30: Fix Your Gut | Dr. Michael Ruscio

MU: 00:03 Hi, I’m Melissa Urban and you’re listening to Do the Thing, a podcast where we explore what’s been missing every time you’ve tried to make a change, and make it stick. What comes to mind when I say the words gut health? Maybe it’s the bloating, stomach pain or reflux you’ve been struggling with. Maybe you immediately flashed to a shelf full of probiotics at your local health food store, knowing they’re important but not really knowing where to start. It’s probably not the insomnia, anxiety or thyroid issues you’ve been having, but it should be gut health and microbiota are huge buzzwords these days, but what does that really mean? How do you know the status of your gut and what can you do if you suspect it’s messed up? I’m going to answer all of that for you today, leaving you with a step by step guide to better gut health. The best part is you don’t need a doctor’s visit, expensive lab testing or a boatload of supplements. Today my guest is my friend, clinical researcher and functional medicine, Dr. Michael Ruscio. He’s also the author of Healthy Gut, Healthy You,

MU: 01:20 my personal gut health bible. Michael has helped me with some of my gut troubles after traveling and illness got me down and today he’s here to break down the science and practical application of getting your gut healthy. We’ll cover what gut health really means, how it gets messed up in the first place, and how issues in the gut can manifest in unexpected ways. He’ll cover the simple dietary change going beyond the Whole30 that may be the missing piece in your digestive issues and exactly how to design the perfect probiotic regimen for you. There are also a ton of free resources straight from the doctor in today’s show notes, if you’ve been confused about gut health, struggled with health or digestive issues that you haven’t been able to resolve even with dietary changes or are simply looking to improve sleep, energy, mood, and your immune system. This is the only podcast you’ll need to listen to. I planned it like that. You’re welcome. Okay, enough talking. This is a really good one and it’s a little bit longer than normal because the info was too good to leave any of it out. So without further ado, now onto the episode.

MU: 02:38 Hi. Hi. I’m really excited to talk to you today all about gut health. So I guess officially I will welcome you to Do the Thing. Dr. Michael Ruscio, thank you so much for joining us today. Yeah, thank you for having me. All right. So before we begin the podcast, I ask every guest, what’s your thing?

MR: 03:20 My thing is helping people to understand how their symptoms and this includes even non digestive symptoms could be coming from their gut and then what steps they can take to treat this underlying cause.

MU: 03:32 I love that. And I also want to let people know that you and I have been really good friends for a really long time and you’ve helped me with some of my gut issues in the past. So when I wanted to kind of get to, you know, the concept of Do the Thing is like thinking about what’s been missing every time you’ve tried to make a change. And with a lot of people, I think they feel like they’re doing the right things, they’re changing their diet, they’re eating more vegetables, they’re eating lots of salads, they’re taking, you know, probiotics. And there’s something missing in that equation. And I think the information you’re going to share today might unlock some action steps for them.

MR: 04:05 I think so. And gut health seems to be an area where people turn to the internet and boy did they get confused. Oh my gosh. High carb, low carb, low fat, gluten-free, uh, eat whole grains, oxalates, probiotics, not probiotics, antimicrobials, SIBO. Uh, it gets messy, but a few, if you have someone who’s as I have for about 13 years now doing this, every day, you figure out after awhile what works, what doesn’t work. Of course that’s heavily informed by what the scientific research show is that it’s not that hard. But if you just start Googling stuff, yeah, you get pretty confused pretty darn quickly.

MU: 04:42 I mean, I get confused and I’m someone with access to some of the best doctors. I’ve picked your brain over lunch a million times. I have, you know, access to some of the latest literature and you’re sending me your pub med studies. Like I get confused with some of this stuff, so I can’t imagine how overwhelming it is for other people. I want to start kind of at the beginning though. It seems like everyone is talking about gut health these days. What do they mean when we’re talking about gut health? What are we looking for in terms of a healthy gut?

MR: 05:11 That is surprisingly a hard question to answer. Um, now we could say someone has a healthy gut. If they have no gut symptoms, I have no reflux, I have no bloating, I have no constipation, diarrhea or abdominal pain. But even that doesn’t stand the scrutiny of science because we know there are some people, and this has been even published in the conventional literature who have for example, celiac disease, full-blown and they will only have neurological symptoms as a manifestation of that. So we can’t say I have no digestive symptoms, therefore I have a healthy gut. And I was also in that boat of, I had a parasitic infection, had no digestive symptoms, only had brain fog, insomnia, fatigue and depression. So symptoms aren’t a great measure. And then there’s this test that tests zonulin for leaky gut or SIBO breath testing. And these all have a degree of merit, but none of them are perfect.

MR: 06:07 And I would argue that they actually harm the consumers more than the help them because they oftentimes paint a picture of things being worse than they are and aren’t super clinically informative. So rather I would say I’m regretfully, there’s not a good one test that will tell us this. But rather I would say if someone has gone on a Whole30 and done a huge step forward in terms of getting rid of antigenic and inflammatory foods and they’re sleeping and they’re exercising and they’re still not well, I would look to making some tweaks to optimize your gut health as the next best intervention.

MU: 06:46 Okay. So when you, so when you say optimize your gut health, are we really talking about the bacteria in your gut and making sure they’re in a healthy balance? You don’t have too many of the bad guys and not enough of the good guys? Is that an overly simplistic but still kind of accurate way to look at it?

MR: 07:04 Yes. I would say it’s overly simplistic but still generally tends to hold true. There are other things like the immune system that sometimes needs to be dampened. Um, but yes, one of the things that we’ll see as someone improves the health of their gut or even improves the health of their body. Cause remember your gut bacteria grow in the environment that is your body. So if you abuse your body on healthy soil, unhealthy bacteria, grow. If you treat your body well, then we’ll see healthier bacteria grow. And that’s also been shown, they, they’ve done some studies taking sedentary people tracked their microbiotics with serial repeat samples. And what do you know the bacteria in their gut actually got healthier once they started exercising. So yes, the bacteria and fungus in your gut play a pivotal role in that, not exclusively, but definitely part of the mix.

MU: 07:53 Excellent. And so how do they get messed up in the first place? You were just talking about the soil we eat, uh, through our vegetables and the foods that we grow. Having an impact. You were talking about exercise having an impact. I know stress has an impact on our gut bacteria. I feel like more things than you could imagine. Impact our gut. Is that true?

MR: 08:13 This is absolutely true. They’ve even done studies showing that in families that wash their dishes with a sponge, they have different microbiotas than those that use a dishwasher. Uh, so there’s many things that, that your microbiota…

MU: 08:30 um, that’s overwhelming because now it makes me feel like I have to scrutinize every single action I take. Um, by the way, is a sponge or a dishwasher better,

MR: 08:39 well, they’ve shown lower incidences of allergic diseases in those, that wash with sponges. Part of the, the theory is that that is because it allows more bacteria to kind of build up and they’re not quite as quote unquote hygienic, but we also have to be careful because it may be more wealthy families are using dishwashers and they also may have more hygienic practices that accompany, uh, having more, you know, economic, uh, reach, if you will. So we have to be careful with observational studies. I don’t want to attribute it all to the sponges, but that’s definitely an observation and a theory that’s out there.

MU: 09:14 But that’s really interesting because what I have, from what I understand to having exposure to too many bad bacteria, like not washing your hands and shaking hands with a bunch of people in a crowd is problematic, but also being too hygienic is problematic. You know, having that, um, sanitizer on in every single surface and having everything super squeaky clean and never petting a farm animal is also problematic. Right?

MR: 09:38 Yeah. There. There’s a balance to be struck there and it’s not an easy balance to strike because the immune system surprise surprises is really complicated, but the, the general observation there is is certainly true that if, if we go from the one end in third world countries, people often have a high incidence of parasite infections and there’s a high infant mortality death rate and then we go all the way to the other hand where people are slathered in antibacterial soaps from the moment that they’re born and they have reduced contact with natural environment environments like soil and animals, then that’s probably going too far and somewhere in the middle is optimal. It’s just trying to figure out exactly where that middle is. That’s a little bit more challenging

MU: 10:24 and it’s really impossible isn’t it? Like I’m not going to walk around testing my microbiota and testing my surfaces every single day. I feel like if you can get pretty far into the weeds in terms of am I doing the right thing for my gut in this moment and then that can be overwhelming to the point where you know you’re actually hurting your health versus helping it.

MR: 10:45 Exactly, and there’s an important distinction we should draw, which is there’s these two items. There’s clinical and gastroenterology meaning someone has, for lack of a more scientific term, a messed up gut. What clinical interventions have been studied are tried and true compared to microbiota, academic research, which is just starting to piece together associations and how all of this works from a more academic perspective but doesn’t really inform what you can do about it. And this is really important because people oftentimes get pulled into all this academic nuance that doesn’t translate into clinical interventions. And so they flounder because they’re, they’re ignoring clinical gastroenterology, which are these simple things that have been shown clinically effective that we can do to help improve one’s gut health.

MU: 11:35 Absolutely. So that’s what we’re going to focus on for the rest of this episode is the clinically effective things that are proven to help. And I don’t know anybody who’s a bigger expert in that than you are. So let’s go back to what you said earlier, which is there are some obvious signs of a messed up gut as you, so clinically scientifically put it a few minutes ago, right? If you’ve got diarrhea, if you’ve got bloating, if you’ve got reflux, if you’ve got stomach pain or constipation, those are obvious signs that something’s going on with your digestion. But there are other signs too that maybe have nothing to do with digestion that could point to the gut. What are some of those?

MR: 12:12 Well, there’s a number of them. Uh, insomnia because that’s one that I suffered with and I’ll never forget, but that’s also been published in the peer reviewed literature, depression and anxiety, actually fatigue, joint problems, skin eruptions of various sorts. And again, this is where we’re learning more about the connections in the academic research, the, the gut brain connection, the gut skin connection, the gut joint connection. Um, even thyroid actually, and this is one of the things where I think there’s an absolute epidemic of natural and alternative providers, including myself in that camp, so this is not a disparagement, but who are way too quick to diagnose someone with a quote unquote thyroid problem and give them thyroid medication and it’s disturbing how many of these patients actually have no problem at all with their thyroid, but their fatigue, their depression, their constipation is actually being driven by a problem in the gut and we’ve even gone so far as to publish a number of case studies on our website documenting this same thing. Mary Sue spends a year and a half going from thyroid specialist to thyroid specialist, finally ends up in our clinic. We informed them that their thyroid diagnosis was incorrect from the start. We do some simple stuff that we’ll talk about here in a moment and literally in two or three months in some of these cases and years long bouts of symptoms are resolved.

MU: 13:37 Incredible. It almost sounds like the gut, that gut health is like foundational that a lot of these other things, insomnia is not something I ever would have connected with the gut. Definitely mental health issues I have definitely skin conditions but like all of these different things, these different symptoms that appear to be unconnected might all be rooted in and have a foundation in what’s going on in your gut.

MR: 14:01 Agreed. And that’s why I try to bring people back to the recommendation of start with these pillars of diet and lifestyle and then reevaluate and if you’re not where you want to be then instead of going to heavy metal toxins or mold or thyroid conversion or testosterone, I would first take some time to really focus on trying to optimize your gut health because you may see again the insomnia and depression you thought was from thyroid actually goes away cause it was likely being driven by the gut.

MU: 14:29 Right. So it’s really interesting. I would imagine cause you’re a doctor. I would imagine if I said to you, how do I want to start like optimizing my gut health, I would assume that you would say, well come to me and do a bunch of lab tests and we’ll see what’s going on with your poop. But you have a different approach. And I like your approach. What’s your approach?

MR: 14:47 Well, you know, I, I used to order the testing that everyone would think a doctor would order and after years and years I started saying, boy, it doesn’t matter if this test is a little high here or a little low there or that test shows X or Y. I ended up doing a lot of the same stuff and it turns out that many of the treatments in natural medicine can be administered without needing a test. And that many of the tests that are being used in functional medicine actually have not been scientifically validated. So they’re just pretty inferential. And so you can actually get pretty far down the road of gut health interventions you can do on your own without doing any testing. And it’s really important to understand this because patients will come in and they’ll say, doc, I’m so sick of this depression of this joint pain of this insomnia, I’ll do anything.

MR: 15:44 Well, okay, but doing anything doesn’t mean that we have to do thousands of dollars of non-validated testing to get you well. And it’s, I don’t want to say it’s preyed upon, but I think clinicians are too quick to reach for the testing thinking that’s going to help their patient. But if they actually double check the science supporting the testing, it’s not really there. And a lot of cases, and what ends up happening is someone who may not have a lot of funds to put into their healthcare, feels like they already wipe out 80% of their income that they have for this health project just to get over the hump of testing. So the testing is one area that we can really cut out at least for most cases and put in the back burner and say people a lot of money by doing so.

MU: 16:28 That’s incredible. It feels like an incredible hack. And I’m not hearing a lot of people say that. Not a lot of medical professionals say that, but you’ve just given hope to so many people who don’t have the economic privilege, the time, the capacity to find a functional medicine doctor in their area. The idea that you can take your own health into your own hands with some really simple changes and perhaps eliminate or at least make enormous progress on some of the things that are alien to you. Like that’s huge.

MR: 16:57 Well thank you. And I don’t say that lightly. I think one of the problems that this space also suffers from is people making hyperbolic claims. So you know, I don’t say that lightly and I think you know me well enough, Melissa to say that I’m, I’m usually pretty conservative and the stances that I take, but we’ve literally had people who have read my book Healthy Gut, Healthy You after going to three, four, five doctors including functional medicine doctors and they weren’t helped by this handful of doctors yet the book protocol, they do all on their own with no testing and they were able to completely resolve their symptoms. So you know, I don’t say that lightly and I want people to know there is hope out there. One caveat, do not discount conventional medicine. It’s, it’s important to have those routine followups. The point I’m making is if you’re suffering with these symptoms, I’m looking for this kind of functional natural advice. You don’t have to spend a bunch of money on testing to start going through some of the tools that we have in our toolkit.

MU: 17:58 Yeah, and I think the other thing that’s important to note, just like the Whole30 it works so well for so many people, but it’s not a promise or a guarantee and it certainly doesn’t replace, you know, one on one conversations with qualified healthcare providers, but you’re one of the few people I know who work with patients just as much as you’re in the literature. Usually with clinicians, it’s one or the other. You see a bunch of patients, but you’re sort of distanced from what like the latest scientific findings are starting to suggest or you’re really deep into the literature but you don’t really have an understanding of like how that works in the real world and you’re one of the few people I know who do both like on a daily basis. So I think it gives you a lot of street cred to be able to make these kinds of recommendations.

MR: 18:40 Yeah. Well thank you. And it is really important because is you’re absolutely right. If you’re in the clinic five days a week, it’s really hard to review the evidence on let’s say the last functional medicine test we reviewed, it was a couple of weeks of work. So I’m in the clinic two days a week and I work outside of the clinic with the research and everything else about four days a week. It was a few weeks just to review the evidence behind one test. So it’s, I understand from a clinician perspective, it’s not easy to keep up on this. But then on the other side of the fence, if you’re only reading the research literature, you never have that, you know, you’ve never been a a soccer coach or you’ve never played a soccer game. So how can you be a good soccer coach and need some time on the field to really see how all this stuff interfaces with an actual person. Yeah, exactly.

MU: 19:31 Let’s get back to where can the average person start at home. So we’re all the way at the beginning. I think I’ve got some stuff going on with my gut. I’ve got some of the conditions or some of the symptoms that we’ve talked about. Where should I start? And I’m assuming it’s with your diet.

MR: 19:46 Yes. And, and the diet that you advocate for, Melissa is where I think most people should start removing processed foods and foods that are oftentimes either inflammatory or antigenic. Just kind of using those terms somewhat loosely, but your gluten, your soil, your processed foods, your dairy, and also reevaluating your relationship with food. And if you’re like a therapeutic eater and bingeing on junk food, that is a amazing place to start. And when someone walks into my clinic and they never heard of the Whole30 or an elimination diet or a paleo diet inside my head, I decided this is going to be easy, right? Because there’s a huge, huge step right there, right, right. But then what do we do for the people who are eating a healthier non-processed whole food based diet? What’s maybe a bit paradoxical is that for some people this seems the inadvertently push them in a direction that may not agree with their gut, and again, this is

MR: 20:48 going to sound really ironic, but a high intake of fruits and vegetables for some people, especially with sensitive digestion, can actually make them feel worse. And they’ll come in and they’ll say, Oh look, I’m doing all this stuff to feel better, yet I feel more gassy, more bloated, more abdominal pain. And I absolutely understand that can be very defeating, but there’s a somewhat simple answer for a lot of these cases. Oftentimes what’s happening underneath the surface is someone is inadvertently eating a high FODMAP or FODMAP is kind of an acronym that just really means prebiotics, the compounds in carbohydrates that feed bacteria and someone will end up going up inadvertently on this higher FODMAP intake that flares their gut. And if we can just identify that and have them do kind of a uh, iteration that’s more cognizant of selecting fruits and vegetables that are lower FODMAP instead of higher FODMAP, that can literally lead to all those symptoms going away in some cases in one to two weeks.

MU: 22:03 So FODMAPs are fermentable carbohydrates that are found in higher quantities in certain fruits and vegetables. So when someone goes to do a Whole30 and they all of a sudden start adding more plants to their diet, if they’re sensitive to these FODMAPs, their digestion can get worse. So you’re saying the answer is to identify those fruits and vegetables that are high in FODMAPs and kind of doing a little experiment within an experiment where you pull those out of your elimination diet and see if that helps.

MR: 22:30 100% it’s just another degree of personalization of one’s diet. Exactly. And what’s a little bit counterintuitive is we don’t associate broccoli, cabbage, cauliflower, avocado, apples to being a onions, garlic to being bad for you. And it’s not to say that these are quote unquote bad for you, but for some people, too much of them will definitely Clair their gut. So yes, some of these paradoxically healthy foods, if we can just give them a simple food list and we’ll send you a list where there’s a column of foods to avoid and a column of foods to focus on. Now you can take a diet inventory and try to focus on the foods that are lower and FODMAP. And again, just like you’re saying that one additional degree of personalization in the diet can lead to improvements.

MU: 23:19 So you basically just described half of the Whole30 which is cauliflower and avocado. If you’re all of a sudden eating way more of those and you notice your digestion is worse. What we’ve done is we’ve created a low FODMAP version of the Whole30 shopping list and I created that with you about a year ago based on your research. So you essentially take the Whole30 shopping list. We’ve crossed out everything that is high FODMAP, it’s going to be some vegetables, fruits and pantry, staples like almond flour and you eat from this sort of list of low or medium FODMAP foods. And after, how long do you think would you start to see improvement in your symptoms?

MR: 23:59 Well, for those who respond quickly, really it could be in a couple of days. That would be kind of, if you have like this, this bell curve distribution, there’s going to be some who respond more quickly. Others who respond more slowly, I would say give it at least two to three weeks and if by the second or third week you’re not getting a strong indication that you’re moving in the right direction, then this probably isn’t the right maneuver for you.

MU: 24:22 Got it. And typically, you know, I think the Whole30, if you start an elimination diet or the Whole30, it can affect your digestion in the beginning just as your body gets used to maybe you’re eating bigger meals, maybe you’re eating more fruits and vegetables. At what point during your Whole30 are you thinking to yourself maybe a low FODMAP approach is what’s needed right now?

MR: 24:43 Yeah, that’s a great question and it depends a little bit in terms of where they coming from because if they’re coming from the S.A.D. Standard American diet, they may have to work through a couple of weeks of what is sometimes called the low carb flu. Even though they’re not necessarily going low carb, they’re getting off of a bunch of sugar and so they’re having to kind of um, detox if you are kind of withdrawal, almost like coming off caffeine. Uh, you know, if you’re coming off caffeine and you feel a little bit tired and headachy, that doesn’t mean something is wrong for the first few days. It’s just your body kind of adjusting. So if they’re coming from the standard American diet, I would give yourself at least four weeks. If you’re coming from already a pretty healthy diet and you’re making just a few small tweaks, I’d say two weeks. So for those coming from an already healthy ish diet, maybe they were doing Mediterranean and now they’re going to Whole30, two weeks. If they’re going from no diet plan at all to just something to begin with. Cause there’s more adjustments that need to be made, I’d say by four weeks.

MU: 25:40 Great. And this is something where keeping a food journal can be really, really helpful such that if you’re just logging your meals, so day one, a full 30 this morning for breakfast, I had X, Y and Z. And you happen to notice that your symptoms correlate with say days where you have a meal that has a lot of garlic or days where you’re eating a ton of cauliflower rice. That can also inform you as to whether foods are working for you or not.

MR: 26:03 Yep. 100% and you’re right, it’s making those small connections can sometimes go a long way. And that’s part of what a good clinician will do. If you come in and you’re reporting, Oh, you know, I still have all these, I just have symptoms and I’m eating the Whole30 diet and I’m, you know, I’m really having lots of, you know, and you described a lot of brassica family and a lot of avocado, a good clinician is going to be saying, Hm, that’s a high FODMAP. That’s a high FODMAP. That’s a high FODMAP. Hmm. Maybe this person is just eating way too many FODMAPs. So absolutely.

MU: 26:30 Yeah, that makes good sense. All right, so we’ve talked about diet and we’ve talked about doing an elimination program and maybe even further digging down into whether a low FODMAP diet might be appropriate. Let’s talk about probiotics because I like gut health is synonymous these days with the promotion of probiotics, and yet the world of probiotics is so complicated. Can you make it simple for us?

MR: 26:53 Yes. Am I’m glad we’re touching on the topic of probiotics because there is so much confusion about probiotics, almost hair pulling. We, so there are people who will tell you, well, if you have digestive symptoms, you could have SIBO or small intestinal bacterial overgrowth, therefore don’t use probiotics. And then you have people on the other side of the extreme saying everyone should be using probiotics. And it’s hard to kind of parse what’s true and what’s not true. And then you add to that many companies are trying to market their, you know, new probiotic formula and just kind of flooding the internet with all these interesting articles that are more so marketing than they are signs, but they’re trying to look scientific. It can be very difficult for the consumer to parse all of this. So yes, we can definitely make this pretty easy to navigate.

MR: 27:42 I think the first thing we should make sure to establish is that probiotics aren’t only for those who have digestive symptoms. Um, we, you know, we should definitely mention that there have now been, I believe that eight clinical trials summarized in two meta analyses and a meta analysis is just a summary of the clinical trials finding that probiotics can improve either depression or anxiety. A few exciting early studies showing that they can improve insomnia. One study actually very interesting showing that they can improve and in some cases decrease the dose needed of thyroid hormone. And the connection there is that thyroid hormone medication like Levothyroxin is absorbed in the small intestine. And so if you do have an imbalance in the small intestine and the probiotics help with that, well then you may need less medication.

MU: 28:37 So probiotics are incredibly helpful, not only if you’re having digestive distress and gut issues, but also if you’re having symptoms that, as we talked about earlier in the podcast, maybe you don’t even relate to your gut, but there are so many different kinds of probiotics and they all have fancy names and they’re all labeled and packaged differently. So like, what am I looking for?

MR: 28:59 So if you look at all of the probiotic research, you eventually see some trends emerge and we can take pretty much every probiotic on the market in the United States can be organized into one of three categorical types. Category one is a blend of different strains that are either lactobacillus or bifidobacterium. So you’re looking in the back of the label, you know, don’t, don’t look at the name cause the name of the probiotic is more marketing than it is anything else. Look on the back and you’ll see lactobacillus acidophilus, bifidobacterium, infantis. And you’ll see anywhere from maybe seven to 15 different strains that are lactobacillus or bifidobacterium. There might be one or two other strains in there that are non lactobacillus or non bifidobacterium, but the vast majority will be lactobacillus and bifidobacterium. So that’s your category one and what this type of probiotic, there’ve been over 500 clinical trials, so it’s, it’s the most well established, the most well studied and can definitely be quite helpful.

MR: 30:04 Now category two is actually not a bacteria. It’s a fungus, Saccharomyces boulardii. And if you look in the back of the label, there will be just Saccharomyces boulardii and there’s been just over 100 clinical trials with Saccharomyces boulardii. And then category three, this is kind of the new kid on the block getting more attention lately, especially in the paleo community because it’s a soil-based probiotic. And the theory with this probiotic is it supplies these strains of bacteria that we would be contacting if we had better contact with dirt farm animals. And so on the label here you’ll see various bacillus strains, bacillus with a B, some Tillis bacillus coagulans facilitates… So why this is helpful is because any probiotic can really be categorized into one of these three categories. How this can empower and liberate the user is understanding that you don’t have to keep trying probiotic name to probiotic name, right?

MR: 31:12 What will happen with some people will try one probiotic and maybe they don’t see much of a benefit, so then they try another and then try another. They don’t realize that those three that they tried were all just different iterations of category one. So they keep trying the same thing, but because they didn’t understand the categorization system, they were kind of spinning their wheels. So when you understand the three categories, we can make one other connection, and this is more so my clinical observation. This hasn’t been published yet. I think at some point, this will probably make its way into the published literature, but if you picture a stool like, like a chair, like the kind you would sit on one leg of a stool or a one legged stool could be akin to using one probiotic. Okay. A one legged stool kind of supports you in balance, but it’s wobbly. If we had a three legged stool, AKA these three different categories of probiotics we were using at the same time, that’s a three legged stool that’s much more conducive to balance a one probiotic protocol. Yeah, it supports balance. But if we can use all three at the same time, that seems to be more conducive to supporting balance in the microbiotic ecosystem in your gut.

MU: 32:23 And I know that from reading your book. So you know, I actually use the probiotics from your Healthy Gut, Healthy You protocol, and I use one of each, all three and it makes it very, very easy. So I’ve got my three legged support and I know exactly what I’m getting because you’ve kind of curated it for me.

MR: 32:42 Yeah. And, and you know, it’s not to say that one probiotic may not get you there, but I, I think what happens with a fair number of people is they use one probiotic and they get a little bump, but they’re always saying, eh, you know, I still feel like something’s a little off. And, and we actually just published a case study with, uh, with this uh, lady named Phyllis because she was on a Whole30 diet for awhile. Then she went to low FODMAP and she got a little bump from low FODMAP and then she was on kind of the probiotic merry-go-round one and another than another. All we did when she came into my office was put her on all three probiotics at the same time and 30 days later her a year and a half of nonresponsive symptoms were gone. So this definitely can pay, know, fairly robust dividends if we get all three of these supports in place at the same time.

MU: 33:33 That sounds incredible. How long after beginning? So this is kind of the thing about probiotics, right? It’s not like you take them one day and then it doesn’t work like Advil where all of a sudden you feel better and our leader after, how long should you expect to be seeing a positive trend when you start a probiotic regimen?

MR: 33:50 Great question. The the, the same trajectory that we outlined with the low FODMAP diet essentially applies here. Those people who respond quickly may notice improvements within two or three days, but I would give yourself two or three weeks to be able to assess benefit. And there’s another detail here that’s really important, which is you’re not necessarily looking for 100% improvements by week two or three, but rather you’re looking for, okay, I can clearly notice an improvement. Now that improvement might be 30% but you want to clear that first reevaluation hurdle at two to three weeks. And if you are improving, ride the wave until you peak and you may notice it takes you two months to hit your maximum improvement and finally plateau. So evaluation window one is two to three weeks. Maintain what you’re doing there with the three probiotics at the same time until you’ve hit a peak level of improvement and then reevaluate.

MR: 34:51 Now if you reevaluate in your 80 to 90% improved, I would just give your body time. Cause if you’re that close to your goal, oftentimes it’s a little bit of time and you get the rest of the way there. Cause there is a little bit of a law of diminishing returns where the farther you go, the less rapidly you realize improvements. But if you plateau around 50, 60%, you know, then you may want to consider layering in another type of support and not coming back to Healthy Gut, Healthy You is exactly what healthy gut, healthy you lays out, which is kind of a stepwise process. So you can navigate this stuff and not necessarily just make your, your treatment protocol. Oh I heard a new uh, a new podcast today and they talked about this and you know, then I just jump on this for awhile and you know, it’s kind of like the supplement merry-go-round. Um, I tried to people from that with healthy gut healthy. You and give them a really kind of tenured protocol where it’s, okay, we’re gonna start here, step one, reevaluate, step two, reevaluate. So they have a linear process or somewhat linear process. They can work through them.

MU: 35:50 And I’ll make sure to include all of this information in the show notes because I’m pretty sure nobody knows how to spell lactobacillus Saccharomyces. It’s very complicated.

MR: 35:57 Right? Yeah. And I know we sent you over the, the names of the categories and then also the dosing protocol that I use just to help give people some guidance there. And I should also mention really quick that in our dosing protocol there’s a range, meaning it might be two pills, one to two times per day. And I just wanna mention briefly. Sometimes people want to be told, well, exactly how much should I take. It turns out that in the studies there’s been a range that had been shown to be effective. So hopefully I can kind of preempt this and help people to look at this in an empowering way. Meaning there’s a range. So we don’t have to be anal about a specific range, but rather, okay if you’re trying to be on a budget, go with the lower end of the range or if you’re trying to go gung ho you can go to the top end of the range. But the good news is there’s a little bit of flexibility in the approach so we don’t have to be, Oh my God, I miss, you know, I miss my second dose today is that, you know, am I going to ruin the protocol? No, there’s a range. As long as we’re in the ballpark, that’s okay. And just keep sticking with the general process.

MU: 36:55 And let’s also remind people that when it comes to probiotics more is not necessarily better. So let’s not look at that range and think, well if I want to get better twice as fast, I’m going to take twice as much. Cause that could very well backfire.

MR: 37:06 Hmm. And so that’s another thing we should, we should mention, I’m really glad you said it cause you gave me a, an idea about what do we do on the back end of this. So the, the protocol that gets you to your improvements isn’t necessarily the protocol that you need in perpetuity. So what I recommend people do is once they’ve hit their peak improvement, stay there for one to two months and make sure that you can see a consistent trend in that new peak level of improvement. But then once you’ve been stable for one to two months work to find your minimal effective dose, cause that’s really important part on the back end that we should try to do is find a minimal effective dose. And I should also mention that to find the minimal effective dose, sometimes we have to discover the ineffective dose.

MR: 37:50 We just published another case study our website with a gentleman named Mason who had a fairly pronounced reflux and it was totally gone actually on the, uh, in part three biotic protocol. And at his follow up a month later while he was doing his kind of weaning to find his maintenance plan, his follow up, he said, yeah, you know, I was at 100% last time we spoke, but now I feel like I’m at 90% my reflux coming back a little bit. And I said, well, how did the weaning down in the probiotics go? He said, Oh good, I’ve been off all of them for 30 days. I said, sorry, so your reflux is 10% worse and you’ve been on or off the probiotics now for 30 days? And he goes, Oh, maybe I should try to take the lowest end of the dose range. See if that gets me back to

MR: 38:35 the harbor. So just, just something to keep in mind that we want to be prime that minimal effective dose, but remember that sometimes you have to find what’s ineffective to find the minimal effective dose.

MU: 38:45 That’s really smart and that makes a lot of sense. There’s one more probiotic topic I want to ask you about before we move on, which is what about probiotics from food? We talked about probiotics in terms of the capsules in the three different strains, but where do probiotics from food, like sauerkraut or kimchi come from? Like how, where do they fit in?

MR: 39:04 Yeah, great question. And this is one I had never really drilled down in, into a comparison on this, but I recently wrote an article on probiotics and I, I, me and my team created, I’m sorry, my team and I, um, created a table looking at a few different foods and taking, let’s say, sauerkraut, yogurt, Keifer. And we looked at how many probiotics are on a serving of that as compared to how many probiotics are in a serving of a probiotic. And if you look at sauerkraut as an example, and we’ll send you a table, Melissa, if, if your audience wants to look at this, but sauerkraut has about 3 billion CFU or colony forming units per serving. Now for the probiotic that I use, lacto bifido blend probiotic, that’s, that’s the category one that’s about equivalent to one eighth of one capsule, right? So sauerkraut is a good start. Yogurt, same kind of thing. 2.5 billion CFU. That’s equivalent to about one 10th of one capsule. Um, and so I think fermented and probiotic rich foods are a great place to start and definitely something people should bring into their diets. Yes. But if your guts failing in balance and you’re really trying to get over that hump, that’s when uh, at least a term on a probiotic may supply a more clinically sufficient dose to get you back to balance.

MU: 40:27 Excellent. I read that article actually and I had no idea, I guess about the disparity between how much you’re getting from food and how much you’re getting from pills. So I’m going to keep eating my sauerkraut and my Kiefer, but I’m not going to expect it to take the place of my probiotic regimen. That’s kind of what you’re saying, right?

MR: 40:44 Yup. And it comes back to kind of that hierarchy that we’ve been developing throughout the call start with diet and that diet would include fermented foods. But then if things don’t help from there, you can consider going from the Whole30 diet, including your kefirs, kimchi, your kombucha is. And then you can potentially tweak to a FODMAP restriction and then finally consider bringing in a clinical probiotic and trying all three of those categories together at once.

MU: 41:08 I think that’s perfect. So we’ll make sure to include all of that in the show notes so people can get started on their own. All right, Michael, there’s one more kind of strategy I want to talk about cause it worked really well for me a few years ago, actually many years ago, cause it was before I knew you and I could call you for help. I had come back from a trip and there was something I ate during this trip and my gut was a mess. It was like ruining my life. I had to be in the bathroom like every five minutes. And in an act of desperation I just kind of stopped eating for a couple of days. I drank water. I think I drank broth. I drank herbal tea, but I was just so unhappy that I just thought I’m just going to give my gut a break and I got better. Is that an actual medically proven strategy, this kind of fasting?

MR: 41:51 Yes, it is. Fasting, I think we’re kind of in this Renaissance of fasting right now where more and more research is being published, showing the utility of fasting and more people are experimenting with either time restricted feeding or intermittent fasting. And that includes, you know, a, a, a handful of studies only at this point, but definitely some research showing that fast and can be helpful. One of the things that I often recommend for people is kind of this liquid fast, meaning it’s not a true water fast. Uh, but what we can do is administer a complete meal replacement. So you have carbs, proteins, fats and vitamins that’s also pre digested. So helping them kind of,

MU: 42:36 That sounds kind of gross. No offense.

MR: 42:38 Yeah. So it’s not as bad as it actually sounds. Yeah. It’s not like a mother bird regurgitating to her chicks. Um, but because, because the protein, carbs and fats are pre digested, your gut doesn’t have to do any work to absorb them. And so if you are inflamed and if those bacteria are maybe overgrown, the, the pre digested and hypoallergenic kind of super clean liquid meal replacement can allow someone to essentially just sip on a shake throughout the day, still get their nutrients, not feel like they get the, the fatigue and some of the challenge that can be associated with fasting. But this can give the gut a break from having to work. Kind of like if you sprained your ankle, you had to take a few days off of running. So if your gut super inflamed as you learned a few days off from eating can actually really be like hitting the reset button and letting all the inflammation quell.

MR: 43:34 And because these formulas are dairy free and soy free and, and um, gluten free, it also gives your body a break from the allergens and can help to starve fungal and bacterial overgrowth. And these can be really powerful. Um, even looking at children, sadly with inflammatory bowel disease, one, two year study found that kids that replaced one to two meals per day who had inflammatory bowel disease with one of these shakes compared to kids who didn’t. The kids who did actually had better growth, probably because our guts were healthier and they were better absorbing nutrients. So anywhere from one to four days on either exclusive or mostly liquid nutrition, just sip on these shakes all day and then maybe you have no meal or maybe a small dinner. And that can be very helpful in just resetting the gut calming things down and getting you past this kind of flair or irritation period that you might be in.

MU: 44:32 Yeah, and it’s, so I just do want to point out, it’s very, very different than fasting. People who fast, intermittent, fast for weight loss or people who are fasting like this is a very specific protocol designed to help in cases of like severe gut issues or when you’ve been doing all the other right things and you still find that you’re having these issues. So it’s different than a general conversation about intermittent fasting.

MR: 44:56 It’s just another option. Um, and for some people, just like you said, the best approach seems to be taking a short term off of food. It’s just with these what are known as elemental diets, the these liquid diets. So let’s say, let’s say you were using something like this, but it had gluten and casein in it. Yeah. And you’d go, Oh, I’m doing this liquid diet, but why do we feel worse? Well, Hmm. You know, that might be why. So of course this is something that’s constructed the kind of really be the best of both worlds. You get some of the benefits of fasting, but you also don’t go hypo caloric. And that tends to make it a lot easier for people. Perfect.

MU: 45:37 We have 1000% accomplished. My goal, which is demystify the world of gut health and show people how they can take some really practical, actionable solutions. Right now at home, I close every episode by asking this. What’s one thing you can recommend for someone who is ready to Do the Thing?

MR: 45:56 Well, I would say take steps to improve your gut health. And for this group, I’m assuming that would be first two to three weeks low-FODMAP. Then if that’s not getting you fully there, add in the three probiotics, give that a few weeks and ride that to its peak. And if none of that works, considered using Elemental Heal, which is a meal replacement to kind of give your gut a reset. And that right there is a powerful assortment of interventions that should be able to get most people feeling better in getting hopefully to the underlying cause of their symptoms.

MU: 46:34 Where can people find you and learn more about you and your book and your podcast? You, you give away so much information via your website and podcast. So where can people go?

MR: 46:45 Oh, thank you. Uh, drruscio.com Is the best place to kind of plug into everything that I do. That’s D R R U S C I o.com. I have a podcast and weekly videos and articles and also my book is Healthy Gut, Healthy You. It’s available on our website and also on Amazon.

MU: 47:05 Wonderful. Dr. Michael Ruscio. Thank you so much for joining me today on Do the Thing. It was good to talk to you. It’s seamless. Thank you. Sweet. That was awesome. Oh my God that was so good. No don’t, I dunno. Don’t stop. It doesn’t matter. We should just keep the conversation going for like four hours cause that was so good. I just want to pick your brain. That was amazing. That was exactly what I was hoping for. Thank you.

MR: 47:26 Yeah, I’m glad I didn’t overwhelm you with all charts I sent. I think I sent too much information.

MU: 47:30 I was like, I’m going to have to contain his big old brain and like a little box to make sure that we keep this like really practical and actionable. But that’s one of the things that you do best is you take all this sciency stuff and you make it really like translatable. So you did awesome. Perfect. It was perfect.

MU: 47:52 Thanks for joining me today on Do the Thing. You can continue the conversation with me at Melissa, you on Instagram and visit whole thirty.com/podcast for today’s show notes and bonus content. If you have a question for Dear Melissa or a topic idea for the show, leave me a voicemail at (321) 209-1480. Do the Thing is part of the onward project, a family of podcasts brought together by Gretchen Rubin all about how to make your life better. Check out the other onward project podcasts, happier with Gretchen Rubin side hustle school and happier in Hollywood. Finally, before you leave, please subscribe, leave a review and tell your friends to Do the Thing. See you next week.