Live Like a Girl with Dr. Mindy Pelz - Why Is Gut Health So Important? - With Dr. Michael Ruscio

Episode Date: February 20, 2023

For full show notes, resources mentioned, and transcripts, go to: www.drmindypelz.com/ep161/. To enroll in Dr. Mindy's Fasting membership, go to: resetacademy.drmindypelz.com. This episode is all about gut health, repairing the microbiome, and the benefits of probiotics.  Michael Ruscio is a doctor, clinical researcher, and author working fervently to reform and improve the fields of functional and integrative medicine. 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 research has been published in peer-reviewed medical journals, and he speaks at integrative medical conferences across the globe. While actively seeing patients in his clinic, he also runs an influential blog and podcast, as well as a newsletter for functional medicine practitioners. Please see our medical disclaimer.

Your symptoms are the primary barometer. We say at the clinic, your body is boss. So we want to really listen to and steward the signals from your body. Hey, Dr. Mindy here. And welcome to season four of the Resetter podcast. Have I got a lineup for you this season? Lots of deep thinkers, a lot of brilliant minds, all with one focus. To move the needle forward on your.

mental and physical health. So please know that this podcast is all about empowering you to believe in yourself again. And I want you believing in your body. I want you believing in your mind. I want you believing in your spirit. If you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Enjoy. On this episode of The Resetter podcast, I bring you Dr. Michael Ruchio. Now, you will hear in this podcast, I have been following Dr. Roushio for many years. He has been one of the leading experts on the microbiome. And I fell in love with his podcast many years ago because he brought the research on really important topics like probiotics. And in this conversation, what I really wanted to

dive into with him was where the microbiome comes into play with hormones and moods. And this is really important because I know a lot of you are taking HRT or you're doing bioidenticals or you're on antidepressants or you're on thyroid medication. And what I know about the human body is that just getting the hormone in your body doesn't mean that your cells are using it. So I wanted to ask Dr. Rousio as a leading expert in gut. health, I wanted to really ask him, like, where the gut came into play in helping us break those hormones down. And his answers were really thoughtful and really innovative. So I think you're

going to find some really good insight if you're on any of those medications. The other part that I really wanted to dive into with Dr. Ruscio was around moods. You know, we've talked about this before as we've come out of the pandemic. Mental health is this hot topic. and where does the microbiome come into play with this? And you're going to be shocked at some of his answers. We talked about the newest study on SSRIs, the claiming to not help with depression. So we dove into that. He talked about the power of cold and heat on depression and your microbiome.

We talk about saunas in general. There's a long discussion about saunas. and so a lot of other tools outside of probiotics and fermented foods that you might be able to use effectively to help repair your microbiome. And then the last part of this conversation that I think will be really helpful to you all is this idea of how do we choose the right rope probiotic? I feel like when it comes to gut health, probiotics are really hard to understand. So he broke them down into three categories.

he gave them names. He talked about what you would want to, how you would want to use these three, how long you would want to use them, and how effective they were in relationship or in comparison to fermented foods. So this is a really, really thoughtful discussion. I told him when we closed and we were done recording at that point, you know, I've interviewed a lot of doctors on this podcast. and, you know, everybody has their expertise, but everybody, there's a tendency for a lot of healthcare practitioners right now to become quite dogmatic about whatever their specialty is.

And what I mean by that is they feel like their way is the right way. And I think you all know this, that I'm a big fan of finding your way and taking the tools that I teach you here, taking the tools that you learn in my books and in studying other people, and finding what works for you. And I felt like Dr. Roushio and I really saw eye to eye on that. So you're not just about to hear a conversation about gut health and hormones and moods and some fun biohacks, but you're about to hear a paradigm that you can use to be able to take every single tool you use from every single podcast and put it into the right

formula for you. So you're going to love this interview. It was really, really helpful, useful, and applicable. And I hope it changes the way that you look at your gut health or anything that you've learned about it. It's a whole other level in which we can discuss the microbiome. So Dr. Rouschio, enjoy. Okay, well, first off, I have to start by welcoming you to the Reset or podcast. I actually have been following you for several years.

I love your work. So thank you. Well, you're one of the three people, so thank you. I'm one of the three and I didn't even tell you. It's a close-knit group and now I know the third of the three. But thank you. It's great. Well said.

Well said. So, you know, what I love about your work is that you've been really talking about the microbiome before the microbiome was sexy to talk about. Like you had really been diving into a lot of concepts for years on that. So before we dive into hormones and mood and the gut, can we talk just about what's your why did you dive in there first what's your passion why do you think it's not a sexy it's not a sexy story but when i was in college i was uh you know your your your your type a high achiever i wanted to go into medicine and i was kind of a burly guy

so my advisor said well be an orthopedic surgeon because that's what the the burly guys do and when you're what 20 you okay sure um so i'm trucking along and uh i played lacrosse and college, always high energy, obviously type A high achieving. And then I fell from grace pretty swiftly and had debilitating insomnia, brain fog, food reactive brain fog that was just terrible, feeling like you couldn't communicate like you were studying, stuttering over your words and low energy, bouts of depression, fairly acutely. And nothing else really changed. I was doing all the stuff. I was studying both holistic health and was pre-med. So I was eating slowly and taking walks and getting time outside and getting morning sunlight and eating organic and exercising and meditating

and stress managing and sometimes even burning sage in the evenings and all the things. But then all a sudden started feeling terribly. And long story short, it ended up being an intestinal parasite. Amoeba Hesolitica, which I mean, this kill, as I know you know, but this kills people in third world countries due to diarrheal death because you dehydrate secondary to the diarrhea. And that's what I had. And I think because I was healthy, it didn't manifest as super overt digestive symptoms. And so in my case, it was just this food reactive brain fog. The gut just wasn't functioning well and fatigue and depression and poor sleep. And so this was discovered by a provider in alternative medicine. And so it diverted my path.

into alternative medicine and also to have an emphasis in gut health because addressing that parasite was the only thing that helped me. And before that, I had been looking into things like thyroid or toxins. And there's all the things that kind of come up quick in a Google search when you search for fatigue and brain fog. Oh yeah. Dr. Google will take you a lot of places. And I jump through all those hoops with well-intentioned practitioners or protocols. But the lesson I learned was if you have an active issue in the gut and you don't address that, then a lot of those other things are just trying to put the foundation on the house without or putting the top of the house on without the foundation. And so that's why I've been such a big advocate of gut health for

going back now 15 plus years. And, you know, the party kind of eventually came over to gut health being a cool area. And that was nice for me, kind of having had my own experience and having had written a book and done some research and also have a clinic that centers in gut health. It was really nice to see the recognition that, boy, like, you don't necessarily need an antidepressant in some cases. It could be your gut. And what a gift to help someone uncover that. So that's what I geek out on now. I love that.

Do you feel like the world is starting to wake up to the microbiome? Like, we've been a little slow to the microbiome conversation. Are we gaining momentum with that conversation? Yeah, we have been slow, and I do think we're waking up, both in good ways and bad ways. I'll give you an example. if you don't mind of a bad way. Yeah, please. U biome, the stool test that was all the rage for years and years.

They were shut down by the FBI due to fraudulence. Now, the fraudulence was insurance fraud, and that's bad, but what was worse was when they looked deeper into the scientific evidence that informed the test, and this was shocking, they found that part of what was used to determine if you have a normal stool or an balance stool was dog poop. They analyzed dog feces to establish some of their normative ranges. So that's some of the bad. With the surge in interest in the microbiome, you have the scientists and the charlatans coming to the table. And for healthcare consumers, it's really hard to delineate. Well, who is a scientist and who's a charlatan? Because everyone wants to look like a scientist,

right? Everyone, look at our science. Look at our science. Look at our science. But you have to really look carefully because if that science was an animal study, a dog maybe, that doesn't necessarily map on to humans. So it's great that there's all this interest. But with that, we have to be a little bit careful because unfortunately there are those who are looking to sell a product. And they might believe in the product, but the product may not have the requisite amount of scientific vetting to ensure it's going to help the healthcare consumer. Yeah. What it reminds me of is a little bit of the wild, wild west, when any new trend starts and it gets really hot, there's going to be a lot of people doing it in all the wrong ways.

It's a recurring story throughout history. You know, this happens. Yeah. And so do you think when, you know, this is a concept that I've really thought about a lot, is that when I approach my health, what's more important for me to take into consideration? My human cells, like what my mitochondria need, what my mitochondria need, what my. genetics might need, the cellular membrane, you know, what it might need or what my bacteria need. You know, we've heard 10 more times more bacteria than human cells. But how do I prioritize

what the, where to put my bacteria? Is it ahead of my cellular needs? The question you're asking, it's such a hugely important question. And different people have different perspectives on this. I'll give you mine. Okay. So there's these mechanisms that you just outlined, bacteria, intestinal bacteria, maybe intestinal fungus, mitochondria, maybe simulating certain metabolic pathways. So there's all these different mechanisms that we can consider when we eat, when we move, when we do anything, when we supplement. If we try to intervene at the mechanism level, what's challenging about it is we're not

sure if that mechanism is going to end up having the effect of better mood, clear skin, better sleep, whatever the outcome measure is. So the way I like to look at this is, let's intervene in such a way that we know it's going to change the health of the individual and put that first rather than trying to intervene at the level of whatever the mechanism is. And here's a microbiota example of this. We know that prebiotics and fiber feed gut bacteria. And this sounds like a good thing, and it is a good thing for a fair subset of the population. However, anywhere from 20 to 40% of the population has what's known as a functional gastrointestinal disorder. They have loading, they have gas, they have reflux, they have constipation, something like this in this broad umbrella term of

FGDs. And for these people, not for all, but for a fair number, eating a high level of prebiotics or fiber can actually make them worse. And it can flare their reflux. They can flare their constipation or their diarrhea or whatever. So if we went to the mechanism, well, feed good bacteria, good bacteria, good for host. But if that flares the symptoms of the individual, that's not good for the entirety of that person. So paradoxically, in some cases, eating lower fiber or lower prebiotic, actually is better for the net outcome of the individual. So when we look at outcomes, that tells us when we summarize all the impacts of the mechanism, which one translates to the total good that we're trying to achieve.

So I don't know if that's going too nerdy. No, how would you know what that outcome is? Like, how would you know if you fell into that category? Right. And so this is where I think working through a somewhat linear hierarchy can help someone figure this out. So we have a few different steps you can take. And then your symptoms are the primary barometer. We say at the clinic, your body is boss. So we want to really listen to and steward the signals from your body. So let's say someone comes in and they have fatigue, brain fog, and constipation.

Somewhat common symptoms, right? Now, there's all these different things you can do. But you could go high carb, carb, low carb, keto, you could supplement with fiber, you could not supplement with fiber. So how do we reconcile where we go? Well, let's start with food quality first, right? If the individual is coming in and they're drinking soda and they're eating lots of processed food, which I'm assuming most of your audience is not, but just to acknowledge kind of step zero to one, you start there. Okay.

And if they're at a decent baseline diet, okay. Then from there, let's maybe consider a low phobamp diet if they have digestive issues because we know that can help for some people after they've gone through dietary step one, which is basic food quality. And you go on that diet for about three weeks and either your symptoms improve or they don't improve. And then you can line up next to that,

maybe a intervention with probiotics, let's say. But the point I'm making is we have to start making our decisions based around the response of the individual, not based upon what's in vogue. Microbiome good, high fiber, high prebiotics, And that message gets out there and it helps some people, the people who will benefit from that, but it might make other people worse. And so unfortunately, what ends up happening is a healthcare consumer is secondary to what's in vogue.

And what I try to do is say, these things have a time and a place. Let's just try to figure out which one for you in what order so that you have the highest likelihood of improving your symptoms as quickly as you can. Yeah, I could not agree with that more. And one of the things that I'm seeing just from the perspective that I'm looking at from health is that, a podcast like this, it's a great example. It could either be used to improve your health or it could pigeon you, hole you into the wrong strategy for you.

And the problem that we have is we're looking for the absolute in health. And the only absolute is for absolute. So it's like if you can't do what your friend did, you can't like if we could sit up here and say, oh, the FODMAP diet is amazing for the gut. Well, maybe that will work for some people, but it doesn't work for others. So the challenge I have to the public is listen to these podcasts and then test it just the way you said.

And I love that. Let the body be the boss. Otherwise, you're going down into a path that could be as unhealthy as eating McDonald's all day. Yep. And this is where I think it's helpful just to give people the benchmarks of for most diets, by the second week, you'll notice something. And by the third-ish week, it's not to say you're fooling your. proved, but you're able to say, hmm, I'm feeling better. I'm going to keep going. Or if you're not, time to put something else in line for the next experiment. And that way you can be moving, right?

Like one of the other things we say at the clinic is keep patients moving forward, right? We don't want to hit the stagnancy. If it's not working, let's keep thinking, let's keep iterating, but let's not just come back to the, well, you know, you got to give it time. Like that, no clinician like saying that, by the way. and they don't say it because they want to say it, but sometimes we're not sure what else to do. And so I think it is really helpful to keep an individual moving forward. Yeah. One of my favorite statements is you don't need motivation.

You need momentum. Yes. And when you get momentum with your health, you're like excited. You're like, what's next? What's next? But when somebody's like, oh, I'm not motivated to work out. Well, sometimes momentum looks like putting your favorite workout outfit on and you're like, oh, well, actually, I feel like it now. So I would say the same thing

is like if you are, if you're trying a probiotic or a different diet, like something just to give you that step forward is going to keep pulling you to some better health place. Yeah, and then you reinvest, right? You reinvest a little bit of energy and now maybe you start exercising a little bit more and then, you know, you have a little bit more energy and that's what we're after. Yeah, we're after that little bit of potentiation that can keep spiraling upward. That's right. That's right. I love the way you phrased all that. So talk to me a little bit about moods in the gut because I can tell you, you know, the world that I'm living in is a lot is the hormonal world. And we have a, for women over 40, we have such a huge emphasis on, oh, you need to make more estrogen. You need to make more

progesterone. We've got all the bioidenticals in HRT. But what I've been educating my, my audience on is there's making the hormone, there's, and then there's breaking the hormone down. And so much of the breaking the hormone down happens in the gut. So could we start with like what is the purpose of the microbiome in hormonal activation? Yeah, absolutely. Well, we know that the microbiome helps to detoxify estrogen and progesterones. So it does play a key role in detoxification as the one aspect. There's another that it's a little bit more of a clinical observation, but, and there's some early data to support this, that different gut interventions seem to have a hormone balancing effect. Now, and sometimes it's hormones and sometimes it's things tend to the hormones.

For example, some studies have shown that probiotic supplementation can improve absorption of iron and B vitamins. So it might be that a history of heavy periods, depleted iron, that iron is either low or borderline low, and now that's causing things like fatigue and some brainfall, and maybe sluggish with their exercise. And so the probiotic may support the symptoms of female hormones through a two-fold mechanism. One, through helping better detoxify or get back to kind of normal detox. And then the other is with absorption. And it may not really be that the, you know, the iron doesn't help the hormones directly, so to speak.

But, you know, at the body is boss level, if you're saying, well, the probiotic made my depression less. and I have better energy, then that's a huge win. So what's happening is probably multifold. Part of it is the impact that the intestinal bacteria have on conjugation of hormones and detoxification of hormones. But then there's this other facet that's probably multifactorial, one of which might be nutrient absorption that also seems to improve symptoms. And this is a thing that to me is super clear.

And even when I was writing Healthy, Gut Healthy You, even though the book's all about, as the title suggests, gut health, there was a chapter on female hormones because I had seen such an interplay and such a connection between women coming in, men also, but different category, women coming in with digestive symptoms and then also female hormone symptoms. and the female hormone symptoms so routinely improved from the gut care, I wanted to call that out for women so that they could understand the importance of this component to their hormonal health. Oh my God, I love that. So let me put it in real applicable terms. If I get on HRT because my estrogen is low, but I've been on 18 rounds of antibiotics and multiple steroids and my gut and eating horribly,

my gut's a hot mess. is that enough just to supplement with HRT or is it going to behoove me to start to repair my gut so that actual estrogen that I'm ingesting is going to be able to break down? I mean, I'm obviously very biased here, but I would say it's always a good idea to look at hormones as more of a cherry on top and dietary lifestyle and gut health as the foundation. And it's not to by any means short change hormones because direct support can be super important for both men and women in some cases. But in an inflamed body, and we're going to assume if there's GI symptoms or some degree of inflammation just as a presumption, hormones, at least in my experience, and there's some evidence to support this, don't tend to always do what you want them to do if they're being administered into an inflamed body. So one of the ways that we help kind of improve the milieu for the hormones to work the way that we want them to is with this foundation that we termed the diet, lifestyle, and gut health foundations.

And now you're in really great shape to get the most out of your HRT or your bi-identicals or even if it's herbs like Dong Quai, Black Cohash and Chase Tree. You'll get even more out of those, at least from my clinical observation, if you're doing this on top of that diet, lifestyle. and gut health foundation. Yeah, it's so well said because what I've, and I'm sure you see the same thing, but if you don't, let me know, that it's really, we very much want to reach for the pill. And at some point, it's like, well, I don't do medication, but I do do supplements. So they come to doctors like you and me, and they're like, well, give me the don quai, give me the maca, give me the thing that's going to help my hormones.

But we don't want to do the work with the lifestyle because that's a lot hard. harder. So what I just heard you say is like, you can reach for those supplements, but they're not going to be as effective until you do the work. Yes. And this is also, I think, tying in with one of your earlier points of kind of getting that initial small win. And this is kind of the art of health care, where maybe someone does need the hormones earlier to give them a boost, but then the clinician's going to redirect them toward, okay, now we got to start exercising, right? Because we got a little boost with the hormones, but we don't want to keep stacking on top of, you know, we don't want to hormone our way out of all your problems. As soon as you're at a point where you're not

depressed and you have enough energy to do those healthy foundational behaviors, let's get into those. So, you know, sometimes we can invert the model to meet the individual, but I think as long as big picture, we get the balance right, then we'll be, you know, experiencing that level of optimal health that we want to. Yeah, I like that. So when we look at, When we look at the female menstrual cycle, the time of the whole cycle where we have the most amount of hormones is ovulation. And in general, when I look at the characteristics of estrogen, progesterone and testosterone, during ovulation, we should feel pretty good because we have all of these hormones coming in in spades. But what I've noticed is that there's a subset of women that don't feel very good at ovulation. And where my brain is gone is to think that it's possible that those are the ones that don't have good gut health.

Have you seen clinically where there's actually, when we have problems in ovulation, there's a bigger challenge in the gut. And so those hormones are just not being broken down. Interesting. Yeah. Offhand, I can't say I've made that direct connection. But one of the things that we do look for is a history of painful menstruation. and sometimes this goes back to when they were first menstruating in their teens and they had kind of like doubled over intense pain. Maybe they've been in the ER for a few times because of that.

And then oftentimes they've been on birth control for many years and we're seeing them much later. But we make a note of that because that can be an indication for endometriosis. And in some cases, let's say if there's non-responsive constipation, we're thinking there may be excess endometrial tissue that's interfering with the intestinal lumen and stool passage. So I know it's not directly answering your question. I can't say to that question. I have a tight observation, but very painful periods, you know, that's one of the things we'll make a note in their chart. And if we go through the diet, the lifestyle, the gut health recommendations, and some

symptoms are improving, but there are still others that aren't, we might refer out for an evaluation for endometriosis in that case. Got it, got it. And do you see a correlation between women that have been on birth control? for decades and new symptoms appearing, you know, I would go as far as to say the menopausal symptoms, depression, things that tend to really hit women at 40. Can we make a one-to-one relationship that, gosh, the longer you're on birth control, the worse that that menopausal journey is going to be? You know, in terms of clinically, I can't say we're not really set up

to be examining that data in a clinical context. I think that's more like a researcher setting where you want to be tracking individuals over time and then looking for length of time on birth control and then severity of symptoms post birth control. And that's no easy thing to be able to achieve, right? So I can't say that I've been able to parse that out of our data. I know, or at least anecdotally, I've heard that criticism made,

that length of time increases the likelihood of there being issues when coming off of birth control. And I think that makes sense. And this is why I'm more favorable of something like a copper IUD, at least from some of the people I've interviewed who are experts in this area in particular, have really advocated for copper IUD or just non-hormonal birth control due to those exact reasons. And then one of the other things I like to tell people kind of in a similar vein tangential to this is, okay, you know, we can't change what's happened.

let's just maximize with what we have right now. And there's so much that we can do there because sometimes people will come in. They'll say, well, I had antibiotics as a child. I wasn't breastfed. I was formula fed. And now I have really bad IBS. You know, am I doomed because of that?

And I'll say, no, like there's all of these clinical trials that show people with these symptoms can improve, irrespective of their background. Sure, some of these things may increase your risk. But if we have tools to fix that issue, then you shouldn't look at your past as a prognostic indicator for your future. Yeah, I'm so happy you said that because I think that we really have to,

especially in the health movement, we come out and we're like, this is bad and this is bad and this is bad. And the patient, the person listening is like, okay, what can I do? Like wrap myself in a bubble. And, you know, I think then when you look at how you live or I live, you would see pretty quickly we're not deprived. So we've all had bad things in our past and we've stepped into healthy lifestyles. with the gut, how quickly does the gut repair?

Very quickly. I mean, the intestinal tissue will turn over in about 72 hours. Now, the immune system in the gut is another issue, and that may take a little bit longer, but very, very amenable to improvement. And just in response to the other thing that you said, I think this is important to keep that in mind regarding diet because it's so easy to research all the things wrong about diet,

dairy is a problem for some people. Glutons are a problem for some people. Fobinths are a problem for some people. Solicilates are a problem for some people. Histamines are a problem for some people. Oxides are a problem for some people. Lectins are a problem. And then what can end up happening is people have a really contorted relationship with food.

And they are, and this is kind of one of those downwards spirals, right? We described the upward spirals earlier. So now someone could be under eating and also withdrawing from social opportunities because at a dinner out, right? How much control do you have? So they're under eating. They're socially deprived. They may not be sleeping well because they're under eating. And all this starts to really snowball. And it can be so freeing when someone says, hey, like, let's open up your diet. I don't think you have a problem with gluten. I don't think you have a problem with dairy. I don't think you have a problem with histamine. Or at least you can have some, right? Like, yeah, go out, go to a dinner,

be social. You're not going to ruin your health if you eat off plan a little bit. Yeah. let's focus on food quality, 70, 80% of the time. But then you can also have a life. And it's important to have a life. And just that shift for some people, they will literally come in and report higher mood and vigor and well-being from that one shift. Yeah. Amen. I am so in alignment with you on that.

I feel like we need to live life and eat healthy. The idea is not to become rigid around each one of these pieces. The idea is to be playful and curious about what would it be like if I avoided gluten 90% of the time. But then what does it feel like if I added in 10% to have, we need to be a little bit lighter how we're approaching the dogma of health, of alternative healthcare. I was if I don't know another way to say it. We're not necessarily, I don't think you and I think of ourselves as alternative, but, uh, of natural health care. Um, you know, we, we can get really orthorexic, right? That's, that's a literal term that's showing up.

Like, how would somebody know if they had a gut problem? Because I think it's surprising that it's not just constipation. Well, there's the obvious digestive symptoms of, you know, the short list would be constipation, diarrhea, bloating, abdominal pain. Reflux could be another. Feeling like something is stuck in your throat, also known as eosinephilic salvagitis could be a third. Fatigue after meals could be another. If there's a history of a That's another that could potentially mean impaired gut health. But then there's all these what's known as extraintestinal manifestations of poor gut health. And this is where you can have something like food reactive brain fog. You can have issues with your skin.

So pimples, lesions that have no known cause. You can have this paradoxical joint pain. I have a sore neck here that you can't really tie to a workout or to a thing. mood imbalances, mood swings are another big one. Insomnia is another. So what I like to say is because there are so many causes for a symptom, let's say, like fatigue, it's better to, again, come back to kind of this linear progressive hierarchy of intervention and look at, okay, if we know that maybe up to 40% of people have issues in their GI,

and let's say hypothyroid, which affects about, you know, the stats here are debatable, but if you're going to be sort of conventional in your diagnostic criteria, about 0.3% of the population has true hypothyroidism. Now, you can debate and say maybe it's closer to one, whatever, right? Maybe it's 4.6, maybe it's even higher. But that's still very different from up to 40, right? So if we were going to say, okay, which one comes first? we'd say let's look at GI health first before we consider something like hypothyroid or

mitochondria so they have a time and a place but we have to rank order them according to probability yeah because like me fatigue brain fog insomnia and low mood no digestive symptoms right what i did what i did was went to heavy metals and thyroid and i got was a last stop. In fact, the doctor who said he thought it had a gut issue, I was like, what? I have no gut symptoms. So it's those cases that I'm, like myself, most passionate about helping people understand that if you're having these symptoms, you haven't figured out why yet, go through a couple gut interventions, a couple of light experiments, like you said, with your gut health, and see if the needle moves. Because from a probability perspective, those are fairly common.

to be the causative factor of something like fatigue or brain fog or mood swings. And are there like a few gut interventions that everybody should do that are just tried and true that everybody should do? Well, I'm a huge advocate for probiotics. Okay. We do a podcast every month on probiotic research. I'll select about 10 studies. We monitor every time a study is published on probiotics, we monitor the research feed.

and some are noteworthy, some are not, but then we'll do a podcast one per month, usually on the top 10 to 12 studies published in the past month on probiotics. And what you see in this research feed is things like necrotizing enterocolitis in infants improve with probiotics, all the way up through some studies showing that cognitive decline in elderly improve from probiotics. And in between, you see resolution of SIBO,

you see improvements in thyroid hormone medication absorption, you see improvement in female hormone symptoms, you'll see some reductions in inflammatory authorities. So because there's all these benefits, plus the gut benefits, I think a probiotic, a good trial on the clinical dose of probiotics is one of maybe two or three cornerstones of those gut experiments. And does it matter which probiotic you take? Because that's a whole wild, wild west. industry as well. Yeah. So here's the long short on this. There's kind of two camps of thought. One camp that says, while the research is interesting, we don't yet know what the best probiotic is. Therefore,

we need more research until we can recommend a probiotic. And I get where that's coming from, right? But probiotics are not invasive. They're not expensive. So we may be out in kind of this witch hunt to find the best probiotic. Because when you look across trials, you will see that for the same condition, let's say constipation, all different types of probiotic formulas have been shown beneficial. So what that tells me is there may not be a best probiotic. but categorically, probiotics may work.

So now if you're going to be uber, Uber, super scientific, you want the really large randomized control trial with over a thousand individuals and you found that this

one probiotic was the best, like a drug trial. I don't think that's ever going to happen with probiotics. And because we've seen, again, so much uniformity in improvement across different conditions,

find a company that follows good manufacturing practices that, you know, you know, isn't going to be snake oily. Try the recommended dose and use that for about a month and see if you feel the needle move. Now, one tip I'll equip people with in case one formula that you try doesn't sit well, the way that we break these down is into this three category system.

The first is a blend of lactobacillus and bifidobacterium. This is like your VSL3, you may have really popular probiotic. VsL3, Vizbiome, it's just a blend of lactobacillus and bifidobacterium. This is the most research type, most traditional. So that's type one. Type two is actually a fungus. This is floristore or Saccharomycese blari. So that's another type of probiotic that you could trial.

And then the third is this newer kid on the block. You have a few different formulas, megaspore, prescripticist. They're a combination of bacillus. It might be bacillus subtilus, bacillus, licinformis. But that's your third type. And what can allude some people is one of those, for whatever reason, may not sit well with a person. So they try a probiotic and they just don't feel well the entire time. And they go, well, probiotics aren't for me.

Look on the label, right? Identify which one of those three was the one that didn't sit well with you. and then try one of the other two. Chances are very likely that one of these three will move the needle, and you want to discover that, and then keep going with the one or even the two that do. If you, that was so well said. Thank you.

You actually cleared up something in my own head, so I really love that. But how do we know if it sits well? Because the way I was always trained is if you take a probiotic and you start getting diarrhea or, you know, get constipation, it could be a sign of die off of the bad bacteria. Do we still believe that? Like, how would I know if it's working well for me?

Yeah. So it's a great question, really important question. And it's the length of duration of that turbulent response that helps answer this. Okay, great. Usually if it's something like a herksomers or a balancing reaction of some sort, that's going to last for anywhere from two to maybe four or five days. And then it should have bait. Got it.

So we tell our patients at the clinic, and this is in our materials for probiotic, you know, recommendations also. If you get to the five-ish day mark and things aren't getting better, it probably tells you it's an intolerance. And this applies to many herbal medicines also because we want to distinguish between rebalancing herks and merge type reaction versus intolerance never going to be good for you. And it's the length of time. So, again, you know, usually around two, three, four, or five days, you'll see that. wax and wane. If it's adjusting, if it persists, then move on to something else. I love that. And do you believe in monoculturing? Like, do we need to worry about changing up our probiotics so that we don't keep growing just one subset of bacteria? Yeah, I don't think we have

adequate research to accurately answer that question. But there's a few trends in the IBS. So looking at irritable bowel syndrome as one model to tell us how to intervene for with them with gut health. There's some studies, not all agree on this, but some studies indicate that the higher the diversity of the probiotic meaning, the more strains, might actually equal a better outcome. So this is why we recommend what's known as triple therapy, where ideally, remember those three categories, we'll have someone take, let's say, two capsules from one bottle, two capsules from the other bottle and two capsules from the third, just to have the broadest sort of support for the gut. I don't think that rotation matters. You can make an argument for that, but, and this is my

inference, but from an immune perspective, I think consistency of stimuli tends to be beneficial. And part of this is taken from, again, this inferential, but there's some data that if you grow up on a farm, you have less allergy. But if you just visit a farm, that can flare your allergies because the immune system tends to calibrate to what's present in the environment in an ongoing basis. Okay. So with that constant exposure, the immune system can kind of attune. But if it's just episodic exposure, then that may be more prone to lead the immune system

to react. Again, that's an inference, but this is why we favor more of a broad spectrum probiotic used continually. and then this is the other kind of, I think, important time point piece. Once someone has plateaued, meaning they've improved, plateaued, and they're stable for about two months, then we try to wean them off or find the minimal effective dose. Yeah, so the idea is not to be on it forever. The idea is to not be on anything forever unless you've qualified.

Again, your body's boss, right? So I use a probiotic most of the time, and I can't say I notice a lot when I go off of them. but what I had noticed was if I go out for a dinner, have some wine and kind of say whatever with the food, that's what I'll notice, you know, bowels may not be as great. So little things, right, nothing major. But through some experimentation, I noticed, okay, I'm going to do a probiotic, you know,

maybe most days, if I travel, I don't worry about it. I take breaks periodically. I'm not obsessive about it. But what I noticed was the probiotics were really helpful at first and they give me a little bit of an edge sort of in the long term. I wouldn't say they're needed, but they help keep me from kind of not being an average, and I feel like my GI functioning at optimal. But the goal is to be minimalistic because I'm positive.

You see this. What we call supplement creep, just all these supplements from every blog you read and video you watch and all of a sudden, it's like, holy cow, we have to periodically go through and try to weed out things that we no longer need because over supplementation is a serious problem. Yeah, I would agree. And I actually believe in supplement cycling because otherwise, I mean, ultimately you want your lifestyle to do everything. And so you cycle in with certain supplements, you cycle out.

But I would agree. The goal is not to just move everybody from medicine to supplements. Really, we want to create some lifestyle changes, which leads me to wonder if we look at something like sauerkraut or raw kefir, how does that compare to a probiotic? The doses in something like sauerkraut, kombucha, kimchi, they're quite a bit lower than what you'll see in a probiotic. You'll get anywhere from 1 eighth to one-fourth of one capsule of a probiotic is what you'll find in something like sourcrow, kimchi. So it's something, and it's good.

And it's something from a dietary respect I'd recommend an ongoing basis. But it may not be enough if someone has an active GI issue. it may not be enough to fully kind of get them over that hump alone. And to your other point, I do agree with supplement cycling kind of once we've gotten through the clinical woods. I wouldn't say like while we're trying to troubleshoot someone's GI, we try to say if it's working, let's like keep it going. But then when we're on the back end, that's when I think you make more of a case,

and especially for something like a B-complex vitamin or something like that as a hedge, that's when I really agree with you. And I like the concept of just periodically going on a bottle. Yeah. I've just found it, you know, the body's always adapting. So you're just continually kind of surprising it and keeping it fresh and moving in a growth phase. So last, something that's really been deep on my mind is last summer, there was some studies that came out that said SSRIs were not considered to be the end all, be all that we originally thought they were. And that depression wasn't necessarily equated. to low serotonin. Where does the microbiome fit into that? Because the problem I think we have with studies like that is it's just all in isolation. Like it might be that maybe somebody's microbiome is making more serotonin.

And so they do an SSRI and it doesn't really help. And somebody else is really, microbiome is not making enough serotonin. And the SRI is going to really bring that up. So talk a little bit about serotonin neurotransper. So much, so much to say here. We did a video breakdown on that study recently also. So if you haven't seen it, you may enjoy it. But so that study, it was an umbrella meta-analysis, meaning it was a meta-analysis of

med-analysis. A metanalysis is a summary of clinical trials, right? So there might be a few hundred clinical trials. They can be summarized in a met analysis. In this case, there's so many datum on SSRIs, the met analyses, there were so many of those, they were summarized in an umbrella meta-analysis. So it's an incredibly helpful type of study and extremely good way of getting a purview

of what the science says. But it wasn't answering the question, are SSRI or similar medications effective? It was looking at, is there a correlation between serotonin levels and depression? These are two different questions, right? We say on the one, depressed people, let's measure you, what's going on. That's one, that's what this study did.

Another type of data would be, okay, depressed people, let's give you medications and see what happens. That's not what this study did. So this study, great data, but it did not disprove the medications have any merit. It did find that there was no correlation between serotonia levels and depression. Now, when we were reviewing the study, we also wanted to say, well, let's be fair, even though I'm not, excuse me, even though I'm not someone who is a big advocate for drug therapy, I also try to be objective. And if the therapy works, then people should know about it. And what do you know? The meta-analysis is looking at interventional trials with SSRIs or SNRIs, find benefit. So we should just report that. Like, there it is. Period. It could help.

Now, yeah, they could help. Now, again, would I recommend that as an initial therapy? No. But might there be someone who's in a really tough place and for whom they need to win? Yes. Right. So I think it's really important to report in these data objectively. And then coming back to kind of in a hierarchy, there are at least one, or there is one meta-analysis that found probiotics can improve depression and also a similar meta-analysis finding that probiotics can improve anxiety. In that video breakdown that we did, we compared the effect of sauna therapy to drug therapy on what's known as the Hamilton Depression Index. And drug therapy led to a two point reduction and sauna therapy led to a four to six point reduction. Wow. So that's pretty, now I should be careful to say the drug study was a metanalysis and the sauna study was one small clinical trial. So it's not exactly an apple to apple, but it was just to impress upon the viewer that there are many methods that can improve your depression.

Exercise would be another, right? So, yeah, I would definitely say that the diet, lifestyle, and gut health foundations play a big role in depression. And within that, the lifestyle piece would be exercise and sauna. and then absolutely if those things don't land fully, hormone support can be really helpful for mood. As I know you know very, very well, especially for women but also in men. If there's low mood, then hormones can be really helpful. And the hormones do impact the neurotransmitters, but maybe that's not the mechanism, right? Maybe it's something else that the hormones are doing that's improving mood, but there does seem to be a connection. But yeah, so sorry for the diatribe.

No, no. I love it. I love it because this is something that I'm 53, and I've been thinking a lot, you know, I entered into my perimenopausal years very healthy and found out that there was a lot I wasn't doing for my health to be able to adapt to the loss of hormones. And one of the, the surprising things for me has been the mental health piece because I'm typically optimistic and energized and clear-headed. But as estrogen has gone away, I've seen dopamine go down, which I know estrogen's a precursor for both dopamine and serotonin. Yesterday, I read a study that said oxytocin can't even be used as much by the brain

when estrogen is low. So, you know, you look at a 53-year-old woman who's trying to live a really healthy lifestyle, but you're naturally losing these hormones that are affecting the neurotransmitters. What do we do for that woman and where does the gut come into play in that scenario? And this is one of the areas wherein I wonder if the sort of ancestral and naturalistic framework through which I examine many topics breaks down to some extent. Because I'm assuming that even though we both live really healthy, we're probably working more than our hunter-gatherer ancestors did. And in the book Civilized to death, Christopher Ryan broke down. that hunter-gatherers on average work four hours per day.

And I'm not working four hours per day. I'm not sure if you are. And kudos to you if you're only working four hours. So there may be this, okay, let's look at ancestral practices for all these things we can learn. So arcadian health, diet, movement, community exercise, time in the sun. But then also realize that we're in a different environment. So there may be some dials we have to adjust slightly to try to allow. us to thrive in this environment.

Oh my gosh. I love that. So, okay, so where did sauna come in? Where did the sauna come in in the ancestral world? And, you know,

like, when I look at, like, weighted blankets and chili pads that, that, you know, a lot of men and puzzle women are using, you could actually go back and say,

well, the cold and lowering your blood, your temperature is a little bit primal. They slept on the ground, and the ground could have been possibly cold. They had animal, a night. Right.

Yeah. They had animal hide. So maybe that's a weighted blanket. So where does the sauna come in? Yeah. You know, a good question. I don't know that I'm assuming there's no hunter gatherers who are doing sauna. Right.

But I think it sort of pushes a little bit more aggressively the concept of not having a thermal regulated environment, meaning when it was hot, you were hot. Right. It was summer and it was 100 degrees. You're walking around. Maybe you're in the shade, right? But you're not able to. to thermo-regulate your environment.

And that's, you know, so I do think it fits. We're just pushing that to a little bit more of an extreme to get an even higher degree of health benefit. But the way at least I try to embody that in my day-to-day life is I do sauna, I do coal plunge, and then I try to minimally thermoregulate my environment. When it's summer, I try to keep it a little bit warmer in here. When it's winter, I try to use the heat minimally. and it is amazing how much your body can start to be able to shun blood better to either throw off heat or conserve heat with all these capillaries and muscles you have to direct blood flow in the periphery.

So I would say SOTA is an ancestral concept sort of taken to a, you know, more techy extreme. But the data on SANA, I think, are really compelling in terms of brain health, cardiovascular health, reducing all cause mortality. I think a sauna is one of the best investments that someone can make. Also, because you just sit there. And you can also invite friends over. I have a barrel sauna. And it's become sort of a focal point for, yeah, you know, come over and you just broke up with your girlfriend or, you know, you had to fight with your spouse or some tough

business stuff. Come over. We'll do a sauna and we'll talk. And it's wonderful. That's interesting. And so infrared versus just good old fashioned, you know, heat, does it matter? Yeah. we wrote an article comparing the two, and even though my bias and my preference is toward the traditional sort of, you know, coil heater with rocks, the data is going to be pretty equivalent in terms of the health outcomes. Now, if you're someone who likes to get hot and you're maybe a little bit more of an intense person, right? If you're intensely exercise and you kind of like to push things, then I think you're only going to be happy with the traditional sauna because they get a lot hotter than infrared. My sauna goes.

up at 230. I'll set it at about 210, and so it'll oscillate between 200 and 210. And that's a really good sweat. And you come out of there and you can, you just feel like, man, the circulation has been potentialated, the heat shot proteins and the brain-derived neurotrophic factor, all that's going. And I feel great. Infrared, it's a little bit more mild and for me not as fun. But, you know, for some people that may be a preference. So. And so is it up-regulating neurotransmitters? Is that what the depression piece is? Good question. I'm assuming I haven't actually looked into that. It may have been one of the, we fact take so many things in the article. We do know that it improves mood and slows neurodenerative decline. One of the mechanisms is through similar to when you exercise, you have this brain-derived neurotrophic factor. So you get circulation and then some of these compounds like BDNF, which helped to fuse better connections between your neurons. I'm assuming there's some modulation of serotonin and dopamine.

If not, I mean, there's definitely catacolamines which are going to increase to increase the heart rate. Because my heart rate, I'll track with my Garmin watch. And once I get to about 130 BPM, that's when I'll get out. And there's catacolamines like adrenaline and cortisol that are going to help facilitate that. It's so fascinating to me because in all, and I'm sure you have this in your podcast, each conversation I get into, I start to see that the modern world has really taken us so far off course from our health. And one of the ways to find our way back is to ask what our primal ancestors did with a few modifications to your point. And I had never, ever thought about temperature regulation.

You know, fasting is my passion, and I've been all talking about that as far as our ancestors did that. but the thermal regulation is really interesting. Is there a connection to that and the microbiome? Does the microbiome need that seasonal change in temperature in order to flourish? Great question. I haven't seen any research on this. There may have been something published that we've missed. But if we look at heat exposure similar to exercise,

and I can say from a beats per minute perspective that I track with my Garmin watch, I mean, 130 beats per minute, if, like, you know, do cardio and you'll see that you'll be 130 BPM a lot of that time. If you're lifting weights, you have to be pretty vigorous with your weight lifting. They hit 130 BPM. So I'm just painting the connection between sauna and exercise. And we do know that sedentary people who start exercising see improvements in the health of their microbiota. So I'm assuming there probably is some favorable benefit from sauna. I don't know that that's been studied just yet, but it's probably one of the many studies

with all the studies coming in the pipeline in microbiota research. And there's some research, and you've probably heard of Wim Hof, the guy who hiked Everest in a bathing suit, he's been able to document in other people in a college university study setting that his technique of breathwork and cold exposure reduces overzealous immune activation. So that ties in with the gut because what can happen in some conditions, maybe an IBS, definitely an inflammatory bowel disease, is your immune system starts attacking good intestinal bacteria. So the cold exposure may help sort of attenuate this overzealousness of the immune system or may help give your immune system better balance. Oh, my gosh. You've given me like a deeper level of thought on some of these things that I've already been like.

my mind is like, this has been amazing. Okay, I have to ask you one more question before I ask the final one. Of course, I got to ask you what you think of fasting for the microbiome. Fasting can be a phenomenal tool, especially if someone is symptomatic, oftentimes patients will come in and say, I feel okay if I don't eat. And it's like, great. Well, you know, that's not a long-term viable strategy, but it tells us how important it is to have some points of fasting. So yeah, I'm a big advocate for fasting. I do think, it can be overused. And so sometimes we have to kind of bridle it back.

And I'm sure you probably discuss this that if you're starting to be low mood or fatigued or not sleep, well, or get dizzy, then that could either be too much fasting or too low electrolytes or both. But yeah, I think it's, you know, coming back to the ancestral concept, we didn't always have food. So another evolutionary pressure that we evolved underneath and could do well to sort of replicate that as best we can. Yeah. I love, I hope everybody else like this conversation, but this was, you gave like concepts that I've been really thinking about it. You gave some new context to it. So I just, I really appreciate that. So before I go into the last question, where, where can people find you? Because you have a clinic in Austin and you're actively seeing patients and you have an amazing book and an amazing podcast. Where else, where's the best place to send people to? If you go to my website, there's two websites. There's Dr.rusho.com. That's the main website. And then the clinic is Rousho Institute.com. And my last name is R UsCIO.

If you just search Michael Rucho, you can find me pretty easily. But yeah, we have clinical practice with a small research team, myself and three other doctors. And then on the other side of the world at Dr. Rucho.com, a podcast book and a bunch of educational work there for people. And, yeah, it shouldn't be too hard to track me down there. I'm trying to do some more on social media. great about it, but I'm trying to post more there also. It's an animal.

Social media is like a big, big animal. Yeah. You may not want to go there. Okay, here's my last question. It has nothing to do with the microbiome. At least I don't think it does. Our theme for this year for our podcast is self-love. Do you have like nurturing practices that you do every day?

And if so, what are they? And then the second part of that question is, what do you feel? I'm really trying to get people to highlight what are. geniuses are. Do you have superpowers that you're like, yes, this is my superpower. What would those be? Well, the superpower, I think, is just obsessing over health and figuring out how to solve the equation of an individual's health care. And I was the first one. And I've always been someone who, I think some people are tuned into how they feel and other people are a little bit more detached. And I've always been very tuned in. And it served me well and serves me well in clinical practice because a lot

of what you're trying to do is just read the signals from someone's body to reveal what they need to thrive. So I think that maybe OCD along with a selfish desire to be as optimal as I can have come and coalesced together to help people. And then in terms of self-love practices, I have a whole slew. I'll just give you a few. Every morning I go in my cold tank for about five minutes. So I have an outdoor shower. So I shower outside is brisk. cold, then I jump in the cold tank. It's super invigorating. And then I'll make an espresso.

I'll do a walk around the block and I'll meditate. And then I'll start my work day. So that's a really nice way to kind of start the day with a lot of, you know, invigoration and some caffeine and some movement and some time outside. And then a meditation that kind of still me and focus me and then right into the day. And then in the evening, I'll do sauna and cold tank contrast. So, I'll do about 15 minutes at 200 degrees, jump in the cold tank for about a minute, and then go back and do two rounds. And I also exercise every day, usually around midday. Yeah, so those are a few things that I do that are really helpful. And I don't have a TV, maybe one other thing to put on the board.

I recently moved and I gave me an opportunity to get rid of the TV. I do have an iPad, but what's nice about the iPad is it's small. So it's discouraging of watching TV. And what's been beautiful is it's not just the, I'm on the couch, lay back and have the big TV there. So that, that like junk food in the cabinet of convenience for the TV is no longer there. And I find myself listening to music more. And it's such an amazing exercise for your brain. Because when I lay back and listen to music, I'll say, oh, you know what?

I haven't called my mother in a couple of days. I should probably call her and ask her about how she's doing with X. So all these things that are in your subconscious have a chance. to come through because you're not just being passively entertained by television. So that's maybe one other thing that's been a recent discovery that's been really helpful just to have that time in that space to think about how to be a better person or, you know, things that you want to do. Like, oh, remember I said I was going to do that trip?

I never did. Why didn't I? I don't know. I'll do it. Right? So, yeah, there's a few ramblings. Hopefully something I was useful. I love that.

That was actually such a good answer. I really appreciate it. a lot of throwness. And you know what I think is I do the same thing where I have a morning time and an evening time. Like they anchor my day. And what's really exciting is when I wake up in the morning, I know this is what I'm going to do.

I don't have to think about it in that kind of hazy state. And at the end of the day, I have the same thing that I know what I need to do to wind down. So I absolutely love that. Well, Dr. Ruchio, thank you so much. I really appreciate you coming. And again, just happy to be one of your three followers. So, yes. Well, that's been a great conversation.

I'll see you a picture. Yeah, I need to get a little plaque up here with the three in our audience. But no, in all serious, it's been a great conversation. I really appreciate you and your perspective and the questions. And hopefully this has given people, you know, some insights on where they can move this really important dial of their gut health. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things. health to you. If you enjoyed it, we'd love to know about it. So please leave us a review,

share it with your friends, and let me know what your biggest takeaway is.