Michael Ruscio is a doctor, clinical researcher and best-selling author whose practical ideas on healing chronic illness have made him an influential voice in functional and alternative medicine. His work has been published in peer-reviewed medical journals and he speaks at integrative medical conferences across the globe. Dr. Ruscio also runs an influential website and podcast at DrRusio.com, as well as his clinical practice located in northern California.

LEARN MORE AT​:

drruscio.com
@drruscio

Healthy Gut, Healthy You: The Personalized Plan to Transform Your Health from the Inside Out

SHOWNOTES

Healthy Gut, Healthy You: The Personalized Plan to Transform Your Health from the Inside Out

01:50 - BiOptimizers: A company whose mission is to fix your digestion! They make a range of awesome supplements, including digestive and proteolytic enzymes, gluten-hacks, a "one size fits all" superstar probiotoic, HCL, and more! Get their super potent Masszymes to digest your food properly!!! Use The Link masszymes.com/melanieavalon With The Code melanie10 To Get 10% Off Your Order!

04:08 - LISTEN ON HIMALAYA!: Download the free Himalaya App (www.himalaya.fm) to FINALLY keep all your podcasts in one place, follow your favorites, make playlists, leave comments, and more! Follow The Melanie Avalon Podcast in Himalaya For Early Access 24 Hours In Advance! You Can Also Join Melanie's Exclusive Community For Exclusive Monthly Content, Episode Discussion, And Guest Requests! ​

04:20 - Paleo OMAD Biohackers: Intermittent Fasting + Real Foods + Life: Join Melanie's Facebook Group To Discuss And Learn About All Things Biohacking! All Conversations Welcome!

04:35 - BEAUTY COUNTER: Non-Toxic Beauty Products Tested For Heavy Metals, Which Support Skin Health And Look Amazing! Black Friday SALE: 15% Off Sitewide With Free Shipping! Shop At Beautycounter.com/MelanieAvalon To Receive A Free Beauty Counter Gift From Melanie! For Exclusive Offers And Discounts, And More On The Science Of Skincare, Get On Melanie's Private Beauty Counter Email List At MelanieAvalon.com/BeautyCounter!

10:05 - Dr. Ruscio's Personal Health History: Rabbit Holes, Over Researching, And The Gut Health Condition  

13:00 - Dietary Dogma: Does Everyone Need To Be Gluten Free? How Much Testing To Do? 

15:15 - Why The Solution Is In The Gut: The Role Of The Immune System And Inflammation

19:25 - ​What "Qualifies" As A Healthy Microbiome? Should You Try To Change Your Microbiome? 

22:45 - Glycemic Response To Foods

DAYTWO | Glycemic Control

25:25 - Why You Can't Micromanage Your Gut Microbiome 

27:30 - Do We Have A "Natural" Microbiome? : The Role of Genetics And Dietary Interventions

31:00 - The Low FODMAP Diet And Starving The Gut Microbiome 

33:00 - Inflammatory Response To Both "Good" and "Bad" Bacteria 

35:45 - Long Term Restrictive Diets And The Immune Response

38:10 -The Role Of Mindset In GI Health

38:55 - FEALS: Feals makes CBD oil which satisfies ALL of my stringent criteria: it's premium, full spectrum, organic, tested, pure CBD in MCT oil! It's delivered directly to your doorstep. CBD supports the body's natural cannabinoid system, and can address an array of issues, from sleep to stress to chronic pain, and more! Go To https://feals.com/melanieavalon To Become A Member And Get 50% Off Your First Order, With Free Shipping!

41:25 - FOOD SENSE GUIDE: Get Melanie's App To Tackle Your Food Sensitivities! Food Sense Includes A Searchable Catalogue Of 300+ Foods, Revealing Their Gluten, Lectin, FODMAP, Amine, Histamine, Glutamate, Oxalate, Salicylate, Sulfite, And Thiol Status. Food Sense Also Includes Compound Overviews, Reactions To Look For, Lists Of Foods High And Low In Them, The Ability To Create Your Own Personal Lists, And More!

43:30 - Implementing The Interventional Pyramid (Diet, Probiotics, Dietary Changes, Etc.): Finding The Simple Change To Catalyze Change After Suffering For Years

49:40 - Fear Of Setbacks 

​Dr. Ruscio On The Intermittent Fasting Podcast

50:30 - The Role/Order Of Antimicrobials And Probiotics 

54:10 - Which Probiotic Strains To Use: Lactobacilli/Bifidobacterium Blend, Soil Based, Saccharomyces Boulardii

56:40 - Clinical Trials Of Probiotics 

57:20 - Colonizing Vs. Transient Strains 

1:00:30 - What Strains Occur At Birth?

1:02:45 - How Long To Try A Probiotic, And How Should You Judge Reactions?

1:06:30 - Lactobacillus Vs. Bifidobacterium

1:09:55 - The Role Of Histamine 

1:11:45 - How Long To Recovery?

1:13:00 - Limbic Imbalances And Expecting To Be Sick

Dynamic Neural Retraining System

The Gupta Program

1:15:00 - Thoughts On The Placebo Effect 

1:17:20 - What Is A Healthy Approach To A Dietary Plan?

1:19:00 - Why Setbacks Are Ok!

The Roots Of Consciousness: We're Of 2 Minds

One Head, Two Brains

1:24:00 - Trusting The Process: The Importance Of Not Worrying, Overanalyzing, Or Jumping Ship 

1:28:45 - The Importance of Relaxing And Finding Joy

TRANSCRIPT

Melanie Avalon:
Hi friends, welcome back to the show. So I am super excited to be here today with a fellow podcaster who pretty much needs no introduction. If you are at all familiar with gut health, GI stuff, probiotics, podcasts, all of that stuff. I am pretty sure you probably know this man very well.

Melanie Avalon:
I'm here with Dr. Michael Ruscio. He is the author of Healthy Gut, Healthy You: The Personalized Plan to Transform Your Health from the Inside Out. He is a doctor, a clinical researcher. He has his own practice and one of the things I love about Dr. Ruscio is, well there are a lot of things, but he is following, he looks at all of the studies, all of the latest data. He's working with patients. He really paints a very comprehensive picture, especially when it comes to a topic that can be so complex and so confusing for so many people, which is GI health and I mean there are very few people that I honestly would look to for their opinions on all of the latest data and like wholeheartedly trust his opinion on pretty much anything related to that and that is Dr. Ruscio, so thank you so much for being here.

Michael Ruscio:
Wow. Well, thank you for the intro. That's a pretty big bill for me to live up to, but I will do my best.

Melanie Avalon:
Well, I mean it from the bottom of my heart. I just love how you stay so on top of all of the research and bring that to both patients and clinicians, which I think a lot of especially figures in the health world regardless of intentions they often I think have an idea of what they think is most likely right and then sort of push that foot forward when looking at studies and things like that. But you, I just feel like you're always looking at the research, you're looking at the data, you're looking at the patients and if things are changing, you're open to saying, "Hey, things look different now than maybe what we thought." And I really, really appreciate that. I know it's really complex and complicated in our health world today.

Michael Ruscio:
Well thank you. I guess, my shtick is maybe not having a stick and just trying to always be open-minded and being critical and so it makes it a little bit easier I think to be constantly changing and evolving my opinion because I'm not vested in one theory like low carb or Mediterranean or the power of probiotics or the danger of probiotics. It's more so, "Well, let's see what the evidence shows."

Michael Ruscio:
And knowing a body of evidence that's going to be changing and we're going to be learning more. And so let's just keep kind of fluid, keep this kind of core philosophy, which doesn't change much, but some of the nuance shifts and as data changes, we keep kind of molding that clay and into the best offering that we can for people, so thank you. I mean it's a lot of work and it's nice that people are noticing it and that it's appreciated.

Melanie Avalon:
Yeah. I actually had an epiphany the other day about this whole concept and that was that I think for some people who have never had any acute health issue that they're aware of, like a lot of people will start a new dietary protocol or something and it works fantastically and it just keeps working. And I can see how if that happens to you and it's always working, why you would be more likely to push it. But I think when people have personally been in a place where things are not working, despite everything that you're doing, that it also could, at least I know for me, make you more open to being open to things. I don't want say that's the case for you, but I do know you have your own personal health history with GI issues. So I was wondering if you could tell listeners a little bit about that and why you came to where you are today.

Michael Ruscio:
Sure. Well, it was a long row, so I'll try to give you the short version of it. But when I was in college, I was premed and I was also a college athlete and used to feeling you know when you're 20, you feel pretty darn invincible and that was nice of course. But boy, all of a sudden for reasons I couldn't determine, I was having brain fog, crippling insomnia. If anyone's ever had insomnia, you sleep for 45 minutes, you're up for 30 minutes, you'll sleep for 40 minutes, you're up for 20 minutes. It was very severe insomnia, obviously and just really crippling. So I'd be unable to sleep at night, tired during the day, brain fog, my mood was starting to have these lulls and I really couldn't figure out why.

Michael Ruscio:
One thing led to another. Eventually, I found a doctor who posed the idea that I could have an intestinal issue and in my case I had an intestinal infection. Intestinal infections aren't super common, but definitely imbalances in the gut are. So, mine was kind of the worst that you can have a pathogenic amoeba infection and this was wreaking havoc in my gut and causing inflammation, ostensibly leaky gut and leading all these symptoms.

Michael Ruscio:
But before I figured that out, and this is one of the things I tried to save my patients and our readers from, I Googled my symptoms. I thought I had hyperthyroid or poor thyroid conversion. I thought I had mercury toxicity. I thought I had adrenal fatigue. I thought I had low testosterone, and so I kept pursuing all these really dead ends. I might get a little flicker of improvement, but nothing really that addressed the cause of the issue until I took steps to improve my gut health and that really taught me that there's a lot of noise out there. It's not to say that adrenal supports or testosterone supports or thyroid, other medication supports are never needed, but in my experience this is definitely been true in my patients, oftentimes those things are pursued before one's gut health and at least the same result I had.

Michael Ruscio:
Spinning your wheels, spinning your wheels, spinning your wheels, and then what do you know? The patient that's seen three doctors all using different thyroid approaches and getting the patient nowhere sees a gut-centric provider like myself and within a few months, all their symptoms are gone. Wasn't actually their thyroid in this case. Again, it's not to say that that always happens, but it does happen a disturbingly high percentage of the time.

Michael Ruscio:
So I went into natural medicine and pursued everything that I was noticing health me personally, and there was a lot of good, but there was also maybe equal amount of dogma. I remember being a student and thinking, "Holy cow, these natural providers are just zealous about gluten-free diets." It was like gluten-free diets and fish oil could cure the world. I mean, I agree that those bowls can be very helpful, but does everyone, does 100% of the population need a gluten free-diet? It turns out, no. It turns out the best evidence we have suggests about 3% according to a study by Volta at University of Bologna, but it doesn't stop people from really inculcating people into thinking that everyone needs to be gluten-free. This is one example.

Michael Ruscio:
So I try to bring to people now this balance where a lot of great stuff in natural medicine, a lot of good science in natural medicine, but also a fair amount of dogma, a fair amount of overreaching, a fair amount of overzealousness. This hurts people by making them afraid of food, making them think they have to do copious amounts of testing, causing a financial burden. So if we can find the right balance between things that work, things that have been scientifically validated and an open-minded progressive approach, but also filter out some of the craziness then we can really hand people a great model for improving their health.

Michael Ruscio:
And so that's what I'm doing now in the clinic with some of the research that I'm publishing, with the book that I wrote, Healthy Gut, Healthy You, and really just trying to carry the torch forward for we have a lot to offer people, but this new generation of doctors has to really kind of be cutting out some of the wastefulness and fear in the model and focusing on what works and boy, if you do that, people will just see phenomenal results.

Melanie Avalon:
Yes. Well I, I love that so much and I, and I believe so many listeners, can relate to that so much about trying to find the thing that's causing the problem. Is it the thyroid, is it the heavy metals, is it Lyme disease? You know, going down all of these holes and trying to find the root cause and then so often, like you said, the root cause or the root answer maybe, maybe the solution lies in the gut. So simple question with maybe a simple answer, maybe a complex answer, why can the solution often be in the gut for all of these other things?

Michael Ruscio:
Great question. Well, for a few reasons, one of which is the fact that the largest density of immune cells in your entire body is located in your small intestine. Now, why does that matter? But we know that the immune system is the main driver of inflammation in your body and so if the gut is not healthy, then you have this highly immune-active area that is also unhealthy or perturbed.

Michael Ruscio:
We could use a loose example of this leaky gut or the gut lining is not healthy. It's not allowing the right stuff in and keeping the wrong stuff out and therefore the immune system is called in to use its instrument of cleaning, inflammation, but as a byproduct of the inflammation, you can have a litany of symptoms: Joint pain, brain fog, skin issues, of course digestive issues, depression.

Michael Ruscio:
Now, that is a theory and here's something that every healthcare consumer should be looking for in one's argument. That is a theory saying that the gut connects all these systems, but we do have clinical trial evidence showing that you can reduce disease activity and inflammatory markers in rheumatoid arthritis, to use a joint example, to reduce anxiety and depression, to use a brain example, to reduce IBS symptoms, of course, to use a gut example and even some preliminary data showing the ability to benefit hormones, both thyroid. Actually one study showed that probiotics could reduce and/or stabilize the dose of thyroid medication needed and other data points have shown that patients with digestive infections can actually reduce and stabilize the amount of thyroid hormone they need after treating those gut infections.

Michael Ruscio:
So the important thing is there's not only this academic mechanism we can draw out that might connect the gut to these systems, we actually have interventional clinical trials proving it. Here's a group of people, here's our illness, here's the gut treatment, and boom, a positive result for whatever's being measured. Now, I also want to throttle back a little bit and be careful not to say that the gut is not a panacea, but it's pretty remarkable, the wide litany of things that can improve when we improve one's gut health in part because of this common inflammatory component.

Michael Ruscio:
Also because the majority, well, 90% of your calories and all of your nutrition is also absorbed in the small intestine and everything is absorbed in the intestinal tract itself. So if that's not working well, then you may not be absorbing all the nutrients adequately from your diet. So those are two big reasons. The inflammatory piece and then also the nutrient absorption piece and it shows us how the gut can lead to resolutions of so many things from brain to skin to joints and why it's a really great starting point if you're not sure where your symptoms are coming from.

Melanie Avalon:
Yeah, so it seems that there are so many huge pieces and I'd love to dive deep into them even further. Like you're also talking about the immune response, the inflammation then there's the gut microbiome and there's actually absorbing the nutrients. And I guess a pickle is that we ideally need all of these things to be functioning correctly, so it can seem a little bit overwhelming to address all of those at once, but then maybe that means that a healing approach in general as you discussed in Healthy Gut, Healthy You could address all of these things. So I'd love to dive deep into some of these things if you're down for it.

Michael Ruscio:
Yeah, I talk about this all day long, so we can go wherever you want.

Melanie Avalon:
Awesome. So starting with the gut microbiome, in general, do you think that there is a "healthy microbiome?" Because there are all these studies on the different types of bacteria that we can have and some are correlated to health markers and then some are correlated to worsening of conditions, but it seems like they can be so different, especially from different populations and depending on your environment and your genetics. So can we even say what a healthy gut microbiome is? Does it even matter? What are your thoughts on that?

Michael Ruscio:
Yeah, I mean that's a pivotal question and one of the main posits I developed in Healthy Gut, Healthy You is it's a mistake to try to force changes in our gut microbiota. It's a mistake for a litany of reasons. The main reason is because gut microbiota research, I should maybe even take a step back and draw a distinction.

Michael Ruscio:
There's clinical kind of gastroenterology, meaning we know as one example, albeit a bit controversial, Small Intestinal Bacterial Overgrowth or SIBO can be problematic. We know how to test it. We know it correlates with certain symptoms and we have treatments that correlate with the symptomatic improvements and also correlates with the lab testing showing improvements in correspondence with the symptomatic improvement. So that's clinical gastroenterology.

Michael Ruscio:
Microbiota research is more so looking at the thousand some-odd species of bacteria in your gut, trying to group them into clusters called phylum. Trying to look at is there any relationship between phylum ratio as a disease or a specific species and disease and we are so early here that no credible researcher in this field, save maybe one or two exceptions we can come to in a minute. No credible researcher for the majority of microbiome testing is advising that you do a test like uBiome, biome American gut and try to use that clinically.

Michael Ruscio:
It's one of the most common questions I get from patients. It is one of the most commonly incorrect beliefs that patients are walking around with, probably because these companies are marketing their tests and I think most of them are not marking them nefariously, but there's enough vague suggestion that people kind of easily make their own conclusion, that these tests can help with disease. But even on my podcast, we've had arguably one of the top researchers in microbiota research itself, Rob Knight, and he's very plainly said, these tests cannot be used clinically.

Michael Ruscio:
So, there's a very important distinction to draw, which is we're learning a lot about the academics, about the microbiota. There's still a lot we have to learn and that hasn't yet gotten to the point where we can translate it into: Eat this diet, use this probiotic, use this antibiotic, use this antimicrobial. We just haven't gotten there yet.

Michael Ruscio:
The one exception is a lab called Day 2, which has independently validated that their microbiota assessment does appear to be able to predict glycemic response to foods. So if someone is struggling with dialing in their diet that lasts a little bit, this may be able to help them determine, "Wow, I do not respond well to rice, but I respond well to potatoes, so I'm going to focus more on potatoes and less on rice," to help one really craft an individualized plan for their diet. Now, that's definitely a refining piece because for most people, the first few steps are food quality, frequency of eating, whether they're fasting or eating regular meals or finding some sort of mix, sleep, these foundational pieces are probably the most important.

Michael Ruscio:
But if someone's really trying to fine-tune their diet, then the lab Day 2 can help predominantly from the perspective of blood sugar regulation. But for the person who has brain fog, joint pain, nonresponsive IBS, gas, bloating, constipation, diarrhea, reflux, the microbiotic tests don't really tell you anything and it's unfortunate because so many consumers are kind of hoodwinked on what these things do, but if you can focus on the clinical gastroenterology side, there's a world of therapies that have been shown to help various cohorts of patients. Patients with brain fog, patients with depression, patients with joint pain, patients with this kind of recalcitrance with their thyroid medication.

Michael Ruscio:
But there's a distinct line between the clinical gastroenterology interventions and the microbiota research, which is more so in the phase of academics, data gathering, looking at trends and looking at relationships. Now you hear about the latter of these two much more because it's invoked, but just because it's popular, it doesn't mean it can actually help you. So there's a really important distinction to draw there between clinical interventions and more so, academics. I hope that's not too boring, but it's an important concept to really understand.

Melanie Avalon:
No, I think it's super important. So it sparks some ironic followup questions for me that now I'm not even sure how relevant they would be because I did have some questions about trends that we do see with gut populations. So I'd love to get your thoughts on that, but then they will be in the context of what you just said, which is the fact that we don't even necessarily know the implications of these trends.

Michael Ruscio:
Yeah, and so here's maybe a philosophical construct we can lead with to help this all tie together. There's likely a bidirectional relationship between the microbiota and the health of the host. Now, what we would like to be the case is that unhealthy bacteria, we change those unhealthy bacteria to healthy bacteria, and now we have a healthy host. So what is appealing is I'm overweight, I have brain fog, and I have joint pain, it's because of these bacteria nefariously and now if I can just change these bacteria, now the corresponding disease, condition or symptom will go away. That doesn't really seem to be how this works at all and I write about this in Healthy Gut, Healthy You and I actually list examples where what we thought would happen is actually opposite of what happens and I summarized this as you can't micromanage an ecosystem.

Michael Ruscio:
Now there's another way that this may work and I think this holds more plausibility, which is the health of the host dictates the health of the environment in which the bacteria grow. So interventions that improve the health of the host, improve the soil from which these bacteria grow, and then therefore lead to healthier bacterial populations, so we can still intervene to improve the health of the host and improve whatever disease or symptom one is suffering with. But it's not this kind of direct line to these bacteria high, that bacteria low, we do X, those things rectify and now, the person gets healthier.

Michael Ruscio:
It'd be great if things were kind of that neat and nice, but there's better support for the hypothesis that the changes in bacteria that we're seeing are often not causal. They're actually associative to whatever disease state is present and then the question becomes, what is best for the individual in managing that disease state. Does that make sense?

Melanie Avalon:
No, I think that is a wonderful thing to bring up and something I actually did want to dive deep into with you is this concept of the ecosystem in the individual and this idea that the healthiest ecosystem is ultimately the healthiest microbiome for the individual. So regardless of, if it matches up what we see in these studies, that it's a comprehensive view.

Melanie Avalon:
Question about that. Do you think that any given person based on genetics, well, I guess really based on genetics is what it would have to be, that they naturally have some sort of "ideal microbiome" that will best support them throughout their life or is it a matter of their environment could change, so various different microbiota or various different ecosystems could support their health?

Melanie Avalon:
The context that I'm coming from with this is, I know like we'll see in studies that the gut microbiome can rapidly change based on different dietary interventions, so could it be that various different healthy diets could support different ecosystems in an individual and those could potentially all work or do you think based on genetics that a person is predisposed to one sort of ecosystem? Does that make sense?

Michael Ruscio:
Yeah, it does. And so we might be able to term the ecosystem types as what is sometimes referred to as enterotypes, so this is kind of like the gut microbiota type that you have. And there's three, maybe four enterotypes and these do seem to have impart a familial characteristic to them, whether that's genetic or phenotypic. It's hard to say that there's very likely a combination of the two, meaning both the genes and the environment.

Michael Ruscio:
But then the bigger question is how can we use that to improve the health of an individual and that's where things become much more challenging because we come back to this problem of cause and effect. Here's an example. We take sedentary individuals and we start tracking their microbiotas over time. When those sedentary individuals start exercising, the health of their microbiota improves. So we could erroneously say, these unhealthy people have unhealthy bacteria and these healthy people have healthy bacteria.

Michael Ruscio:
But if we didn't, what's known as isolate for or use our regression analysis to tease out the fact that the "healthier people" are exercising and the unhealthy people aren't exercising, we may have missed the causative factor for why the healthy people have healthier bacteria because they are exercising. So this is where it gets really complicated to say there is a one best microbiota and there are a litany of examples supporting how the theory that there is a or a couple best microbiotas breaks down.

Michael Ruscio:
Another great example, one of the most effective diets after you get on a generally healthy diet. So step one is always get off of processed foods. Eat fresh, whole unadulterated foods. Now that can be higher carb, lower fat, lower carb, higher fat. There is wiggle room with the macronutrient breakdown, but the first step is food quality. So after we get that stuff out of the way, if patients still aren't responding to diet, the next dietary intervention that has an impressive amount of data to support it is the low FODMAP diet and the low FODMAP diet tends to not feed the intestinal bacteria.

Michael Ruscio:
So if feeding intestinal bacteria was so incredibly important for an individual, then how is it that a diet that reduces the food for healthy bacteria and therefore to a degree may actually starve healthy bacteria leads to a reduction of inflammation, a reduction of leaky gut, and improvements in symptoms like gas, bloating, constipation, diarrhea, reflux, and even inflammatory bowel disease. So what may be happening there is the individual's immune system is hyper-reactive to the resident bacteria. So otherwise, normal healthy bacteria, but in an environment where the immune system is overzealous, now those bacteria may be a problem.

Michael Ruscio:
And so it's not only the microbiota, but it's how the microbiotic gets along with the immune system. And this is how things that may in effect starve intestinal bacteria actually can lead to an improvement in the health of the host. So there's many examples where we see interventions that may not be best for the microbiota are actually better for the host. And this is why we should take a big step back and not try to force your gut microbiota into one shape so to speak. Because what that does is, it discounts all of the clinical gastroenterology science and rather tries to pigeonhole you into a theoretical based upon what we see in the academics.

Melanie Avalon:
Okay. So that is fascinating. And that was something that I was fascinated by in your book was when you were discussing how our bodies could have inflammatory responses, and like what you just said, to both "good" and "bad" bacteria, which that brings on a whole another aspect because then it's like even if in theory you could have I guess a wonderfully healthy, awesome gut microbiome, but if you have the inflammatory immune response, I mean, what, what would you do then?

Michael Ruscio:
Right and that's what's so paradoxical, especially when you look at inflammatory bowel disease literature, that interventions that are lower in fiber, which feeds bacteria, lower in prebiotics, which feed bacteria actually lead to reduced inflammation and reduced disease activity. So you know, it's not to say that everyone should go on a lower fiber and a lower prebiotic diet, but because of the immune overzealousness in those individuals, the same dietary approach that works for otherwise let's say you've got a really healthy, robust person, maybe they're a cross-fitter, they're eating lots of sweet potatoes and tons of vegetables and starches and they're feeling great and the kind of moderate, the higher carb, higher fiber, higher prebiotic diet works well for them. It's not going to work well for everyone.

Michael Ruscio:
And so that's, that's where the wheels kind of fall off the argument, I guess to say it plainly. For people with the most compromised gut health, the microbiota academic recommendations are actually the worst. And this is the ultimate paradox, which is the people who need the help the most are being given these answers that are more so in some cases, academic and actually making them worse.

Michael Ruscio:
And that's why it's really important that we look at everything through the lens of clinical gastroenterology because that insures, as one example, we don't take an inflammatory bowel disease patient and put them on a super high fiber, high prebiotic diet because we know that has a tendency to flare those patients even though the microbiota academics suggest, "Well, we've got to feed the bacteria because the bacteria release short chain fatty acids, the short chain fatty acids are anti-inflammatory and if inflammatory bowel disease is a disease of excess inflammation, therefore the high fiber high prebiotics which made short chain fatty acids will reduce the inflammation and will reduce the disease activity."

Michael Ruscio:
Talk to any inflammatory bowel disease patient, they will tell you the last thing they want to do, especially when they're flaring is have high-fiber, high-prebiotic foods for the most part. I don't want to paint with too broad of a brush and make too absolute of a statement, but there is a glaring example of how if we look at academics and then conjecture from there, we can end up harming people because we're not looking at this juxtaposed to what the clinical gastroenterology evidence tells us.

Melanie Avalon:
And so for those who do find themselves in a state like that where they are struggling with GI issues and distress and they find something like a low FODMAP diet, which is not feeding the bacteria if they find that therapeutic, that helpful, what are your thoughts on longer term approaches following a diet like that? In theory, can the immune response change if you starve out the bad bacteria long enough or can the immune response just change the bacteria in general and then foods can be brought back in or do you think there's some people that just long-term they're better on a lower FODMAP type approach?

Michael Ruscio:
Yeah, and this is a great question because one of the most common I guess counter arguments that's invoked when someone mentions low FODMAP is, well it may not be a good diet long-term, which we don't really have good evidence to support that question. There was one study, I believe it was a two year followup, I may be off in that detail, but there was one long-term followup study that found that people drifted to a broader FODMAP intake and the diet continued to keep their symptoms at bay and there were no remarkable issues, nutrient deficiencies or other health problems.

Michael Ruscio:
So I think the best approach here is really to start with an approach that may be a bit more restrictive like healing and then gradually work your way out and try to find the broadest diet that works for your gut. So it is important to put on the table the notion that just because a somewhat strict adherence to a low FODMAP diet for four weeks really helped you, does not mean you should be doing that for four years. So over time as one gets healthier, to your question, yes, they should be able to tolerate more foods. They should have the aim of expanding their diet and having the broadest diet possible, but not everyone's going to get to a point where they can eat the same stuff. Some people really improve their ability to eat dairy, others don't. Some people improve their ability to tolerate gluten or soy or FODMAPs or even alcohol and other people don't.

Michael Ruscio:
So everyone's going to be a little bit different there, but the goal will always be heal your gut and move to the broadest diet possible. And that also ties into another piece I know you wanted to touch on, which is the mindset piece. And you know, this is where we really should kind of provide a countervailing recommendation because yes, dietary restriction can be helpful, but we don't want to stay in that mode forever. The goal should be healing in the short term for greater function in the long term. If you think about someone who had a really bad knee sprain, you wouldn't have them wearing a knee brace and avoiding activity forever, right? It would be a short term and then they would start doing some stretches and some mobility and gradually pushing out the boundaries of their movements until they got back to normal. Same sort of thing is what we want to do with diet.

Melanie Avalon:
Yeah. I'm so happy you brought up the mindset piece because I was actually talking to a friend about this the other day because we were talking about how fast the intestinal lining cells are supposedly supposed to heal, like the turnover rate is supposed to be very, very fast?

Michael Ruscio:
Yeah, about 72 hours. Yeah, it's quick.

Melanie Avalon:
So we're like, how can it be that intestinal cells can in theory heal so fast and also that with the gut microbiome we'll see such changes, rapid changes with dietary changes. So there's all this potential for very fast change and yet people find themselves stuck in these chronic gut situations for years and years, oftentimes even seemingly trying to follow things that should be fixing the situation in theory.

Melanie Avalon:
So do you think with that it's a matter of the person hasn't found the right food combination that is supporting an anti-inflammatory stat, is it the diet, is it what they're eating or is it also this immune response and how is it possible that the immune system is always going to have an inflammatory response to certain things, so there's like no way around that.

Melanie Avalon:
And then that's why I'm wondering like maybe it's just the mindset thing, maybe the fear response, not even on a conscious level, but maybe like a subconscious level of the limbic system and the immune system from that aspect. So I don't know if there was a question in there.

Michael Ruscio:
Yeah, I mean it's really all of the above. Now, think about a pyramid. I always picture and I actually list in Healthy Gut, Health You an interventional pyramid. You have the foundation, the bottom level of the pyramid, that's your diet and lifestyle. Then level two, I would put there probiotics as your primary intervention. Then level three, antimicrobials of various sorts, which can be more powerful in their ability to kind of balance out the gut than the probiotics and at the pinnacle we have certain things like elemental diets which are predigested, low residue, liquid diets, immunoglobulin therapy, some of these more nuanced therapies.

Michael Ruscio:
And so we start at the foundation and the foundation is diet. And what happens with some people is they run in a low carb camp and so they go low carb, low carb, low carb, low carb, every iteration of low carb and at some point, someone tells them try a kind of higher carb diet. They make a few changes there and they feel fantastic or someone's in a paleo crew and they just keep forcing down vegetables, vegetables, vegetables, all the while they really need to be doing a trial on low-FODMAP and eventually they get to that. And it may take some people years until they actually make that discernment or get that advice and then all of a sudden they start moving forward.

Michael Ruscio:
So some of this is just getting competent advice that is not limited to the scope of your peer group. And that's what I lay out in Healthy Gut, Health You, there's a few nuances. There's paleo and low FODMAP I would say are the two general changes because paleo tends to remove inflammatory foods and low FODMAP tends to reduce foods that kind of feed bacteria. That's not every dietary nuance, but that's the kind of West and East on the compass so to speak, but we don't stop there. And the challenge is some people never go beyond that or when they do go beyond diet, it's just, "I read a blog on so-and-so and so now I'm going to try this." And there's no process, there's no, "Okay, here's all of the available therapies. Now how do we organize them in the most logical sequence of steps, so they will work synergistically and continually lead you to the healing end point you're trying to get to."

Michael Ruscio:
So that's the second rung of the pyramid and we have probiotics, a ton of confusion there and what you see on the internet is mostly marketing claims. Many of them are not necessarily untrue, but they're just giving you the one slice that kind of promotes a given probiotic rather than taking a bird's eye view and helping someone walk through a more experienced view on how to figure out the best probiotic protocol for one's gut.

Michael Ruscio:
Now what it may look like is it takes someone a year and a half to finally go low FODMAP. Then they go low FODMAP, they move forward to 30%. Yay, great, but they're not all the way there, so if they can get the next piece of competent advice quickly, they go on a good probiotic protocol and then whoa, another 30%. "Hey, I'm at 60% overall improvement, this is pretty good." Now the next thing they may need to do is administer a course of antimicrobials in conjunction with that foundation they've laid and now they go from 60 to 90 and if you're at 90, you just give your body some time and usually you will get the rest of the way there just through inertia.

Michael Ruscio:
That you would be surprised, you would be amazed at how simple that sounds as I've just explained it, but how patients will suffer and flounder for years without doing that correctly. And I guess rightfully so, internet education isn't really built for that. It's more so, "Hey, we're going to talk about X today or I'm going to write a blog about Y today." So I understand how kind of our soundbite culture doesn't necessarily lend itself to that, but you know, those steps to navigate up the interventional pyramid when executed appropriately can lead to someone who's been suffering for years.

Michael Ruscio:
And in fact, we were talking today about we released a conversation with one of our readers and I believe she had said she had worked with Surrey functional medicine doctors and they did lab testing and all this stuff to personalize the therapies for her and didn't really get anywhere. She read Healthy Gut, Health You and within a few months, she was seeing improvements she hadn't seen prior. So I don't say this lightly, I really wrote book to give people a roadmap, but those are some of the components.

Michael Ruscio:
And then mindset is also important because if navigating that interventional pyramid is not couched in a framework of empowerment and positivity then people will gradually be grabbed by the grip of fear because they will think every time they have a flare, every time they have a setback, something is wrong or anytime they eat a food off plan, "I'm doing all this damage." And those little moments of fear chip away at you and can lead some people not to be able to heal.

Michael Ruscio:
So all these things come together and you can heal quite quickly. Quite quickly is not two weeks, right? But that might be in three weeks, I feel 10% better and another three, I feel another 10 and then what do you know? Three to four months later, I feel 70, 80, 90% better. So relatively quickly, I guess, should be defined as such. But when all of these things are done correctly, someone can really improve quite remarkably. It's just needing to have the right roadmap and then the framework that's positive and empowering and then all those things congeal together and it's pretty humbling how quickly people can heal when they have all that kind of at their disposal.

Melanie Avalon:
Oh my goodness, so many things you touched on and follow-up questions I have. I will say for listeners though, because I've interviewed you, Dr. Ruscio on The Intermittent Fasting Podcast, but this is the first time on the Melanie Avalon Biohacking Podcast and so for listeners, something that Dr. Ruscio has done in Healthy Gut, Health You that I just think is brilliant is, and I mentioned this before with you, but it's sort of like, choose your own adventure. It doesn't have one protocol that everybody follows because obviously that's not going to work. The way the book is laid out, and kudos to you for coming up with this template, but basically you can go based on where you're at and then where you need to go. So there's not just one protocol in the book. You can make it fit you, which is pretty awesome.

Melanie Avalon:
Some follow-up questions about everything you just said. So you were speaking about probiotics and antimicrobials, and I think a lot of people, especially when they feel like they're struggling with an overgrowth situation, that they need to start with antimicrobials, like they need to get rid of the overgrowth.

Michael Ruscio:
Of course. Oh, it makes me want to pull my hair out. People have everything so backwards.

Melanie Avalon:
And then bring in the probiotics, so I think a lot of listeners' ears probably perked up when you were like, "Wait, probiotic," or when you said probiotics and then antimicrobials, so could you expand on that a little bit, the role of probiotics, when somebody does have an overgrowth?

Michael Ruscio:
I'd love to. We want to look at one's gut like a garden. And I don't mean this in this airy-fairy, I'm going to burn sage, but scientifically, if we look at your gut as an environment that needs to be tipped back into balance or like a garden that we're going to methodically improve the health of, you don't take a garden that is being scorched by sun and has nutrients devoid of any soil and then go and pull the weeds out and expect food to grow.

Michael Ruscio:
That's kind of what happens when you just jump right to antimicrobials. It's like, "Op, our garden environment is crap, but we're just going to go ahead and yank out these dead weeds," and then we're going to say, "What the heck? How come nothing is happening?" We have to cultivate a healthy environment. The healthy environment encourages the growth of healthy bacteria, discourages the growth of unhealthy bacteria. Once we do that, if more aid is needed, that's when antimicrobials can be leveraged as a nudge to get you the rest of the way toward the balance, but we don't start with antimicrobial therapy.

Michael Ruscio:
Now probiotics are anti-inflammatory and they actually help reduce leaky gut and they are actually antimicrobial in it of themselves. Five clinical trials have found that probiotics can remove SIBO from the small intestine. In fact, one study found that probiotics worked better for patients who had SIBO as compared to patients who did not have SIBO. They're antifungal, they're antiparasitic, so you can get so much benefit out of first starting with diet and lifestyle and that sounds easy, but like we talked about the paleo person could spend a year and a half in dietary purgatory suffering until they actually tried low FODMAP and then in a month they're seeing marked improvements on top of that.

Michael Ruscio:
Then now that the soil is getting healthier, now, we add the probiotics. The probiotics may clean SIBO if present, may help combat candida if present, may help reduce leaky gut, may help also with motility. And so all of these things are now improving the health of the ecosystem. If someone still has some lingering symptoms, now the system is so primed for balancing the antimicrobials are given at the right time where they will have a lasting effect and a minimal chance of someone regressing after stopping the antimicrobials.

Michael Ruscio:
What happens often times is people try these things kind of haphazardly. They try antimicrobials and they get some results, but not all the results they want and then I do a probiotic for a month and that one wasn't quite good enough, so they go to another one and then they go to another one. They just don't the guidance to put these things in the right order. And the probiotics one is such a beautiful example where not only are people doing it at the wrong time, but oftentimes patients are only using one probiotic where really if we can use three, in my experience, that can literally be the difference between people either not needing to do antimicrobial herbs like oregano or needing to do them.

Michael Ruscio:
And the three probiotics, I'll be quick here and then we can go into the details about the three probiotics if you want, but pretty much every probiotic on the market can be classified as one of three categorical types. And what often happens is someone tries, right now in the paleo community, soil-based probiotics are big and so they try that probiotic and yeah, I saw some results but I didn't see all the results I wanted to. So once that bottle is open, I saw a blog about checking Saccharomyces boulardii, which is the other categorical type and I'll try that for a little while. Yeah, that helped a little bit too, but not completely. Okay, I'm at the local health food store and there's a lactobacillus and bifidobacterium predominated blend here, the other third categorical type. I'll try that one for a little while, but they never use all three together.

Michael Ruscio:
And I should mention this is more so my theory, but I've seen this pan out pretty well in the clinic. When patients use them together, it's a difference between having a stool that you would sit on with one leg, one probiotic compared to three legs, that's three probiotics. It seems that using those three probiotics together, because they all have slightly different action actually is more conducive to helping to balance the microbiota or more accurately lead to the symptomatic resolution that one is trying to get to. So one probiotic can help definitely, and there's ample evidence to show that, but that may be for some people like a one-legged wobbly stool that isn't able to balance super well. Whereas three probiotics at the same time, three legs of the stool, more conducive to balance.

Melanie Avalon:
Sorry, you said stool and so I initially thought like stool.

Michael Ruscio:
Well, hopefully, you wouldn't sit on that kind of stool. That'd be kind of gross.

Melanie Avalon:
I know, but just because of what we're talking about and then when you were painting the picture. I was like, "Wait, I'm not quite following this in my head." And I was like, "Oh, he means like a chair."

Melanie Avalon:
Okay, so quick clarifying question. When you mentioned before seeing clinical trials showing success with probiotics, are those typically looking at lactobacillus-bifidobacterium blends, I'm assuming?

Michael Ruscio:
There are over 500 looking at category one, lactobacillus and bifidobacterium blends. There are over a hundred looking at Saccharomyces boulardii category two and depending on the types you're looking at, anywhere between about 20 and 40 clinical trials with the various soil-based probiotics, category three.

Melanie Avalon:
Okay, so again, this is conjecture and looking at mechanisms and theories besides maybe what actually works, but what do you think are the implications of the fact that like lactobacillus and those types of bacteria are not like a normal member of our gut microbiome because aren't they compared to like bifidobacterium, and you can correct me if I'm wrong, but I believe they are a resident member?

Michael Ruscio:
Yeah. Most supplemental bacteria do not colonize you. Some of the soil-based do or may be able to, I don't know if that's fully been bore out, but it's a great point and it's an important point to understand, which is probiotics likely do not exert their impact by colonizing the host, but rather they work transiently to be antimicrobial, so fighting fire with fire to reduce leaky gut, to improve motility, to reduce inflammatory cytokines and inflammation. So yes, it's not that, "Okay, I was cesarean birthed, I was not breastfed, and I grew up in a really kind of clean environment, so I didn't get a lot of colonization in my formative years. So now I can take the magical probiotic to put all those back in."

Michael Ruscio:
That's not how probiotics work. It's important to understand that because probiotic naysayers will go, "Oh, well, probiotics have been shown not to colonize you, therefore they're all poppycock." It's like, "Well, I wouldn't call metanalysis after metanalysis showing improvements in IBS, in IBD, now two metanalyses showing that probiotics can improve either anxiety or depression. Initial research showing the ability to potentially reduce the amount of thyroid medication needed.

Michael Ruscio:
Actually, I wouldn't call that poppycock, but I would say it's important to clarify and for us as a community not to claim that probiotics are going to colonize you. They have a transient benefit and that's not a bad thing because that that tells us that the adult microbiota somewhat resistant to long term colonization. That's good because that protects us from infection, but it also means that probiotics aren't going to stick, but we don't necessarily need them to stick because it's more so about cultivating that healthy garden, that healthy soil.

Michael Ruscio:
And then once we've cultivated that, most people with healthy diet and lifestyle can maintain the improvements, but, and myself included in this, some people notice with a low dose of probiotics, most of the time they tend to be, I would say, more impervious to, "I went out and eat some crappy food, had some alcohol, wasn't sleeping well." So I want to be careful not to represent it as people will need these in the long-term. Now, if you're someone who has or who's been dealt tough hand, then you may kind of preempt having to live a very restrictive lifestyle or diet by using probiotics. But I think for most people, you'll probably be okay without them, but you'll notice you're a bit more impervious to life when you are on them.

Melanie Avalon:
And so another question about, because you spoke about the initial colonization of one's gut microbiome at birth and how that might be affected by C-section versus a natural delivery, also antibiotics, things like that. So the actual initial colonization in a person and their gut microbiome, is that also speaking to completely different strains that we cannot potentially supplement via a probiotic?

Michael Ruscio:
Yes, there's about a thousand bacterial strains in your gut. So probiotic, even the most comprehensive probiotic, you're maybe going to get 15, maybe 20 strains. So again, it's not that probiotics are going to recolonize you, but they have a beneficial effect on the ecosystem. And so you could think about it almost like, again, using the garden analogy, I don't know how many bacteria and fungus typically occur in a garden, but I'm assuming it's well over a thousand. So it's not to say that when you improve the health of a garden, you have to give fertilizer or water that replaces all thousand some-odd strains, but by improving the health and the environment, you encourage the growths and the flourishing of populations as opposed to if you have inflammation that discourages some of those 1,000, some odd from flourishing and there's kind of this almost inverse relationship you can think of.

Michael Ruscio:
Inflammation may allow unsavory players to thrive and then if we reduce your inflammation, those guys get pushed down. They're not fully eradicated, but they get pushed down into the smaller density of colonization where they should be and the healthy population start to bloom and flourish and it's an important concept. We're not changing what's actually happening in the mucosal bacterial colonization, but we're pushing and pulling the ecosystem and if we're doing things right, we're kind of pushing it or nudging it in a direction where the good guys can flourish and the bad guys are discouraged down to a level that's considered normal.

Melanie Avalon:
Okay, and then some follow up questions about that inflammatory response. So something you mentioned in your book was that if a person is having like an inflammatory response to things, if they try just adding in some sort of probiotics that they might have a reaction to it based on their immune system. Is that something that you can write out?

Melanie Avalon:
So like if somebody wants to try a new probiotic and they seemingly, I say seemingly because it's so hard to know like why you're reacting to what or what you're reacting to, but so say they try new probiotic, a few things. How long should they give it before judging and is it possible that bringing in some sort of probiotic could potentially at the beginning create an inflammatory response but that the immune system would adapt to it? So should somebody commit to a certain probiotic for like a month?

Michael Ruscio:
Yeah. That's a great question because we certainly don't want people to, I guess, suffer through something needlessly, but we want to know is this good suffering or have I hit the kind of the reevaluation window yet? So the reason why the probiotics that I use in my clinic and also the ones that I recommend in Healthy Gut, Health You are broken down into the three categories and it's not just all-in-one pill and so that for that small percentage of people who are reactive, they can pinpoint if the reaction is coming from one of the probiotics. This is rare, but I would say in maybe five to 10% of people are just giving a very loose estimate, they may react negatively to one of the categorical types. So this is part of the reason why we don't have an all-in-one probiotic, but rather we break them out into lacto-bifido blend, Saccharomyces boulardii and soil-based, three different formulas.

Michael Ruscio:
Now, what can also happen is people can be having an adjustment reaction, so time helps you adjudicate. Is it A, my body does not tolerate this or my body's adjusting to this. If you get to a week and any negative symptom is not starting to abate then it's more likely that you're reacting to something. So there's two ways you can approach this. If someone has a history of being reactive then I would recommend starting one categorical type of probiotic at a time and giving it a week or so. And if they're having a negative reaction and their reaction persists past a week, then that category is probably not for you.

Michael Ruscio:
What will happen in most people is maybe a little bit of turbulence for a couple of days and then things start to get better and then add in the next one and repeat. So if any type of negative reaction a correlates with when you started the probiotic lasts longer than a week then there's a good chance it's not going to work for you. An adjustment reaction usually starts within the first day or two and it's starting to abate by day three, four or five, and is either gone or about gone by a week.

Michael Ruscio:
So it's really important to understand that because you're right, we don't want to jump ship prematurely, but we also don't want to have someone suffer needlessly and their reactions can be anything. For some people it could be their skin breaking out, joint pain. Most commonly you may see bloating or constipation, but not for everyone, so there's not a symptom that tells you it's a reaction, it's the timing. So if any symptom starts at the onset of the probiotic and lasts for longer than a week that categorical type probably does not work for you, but that is rare. So just to frame that for people, I see a subset of my clinic are pretty reactive patients and even the most reactive patients can usually at least tolerate one of the three.

Melanie Avalon:
And then quick question about one of those threes, the bifido-lacto blend. Do you ever see benefit in splitting that further down? Because I know a lot of people will often try just bifidobacterium or just like lactobacillus type, like the lactic ones?

Michael Ruscio:
Yeah, good question. You could, I don't think that you necessarily need to. If you look at most of the clinical trials, but there is variants, but they tend to use either a blend of various lactobacillus and bifidobacterium predominantly or Saccharomyces boulardii or a soil-based. Some of the research studies use a mix of category one, category three or category two and category three, but the majority of have kind of broken them out. And then there's this other emerging philosophy that is, "Well, we need the probiotics that are evidence-based and if you have constipation, we need the probiotic that's been proven for constipation." Well that's all good in theory, and it appeals to me because I'm kind of a science snob, but when you actually look at the data, there have been, I believe four similar but different formulas, probiotic formulas, that have all shown improvements for constipation.

Michael Ruscio:
We mentioned anxiety and depression earlier. Predominantly, it's been category one probiotics, but the formulas had been different amongst those studies. For SIBO treatment, formulas had been different also, similar but different. So if you haven't wasted a lot of time going through these studies, one by one by one by one and looking at the constitution of the probiotics used in each of those studies, it could elude you that, "Boy, different probiotics all seem to be able to achieve the same end point." That's actually a good thing that tells us that probiotics aren't like drugs. If you give someone metformin, it does one thing, right? If you give them cortisol, it does something else.

Michael Ruscio:
Probiotics, because they are helping to heal your gut and encourage balance in your microbiota, they are treating a root causative issue so that can manifest in a wide litany of different improvements, so it's more about finding the probiotics, in this case, I recommend using all three that will help to improve gut health. And then once the gut health improves, the secondary symptoms improve after that. That's the goal. Not, "Well I read that this is the best probiotic for depression or this is the best probiotic for joint pain or this is a best probate of constipation."

Michael Ruscio:
Usually what's happening there is there is one study that supports that and so it's not untrue for a marketer to tell you that but they're just leaving out that you have leeway with other similar probiotic formulas and so it doesn't have to be that complicated and rather than trying the one formula for depression, the one formula for constipation, not realizing they're almost exactly the same, you can put all that marketing jargon spin off to the side, find a quality formula from each of the three categories and focus on that.

Michael Ruscio:
You can get down into more granular where you do just bifido or people will also recommend non-lactate forming or non-histamine forming and for a whole litany of reasons, you don't have to do that. I see a lot of histamine-sensitive patients and they may react to one formula, but if we personalize, like we talked about a moment ago, the net effect of probiotics tends to be antihistamine and this throws people because they're getting down to the academic minutia. "But wait, probiotics contain histamine except for these special ones." Well, that is true. They contain histamine, but they also combat a number of factors that cause high histamine, so they end up being net anti-histamine. This is how we can put a probiotic into a SIBO environment and see SIBO go away.

Michael Ruscio:
How is it we can give bacteria to bacterial overgrowth and then the overgrowth goes away because the net effect was antibacterial. The net effect can be anti-histamine and that's not conjecture. There's a number of studies using probiotics and histamine-mediated condition like seasonal allergy and rhino conjunctivitis, where these are histamine-mediated conditions that got better with this irregular category one probiotic that contains histamine, but the symptoms improved because a net effect of the probiotics is actually anti-histamine.

Melanie Avalon:
Okay, Glad you brought up the histamine because that's the context I was personally coming from was the whole histamine thing. Okay. Going back or coming full circle back to the mindset and all of that stuff and the protocol. So regardless of where somebody is at with their starting point, do you think that if somebody seems to be in a much more dire state of GI distress compared to somebody else who might just be looking to tweak things, because we see these changes happen potentially fast, does that mean that honestly, anybody can make changes, can see improvements in a month or so or can your state be so bad that it's going to take a long time?

Michael Ruscio:
Good question. For most people, once they're doing the right thing, they should see at least the initial flickers of improvement within a couple of weeks. Now, that's not full resolution, but if you're doing the right stuff, there should be this general trend, a slow march of improvement. Now, you may hit a snag and have a little setback along the way. That's normal. Don't freak out, but there should be this gradual march upward improving, improving, improving.

Michael Ruscio:
There is perhaps one exception to this, which is in those that have what I'll loosely term limbic imbalances who may have been suffering for a long time, may almost at this point expect to be sick. Also potentially those who had childhood abuse of various sorts and in these patients, what I've seen or what I used to see was we do everything that other patients respond to and they seem like they're getting a little bit better, but they'd never seem to get over the hump.

Michael Ruscio:
And what has been very helpful for these patients is some type of limbic retraining therapy and what I think happens is these patients are so expectant to be sick that they can't get their limbic system or their emotions out of that phase of expecting to be sick. And so let's take someone who gets brain fog. Their brain fog is actually much better than it was a month ago, but they get so angst when they have brain fog that they worked themselves into a stress response and they almost inhibit themselves from being able to move forward because they can't look at it half as glass full. Like, "Hey, I am 30% less brain fog than I was last month." All they can see us, "I have brain fog again." And then they fire this pathway in their brain. They think about fear and angst and anxiety.

Michael Ruscio:
So what limbic retraining can do, and I highly recommend either Ashok Gupta's program called the Gupta Program: GU PTA or Annie Hopper's DNRS program and this is a commitment. It's about an hour a day of kind of this intensive meditation, but it can be very helpful for patients who are stuck in that mental rut. And when those patients start doing that, they start improving within weeks. So for all of these people, the road from zero to 100 might be a year, but you should feel like you're making progress every few weeks, every step along the way. And so even though the road, let's say maybe is a year, you don't feel discouraged because you're feeling like you're making progress.

Melanie Avalon:
Yeah. I'm so glad you brought up that whole aspect of the limbic system because I really think that can be really, really huge for so many people. Almost makes me want to do just sort of like a placebo trial probiotic run where I just take a placebo pill and like say, "This is the gut microbiome in a pill" or something and see what happens. I would actually love to see a study done on that, a placebo effect study with the probiotics. Have you seen anything?

Michael Ruscio:
I have not seen a study of that exact nature, but there has been a summary performed in IBS trial, so those with digestive maladies of various sorts. The placebo effect in randomized control trials where the placebo was trying to be minimized, average is about 45%, so placebo is powerful. As another example, there's this debate regarding thyroid hormone. There's T4 alone, your levothyroxine or your Synthroid and then there's these combination therapies like Armour or WP thyroid, and there's debate about what is best.

Michael Ruscio:
In some of the studies in very elegant designs actually, they will take patients that will take their medication and I know they're going into a trial where they're going to study what the best type of medication is, but they don't know what they're going to get. The patients that are taking levothyroxine and the researchers take it away and they give them a white bottle, they don't know what they're taking. They report the same amount of improvement as people who are then changed over to what's supposed to be "better," the Armour Thyroid.

Michael Ruscio:
So placebo actually can have the same effect as a medication change just when someone is thinking that change may be occurring, they can actually start to report benefits. So this is one of the reasons why we should be careful and I do think that in time people should always be working to expand their diet. At the very worst, we can placebo them in the right direction and try to find the minimal effective dose, if any dose at all, is needed of the support items that one might be using including probiotics. And this is one of the last steps in Healthy Gut, Health, which is creating the expectation of being able to curtail or to minimize, because you're right, placebo is very, very powerful.

Melanie Avalon:
Yeah, I love that so much. And then sort of speaking to that as well, so say somebody decides to follow a plan as outlined in Healthy Gut, Health You or commits to some sort of plan, how can we follow that plan and see it as a plan and something to follow but at the same time not feel like it's this rigid fear system where you know we have to do all these things and where we judge every single reaction. I guess, how do you encourage your patients to have a healthy approach to a plan to make them feel better?

Michael Ruscio:
Yeah, also a very important question, and like we talked about earlier, the way the information is just conveyed makes a big difference. I almost exclusively with a few rare exceptions, tell people when following a diet as an example to follow it the best they can, but that they don't have to be perfect. That right there cuts out a lot of fear and anguish when people have amiss, which almost everyone is going to.

Michael Ruscio:
Very few people can be on a diet for a month and never have one deviation, so just the fact that they're told, "Do your best most of the time, but you don't have to be perfect," can really short circuit and circumvent a lot of the fear around diet regarding supplements, not indoctrinating people to think that you're always going to need supplements and educating people on the fact that even the healthiest person has better days and worse days and everyone is human. No one is functionally like a robot where they are impervious to anything. People have setbacks, that is normal, that is okay.

Michael Ruscio:
We were talking before the recording about a gal, same gal who read Healthy Gut, Health You and she said one of the most freeing aspects for her was just the fact that I talk about in the book that setbacks are normal and it doesn't mean like, "Oh my God, I've got to go do a follow-up visit with a functional medicine provider and then do another breath test and a stool test just because I've had some symptoms come back." No.

Michael Ruscio:
If you figure out the plan that works for your gut, you can return to a minimal version of that for a short time to get you back to center. Just like, and I always use kind of these corny musculoskeletal analogies, but coming back to the knee sprain example. You may have had to wear a brace and do some stretches and strengthening exercises. Now, let's say two years later, you're sitting a whole bunch, you're driving a lot, you're flying a lot, you're not exercising as much and oh, your knee starts to ache. Will people be freaking out or they'll say, "God darn it, this knee sprain. Okay. I've got to stop being lazy about not doing any exercise. I'll do some of my stretches, do some of my strengthening exercises," and then boom, in a few weeks their knee is back to normal. No big deal. Nothing to freak out about.

Michael Ruscio:
So I mean, yeah, I think that answers the question, but I just guess who you're getting information from makes a big difference because there are people out there who will tell you like, "Oh my God, you have an autoimmune disease. You can never have gluten." No, not with the best evidence from the best researchers supports. Now sure, some they consider if you have an autoimmune disease, staying off gluten or mitigating gluten, but this need to ardently avoid gluten? Not really supported unless someone has noticed a really strong aversion.

Michael Ruscio:
But my point here, and pardon my long monologue is the way these recommendations are being given, the framework in which they're vectored makes a lot of difference. And I'll just say it simply, most of the time these things are not as dire as they're made out to be. Meaning if you have amiss on your diet, if you missed your supplements, if you have a bad day of sleep or a bad night of sleep, rather and just get yourself back to center, aim for a reasonable day-to-day and if that's your foundation, yup, you're going to weather a couple bad days here and there. We all do, but not a big deal. And if you just keep with a general healthy plan, having had gone through the healing process prior, you know what you can go back to if you feel like you're starting to get a little shaky and that's pretty much all you have to do and you are so empowered when you have those few things operating together.

Melanie Avalon:
Yeah, I think it's so important and I think setbacks could be such potentials for downward spirals for people because if you have a setback, it can just create this moment where you're like, "Oh my goodness, I have to start over. Completely, I've undone everything. I probably have regrown all these bad bacteria." And it can seem like really dark and that you on did all of the potential healing that you had done, but it's good to know that that's not necessarily the case.

Melanie Avalon:
I will say, I think it really comes in to so many people because I think people who are like really, really sensitive to things and it kind of ties into the beginning we're talking about over analyzing information and over looking at studies and data, and I think people do that themselves because they'll overanalyze their reactions to things and they've over analyzed everything that they're doing. They're trying to find connections about what's doing what and they want things to work so bad, so we make conclusions about what's working and not working, when I think maybe just following a steady course without creating judgements every single second along the way might be more healthy.

Melanie Avalon:
The thing that really sold it for me that made me realize I need to stop over analyzing when I'm seemingly reacting to something is that when they do studies where they'll set up patients so that only like part of their brain can see certain objects. It's more complicated than this, but basically like only their left brain can see certain objects and only their right brain can see other objects based on how it's set up. Patients where only their left brains see certain things. if they are asked like why they did certain things, the left brain will basically create stories and create memories to explain what it saw that didn't even happen.

Melanie Avalon:
And I know it sounds really vague, I can put links to it in the show notes, but basically it's like the language part of our brain that's trying to make sense of things can make up memories and make up associations and make up things just to make sense of the world when maybe none of that actually even happened. And when I read that I was like, "Okay, so I just need to trust the process and not over analyze like every single minute."

Michael Ruscio:
Yes. I want to agree with you there a thousandfold. And one of the things I typically tell patients in the clinic, but I think this narrative is also delivered via the book, is I will worry on your behalf. Because it's amazing how exactly what you said, people will find something to try to explain what they're feeling and what I wish people could see is through my perspective, which is all sorts of patients have all sorts of reactions and what really matters is coming back to our clinical road and not getting pulled into, "Oh. Did you hear about the new study that found that rice is high in arsenic and I looked up on Google that arsenic can cause brain fog. I'm wondering if I have high arsenic."

Michael Ruscio:
Hold on. Let's take a step back because we can see great results with brain fog if we keep working this plan of healing your gut, but when people aren't feeling well, they're grasping for any straw. I remember I was there, I thought I had mercury toxicity. I thought my brain fog was from mercury toxicity and I peed in a cup and guess what? I had high mercury and guess what? That lab has now been sued for falsifying their lab ranges, which tells you how awesome some of the labs are in functional medicine, and I did the mercury detox and it got nowhere.

Michael Ruscio:
It turns out for me it was gut and I really had to just heal my gut and my brain fog went almost completely away. I mean, there's a few other things I had of kind of fine-tuned with my lifestyle, but yes, we're searching for answer, we're searching for meaning and I would just offer people, you have to shut off that voice of incessantly trying to grasp at any mechanistic straw that explains why you're not feeling well.

Michael Ruscio:
If you're going to turn over your healthcare to either a clinician, granted you trust them or a book protocol like from Healthy Gut, Health You or another book or a program, as long as you have confidence in the person because one of the things that is a travesty is when someone gets in their own way and this happens. In the clinic, people will wait to see me then we'll go over my entire analysis and I'll give them exactly what to do here, do this for 30 days and they come back and they haven't done any of it because they've gotten their own way. "Well, I was reading this, or the guy at Whole Foods said that, or the second day I was a little bit bloated, so I stopped and then I read this blog that said, if you're bloated you could have this, so I did."

Michael Ruscio:
And they come back and I go, "Well, great, like the last three days have been useless because all you've done is just grasp at every straw in front of you and there's been no scientific basis for what you're doing. There's been no clinical algorithm guiding what you're doing. There's been no parameters set up." Like in the book, we have people focus on doing a minimal amount of things at one time so we can establish cause effect and then learn from that.

Michael Ruscio:
So while I understand how people want to get out of feeling unwell quickly, it really helps us slow down, take one step at a time and find someone who you trust and follow the process because oftentimes that will get you through it more quickly. Even though, I've been there, like, okay, you're doing good for two weeks, now you're having a bad day and you're saying, something must be wrong and then you want to jump ship. Don't jump ship because what often happens is you are on the right path. You just have to weather some of those small storms that come up along the way, but again granted, you have to trust and be confident in the person who's giving you the advice.

Melanie Avalon:
Yeah, I love that so much. That was one of my recent other epiphanies and decisions I've had for me personally is that is to only work with health practitioners that when I go to them, I feel like I'm healing and not like I'm dying. So like if I walk in the room, I feel like empowered and you know, we can fix this rather than here's everything that's wrong.

Melanie Avalon:
So yeah, that and then just realizing that I don't really know what's happening with anything, so like we said, just trusting the process and not trying to reach all these crazy conclusions. And I was laughing so much when you were describing the patients. I know exactly what you mean about the Googling and then I got to do this and then I did this and then it's just, it's crazy.

Michael Ruscio:
Yeah and I've been there, but also, it's disheartening even to see-

Melanie Avalon:
It's well intentioned. I mean, it's because we're just trying to be better.

Michael Ruscio:
Yeah. It's fully well intentioned and I think patients who have a really hard time letting go, oftentimes they do really well without limbic retraining because they're just so scared that they can't relinquish control and if they can't do that then, I mean they can't follow recommendations. If they can't follow recommendations, they can't move forward.

Michael Ruscio:
So for some people we have to kind of take a step back and get them to learn to relax a little bit, rediscover other stuff in their life, find joy again and I know that sounds a little bit airy-fairy, but sometimes it's just if you're focusing on the wrong thing all the time, those pathways in the brain, they are plastic, so the more you fire them, the easier they are to fire.

Michael Ruscio:
So with the limbic retraining, you retrain other parts of your brain that are more path toward happiness and that can do a lot to get someone to kind of let go, enjoy their life even though, yeah, maybe they don't feel perfect, but if they're enjoying their life and they're happy, they can follow recommendations, they can weather a little bit of symptomatic up and down and that prevents them from getting their own way. And that's the saddest thing, when someone has the tools in front of them, but they're too worked up or fearful to follow them. So I, I agree and for whatever it's worth, I've been there, but you know, if you can calm down a little bit and then follow a process then it will definitely pay you dividends.

Melanie Avalon:
Well, thank you so much that. That brings me to my final question that I ask every single guest on this podcast and it's because appropriately enough how much I've realized how important mindset is for all of health biohacking, for everything, just how important mindset is. So what is something that you're grateful for?

Michael Ruscio:
Great question. God, so many things that I'm grateful for. Something right now that I'm grateful for amiss many is music. I've been tinkering with piano for a while and I just feel really fortunate that I have in my apartment a piano I can play and Jessie's great apps where I can have a really smart pianist teach me how to play a song. So I know that may not be applicable to everyone, but I guess maybe it comes back to a broader health lesson of having a hobby.

Michael Ruscio:
And for me it's really nice sometimes to shut off from clinic, from work, from writing, and just get lost and here's a song I want to be able to play. Feel it coming through your fingers and that connection where here's something I used to hear and love and now I'm actually making that sound. It's really, I guess, meditative and enjoyable experience, so that is something that I am definitely grateful for.

Melanie Avalon:
I love that so much. That makes me so happy. Well, thank you so much Dr. Ruscio. This has been absolutely amazing. I'm so grateful for you and your work and everything that you're doing for the world, honestly. I will put links to everything in the show notes. Is there anything you'd like to throw out there for how listeners can best follow your work, anything specific?

Michael Ruscio:
Well, thank you. I mean, I appreciate deeply the opportunity to come out here and just share my thoughts with your audience and try to hopefully throw them a line to get help if they're in need and the best place to go would be my website, drruscio.com, D-R-R-U-S C-I-O.com. You can plug into everything there and also the book or you can just search for the book directly, which is called Healthy Gut, Health You.

Melanie Avalon:
Awesome. Well thank you so much. I appreciate this. This has been amazing and hopefully, I can bring it back in the future.

Michael Ruscio:
Yeah, I'd love to.

Melanie Avalon:
All right. Bye.

Michael Ruscio:
Bye-bye.

Melanie Avalon:
Thank you so much for listening to the Melanie Avalon Biohacking Podcast. For more information, you can check out my book, What When Wine: Lose Weight and Feel Great with Paleo-Style Meals, Intermittent Fasting, and Wine as well as my blog, melanieavalon.com. Feel free to contact me @podcastatmelanieavalon.com and always remember, you got this.