The Melanie Avalon Biohacking Podcast Episode #309 - Dr. Michael Ruscio

TRANSCRIPT

Dr. Michael Ruscio
I offer that for the person who says, well, I'm not under a lot of stress. Well, if you've had some sort of chronic inflammatory issue, part of what you may need is to balance out your nervous system because the inflammation has been a chronic sympathetic trigger or stimulus.

Clinicians' clinical listening and analysis skills have dwindled because there's such a reliance on just treating test markers. And I think it's really kind of crippling and making less effective a whole generation of clinicians.

Melanie Avalon
Welcome to the Melanie Avalon biohacking podcast where we meet the world's top experts to explore the secrets of health, mindset, longevity, and so much more. Are you ready to take charge of your existence and biohack your life? This show is for you. Please keep in mind we're not dispensing medical advice and are not responsible for any outcomes you may experience from implementing the tactics lying here in.

So friends, are you ready to join me? Let's do this. Welcome back to the Melanie Avalon biohacking podcast. Friends, it was such an honor to have Dr. Ruscio back on the show. I have been following his work for almost a decade and he radically has changed my life. I was looking forward to this conversation for so long and it went in so many directions that I didn't anticipate. We touched on a lot of topics I feel like a lot of people aren't talking about when it comes to digestive issues and gut health.

Specifically, for example, how people who may think they have bacterial overgrowth may actually have fungal overgrowth. We talked all about that and we talked about how you can diagnose that with a questionnaire. We talk about what happens with symptom patient mismatch, basically where your experience may not match your lab work and what does that mean? What should you do with that? We talk about one of my favorite things, low FODMAP diets, and we talk about something that Dr. Ruscio said has been his biggest epiphany in a decade. Yes, we are going to tackle that. You're also going to learn the three types of probiotics you should be taking and so much more. I also love, love Dr. Ruscio's supplement line. It's called functional medicine formulations, FMF, and he is the person I trust when it comes to all supplements gut health. So if you're looking for probiotics, Saccharomyces boulardii, especially after listening to today's episode, or you want to do the elemental heal program to heal your gut, he has so many things. I've been loving his triple therapy probiotic and his oil of oregano capsules. You can get 10% off site-wide at his store with the coupon code MelanieAvalon. For that, just go to MelanieAvalon.com slash FMF. That stands for functional medicine formulations and use the coupon code MelanieAvalon to get 10% off site-wide.

These show notes for today's episode will be at MelanieAvalon.com slash Ruscio. That's R-U-S-C-I-O. Those show notes will have a full transcript as well as links to everything that we talked about.

So definitely check that out. I can't wait to hear what you guys think. Definitely let me know in my Facebook group, IF biohackers, intermittent fasting plus real foods plus life. Comment something you learned or something that resonated with you on the pinned post to enter to win something that I love. And then check out my Instagram, find the Friday announcement post. And again, comments there to enter to win something that I love.

Melanie Avalon
All right. I think that's all the things. As a brief reminder, you can get 10% off site-wide for all of Dr. Ruscio's incredible supplements to support your gut health. For that, go to MelanieAvalon.com slash F-M-F and use the coupon code MelanieAvalon to get 10% off.

And now without further ado, please enjoy this fabulous ethereal conversation with Dr. Michael Ruscio. Hi friends, welcome back to the show. I am so incredibly honored and excited about the conversation I am about to have. So backstory on today's conversation, circa 2014 or so, I had a catalyzing incident of a food poisoning situation that sent me down a rabbit hole spiral of neuroticism and freaking out and not feeling good when it came to my digestive health. And when I was scrambling in the darkness and going down all the internet forums and trying to find answers, one of the consistent figures that I look to who radically honestly changed my life was Dr. Michael Ruschow, who I am so honored to be here with today. And what I truly just appreciated about Dr. Ruschow's work, I was listening to his podcast at the time, was he was diving into all the latest science, all the studies, all the time, and really synthesizing it and also interpreting it for people like me who had digestive issues and making it applicable and practical and providing the actual takeaways without all the fear that so easily comes to people with digestive distress. He was just so empowering and so amazing. And so then fast forward a little bit to 2018, he released a book, Healthy Gut, Healthy You, which not surprisingly was, it was basically everything he was doing incarnate in a book and created this sort of manual that people could follow to actually take charge of their gut health. And I actually remember saying this last time I interviewed you, it's kind of like a choose your own adventure where you follow this path of the book to really implement the dietary protocols and the supplements to work for you. It's a game changer. So then it was such an honor to have Dr. Rucho on my other podcast, the Intermittent Vasting Podcast. And I was just looking this up, it was episode 68 and we're now on like episode 300 something, 330 or so. So that was a while ago. So long way of saying, we set up this interview, his team reached out and I was just so excited because so much has happened in the world of the gut microbiome and digestive health in this time. And like I said, I just, I don't want to start crying, but like I just, this man is doing so much incredible things because so many people struggle with digestive issues and health issues in general. So that was a long winded way. Welcome you back to the show, Dr. Rucho. Thank you for everything that you do and thank you so much for being here.

Dr. Michael Ruscio
Gosh, thank you. That is one heck of an intro and it's why I love doing what I do, right?

Cause I had GI issues myself and it was really, really terrible. And if I can help anyone get on the other side where they sleep well, they poop. Well, they don't have bloating. They're not scared about food reactivity. They have good energy and mental clarity. It's, it's such an amazing gift. I mean, what, what does that, uh, saying RFK use it in his HHS address, a healthy person has many dreams. A sick person, just one that really sort of struck me, right? So pumped that everything helped you. Thank you. It's an awesome intro.

Melanie Avalon
It's just incredible what you're doing. I remember that quote when I was in my, I call it my dark time and it was like in my dark hole of digestive issues and then, you know, mercury poisoning, hypothyroidism, heavy metals, all the things, it was not good, anemia. And I remember that quote, it's like, yeah, basically when you have your health, you want everything. And when you don't have your health, all you want is your health. And it's so true.

And then like I said, people, like the internet rabbit holes are a date, like they're very helpful because there's so much agency to, you know, learn what might be going on and try things. But it is a dark path of getting all in your head and self-diagnosing. Have you seen it get better now or worse now with the advent of AI? Have you found that to be helpful for people?

Dr. Michael Ruscio
I'm not sure. I mean, I think people come in maybe with data, better synthesized. Like I had a patient last week who said, I saw the lab work come in. I was positive for A and for B. And so I looked up the top thought leaders and what their treatments would be. And I've sort of like ranked ordered them by estimated efficacy. I was like, wow, like this is a pretty cool thing that you can bring to the table. I don't know if it's going to help people be any more effective because that's, it's much more of like the, I guess the art of healthcare is knowing who to pair with what, but certainly I think it's going to give people more information than discuss with their healthcare provider who can then ultimately kind of be the quarterback because it is a really common thing.

As I'm sure, you know, people, they get attached to a certain hypothesis because it just makes the most sense to them. Or maybe it's what's most vogue on the internet, but it doesn't mean it's actually what's driving the issue for you. Like SIBO as an example, small intestinal bacterial overgrowth, that's really had this day of popularity and it is a legitimate important thing, but it's not everything. And sometimes you'll see people who are a year plus into really hammering SIBO and they're not getting any better because their paradigm is just all about SIBO. So that's where having someone who can take a bigger picture perspective might be able to direct you to the underlying cause it's been missed.

Melanie Avalon
I'm smiling right now because I have a genuine question about that because with SIBO, that was my diagnosis. When I was back in that dark time, I was so, because you mentioned SIBO having its day, I was so overwhelmed with that diagnosis. I identified by it and I did get diagnosed with it. It's all I could see and I interpreted everything I did through that lens.

I made a conscious decision. I don't know when it was, but at some point I was like, you know what? Because I was constantly in attack the bacteria mode, got to kill this bacteria in my small intestine and that's all I wanted to do all the time. I had a moment where I was like, I'm just going to not anymore. I'm just not going to do that. That actually was so healing for me not to have this idea of trying to kill this bad bacteria in me.

I used to be so immersed in a mesh in the SIBO world and now I'm not. Is it still as popular as it was or am I just, do I not see it as much because I'm not looking for it now?

Dr. Michael Ruscio
Yeah, I think it's still as popular as it was. I mean, you know, ask three different people that you might get three different answers. But certainly, it's still something that's a invoke topic for researchers online, the thing that I would maybe want to introduce to the conversation that I think can be quite helpful. We've been thinking through this, what we call gut typing model, there's bacterial overgrowth on the one type, and then the other type is fungal overgrowth. And this sort of hints at something that's important, you know, in theme with this conversation, which is fungal overgrowth hasn't had necessarily its day of popularity and academic research. And it's not something that I've seen make quite the rounds in the podcast sphere or blogosphere.

I mean, certainly, I think people have probably heard of fungal overgrowth. But it's much more ethereal in terms of the diagnosis where SIBO has a validated breath test, it's able to be done routinely in clinical practice. For fungal overgrowth, maybe you get it on the stool, maybe not. Maybe you get it on a blood antibody test, maybe not. Maybe you pick it up on a urinary organic acids, maybe not. It's much more of a clinical diagnosis. So because of that, you'll see some people who have been really hammering SIBO and not getting much better. And their symptoms are similar. But they're actually being as would be caused by fungal overgrowth. But they're actually being caused by fungal overgrowth. One of the main points of relevance is the diet for fungal overgrowth versus bacterial overgrowth gut type are kind of polar opposites. And so if nothing else, we can just give people a lot more clarity on what to eat so as not to trigger their symptoms. And if they're not triggering their symptoms, they're healing. And if they're healing, they should be able to have more dietary tolerance down the line. Sort of one of the other concepts we've been developing is this analogy that diets should be looked at like a rehab plan. I always say that if you hurt your low back, you wouldn't equate that one or two month rehab plan, right? Like avoid sprinting, avoid cycling, because you're bending over, avoid heavy weightlifting, you wouldn't think that you'd have to do that forever. Once you rehab, you'd be able to go back to cycling, sprinting, weightlifting, whatever it is. So we keep trying to frame diet also in that perspective.

So the first step would be identify what your gut type is, eat and supplement accordingly. And then you should find your way to improve tolerance.

Melanie Avalon
Okay, I am so excited to be talking about this topic.

So when people with the fungal stuff, is that the same thing? Because I think the thing people might be familiar with is candida. Is that all of it? Is that some of it?

Dr. Michael Ruscio
as one type of fungus. There's several, but it's the most common one to overgrow.

But there are, and this is part of the challenge, right? Which is you might have a stool test that just looks for candida, but there's multiple forms of candida. There's also non-candida fungus like geotrichum. And so this is why we've been finding, it's a questionnaire that was validated by Santelman and colleagues. It's seven questions. It's called the FRDQ7, fungus related disease questionnaire seven and seven questions. And this predicted if people would improve from antifungal therapy. So this is a screening tool that we use early on in the clinical process that can help give you some pretty accurate clues that don't even require you to do a lab test. Because if you did want to try to hit all those tests I mentioned a moment ago, a stool test, a blood test, a urine test. First of all, it's kind of a pain in the butt. People got to go to a specialty lab and have the blood kit drawn and sent out. They got to do a poop test at home. They have to collect their urine and make sure they send it out like Monday to Tuesday and not on the weekends. But it's also going to be over a thousand dollars of cost. So all these little things do add up in terms of how broken or disordered someone feels. And then if someone is on a budget, these lab tests add up really quickly. So unless a lab test is definitely going to be helpful, then we like to use, if available, if we have the luxury of it, a peer reviewed symptom inventory that will quantify someone's risk. So in this case, the FRDQ7 has been a very helpful method.

In fact, we published on our YouTube channel. This was only about a month ago. It wasn't even my patient. It was one of the other doctors in our clinic, Dr. Scott Spiritigliosi, awesome clinician, great human being. He was working with this gentleman, Keith, had been treated for SIBO. I think with this conventional gastroenterologist had some improvement, sure, but was still so tired that he couldn't exercise and wasn't golfing and had such bad diarrhea that he couldn't leave the house because he had urgent bowels. So his life was really debilitated. And what do you know? He scored very high on the FRDQ7. We got him on a candida diet, used antifungal antimicrobial therapy, and within a month, he's back at golfing, back to exercise, and just had a complete 180 in how we felt.

So sometimes we think that a lab test is, air quotes here, scientific, but a lot of labs, especially in functional medicine and the biohacking space, as cool as they are, they're much more theoretical. One thing I'd want the consumer to be better aware of is sometimes a validated symptom inventory can get you much farther than even over $1,000 of lab testing.

Melanie Avalon
this is beyond incredible. I remember in my journey, I definitely had a moment where I was convinced I had a fungal overgrowth and I did a stool test and they're like, it's negative.

And I was like, well, I don't know what that actually indicates. With the questions on that questionnaire, what are some of the symptoms that differentiate a fungal overgrowth from other conditions that might be going on?

Dr. Michael Ruscio
Great follow up question. The one or a few kinds of elephants in the room, carb cravings. If you're someone that you need to have a sweet after dinner, you're always, you know, leaning toward chocolate or chips or what have, I mean, context your matters, if you're eating enough, if you're on a starvation diet and really trying to lose weight and you have cravings, that's normal, right? But if you're eating a normal normative diet and caloric intake, but you're still saying, Oh gosh, I just, I want some carbs or some chips or some rice or some juice or some fruit or some chocolate. That's one indication.

Another is fatigue. If someone has had any history of recurring vaginal yeast, jock itch, white tongue, or toenail fungus. If someone has had multiple rounds of antibiotics previously females, long-term birth control, hormonal birth control, itchy or watery eyes. And if people notice that their symptoms get worse when it's humid or wet out, uh, I think that's all of them that I may have missed one, but that's kind of the synopsis and the thing I would say to compliment that is fatigue and brain fog are two symptoms that you see much more of and much more prominently in fungal overgrowth than you do in SIBO.

Melanie Avalon
Wow. Okay. I'm such in my happy place talking about this right now.

It's funny because I... So I had a... You're speaking of the fungal overgrowth. I had that in my toenails actually, and I got turbinifine, the antifungal drug. And I remember I was going down the Reddit rabbit holes reading about turbinifine, and so many people were saying that they got on it for like that reason and then experienced all these other benefits from it. And I guess it speaks to people having systemic fungal overgrowth problems.

Dr. Michael Ruscio
Well, usually what's happening in the, you know, toenail is reflective of what's going on in the gut. And I think most fungus probably starts from the gut outward, not 100% of cases, but that's a general trend. Okay. Yeah.

Melanie Avalon
I'm actually... It's embarrassing to say this. This is so timely.

I was not freaking out, but I had a moment yesterday actually because I was getting my nails done at the nail salon, and I thought there was some ink under my nail. That's what I thought it was. And then she said it's like fungus starting underneath that nail. And so now I'm semi-panicking about it.

Dr. Michael Ruscio
Well, there's a lot that can be done.

Melanie Avalon
I got tea tree oil stuff, but I'm like, does that mean it's like, like how often, how often is that an indicator of systemic, a systemic issue?

Dr. Michael Ruscio
It's an indicator enough to be on that inventory by a Santelman. So yeah, I mean, I would, I would be thinking about, there could be gastrointestinal Candida and that's where looking at, is there any brain fog, fatigue, loose bowels, bloating, carb cravings, right? And kind of looking to paint a picture because as a clinician, with any, what we would call a differential diagnosis, I'm always building supporting points on the one side of the ledger, and then contradicting points on the other side of the ledger. And, you know, you run through all the viable things, you know, SIBO, reflux, Candida, IBS, and you're trying to make the best case for for whatever or you would treat whatever the best case is, right, wherever you see the most data points supporting, that would give you the best probability.

And I know that may not be the sexiest thing, you know, it's better to say, Oh, yeah, this new probiotic and it's so amazing. But this, it's just not how clinical practice works. It's much more methodical, thoughtful and weighted by probabilities than it is, you know, here's the I guess this, this is like the old species canard that will never die the magic bullet, right? People have been getting sold on magic bullets from the start of time and will probably always because it's it's just an easy attractive fix. But, you know, not to say clinical practice is incredibly challenging and arduous. But we really have to listen to the individual and use that to figure out, you know, what tools do we bring to them, rather than what I see a lot of in the space, not to kind of like go on too much of a tangent, but you see a lot of magic bullet fan fare. I wish there was such fanfare about getting a better read on the bio individuality of a person and then making the corresponding recommendations.

Melanie Avalon
Has the definition, I think I actually don't even qualify for IBS anymore because doesn't the definition now require that you actually have pain?

Dr. Michael Ruscio
That pain that the hallmarks are for over six months, pain, and then alter bowel function, constipation, diarrhea, or an oscillation between the two. And it's even been recategorized to a new term that I do think is more representative called disordered gut brain interactive, interaxes, F G D G B I sorry, and this is because the, the brain is such an important component. Of gut health and, and just actually yesterday in the clinic, oh, this is actually so, so timely, so phenomenal patient, a just like woman after my own heart, right type a workaholic go getter. And she had a history of SIBO, which we treated and she's been really solid. And we just check in once per year now to keep tabs. And every once in a while she has a speed bump. So she checks in. And as we were chatting and going through a visit, this is just yesterday, actually, one of the things that came up upon me probing was the two regressions she's had over the past two years, both followed stress, either work stress or some other, you know, personal issue.

And so I said, okay, well, what I'd like you to do then is meditate for an hour per day, and I said, no, I'm just kidding. Cause I, you know, her being like a busy mom and working professional, I know she can't do that, but the point I made was if you could meditate for an hour per day, it would probably help. But there's a really fascinating new device called a vagal nerve. They're not necessarily new, but they're newer vagal nerve stimulator. There's different ways you can do this, but the devices I favor, they're essentially earbuds with little mini tens units that create a light buzzing sensation in your ear. It stimulates the tragus nerve, which connects to the vagus nerve, which is the parasympathetic intervention for the body and what this does, if you wear it for 20 minutes every day, it's super easy to do. You can do it while you're working, while you're going through your morning routine, while you're washing dishes, whatever you better train your nervous system to swing out of the sympathetic fight or flight and into the rest, digest, recover parasympathetic. And we know that that has a very big impact on IBS. We see studies where people do hypnosis improve IBS or yoga improve IBS. We know, and coming back to the name, right, disordered gut brain interaction, these interventions that can help be corrected to the brain can definitely have a big impact on IBS and associated symptoms. So for her, that was essentially other than doing a little bit higher of a dose of probiotics, just get on the vagal nerve stimulator, which people can buy. The product we like is called vague use them. And I think that's going to be enough to help her better train her nervous system because she being such a hard worker has probably over time kind of locked her nervous system in a low level sympathetic response all the time. And just like with HRV, you want to be able to, you know, have variation in your heart rate, you should be able to have variation from the sympathetic on the one side and the pendulum should be able to swing over to parasympathetic.

Dr. Michael Ruscio
If you get stuck low level sympathetic all the time, you can't recover. So for her, I'm very optimistic.

This is going to be the final touch that's going to prevent those periodic turbulent points that she's hit a few times over the past few years.

Melanie Avalon
That is incredible. I completely forgot.

I used to really use at night and talked a lot about a product called Nuvana, which is also a vagal nerve stimulator. And it's the whole like the earbuds that you put in your ears. And yeah, I found it to be pretty profound. So I'll put a link to the product.

What was the product that you mentioned that you said you like?

Dr. Michael Ruscio
It's a VAGU STEM, V-A-G-U-S-T-I-M, like Vegas STEM. Yeah.

Melanie Avalon
I will put a link to that and to the one I have in the show notes. I actually recently did a whole interview on the polyvagal theory and the nerve system and it's called the secret language of the body and it blew my mind because I didn't realize I had been looking at it very binary.

I like looking at it as either sympathetic or parasympathetic and I didn't realize there were, I don't know, that there's all these different overlaps that you can have and actually the fainting response is actually the parasympathetic nervous system and I was like, oh, okay, clearly it's not just fight or flight and rest and digest. That's amazing. Okay, so vagal nerve theory.

Dr. Michael Ruscio
Well, you know, the other thing I would tie in here really quick that I found to be pretty interesting is that inflammation is actually a sympathetic or stress response stimulator. And so the reason why we started looking into this is in some of the patients that were treating for chronic infections, they'll get a die-off, right? You probably heard of die-off with what's known classically as the Gyruss-Herxamers reaction where you have fatigue, brain fog, joint pain, you feel flu-like. It's more common, by the way, in fungal overgrowth, but some individuals, their die-off was just so pronounced with things like palpitations, tachycardia, racing heart, insomnia, anxiety that they couldn't get through treatment.

And this, you know, it's funny because sometimes you can't help but think there's an external hand guiding you because in the course of like three days, we had three or four of these cases all at once. So it makes it so obvious where you go, hmm, you know, there's something here that we need better answers for. So as we started digging in on some of the research, the vagal nerve stimulators have been shown to be helpful in clinical trials for chronic fatigue as one use case, POTS. So POTS kind of alludes to what you mentioned before where people have a really hard time regulating their blood pressure. They typically have low blood pressure and if they get up quickly, they're dizzy, they can fall over and they can also have palpitations and a racing heart because of this. So the vagal nerve simulators were found to be beneficial for POTS also and for insomnia. So we've combined that along with things like magnesium threonate, which has better penetration to the brain, fish oil, and then some adaptogens in attempt to try to calm down someone's nervous system so they can get through the die-off period. So that was kind of the inception of this. I offer that for the person who says, well, I'm not under a lot of stress. Well, if you've had some sort of chronic inflammatory issue, then part of what you may need is to balance out your nervous system because the inflammation has been a chronic sympathetic trigger or stimulus.

Melanie Avalon
I'll be curious if there's research on this, given that, especially like you were saying, there's not as much on the fungal stuff. So we know the gut microbiome communicates via the vagal nerve to our brain.

Does the fungus do that as well?

Dr. Michael Ruscio
I would be surprised if it didn't because there's such a bi-directional relationship between the gut and the brain. And we know that fungus can cause actually, I would be shocked if it didn't because fungus in particular, the reason why I think it's a little bit harder to treat and more problematic within the, you know, understanding that all of these things can be resolved.

So for the audience, if you're thinking of fungus, I don't want you to freak out on me. There, you know, these things can totally be fixed, but compared to something like SIBO, small intestinal bacterial overgrowth, what fungus will do many of them is they'll grow something called a hyphae.

Melanie Avalon
Yes, I was waiting for this. It's like so scary sounding.

Dr. Michael Ruscio
Yeah. So it's a little micro filament, kind of like an anchor that helps hold it into tissues. Almost like if you tried to pull something like, like a moss growing on a tree off of the tree, it has those little filaments though is high fear. Those filaments really irritate the immune system.

And so if that's going to connect apparently up through the Vegas, then yeah, it probably has more of an impact than the bacteria does.

Melanie Avalon
Wow. So speaking of brain fog, back in my dark period, I had a lot of brain fog. I rarely ever get brain fog now.

I will get brain fog and intense brain fog if I have nutritional yeast, like the food. Eating yeast, if that creates problems for you, is that an indicator of anything? I don't know if it's like an equivalent of eating dead probiotics.

Dr. Michael Ruscio
You probably still have some yeast. Yeah. I look at this on a scale of degrees, right? So coming back to Keith's case from, from Dr. Scott and the clinic, his brain fog and fatigue were debilitating at the other end of the spectrum, someone can be pretty much normal except for maybe there's a little bit of food reactivity, maybe to things like yeast or high sugar intake, maybe there's a little bit of toenail fungus, right?

There's just a little bit of symptomatic signal. So, you know, it's on a spectrum. What I would suspect coming back to that rehab analogy, once we heal the gut, you should have pretty good, broad dietary tolerance, but initial phase maybe going a little bit lower Candida in terms of foods with fermented byproducts, including yeast ferments, but not limited to that. Also bacterial fermentation, because they both produce histamine. And if those filaments are triggering your immune system, you might have a high level of histamine, which sort of pushes you further into inflammation. And this is the utility short term. Again, of a low histamine diet is that if someone is reactive, if there is inflammation, part of what signals that inflammation is histamine, this is why people, when they have seasonal allergies, use things like Claritin antihistamine. Well, there's also dietary intake of histamine and early phase. Again, if things are really sort of tumultuous and inflammatory, that's where a low histamine diet for let's say a month can really help to start. Calm things down.

Melanie Avalon
If you're, speaking of histamine, if you're curious about how nuanced and neurotic I got about things in the past, I remember with histamine specifically, I was fearful because I was like, well, I don't want all this histamine, I need to be on a low histamine diet. But then I also knew that histamine stimulates like stomach acid production and motility. So I was like, well, and I have a fear of constipation. So I was like, well, at least if I get histamine, then maybe that'll help things move along. But the conversations I would have in my head were just so, I don't know, it was really overwhelming.

Dr. Michael Ruscio
And this is why I think people need a clinician because you know, clinicians go through this too, but eventually there's a photo by, I think his name is Alex gray. He's the, uh, the artist who does a bunch of cool, like spiritual anatomy diagrams. There's a diagram called the wounded healer and early phase, the healer is ripped apart in like a thousand directions. And then they're finally like taking a step onto the mantle with all this knowledge in their hands. They've kind of figured it out. And they, you know, they have this taster act that they're, that they're bringing forward. That's what a clinician does.

They take you from the chaos to the direction. And what you're describing is definitely that tumultuous, chaotic, you have all these sort of spinning cycles of thoughts. Well, this causes that, but I should also this, and that can be such a disempowering and I think fear generating place where, you know, again, I'm not trying to overly make the case for a clinician. If someone hasn't tried much yet to improve their health, sure, you know, do it on your own, read some blogs, a book, what have you get started. But if you've done that and you're still floundering, that's where just having someone who can objectively look at everything going on in your case and say, Oh, you know, this is where I think we need to hit because it's seems to be where your symptoms are coming from can just really give you more direction. But it can also short circuit that worry because now someone's just, you know, instead of allowing you to stand that hamster wheel of fear and rumination, giving you some direction. So now you can focus that, that energy, that mental energy on action, rather than just like hyper analyzing everything you've read or ate or felt.

Melanie Avalon
So like chat GBTAI, which I use a lot, I feel like they've trained it to, to talk to people a certain way that doesn't create as much fear, at least, at least in my experience. It's been helpful. This actually really connects to a broader question I had that I was dying to ask you. So I'm really glad we're talking about it.

So you mentioned, for example, if somebody doesn't have brain fog, but then they have like some yeast or some sugar and they experience brain fog that maybe they still have this underlying, you know, fungal issue going on. So two-part question, one related specifically to the fungal stuff still, which is, do they go dormant? If you go on a, you know, an anti-fungal diet, can they just kind of go in hiding and then, you know, come back when you have sugar or yeast? But if you've healed your gut, would that not matter? And then the broader related question is, so I went on a low FODMAP diet to deal with my SIBO and I love it. Like I still love it. I love all the foods that I eat on it. I do exist though within a pretty limited spectrum of foods, but I'm happy there. Like I'm happy eating those foods and it covers all my nutrition, you know, it's lots of like fish and chicken and steak and blueberries and cucumbers and things like that, but it is very limited. So I know if I were to have some sugar right now, like a lot of, like a processed food type situation, yeah, the brain fog would be there if I were to have, like if I were to go off of it, I would not feel well. And so I'm often haunted by these questions of, am I existing in a state of not being completely healed? I'm just keeping things at bay because I'm following this restricted diet or, you know, is it okay to just be happy here? So it's a big question.

Dr. Michael Ruscio
No, it's a good question. I think it's okay to be where you currently are. I look at it akin to wearing a knee brace, right? You're wearing the knee brace and maybe the knee brace plus avoiding certain activities and you're okay.

That being said, might there be a higher level of function and performance that you could hit? I do think so. In my opinion as a general rule, and there's going to be some exceptions to any rule, but if we've done everything right in the gut, we should see a pretty good dietary tolerance and resilience within limits, right? You should be able to go out and have a beer, a few slices of pizza and not feel like it floors you. Could you do that every night for three weeks in a row with no repercussions? It's probably too big of an ask, right? So you should be able to have just said really practically, you should be able to periodically eat whatever you want and have little to no repercussions. That would be the game. That would be the goal.

Melanie Avalon
but it's why I debate it all the time is like understanding that's the goal and also wondering, but then do I want to eat the pizza and the cake? Like maybe I'd rather just have my steak.

Dr. Michael Ruscio
Yeah. And I, and I agree with you where we're absolutely, I would say eat the healthiest food you can as much as you can, but I'd still like for someone to be able to have like maybe it's sushi instead, right? Maybe it's sushi and all that rice would be a problem or maybe for other people who are more FODMAP intolerant, it's some big salad, right? You're at a Greek restaurant and there's a salad, everyone's going, Oh my goodness, it's, it's wonderful. And you just want to be able to partake. That's what my goal would be.

Yeah. Good point. It wouldn't be to enable people to have destructive dietary habits, but at least give them the tolerance to be able to eat. Again, I deal a great point. Healthy food, but a wide swath of healthy foods without having all these reactions.

Melanie Avalon
Yeah, for the first part of it. So do the fungus, do they go dormant when you go on a diet to address it?

Dr. Michael Ruscio
you know, I'm not sure it's quite that simple kind of to the second part of that question, which was, does it not matter if you get your microbiome healthier? I think it's more about tending to the garden that is the ecosystem. And if you have healthy bacterial populations, less inflammation, good motility, which is in part mediated by the brain intervention, then you have all these safeguards that are holding the ecosystem in a good balance. And so I think that's a better way of framing it.

I mean, sure, there probably is some degree of dormancy when you change the food intake. And so if you do nothing but just change your diet and not to say changing your diet is nothing, that's a really important point, right? But if the only modification is changing your diet, that might not be enough to get someone fully back to balance. And so they find themselves in a situation where if they do deviate from said diet, their symptoms come back.

Melanie Avalon
Okay. I understand this is a bit of a misleading characterization or potentially not communicating the accurate information, but with bacteria, for example, we'll think of them as good bacteria or bad bacteria. And I know it's much more nuanced than that.

Is there also though pathogenic versus quote good fungus or do they tend to be more pathogenic? Are we born with certain fungus? How does it compare to bacteria?

Dr. Michael Ruscio
Yeah. I mean, just like bacteria, some bacteria are strictly pathogenic and some are highly symbiotic, you know, some will kill you and some are your friends and fungus the same way.

I think maybe a, a more accurate way of thinking about it would be the commensals, the ones that are normally there or because there's like invasive infectious bacteria and fungus, but those aren't the normal players, but if we are talking about the normal players and that's kind of what we're trying to manage, at least in this conversation about bacterial type versus fungal type, you know, the, the chronic infection is a different conversation. And so I just want to kind of draw a dividing line between these two. That's more so just overgrowth or decompartmentalization where there's too much in one cavity or they've gotten into a cavity they shouldn't be in. So it's, it's the, it's like the good guys or gals, but kind of in the wrong places or too many of them. That's usually what happens in bacterial or fungal overgrowth.

Melanie Avalon
Okay, gotcha. Yeah. And now I'm just reflecting on, especially with the microbiome, and I guess I would have a question about how this applies to fungal as well. But it's just so interesting to me that with the microbiome, on the one hand, it seems so difficult to change. Like people feel like they just can't, you know, that it takes time and they can't fix their gut issues. And it just can seem very permanent and stagnant.

And at the same time, I feel like it changes so quickly from so many things. Like I feel like, especially all the environmental factors in diet, and it seems like, you know, you just think differently and your microbiome changes. So it's just, it's confusing.

Dr. Michael Ruscio
Well, there's also, I think, a really important distinction between more academic research and then clinical science. The academic research has shown that people who dish wash in a dishwasher versus sponge washing have differences than a microbiota. People who live near cities or those who live instead near forests or oceans have different microbiotas. The amount of vegetation near someone's house impacts or skin microbiota.

How relevant is that clinically? I don't think it's super actionable, which is why I come back to, as a clinician, when someone comes in, I'm trying to listen to their story and adjudicate, is this bacterial overgrowth or is it fungal overgrowth? Because once I know that, then we know, OK, we go low FODMAP for the one or Candida diet for the other. Then what you're looking for to reinforce that you've made the right decision as a clinician is the next time you speak with that person, they go, oh my goodness, like Keith, I have less fatigue. I'm now golfing. I'm no longer homebound because of my urgent bowels. And that's really the most important thing, I think, for a astute clinician is, has the person's symptoms improved? Because kind of like you said earlier, people will have a lot of testing and they'll sometimes just treat those test markers to the exclusion of really listening to the person and I think this is actually a really endemic problem right now that because there's so much testing, clinicians, clinical listening and analysis skills have dwindled because there's such a reliance on just treating test markers. And I think it's really kind of crippling and making less effective a whole generation of clinicians.

Melanie Avalon
Yeah, actually, Dr. Ruscio, this happened to me this past week because I try to, I really, really appreciate functional medicine and ideally I would do everything through a functional doctor. At the same time, I like getting what I can out of my insurance. So I try to do the best of both worlds, which is work with functional doctors, but then for certain things, if I can find conventional doctors on my insurance plan and get labs drawn and things like that, I'll, you know, go that route. So kind of like make it work for me.

So I work with an endocrinologist because I'm on thyroid medication. He's conventional, but he's very open-minded and he'll do all the tests. So it works for me, but it was interesting because this week, for example, I, we tested my thyroid labs and everything was in range, but my TSH was a little bit suppressed, which I think makes sense because I'm on compounded thyroid medication. But in any case, he was trying to convince me that we need to lower my thyroid medication and I was like, but I'm feeling good. Can we please just not rock the boat? And like the TSH was only barely suppressed, but it's just this broader conversation of treating like you were saying, treating the paper versus the person in front of you. I definitely think it's a systemic issue.

Dr. Michael Ruscio
Yeah, it is. And, you know, I do like to think that things here are now starting to course correct. But with the that advent of all this testing, I think clinicians have been kind of grappling for how to integrate that and how to use that. And I think a lot of clinicians are on a similar learning curve that I've been on, which is 10 years ago, I was doing five times the amount of testing that I'm doing now, like every patient would get an adrenal test would get two stool tests, and probably a blood test. And now, we usually do not order any testing out of the gate.

And it's just learning, right? Learning and the one key ingredient is, as a clinician, you've got to be self critical. So that would be a warning sign for anyone listening to this, if you're working with her thinking about working with a doctor or any sort of clinician, if they seem too self assured, if they're too like, it's got to be this way. If things seem kind of extreme, and you don't ever hear them say anything that's self critical or reflective, then in my view, that's a huge red flag, because clinical practice is hard. And so you've got to be humble and curious. And for the person who seems like they've got it all figured out, they definitely do not. But that attitude is certainly not going to help them figure out anything additional. Because what's it all saying, you can't teach someone who knows everything. So anyways, we have my soapbox, but just my two cents on that.

Melanie Avalon
No, I love the soap boxes and I kind of use that as a litmus test for when I'm trying to find a conventional doctor, which is how receptive are they to me bringing them actual studies and being like, well, will you read this? So that kind of weeds out who I can work with or not.

Actually interestingly, I don't know if you've heard of a company called Jonah. Have you heard of them by chance?

Dr. Michael Ruscio
No, I haven't.

Melanie Avalon
So I've had the founder Leo Grady on my show. They are, I'm going to say the world's first.

So they do a stool test and then they analyze your results. The AI is set up to look at, you know, basically all the credible studies out there on the gut microbiome. And then that AI platform analyzes your results through looking at all the studies ever. But what was really interesting about it was I got my results and nothing. The only category that matched was skin health, which was, I said I had a great bacteria for skin and that I had, you know, no skin issues and good skin, which I do experience ever since doing Accutane in high school. But in any case, every other category, most things did not match me, like the health issues. I was either the opposite of it or it just wasn't accurate. I was talking with them and they're like, well, you know, it's still a warning sign. We've had quite a few debates about it, Leo and I, because it's like if this is indicating that I have a bad microbiome profile, which manifests in this health condition, but I don't have that health condition, I just don't know how to interpret that. It's confusing.

Dr. Michael Ruscio
Yeah, I think it's a hubris where, you know, we, we think we know more than we do and you know, this, so maybe I'll take a step back and zoom out and say this. So if we think about the evidence-based hierarchy picture in your mind, a pyramid at the bottom of the pyramid, obviously it's the widest. This is where we have the most voluminous information, but it's of the least value. And that's things like observational studies, animal studies, in Vivo studies, in vitro studies, we go layer up. We see things like cohort studies, like people who eat this diet or live here, you know, do or do not have a said health condition, one more level up. And as we're going up, there's less evidence, but it's a better quality. Then we have interventional control trials or the randomized control trial. And at the very top, we have summaries of those randomized control trials called meta-analyses.

Now we don't always have a lot of robust science, but it's also, so like fungus, fungal overgrowth would be an example of where we don't really have this pyramid fully filled in. For SIBO, I would argue we kind of do, we have really excellent research.

But the point I'm making is a lot of these microbiome tests, they're just, they're showing correlations without any cause. And so even if you had the best AI computer, we go, you know, forward 50 years in the future, get the, you know, quantum computing AI, bring it back in time to modern day and have them analyze the data, it's still limited by the same data, which is mostly just loose correlations. And most researchers in microbiome research will comment that it's not clinical. So this is one of my biggest gripes is where people in, in like the tech sector are trying to push clinical relevance to nonclinical data.

And it's great for me because people go, they do that, they get nowhere. And then like, well, damn it, I need a doctor. Right. But I just wish people wouldn't waste so much time and money. And some of these companies are really making irresponsible claims. UBIOM, you've probably heard about what happened to them that, you know, they got shut down by the FBI for, so UBIOM was a microbiome mapping stool test. And they made all these promises. And I remember saying to myself, how are they able to make these claims? Cause I know they weren't true. And I don't think that the government should regulate. I actually think it's really important not to regulate because people have the right to be wrong and consumers have the right to do whatever they want.

And certainly I don't think we should be censoring clinicians, you know, so, okay, that's fine. They can say whatever they want. But I was also just wondering like, how is this happening? And no one's calling them out or nothing. You know, nothing bad has happened because they're making all these grandiose claims. Well, what do you know? They get shut down by the FBI for insurance billing fraud. And during the investigate, when was that? This was 20, I think it was, was this pre-COVID? I'm not, I'm not sure, everything's blurring together now. It was pre-COVID or post-COVID. It was, it was within maybe roughly five years.

Melanie Avalon
Okay, that makes sense. They were gonna come to the show and they kind of ghosted me. I think I missed that.

Dr. Michael Ruscio
Yep. But here's the other thing, right? Here's the, what I found to be the most appalling was when they were going through to create the normal ranges, right? Cause you do a poop test and for all these bacteria, they're going to tell you, are you low, normal or high? They used in part dog feces to establish those levels.

And so this is the point that I'm making. We saw this with, was it thranos? I always mispronounced that name. They have the blood drop thranos. So like, cool. I think we, we want to be pushing the envelope and we want medical and health science to advance, but I think consumers should really be a little bit cautious and bridled because there's just a whole heck of a lot of putting the cart before the horse.

Melanie Avalon
Wow. Okay.

I will say, so like using Jonah, for example, it was, I mean, it was fascinating getting my results because I could see it was the most comprehensive overview of, you know, all the species in my gut that I'd ever seen. But it just, like you said, it's not congruent when things aren't actually lining up with your physical body. And so I think we're getting lost in the data.

Dr. Michael Ruscio
Yeah, I think, I think people think they make the mistake conflating data with accuracy and I would argue the opposite and then like, look back at what I was saying a moment ago in terms of, I used to order like five tests or I'm doing five times less testing because really at the end of the day, if we make the correct intervention, someone's symptoms will improve and then hundreds of mechanisms may actually change as a result of that. What happens a lot of times with, with like the tech approach is they're trying to quantify these hundreds or even thousands of mechanisms and then infer what should be done and that's, it's backwards, right?

If we're doing the right thing, the person will feel better and the mechanisms sort themselves out. That's why interventional studies that look at hard endpoints like, are you pooping the right amount, right? Do you have less brain fog? That's the coveted end point. Not, well, you know, these 17 bacteria shifted in what we think is an anti-inflammatory direction. And like you're saying, you might look at someone and you go, well, Susan, these 17 bacteria shifted anti-inflammatory. Do you have less joint pain or brain fog? Nope. I actually have more, right? And like, you see this sort of thing happen all the time.

Melanie Avalon
Yeah, no, it's really fascinating. While we're speaking about new things in this world, and this is a more visceral related topic because it actually is something physical, have you heard of Z-biotics?

Dr. Michael Ruscio
I have. Yeah, we actually were having a debate about this the other night.

Melanie Avalon
Oh, really? With them or about them?

Dr. Michael Ruscio
There's a lot of entrepreneurs in my Austin friend cohort, and one of the guys I was at dinner with is friends with the owner of the company.

Melanie Avalon
For listeners, they make genetically engineered probiotics. They have one that helps you break down acetaldehyde in your stomach from alcohol and one that converts sugar to fiber to help, and it's supposed to be some sort of fiber that we don't typically have in our diet.

I was just curious your thoughts. Taking the z-biotics helps me so much before the drinking. So do you have thoughts on that on genetically engineered or modified probiotics?

Dr. Michael Ruscio
I don't see the case that the genetically engineered bacillus species that they're using, which I believe is bacillus coagulans, if I'm remembering correctly, is any better or different than just a regular bacillus coagulans. Bacillus coagulans, which is one of what I would call a soil-based probiotic, they're being three different sort of formula types, that can be antifungal, and if it's antifungal, it should help with acid aldehyde, this metabolite of sugar feeding fungus, including sugar as alcohol.

So I see plausibility in the mechanism, and I'm a big proponent of probiotics. I just have a little bit of a hard time with thinking that it's going to be demonstrably more effective than a good clinical soil-based probiotic with bacillus coagulans and maybe a few other bacillus species. I could be wrong, but that's just my take.

Melanie Avalon
Okay, now I want to do a part two interview with them and ask them more specifically about that. Yeah, so so interesting

Dr. Michael Ruscio
But you know, that being said, I'd rather people have that than take Advil, right? So like, you know, zooming way out and not letting the perfect be the enemy of the good, like yay on that and nay on the Advil, I think that's a good step.

Melanie Avalon
I know I use I shutter thinking about like when I was in college I would I would pregame with Advil I was like I'll just

Dr. Michael Ruscio
Oh my God, I would do the same.

Melanie Avalon
And I think about that now, I'm like, what was I thinking? It's so horrible.

I find now that I have my whole system. If I do my dry farm wines, my z-biotics, my NAD, my glutathione, like I'm good, I'm good. I got my system down. Actually, one other question just because I am, it's something that I've been looking at more. I feel like people are talking more and more about urolithin A, which is something that some people's gut bacteria naturally produce. I know it's like super tangency rabbit holy and specific, but do you have any thoughts on urolithin A supplementation?

Dr. Michael Ruscio
Yeah, this is something I haven't really done a deep dive on, so don't have much to offer here. Okay.

Melanie Avalon
No worries. Well, was there anything else you wanted to touch on? I know there's literally so many different topics I could talk to you for hours

Dr. Michael Ruscio
Well, I mean, maybe just some brief to give people two things, a quick overview on those types of probiotics. And then secondly, just quickly touch on chronic infections more as like a public service announcement, because I think there's some elements here that are not very well understood, but they plague people and can for many, many years of their life.

So let me just start with the easier one, the probiotics, because there's a dizzying array of different formulas out there. The thing I would like consumers to know is that, and this is more so my heuristic, but I think it's just a reasonable read of the science that's been published and trying to give people some practical usage guides. You have three different formula types. The first are blends of lactobacillus and bifidobacterium species. So there might be anywhere from five to 15 different species. When you look on the label, you'll see lactobacillus acidophilus bifridobacterium lactis, bifridobacterium brevis, you know, lactobacillus rhamnosus. That's the one it's the most traditional has the longest standing track record and the most research. Second is actually a fungus, a healthy fungus, Saccharomyces boulardii. There's another sort of sister called Saccharomyces cerevisiae, but one or both is another type of probiotic that is very, very helpful, especially for, but not limited to antibiotic associated diarrhea. And then third, like you were saying with the z-biotic are the soil-based that has different bacillus species, bacillus coagulans, bacillus licheniformis, bacillus clausii. And the way I look at probiotics is any one of these three is a great starting point. If you're on no probiotic, try one, see how you do, give it a few weeks and you'll have your answer. Either things are improving or they're not. If you've used a probiotic and seen little benefit or partial benefit and you want to try to have the strongest probiotic approach, what we've been doing in the clinic and advocating for is what we've also termed triple therapy probiotics, where you use all three together in a clinical dose. And we see this recurring theme in many areas of medicine and healthcare that multiple supports for the same thing are better than just one support, right? You just mentioned a number of antioxidants a moment ago. Three antioxidants is better than one, NAC plus glutathione plus, let's say NAD. Three antihistamines is better than one. Three antimicrobials, let's say in treatment of SIBO or H. pylori, two or three antibiotics or herbal antimicrobials typically work better than one. So we're just simply applying that same concept of probiotics so that people don't need to do things like refaximin or xiphaxin for SIBO or fluconazole or whatever it is, nystatin for fungus. So as to try to get as much possible out of the probiotic intervention.

Melanie Avalon
How do you feel about, I remember one of my functional docs at one point, she was a big fan of actually longish term, low dose Nystatin treatment. She was saying it was relatively benign and stays in the gut and she likes it.

Dr. Michael Ruscio
I would be open to that.

I mean, I think you can, or one may want to start with something like oregano or garlic, especially garlic because garlic has all these other antioxidant and you know, healthy circulation and cardiovascular benefits. But yeah, I'm not opposed to nice that. And I think in some cases, it's certainly something that could be beneficial. And I do agree that it seems to be mostly benign and very well tolerated.

Melanie Avalon
completely forgot that I had that whole moment. The second quick question is you, so speaking of seeing siloed aspects of different things and make and drawing massive conclusions about it, I went through a period with Saccharomyces boulardii, I read that it helped with diarrhea, like you just mentioned.

So I was wondering, well, if it helps with diarrhea, does that mean it's constipating? So then I harbored a fear about taking Saccharomyces boulardii because I didn't want to slow down my... Yeah.

Dr. Michael Ruscio
Yeah. This is what I love about many natural medicines is they tend to be corrective.

And what I think happens in your case is a totally understandable, but, you know, wouldn't be a correct read of the data, which is there's a lot of studies showing that saccharomyces polarity improves diarrhea. But there's also evidence showing that lactobacillus and bifurobacterium improve diarrhea. But there's also data showing that lactobacillus and bifurobacterium improve constipation because they help bring your gut back to more normative microflora. And therefore they're corrective on bowel function, whether it's too fast or too slow, inflammation, leaky gut. So that's the really nice thing about probiotics is they tend to almost be a deathogenic in a way, they help bring your gut back to, and part of actually why that may be is a fair number of probiotics don't actually colonize. Some do, but I think the more important function is the probiotic stimulate different receptors in the gut that modulate inflammation. Some of these are known as toll like receptors. For example, toll like receptor four is really key in governing leaky gut. And so it might be that the immune system and the resultant inflammation that can occur is really attuned nicely by the probiotics. And so that's why it doesn't matter if you're having constipation, bloating, diarrhea, GERD, the probiotics are helping treat upstream the inflammatory issue that's causing all these downstream symptoms.

Melanie Avalon
Okay, it's funny because I and I and the time I knew that like I knew I was being too myopic But still when I see the when I would see the word anti diarrhea, I was like, I just can't Like I just had like such a fear response to that concept Would people with fungal overgrowth with saccharomyces boulardi specifically does it tends to be helpful even being a yeast?

Dr. Michael Ruscio
for that same reason. Well, for two reasons.

One, that whole receptor triggering in the gut. Oh, and let me, let me sneak in one other comment here. There was a meta-analysis that found that even probiotics that have been heated up to the point of killing them were still beneficial, which supports that it's probably like the dead body, so to speak, are triggering those receptors and attuning the immune system in a healthy way. That's why if someone has fungal overgrowth, you're not going to make it worse. Just like we know that certain lactobacillus might overgrow in SIBO, yet lactobacillus probiotics are good for SIBO and they've, they've shown standalone efficacy and totally clearing SIBO.

Melanie Avalon
I remember when I first heard about the, the dead, you know, the heat treated bacteria. I was like, I don't even know what to believe anymore.

I was like, my whole paradigm is completely shifted. I remember I also did BSL-3 and it freaked me out, like how much bacteria it produced with stool increase. So I actually didn't stay on it, even though I thought it was helpful. But yeah, just a quick, quick anecdote. It had so much bacteria in it.

Dr. Michael Ruscio
Yeah, and that's not uncommon to see some shifting the bowels as things adjust. And the VSL3 would be an example of your traditional sort of lactobacillus and bifrobiturium blend.

Yeah, that's a good type of probiotic.

Melanie Avalon
What was the second thing that you wanted to touch on?

Dr. Michael Ruscio
The second thing is chronic infection. So this is something that has been such a huge gift for the clinic over the past couple of years that we've been sort of delving more deeply into this.

Cause admittedly it was something I kind of wrote off early in my career. And here's the lesson coming back. It was because the testing didn't match. And as I've learned that you can't look for testing to totally reaffirm everything, because in a lot of areas, the testing is just not ironclad and some areas it is right. Like blood sugar, pretty cut dry blood pressure, pretty, pretty cut dry testosterone levels, you know, pretty straightforward, but for chronic infections, since some of these, and there's two organisms in particular, I would want to put on people's radar, Babesia and Bartonella.

Melanie Avalon
Mm, Lyme infections.

Dr. Michael Ruscio
Yep. But I, I don't like the term Lyme and not to be too persnickety about nomenclature, but because what we've learned is that people may have been screened for Lyme years ago and they were truly being screened for Borrelia. But Babesia is actually more common and has only been somewhat accurate via testing for the past three plus years. And so some people who had a bad experience in the past or just didn't get any benefit, they may have overlooked that Babesia, which is treated differently because it's actually a protozoa. It's not a bacteria. They may have overlooked that.

And then another organism, Bartonella, which this was, this actually goes all the way back to 1914, 15 world war one trench fever. This was passed by fleas in the trenches. So not even vectored by a tick as we would suspect for a classical Lyme. And it's probably not the organism itself is probably not going to be a problem. You know, if you have a dog or a cat with, you know, fleas or, you know, other biting insects can also pass this, but it's probably not going to be a problem unless someone's been under a lot of stress as trench soldiers would be.

Right. And then their immune system gets suppressed. But what's so problematic about either one of these organisms, but especially Bartonella is if you went through a period of intense stress and this bacteria got a leg up on your immune system, that bacteria, Bartonella is actively immunosuppressive. So people seem to hit this tipping point where they just, they get knocked down and then they never feel normal after that.

And it's because these bacteria can literally infect your white blood cells. They can derange what's known as T cell function. And the T cells sort of put little labels on stuff that the B cells or the antibody should kill. But if the Bartonella targets the T cells, then that whole targeting system for your immune system starts to shut down or not work correctly. So people can really get stuck.

And the symptoms that are demonstrative of Bartonella are these poor people who have mostly neurological symptoms. I have brain fog. I have fatigue. I have insomnia. I have depression. I have anxiety. Maybe sometimes I have like pins and needles. Maybe like you notice that you don't sleep well because your arm falls asleep a lot. Well, that may not actually be your arm. That might be the fact that Bartonella likes to infect outside of the brain as its primary target. It also likes to endothelium or the lining of the blood vessels. And so it can cause circulatory issues. So if someone is having circulatory issues, lots of neurological symptoms and some pain, it can cause tooth pain, it can cause low back pain, it can cause shin pain. In fact, Bartonella, going back to those soldiers in World War I, they would have what's known as a five-day fever and one of the hallmarks is not the only symptom, but they would have this shin pain, shin pain on one side because Bartonella likes to hang out in the bone marrow, which is why people can have things like chronic low back pain and they can't figure out why.

Dr. Michael Ruscio
So this is something that we've seen a number of people, and I actually put myself in this camp who had these low-level lingering symptoms and I felt like I had to work really hard to be at average the good health, but I felt like I had to do so much. And then I had a period of really intense stress and the wheels absolutely fell off. And I'm talking really high stress, but nevertheless, I knew something was clearly wrong. And thank goodness, I happened to be on a panel next to someone who had a specialty in vector-borne infection, that's the more contemporary term. And I was like, wow, this I think accounts for why most of my life I've been a poor sleeper, like a really sensitive sleeper, and I've had bouts of brain fog on and off. And thankfully, I got so beat up to where I had to figure this out, but now in the clinic for a decent cohort of people, it accounts for why they've had to continually work so hard to maintain average-ish or sometimes below average health.

So for people, I would just tell them if they feel like they're working really hard and they're still not that healthy, then I would get screened for Babesia and Bartonella. Igenics is a good lab that can screen for these. There's also a questionnaire called the MSIDS 38 that we use kind of as a first pass screening. And then if that comes back high, we might then do the blood test. But this eluded me for so many years. And now that we're looking for it in the clinic, we're seeing at least one case of this per day, which is amazing. So I truly do feel like this is a PSA just to make sure people are aware of this.

Melanie Avalon
Wow, this okay, this is beyond fascinating to me. And I actually recorded the audiobook for Stephen Buhner's Healing Lime, which again is about lime, but the full title is like lime and co-infections

Dr. Michael Ruscio
to infection in this room.

Melanie Avalon
Yeah. So there was a lot in there about these two things. But even at the time, because I recorded that, I mean, like almost a decade ago, probably actually 2017, I think, yeah, there was no really focus on the co-infections and definitely not testing or anything that I was aware of.

So is there a treatment protocol that's effective?

Dr. Michael Ruscio
There is, I mean, there's a whole litany of different options, herbal antimicrobials, and there's a whole bunch of herbals that can help. There's antibiotics, there's antimalarials, things like hyperbaric oxygen can be helpful. Methylene blue, actually, if people have taken methylene blue and noticed any funky side effects, that's a big flag for Bartonella because it's actually a pretty powerful Bartonella. And also, if people notice that they're sensitive to supplements, especially antimicrobials, it might be that you're just kind of kicking the hornet's nest and they're not actually intolerant, they're just having little bits of die-off.

And that's been, again, one of the biggest gifts is the people before that we thought were really sensitive. It's like, no, no, no, no, no. You're having die-off and we're going to work through this, but you're probably going to have a week or so where you feel kind of crappy. And then another few weeks later, if we get into a biofilm, you might have another week. And that's going to keep happening until we clear all this infection. And this, to me, was a hard pill to swallow that it can be months of treatment. But if you look at a similar model of bacteria, again, Bartonella is a bacteria, tuberculosis, there's no risk of one causing the other, but they're both slow-growing bacteria. And it's well established that tuberculosis takes four to 12 months to fully clear.

So again, the gift, the silver lining here has been that people used to think they were sensitive, they were reactive, they'd try stuff and stop, try something else and stop because it didn't have this bigger piece of context that was this is a slow-growing infection. It can also have biofilms. So you can have these random bouts of die-off where you feel poorly. Don't stop. Keep going. Because on the other side, when you clear the infection, you're going to have your life back because these people also, it really does affect your quality of life quite severely.

Melanie Avalon
Wow. I had no idea. Thank you for drawing attention to this. If people, so they need to find a doctor that would be familiar with this, right?

Dr. Michael Ruscio
Yes. And there's a good association that trains doctors called ILADS. I-L-A-D-S. It stands for the International Lyme and Associated Disease Foundation. They're still using that Lyme term, even though, you know, because the association was formed, I think, over 10 years ago. So, you know, the nomenclature might be a little bit antiquated, but that's, I think, the best body for training doctors.

And they have a directory that people can, you know, check. And also, you know, we do telehealth consulting and people need help also. Yeah. Like I said, this has been the biggest revelation for me as a clinician in the past 10 years. So, I'm definitely really excited to share it.

Melanie Avalon
Wow. And yet, are you actively taking new patients? Like, can people work with your practice?

Dr. Michael Ruscio
They can. Oh yeah. I mean, it's, it's at the core of what we do, the clinical stuff. I, I'll never stop doing it. I love it.

And we have a great, you know, it's a small team of doctors, but super dedicated, super sharp. Yeah. And more than happy to help people if they're in need.

Melanie Avalon
Amazing. What is the link for that?

Dr. Michael Ruscio
Just go to drroosshow.com and I'm a header there. There's a like clinic button. Okay.

Melanie Avalon
Perfect. Yeah, no, all of this resonates with me so much. I kind of feel like where I'm at now, because like I bring everything full circle. Having been in that really intense struggle where I was diagnosing myself with all the things and constantly treating and didn't feel well either to where I am now, which is I feel pretty great.

I love what I love what I do. But I don't obsess over health anymore. And at the same time, I think, and so much of what you were saying was just landing with me, I feel like I probably have some resident things that are under the surface. Because if I get really stressed, I might get sick. And whenever that happens, I'm like, I don't think I caught anything outside. I feel like it's something already in me. I just feel like, yeah, I wonder if there are some things.

Dr. Michael Ruscio
Oh, you know, it's funny if you don't mind really, really quick. Oh, please do. My mother has this same thing and it took me so long to connect the dots, but every couple months she'll be like, Oh, you know, that this like gland thing I get where I get kind of tired and my, like, you know, my elbows and my shoulders hurt and it finally hit me. I was like, my, this sounds to me like probably, especially given cause her throat would also get sore. This sounds to me like Epstein bar virus is probably just recurring periodically. So we got her on just two herbals, olive leaf and cemento or AK cats claw. And she said, she's had the longest stretch with none of that, you know, a few days of feeling like she has a flu that she's had in recent memory.

So like the examples of this and two people actually also in her office have had a chronic vector-borne infection also. So one, that's why I'm saying like, this has been such a cathartic realization for us because now that we're looking for it, we're seeing it so often. And again, a lot of the people are those people who they're so smart about health, but because they've had to be right. They've, they've had to like research and figure out all these supports just to kind of keep them propped up and functioning. And that's great that they're there, but they can get knocked off, you know, with, with travel, stress, whatever. And so it can be a little bit of a process to dig people out of that, but there's a lot of wellness waiting on the other side, especially as it pertains to brain health.

Melanie Avalon
I remember when COVID first happened. I was like, well, you know what, maybe I'll get COVID and my immune system is just going to freak out and attack it and in the process, it's going to kill whatever else is going on inside of me.

Would CMB be one of those in that list?

Dr. Michael Ruscio
Yeah, Cytomegala could be also for sure.

Melanie Avalon
I remember I tested positive for that in the past, so I've always wondered if it's hanging out waiting.

Wow. Well, this was so, so amazing. Thank you so much, Dr. Ruscio. Like I was saying in the beginning, you've radically changed my life for so many years and so many other people. And I'm just eternally grateful for what you're doing. And I just love how it's always, you've always got the latest science and like the latest things. And so I really, I'm so appreciative of your work. So thank you, thank you, thank you.

Dr. Michael Ruscio
Absolutely. No, your story just puts the wind in my sails and this conversation has been just wonderful. So thank you for having me on.

Melanie Avalon
Well, thank you. So really, really quick, it's the last question I ask every single guest on this show.

And it's just because I realize more and more each day the importance of mindset. So what is something that you're grateful for?

Dr. Michael Ruscio
I am grateful. I'm so grateful as simple as it may sound for nature. I have a nice park with a waterfall near my house and on most days I go down there and there's probably not ever a day where I don't just have a moment where I smile and appreciate just the wonderful gift that nature is.

Melanie Avalon
Amazing. I love it.

Well, thank you so much. I will eagerly follow all of your work. Listeners can get links and everything in the show notes and hopefully I'll see you at Dave's biohacking conference in Austin.

Dr. Michael Ruscio
Yeah, let's make a point of it. Let's do it.

Melanie Avalon
Awesome, awesome. Well, enjoy the rest of your day and thank you.

Dr. Michael Ruscio
Thank you. All right. Thanks again. Bye bye.

Melanie Avalon
I thank you so much for listening to the Melanie Avalon biohacking podcast. For more information and resources, you can check out my book, What Win Wine, as well as my supplement line, Avalon X.

Please visit MelanieAvalon.com to learn more about today's guest and always feel free to contact me at contact at MelanieAvalon.com and always remember, you got this.