Kyle Kingsbury Podcast - #4 Gut Health with Dr. Michael Ruscio

Episode Date: October 23, 2017

Gut Health Q&A with Dr. Michael Ruscio. For more info got to DrRuscio.com Connect with Kyle Kingsbury on Twitter and on Instagram Get 10% off at Onnit by going to Onnit.com/Podcast                Onnit Twitter         Onnit Instagram  

Thank you guys for tuning in to the On It podcast. Today's guest is Dr. Michael Ruscio. I first learned about Dr. Michael Ruscio at Paleo FX as he was a speaker on gut health. And I heard about him through friends of mine, Ben Greenfield and Rob Wolf, and got to listen to him on their podcasts on the Ben Greenfield Fitness Show, as well as the Paleo Solution Podcast with Rob Wolf. Absolutely excellent episodes. and Field Fitness Show, as well as the Paleo Solution Podcast with Rob Wolf. Absolutely excellent episodes. Then I started diving deep into Dr. Ruscio's own podcast, Ruscio Radio,

which is a phenomenal podcast that talks all things gut health, cognitive health. He really breaks down a lot of the myths that are going out there, you know, concerned with adrenal fatigue and different problems that people get into when they start looking at their health a little bit closer with functional medicine doctors and things like that. And really just a wealth of knowledge. Hope you guys enjoy the episode as much as I did. Thanks for tuning in. All right, we're here. I've made my way out to Walnut Creek, California to interview my buddy and teacher, Dr. Michael Ruscio. Thank you for joining the On It podcast. Hey, buddy. Good to be here. Hell yeah. So let's get a little background on you.

What got you into medicine? Well, in college, I wanted to actually be a lawyer at first, and then I eventually realized that that was bringing out some really negative aspects of my personality. So I had an aha moment. I always loved making workout plans for my friends and reading about health and fitness and nutrition. And my cousin said to me one day, have you ever thought about going into health or medicine?

Because this is what you are doing anyway as a hobby. And I never thought about being a doctor before, but that then got me on the path. Long story short, I was pre-med, doing all the requisite classes, keeping my GPA high. I was slotted to go probably into orthopedics, probably orthopedic surgery, and I ended up contracting intestinal parasite. And at 23, I went from being a college athlete,

the guy who could just get laid out and bounce right back up and almost feel better after that because you get that adrenaline rush, just a ton of energy type of guy, to all of a sudden having insomnia fatigue depression just feeling really terrible and i didn't know but i had an intestinal parasite and i saw three doctors two conventional doctors no one could figure it out i ended up seeing a functional medicine doctor he said to me i think you have a parasite. I thought to myself, you're full of shit. All right. Because I, you can say shit here. Okay. I wasn't going to drop it. Okay. Uh, I wasn't sure I had never been to Mexico and never had food poisoning, anything like that. It turns out he was actually

right. I had amoeba histolytica, which is a fairly pathogenic amoeba. And that was at the root cause of all my problems. So I decided to go into integrative medicine, functional medicine, with a focus on GI. That's kind of brought me here today. I've been in practice for several years, and I do some clinical research, and I've been writing a book. Essentially, that's the short version of the story. Fuck yeah, that's perfect. I think Rob Wolf, a lot of these guys, Chris Kresser, anybody that's involved in kind of the ancestral health community or functional medicine community usually had some serious shit go wrong with them and met up with conventional wisdom that didn't tell them a damn thing about their issues. Right.

Right. And I think that's where we all start to figure shit out on our own, going into the Internet, diving into some different books. But it doesn't always hit the nail on the head. You've talked quite a bit about testing before on your podcast, and you have an excellent podcast. I recommend people check it out. But what are some of the failures in these common tests that people see, like testing on intolerances and anything else for that matter?

Well, coming back to the comment you just made about people having their own experiences, I also had the experience of going on the Internet, self-diagnosing with adrenal fatigue, with hypothyroid, with low testosterone, with metal toxicity. I even did some tests, some adrenal tests, some urinary tests for mercury and other things. And I was convinced I had all these other problems. I treated all these other problems and none of them really produced any significant results, which, which taught me a very important lesson, which is if you, the most important system to start with is your gut. It's not to say a gut is going to, fixing a problem in the gut is going to be a cure-all, right? But if you have a gut problem and a problem somewhere else, like let's say you have adrenal fatigue, even though I hate that term, and we can go into that in a minute if you want. Let's say you have, quote unquote, adrenal fatigue.

It may be the inflammatory and stressful process in your gut that's causing the adrenal fatigue. So you can chase down the adrenal fatigue, you can test it, you can treat it, but it's not telling you what the cause of the problem is. It's not treating the cause of the problem. So I had the experience myself, and I noticed the same thing in my practice where patients were coming and seeing other doctors and they were doing all these other tests and they were missing the fact that they were pooping three times a week or they had really bad GERD or they had, um, they had abdominal pain and bloating or, or what have you, or even sometimes people don't have any digestive symptoms, but they do have a digestive problem that manifests solely as things like fatigue, insomnia.

And I was actually case in point for that. I had a really bad pathogenic amoeba that was literally cutting into my intestinal lining. Amoeba histo, meaning tissue, litica, meaning to lice or to cut. And I had no diarrhea, no IBS, no abdominal pain, but I did have brain fog, predominantly brain fog, fatigue, insomnia, and some depression. Those were my predominant symptoms. So I learned pretty quickly that the promise of testing has been way over inflated. And if I'm just going to be really honest and upfront with people, we've been taking advantage of both as patients and of doctors. Doctors who want to help people, that desire has been hijacked or misleveraged. And patients who are desperate to get well have essentially been sold a line of BS, which is if we can just get this additional testing, we can figure out how to get you well.

To some extent, that's true. Maybe 20% that's true. And I would say maybe about 60% to 70% of testing that's done in functional medicine routinely is either invalid or oftentimes it's not needed initially. And if you can get to that initial problem, the other testing is therefore not needed. And adrenal fatigue would be an example of one test that's not needed. There are several, but essentially the long story short on this is testing, being able to do this copious excessive testing,

being able to tell you everything that's wrong with you and giving you this customized plan to fix everything is way overstated. And really practical, clinical functional medicine tends to work much better and it's much cheaper. Yeah, you can spend thousands of dollars. And another problem too, is that a lot of this stuff comes out of pocket. It's not going to be paid for by insurance and you're just racking up bills there, racking up bills on supplements and different parts of this protocol and being very limited on what you can and can't eat is also an issue, right? It's very hard to stick to things that, you know,

it's very hard to stick to any diet if you don't see results from it. So let's talk about an elimination diet and a low FODMAP diet. Where do we see benefit in that? I think a lot of people don't necessarily understand that what a paleo or ancestral health diet is really the benefit of doing something like that for a period of time and then reintroducing foods. Sure, sure. So when you approach diet, there's a few important tenets. Probably the most important foundational tenet is just avoiding processed foods, right? I

think we all get that. Buy and make your own food. Buy fresh whole ingredients, cuts of meats, chicken, fish, what have you, vegetables, some fruits, maybe some nuts and seeds. And if you can do that as your starting point, that's a huge first step. But then if you want to refine it a little bit more, maybe the second step would be cutting out common foods that are either allergenic or inflammatory. And this is what the paleo diet does an excellent job with, right? Foods that are often inflammatory, like grains, for example, grains and dairy are two of the foods that are more prone to cause maybe not a true allergic reaction, because that typically means like an IgE reaction where you swell up and your throat closes that some people have like bees and nuts. It's not a true allergic reaction. It may be termed better a food intolerance

or a food that can just cause discomfort and inflammation in someone. And this is what the paleo diet does a good job of eliminating those foods. So are people familiar with the main tenants of the paleo diet? I think for the most part, you're going to eliminate all legumes, grains, dairy, this type of stuff. Right, exactly. And of course, also processed foods. Yeah. And that's really a good place for people

to start. And that works well for a lot of people. And for some people, it either will not work at all or only partially be helpful. And they may need a different diet. They may need to restrict foods that feed bacteria in the gut. And this type of patient or person often will have digestive symptoms. They'll have bloating. They'll have abdominal pain. They'll have constipation or diarrhea or oscillate between the two. And they, in many cases, may have a bacterial overgrowth. And when you eat foods that feed bacteria, you actually make that problem worse. And what's paradoxical about this is these foods are seemingly healthy. Something like asparagus, for example, is high in FODMAPs.

Cauliflower and broccoli, high in FODMAPs. So break down FODMAP because that's an acronym. So FODMAP stands for fermentable oligodiamonosaccharides and polyols. So it's just different forms of carbohydrates and essentially the structure of the carbohydrates that make them essentially harder for us to digest. So then bacteria in the gut have to help, and the bacteria in the gut digest those,

and they essentially eat those. And since the bacteria eat those, you're feeding bacteria, and of course that can cause bacterial or exacerbate bacterial overgrowth. clinical trials that have been done showing pretty impressive benefit, especially in IBS. So the symptoms of IBS, irritable bowel syndrome, typically encapsulate bloating or abdominal pain accompanied by altered stool frequency. So you either have diarrhea and you have more frequent looser stools, constipation where you have straining and difficulty passing or days in between passing of stools, or you offset between the two. And in clinical trials where we examine this diet, there's very good evidence showing benefit for people with IBS. And we're seeing some evidence come out that people with fibromyalgia or joint pain may even have some benefit from this diet also. And it may be because people have

inflamed and irritated guts. There's a little bit too much bacteria in the gut. And by restricting these foods that are seemingly healthy, you actually starve that overgrowth and you kind of recalibrate or rebalance the gut. You don't have to eat this diet forever. Typically, you restrict for four to eight weeks and then slowly reintroduce the tolerance. But that can be a common dietary missing piece for a lot of people.

They've gone paleo, but now they're eating tons of vegetables. And unbeknownst to them, they're not eating a high FODMAP diet. So they have to modify things a little bit, go on a low FODMAP diet. It's not very hard to do. It's just knowing what to do. And it's not hard to access. You can go on the internet and you can search low FODMAP diet. You'll see not every diet will completely agree. and sometimes that frustrates people. But it's not about being perfect. It's about getting the broad 70%, which most low FODMAP diets agree on, and adhering to that.

Because you just want to bring down the load of which you're feeding the bacteria in the gut. And if you can do that, then, um, you know, you should see results usually within one, even two weeks, you should start to see results from this. And then again, ride that out for four to eight weeks and then reintroduce. That sounds good enough. I think a lot of people will find that that explains some differences. You know, a lot of people try a diet for a little while and they're like, Oh, that, that fucked me up. Or I don't feel good now i don't feel everything they were talking about yeah this can lead to some some other implications that maybe you have a different window or a

different avenue to go down right and all without testing right based on feel listening to your body glad you said because i was just gonna i was gonna say that a minute ago that this whole dietary thing you you really don't need to do food allergy testing. There have been some studies done and looking at food allergy testing compared to people who just do it based upon elimination and reintroduction. And we have such a good understanding about this now that oftentimes what you see in the research literature is people end up eliminating what most of the food allergy tests are suggesting anyway. Not to mention that in my clinical experience, the patient experience and what the food allergy tests tell you often don't match. And I'm a specialist. I specialize

predominantly in GI. So this is what I do. And I haven't done a food allergy test in probably three years now, but we have excellent results with quote unquote food allergies and repairing the gut. You just don't need that test to get you there. That makes perfect sense. And I think less is more in a lot of these things, right? Absolutely. And you know, for one other reason, and this is often underappreciated, but very important. If you're doing too much testing, it's like having too many computer programs running at once. It slows down your processing speed and can be very difficult for a clinician or if you're working with a doctor to figure things out. Because if you have 15 tests that you've done and you're trying to treat all those tests at the same time, you don't know what's helping, what's not helping.

More importantly, if someone has a negative reaction, which patients oftentimes do, you don't know if it's a negative reaction to item 1, 2, 3, or all the way through item 15 for the different things that you're doing. So more testing isn't better. Testing the fundamentals and the important things and focusing on a couple of things at a time is really, I think, a much more sound process. That makes perfect sense. So we talked a little bit about not feeding the microbiome. And with all the literature coming out now, it's, hey, you want to take these probiotics and you got to feed them with prebiotic. You got to get all the good fibers out now, it's, hey, you want to take these probiotics and you got to feed them with prebiotic. You know, you got to get all the good fibers and start taking fiber supplements because you're not getting enough fiber in your diet. Where I mean, obviously, I think you just went in, dove into that quite a bit.

It's not all good bacteria that are being housed in the body. And odds are, if you're having digestive issues, you really don't need to add more fiber to your diet. Can you give some examples? You know, I think a guy we both learned from was Paul Cech. He talked quite a bit about Weston A. Price traveling the globe and looking at these different indigenous tribes. Can you dive into that and see some of the differences in dieting? Yeah, it's a great question.

And unfortunately, I think that because of this boom in research regarding the microbiome, gut care has maybe gotten a little bit worse because a lot of this literature is preclinical. It's observational. And any good clinician or any good scientist knows that you shouldn't take an observation and generate a clinical recommendation from that. And so long story short, a lot of the observational data is coming from either third world countries and or hunter-gatherer bands, all whom which live in a semi-equatorial region of the globe.

And we know that when you're eating the naturally occurring foodstuffs in those areas, they tend to be higher in carb for hunter-gatherers or unfortunately for communities that are third world, carbs are the cheapest food stuff to produce. So we see these people living in maybe healthier environments where they're living like hunter-gatherers, but they're eating tons of carbs. And we're saying, well, they're healthier. But it's not... This tribe doesn't eat saturated fat. Yeah. But it's not to say that they're healthier because they're eating more grains.

They're probably healthier because they're living a hunter-gatherer lifestyle. They're living in the dirt. They have no stress. They're walking. They're honoring their circadian rhythms. They have, again, very little stress. So long story short, what ends up happening is people make recommendations based upon those observations that we need to feed our gut bugs, feed our gut bugs, feed our gut bacteria. And that can work for some people, but usually the more symptoms you have, the more likely you are to negatively react, negatively react from that approach. And Lauren Cordain and I believe it was also Boyd Eaton did a global analysis of hunter-gatherers and they found, I believe it was roughly, I believe it was 65% of hunter-gatherers worldwide obtained more than 55% of their calories from animal foods. So essentially, the majority of hunter-gatherer tribes, when you look at the entire globe, obtained over 50% of their calories from animal foods. So this thinking that we all need to be on this high-fiber, high-prebiotic diet,

I don't think is well supported. And who that deserves is, or who that's a disservice to, is people who may be of genetic descent or just have guts that do better on a lower-carb approach. And there's definitely those people out there. And we definitely see in a number of clinical trials, when we compare something like a vegetarian or American Heart Association type high fiber, high carb diet to a paleo diet or a low carb diet, we tend to see better outcomes. Now, it's important to mention that both diets

will work, right? The American Heart Association type diet, which is kind of your classical food pyramid type diet, right? Lots of carbs and lots of grains at the bottom of the pyramid. That compared to no diet will improve someone's health. But if you put that diet next to a paleo diet or a lower carb diet, as has been done in some comparative clinical trials, you see, yes, while they both help the paleo or the lower carb diet helps more. And that's, I think that accounts for confusion because some people may hear, hear me say the paleo diet works and they say, well, my vegetarian friends listen to a podcast and

this guy was going on and on about all these great studies about the vegetarian diet. It's true, right? All these diets can be helpful when compared to no diet at all. But when you look comparatively at one to the other, that's where you can see one diet may have an edge over the other. And also to be fair, the effect size between these isn't huge, meaning you may see an average weight loss of two and a half pounds on a vegetarian diet and it's now six and a half pounds on a low carb diet that's not a huge difference but it is a difference right and so if you want to try to select a diet that has the highest probability of success for example for weight loss a lower carb or a paleo type diet you know is usually shown to be the best so

um a lower carb or paleo type diet has shown to be helpful for cardiometabolic conditions. So heart disease, marker improvement, obesity, blood sugar, triglycerides, things like that. And there's also one or two studies showing for colorectal cancer, they work equivalent to a diet like the Mediterranean diet. So all diets can work, but some diets work slightly better than others. How this is so interesting is that when you see this research showing that a paleo or a lower-carb diet, oftentimes which are not these super high-carb diets like you're seeing microbiota enthusiasts recommend,

you see a very shining dissonance, which is these observational trials are leading people to say, we should all be on high-carb, high-fiber diets. But when you look at the clinical trials, you clearly see when we test the hypothesis in humans, it's actually oftentimes a little bit of a lower-carb diet that works better. Not all the way ketogenic, not going crazy, but a lower-carb diet that tends to actually have a slight edge. Oh, yeah. Let's jump right from there. Let's talk a little bit about the difference between a low-carb diet per se versus a true

ketogenic diet that would be 40, 50 grams or less of carbohydrates per day. Obviously, there's been a lot of research, and I listen to guys like Dominic D'Agostino. I've went balls deep into ketosis for a couple of years. I enjoyed that for the time that I had. I do feel with the amount of work that I do glycolytically with Brazilian jiu-jitsu, martial arts training, power lifting, those kind of things, that adding carbs back in makes me feel better. Right. And let's talk about that because people really confuse the two. Like, well, what is low carb and what is ketogenic and what are the differences? Because people will throw keto out quite often. Sure. And it's not necessarily being in ketosis. It's just

a tag word at this point. Yep. No, it's a, it's a great point. And, and I agree with, with you in that most people do not need to go all the way to full blown ketosis. I think a population of people who have the highest probability to benefit from that are people who are overweight or they're exhibiting signs of what I would term metabolic excess, meaning they're either overweight or they have high triglycerides, high blood sugar, high total cholesterol, right? These are people that just have these signs of excess. And so something like fasting or something like a low carb, you know, a very low carb, even ketogenic diet will work for them. Those people will still derive benefit even if they don't go all the way to ketogenic,

which may be, you could say, maybe around 50 grams of carbs a day. And they may still derive benefit from going 100 grams of carbs a day or 150. So I like to recommend people start with a lower-carb diet, which is around 100 to about 150, maybe 175 grams of carbs a day. And if you map that out, that's not a lot of carbs, right? That's mostly vegetables, right? There's maybe a little bit of fruit in there, maybe a little bit of something starchy, but it's not a ton of stuff. So it's definitely a lower carb diet. But the other end of the spectrum, so we have the one end of the spectrum is these people

exhibiting signs of metabolic excess, right? Overweight, high triglycerides, high cholesterol. The other end of the spectrum is people who are exhibiting signs of burnout. They're tired. They're not sleeping well. They can't focus. And these people may be under a lot of stress in terms of training, like jujitsu. They may be executives who are burnt out. They may be people who are just trying to cram it all in. So they're sleeping five and a half hours a day to get up early and do a two-hour workout in the morning and then be a mom all day and then build a business at night. And they're just burning the candle at both ends. But that's the other end of the spectrum, and that is the subset that I see have the highest likelihood to do really bad on a ketogenic

diet. Because now they're taking an already stressed system and they're adding additional dietary stress on top of that. And it sounds like you fit that profile, you know, to a T. Yeah, 100%. I think so. That's something people don't understand is that a true ketogenic diet is creating a stressor on the body and it's a

hormetic stressor that can have tremendous benefit so long as that's one of the only stressors right people don't think of the system as a total system and that all stress is stress correct so whether it's weight lifting or some type of training that you're doing you know physical stress emotional stress from your spouse significant other boss and then whatever the case may be, shit's going on in life. And if you're not getting enough sleep, that could be the biggest factor for stress. And a lot of people are asking me right now about, you know, I want to start intermittent fasting, but I do shift work. It's like, well, that might be one stressor that you can get away with some intermittent fasting as long as it's not too much. But how far you go, you have

to listen to your body. And if you're adding into the things like, I'm going to get this crazy workout in, fasted, and then going to work at midnight to 6 a.m., maybe not the best idea. Yeah. Yeah. And I'll give you an example from my own personal life. And to bring one of our mutual friends into the conversation, Ben Greenfield, he came on my podcast recently and he was talking about how if you fast after a workout that can really help increase your testosterone. And we had also talked about how a steam bath or a sauna after a workout can increase erythropoietin. So what I experimented with for a little while was working out, then going into a steam bath for 20, 30 minutes, and then fasting for a couple hours afterward. Now I had exceptional mental clarity and a ton of energy, but my libido absolutely tanked, right? And so I learned, okay, this is

pushing my body into too much stress. And sometimes you can want to try to tinker with your body if you're only thinking in mechanisms. But don't forget just to have the simple observation of how am I feeling when I'm doing this. I have a decent amount of stress in my life with all the work and everything that I'm doing. So clearly for me, that was just pushing the stress load too far. And the energy I was feeling was a jacked up stress response. And if I kept doing that, in addition to my libido not being good, I probably would start sleeping poorly, being tired during the day. And it's just important to listen to those early warning signs because if you don't, then what you end up doing is you have more, you start using caffeine

and you know, you keep kicking the can down the road until you totally kind of crash. And then you have to, you feel like absolute dog shit for a few days and have to recover. So listen to those early warning signs, definitely. Yeah, I think a good rule of thumb for a lot of people is to take baby steps into this. I'm probably similar to you in a lot of ways in that if I see something's good, like I've read the same studies. I think I heard it first from Dr. Rhonda Patrick, but but like oh shit i'm gonna increase epo if i jump in the sauna after i lift weights tempting every day maybe not maybe not maybe we try twice a week

and see how i feel and then i can start to build from there those types of things and as you it's the combination of all that too you know combination of the fasting as well and i think mark sisson talked about that you know how he'll he'll fast after a really hard workout but his next day is candy ass it's super you know like he might go do his i think frisbee golf is this thing or um not golf but uh whatever the fast sprint one is frisbee whatever the hell on the beach oh ultimate ultimate frisbee there we the hell, on the beach. Oh, Ultimate Frisbee? Ultimate Frisbee. There we go. So he's sprinting around doing that. He's getting some good work in.

He'll fast after that. He'll use it for the longevity hormones coming in, right? But his next day is super leisure. He's going to do stand-up paddle boarding and probably read a bunch and call that a day. Right. So having that balance of push hard, rest hard is very important. So we talked a bit about the differences between ketogenic and things like that. But if somebody's going to go super low carb and they're seeing benefit, when's a good

marker for them to decide to add carbs back in a little bit higher? And that doesn't mean going off the rails and going back to a standard American diet, but coming back to a low carb approach that might fit into that 100 to 200-gram range. Well, I would ride it out until you've achieved your maximum benefit, let's say weight loss and maybe mental clarity are one. So let's say you're a little overweight and you feel foggy intermittently throughout the day. You start going ketogenic and you're losing weight and your mental clarity feels good

and so things are definitely moving in that direction. Ride that wave until your weight loss plateaus, your mental clarity kind of plateaus in terms of its peak, and give that a couple months. I like to see someone riding a wave for a few months, keep things consistent, listen to your body, kind of reflect on how you're feeling. And, of course, if before that you start

noticing any regressions, like all of a sudden I'm feeling tired again, or I'm not sleeping well at night, or I'm having really intense cravings, then that would give you a prompt to reintroduce before a couple months, you know, one, two months. But usually one to two months, maintaining what you've been doing, the ketogenic type diet, and then start bringing your carbs back in and see how you feel. Now, for some people, I can do decently on any kind of carb intake. I've tinkered with high carb, low protein or lower protein. I've tinkered with, you know, high fat, low carb, and I tend to do decent on either one. So for those people, they're lucky, right? You don't, don't be like, Oh my God, like I don't feel bad now that I've brought my carbs

all the way up to 300 grams a day. What's wrong with me? Say to yourself, great. I can, I'm very flexible in what I can do. But if you bring your carbs back up, let's say you're doing 70 grams a day and now you've stepped up to 150 and you're noticing you're feeling tired, you're starting to gain weight, then back it back down. For most people, it'll be fairly apparent. So don't micro-assess yourself because then you can start seeing things that aren't really there. If you're looking too closely, you'll drive yourself kind of crazy. And another thing that you may want to do, I don't know if this is getting too advanced, is periodically undulate your macros. So for a little while, you're going to do really low carb,

and then you may add in a day or two of higher carb. And there's a few different approaches for this. There's a book out there called The Alt-Shift Diet that's five days ketogenic and then three days high carb, low fat. And it's kind of this oscillation. Mike Nelson talks about this via the concept of metabolic flexibility where your body can shift to different energy sources. The guys over at MindPump that talked about this, just a simple kind of calorie and macro undulation. And if you think about it from a developmental or ancestral perspective, we probably had periods where we just killed a huge bison and we're going to eat a bunch of meat. And then when that meat's gone and we don't have a kill laying around, which we wouldn't, we're going to forage until we have another kill. And so during the foraging period, we're going to be probably higher carb during that bison kill time. We're probably not going to give a shit about berries and just focus on the delicious chunk of meat that we have

and be, you know, higher protein and higher fat. So, um, you know, without hopefully getting too ahead of ourselves, I think there, there's definitely some interesting stuff coming out about undulating your macros and even your calories too. Yeah, 100% agree with that from personal experience. I think it paid dividends to spend a couple solid, you know, 8 to 12 solid weeks in a ketogenic state, you know, under 50 grams a day to really experience that and teach my body how to burn fat for fuel again before I started going back and forth. But every successive time that I wanted to spend a longer period in ketosis, there was no keto flu. I was able to jump right back in. I saw, you know, ketone blood measurements of beta-hydroxybutyrate go back up fairly quickly. It didn't take me the four, the full four days to get there, that kind of thing, right? I think once we've kind of taught

our body that metabolic flexibility, it becomes much easier to manage that shift back and forth. So let's talk again about fasting. When we're talking about feeding the microbiome and then we talk about some of the differences, like if you're closer to the equator, obviously that's going to be higher carbohydrate. You're going to have smaller game like fish, maybe poultry, those kind of things. And this is just ancestrally speaking. Closer to the poles, larger game, red meat, that kind of thing. Lower carbs, certainly for a lot of the winter months of the year, that kind of stuff. But everyone here in America doesn't necessarily fit that.

We have a lot of mutts. We have a lot of crossbreeding going on. And our genetics really don't, they don't always fit. My mom is from Mexico and my dad's from Germany, so I have a mix. You could take either one of the ancestry based on how you're born. But what does fasting do in benefits to the microbiome? Well, that's an interesting question. And I think there's a decent amount here that we don't know with the specifics in terms

of how it affects the microbiome. And maybe we should just draw one quick distinction because now that the microbiome is, or the microbiota is kind of in vogue, that term is used very loosely. And so I think the best way to think about this is in two different entities. There's your gut health, and then there's the microbiota.

And they're connected, but there's an important clarification that needs to be made, which is there are things regarding gut health that we know and understand well. For example, we know how to test for small intestinal bacterial overgrowth. That testing has been validated. We have studies that have shown when we treat patients, they improve symptomatically and that correlates with an improvement in the test, We have similar data for things like fungal overgrowth, for things like H. pylori. So finding frank problems in your gut and treating those is kind of like gut clinical testing.

Then there's mapping the thousand-some-odd species of bacteria in your gut. That's the microbiota testing. And this, just to be very clear, has no place in clinical practice. If someone tries to tell you to do this test to help you lose weight or to help you improve your IBS, they're probably well-intentioned, but they're definitely wrong. And I rarely make such strong strong statements and it makes me uncomfortable to do that but it's because this has been so bastardized on the internet that if you can do

a test like an american gut or a u biome which are good tests i think we should support for research purposes but if you think doing that test is going to tell you what's wrong with your gut so that you can lose the weight or gain the energy that's not the case. And this comes right from one of the main scientists who's developed this technology, Rob Knight. And we've had conversations about this. He's been on my podcast. We've cold extra'd at the International Symposium of Natural Medicine and had this discussion in a group setting. So it's just important for the healthcare consumer not to get roped into that. So when you ask how does it affect the microbiota or the microbiome, I'll come back to what we know clinically.

We know that fasting can be very helpful for people's guts clinically. It can be anti-inflammatory. It can help with the repair process. And we have clinical trials showing that in patients with IBS and with IBD, fasting can actually lead to an alleviation of symptoms. And it's probably because we need time without food to allow the gut to heal, to perform housekeeping. And the analogy I like to use with my patients in my practice is if you sprained your ankle and you were running three miles a day, how long would it take for your ankle to heal? Right? Probably a long time.

So if your gut is injured and you're eating three meals every day, it's going to take your gut a while to heal because it never has a break. So this is where fasting can come in and you can do fasting in different applications. And we can talk about that in a minute if you want to, but definitely I've seen that fasting or intermittent fasting, or even modified liquid fasting can be a very helpful tool to help people's guts heal, repair, and to alleviate symptoms. Definitely. Hell yeah. I guess I should backtrack. The reason I asked that question for the listeners, because I realized this as you were speaking, it said that one of the issues with going low-carb is that you're going to starve the microbiome. And so sorry for leaving that part out, right? And then going back to what you were talking about with everyone on the hype train for a high-carb, high-grain, high-fiber diet, saying you need to feed these guys, these kind of things, leaving the argument of what's good versus bad within you out, which we've already discussed. And I think you really nailed that. But just talking about,

you know, if somebody, if somebody stays low carb for a period of time, won't you starve all the good guys? And we've really, it's really been disproven. And I think one of the reasons why I was one of the first people to say this, and now more and more people are starting to agree with me, is because when you look at the clinical literature, clinical literature doesn't lie, right? Speculating based upon observations can, you know, quote-unquote lie to you. You can be misled by that, right? So I look at the clinical literature, the clinical trials, and they clearly show that interventions that are lower in carb, I'm not saying ketogenic, but oftentimes interventions that are lower in carb tend to work well for a variety of healthcare conditions. And this is

most glaringly notable when we see that a low FODMAP diet, which by definition starves some of the gut bacteria, the microbiota, is vastly helpful for IBS and for IBD. Now, we think about this so bacteria-centric, but there are other mechanisms that are improving on a low FODMAP diet. Now, there was a group of researchers, and there's been about three or four studies that have looked at this. In people that have IBS, they may have impaired motility, meaning that food doesn't move through the intestines at the appropriate pace. It kind of gets stuck.

It builds up. It forms bacteria. That bacteria releases gas. That gas causes pressure. That pressure causes pain and also alters your bowel function. And they also may have an oversensitivity to pain called nociception. Now, serotonin is very key in helping with reducing pain and also with helping motility or things move through the intestines appropriately.

In a few studies, they've shown that a low FODMAP diet actually increased the density of serotonin cells in patients with IBS to become more like that of healthy controls. So when you think about these things only through the tunnel vision perspective of the microbiota, you may say to yourself, well, it's not good because it's starving bacteria. But when you look at it more broadly, you see that, geez, maybe we're repairing the endocrinology, the endocrine cells, the serotonin cells in the intestines that's partially responsible for this pain signaling and for this altered motility. Also, two other studies have shown a low FODMAP diet can reduce leaky gut, and this ties in with the immune system, and also can reduce histamine. And histamine is a signaling molecule that's used by the immune system.

And when people have a predilection toward allergies or maybe they have a very sensitive immune system in the gut, they can have too much histamine. That histamine can exacerbate leaky gut. And part of what may be wrapped up in this is people may have altered or unhealthy gut immune systems. Too much bacteria causes that immune system to go haywire. So if you starve the bacteria, the immune system is happy and everything in the gut

starts to work better. There's more serotonin cells. There's less leaky gut. So it's very important not to look at these things through a narrow lens of only the microbiota. And it comes back to this, you know, what's that old saying? You know, you know enough to be dangerous, right? You know enough to not know that you're wrong, but to do something that you shouldn't do. And that's why it's, you know, I understand and I applaud people for educating themselves about their health, but don't go too far without bringing in a consultant.

Just like you wouldn't represent yourself in a court of law. You wouldn't go read a bunch of law blogs and think that you were a lawyer. You really shouldn't do the same, you know, try a few things on your own. But if you're hitting a roadblock, bring in a clinician.

It'll get you to where you're trying to be probably faster and probably more economically. So I'm sorry. I think a good rule of thumb on that would be to have somebody who understands a similar mindset to you. That's not going to put you through thousands of dollars worth of testing, and let's just keep going and keep going and see what comes up. Right? So you've mentioned a couple of things. Obviously, you're a master of the gut, and you also understand the thyroid at great lengths. What are some of the ways we can test for things like

small intestinal bacterial overgrowth if we know it's there, if we have maybe some of the signs that it's there? Sure, sure. So the best test to use for small intestinal bacterial overgrowth is a two- to three- hour breath test that will take serial measurements. Usually it's every 20 minutes of hydrogen and methane gas. Now, there's two solutions that can be drank as part of that test, either glucose or lactulose. And there's debate as to which one is the most accurate.

They can both work with the right clinician. I prefer lactulose, but essentially you're going to drink a solution, either glucose or lactulose. You're going to breathe into a test tube approximately every 20 minutes for two to three hours, and you're going to measure hydrogen and methane. These are test kits that can be done at home, which is convenient. They can also be done in office, but for most people, since it's a two- to three-hour test, much more convenient to do it at home.

And some labs do this direct-to-consumer. A lab I like is AeroDiagnostics. They offer clinician accounts, and you can also go direct-to-consumer. They're who we use in the clinic. I know the owner of the lab. He runs a tight ship. He does a really good job. So for SIBO, very easy to test.

That's something that's actionable, because if you find SIBO, there's established treatments for SIBO rather than if you do an American gut. Again, it's not a bad test. I think it's good to support this if you want to support the research, but you can't take the American gut results and say, I'm going to treat these. We don't know what to do with that information. But we do know what to do with a SIBO test. And there's also stool testing that can look for things like H. pylori, Giardia, toxoplasmosis, blastocystis hominins, things like this, candida. It's kind of like your more traditional parasitology workup. And those are really good places to start in terms of gut health. There's other things for thyroid, but I'll stop there in case you want to dig into that.

Yeah, let's dive a little bit further on that. What are some signs that people would have small intestinal bacterial overgrowth, and how does that affect us globally? So this is what's interesting about this, because not everyone that has a problem in the gut will manifest it as typical gut symptoms, right? So your typical gut symptoms are usually altered bowel function, either constipation, diarrhea, or a combination of the two, abdominal pain and or bloating, sometimes GERD, sometimes reflux. You know, those are really some of your main ones. But we know, for example, that some cases, and I've seen actually in the clinic, some cases of SIBO that only manifest as rheumatoid arthritis.

And a patient comes in and they said, hey, doc, I know that you're a gut specialist. I've heard a lot about the connection between the gut and autoimmunity. Can I be tested for SIBO? And maybe that'll help my RA. And wow, like in some of these cases, we've seen people get off their RA drugs after treating SIBO. Again, I'm not painting this as a panacea. I think we have enough of that going on on the internet, you know, as is, but it's an intelligent place to start and it can be done as part of a reasonable evaluation. So you can have a camp of people that have classic gut symptoms. That's like your bullseye giveaway, right?

But you could also have people that have things like joint pain, things like skin conditions. And we know that there's people with celiac disease, for example. It can manifest, so celiac disease being a full-blown autoimmune response to gluten, it can manifest in some patients as solely a skin condition, a neurological condition like brain fog, or even like joint pain. And there have been trials. If you're listening to this and you're a doctor and you're shaking your head,

there's been one rheumatology group that published a series of case studies in patients that had non-celiac gluten sensitivity. So it means they weren't even full-blown celiac, but they noticed they had tremendous improvements in their rheumatological symptoms, things like joint pain or ankylosing spondylitis, when they went gluten-free. And then when they went back on gluten,

they saw a resurgence of these symptoms. And some of these patients had no digestive impairments at all. So we do know that inflammatory issues in the gut can manifest only as non-gut symptoms. Another example would be urticaria or hives. There have been a few trials that have shown that either parasitic infections or blastocystis hominins infections can manifest as hives or cause, not manifest, but ultimately cause hives indirectly. And more importantly, the treatment of these infections has shown the ability to cause a remission of the hives. So to your question, I don't think people should be looking for a certain constellation of symptoms, but if they've got their diet in decent order, if they've gotten

their lifestyle in decent order and they still haven't seen much response, the next place I would go instead of Lyme testing, adrenal fatigue, heavy metal testing, mold, right? Nutrient deficiencies, food allergies. The next place I would go would be a good evaluation. See anything there through to completion. Like a comprehensive stool analysis. You know, oftentimes I, I to completion like a comprehensive analysis i you know oftentimes i i like a comprehensive stool analysis paired with the SIBO test but you know in in in my book which will be out in february you don't have to do any testing and what's the name of the title for that for the listeners healthy gut healthy you awesome healthy gut healthy you there's a whole protocol that really does not require any testing.

And the reason we can do this is because many of these overgrowths or imbalances can be treated with herbal medicines. And even if you don't necessarily have SIBO, you can still use a course of oregano, and it's not going to do any damage. But I've learned through years and years in the clinic that sometimes patients are exhibiting these paradoxical symptoms and all the testing is negative and we treat them with a round of herbal medicines as if they had an imbalance in the gut and they improve. So certainly we don't need to make a lab justified case to try a short course of oregano or alicillin or berberine. People are using things like berberine to lower blood sugar, you know, in high doses for long-term. This guy right here. Yeah. Yeah. So, you know,

if you know how to do it the right way, as, as, as the protocol in the book lays out, we go step by step at the end of every step you reassess. And then depending on your response, you're either done or you move on to the next step. So that way, if you're someone who's relatively healthy, you maybe only go through two steps. But if you have really severe IBS, you may need to go through all of the steps. That makes perfect sense. Damn, that hit the nail on the head there. So parasites, I'm sure you're going to cover in the book. You and I have both dealt with them, different strains, things like that. They're not necessarily going to work the same way as a bacterial overgrowth would, but do they eat the same foods? Like how do they, how do they work in the body? So bacterial and fungal overgrowths are

actually vastly more common than traditional, you know, quote unquote parasites. Even though I actually had a parasite, the, the imbalances and the things that are already there, so this would be like SIBO or candida, those are much more common. Something like a low FODMAP diet, for example, as I understand it, it wouldn't work for a worm or for an amoeba or something like that. Those typically require targeted agents. But the good news is that many herbal medicines are antibacterial, antifungal, and antiparasitic all in one vein. So it's not to say herbal medicines are going to work all the time for everyone, but if you use them at the right time,

if you get someone's diet and lifestyle in order, and then maybe you add in some probiotics and other gut supports that will bring them up another level in terms of their gut health, then you're really primed to have an optimal response to a nice gentle push with some herbal antimicrobials. And that's what I think separates success or failure between some people. They don't lay a foundation and they try to cure things with herbs, but they haven't built themselves up to have that foundation laid and they're not able to get the results

with herbs. Yeah, they feel just die off, I guess, from candida. Or they feel like their body is actually worse from doing a treatment protocol with something like black walnut, wormwood, cloves, different things. And sometimes that's just reactions. Sometimes people just have allergic type reactions or intolerance reactions. And it's important to realize, at least in my opinion, there's no studies that have really looked at this. So this is more of just a clinical observation. But die-off generally tends to last only a short while, a few days, maybe a week,

and then it rolls off. It kind of rolls on and rolls off. If it's someone having an allergic or an intolerance reaction to something, it'll persist after two weeks, after three weeks. And unfortunately, sometimes people are advised to push through it because it's, you know, it's, it's this, this die off. But if it's, if it's persisting for well beyond a week, you're, you're probably just having a negative reaction. And some people will, some people do not tolerate berberine. Some people do not tolerate alicillin. So it's important to, you know, take that into consideration and shift treatment approaches. If you're experiencing that prolonged negative kind of feeling. Man, that makes a lot of sense.

All right, we got a little bit of time left. I want, you know, something that I have in mind when I, and maybe to a fault, but I appreciate when I look at people that are in good shape. I double appreciate that when I'm talking to a health professional or somebody that's trying to coach me on how to look and feel my best. You got to fucking look the part. You 100% look the part, right? So let's talk about some of the practices that you have on a personal standpoint for weight training, diet, things like that, that you embody to look the way that you do. You look phenomenal. Oh, thank you. Thank you. You know, I generally eat lower carb, probably about 120 to maybe 160 grams of carbs a day.

Mostly paleo. I do eat some dairy. I do eat some grains sometimes. I really don't have any problem with gluten, but I don't make that a dietary staple. I play with intermittent fasting. Sometimes I do it, but if I do it for too long and then they start to feel kind of burnt out. So I don't do it all the time. And I kind of oscillate back and forth where sometimes I feel like I'm eating too frequently. And what, what, what happens is,

and there's just little things I've noticed in my own body, but, um, if I intermittent fast for too long, I start to feel kind of burnt out, you know that like stress, you know, you're a little foggy. You feel like you're on that hamster wheel. Heart rate's a little bit higher. You're just too amped up. So if I intermittent fast too much in terms of too long in one day or too many days in a row for too long, I start to get too sped up. But also on the other end, if I'm eating breakfast, lunch, and dinner for too long, I'll start to get a little bit of fatigue, most notably in my morning meal. And so I kind of wax and wean back and forth between those depending on how I'm feeling. Also, I noticed that when I got into my 30s, I couldn't eat the same amount as when I was in my 20s. And, you know, man, right from probably college,

I was on this, you know, four to five meals a day, kind of like a healthy bodybuilding regimen where I eat every three to four hours. And that served me well up until probably like 32. And then I just started feeling more full all the time. I feel like I didn't need that much food. But I kept doing it because it's what I had always done. And then I, I ended up gaining a few pounds and then I said,

you know what, I'm just going to take some of my own advice, stop listening to everything that I've read, what everyone tells me, and I'm just going to listen to my own body. And that's where I actually kind of fell into intermittent fasting. Um, and that tended to really work well for me. And then, then in terms of exercise, I've recently actually scaled back my volume of training because right now I work a lot. I probably work between 50 to 65 hours a week, which doesn't sound like a lot,

but if you actually map that out, it's a decent amount. Some people will say I work 80 hours a week, and I challenge anyone who actually works 80 hours a week. I'm talking actual working hours. It's a lot. I've noticed I've had to scale back my training. The main thing I've had to change there is I used to always do either superset or giant sets, however you want to define them. But I, you know, maybe I'm doing some predominantly pressing and pulling movements in the gym. And I would go from bench press to pull-ups, bench press to pull-ups, back and forth, back, forth, back, forth. And so very little rest, very high metabolic demand. And I've learned that that pattern of training, which is lots of volume in a short period of time is the most prone to cause what's termed in the exercise physiology literature

as overreaching or just overtraining or burnout. And so what I've had to do is really start taking like a minute and a half to two minutes in between my sets and bring that kind of, you know, cardiometabolic intensity down. And it's actually made a big difference. I think I've actually lost a little bit of fat from that, ironically, but I think given my lifestyle of working kind of a lot right now, cause of everything that's going on, I've got to offset that a little more in other areas. And that's why I can't do too

much fasting. It's why I can't have my exercise too, too crazy. I do play soccer twice a week and that's where I get my like really high intensity, but I couldn't be doing three to four days a week of high intensity weight training in addition to in addition to that because it just put me over the edge. So those are some of the most salient things that kind of come to mind. I love it. Well, I want to steal a quote from you that I think you got from somebody else, and maybe you know who this is. But he who has the best can do the most with the least. Yeah, I actually got that from Paul Cech, yeah.

I love that quote. I absolutely love that quote. And just going back to what you were just talking about, sometimes, I mean, obviously with the testing and things like that, that applies. But how we live our lives, if we're able to get the most with the least, that's the minimum effective dose. That's what we should be gunning for. Exactly. Not trying to be, I mean, if you're trying for a world championship, different person, different topic, different conversation. But for most of the people out there, including two guys sitting across from each other right now, I think it applies very well. Absolutely. It's just important

to, I think, find your own truth, right? You might read about how all this high intensity exercise works great for someone or how the super low carb diet works well for someone or how a high fiber, high prebiotic diet works well for someone. Don't get pulled off listening to your own body. Maybe experiment with those things. But ultimately, if I could give people one thing to do, and one thing that I do so often in the clinic, is I just reassure my patients that doing what's working for them is okay, right? And sometimes they'll read things that are saying, well, I shouldn't be doing this. I read about this or that or the other thing, and they keep doubting what's working for them, and they keep doubting the own observation that, hey, I do this and I feel good.

And so one thing I've definitely noticed, if you can listen to your own body and be confident in that observation, that'll get you really, really far. Because there's many different things that work for different people. And so the way to find your own truth in that is just quite simply listen to your own body. 100%. Where can people find you online?

Talk about your podcast and the new book coming out. Sure. So everything you can find at drruscio.com, which is D-R-R-U-S-C-I-O.com. And we've, as you know, we've got a weekly podcast. We do a weekly video. We do periodic articles. I also have a clinical training newsletter. So if you're a clinician or a healthcare provider, you can plug into that. It's a monthly publication. And then the book's coming out mid-February, and that's entitled Healthy Gut, Healthy You. It's all about the gut and how by fixing problems in the gut, you can have this far-reaching impact.

And the book ends with a self-help plan that's very personalized so that if you can't access a doctor or the only doctor that you've talked to wants you to do $4,000 worth of lab testing on day one, you can start off with a protocol in the book. It should get you pretty far. And I'm doing speaking here and there, but that's the brunt of it. Awesome, brother. Thank you so much for joining us. My pleasure. Appreciate it. Thank you for having me.

Thank you guys for tuning in to the On It podcast with Dr. Michael Ruscio. I'm sure you have a ton of questions, so be sure to check out Ruscio Radio Podcast and Dr. Michael Ruscio's website, which he mentioned, as well as be on the lookout for his book coming out in February. It's going to be a phenomenal book. I've had a chance to peek at it already, and I can tell you right now it's going to be a game changer. All right, guys, you've got questions. I've got answers. Every Wednesday at 6 p.m. Central Time, I'm going to be on Onnit's main page on Facebook

doing a Facebook Live Q&A. The Facebook Live Q&A runs for 30 minutes. If you can't make it at 6 p.m. Central Time, all you have to do is write in your questions and I'll be sure to get those answered for you either by writing it or talking about it on the Facebook Live, which you can check out at any point in time after the show airs. But be sure to tune in live if you can.

We're going to get a lot of information rounded out, talking about the podcast, talking about different health topics, and I think you'll enjoy it. And I'd also like to bring up a wonderful product that I take from on it called Shroom Tech Sport. It has adaptogens and cordyceps sinensis, which is a mushroom that is an amazing product that helps the body with ATP production as well as oxygen utilization. That means you're going to be able to work out harder and longer. It also is caffeine-free. So even though I like to work out with a little bit of caffeine in my system, I can do that with a different product, like some good optimized coffee, and then throw the wonderful Shroom Tech Sport in on top of that. The fact that there's no caffeine in it also helps me if I'm going to have a late workout, and I don't want to be up all night after the workout. You know, for people who are just

pressed for time and really need to get a good hard workout in, a lot of the best jiu-jitsu classes I attend are late at night, and you want to have the best workout you possibly can, but you don't want to be up until midnight or 2 a.m. because of the fact that your pre-workout contains caffeine and other stimulants. Shroom Tech Sport is the one that's right for you. Check it out at onnit.com slash podcast.