Barbell Shrugged - [Gut Health] How to Heal Your Digestive Tract w/ Dr. Michael Ruscio, Anders Varner, and Doug Larson #724

Episode Date: December 6, 2023

Michael Ruscio is a DC, clinical researcher, and author working fervently to reform and improve the fields of functional and integrative health. With his clinical and research teams, he scours existing studies to inform his ongoing clinical research, patient care, and guidance for health seekers and fellow clinicians around the world. His primary focus is digestive health and its impact on other facets of health, including energy, sleep, mood, and thyroid function and optimization.  Dr. Ruscio’s, DC, book, Healthy Gut, Healthy You, has paved the way for a ‘start with the gut’ philosophy that has enabled doctors and patients to see improved outcomes with minimal expense and effort. Since 2011, Dr. Ruscio, DC has pioneered the way to providing practical, cost-effective functional medicine care by pragmatically applying evidence-based therapies to thousands of people with real symptoms. Dr. Ruscio’s, DC, ability to objectively analyze medical literature has made him a trusted voice of reason, which he shares in his top-rated podcast and blog, and in a newsletter for functional medicine practitioners.   Connect with Dr. Michael Ruscio Instagram YouTube Anders Varner on Instagram Doug Larson on Instagram

Shrugged family, this week on Barbell Shrugged, we are hanging out with Diker Michael Ruscio, talking about one of my favorite subjects of all time, gut health. We're going to be digging into probiotics. He's got a wealth of knowledge of probiotics, a little bit of the history of gut health, because I've actually never understood when we started to pay attention to the gut as the source of overall physiological health. But he's also just a wealth of resources. I even get to talk a little bit about how we work or how he recommends using probiotics with children because most of the people listening to the show have them. And I know in my household, it's a big topic. So I really enjoyed this call. Anytime we get to dive deep into gut health and kind of understanding the

physiological effects of gut health on our digestive system, how to improve it, tactical steps you can take on a daily basis just to improve your gut health, always really gets me going. As always, friends, you can access a free lab lifestyle and performance report from Dr. Andy Galpin

and Dan Garner by heading over to rapidhealthreport.com. This is a video that everybody inside Rapid Health Optimization will receive, and you can access that free report over at rapidhealthreport.com. Friends, let's get into the show. Welcome to Barbell Shrug. I'm Anders Varner, Doug Larson, Dr. Michael Ruscio. Welcome to the show. Hey, guys. Good to be here. We're going to be talking about gut health. And as I mentioned, pre-show 20 minutes ago, I was just realizing, I don't know much about the actual history of when people started looking at the gut as kind of like the center of how we can

start to make people healthier. And I'd love to hear just like a little bit of the background, probably, which is like a gut health 101 that you went through in, in your training. But when did scientists start to really like look at the gut and say, this is the place that we need to be focusing to, to start really getting people healthy? Yeah. Well, it depends on how gross of a, of a backstory you want to go to all of it. The grosser, the better, the more gross, the better. I believe it was known as yellow dragon soup in Asia, which was the really sort of ancient form of fecal microbiome transplant therapy. And for the audience, that's where you take donor stool and give it to someone who's ill. And it can be really helpful, especially for resistance C

diff infections. But you know, way back when they would actually make a soup out of a healthy person's poop and have someone with uncurable gut ailments drink the Devil Dragon soup. So it goes pretty far back. I'm so happy I asked this question now. But maybe a little more contemporary. There was Henry Boulard. I believe it was in the 1920s. He was traveling in Indochina looking for a new way to ferment wine. And at the same time, there was a cholera outbreak.

Everyone was having diarrhea. But he noticed that one group of people who were drinking a certain tea didn't have diarrhea. And he later isolated Saccharomyces boulardii probiotic from that tea. And that was why the people didn't get hit with the diarrhea from the cholera outbreak. So, you know, there's that. And then there's Meshnikov who observed some Bulgarian villagers who were drinking fermented milk lived longer than the people in other villages in the same area that weren't. So, you know, there's a pretty long history or Hippocrates people all heard that, you know, quote that health and disease starts in the gut. So it goes pretty far

back. Yeah. Uh, the first time I ever started to focus on gut health was probably, uh, a somewhat of a common story, a little trip to Mexico, nursing a little hangover and going and getting the iced coffee from Starbucks, which then put me in bed for like 10 days. And on like day five, I was like, something has got to change. I got on the internet. I started, I was like, how do I fix this thing? They're like, go get probiotics. So I went and bought at the Sprouts down the street. It was like probiotics for 80 year old men. And I i was like that's gotta be the most aggressive one that i can take so i just started like shut and then the next day i woke up everything was great and i was like i healed it great yeah to then realize that i needed to do

more than like two days of it and it all pretty remarkable response in two days shows the power of probiotics and then it was uh was, and then the war inside. And I was like, man, there's like a little battle going on in there. I'm feeding it with good soldiers. The bad soldiers are in there. They just killed all the 80 plus year old probiotics that my uneducated brain thought were good for me. And now I'm back to normal.

So then I just kept taking them. I'd love to dig into probiotics and kind of understand like how do people find the right ones, the dosage, everything over the counter is like a, is always like a question mark of like, should we really be taking this or did they just need something? Yeah. You know, and I've changed my tune on this over the past, maybe two or three years. I think one of the challenges in the functional medicine, integrated medicine field is so much education comes from the supplement companies to the doctors, whether it be weekend seminars or, you know, just, you know, insidious funding of various sources. So because of that, you get very

sort of supplement company centric messaging. What it's got to be the, you know, the special form with a special capsule and the special this, which is usually being marketed by the company that makes the special X, Y, or Z. Enter a meta-analysis this year by Zorzella and colleagues. Fascinating meta-analysis. They took a bunch of probiotics, and this was a meta-analysis. So they're summarizing different clinical trials. So it's not just like a cherry pick of one study found this, it's multiple studies found this. And what they did across all these studies was took probiotics, heated them up to kill them, and then gave them to subjects and compared them to live

intact probiotics. And they found about equivalency in the results, meaning that even a dead or a heat-killed probiotic is about as effective as a live and intact probiotic, which tells me a few things. Refrigeration, not necessary. Special enteric coating, not necessary. And does it need to be uber high quality or high dose? Probably not. I mean, you want to look for basics like GMP or good manufacturing practices and make sure it's not ridiculously inexpensive because sometimes that just cutting corners and the sort of pernicious thing about the low cost probiotic, not to say higher cost is better, but we have a video where we actually broke this down. You look at a couple of the formulas on Amazon, Amazon sellers, knowing that people want to have a low price point to entry, $15 for one formula, $20 for the other formula. And we compare that to one that we use

in the clinic, which is about, I think it's $45 for a bottle. But then if you do the math of doses per bottle, you would need five bottles of the cheaper probiotic and one bottle of the one that we use. So that's where things can get kind of sneaky. So I would say it might be more important once you're looking at just basics of quality, meaning GMP is a good thing to look for that a company follows, then you're probably okay. Then just be careful that you're not buying necessarily the cheapest product. You do some quick math in terms of how many capsules per serving and how many servings per bottle. So you don't buy a cheap probiotic. oh, I got a good deal, but there's only seven

servings in this entire bottle. For that meta-analysis, you're comparing live versus dead bacteria. To what degree is placebo entering in there versus some being fed a pill where there's no alive, no dead, but they still think they're taking a pill and then like a complete control group, et cetera. Dr. Justin Marchegiani Sure. Well, that's where the – with a meta-analysis, they're going to be summarizing randomized control trials, which will always have a placebo arm. So totally, it's a super important question, but that would be guarded against – I mean,

you can never get placebo down to zero, but at least the study was designed in order to mitigate placebo as much as possible. Dr. Justin Marchegiani Gotcha. So all the bottles that we see where it says like live cultures and it's like marketed, like that's an extremely beneficial thing, or at least that's kind of the implication, that doesn't really seem to be the case? Dr. Tim Jackson No. I mean, that's what we thought, right? And I think it's, you know, there's some things that the field is doing, which is totally questionable

and people should be called out. This is one where I think the science has just this year shifted. And, you know, now you're probably going to see companies and messaging catch up to that, but to your question, yeah, it seems that the live intact doesn't really mean as much as we thought it did. This is something I wrote about. I released a book in 2018, healthy, good, healthy you. And there was one study of this kind. And so I made kind of a book in 2018, healthy, good, healthy you. And there was one study of this kind. And so I made kind of a in passing comment, like maybe this isn't as important as we think, but it's only one study. So we need to wait until more studies are published with the study this year being a meta-analysis of, I think it was 11 trials, pretty conclusive data showing

that yeah, if it's, if it's live and intact, it doesn't really seem to matter. For, for probiotics to only have one single strain in them versus the, from what I've heard from other people that there's many, many dozens or hundreds of different types of strains within the gut itself to, to what degree is it beneficial just to inject a single strain into that very complex system that is much more complicated than just one one siloed version well i mean a single strain or species will be better than nothing and maybe just to delineate so you have people have probably heard of lactobacillus acidophilus that's the species then you can go even further and give it a strain designation and just using arbitrary, it might be A156. So it's lactobacillus acidophilus species, and then the strain is A156, or usually there's some

sort of designation like that. So when compared to nothing, a single species or a single strain is going to be better than nothing in most cases. It's kind of contested in terms of, should we be using a single or using a multiple species or strain formula? There's a trend, it's not conclusive, but there's a trend across multiple studies showing that multiple species or strains is probably better than just one. Shrug family, I want to take a quick break. If you are enjoying today's conversation, I want to invite you to come over to rapidhealthreport.com. When you get to rapidhealthreport.com,

you will see an area for you to opt in, in which you can see Dan Garner read through my lab work. Now, you know that we've been working at Rapid Health Optimization on programs for optimizing health. Now, what does that actually mean? It means in three parts, we're going to be doing a ton of deep dive into your labs. That means the inside out approach.

So we're not going to be guessing your macros. We're not going to be guessing the total calories that you need. We're actually going to be doing all the work to uncover everything that you have going on inside you. Nutrition, supplementation, sleep. And then we're going to go through and analyze your lifestyle. Dr. Andy Gal we're going to go through and analyze your lifestyle. Dr. Andy Galpin is going to build out a lifestyle protocol based on the severity of your concerns. And then we're going to also build out all the programs that go into that based on the most severe things first. This truly is a world-class program, and we invite you to see step one of this process by going over to rapidhealthreport.com.

You can see Dan reading my labs, the nutrition and supplementation that he has recommended that has radically shifted the way that I sleep, the energy that I have during the day, my total testosterone level, and my ability to trust and have confidence in my health going forward. I really, really hope that you're able to go over to rapidhealthreport.com, watch the video of my labs and see what is possible. And if it is something that you are interested in, please schedule a call with me on that page. Once again, it's rapidhealthreport.com and let's get back to the show. And maybe to fill it in a little bit,

it's not because the probiotics are sort of taking up residence. They probably have more of a transient passerby impact where they release antibacterial antifungal peptides that fight things like SIBO and dysbiosis. They help attune the immune system through sort of pinging these receptors in the gut known as PRRs or TLRs. And that helps with inflammation and erection of leaky gut. They help with motility. So it's probably this sort of transient impact that they have, which is why I think sort of getting either consistent dosages through foods or through supplements as a general rule is probably better than a sort of, you know, like one week or two day protocol, because you

want to have that ongoing effect of, of triggering those receptors, which were so hygienic now that we're really missing a lot of that exposure. So that's why I think moderate to longer term supplementation with probiotics is probably a good idea. Yeah. How is it that they are so effective for what seems to be so many different categories? There's kind of the obvious categories of like, you know, Anders has the funny story about being in Mexico and eating the wrong food. But people think about diarrhea, constipation, it's directly related to gut, but then there's like skin health and all kinds of other things. Like they seem to affect many different bodily systems and what have you like what you kind of briefly mentioned

something similar to the mechanism mechanisms behind it but how how do they seem to affect so many different systems within the body i love this question if you look at the small intestine which is where most of the impact is going to be it's 22 feet in length and just as context the large intestine ironically is only five feet in length. Small intestine, 22 feet in length. The absorptive capacity is so vast, it's about the surface area of a tennis court. And this is why 95% of calories and of nutrients are absorbed in the small intestine. It's also where 70% of your immune system resides. So if there's a problem in the small intestine, you can have local symptoms, you know, like the food poisoning, IBS, diarrhea, constipation, reflux, but because of the nutrient malabsorption, that's a possibility. And probably more importantly,

the impact on your immune system and therefore systemic inflammation, that's how we see connections to the brain, to the limbic system, to the joints, to the skin, to things like fatigue. So yeah, it's really quite a remarkable lever, your intestinal tract to really influence your health globally. When I think about, when I used to think the the gut health, I always thought we have this like five pound block of bacteria in our stomach that's digesting the food. But now I think about it much more in like the full digestive system. Is there like a microbiome in your mouth and then kind of all the way through there that maybe we shouldn't just be siloing this just to our stomach or small intestine, but it actually starts in the minute we start to ingest food. Yeah, you're totally right. It does. It's really the entire tract

that's important. The one point I try to distinguish is about the importance of the small intestine. And this is to offset a lot of what you read in here that's talking about the microbiome or the microbiota. It's really referencing the large intestine. And what ends up happening is people do direct-to-consumer stool tests. They quantify the large intestine microbiota. They make a bunch of changes based upon that. And that's where 5% of calories are absorbed, a minimal impact on the immune system occurs. And this is why people will get sort of frustrated, like, oh, I did this test and it told me to eat this and take that. And then I felt worse or I felt no better. And it's because, well, yeah, I mean,

you're targeting a real small slice of your intestinal tract. You know, the more important, probably the most important would be your small intestine. But to your point, the mouth matters, the stomach matters. You know, some people do have low release of hydrochloric acid, although I think that's really overblown in the functional community. Like everyone needs to be on HCL. You can't have enough stomach. It's really, you know, inflated, I think. But there are some researchers, namely gastroenterologist Richard McCallum, who's found that if people don't have adequate stomach acid, oral cavity bacteria don't get killed when they go into the stomach. It seeds the small intestine, and then you have a small intestinal bacterial overgrowth

of the oral cavity bacteria in the small intestine. So all these things do matter. The one thing that I try to raise consumer awareness about is that a lot of the messaging about eat more plants, eat more fiber, eat more prebiotics is definitely better than the standard American diet. But for some people, if they go too far in that direction, they actually make their symptoms worse because the small intestine, again, so important. And we know that too much fiber, too much prebiotic can actually flare those symptoms. And conversely, something like a low FODMAP or a low prebiotic diet has been shown to reduce symptoms, very effective for reducing symptoms, reducing SIBO and reducing

leaky gut. And so it's because of such a large intestine fiber prebiotic messaging that that's so commonplace. I try to sort of give people this other perspective that we want to find that Goldilocks zone of thinking about the small intestine and the diets there in that can be effective and helpful. And for audiences like yours, who I'm assuming are probably doing a lot of attention to how they eat this, this can really bite them because we'll see people in our consulting practice who are so frustrated because they've increased their fruits and vegetables and they're getting worse. Yeah. You mentioned a lot of the, like just us living in a, in a very sterile environment. I think, I think about this so much about what

happened with COVID where every single building you went into, they were just like handing you hand sanitizer and you're like, get that stuff away from me. How should we be, this is probably oversimplified, but should we be living like a little bit dirtier of a life specifically to kind of help with gut health? I mean, yeah. As, as, as, as a, almost as like a, the extreme when our kids are sitting there eating like toys and they're in like a museum and they're like, or they're in the target shopping cart, like eating the handle and you're like, get that out. Is that actually good for us? It's a little hard to answer because I look at this as new dirt and old dirt. I think old dirt exposure is, and when I mean old, I mean like ancestral, right? In the woods, farm animals, things like that. Things that our immune systems are somewhat

attuned to. Probably pretty good. Farm life would be another one. Modern dirt, and this is something else I did develop in Healthy Gut, Healthy You. If you look at some of the slums in Bangladesh, there's some interesting research showing that they have more diverse microbiota, but they also have vastly higher parasitic diseases and things like chronic diarrhea because of that. So there is a little bit of a delineation where we want to be careful not to just say, well, you know, anything, anything that gets put in his mouth is fine. And I would say steer carefully toward the older and be a little bit cautious with, with the new dirt sort of exposure gotcha so is that just a rationale for letting your kids play outside in the dirt versus playing on the airport rug you know like on the ground in a in a indoors large area like at the mall or

like i said the airport versus just playing in the front yard uh or like i've also seen like kids the kids that have pets tend to have kind of quote unquote healthier microbiomes than kids that don't have pets, kind of in the same vein. Except for gerbils. A recent study found that gerbils actually increase the likelihood of diseases.

Trying to lower your pets hanging out in your house. Yeah. But yeah, I mean, again, there's not really robust literature looking at this in a really specific fashion, but I think drawing the most reasonable conclusion would be, yeah, you know, the more natural the dirt, let the kids be in it, maybe wash them up minimally, if not at all post. And then the more contemporary, the dirt like airports and stores and things like that, public restrooms, I'd probably be a little bit more careful.

When it comes to antibiotics, um, it's, you know, where it's almost impossible to go through an entire life without getting sick. And then some doctor is going to put you on a 10 day protocol of, of some sort of antibiotic. Um, what, what kind of, and I'm sure it varies from antibiotic to antibiotic, but what kind of damage is getting done to your microbiome by taking those? And then how do we, how do you kind of rebuild from there? You know, this is also something that was kind of eyeopening for me in the sense that the adult microbiota, it's fairly resilient to imbalances being formed from the use of antibiotics. And some studies have looked at this sort of mapping the microbiota over time, pre-antibiotic exposure, then you see a skewing after the antibiotics, but it's pretty good at returning to normal. Now, one thing that people can do as a safeguard, this is an adult, so I'll answer for kids in a second.

But if they take a probiotic simultaneously, there is really good data showing reductions in antibiotic associated side effects and a preservation of the microbiota. Now there's also one study out of Israel, one small study that found counter, that found taking probiotics after antibiotics may delay the normalization

of the microbiota to normal. And it got all this media attention, whereas a systematic review of about 10 trials, all 10 trials found the opposite. And I just make that remark because it's quite honestly, it irritates me immensely how one point that's controversial can get all of the press and literally 10 clinical trials finding something else get no meaning mentioned. It just happens to be the one that pushes more medicine. Well, or it's just something that the news will find more interesting or, you know, there, there does seem to be, and I am by no means a anti-medicine or anti-conventional doctor

guy, but there does seem to be an anti-probiotic bias amongst conventional doctors. And I don't know why, but you know, some of these guys are my friends and we have really nice back and forths, but it's pretty, it's pretty striking. And that's a, it's a broad statement I'm making. So it's not going to be true for all, but there does seem to be, I think there's like discomfort and maybe it's because there's not one pharma company that makes the one probiotic that everyone should use. Right. You know, to your earlier point, it's kind of the wild West with supplement companies, but that doesn't mean we should throw all of the research out with the fact,

which is good research with the fact that supplement companies are not regulated, because that's probably going to do more harm than good. If your medical doctor is kind of hemming and hawing about using a probiotic. And that might be why pieces like this get so much media attention. It just seems to be either what media outlets like, or I don't know if there's like this nefarious monopoly man behind the scenes trying to suppress. There's a wizard back there for sure. The wizard of Oz. He's into probiotics now.

It's great. Are there no pharmaceutical grade probiotics available? There are. Yeah, there are. And you're seeing more and more research being funded by the pharma houses who are making the um the formulas but there's not many that are prescription and i think that's what makes the doctors a little bit maybe uncomfortable you have things like vsl3 and floristore that are fairly big probiotics and sort of conventional uh but

even within that yeah it just seems that the conventional doctors, again, there's a tendency, I'm not going to lump all in together, but they're a little bit more uncomfortable. And as an example, you'll see people for SIBO or small intestinal bacterial overgrowth who are conventionally trained, much more quick to write a prescription for rifaximin, the antibiotic, which I think is a good antibiotic. It's well-studied. It's definitely helpful. It's FDA approved for IBS, but there'll be much more quick to write a prescription for that than saying, well, let's do a 30-day trial on probiotics first and maybe consider the antibiotics second. Yeah. When you've mentioned SIBO and those letters stand for small intestine bacterial overgrowth and there's bacteria of

potentially like thousands of different species that that could be um is is kind of the shotgun approach of let's just put a bunch of good things in there and try to help or is it a much more focused, like, like rifle approach to this specific strain is going to help this specific overgrowth? Because just small intestine bacterial overgrowth, when I hear that, I go, I'm going to need a little bit more than just broadly. There's some bacteria in here that's causing problems. Is there a path to finding specific strains that help specific overgrowth? Or is it just, let's kind of overwhelm the system with good things and see if we can fix the problem? Yeah. I mean, this hints at kind of the Occam's razor hypothesis, or the way I look at it is the complexity complexity efficacy curve where you have complexity on the one axis and efficacy on the other and usually the more complicated the solutions are the less efficacious

they are or as occam's razor posits the simplest solution is usually the best yeah it's challenging i think for for nerds like myself because we're so in love with physiology and it's almost like you know you know basics. So you're always looking for the new, the novel, the next thing. And unfortunately what ends up happening is that permeates into the blogosphere or the podcastosphere. And you have people with all their, their pet hypotheses, making this much more complicated than it needs to be. What I can tell you is this seems to be pretty simple. Looking at meta-analyses, comparing different types of probiotics, they're all showing efficacy for SIBO.

Other research has even looked at, for constipation as one model, different formulas, different probiotic formulas in a side-by-side, and it found equal effect. So if the probiotics were like drugs, they had a very sort of narrowed mechanism of action, I think we'd want to have that very specific approach. And you do see that bleed over from sort of the reductionistic science perspective, and it's getting a little bit superimposed on the probiotic research. But if you take a big picture view, again, you see different formulas with different species or different doses or different strains, all showing similar efficacy for SIBO or for various conditions. So the way I look at it is

if the probiotic is improving someone's symptoms, that tells you it's the right fit for them. And usually a broad approach with probiotics rather than a single species or strain tends to be more effective. When we make it more complicated than that, you end up seeing a lot of the horror stories that we end up speaking with in our consulting practice, which are people who have spent thousands and thousands of dollars on testing. And then they've had the tests treated. And unfortunately, this hypothesis really breaks down upon scrutiny. I'll give you one quick example. Zonulin is a marker of leaky gut. Now you can do zonulin via blood, or you can do zonulin via stool. Since it's much easier to do it via stool, you're seeing this adopted by most of the functional medicine stool testing labs.

And what will happen is someone will come in and the majority of the emphasis is put on their labs. Oh, you have zonulin and you have low this bacteria and high that bacteria. The sad thing is that just this year, Frontiers in Immunology published another meta-analysis that found that stool zonulin was not accurate, did not track people's symptoms. So as one example, as more research is being done,

we're seeing that if you've been treating stool zonulin, you might as well be just burning your money because it's not accurate and it doesn't track. And there's multiple examples of this. Ubiome was kind of all the rage a few years ago for quantifying the microbiota. They got shut down by the FDA for insurance billing fraud. And as part of that investigation, they uncovered that they were using dog feces to establish the normative ranges for human testing. So the more you start pulling on this string of what's going on with the labs, whether it's intentional or unintentional, you see that treating the specific species or the specific findings in a lot of cases really doesn't work.

There's one important clarification I should make, which is this doesn't apply to conventional medicine. I'm not saying for conventional gastroenterologist is telling you you need a screening for colorectal cancer or a blood test for suspected hypothyroid to slough that off. What I am saying is when we go into the field of integrative and alternative medicine and we're doing these sort of non-conventional tests, a lot of these are really questionable. And because of that, the attractive hypothesis of treating the specific bacteria in a very targeted fashion really breaks down. And what we end up doing is looking at the person and listening to them and then applying

the therapeutics that are shown to be the most effective for people with the symptoms like they have. Dr. Justin Marchegiani Yeah. You've mentioned a couple of times, and this is, I think, probably like some of the more common symptoms. And I'd love to know why our body reacts in certain ways to certain issues that happen in And then, or the reaction is to hold on to everything. And then on the other side is people that have loose stools every day of their life and their body's just trying to get rid of everything as fast as possible. I don't know why your body would be under threat and feel like holding on to the thing that seems to be causing the problem is your body's natural reaction or natural solution to that problem? And then on the opposite side, why is it get rid of everything? It doesn't matter

what, just every day, do your best to eliminate. Yeah. There's sort of two frames I view this through. There is some pretty compelling data showing that people who have had stressful childhoods, childhood abuse of various sorts, tend to more so be constipated type. And especially when they're under stress, let's say in adulthood, that's kind of how they skew is toward constipation. So that's one thing, sort of the brain-gut connection. Then over to SIBO, we do know that depending on the type of bacteria that overgrow in the small intestine, they have a tendency to either give you diarrhea or constipation. The hydrogen-producing bugs tend to produce diarrhea, and the methane-producing bugs, two different gases that are assessed by the breath test, tend to produce diarrhea and the methane producing bugs, two different gases that are

assessed by the breath test tend to produce constipation. I mean, the good news is sort of coming back to the Occam's razor, simple path hypothesis, a probiotic and probiotics have been shown to resolve whether it's hydrogen or methane dominant. They work seemingly equally as well for either type because they're, you know, if we're doing something corrective, that is upstream to the specifics of the imbalance downstream. And this is why a probiotic can help with both diarrhea and with constipation. What are your thoughts on using probiotics for just kind of a normal, healthy person? You have normal poops most of the time, loose stools on occasion, but you're pretty normal most of the time, no major symptoms to manage.

Should you be using probiotics on a consistent basis or is there a downside there? Well, also something that I've recently changed my mind on, my opinion on this used to be, if you're healthy, you probably don't need a probiotic. And I still think that's generally true. The healthier you are, the less stuff that you need. There were two papers published this year that found otherwise healthy individuals actually had better mood or healthier emotions. One of the studies was in nurses who found that they had better mood and higher empathy when they took a probiotic. So they weren't depressed and they weren't sort of cold at baseline. They were otherwise healthy, but they had even better mood. And a different study found a bolstering of antioxidant production in healthy people who took

probiotics. So when I combine that with some of the research from Henry Boulard and Metchnikoff about the observational data on probiotic rich food consumption. I think whether it be through foods or through supplements, getting in probiotics on a continual basis, you don't have to be anal about it if you're going on vacation or something. I mean, actually, depending on where you go, you may really want to bring your probiotic with you, but you don't have to have a separate suitcase for supplements and be supplement dependent. But I think as a general rule, trying to either get probiotics ongoing from food or from supplements is a good idea. Now, one of the things that people will sometimes question or wonder about is, well,

you know, will I become dependent? And I think, again, that's the wrong way of framing this issue because we evolved under constant exposure to bacteria. i look at this as we're simply trying to replicate more ancestral conditions with either foods or supplements than it is we're using something like testosterone that's going to have a negative feedback loop and suppress release is the improved mood thing like like a serotonin neurotransmitter related thing, or is that like a decreased inflammation thing? Or what do you think the mechanisms could be there? It's probably twofold. One is probably inflammatory. The other, and this year in particular has been a really interesting year for probiotic research. A few researchers have looked at people in functional MRI scans and found a reduction

of activation of the limbic system, whether it be hippocampal or amygdala. And the limbic system is sort of medial temporal lobe in your brain. It governs the stress response. And it's what helped us survive a really hard hunter-gatherer upbringing, if you will, right? You know, we're walking through the meadow, my buddy eats some berries, he throws up for an hour and dies. Okay. Limbic system wants to sear that memory of that berry into your nervous system. So it tags things with fear and emotions that you don't forget. So it's a really helpful part of our brain, but modern day with all the pings

you get from social media or stress at work, the limbic system can become overactive and this can impair things like memory, sleep, mood. So coming to these studies with the functional MRI, they'll look at activity of the amygdala or the hippocampus pre post probiotic intervention and see a dampening or sort of a correction of the level of activation of those brain centers, which correlate with things like anxiety, depression, and memory. So it's probably partially inflammation and partially directly how the probiotics impact the limbic system. As you're mentioning that you also also mentioned sleep. Does that, those adjustments then improve sleep quality as well? The data here are a little bit mixed.

You do see some trials finding benefits for sleep. I think it's more so when people have active digestive symptoms that are interfering with their sleep. So they have IBS and there's some pain or reflux, or if they have inflammatory bowel disease and they're having diarrhea, that's where it's pretty clear that as probiotics improve the GI symptoms, people sleep better. If it's insomnia for no known cause or without IBS or IBD, the data there are a little bit more mixed. So I would be inclined to try a probiotic for a month and see if her sleep gets better. But just to sort of report

on the research objectively, it's a bit more sort of, you know, some finding benefit, some studies not finding benefit. Gotcha. You know, now that we're kind of moving into the second half of the show here, let's dig into the practical side of things here. Do you have any like very tangible recommendations on the diet side, on the, what exact supplements you could potentially take? You can mention any name brands that you think are particularly high quality. I don't know if you're associated with any brands or if you sell stuff yourself even, but what are your thoughts on exactly what to eat and where to get the highest quality sources? Dr. Justin Marchegiani Yeah. I like a sort of a relaxed paleo diet template as a

general starting point. And when I say relaxed, I mean, I don't have religious hate for dairy or for gluten. And I think it's a little bit ridiculous how people in my very field and me maybe five years ago would have you think no one can consume gluten or dairy. If you look at the stats on this, it's about a 5% prevalence of non-celiac gluten sensitivity. Some studies a little higher, some a little bit lower, but you average them at about five. So, okay, that's something, right? There's definitely a group of people who don't have celiac who do react to gluten, but it's like 5%. So I think we really need to rethink the messaging of anyone with a problem should be avoiding gluten in perpetuity. Dairy, it's about a 5% also lactose intolerance, and it's a little bit higher for casein intolerance. I'm sorry, flip that. It's

about a 40% lactose intolerance prevalence and a 5% casein intolerance. But here's what's exciting about gluten and dairy. If it is a problem of fermentation, meaning you're fermenting some of the gluten or you're fermenting some of the dairy, that's a microbiota and enzyme problem. And this is probably why we see some research showing adults can improve lactose tolerance when using things like probiotics. Because as you improve your gut health, the lining of the gut releases enzymes. And so if there's some inflammation and damage, you can't release as much enzyme, therefore can't digest the food, therefore have reactions to the

food. One. And then two, if there is too much bacteria in the small intestine, they ferment the foods. So the carbohydrates in the wheat or in the dairy get fermented, too much bacteria, too much fermentation, more gas, more pressure, maybe diarrhea, maybe constipation. But the good news about that is those are able to be remedied. So I think what happens in some people is they go off gluten and dairy and they see an improvement because of the reduction of the FODMAPs or the prebiotics. And then they go, aha, I can never have gluten or dairy. And that's the wrong way. It's like, no, it's actually much more of a optimistic prognosis. If you reintroduce, and we see this with the FODMAP reintroduction studies, there's really good tolerance of over 50% of the foods that people reintroduce when they go low FODMAP

and then they bring higher FODMAP foods back into the diet. So a starting point would be paleo, paleo-ish. And then depending on how that's going for you, the low FODMAP diet for some people is going to be a bullseye, especially if they have digestive symptoms because they might be eating too much cauliflower asparagus broccoli apples you know all these healthy food but they're really rich onions and garlic rich in prebiotics and a temporary reduction of those can starve the overgrowth allow the intestines to heal and reduce

inflammation and release better enzymes and then you bring them back in. And most people, like I said, have a really good tolerance after that. So, um, paleo and then low FODMAP, uh, I think are two and probably for your crowd, the low FODMAP especially is something to, you know, give it a three to four week trial. If it's going to help, it's going to be pretty quick. Most people will see improvements within one or two weeks and then, you know, ride that out until you plateau and then start bringing foods back in. Gotcha. What about on the supplement side of things? On the supplement side, you know, after diet, I would then try probiotics and we do make our own probiotics. It's something I'm really proud of that we've been doing this now for about five

years and we've developed one formula and this kind of ties into another question about how do you organize probiotics like the the thousand some odd formulas on the market is there a way to heuristic those into an organizational framework and what i had been seeing year over year over year reading the research on this is the probiotics tend to be one of three formula types. We mentioned earlier Saccharomyces boulardii. So your big trade name there would be Florastor. That's just a fungus. It's a healthy fungus. So that's one type. Another type would be blends of lactobacillus and bifidobacterium. This is probably what you had when you went to Whole Foods, the 80-year-old probiotic was probably a blend of lactobacillus and bifidobacterium. This is probably what you had when you went to Whole Foods, the 80-year-old probiotic was probably a blend of lactobacillus and bifidobacterium. Your blockbuster product

there is going to be something like VSL3 or VisBiome. They're going to differ a little bit, but what you'll see if you compare ingredient labels is a bunch of lactobacillus and a bunch of bifidobacterium. So that's number two. And then the third is a little bit more new age, soil-based probiotics. And this is where you'll see something like Megaspore, Biospora, and you'll have various bacillus species or enterococcus species in those formulas. And what's helpful about this framework is you no longer have to buy probiotics based upon the name, right? It's like Gut Heal 17 or you know, gut restore seven, you know, or whatever

it is. You can look at the ingredients and say, oh, this probiotic is a blend of lactobacillus and bifidobacterium. This probiotic is a soil-based probiotic. This probiotic is a Saccharomyces boulardii. And you want to try the different categorical types. And I'll give you the specific dosages in a second, but it does, you know, the differences across the formulas are what you want to try to isolate for, meaning you want to try one formula and ideally you want to combine all three. And that's the probiotic that we developed where we used to send patients home with three bottles and say, take two capsules of this, two capsules of the second, two capsules of the third. And people were griping like it's helping, but it's kind of a pain in the

butt. So we put all three into one that we call triple therapy probiotic. This hasn't been studied yet, but we're hoping to study this and publish something on it next year. But we have documented a number of case studies where that triple therapy approach has been better than just one formula alone. And if you think about it in multiple different areas of medicine and healthcare, if you combine agents, you get a better effect, right? And maybe a crude analogy would be, you guys can probably rip this apart, but for like shoulder rehab, if you do one exercise, you're going to get some stability. But if you do three, that's like multi-planar for rehab, you'll probably have a better effect. So it's kind of the way that I think about it is you're going to have a more robust rehab protocol for your gut by using all

three probiotics. The specific dosages, and I'm just going to pull up my notes here. For the lactobifido blend, of course, I get signed out of my Google account, right, as I'm trying to do this. So the lactobifido blend, I'm going blind on this, so fact check me. We have a bunch of materials, but the lactobifidyl blend is about 10 billion CFU per day as a minimal effective dose. You can do higher, and a number of studies have used higher, but I think that's a decent place to target. The Saccharomyces boulardii, between 10 and 15 billion per day, and then the soil-based probiotic, between 3 and 15 billion per day. And then the soil-based probiotic, between

three and six billion per day. And those are just approximations, but they give you sort of, okay, I have this formula, how many capsules do I take in a day? And it's usually going to be anywhere between two and four capsules per day, but just to give you the specifics of a protocol. And then the time interval is also important. Again, this year has been pretty interesting in showing that two to three months is really the minimal duration that someone should use a probiotic to assess its full effect. It's not to say you won't notice anything sooner. And if it is the right formula, you'll probably notice something by week two or by week three. But some studies are showing a pinnacle of improvement at the two to three month mark.

And that's important because if the expectation is, well, it didn't solve all my problems in two weeks, and then you stop, you might be on a trend line to really seeing some significant improvement at the two to three month mark. As somebody that formulates these things, this is like the skeptic in me when i walk in and i see the 80 billion number on the shelf and i'm like come 80 billion who counted these how are we supposed to like from the consumer looking at the shelf and seeing numbers like 10 15 80 billion of these cultures like or bacteria going in as somebody that formulates this, where is the process of knowing that that's what you're actually buying? Because obviously I'd have

no idea if I was getting 80 or 15. I would have no clue. And this is why we've developed this meta protocol. So that protocol that I outlined is myself and our research team looking at multiple studies across multiple conditions. So if we look at IBS literature, the IBD literature, the depression literature, the psoriasis literature, where can we sort of average out, again, coming back to the simple solution is usually the best. And that's kind of where you clock in. Why that's important to your question is one of the marketing points is, you know, we have the highest dose and that doesn't actually seem to be a true hypothesis in that there's not a direct line between higher dose and better outcome. In fact, you probably want to stay in the, in the middle of the dose range, meaning if you go vastly higher, that it could be good or it might be bad. So the higher the dose, not the better. And then how do you know that? This is

where third-party verification is important. And it's something that we do periodically, both to assess the shelf life claims, although given the Zorzella meta-analysis, I'm now realizing that's less important. And also what is a viable dose at time of manufacturing? So, you know, those things are important. I wouldn't say they're going to be the end of the world, you know, again, because especially with that Zorzella meta-analysis, we're seeing more kind of question how fastidious we have to be with the probiotics, which is totally in alignment with everything else I think we've been discussing, which is getting uber granular doesn't seem to be that important with the one caveat that you need a company that's going to be doing a decent job

with manufacturing and not just putting some crap in there to fill the pill, which can be a legit thing, right? If you're, I mean, a capsule doesn't just fill itself. So if you're going to put a small amount of probiotic in there, there can be other junk that you put in there to fill it. And that for some people can also be a problem, especially if it's filled with a lot of things like prebiotics, which for some people can flare their, their GI symptoms. On a, on a purely selfish question. Doug's got three kids under eight years old, nine years old. I've got a five and a two-year-old. You guys look well-rested. Jeez. Yeah, right? We have these little packets. I couldn't even tell you the name of them. We dump a little probiotics into some milk in the morning. Are there recommendations for

children, kids, teenagers? Does that progress over time to get them to adult dosing? Yeah, this is a great question. It's something that we're currently researching and we've been working on a formulation for children. And there's been many rounds of sort of research and fact-checking, research and fact-checking. Thankfully, we haven't been able to find anything showing. And grain of salt here, we have one more sort of round of fact checking to go through to finalize this so this is sort of the the draft but we weren't able to find anything showing that the same probiotics that adults use are gonna be at any time and place a problem for kids there was some potential

concern about the soil based probiotics so we dug a little more deeply into that and weren't able to verify any of the sort of the concerns or the claims out there. In fact, there are some data showing even kids in the NICU have better outcomes when using a probiotic. So no, I don't think other than just using a half to a fourth of the adult dose, you're probably going to be okay. And there's some pretty compelling literature. We do a monthly podcast just reviewing all the recently published science on probiotics. So we have a pretty good pulse on this. And you see there was just one with kids with jaundice. So these poor little infants who are under the lights for jaundice had better outcomes with their jaundice when using a

probiotic or the kids in the NICU or allergy for young kids. And not every study shows a benefit, but it's like an 80, 20 distribution of benefit compared to the null in the findings with kids. And I haven't seen anything that gives me pause regarding some sort of deleterious effect. Yeah. It's almost like the, the multivitamin idea. It's like, you should take one. It's going to help in the long run. It's a good thing to do every day. There there's, they're very beneficial. So you should just have them even, even kids just make sure you're getting the full dose of it. So, um, that's awesome. Where can people find your podcast? I would love to tune in.

Yeah. If you just search my name, uh, Michael Ruscio, it's on all the podcast players. This year we started doing YouTube just so we could show the studies, which has been really cool to be able to, it's not just my words, like here's a PubMed study. Here's a zoom in on the conclusion or a chart. Because I think that's really important. One of the things that, again, being a little bit candid, but that bugs me about the field of alternative integrative medicine is there's a lot of people with self-interests and I have self-interest, right? And we have a consulting practice. I have a book, we have supplements, but I put the scientific process first. And, you know, sadly, it seems that consumers are so

willing to listen to ways that can improve their health to a guru who makes a convincing story. And the gurus that don't care about fact-checking are much more convincing because there's never any tenuousness in their voice because it's just my message all the way down. So we do put a lot of time into fact-checking and research and we publish research. So that's what's been nice about YouTube is like, here's the actual evidence and you can see clinical trial, meta-analysis, systematic review, not some obscure study in mice that I'm spinning to sort of fit my own agenda. Yeah. I would also love to know just how often do you find yourself as new researchers coming out

from tweaking formulas or just kind of like reframing the way that you're working with clients? Yeah. Well, I mean, the few examples I shared about the probiotics was a really good example where we used to ship our probiotics with freezer packs and be much more fastidious about that. We've since stopped doing that. And, you know, we're trying to help people also see that a higher dose is not better. And we also try to be good about recommending to people sort of this inverted U of supplement use, right? Like as you're trying to figure out what works for you, you're going to be building a protocol, using more things, but then the backside of trying to find the minimal effective dose is so crucially important. And again, as someone who consults with people,

you'll see someone literally send you an Excel table of their supplements. And I think this is supplement creep where they listen to a podcast or they read a blog or a book and they add a few things and add a few more things with the next read or listen. And before you know it, they're on like 30 things. Dr. Justin Marchegiani Like when someone sends you a picture of their cabinet, it's just a stack of supplements. Dr. Tim Jackson Yeah.

Dr. Tim Jackson Where did you get that? Dr. Tim Jackson So I think having that expectation of minimal effective dose is really important so you don't fall into over supplementation, which can also be bad for the gut because all even the cleanest supplements have some excipients and other things like the vegetable capsules in them that in a smaller dose, isn't a big deal, but times 30 capsules in a day can start to become problematic. Yeah. This is fantastic, man. I really appreciate coming on the show where, uh, podcast, where can people find you? It just, uh, go to the website, drruscio.com D R R U S C I O.com. You can plug into the book, the podcast and YouTube supplements, uh, our consulting practices if you need help.

And, uh, yeah, it's been great guys. Really, really had fun. Fantastic. Doug Larson. You bet on Instagram, Douglas C. Larson. Uh, yo, I really enjoyed this. Uh, I'm stoked to check out your YouTube channel. I think, uh, being able to see the studies and whatnot would be really interesting. So 100% checking that out. Appreciate you coming on. Awesome. Awesome. Yeah, thank you. Absolutely. I'm Anders Varner at Anders Varner and we are Barbell Strug to Barbell underscore Strug. Make sure you get over to rapidhealthreport.com. That's where Dr. Andy Galpin and Dan Garner are doing a free lab lifestyle and performance analysis that everybody inside Rapid Health Optimization will receive. You can access that for free over at rapidhealthreport.com.

Friends, we'll see you guys next week.