359: New Year, New Gut: SIBO, Fungal Overgrowth and More Functional Medicine Secrets | Dr. Michael Ruscio
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Welcome to the Ancient Health Podcast, where East meets West in the world of medicine. I'm Dr. Chris Motley, and here we explore how modern Western science and traditional Eastern wisdom come together to unlock the body's full healing potential. Each week, we'll dive into powerful tools, techniques, and approaches from both sides of the world to help you optimize your health and live with vitality. Let's bridge the gap between ancient practices and cutting-edge medicine. Let's get started.

We're here with Dr. Michael Ruscio, a DC naturopathic practitioner, researcher, and clinician. As the author of Healthy Gut, Healthy You, Dr. Ruscio has been a guiding force in helping people unlock true health through the power of gut wellness. He founded an institute of functional medicine to help bring people the latest information and tools to take control of their well-being. He also has a well-known alternative health podcast, Dr. Ruscio Radio.

Hello, friends. Welcome to the Ancient Health Podcast. I'm your host, Dr. Chris Motley. This podcast, we're going to dive deep into anything we can put our hands on. So, Doc, I really appreciate you joining me today. Thanks for the kind words, and it's amazing to be here. So, one of the things that, again...

That I appreciate for individuals out there, Doc, that we see on any type of social media front is individuals who can explain what they're talking about, but do it in a way that's so calming and also very plain and simple.

But you can tell that you've come from experience. And the one thing we always want to talk about here on the podcast is a little bit about yourself. I always say, give us a little idea about what's going on in your life, who you are, where you're at. I know people already know who you are, but give us a little brief background. Sure. Yeah. Well, I think like so many in our space, I had health issues myself and

What do they say? The womb is the gift. That was, I think, the case for me where it diverted my path from wanting to go into orthopedics as a young jock, admittedly, in college and meeting with my pre-med advisor. What do you want to do? I'm not really sure I want to help people. Well, you're kind of a strong guy, so you'd be a good ortho. That was the extent of what I should do with my life until 21 years old, roughly. Went from being very healthy to having

depression, debilitating insomnia, brain fog. Like, I was feeling quite poorly. And I wasn't living an unhealthy lifestyle. I was eating organic food, whole fresh foods. I was exercising. I was meditating. I was taking time and doing all the things, right? But still, my health just fell apart. And through the process of discovery and discovering sort of alternative medicine, I

I figured out that I had an intestinal parasite. I had an amoeba, amoeba histolytica, which actually prims rare. As someone who's ran over maybe a thousand stool tests, earlier in my career, I was, where are the parasites? Because I had a parasite. And...

Yeah. After running two stool tests on pretty much every patient for about seven years. Wow. Very rare that you would find true parasites. And sometimes we use the term parasite as kind of like a colloquy, like, oh, I've got a parasite, but it's, it's actually much more common that someone will have the normal stuff. Hmm.

bacteria that's commensal or fungal that overgrows and causes a lot of the problems that we attribute to parasites. So I was maybe a little bit of an outlier in the specific issue in my gut, but nevertheless taught me that, boy, if you have a problem in your GI, like I was doing everything right, you can still feel very, very poorly. And it wasn't until I addressed the

that amoeba, the issue in my gut that I started to improve. So let me fast forward. And I, you know, I go into alternative medicine and there was so much that I had loved, but kind of to your earlier comment, I thank you again for the, the, the calming voice praise. I appreciate that because part of what I didn't like in the field was some of the really absolutist thinking about everyone's got to be gluten free and everyone's got a parasite and nobody can have dairy and

It felt a little bit dogmatic to me. And then when I got into practice, I saw how some people, especially if you're a very compliant rule follower and maybe a little bit anxious in your constitution,

Those people get really harmed by the strong absolute messaging. And that's part of the reason why I try to bring a calm perspective on this and just work the problem logically and don't sort of infuse fear or absolutism into how we think about whatever the issue is in the gut. And that's part of what spurred some of the research that we've published, just trying to give people...

An understanding of risk and right. Cause if we don't give people an understanding of risk, they tend to go to very black and white scenarios. And instead of understanding that through sort of a gradation of risk. So, you know, that's kind of the long short had my own health issues. It was really unpleasant. Learned a lot from it. Deeply ensconced now in natural medicine and also research and trying to give people that, that balance of, yeah, there's, there's something too many of these different components like gluten-free is one example that I'm

almost none of these things had to be followed to an absolute degree. And just really quick, one other thing, I'll just slip in here.

It's the psychosocial ramifications for some people. If you go to a wedding and you want to be able to have one slice of wedding cake, I would say for most people, that's probably okay. So the small, maybe 1% of the population that's truly gluten intolerant, we can unpack that more. I don't mean to kind of be jumping the gun here, but that's sort of the long short of who I am and some of what I've been up to.

I think it's that people really identify with you too about like you talk from experience, like even like with you doing stool testing about how you don't try to focus in on one thing. And I think many people out there, you're right, is they get turned off by the fact that people will –

say it's all Lyme disease or it's all parasites. Because I remember when I had Lyme disease pretty badly, Doc, I was really trying to look out for it. And the fact almost sort of shied away from it after a while. It's like, I don't want to try to find Lyme disease. And there was, like you say, dogmatic positions about people with Lyme disease. It's got to be old and it's got to be that, which I'm not saying it isn't. I mean, I think that's like you just said, like the practitioner who goes through it

It's really good for that practitioner to go through it so you know how to address it. That's what I loved when we talked about your journey. When you talked about in your book, Healthy Gut, Healthy You,

And you talked about what you had gone through and you talk about some of the main points in the gut, in gut health. When you got into practice, like you had the parasites and such, and you started to dive into it, getting your own, your radio show, what are, maybe this is a little too general doc, but people out there, I would think, what are some of the main things that you're starting to see like in gut health? I hope I'm not being too general. Like, what do you think? Like you said, we're not just harping on gluten, but what are some of the main things you look at? I mean, there's, there's,

Three things I would start with. One is the mental component because we know that people who have gut issues find some correlation to food and then they can start, you know, some foods trigger me, some foods don't. So that can lead to a lot of

self-monitoring that can be too vigilant where people overly restrict their diet. And this can have negative ramifications regarding stress, which we also know can make gut issues worse. So again, finding that balance regarding the brain and the gut-brain connection, which is a really legitimate thing we're learning so much more about that these

food reactive situations, whether it be bloating, constipation, diarrhea, reflux, there's a brain component to these. So mindset, not to say it's all about mindset, but mindset's one really important piece of this conversation. And then in parallel with that, a framing or a heuristic we've been using that's been quite helpful, he was thinking about and trying to ascertain, is someone's got more of a bacterial overgrowth type or a fungal overgrowth type? And

Why this is so relevant, firstly, taking a step back and sort of what does the evidence say here? We don't have a lot of data, but there was one really compelling study by Shatish Rao. He's a conventional gastroenterologist out of University of Augusta. And he surveyed about 300 people with GI symptoms of no known cause. And he found about 20% had fungal overgrowth, about 20% had bacterial overgrowth, and about 20% had both.

So it kind of gives a little bit of credence to this model that the gut can skew in one of these two directions, more toward bacterial overgrowth or more toward fungal overgrowth. And even with the people who have both, it does seem that one of those is the more important issue. And why all that matters is when we're trying to select the diet for somebody, the diets for bacterial versus fungal overgrowth are almost polar opposites. Really? Yeah.

bacterial overgrowth type people, the SIBO people, they tend to do well on things like white rice, potato. In fact, if anyone's done a SIBO breath test, they know the preparation diet for that is essentially white rice and meat. And some people will say, doc, boy, that day of doing that prep diet, I felt awesome.

That's a classic bacterial overgrowth type because the starches don't feed bacteria. They starve bacteria, so you feel good. Now, conversely, if it's fungal overgrowth, those starches feed the fungus. And so the people who say, I did a single blood test, or if I eat a lot of rice, I feel foggy, I feel tired, I have diarrhea, that's a fungal overgrowth type. So again, why that matters is

The bacterial overgrowth types do better on kind of like a moderate carb, some starches, a little less vegetable. Yeah. And then the fungal overgrowth types do much better on sort of your classical kind of lower carb paleo or keto type diet where they're really going to bring those foodstuffs like starches and potatoes and sugars down. I mean – and so, Doc, that is good for me because that is like – so the lower starches for the bacterial overgrowth for SIBO. So –

Because it really like in the Chinese medicine world, you know, sometimes we talk about not just using symptoms. I'm not just a symptoms. However, like in the Chinese medicine, Ayurvedic world, it's like symptomatology. If you really follow it can give you the history can give you exactly where you need to go. So that's what like here. Some of the things I wanted to ask about that, like,

With the gut health and that you're starting to get this health history, do you like to promote like herbals? Like, okay, so you have testing. Some things may not be as reliable. Do you like to promote herbals? What's like your...

Like, do you like to do that kind of cleansing first or do you like to do an elimination diet? What's your, what's your approach? Great, great question. And the thing I'd want the listener to take home above anything else is think about this in a, in a phased approach. Like I know that we want to get from not feeling well to well as quickly as possible. And as somebody who's been there, I get it.

But the old fable of the tortoise and the hare has a lot of relevancy here. Because when you swing for defenses and you try to just throw a ton of stuff at somebody, oftentimes what happens is something in there may actually end up inadvertently triggering them.

And so you don't see a lot of responsiveness because there may have been a few things that helped, but simultaneously something's also triggering them. And so when you follow up and say, how are you doing? It's a mess because you've done seven supplements and a really aggressive dietary change and you didn't get a chance to capture the most important thing, which is reducing variables, asking the gut sort of one or two questions. Like, how do you do if we go to a low FODMAP diet? Mm-hmm.

And getting the answer, because it's really the individual's response to any given change. That's where the magic is. That's the most accurate diagnostic information in my view. And so that's why, you know, again,

Phrase one, let's make a dietary change and maybe one or two supplements. Give that about four weeks. Follow up. Are we trending in the right direction or not? If we are, do more of that. It sounds so simple, but it's often missed in clinical practice. If we're improving, do more of that. If someone's not improving, then we can change the hypothesis and change sort of how we're supporting the individual. So step one would definitely be diet.

And yes, on herbals, but what I tend to like to pair with diet is probiotics. And the reason for that is probiotics are anti-cebo, they're anti-fungus, they're anti-parasitic, even though parasites aren't super common, they're anti-leaky gut, they're anti-inflammatory, they're pro-motility.

So you get so much benefit from using probiotics. And even some studies now are showing that if you take a group of people with symptoms, half of them get just low FODMAP diet. The other half get low FODMAP plus probiotics. The group with the probiotics plus low FODMAP have better symptom resolution a month in. So I think it's a good balance where...

Uh, probiotics generally tend to be very well tolerated. And even if you don't know exactly what's going on underneath the hood, is it bacterial or fungal overgrowth? Probiotics are going to work equally as well for either one of those. Plus again, they're going to hit leaky gut too. So that's sort of with the phase one diet and probiotics. I love that doc, because you know, with probiotics, I was going to ask you, like, do you have like, maybe I know you

With your testing, you go through a plethora of which ones you would use. Do you like one in particular? Because I know that a lot of my patients always like – they kind of ask me about three or four different ones that come in. We have some here at the office. What is your favorite? Yeah. It's a very confusing landscape regarding probiotics. And I think part of the reason why it's confusing is there's a lot of market pressure in probiotics, right? If you –

If you look at a lot of the information that, and this is a sort of sad occurrence of affairs, but a lot of information is actually info marketing. It looks like science. And oftentimes it is science that's being cited, but the big problem is cherry picking.

Right. We're a company. We make this one probiotic. So we're going to tell you all about why this is the best probiotic. But they might ignore other studies showing that a different but similar probiotic worked equally as well and move and following very closely for well over five years now. The science is being published. And sure, if you go back maybe seven years,

It was the first probiotic that helped constipation. So up until that point, no probiotics had shown the ability to improve constipation. So then it became, well, this is the probiotic for constipation. But three months later, a different formula did a clinical trial for constipation, also demonstrated benefit.

And so now there's been even comparative trials that have done one probiotic for a month, a two-week washout, different probiotic for a month, comparable effects on constipation.

And so it goes on and on and on. That happened with depression. There was the first probiotic that did great work of publishing a clinical trial showing benefits for depression. And that got marketed as the probiotic for depression. But months and years later, there are now five, 10 different clinical trials with varying probiotics, all showing benefit for depression. Right.

And it's simple. If we get out of the reductionistic framing...

and realize that the probiotics aren't functioning like drugs that just modulate serotonin directly or block reuptake or whatever it is, if they're healing the gut, then the objective should be using a diverse array of probiotics to heal the gut. And then for some people, gut issues manifest, and I know you know this, but as joint pain, for other people as skin reactions, for other people as brain fog, for other people as burning, other people as constipation. So the real objective is, in my view here,

Using a broad array of probiotics to try to heal the gut and then let the manifestation of the gut healing come to the surface. And so this is why we advocate for an approach called triple therapy, which is essentially, if you take a step back and you look at the probiotics out there, there's your really traditional lactobacillus and bifidobacterium. This is sort of a yogurt-based probiotics.

They have the longest history of use. There's the most clinical trials there. So VUSL3 is kind of your really traditional one that maybe someone's conventional doctor recommended way back in the day, or VisBiome is something similar, more of like the big box companies. You also have

Different from that healthy fungus, this is Saccharomyces boulardii. So it's actually not technically a probiotic. It's not a bacteria. It's a fungus. But Saccharomyces boulardii has a lot of trials. The sort of OG formula, if you will, is Florister. Another one that someone's conventional doctor may have recommended because it's got a long history of use. And then the more newer kid on the block are the cereal-based or the spore-forming.

These are the bacillus species that you see in different formulas. And they all have research of varying degrees showing benefit for different conditions. So the way we look at this is, well, rather than looking for the one

you know, probiotic for the given symptom or condition. We try to get people on all three. So people have kind of like a super probiotic, almost getting closer to an FMT in a way in that we're trying to get as many probiotics into the system as possible. And we see this supported in many different conditions. We know that when treating SIBO, let's say we are using antibiotics, two antibiotics tends to work better than one.

There's the Jerry Mullen study out of John Hopkins that found that two different herbal formulas for SIBO worked really well. So there's this sort of recurring theme that use more than one support for the thing you're trying to tackle. Lime would be another beautiful example of that. It's commonplace to use multiple antibiotics or multiple herbals.

So we're just bringing that same concept to the use of probiotics. And I think it's so important because we want to get as much yardage out of probiotics before we go on high dose oregano or Zyfaxan or whatever it is. And those are all fine and good. But again, let's get as much improvement from probiotics as we can. So that's why we use and advocate for the triple therapy approach.

I love that approach because I think when we're talking about Lyme disease or any condition, it's like a good shotgun approach because they're saying, Doc, is it true? I don't want to get off subject, but we're talking about the gut and how you're showing – even in your book, you talk about how you're healing the innate ability of the gut, but also bacteria. Yeah.

bacteria that are not as beneficial as they ought to be. They call them quote the bad bacteria, but they can actually, they're very smart and like, and in microbes can actually like try to evade you and kind of be like, try to escape. So like the shotgun effect effect is very, very it's like, it's very effective. When you do that type of effect, what are some of the things that see, cause you see, especially with the mood and, and you can go around like in your opinion, does the mood get changed a lot when that happens?

Yes. And there's a meta-analysis demonstrating. So for the audience, a meta-analysis is a summary of all the good trials in any body of literature. So if you really want to have a truth serum, it's a meta-analysis because by definition, it might be summarizing 10, 15, 20 different clinical trials.

So it's really hard to cherry pick a meta-analysis because definitionally it's summarizing all the data. Whereas you can find just one clinical trend. This is the pernicious thing about science where people will just still find the one trial that supports their preconceived beliefs and they'll cite that one trial. So it's easier to be misleading with any individual clinical trial. It's very hard to be misleading with a meta-analysis. So

So there's a meta-analysis on probiotics for depression, which is fantastic. And coming back to my earlier point, that meta-analysis summarized different formulas across the different clinical trials. And so this is why I don't have a very particular view because even when the researchers are pulling together, I think it was over 10 clinical trials, the formulas and the dosages weren't the same, yet they all were beneficial for depression. Right.

The other thing that I think is really cool about probiotics for depression is it's not just depression in the brain, but it's also that brain-gut connection. And I'll swing together two studies, one by Alex Ford, who's at University of Leeds, and then a follow-up study by Imam Quigley, who's at Houston Methodist. And essentially what they found in these two different studies is

When people have gut symptoms, they have an overactivation of the fear center in the brain called the limbic system. Mm-hmm. Proteotics, to the degree to which proteomics reduce gut symptoms, they correspondingly correct and make more normal the activation of the limbic system. So there's this beautiful connectivity to as the gut gets healthier, the limbic system gets healthier, and that makes the gut even healthier. It's this sort of loop, right?

And they know this by doing functional MRI. How do they know what the limbic system looks like? They put people in functional MRIs and they scan their brain pre-post intervention. And you can see through circulation how much these centers are lit up. And there's the appropriate amount. There's too little and there's too much. And people with IBS have too much limbic system activation. And part of that is probably due to this really ancient kind of playing on the theme of the podcast here.

center in the brain that wants us to avoid danger. And I've used this example before, but let's say way back at hunter-gatherer days, let's say you and I were out for a walk. You grabbed some berries, had a handful, and then I watched you throw up and die because they were poisonous berries. The REMWIC system wants me never to forget those berries, right? So that's what it's there for.

But modern day where we don't have all these dangers to be looking out for, it can sort of trick us in terms of thinking that there's more danger out there than there is. And that creates fear. It also actually exacerbates food reactivity to some extent or makes the immune system more reactive. So it's a big deal doing it will get that limbic system to the appropriate level of activation.

You described that so well, Doc. Well, good heavens. So there's a loop going on and you say there could be a recorded memory of like something that would activate the limbic system. So many people out there probably I'm thinking this. So whenever you go into like limbic system fear centers. So the way you eat could definitely affect how your mood and your fear responses. So fear could be like a mechanism about what's going on in your gut then.

Exactly. And to close the loop, I'm sort of the imam quiggle part of this. He also showed that cortisol levels normalized as the limbic system calmed down. So for the people in the morning who are really, let's say tired and they feel like, oh, if I don't have coffee or whatever it is, I just can't get up and get going. It's because people oftentimes have suppressed cortisol output in the morning when we want it to be high, it's not high.

Uh, and the limbic system contains the thalamus and the hypothalamus, and that's the signal center to tell the adrenals to make hormone. So it's beautiful how all of this fits together when you understand the physiology, like the gut, the brain, the brain, the gut and the brain and the hormone centers like the adrenals.

are all connected. And the question is, you know, where do we intervene? And certainly you're not saying the only one, but Probiotics is a key support to help with this whole sort of cascade of physiology. I mean, like, I love that about on your social media and even in your book, when you're talking about like the connectivity of it, because if mood is changed and physiology has changed, many people out there like,

I think like you say, that's a beautiful thing about reductionist view. We're in a society where things are reduced and you're tying it together. And like when we talk about biochemistry as well, we're talking about how each part of your life is directly affected by the gut. Like that's one of your main state, like the main focus. One thing I was going to ask you too, when people see like how much it's intertwined with the way they're thinking, and this is again, guys, not to be off subject, but

But many times patients will have like constipation. Okay. So I'm saying that

Is that like a clear sign doc? Like you, you need to have a bowel movement, but what is like your overall view on constipation? Cause people don't drink enough water per se. Maybe I'm hyping water too much in my office and it may be something like a simple question, but doc, like if it's that intertwined with your mood, your emotions, everything like being constipated has to say something pretty severe, I would suspect. Yeah. Yeah. And, uh, 2023 was a pretty interesting year in terms of, there was a few clinical trials that really demonstrated the

efficacy of probiotics for constipation. One thing I'd want people to keep in mind is a few of these studies, surprisingly me, they didn't find that constipation improved until the second or third month of probiotic administration.

importantly, this was done in placebo controlled fashion. And so what they would do is picture this graph and the graph is showing you on the Y axis number of bowel movements in a day. So at first they're near zero, right? And then both placebo and probiotic group are coming up a little bit because whenever you're in a trial, even if you're taking the sugar pill, the power of the mind, I guess, the placebo effect is going to have a positive benefit or a positive effect. But

Only at about the second month, you see the probiotic group significantly have more bowels in a day than the placebo group. And I said, huh. So I have to be a touch more bridled because usually I want to get people results as quickly as possible. And the general finding in my experience has been you'll know within a month if the therapy is helping.

But constipation may take a little while longer. Again, it wasn't until the second or even in some people the third month that the probiotics had that benefit. And it might be because the probiotics are trying to fix a few things. One, it could be the gut-brain connection. Two, if there is bacterial overgrowth, some of the bacteria, if they're methanogens or methane gas releasing, that gas actually causes a slowing of motility and therefore constipation. Oh, okay.

And it may take a little while to bring the load of those bacteria down enough to then see the improvement in constipation. But yes, there's a brain component to this. And there's also some interesting research showing that people with childhood trauma have noticeably more constipation than those who don't. And it seems that through some mechanism, which I don't know that we fully understand yet, or at least I haven't seen prior trauma,

or leads to constipation. It's almost for certain got a brain component to it. I just don't know exactly. And it's also probably limbic system. But yeah, so there's a lot going on. But water, like you said, movement is another. There's a number of studies finding, and I say this, it's a little bit trite, but if you move, your bowels move too. So water, movement, and then fiber movement.

Fiber is a little bit of a double-edged sword. Some people up their fiber and they get more constipated. Other people up their fiber and it works really well. Water is going to be important to make sure you're not sort of just putting fiber in without adequate water and you have this like hard cork that gets stuck. But given that the water intake is sufficient, try increasing fiber and it tends to go one of two ways in terms of it helps some people.

It doesn't help others. This is why I recommend if you're going to add a fiber supplement like psyllium or whatever it is, wait until you're a couple months into treatment. Your symptoms are improving. That's when adding fiber tends to be the most beneficial for bowels and it's not going to be flaring. Some people will get bloated also when they have fiber. So I wait a little while on the fiber just to time it appropriately. So about a month or so after. And, Doc, like there's so much – I mean –

You're right about like fiber. Cause I, I think it's a big point of discussion too. I think a lot of people get mixed reviews about how they feel about fibers. Cause isn't a fiber. And again, I sometimes I jump on rabbit trails, but fiber is so important. Like when you're starting to clear it, doesn't it help like,

Your body combined with parts of your digestion to help with your hormone, like to clean out the hormones and clean out the gut. Yeah. Totally. The way I think about fiber and just a general framework, I bring up the conversation of gut health and diet is it's like a rehab plan. So if you had a really significant back injury.

What we would do to get you back to full activity would be different than the exercise plan to maintain health, right? So if you had a back injury and you said, well, just do what Mike does. Eat the way Mike does because Mike has healthy bowels. It's not going to work. So if you went out and started doing weight training and cycling and running and sprinting with an injured back, that's really going to flare you. Mm-hmm.

Same thing happens with, I think, fiber in the gut. When the gut's irritated, if you put fiber into it, you're going to flare that injury. So it's part of the reason why I say, let's go through the rehab first. And yeah, then we can get you back to running, to cycling, to weightlifting. But between here and there, we need a rehab plan. And oftentimes that rehab plan will be a little bit lower fiber in some cases, like a low FODMAP diet's kind of lower fiber. And even for some people, carnivore. Sure.

short-term helps to kind of calm things down because remember fiber will feed bacteria and if there is a pre-existing bacterial overgrowth that's part of why i think we need to worry on the timing of fiber but the um the perspective that i want people to take away is the rehab plan because so often i know you probably see this too people think whatever diet helped them day one yeah is their forever diet you hear all the time we have to be on keto forever or low FODMAP forever nope

Almost for certainly no. But right now, as we're rehabbing you, that's what we have to do. And when you frame it in parallel to like a musculoskeletal injury, people get it. Like, oh, that makes so much sense. Yeah, like I would heal my back and then I could go like, you know, the PT wouldn't ever sell me on, well, Jim, I'm going to do this.

This, you know, firm rolling, stretching, stability plan is what you do forever, right? People would just intuitively get that the rehab plan is only for a few months and then you resume normal activity. Same thing tends to happen with the diet. I find that like every person will come in thinking that like gluten's wrong and that I have to stay off this forever and then I have to stay off eggs forever. And in no way am I making light of that, Doc. You know, it's just like…

We both know it's like, no, you're in this phase of your healing. So you're able to have more leeway. And I think people out there are happy to hear you say that. Like when somebody's coming in though, and I like you to talk about what's your favorite thing in health. So people want to know more about you too. So when somebody comes in or you're dealing with a patient, I'm

What are some of the things, I guess, that you encounter most about gut health? Or what's your favorite thing to work on with a patient with their gut health? If you don't mind, just one quick note on gluten. Yeah. It falls into the same rehab scenario because there's two main issues with gluten. One is, does the person have true protein allergy, gluten gland? And that tends to be more lifelong, and that's kind of –

celiac or non-celiac gluten sensitive. But different than that is remembering that wheat, rye, and barley, the main gluten-containing grains, those are also rich in FODMAPs or those prebiotics that feed bacteria. Good news about if this is where your gluten reactivity is coming from, from the FODMAPs, that's very able to be recovered. Very, very able to be recovered. And the same thing with dairy. And part of this is because

reactions or tolerance of those foods is dependent upon two things. The bacteria and fungus in your gut, which we've been talking about how we can fix that. And if your gut's inflamed, you make less enzymes that digest the carbohydrates in those foods. And that can also be healed.

And so for a lot of people, I think what ends up happening is they go gluten-free, they feel better, and they assume I'm pseudo-celiac. I can never again have gluten. And in a lot of these cases, not all, but I think the majority, it's actually a FODMAP intolerance, a carbohydrate maldigestion. And as the intestines heal and the bacterial population balances, they can consume gluten again. So that's one of the things I enjoy about

coaching people through is not being overly avoidant of food. And if grains are a health food or not, that's a different conversation. But again, thinking practically about the person who wants to be able to go to a dinner every once in a while with their friends and have a slice of bread and not be stressed out about it. The argument I'm making is for a lot of people, the answer to that's going to be a yes. And there's others, like you're saying, that clearly they can't do any gluten ever. That's a smaller subset and I

Again, what I'm arguing for is people to try gluten again, not claiming it's a health food, but just even socially as their gut heals. And they might be surprised with how well they do.

So there is hope for individuals. They can probably have gluten if they do it the right pathway. They could have some gluten. They could have some dairy. And I think people do lose hope. I think when individuals think about food and being restricted, I did. I couldn't do eggs for a while, Doc. I mean, I couldn't do eggs. I couldn't do gluten. And if you go to a breakfast spot, I couldn't eat anything. I'd be like, my friends were all enjoying it. But now, thankfully, like healing the gut, it's been helping where I can eat those things. Now, with this,

And the main points like when patients come in and you're taking them through this journey, when a person does come in and they choose to choose their journey with you, do you have like an extensive history? Are there the basic tests? I know you say there's some tests that maybe not the most reliable, but are there some basic tests that you say, this is what I like to go with?

Yes. So the C-Row breath test, I think it's a good test. It's a validated test. I don't use it very often because I think we can be probably equally or if not more accurate with just looking at the person's history.

I'll come to the ones I do recommend, but I just want to hit a few of the common ones that I don't think are super helpful because, you know, there's 400 bucks. And then if you want to try to test for Candida, which I also think isn't super helpful, to be the most comprehensive, it's stool, it's blood antibodies, and it's urinary organic acids. And that's near $1,000.

So right there is over $1,000, $1,500 of testing that we don't necessarily need. Then we add the office visit fees. Then we add the supplement visit fees. And inadvertently, now we're contributing to someone's financial stress. So in a lot of these cases, I don't think we need the gut testing. I do see a growing case for testing for Lyme.

And really, I think the more contemporary term for people is vector-borne infection because we're learning that the Lyme bacteria Borrelia is actually less common than Babesia. So this is important, and not to get too into the weeds, but...

Borrelia or Lyme, that's a bacteria and it's sort of friend Bartonella, also a bacteria. But Babesia is actually a protozoa. And so it's different drugs and it's different herbs to treat that. And I think what happens in some cases is

People, and I know you've heard this, people may be on aggressive antibiotics, so this is antibacterial, for months with little response. And it might be because they have all the symptoms that look like Lyme disease, but it's actually Babesia protozoa, and that requires different therapeutics to treat it. Yeah.

And the Babesia testing only, to my knowledge, over the past few years has really become kind of broadly available and accurate. So it may have been a gap in sort of like the Lyme radar. But because that delineation is somewhat important, is it bacteria, Borrelia, Bartonella, or is it Babesia?

I think testing for Lyme, not out of the gate, but if someone's gone through a few of the phase one, phase two steps, and we've seen some improvement, but we're hitting a ceiling that's kind of low, that's when I think testing there has merit. And then potentially,

testing for mold or at least probing into their history. Were you feeling well? Then you moved and all of a sudden you started having respiratory symptoms, brain fog, insomnia. The testing with mold is,

I don't think the urinary, so there's a urinary test. I don't think the urinary test is very helpful. Dr. Andrew Campbell recently came on the podcast. He's a big advocate of blood antibody testing, which we're starting to experiment with at the clinic. And I'm still making up my mind. Any one of these new hypotheses, when you first come across them,

Sounds so awesome. Yeah. And then when you subject it to some rigor in the clinic, you see, you know, how often does treating that lab finding actually lead to improvements? And that's the other part of the loop I'd like patients to try to understand better is not all of these tests have a very high what's known as predictive value, meaning that

treating that positive marker is going to predict a positive response in how you feel. And this is one of the big problems in functional medicine. We do all this testing. A lot of it is experimental and people end up kind of chasing their tail, treating the lab markers. So I'm open with the labs, but the way I frame it is I look at labs for the most part as like 25% of the data we need to make a decision. So the other things are weighted more heavily. Your history, your

your symptoms and your response to treatment, that's really the majority of the 75% of what guides decision-making. There's a few exceptions, but so a good blood panel looking at things like vitamin D, you know, metabolic panel, insulin, blood sugar,

Sometimes we'll run a G6PD test if we do suspect someone has Lyme. Methylene blue, as your audience may have heard, it's used in lower doses as sort of a cognitive enhancer, mitochondrial support. But in much higher doses, it's a pretty interesting anti-Bartonella treatment. But you can't do that in high doses if you're deficient in this G6PD enzyme. So, you know, depending on how someone looks, if we're thinking, hmm,

yeah, this person's done keto. They've done low FODMAP. They've done probiotics. They've done some herbal antimicrobials and they're still floundering. Maybe this is a Lyme case. So we'll build that into the blood work out of the gate just to try to, you know, have that tucked away so that if the Bartonella comes back positive, we can roll it into methylene blue if we choose to. I'm on a thyroid panel in some people. That's one of the cases that I think is really clear cut in terms of that can be very instructive in terms of, you know,

So taking a step back, thyroid is kind of the one exception where symptoms aren't super helpful that their lab values are. So for a lot of these things, especially in GI, I put symptoms way above lab values. Thyroid is the one inversion of that rule where symptoms aren't super predictive of if someone's hypothyroid or not, that the lab tests are really helpful in clarifying if someone needs hormone.

I love it that you're taking this approach that you're not just saying, we're going to throw all these tests because I think like you're right in functional medicine, you know, I'm doing like

A lot of like Chinese medicine testing and they've, I've done some functional medicine testing, but not to the extent that you, that you do doc. And I think that having a doctor that could analyze and look at symptoms in a positive way, like knowing a history and say, no, we don't have to do all those tests because there's people that spend thousands. I mean, I, you know, you have them that come to you too. And there'll be like, Oh, I just spent, you know, $30,000. I was that guy, you know, in defense of the healthcare providers watching this, I was that guy for a number of years and,

But, you know, there's always this critical voice in the back of my mind. And maybe it's because I'm, you know, I'm always, as a clinician, a little bit insecure. And so, you know, that sort of eats away at, well, boy, like I've ran all these parasite tests. Where are the parasites? Right. So at some point you have to say, do I need to be doing two tandem stool tests on every person and spending the seven, eight, $900 to do so? Yeah.

So once you start pulling on that string, paradigm shift, and there's this old quote by Earl Nightingale, which I love, which is, once the mind of man is expanded by a new idea, it can never again return to its original dimensions. Oh, oh, yeah.

I'm going to remember that one. Earl Nightingale, he said? Earl Nightingale, yeah. Once you no longer look at every test as being sacrosanct and you start questioning them, it really shifts the paradigm to being much more choosy with your test and then thankfully much more responsible with your patient's money. I think we're all trying to be as responsible as we can, but I think the paradigm needs to shift a little bit.

I do too. I think – one thing I appreciate about your podcast and about your social media is like when you talk about looking at somebody, let's say when they – most people in our culture probably have some form of SIBO or like they could have Bartonella. They could have Babesia. Do you find like –

There are lifestyle changes that everybody out there should do because regardless, even if you necessarily didn't have just straight SIBO or fungal, but they should do some of these things because they need to heal their gut. Like in this culture, there's some standards that you go by. Yes. And you're totally correct. I mean, the.

The pieces we tend to gloss over are foundational. I think we gloss over them because so many of the people we interact with are just incredibly well-read, but this is still so worth repeating. And there was one study looking at chronic fungal overgrowth. They were giving Nystatin. They were giving a drug, but what they did was half of the group got just Nystatin. The other half got Nystatin plus a candida diet.

The resolution rate doubled when they did diet plus Nystatin. Doubled from 42% to 85%. So yeah, it makes a big difference. And then with Lyme, Joseph Berascano has a lot of good information. And he says that three things that he finds holds back treatment, lack of compliance with their treatment program, sleep deprivation, and alcohol consumption. So all lifestyle-based things. So the diet for your gut type, I think that's

Really helpful because I'm assuming pretty much everyone watching or listening to this, they're eating fairly healthy, but it's possible that within this wide swath of healthy foods, you're eating organic, fresh, what have you, that it may not be the right macronutrient composition for your gut type as sort of that shorter term rehab diet. Exercise, hugely important for your immune system, for inflammation, for your mitochondria.

Your stress levels. And this is why I'm so attentive to how we build this into the conversation about food, not wanting to impart undue stress due to food fear. So, you know, those are a few, but certainly diet, lifestyle, time outside, having something meaningful in your life also, because there are some people that want to get well. And again, I've been there, so I get it.

So badly that they, they're not doing anything of enjoyment or any hobbies and they're just constantly ruminating and like researching their symptoms and that can bring me to a really dark place. So what's that old Nietzsche quote? He who has a why to live can overcome any how.

Oh, right. So, so have you like having something, and I know sometimes it's easier said than done, but you know, having something bigger than yourself that you're trying to get through this health journey to, you know, to, to get to, I think is, is all, all of these things are really important. And I think that if people would, by the way, doc, great quote, I'm going to have to like hit you up lately. Like give me some of the quotes, man. I'm not thinking about these. Um,

So with the foundation of gut in your book, and I want you to – we're going to put that on the show notes, okay, and these foundational pieces. When you started cleaning up the gut, and I know that I'm always very cautious about your time and such, but –

With energy production, and this is one of the last, I think one of the things I really love about how you talk about thyroid gut connection, because you start to heal the gut. Everybody's super tired. Can you touch just a bit about why is there so much reduced energy in our culture and that directly associated with the gut, with the thyroid? Yeah, yeah, yeah.

You know, this is, there's so many directions that I have to go or would like to go here. Let me lead with the one that's a little bit more nuanced, but I think it's really interesting. I have this growing suspicion that for people who have suboptimal body composition, meaning they're carrying around more fat than they feel like they should, when they're tired, there's something impeding mitochondrial function. And, you know, the mitochondria will burn fat, fatty acid oxidation to make energy and

And there's this phenomenon known as the cell danger response. When there's inflammation, especially when there's infection, that actually turns down mitochondrial function.

And the way I think about it, it's a little bit crude of an analogy, but in your basement, let's say you had your furnace. Let's say your furnace, you know, to make heat or produce air conditioning or whatever, it's going to get a little bit hot. Have you ever felt a furnace where you can tell, oh, you know, it's a little warm? Yeah. So the furnace, to an extent, it has a heat sensor.

And if it gets too hot, it says we have to shut down or we're going to burn up. I think with the mitochondria, the same thing happens. They're your furnace. They make your energy. But if there's all this inflammation systemically due to an infection or whatever else, the mitochondria can sense that and they say, we're going to turn down energy production because we don't want to burn up. And then you have fat accumulation and you have fatigue that

The question is, what do we do about that? And this is where I think the conversation about gut health, about chronic infection might really be what underpins a lot of this mitochondrial dysfunction. I think like when we talk about how much mitochondria, like you say, with different responses that are ingrained in us, it's like as a culture, you're starting to see like

certain amounts of fear, certain amounts of like this overall energy that seems to be coming over our culture in the last few years that people are in a constant, I guess they say fight or flight. So with that doc, when we talk about like with energy production being affected by the gut and all aspects of life being affected by gut, do you see here in the future, like what do you see? This is

Again, a vague type question. I hope it's not. But what do you see like for the future of like gut health? Like where is it leading? Is it just – I mean it's probiotics and it's just like I love your foundations. It's like you just got to stay steady and firm. But is there any like advances or any new therapies or anything like that that you see coming down the pipe that would improve? Yeah, and there's a few that are already kind of here, but I should just kind of give an honorable mention if you will. Like you said, herbs, antimicrobials.

Antimicrobial is a term I use, I know the field kind of uses as something that's antibacterial, antifungal, but it's natural. These are powerful. There's one study looking at this New Zealand shrub called Hoyopito.

And it was giving this herb in comparison to nystatin for women with recurring vaginal yeast infections. Yeah. And there was a significantly higher cure rate with the herb as compared to nystatin. What? Different study looking at chronic relapsing SIBO. They gave half their group...

berberine, the other half rifaximin or zyfaxin. And they did something really smart in this study. They followed them for a little over six months because what you see in some SIBO is you feel a while when you're on the antibacterial or the antibiotic, but then when you stop a few months later, symptoms come back. They found a much longer prolongation of being symptom-free when using the herb berberine as compared to using the antibiotic zyfaxin.

So there's more and more research showing us that herbal medicine really has a time and a place. And it's just coming back to the individual, listening to them and trying to figure out, is it fungal? Is it bacterial? Is it maybe Bartonella? And how do we pull from this wonderful arsenal of herbs that we have?

to meet the individual's needs. So I would say herbals, there's a lot there and it's a wonderful tool that people have with easy access. You don't need a prescription. They tend to be much safer in a lot of cases in antibiotics.

The other thing I would want to mention too is, especially for the bacterial type guts, is an elemental diet. An elemental diet is essentially a predigested shake that is formulated to be hypoallergenic and very easy to absorb. It actually absorbs within the first two or three feet of the small intestine, which is about 22 feet in length total. So all

almost like a springed ankle, you give most of the gut a rest. And so if there's leaky gut and overgrowth and inflammation, and every time you eat, the food is just making its way through this really inflamed tract, you can give it a rest by using an elemental diet. And that's something I'm really excited about. It can be such an easy unlock for some people. We call it doing a reset. You just do exclusive shakes for a couple of days and you're

Um, the difference here is some shakes people make, they have a lot of prebiotics in them because they're trying to keep the carb content low. Yeah. So they put in prebiotic sweeteners, but if you have that bacterial overgrowth, you're going to bloat, you're going to have diarrhea. So, um, that's another tool I think is really interesting is, is using an elemental diet kind of as a gut rest.

Do you have your own shakes, Doc, that you produce for the Elemental? Because I got to get it from my mom, so I'll get it from me. Man, I'll promote the heck out of that, Doc. This is great. I'm proud to say that we launched the first commercially available fully Elemental diet. Because this goes back to about –

God, about 2016, 2017, I was speaking at the GastroNP, which is a wonderful naturopathic gastroenterology conference. I was mentioning the elemental diet, and I was expecting everyone there to be using it fairly regularly, and very few people were. And it's because the only formula available is

was known as by the next plus, which if you ever lick like a, um, uh, an envelope that, that, uh, glue, you know, that glue has a nasty taste. That's exactly what this tasted like. It was pretty horrid. Um, and,

And so thankfully I had a few friends who were in the supplement space and I said, Hey, how do we do this? Like, how do we, how do we make our own supplement? And, you know, they kind of gave me the walkthrough of, you know, you've got to invest in buying a lot of units, but if you're okay with that risk, you know, then you can go to a manufacturer and say, how can we make this thing do what it does as the Vivinex Plus does, but improve the flavor profile. And so, you know, that's what we did just bore out of,

The research on elemental diets is really compelling, but no one would use it. So we said, can we make this taste better? It turns out that we could. It just, you know, no one had really, no one had cared to take that therapy and make it a

therapy that was used for people other than on the brink of going to the hospital. Because those people will use it because they're desperate. But what about everybody else? Right. So that's sort of like the problem that we tried to solve. And, you know, I think we've done a pretty decent job because it's, you know, it's not a Snickers bar, but I'll say it tastes pretty darn good. And now it makes it so much easier for people to use.

I'm serious, Doc. I'll get your contact info. I mean, I'll get a hold of this because I really even know my patients need it. And I know even family members that need that very much so because that makes total sense about how the gut lining and the intestines are inflamed part of it. You give it a rest. So.

Yeah. Oh, and real quick start. So people could theoretically do this with like a water fast, but it's really hard for people to do multi-day water fasts. As I'm sure you know, they won't sleep well. So I think we need to find the middle ground and that's kind of what the elemental diets are built to do.

I'm really interested in this, Doc, because you're answering the questions that I've been – this is what my patients have been asking me the last two months. Great. Awesome. We'll get that going. Doc, what's – I like to ask you a few questions because, I mean, you're a wealth of knowledge, and I want everybody out there to follow everything you do. And I don't say that lightly because you have really good scientific explanations like –

Anytime about gut health, you can look on your page or even on your YouTube channel and you break it down really well. Where would people find your info and where your product's at? Because I mean, can they find it usually just on the website? Usually people just treat you. Yeah, if you Google my name, Michael Ruscio, R-U-S-C-I-O, I come up pretty easily. It's drruscio.com is my website. And we have the book and some products and the podcast and the telehealth clinic for people who are in need.

I mean, I think that, man, this has been really good because like part of me, though, like in an interview doc, it's like I want to ask you like, you know, personal questions like for my patients and stuff. But I know it's like I don't want to get sidetracked, but I love this. But one of the things I really like to ask people is like, what is your your favorite health hack for the year? Like there's something that you're really I know you had elemental health, but is there something personally that you see out there and you go, man, that's a really cool health hack. What is yours for the year?

Yeah. You know, something is funny because Josh and I were talking about this when he came on my show recently, it's hyperbaric oxygen. And this is part of where I came up with that theory about the mitochondria, because when I was doing hyperbaric, I was very easily able to get into ketosis. So I have the biosense breath ketone meter. Yeah. When I had a

phenomenal amount of energy. And then I ended my month of dives. And the longer I went from that, the harder it was for me to get into ketosis and my energy wasn't quite as vigorous as it was. And now what the hyperbaric does is because you have pressurized oxygen,

you really feed the mitochondria and you actually grow more mitochondria and the ones you do have get larger. So it's a really powerful mitochondrial support. And for people with Lyme, if you look at all the things that Lyme does negatively, turns down the mitochondria, turns down circulation, creates chronic inflammation,

And the hyperbaric addresses all of those, improves circulation, improves mitochondria, breaks down biofilms, reduces inflammation. So I think for that community, this could be a really important unlock. But for me, yeah, I'm now going through my second series of dives and a little early to say, but I'm excited at the prospect of if people are

sort of stuck in that inhibited mitochondrial state, that cell danger response I described earlier. When complementing treating the infection or the gut issue with hyperbaric, I'm excited at the prospect that that might hold for people as a natural therapy, right? It's non-drug therapy and it's really rejuvenating where, you know, you can say for, let's say for Lyme,

I think there's some really interesting research from Richard Horowitz on aggressive antibiotic therapy. But, Bori, that comes with some issues attached to it, like fungal overgrowth in the gut. Some of those antibiotics actually are poisonous to the mitochondria. So I'm open, and I think for some people it's a clear win, but what if we could do an aggressive herbal approach

paired with hyperbaric? What if that was as effective as the big gun like DAPS own protocol it's known for Lyme? So I don't know, but that's one of the things that we're experimenting with. Anyone, we found a company, great job. I don't know their name off the top of my head, but they will actually send people a hyperbaric unit and you can use it at home.

What? It's a two-month commitment. It's about $900 a month. So it's not pennies, but for having an at-home hyperbaric unit, that is an amazingly good deal. So we've been referring some people to get a chamber, and then we're doing the herbals in parallel with that. Again, it's too early. We haven't had enough people report back, but it's a therapy which I'm really excited about.

Doc, I'm interested in this because I have some patients that I need to send your way because I like just that explanation because even I would love to try to do things like that because I want to get that info about that company, but utilize your program. That'd be great. And what's the name of the group again? Their company?

I don't know off the top of my head. Well, I can send it over to you. You can put it in the chat. One thing I will say, and this is just my own speculation, I do think people should be making some headway if they do have an infection before they start doing the hyperbaric. Gotcha. So I would say pre-treat for a month or two with the herbals and then go to the hyperbaric. That's just my thinking on this. But the fear that I would have is,

If you start strengthening the immune system to fight that battle that it's kind of losing with a chronic infection and you send in no supports, it's just hyperbaric, I think what might end up happening is the war goes on longer than it needs to. So you want to kind of send reinforcements. If it's going to be hyperbaric to strengthen your immune system, send in some immune support agents with the herbals that can kill. And I think together, that's how you kind of win battle.

you know, the, the war and not have a prolonged battle, I think. And who knows, I might change my opinion on that. I would love to see it doc. I mean, with that kind of was hyperbaric mixed with herbs. I always love new therapies and it's coupled with scientific and you can just do those different things that can like kill off infections. I'm all about cleaning out infections. I love it. So, I mean, I'm all about it. So when you put it out, doc, we're going to do another podcast when you tell us more about when you, when you see more of the research, that'd be great. And I mean,

And I say this doc, I mean, this has been a great combo. This is like one of those learning combos I really enjoy, but you know, you're a scientific dude. You look like, you know, you're a really smart guy, but what are something that somebody would really, really be surprised to know about you? Like, I like to know those things like, uh,

Uh, yeah, I mean, maybe I'm, I'm a big kid and I think it's important to maintain that, that big child to give you a quick story example in case it helps people at all. Uh, Halloween, I decked my place out. We have a really good neighborhood, so there's just kids everywhere. Yeah. Uh, I have a Vespa scooter.

I was dressed in a scary clown costume and I was playing this sort of creepy circus music and just riding around on my scooter, scaring people on Halloween. So, you know, just have fun. Right. And yeah, you know, when I was done driving, I had a few drinks. I had a piece or two of candy. I'm not a huge candy guy, but, you know, live generally healthy. And I think if we can

Kindle as much energy as possible and then put that into fun, adventure, exploration, whatever your thing is. Maybe it's music. Just don't forget about that aspect of your life because it is so, so important to have fun. Doc, this has been good. I mean, I think that –

That your explanations, I think everybody out there, if you're listening and watching this, please check out Dr. Ruscio's information because you're going to get a very clean and easy step-by-step approach. It's scientific. It's smart words, but I'm saying at least he explains it to where you can understand it.

And, Doc, you're putting out the good fight. You're working with people, which I love and I'm so thankful for. I'm really thankful that you came on the show with us today. Me too. This was a great conversation. It was a great conversation. I just like hearing from my colleagues. You guys, you're changing the world. Everybody out there, hey, if you know anybody that needs this information, Dr. Ruscha has a great show. Go over there. Comment on his stuff. You can comment, and we can send it over to him. We're going to have some great things in the show notes.

and on his show. So guys, take it easy. We're really appreciative that everybody out there is listening. If you guys like this show, drop us a comment, hit the bell. They always tell me to hit the little bell so you know when a new episode is coming out. And again, Doc, thank you so much for this great convo. Appreciate it. Thank you. It was a pleasure.

All right. Thanks, guys. Before we wrap up, please remember that the information shared in this podcast is for educational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice. No doctor patient relationship is formed through this podcast and the use of information here or materials linked from this podcast is at your own risk. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment.

Always consult with your health care provider before making any changes to your health regimen and do not disregard or delay seeking medical advice for any condition you may have. Thank you for joining us today on the Ancient Health Podcast. We hope you've gained valuable insights into the harmony between Eastern and Western medicine. If you've enjoyed today's episode, be sure to subscribe, share, and leave us a review.

Remember, true health is about balance, mind, body, and spirit. So stay tuned for more episodes where we continue to explore how ancient wisdom and modern science can work together to help you thrive. Here's to your health, balance, and well-being. I'm Dr. Chris Motley, and I look forward to our next episode together.