oh man.

Abel: I see a little bit of that going on with the people who were just chowing on cream cheese and other fatty foods that are “keto”, but that’s not really nutrition.

So what are the implications for some of the super high fat Keto diets that some people are doing these days?

You know, I haven’t dove deep into that specifically, but there are a couple of salient points we can pull from the literature on this, that aren’t relevant to the conversation.

I would agree with what you’re generally pointing at, which is, if you’re going to go Keto, we should always opt for the highest quality of food, in this case, fats.

But sometimes the contentious point is, “Well, you need fiber to feed your gut bugs, and to sweep your colon and all this. And if not, you may have an increased risk of colorectal cancer or all these other things that fiber helps prevent.

And this was the most challenging part of the book to read. Literally, 157 pages of abstracts that I had to call through. And I almost… If I was ever going to quit, that was the closest I came, because I care about the truth.

What I don’t want to do is bring my preconceived bias in on the conversation and then exit with that same preconceived bias.

And to think that way is much more difficult, because you have to give every piece of data your equal attention, and also monitor yourself for any biases that are creeping up, while trying to catch yourself if you’re only looking at the things that show favor for what you think should be right and kind of negate the things that don’t.

It was very challenging.

And not only that, but you have to look at the level of the quality of the evidence and observational trial doesn’t carry as much weight as a randomized placebo-controlled trial.

So there’s a lot there to weigh and it was very challenging.

But what I can tell you from going through that is there’s no consistent data showing that fiber prevents colorectal cancer, diabetes, heart disease, obesity.

No, in fact, you see about a 50-50 split, generally speaking, where some do show benefit but approximately equivalent number show no benefit.

And where this becomes challenging is, if you believe fiber is good for you or bad for you, you can find data to support that.

And that’s the way I concluded that chapter. Which was, imagine if I as an author or a researcher was sold on one camp. I could have written an entire chapter with the pro studies and laughed out the con and actually misled the reader.

And so I said, it’s important to really choose who you follow carefully because if not, you run the risk of being misled.

Now, why that’s relevant is, there are some people that are very sensitive to fiber and certain vegetables, or metabolically do better with a lower carb diet.

Although the effect size for the benefit from a lower carb compared to a moderate carb diet, I think is modest, but it is there.

But anyway, why that’s important is because for the people that don’t do well on higher fiber diets, like those with the IBS and IBD, they get scared.

And they think, “Oh my god, am I going to have an increased incidence of colorectal cancer?”

But, we do see both a Paleo diet and a Mediterranean diet, moderate carb, higher carb, and fiber correlates with that. Both show protective benefit against colorectal adenomas, at least, according to some of the preliminary research, in addition to the broader analysis that I discussed earlier.

That’s important because again, the fiber doesn’t seem to make a huge difference.

It can be used in some select cases especially if people are constipated and then upping your fiber intake can be beneficial.

But for other people—and I think Robb was actually one of these people banging his head against the wall for a while with a higher fiber diet—just seeing when they brought down the fiber content, they felt so much better.

Sometimes just having the confidence to listen to your body can be a very freeing experience.

And I’ve been guilty of that myself. There have been things I was doing dietarily that were just ingrained into my head and they weren’t working for me. But I thought so fervently that I needed to do those things that I never listened to my body.

Fiber, it can help certain things, but you don’t have to have fiber to have a healthy gut, and have a healthy microbiota.

And when I say you don’t have to have fiber, I’m not recommending a zero fiber diet, but you don’t have to have a higher fiber diet in order to have those health benefits.

Abel: That makes sense.

Now, there are several different types of fiber. Some is from fruit and vegetables, and there’s oatmeal and things like that.

Are there any prebiotics that do have some benefit that’s clear?

Well, prebiotics and fiber do show benefit. And this is where it gets murky because there’s not just one pile of studies showing benefit or detriment. There’s a mixture.

There is clearly a data trend in this direction. Those who are the most symptomatic, especially digestively, have the highest risk for a negative reaction from fiber and prebiotic intake. But there’s also some nuance.

But with prebiotics, 3.5 to 5 grams per day seems to be the sweet spot that shows benefit, but doesn’t run the risk, or runs a minimal risk of adverse reactions.

Prebiotics have been shown to help with things like constipation, and inflammation in the bowel. And probably the best data is the ability to lower blood sugar.

But there’s a decent level of adverse events reported, and most of those adverse events are digestive side effects. So it’s important to keep that in mind.

Fiber probably shows a little bit less of a benefit in terms of lowering things like blood sugar, but fiber’s probably the most beneficial for those with constipation in terms of some of these natural therapies.

Magnesium and Vitamin C, natural laxatives are also helpful, but fiber can definitely be helpful for stool bulking, and that can help with expulsion of the stool, and hence, help with constipation.

And there are some fibers that are more prone to making gases and therefore, making you feel bloated, than others. And so, Glucomannan was one fiber that there was excitement about for its potential with weight loss, but it had a high level of adverse events.

And we talk about different fiber types and who may do best with each. But essentially, it looks like a predominantly soluble fiber will be the least devoid of causing reactions and those with sensitive guts.

But there are some fibers that are also low solubility and low ferment-ability and this gets a little bit into some of the murkier details that are only relevant if you’re really sensitive.

But it’s nice to know them if you are really sensitive because when they matter, you’ll be happy to have that information.

Intermittent Fasting and Gut Health

Abel: Now what about intermittent fasting and its effects on the gut. What does that look like?

I think we’re somewhat early in our understanding, although I have to profess, I didn’t do a very deep dive on the impact of intermittent fasting on the gut when I wrote the book.

But we were able to find at least one trial or an observational cohort study in IBS and one in IBD showing benefit for digestive function by using intermittent fasting.

And it’s one of the first things that we actually incorporate into step one of the book protocol where we help people try to outline their ideal diet. One of the pieces to outline is meal frequency.

Some people will not do well with small frequent meals. Some will, but for some their gut needs time devoid of food in order to run various housekeeping functions.

Some of this is apoptosis, which is recycling of dead cells. Some of this is a sweeping function know as a migratory motor-complex which cleans out bacteria and fungus and prevent it from kind of growing up and overgrowing.

We do know that for some people, fasting can be helpful. And we talk about essentially a modified liquid fast in the book that will get people some calories but it won’t be zero calorie because sometimes that can be a little bit challenging for people.

We start them off with a 2 to 4 day liquid fast. Then if they respond well to that then we encourage them to shoot for larger, less frequent meals.

And if they have a really hard time with that, we steer them toward small and more frequent meals. But, definitely for some people, the addition of intermittent fasting can be a game changer.

Abel: This just made me think, it’s not exactly on topic, but in your book you mentioned having to wake up in the middle of the night with cravings.

We’ve heard the gut described as the second brain, and the idea that you had parasites at the time, makes me think those cravings aren’t yours.

We tend to own everything—our problems, our symptoms, our cravings, what we want, what we don’t want.

But what if the cravings weren’t necessarily from you, as much as from the condition from the state of your gut?

I think it’s important that people start to think that way a little bit more. It sounds like that’s more how you treat people.

Yah, it is and I think you make a good point.

There is a degree where the mind has to just override the body and you have to try to have a schedule, and try to let a little type A kind of creep in to get you going in the right direction.

But then there’s also this point of, sometimes it’s the physiology that drives the behavior, and not the behavior that drives a physiology.

So if someone’s really sick and inflamed, they’re not going to be able to get up early and get things done because they just don’t have the biology to drive that.

It’s important to look at it from both ends, where you want to try to set yourself up for success. But we also want to listen to your body and if it’s just clearly difficult and you just can’t do it, then it may not be that you’re weak or whatever it is.

But we need to try to get the biological support there so that the body and the mind can kind of be in the same page and achieve the goal.

Abel: I can’t believe it but we’re already coming up on time. I want to make sure that we don’t miss anything.

Before we go, is there anything that you think is really important for people to understand about the gut, things that they can do?

3 Categories of Probiotics & Balancing Your Gut

Sure. So there’s a couple of other things that I think can be helpful for people.

One is understanding that we can organize all probiotic products into three categories.

And this sometimes eludes people, and what they end up doing is they keep trying different names of products, but they keep trying the same category.

So there are three categories of probiotics, and it’s important someone try one from each category.

Bringing Robb Wolf back in on the conversation, because he always has a funny way of terming things.

He had never tried a Saccharomyces Boulardii probiotics until we had discussed this, and after he tried one, he said he was pooping like a teenager for the first time in years.

Abel: I don’t even know what that means.

Yah, apparently he was pooping great when he was a teenager, and not so much of late.

So for some people just finding that miss in your probiotic protocol can be helpful.

The three categories are: One, Lactobacillus bifidobacterium blends, two, Saccharomyces Boulardii, and three, a spore forming or a soil-based probiotic, and this typically contains strains of the bacillus family.

And so that’s one thing that can be really helpful. The other is understanding how to, I guess we could say, poke the microbiota or kind of nudge the microbiota if it’s stuck in this dysbiotic state, this imbalanced state.

Everything we’ve talked about thus far will build the environment, so as to make it more toward equilibrium.

But sometimes people require a poke or a nudge, or some kind of antimicrobial therapy, and this is where things like oregano, or allicin, or berberine, or caprylic acid can come in.

And sometimes what I observed with people is they’ve done one of these things, but they haven’t done them in the right sequence.

So they’re trying to get the soil to respond, but they just dump a bag of fertilizer and walk away.

We need to do more than just dump fertilizer or hose it down with a ton of water.

And so, if we use a well constructed antimicrobial protocol at the right time when building in these other environmental cues, then that can make the difference between someone who said, “Well, I’ve done a parasite cleanse in the past, or I’ve used oregano in the past, and I was helped for a little while, but not fully,” between them saying, “Yes, you know I finally feel like my gut’s gotten back into balance.”

And then one other thing I would add in along with that is for some people, all these things don’t work or fully work, and what can really help them is the use of what’s known as an elemental diet.

And elemental diets are essentially a very hypo-allergenic, low/no fiber and prebiotic, meal replacement shakes, that you can use and you can undergo a liquid only diet for a short term.

This can actually be a very cathartic chance for the gut to heal. It’s similar to intermittent fasting in terms of not giving the gut any stuff to have to break down.

But this is a full meal replacement, so now someone could be on this for five, six, seven days, or longer, and they won’t lose weight, they won’t feel fatigue, they won’t feel emaciated.

Yes, sometimes we’ll have a negative reaction to the formula, but as a general rule, this can be very helpful especially for those people who have been somewhat recalcitrant to any other kind of therapy.

Abel: Kind of like a reset. One quick question about oregano oil. Having taken it myself, it’s pretty intense stuff. Can you take too much?

You don’t want to take it every day, when do you take it?

That’s a great question. For most people, if they use oregano as part of a targeted antimicrobial/dysbiosis protocol, then they’ll only need to use the oregano for one, maybe two months.

Now some people will have this tendency after they have used antimicrobials to go from feeling really well to then slowly regressing. And this can be mitigated if we get all the environmental cues in order, like we talked about, ahead of time.

And in some cases, people may need post antimicrobial prokinetic therapy, which essentially is a preventative measure that helps keep sweeping bacteria down and out of the rectum and not allowing it to grow back up into the small intestine.

Or people may need to modify that antimicrobial approach a little bit with the addition of what’s known as, antibiofilm agents.

And for some people, they can have a bacterial or fungal colony that can start to build this protective coating around it, known as a biofilm.

And if we can co-administer antibiofilm agents along with the antimicrobial agent, we can break that fence and then the oregano can finally get in there and do what it’s trying to do to rectify that dysbiosis.

We are in the process of publishing, to my knowledge, the first study that has shown that the co-administration of antibiofilm agents can enhance the treatment effect of herbal antimicrobials in eradicating SIBO.

Abel: Wow!

So, there is some growing legitimacy to that concept.

Again, the analogy used in the book is a mechanic. If we let you into the mechanic’s machine shop, could you fix your car?

Well, not if you weren’t trained as a mechanic.

Just because someone can buy oregano at Whole Foods doesn’t mean they know how to orchestrate that along with everything else, and use it the right way.

So, don’t think just because I’m not talking about the newest, best antimicrobial herb on the planet that this couldn’t help someone who’s done antimicrobials before.

Because it’s not about having this magic thing, it’s not about the magic protocol.

It’s having the right process. That sometimes is the difference between success and failure for people, it’s not knowing what to use, when, in the right sequence, and how to orchestrate these things to get that long-term lasting impact.

But it can be done. For people who are discouraged, it definitely can be done.

Where to Find Dr. Michael Ruscio

Abel: Fantastic. Well, before we go, would you mind telling folks a little bit more about your book, the cliff notes version?

And also where people can find you and find your book, as well.

Actually I have a copy right here in my desk, so I might as well hold it up.

It’s Healthy Gut, Healthy You. I wrote this book, it took me 3 years.

There’s just under a thousand references in the book. And I wanted to give someone everything they needed to fully understand all the important issues regarding their gut health.

Most importantly, put that all together into an adaptable protocol to help one heal their gut, and do so in a well-informed, empowered way, not making someone feel dependent upon supplements or afraid of food.

So far the feedback that we’ve been getting has been absolutely fantastic. And if people wanted to learn more about the book, they can go to healthyguthealthyyoubook.com. It’s available on Amazon and also as Kindle books, there’s the e-book version and the print book version.

I tried to make it that one resource that will help you navigate through all these tumultuous topics, and hopefully that book will be it.

Abel: Right on. Well, I can say, having read quite a few books, many of them are quite dry, quite boring. And for the amount of research that you’ve put into your book, it’s very readable, and I think not necessarily easy to understand, but something that everyone needs to understand.

It’s not like all the research is finished, far from it, but I think that the work that you’re doing, and a few other peers in the field, is so important right now because obviously we don’t understand enough about our own bodies and the gut.

Right.

Abel: And the work that you’re doing right now is incredibly important and very much welcome.

Thanks  for coming by the show, I really appreciate it.

Oh, thank you for having me on. It’s always great to talk about the gut and really, I agree that this gut work is so important.

I can’t tell you the number of people who come in and they’ve been chasing down thyroid or serotonin and dopamine levels. There are clearly a time and a place for many different things in the health care picture, but if someone has taken preliminary steps to improve their diet and their lifestyle and they’re not feeling well, what I have observed—and I think there’s a good body of literature to support this—the next step should then be optimizing your gut health and then re-evaluating your symptoms.

And you may notice the symptoms that you thought were heavy metal toxicity or low serotonin or what have you, melt away, and then you can just get on with your life, and start enjoying whatever it is that you want to do outside of your health.

Abel: Right on. “Healthy Gut, Healthy You.” Let’s see, yah, I only read the first 1/5th of it, because it was a Kindle sample, and we were able to schedule this interview really quickly.

But I want to encourage everyone to, at the very least, try that out. You can try the first fifth for free, but get the whole thing because I’ve looked, and there aren’t that many books that are on this subject that are worth reading.

Yah, that are kind of all-encompassing. You get ones that are maybe on gluten and they give you some great information on gluten or fiber.

But what I found is people are just kind of at a loss for how to integrate all this stuff together, and that’s what I try to do by pulling it all together. So they’re not feeling like, “Ah, what do I do?”

Abel:  I dig it. Thanks again for being on the show.

Thanks buddy, thanks for having me on.

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