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Child: Welcome to my Mommy’s podcast.
This episode is sponsored by Our Place. And this company is awesome. They believe in the power of home cooking to bring people together, which I’m also a huge proponent of. And they have created products that make cooking and sharing a meal together, easier and more joyful and free of all the harmful things I don’t like in my kitchen. They have a wide array of things now. I always find myself using their Always Pan and also their Wonder Oven, which is a toaster oven, an air fryer in one. And I get a lot of requests for an air fryer recommendation, especially one that’s free of things like forever chemicals and nonstick chemicals. And my family has been using their Wonder Oven for a while now. And absolutely, we love it. I love that even my little kids can cook in it really well now. So I will often find them either heating or cooking from scratch their own food in the Wonder Oven. The tray they use in the Wonder Oven is toxin-free, and it’s made without PFAS, PFOAS, PTFEs, lead, cadmium, and other potentially toxic materials. The inside of the air fryer is stainless steel and not coated. And it’s compact enough that it fits easily on the corner of my kitchen countertop for quick use. And it comes in a lot of fun colors.
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Katie: Hello and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com and I’m here today with Dr. Michael Ruscio who is an extremely well-researched expert when it comes to the topic of gut health and that is what we go deep on today. Essentially how to fix your gut and how to identify your gut type. And I feel like his expertise is really fascinating on this in that he identified sort of some archetypes of things that are going on in the gut often and how they require almost opposite approaches to resolve. So I feel like this can be really helpful for people who are experiencing gut issues and might find that certain things seem to make them a lot worse or certain things seem to really help but it’s like kind of an obscure thing. Especially if you have ever felt things like the better I eat the worse I feel or you feel like you’ve gotten to a really restrictive way of eating, his explanation today might help you understand some of the reason why.
If you’re not familiar with Dr. Ruscio, he is a clinician, a researcher, and the author of Healthy Gut, Healthy You. And this is really a passion for him is helping people with their gut health. He does this in collaboration with his clinical and research team, both via clinical experimentation and published research. And you’ll definitely hear in the way he talks today from his wide ranging both experience and research related to this. And I feel like there’s a lot of really actionable takeaways if you have any gut issues. And actually, even if you don’t think you do, you might hear in this episode some things that might be really helpful to you and that might illuminate something going on in your gut that you might not have known about. So all that being said, I really enjoyed this interview. I learned a ton. So let’s jump in and learn from Dr. Ruscio. Dr. Michael, welcome. Thank you so much for being here.
Michael: It’s great to be here. Thank you for having me.
Katie: I’m really excited for our episode today because we’re going to get to deep dive and learn from you about all things gut health. And especially, I love that it sounds like you found some really specific things related to kind of different kind of parameters of things that might be going on in the gut and how they lead to different approaches.
I also know that you are so widely researched and have so much practical experience in this area. And I would guess most people listening have at least heard kind of the concept that all disease begins in the gut. So to me, anytime we get to learn more and have sort of like extra knowledge to really benefit our gut, that’s a huge win. For anybody who’s not already familiar with you for background, can you kind of just give us an overview of your journey into this current work that you do?
Michael: Yeah, like many in this space, I had my own stuff, gut stuff, where I was having a lot of symptoms, mainly brain fog, fatigue, depression, and insomnia. And I was doing all the things right. I was eating an organic whole foods based diet. Slowing down, exercising, time in nature, positive mindset. Still plagued by all these symptoms.
Eventually, I figured out that I had an issue in my gut, and that was what was driving all of my symptoms. And so that’s why I dedicated my career and my life to helping people better understand how the dry skin, the brain fog, the poor sleep, obviously the loose bowels, the constipation, the bloating, the pain can really stem back to your gut and then equip them with things they can do to better enhance their gut health.
And one other thing I would say really quick is that a part of the reason that we’re doing so much research is because as much as I love the field, there’s still some dogma. And I think it’s just kind of part of being a human where you can’t help but slip into confirmation bias. And this is where research is really helpful to sort of fact-check our own beliefs so that over time we’re using science to be more precise rather than what you sometimes see, which is using science to kind of footnote your prior opinions. And so I’m in clinic a few days per week, working as a professor a few days per week, and publishing research a few days per week.
Katie: And I’m really excited to kind of delve into this concept that I was reading about and researching for this episode of you kind of identifying these different gut types, because I’m certainly not a doctor and don’t work in clinic. But one thing I have heard over and over just being in the health world and talking to moms these last 10 years is it seems like there’s so much specificity, especially when it comes to the gut and something that maybe works phenomenally for someone and it’s like the thing that fixes them creates uncomfortable symptoms and like is seemingly not helpful at all for someone else. And obviously there’s the bioindividuality and we’re each so unique even genetically, but it seems like there’s something even deeper than that when we’re talking about the gut. And it seems like maybe you’ve sort of cracked the code about this. So to walk us into the topic, can you introduce us to this idea of gut types and what that means?
Michael: Yeah, the gut typing model essentially tries to determine based upon some of your symptoms and your historical findings, and we can come back to those in a moment, but do you have a predilection toward a fungal overgrowth in the gut? So it’d be candida and other types of fungus, which are normal, but they can overgrow. Or bacterial overgrowth, like SIBO, small intestinal bacterial overgrowth, which I’m sure your audience, many of them have probably heard of that.
And so we look for cues and clues that someone might go one direction or the other. And it has a lot of relevancy, especially for diet. Because the diet for fungal overgrowth is very different than the diet for bacterial overgrowth. And this, to your point, I think is what accounts for some people saying, gosh, I heard all about, let’s say, paleo, which I think is a very good dietary plan. My friends were on it, and then I decided to go paleo. And all of a sudden, I had an exacerbation of my constipation got worse. I got more backed up. I had more bloating, more reflux, more pain.
And that might be because for their friends, the paleo diet worked well because they may have had a fungal overgrowth because the paleo diet works really well for a fungal overgrowth type gut, but it can actually flare, a lot of these seemingly healthy fruits and vegetables can actually flare bacterial overgrowth. So that’s no other concept we dig into today. That’s the one I want to try to equip the audience with.
Katie: Yeah, I’d love to dive into this. And actually, before we get into like fungal versus bacterial, which I think is going to be really helpful for a lot of people listening, especially if they’ve had kind of like sticky gut symptoms and don’t know how to resolve them. I’m also curious before we get to that, are there things that you’ve kind of seen in your practice that are universally either helpful or harmful when it comes to gut health? Like, are there any commonalities across the human population to be aware of?
Michael: Yeah, absolutely. And it’s a great question. Some of these may seem a little bit trite, but exercise, we know that exercise will improve the health, the richness of the microbiota, reduce leaky gut, help with motility. Too much or too little can both be a problem. So we just want to make sure we’re not maybe doing CrossFit seven days per week on the one hand and not thinking that just walking is sufficient on the other. And somewhere in between, most people will find the adequate dose of exercise.
Mindset, mindset is a huge one. And I’m sure you probably see this, too, where especially if people have had symptoms for a little while, they can start to develop this really adversarial perspective on their body, on their diet, and keep cutting and cutting and cutting and cutting out foods and fall into almost this orthorexia where they’re afraid of food. And I get it because food can be a trigger.
But the analogy that we use is looking at these diets and the greater interventional plan, like a rehab plan. If someone hurt their shoulder, they would have a very clear expectation like, yeah, I’ll go through the rehab and then I’ll be able to get back to whatever I like doing at the gym or tennis or whatever it is, right? It’ll be a short-term rehab plan, maybe a few months, and then I can resume normal activity. Well, the same thing with the diets. We find that the diet that helps heal you doesn’t have to be the forever sort of more restrictive elimination plan. And that mindset, that empowering mindset with the expectation to be able to expand and heal and improve is really important.
And then, unprocessed foods, avoiding the ultra-processed foods would, of course, be another one. Time outside. I’m sure you’ve probably discussed with your audience that people who spend more time in blue zones or green zones, oceans or forest environments have improved health and longevity. So, I mean, those would be a few of the really important sort of core foundations that are helpful for, to your point, really anything.
Katie: I feel like, yeah, what you just said is so important to highlight about what helps you heal might not be your forever plan. Because I think back to, I was on a relatively restrictive diet at one point when I had auto immune disease and it is not what I follow now. And I feel like it felt overwhelming in that for a while to think like this is forever and to realize like our body is so infinitely capable of healing. And so thankfully for me, it was not at all forever. But I think knowing that in that moment would have felt so hopeful and helpful to me.
And also to your point, I think like our mindset that I hear this over and over again, and certainly it’s my experience as well, but this is such a vital key when it comes to, I feel like recovering from really anything. But if we have that mindset that our body’s out to get us, it’s really hard to be in a state of healing when you’re coming from that mindset or to get, you know, all the nourishment from your food when you’re eating it in a state of fear, because you’re worried it’s going to hurt you. So one thing I try to like really remember to do is to be in a state of gratitude as much as possible. But certainly anytime I’m going to eat, just, I feel like that helps me digest so much. That’s not backed by science. It’s purely my anecdotal experience, but I have personally found that so helpful.
And I feel like this now brings us to the bacterial versus fungal. And this might need a little bit more explanation because I would guess there are people walking around who have one or the other of these and might not have a clue they even have one of these. I’m also curious if it’s kind of an either or, like I know, for instance, in the oral microbiome, you typically either have strep mutants, which leads to cavities or the bacteria that leads to gingivitis. But because they’re both opportunistic, you don’t usually have both. Is that kind of the same with fungal and bacterial or might someone have both at the same time?
Michael: Great question. And we do have at least one data point that squarely investigated this. This comes from Satish Rao. He’s a conventional gastroenterologist at the University of Augusta, and he had a group of roughly 400 patients who had undiagnosed gastrointestinal symptoms. And so he worked them all up for fungal overgrowth and bacterial overgrowth. And he found about 20% had bacterial overgrowth, about 20% had fungal overgrowth, and about 20% had both. So that one data point tells us it can be both.
However, what I’ve noticed, and this is just my trying to read what we see in the clinic. Treating these with a diet, one versus the other tends to be more beneficial. And that’s where a little bit of experimentation and the nice thing about the experiments is within two weeks, people will know I’m on the right track. Because it does seem that one of these populations tends to be more askew. And it’s using the diet to help address that population that seems to have enough healing effect to where you have a spillover benefit on the other population. Because it’s an all-in ecosystem, right? So if we can intervene successfully with diet to reduce inflammation, to your earlier point, the system can heal. So it can be both. But usually if we target one, we get the result that we’re looking for of improvement.
Katie: Got it. So there’s the fungal and bacterial types. Are there other types as well? And I guess that’s combination type, but are there any beyond that?
Michael: There is one, and I always hesitate in terms of, you know, am I going too deep or not? But the third we’ve termed the immune type. These are people who are quite allergic. They might eat and have a runny nose. They have urticaria, flushing, hives, seasonal and environmental allergies. And for these people, there’s one nuance that we can build into either one of these dietary plans, which is just going lower histamine.
And that does pose relevancy for the audience because a lot of people have probably heard about how important fermented foods are with the probiotics the fermented foods contain, which is great. But for some people, those foods will actually trigger their immune system because the fermented foods are also actually high in histamine. And so if you’re that allergic type person, your body’s already producing histamine. This is Claritin and Benadryl block histamine. Well, these fermented foods are high in dietary histamine. So for a little while, we may want to have people avoid otherwise really healthy foods, which would be the sauerkraut, kombuchas, kimchi, you know, so on and so forth.
Katie: Got it. And then, it sounds like there are kind of certainly ways you are able to figure out what type someone might be. But if someone has been given a word associated with something going on in their gut, like SIBO or like candida, does that help them understand, like, maybe that would be a starting point if they were working with you of what type they were?
Michael: It does. Yeah. If someone’s had a prior SIBO test positive or a prior candida assessment positive, it gives you some clues. Part of the challenge here too is the interpretation criteria, for example, for SIBO breath tests, it’s shifted over the past few years. And a number of years ago, the North American Consensus made the SIBO breath test interpretation criteria a little bit more scrupulous. So there are some people walking around with a diagnostic criteria that was antiquated. And what may be happening is they tried, let’s say, the low FODMAP diet, which is what you would use for the bacterial overgrowth. They’re not really feeling any better, but they keep doing it.
So a really key point here is for most people, if the diet is the right one for your gut type, within a couple of weeks, you’re going to know. Now, if you do that, if you do the diet and you’re not feeling better, it’s frustrating, but that’s a cue to try something else because we don’t want to keep doing the same thing for months and months and months without some intuitive sense that you’re improving. It may not resolve all of your symptoms, but let’s say you had six symptoms. At least four of the six are improving. Let’s say just using a random example at the two or the three-week mark.
Katie: That’s really exciting as well that the body, I mean, I believe the body can adapt so quickly, but that’s awesome that even for something like one of these things going on in the gut, that someone might see changes that rapidly enough to be able to know if you’re not, then it’s a good indication to look deeper or look differently.
I’m curious, do people have an initial period at all where things might flare a little before they start to see those results so that someone doesn’t get discouraged? Like I know if someone’s used to eating a lot of processed foods, for instance, and then they go a lot lower carb, they might have that sort of carb flu, or if someone detoxes, they might be told they are having a Herxheimer reaction. Does that happen at all with these sort of gut protocols?
Michael: If someone’s coming from a high-carb diet and they lower their carbs, just like you said, you may see a little bit of that low-carb flu where they feel kind of tired, hangry, irritable. That’s usually transient, three, four, five-ish days, and then they feel better.
When using antimicrobials, so this would be something like a garlic capsule or berberine or oregano pearls, that’s where you can see some die-off. And the die-off is much more indicative of fungal overgrowth. So that is something for people to sort of make note of. If you’ve done, they’re called parasite cleanses, and usually they’re not actually hitting parasites. They’re hitting bacteria and fungus because a lot of the herbs that are used for parasites are also antibacterial and antifungal. But if they’ve done a parasite cleanse or some sort of herbal antimicrobial like I just outlined, and they noticed joint pain, fatigue, feeling flu-like, then that’s much more indicative of a fungal overgrowth.
Katie: Interesting. I want to go deeper on that, but you brought up another topic I was going to ask you about, which is what is your take on, I know there are so many parasite cleanses kind of floating around social media right now. And as someone who specializes in gut health, what’s your take on that?
Micheal: Well, that was my gut issue way back when, I had a parasite. I had amoeba histolytica, which is a pretty nasty parasite to have. And my first five-ish years in practice, I was really keen on testing for parasites. I would do usually two overlapping stool tests on every new patient. So I’ve looked at over probably 1,000 stool tests. And these are the good, the best functional medicine stool tests. And I can say true parasites are incredibly, incredibly rare. It took me many, many years to sort of unlearn my bias coming into this, which was parasites, parasites, parasites. And as I started doing the tests, it’s like, where are all the parasites?
So true parasites are actually quite rare, but nevertheless, people will see improvements from the quote-unquote parasite cleanses, again, because a lot of those herbs, thankfully, they’re multifunctional, where they will combat bacteria, fungus, and parasites at the same time. So if you see improvements from a parasite cleanse, it tells you something’s askew, but again, it’s incredibly rare for there to actually be a true parasite present.
Katie: That makes complete sense. And good to know that even if these things are not necessarily addressing parasites, they might still be benefiting the body in some way. I also, just out of pure curiosity, I’ve also wondered, because I’m like, humans have lived in nature with way less access to sanitation and all the things we have today throughout all of human history. So to me, it’s never made sense that we were meant to have zero parasites in our body. So just like with gut bacteria, are there types that sort of like naturally exist in the body or that are not harmful?
Michael: Yeah, it’s a loaded question because there’s some research which you may have heard of that it’s actually putting worms back into people’s intestinal tracts because we used to think, and not all worms the same. But the worms seem to provide an anti-inflammatory, localized, immunosuppressive effect. There’s this great book called The Epidemic of Absence by Moises Velasquez, if I’m remembering his name correctly. And the way he describes it is your immune system puts pressure on microbes and the microbes put a pressure back. This is kind of the hygiene hypothesis where if we’re raised in an overly hygienic sterile bubble, there’s no pressure back on the immune system. And so autoimmunity can happen. And this is where some of the research is sort of re-inoculating people with worms.
I think there’s other ways we can get there. It’s not a completely neat sort of binary where it’s all or none. That being said, with something like an amoeba or giardia, those don’t seem to have any positive role that they pose to the host.
Katie: That’s so interesting. And that makes complete sense to me on sort of the immune theory of that and that we weren’t meant to live in an overly sort of sanitized environment. I would hope also just things like getting in nature, interacting with the soil, gardening. I know some immunologists recommend having a pet strictly for the exposure to more bacteria from outside, things like that. Not that we all need to ingest worms, but that’s really interesting to me and makes so much sense. Again, I think so many things point to modern society sort of being a breeding ground for nature deficit disorder. And I always think how much could be solved if we simply lived a little bit more in alignment with nature than we often do in the modern world.
But I don’t want to get us off track because I’m still so intrigued by these gut types idea. And I would love to sort of delve into, I know you work with people on this and you have extensively written about this as well. But kind of can you walk us through, say someone, if they have a fungal type or a bacterial type, like what would be some of the initial interventions you would do with them or things for them to know?
Michael: Yeah. And maybe taking a step back, we can provide people sort of a self-assessment. The following would be factors that increase the probability of a fungal overgrowth being present. Carbohydrate cravings. And these are sometimes a little bit pernicious where you may not have ravenous carb cravings, but it may be, ah, you know, at the end of dinner, I just don’t feel satisfied unless I have chocolate or a banana or some chips or whatever. Just that little bit of an annoying craving for something sweet or starchy is one clue that there might be fungal overgrowth.
Recurring vaginal yeast, recurring armpit or groin rashing, toenail fungus, white tongue. Brain fog and fatigue with fungal overgrowth, those tend to go fairly tightly together. And this is partially because the fungus releases certain acids like acetic acid and propionate that will actually trigger brain fog directly and are metabolized similar to alcohol.
If a woman has been on prolonged hormonal contraceptives, that may also increase the risk of fungal overgrowth. And of course, if someone’s had a fairly extensive use previously of antibiotics, that opens up the door. So let’s say someone had acne and they were doing an antibiotic for acne for months and months or years, then all these things increase risk.
Conversely, for bacteria overgrowth types, they may have taken an antibiotic and said, huh, I thought the antibiotic was going to kind of wreck my gut, but I actually feel better. And you’ll hear this from some people. You know, doc, it’s weird. I had, you know, an ear infection or a tooth infection, a UTI, took a course of antibiotics, I actually noticed my gut symptoms felt better. So that’s indicative, that’s a clue of bacterial overgrowth. With bacterial overgrowth, if someone has had traveler’s diarrhea or food poisoning and then their symptoms started, that’s another flag that it could be bacterial overgrowth.
With bacterial overgrowth, the symptoms tend to be more consolidated to the gut. So it’s the reflux, the bloating, the pain, the constipation, the diarrhea, and not a lot of cognitive and fatigue. There might be some, but fungus tends to really have a predominance of these neurological symptoms, whereas bacterial overgrowth, not so much.
And then the other thing with the bacterial overgrowth types is they’ll remark that the better I eat, the worse I feel. And these are the people who might do a paleo diet. They really up their fruits and their vegetables. They have more salads and broccoli and whatever. And they notice lots of bloating, loose bowels, constipation. And that’s because a lot of these healthy vegetables and fruits are rich in the prebiotics that feed the bacteria.
So just maybe just starting there to give people a self-assessment they can take. And there are questionnaires that have been developed. There’s one by Santelmann, I believe called the FRDQ-7, the Fungus-Related Disease Questionnaire 7, seven questions. And he found that was predictive of people who would respond to antifungal therapy. And there’s also the IBS Rome criteria questionnaire, which people can probably find fairly easily online for bacterial overgrowth. And these are tools we use at the clinic because the testing isn’t always super accurate, especially for fungus. There’s multiple types of fungus themselves, and there’s multiple ways of testing.
So what we say at the clinic for most cases, this is not an absolute rule, but testing is about 25% of the data we use to make a decision. And we pair that with your symptoms, your treatment history, and well, really, I mean, it’s those two that kind of make a mosaic that gives us all the information to make an informed decision. Because if someone, let’s say someone had a prior fungal test negative, but they have a white tongue, they have carb cravings and recurring vaginal yeast, that’s really demonstrative of fungal overgrowth. So I’m not going to say, well, sorry, Mary Sue, you know, your test came back negative, therefore it’s not fungus, right? So we look at the lab testing. But in functional GI care, the testing is not 100%. So we want to pair that with really listening to the person and their history and looking at those clues rather intently.
Katie: Got it. That makes a lot of sense. And I would guess there are also maybe some things that typically would be like higher risk factors for one or the other of those potential issues. Like for instance, I was one of those kids that had 40 something rounds of antibiotics before I was five, which in no world is that beneficial for gut health. Thankfully now I feel like my gut is thriving, but it was quite the process as an adult to get there. So I’m curious, are there things like that, that like kind of a red flags that you see of like, okay, if you’ve had this particular thing, you might be more likely to be one of these gut types.
Michael: Yeah, I mean, totally, the prolonged use of antibiotics is going to flag a risk for fungus. You know, as would like we were talking about the carb cravings, the brain fog, the recurring vaginal yeast. And then conversely, if someone’s a bacterial overgrowth, they may notice antibiotics help them or that they. Let’s say they went to a destination wedding, got food poisoning in like, you know, a country that’s known to have an incidence of dodgy things like parasites in the food. But what ends up happening in these cases, if they have an acute bout of food poisoning, that acute bout resolves. But in the wake of that, there’s some low-level residual symptoms. And so that’s demonstrative of bacterial overgrowth. And again, if they notice healthy food like fruits and vegetables flares them, also a risk factor for bacterial overgrowth. So yeah, you can get a lot of information from just looking at your own system and what you’ve noticed triggers you or helps you to be predictive of what you do next.
Katie: That’s so fascinating. And when you talked about the people who say like, the better I eat, the worse I feel kind of situation, it made me think and wonder about, there seems to be this big wave of people trying carnivore right now and feeling a lot better. And it really made me wonder, could that be part of what’s going on with this? Not that I personally have any issue with meat. I think it can be very nutritious, but I do wonder like when you limit yourself to literally only one type of food group and then feel better on that, is that indicating something deeper that might be going on?
Michael: Absolutely. And the reason why I think carnivore works well is because it’s essentially going to combine both a low FODMAP diet, which is for the bacterial overgrowth, and it’s going to combine that with a low carb diet, which is for fungal overgrowth. So you’re really eating to reduce triggers for both food types.
The issue I take with carnivore is that I don’t think it’s justifiable to say adhere to carnivore long term. Now, some people may notice, especially the bacterial overgrowth types, that they never feel like they thrive on a very high intake of vegetables. But that doesn’t mean we throw them out completely. It’s just like the fungal overgrowth types, they may never do well on a high carb diet.
So we want to learn what works well for your system. It’s almost like saying if someone had a, coming back to the shoulder injury analogy, if someone had a really bad shoulder injury, it’s not to say they couldn’t play tennis, but they may notice there’s a few movements they don’t want to overdo. And so they can still play the game, but they’re a little bit more cognizant of not to overdo it. So same thing with the FODMAP triggers for the bacterial type and the carb triggers for the fungal type. And if nothing else, the use case would be, I want someone to be able to go to dinner and eat whatever they want. But no, I can’t eat whatever I want like that day over day, because then it’s going to start to become an issue.
Katie: Got it. That makes sense. And that brings up another kind of related thing I was going to ask you about, which is sort of the, are there any guidelines related to carbs and fiber? Like those are also seemingly a little bit controversial topics when it comes to gut health. And we now have these groups like carnivore that are sort of avoiding both of them entirely. But I’m curious, like in my mind, it seems logical that perhaps we weren’t meant to eat quite so many carbs as we do in the modern world, at least from processed food sources, and that we might need more fiber. But for people in any of these various categories, is there any benefit to like supplementing fiber, even if they’re lower carb or vice versa? Like what do you recommend on that front?
Michael: Yeah, and this is where things get a little bit murky because the rehab plan for a gut that’s not healthy would involve reducing carbs and or fiber. And so what happens is sort of this confirmation bias where people go carnivore, they feel better and they go, oh, my goodness, the carnivore gurus were right. I should never be eating these foods. But it’s well established, coming back to that rehab analogy, that while carbs and fiber, when someone is actively flared, can trigger them. When their gut heals, those foods can actually be health promoting. And sure, there’s degrees. And this is, you know, nuance isn’t sexy, I guess, is one of the key takeaways, especially on social media. People are looking for a really short, simple, clear soundbite. But that’s why I’m glad we had this conversation where we can dig a little more into some of the particulars.
So someone may not do well with carbs or with fiber short term, but they’ll probably do best long term with a degree of those added back into their diet. Can they ever go super high fiber or super high carb? Probably not. And I would agree with you that there’s probably too much carbohydrate in the diet sort of at baseline. But you’ll see some, especially women, if they’re keto for a long time, they start having regular cycles or they’re amenorrheic. They lose their cycles completely. They start having thinning hair, depression, fatigue, a hard time with sleep. Or if people are very low vegetable and fiber, they have loose bowels. They have a hard time moving their bowels.
So phase one would be figure out what diet works well for you and then try to expand your diet to be as omnivorous and nutrient dense as possible. And then, you know, find the boundaries for where you don’t want to overdo it.
And then also, if there was a rehab diet that worked well for you, you might be trucking along fine for six months, a year, what have you. Then there’s stress or the holidays and you’re traveling, you’re drinking, you’re eating bad food, you’re eating sugar. You notice things in the gut start to go a little bit awry. So you revisit for a short term that rehab plan. Get yourself back to quiescence, and then expand your diet to a more normal diet in the long term.
And that’s a really key concept because, you know, again, the thing that I see with a lot of people is they get hammered with so much really binary messaging. And then they become scared of food. And, you know, they’re looking at the menu and saying, boy, I can’t eat that. I can’t eat that. I can’t eat this. I can’t eat the other thing. And that’s really only the paradigm to use during the rehab phase. Once you’re out of that rehab phase, you should have pretty, pretty broad tolerance to multiple different foods. And that’s really our target because no hunter-gatherer society actively chose to be full-on carnivore. There was usually this omnivory based upon what was available. So a healthy gut and healthier the gut, the more omnivorous you can eat.
Katie: I love even that term, calling it a rehab diet. I feel like that’s the perfect way to explain and kind of encompass all in one that it’s a short-term thing that can have a really profound therapeutic effect. It’s not meant to be lifelong. And it’s something that can be like cycled and revisited whenever needed. Because one thing I’ve over time learned, I have this principle for myself of I don’t do anything every single day. I don’t take supplements every single day. I don’t work out the same every single day. I occasionally fast and I don’t even eat sometimes. I think there’s benefit to cycling into letting our bodies stay adaptable.
But I love, especially the way you call it like a rehab diet. And as another example of that, one thing I’m doing right now leading up to, I do a yearly water fast at the beginning of the year for spiritual reasons. I don’t actually recommend or think it’s necessarily beneficial to do a long water fast for health reasons related to some of the things you talked about, but knowing that I’m going to do that for spiritual reasons, I’m sort of cycling things to sort of signal my body that we’re not in a famine and that it’s safe a lot ahead of that.
So I’m making sure I’m eating enough protein. I’m getting a ton of micronutrients, my sleep schedules dialed in and I’m getting more sleep, all those things. But it kind of speaks to that cycling versus like you talked about, like, I think it’s easy to fall in that rigidity, especially when it comes to health. And then to be fearful of anything outside that very rigid kind of paradigm we create for ourselves.
I know we’ve also touched on like, it seems like there’s a dietary component to this. And then there are sometimes other things that are like a both and with the dietary changes that go along with helping the gut. I’m curious, what percentage of cases do you feel like you see that can be resolved with diet and or like over-the-counter supplements alone? Are there some that do actually require medication? Like what can people expect sort of maybe based on which type they are on what their recovery might look like?
Michael: Yeah, great question. I would say that requirement of medication is actually quite rare. And the past, maybe three or so years has been pretty interesting where there’s been a number of trials that have compared either antibiotic for SIBO or antifungal like fluconazole or nystatin pitted against berberine, garlic, or horopito, various herbs. And most of these studies have found equivalency. In fact, some studies, one using berberine versus rifaximin for bacterial overgrowth, found a longer time in remission using berberine than rifaximin. A different study looking at recurrent vaginal yeast found that horopito, this herb, had a longer response time than did nystatin in antifungal medication.
Now, there might be a time and a place, especially if you’re thinking there’s a lot of brain-gut interaction, where a low dose of this antidepressant called amitriptyline might be beneficial and something to consider. So I’m certainly not opposed to drugs. I’m more of a realist in terms of let’s get someone feeling better. We want to get someone to a win as quickly as possible. And as long as there’s not a very stark side effect profile with a drug, I’m totally open.
That all being said, we’re seeing more and more research now challenge the paradigm that the drugs are stronger. And for so many of these gut cases, the difference between success and failure isn’t, let’s say, hitting the SIBO harder. It’s having a better understanding of the individual because you’ll see a lot of people who are, they’re just sort of pigeonholed into treating this one thing. And it might not be that in one example that SIBO is the main culprit, but someone’s just been hammering SIBO for year after year after year. And then you sort of work them up or just listen to them. And they have carb cravings. They have toenail fungus. They notice that carbs flare them. So sometimes it’s just helping someone treat the right thing, that’s the difference between recalcitrance or minimum response and success.
Katie: That makes sense to me too. I’m curious, are there any commonalities that you recommend across the different gut types? Are there any patterns that show up across that are sort of generally helpful if someone’s experiencing gut issues?
Michael: Probiotics have been shown to be antifungal, whether it be oral thrush, vaginal yeast. Probiotics are pro-motility, so they help with constipation. There was a wonderful meta-analysis from the journal Frontiers in Immunology that found probiotics are anti-leaky gut. So they’re such a wonderful tool that can help for all of these different conditions. I would say a commonality in terms of a support that’s helpful would definitely be considering a good probiotic.
Katie: Got it. And I know from the work in the pre-research for this episode, there’s something like related, but different to this. And if you’re willing, I would love to touch on this as well, which is kind of the topic of vector-borne infections. I know that’s adding a whole nother piece into this, but I feel like a lot of people listening may actually, this may be one of their pieces that they need to understand. So I know this could be an episode all in and of itself, but can you explain what vector-borne infections are and how they relate to the gut and toward these gut types?
Michael: Yeah, no, I agree. This is really important. It is a whole other can of worms, but very important. Vector-borne infection are bacteria and protozoa that can be passed by ticks. So the more antiquated term would be Lyme disease. But as we’re learning more about these organisms, we’re learning that Lyme or the Borrelia bacteria, it’s only one of a couple. They call them the big three. So Borrelia would be one, Lyme. Bartonella would be another. And Babesia would be a third. And they’re called vector-borne because they’re spread by ticks, but also by lice, by cats, by biting flies. So there’s a number of organisms that can pass these.
So, kind of coming back to your earlier question about what about the person who’s gone through a lot of different trials and they’re still not fully responding? That’s when we think one of these organisms is at play, especially, especially, especially, especially if someone has a lot of neurological symptoms. So similar to candida, but it goes a little bit, I think, beyond this, where they’ve ever had paresthesias, numbness and tingling, or numbness in their forearm, or they’ve noticed this brain fog for no good reason. They’re doing all the things right, but they still feel foggy, like they’re having a hard time with recall, articulating their words, maybe stuttering or mispronouncing words. If they’re having insomnia.
You know, this is something that as we’re looking at this more and more, we’re seeing even things like Tourette’s. We had a young child who all of a sudden started having some real issues with his behavior and diagnosed with Tourette’s. He came back with Babesia and Borrelia. So, you know, once we’ve gone through this framework for the gut, if we’re not seeing a clear response, like I was saying earlier, we’re not going to sort of, you know, keep doing more of what didn’t get us all the way there. We’re going to look for a different hypothesis. And so for people who are in that camp of feeling like they have to work really hard to have average health, that’s one of the ways I look at and quantify risk of one of these microbes being present.
And the thing that makes them so pernicious, not to go too far afield, but some of these bugs, well, firstly, they are known to have a high affinity for your nervous system tissue. Some studies have found after a vector bite, within, I think it’s 30 minutes, you can see these in the brain and other nervous system tissue. So they have a real attraction to your nervous system.
They can also infect your blood vessels and your immune cells. So this is what makes them a little more challenging to treat because they’re not just consolidated to the gut. And I mean the gut can have such a far-reaching impact. Don’t get me wrong, right? It can be a pretty big lever, but it’s not the same in that some of these bugs get into regions of the brain or they even hide in your white blood cells. It’s almost like attacking the army, right?
So that’s why I’m so passionate about sharing this because there are some people where they are doing red light and peptides and meditation and fasting and just like HRT and all of the things. And they’re only at like a moderate level of health. And they’re so easily tipped off into a flare of some sort. So my heart breaks for these people because they have to work so hard to be average at best.
But there are solutions really just determining if someone fits this profile and then we can focus the care. And also this camp of people is quite prone to die off. So if someone has used some sort of antimicrobial similar to candida, if they had flu-like, headache, joint pain, then I start thinking more so, okay, maybe one of these vector-borne infections is present.
And just one more thing really quick. The questionnaire developed by Richard Horowitz, is predictive of if someone has one of these organisms present. It’s called the MSIDS, M-S-I-D-S 38. And so that’s a really easy way that someone could just go online and fill out this survey and get a quantification of low, moderate, or high risk that you can bring to your healthcare provider, given they’re trained in this, and then start the dialogue about investigation.
Katie: That’s so helpful. And I would guess there are people listening who maybe really kind of heard themselves and what you just said, and maybe have like, felt like they’ve walked an uphill battle trying to get to just sort of baseline health, that this might be a really helpful piece for them. And I don’t want to like go past this topic with also out getting into a little bit more detail, if you don’t mind on, for instance, what does the fungal type diet look like? I know that you said the fungal type diet and bacterial type diets are almost opposite of each other, but can you just give us a little bit more like explanation on what each of those looks like?
Michael: Sure. So for some people with the, well, let me take a step back, I guess, and say for the fungal types, that’s your traditional candida diet. And there’s a number of them out there. We have one that we’ve developed. The objective here is to go as low carb as you comfortably can. It’s really the starches and the sugary fruits that are the triggers. So someone may notice, boy, if I had a lot of pizza or if I had a lot of rice, then 30 minutes, a couple hours, or even the next day, I feel foggy. I feel tired. I might notice my tongue looks white. Or if I drink too much alcohol, my vaginal yeast comes back. So these are all sort of things that you’re looking for.
But this is where sort of the lower carb paleo type diet, maybe even keto for a short term, works really well because it’s the net carbohydrates that we want to bring down to, I would say, maybe 70-ish grams if somebody can. Adequate fat and electrolytes are really important. Like you said, the low carb flu can be an issue. But what happens in some of these cases is they cut out carbs and then they don’t actually replace the carbs with fat. So they inadvertently go hypocaloric. They inadvertently go low calorie. And then they say, gosh, I was really tired. So this is where more allowance for fat.
And then also because insulin helps with retention of fluids, when you drop carbs, you drop insulin, you retain less fluid. So this is where electrolytes are really important to offset that, especially if someone goes lower carb and they stand up quickly and they get a little bit dizzy. Or they notice they kind of have this exacerbation of low blood pressure, this is where electrolytes can be quite helpful. So essentially low carb on the one hand.
Now, conversely, if someone is the bacterial overgrowth type, they may notice, boy, I feel great on rice. In fact, if anyone’s done a SIBO breath test, the preparation for that test is essentially rice and meat for one to two days. So the bacterial overgrowth types will say, ah, I felt awesome just eating steak and white rice. That’s because there’s nothing that’s highly fermentable in there. So the bacterial overgrowth types are going to want to reduce prebiotics, what feed bacteria.
And this is nicely organized into the low FODMAP diet. And things like asparagus, broccoli, cauliflower, avocado, these are all really rich in prebiotics that feed bacteria. And so having that food list and targeting your vegetables and fruits to be low FODMAP and not high FODMAP. And it’s a little bit scattershot in terms of there’s, it’s not as intuitive in terms of some vegetables just due to the carbohydrate structure are higher in prebiotics and some aren’t. But I gave a few examples there of the high FODMAPs. And then things like spinach, kale, arugula, bok choy, I believe also, and these are also lower in FODMAP. So it’s not too hard. Just look at the food list and say, okay, I’m eating a lot of these high FODMAP vegetables. Let me swap those in for these lower FODMAP vegetables. Give that a few weeks. And again, if it’s the right diet for you, you’ll notice pretty quickly.
Katie: Like those are very important points about the electrolytes and also the fats, I would guess, especially for women. Cause I, I’ve done that and experienced it myself where I accidentally went way too low calorie and felt terrible. And it turns out our hormones need healthy fats to be produced correctly. And so that was a big key for me as well as I feel like thankfully we’re past this, but there was that phase of being told salt was bad and we all avoided salt. And now there’s much more understanding about electrolytes and even the need for sodium. But I have found that personally as well at various phases when I was healing and sometimes I actually just needed more salt and that’s what was wrong. So I love that you brought both of those up as things to be aware of if anyone is embarking on this journey.
I also love, like we talked about how you phrase this as a rehab diet. And I’m curious how you said people might start to see results within a couple of weeks. How long is someone typically on this rehab diet before they’re able to like, introduce a little bit more variety.
Michael: Yeah, great question. It’s going to be a little bit variable from person to person, but the general guidelines that we recommend is maintain the plan that’s working until you plateau. Now, for some people, that plateau may happen in four weeks. For some, it might be three months. Usually, people plateau somewhere between one and four months. Where they’re improving, they’re improving, they’re improving, and then they settle into a nice pattern. When you’ve hit that pinnacle, give yourself a month or two. Just because people are dynamic, right? So you want to make sure you’re really confident that, okay, I’ve plateaued, everything is steady here, then start reintroducing.
Katie: Got it. And I know, like we’ve talked about, there’s a whole lot of nuance here. And unfortunately, nuance is not sexy. And it’s not a program you can just sell. That’s like a three step works for everybody type thing. So I’ll make sure I link to your site and to the resources you have to help people actually through that whole process.
But I am curious of a couple sort of like rapid fire, what your take is on these different things. One being, are there any supplements that you sort of generally recommend that seemingly are helpful for the gut? You mentioned probiotics. Are there any others that are kind of a good thing to at least rotate in once in a while for general gut health?
Michael: Well, vitamin D, I’m sure your audience is probably really privy on vitamin D. I also like a good multivitamin, and this is probably due to the population that we see, but there’s a lot of people who are quite restrictive, and they’ve been restrictive for a while. So we’ll often do a vitamin D with vitamin K, a multivitamin, oftentimes pairing that with a B-complex, and a fish oil.
Also curcumin. Curcumin suppresses this NF-kappa-B inflammatory pathway and has been shown to be helpful for reducing the symptoms of IBS. And then we will typically use some sort of leaky gut repair. We created a formula called Gut Rebuild Nutrients. There’s many out there that have things like MSM, aloe, glutamine, vitamin A, zinc. And, you know, that’s a kind of a short list of where we start a lot of people.
Katie: All right, what about, I feel like I’d be remiss in a gut health episode if I did not at least ask you or take on enemas because these also seemingly are having their moment on social media right now. And I’m curious what you think about them.
Michael: Yeah, we wrote an article on this maybe a year ago. I don’t think most people are going to need enemas. Now, there’s one use case where people will say, if I don’t do an enema, I don’t go to the bathroom. Okay. Then obviously I’m with you. I hear you and I want you to be moving.
So what we’ll typically say is do the enemas while in tandem, we work the problem, right? We determine your gut type. We use probiotics. And then there’s also things like magnesium and vitamin C that help with the bowels. If someone tolerates it, fiber can really help with regularity.
Oh, also I should mention that some people, the anatomy of their, especially their colon, it has these really tight hairpin turns. It’s called a tortuous colon where there’s this really tight turn. And just like a highway, people have to slow down when going around that tight turn. Stool will slow down and sometimes even get stuck. So there’s a simple technique people can use of abdominal self-massage that’s been shown in a number of clinical trials to improve bowel regularity, reduce constipation. And that’s probably just because if you just rub your belly, you can push the stool past that inflection point. And I was a little bit skeptical until I saw a meta-analysis of, I think it was over 10 clinical trials that found just rubbing one’s stomach for five minutes per day can lead to two, three, four more bowel movements in a week.
So there’s a lot of tools that we can use that I think preempt the need for enemas. There’s some risk associated with enemas. So that’s why I’m not, and I wouldn’t say it’s a huge risk, but there’s a lot of therapies that are safer. They’re going to have multiple benefits, like probiotics will have multiple benefits. They don’t run any potential risk.
One thing I would also say with probiotics, and this is something I changed my mind on based upon a couple of studies, a few of the research papers have found that people won’t see their bowels become more regular until the second or third month of using probiotics. And that might be because the probiotics are first trying to fight bacterial overgrowth, which slows down motility. And that might take a month or two for that load to be brought down enough to where now they’re regular.
So without going too far afield, there’s a lot of options. If someone is in dire straits and the only way they poop is with an enema, sure. But I don’t think anyone has needed enemas long-term once they’ve gone through these various recommendations.
Katie: Got it. And then a little bit of a deviation from just the gut types, but I’m curious, because I know you also, your expertise is very far reaching and beyond just gut health. So I’m curious on a personal level, if you’re willing to share what your sort of daily non-negotiables are or any current experiments or things you’re finding helpful.
Michael: One thing I’m really excited about is hyperbaric oxygen therapy. That’s where you go in a chamber that’s pressurized anywhere from 1.3 to maybe 2.4 atmospheres. For inflammatory bowel disease, there was a meta-analysis that found well over a 50% response or remission rate of things like Crohn’s and ulcerative colitis. Another study found that the medications used for inflammatory bowel disease was doubled if people did hyperbaric at the same time. So hyperbaric through creating a high oxygen environment is really strongly anti-inflammatory.
The other thing that it helps to do, and I think for these vector-borne infection cases, the hyperbaric can be incredibly helpful because if you look at all the ways those microbes can damage the body, hyperbaric undoes pretty much every one of those mechanisms. Pro-inflammatory, it undoes it. Reducing circulation, hyperbaric actually helps you grow new blood vessels, including in the brain. Mitochondrial dysfunction, hyperbaric has actually been shown to increase the number, and the density and the function of mitochondria. And then it’s also very grow immune in terms of it reduces excess inflammation and helps your body better fight infection.
So the other thing I would say too is we found this wonderful company that they will actually ship you a unit that you can set up in your bedroom, your garage, wherever. And it’s maybe $900 to $1,000 a month. So it’s not incredibly cheap, but if you look at what it costs to do just one hyperbaric session at a clinic, it’s anywhere from $100 to $300 per session. And knowing that people need to do about 20 of these before they see the full sort of anti-inflammatory, pro-circulatory, mitochondrial bolstering function, it’s actually a pretty good value to do one of these rent-at-home hyperbaric experiments.
And then along with that, sauna. I sauna pretty much every day. I use red light daily. And time in nature is a pretty key thing for me also that’s kind of a non-negotiable.
Katie: I love it. That is so fascinating on hyperbaric. I had definitely tried it, but I was aware of some of that, but that’s much more far reaching than I would have expected. And I would guess a very helpful therapy for a lot of people that they might not have considered.
Lastly, like we mentioned, there’s a lot of nuance and a lot of people, especially if they are in the experience of having one of these things going on in their body might need additional help and kind of walking through that nuance with someone. So where can people find you and keep learning from you if they kind of resonated with things you were talking about and feel like this might be helpful in their path?
Michael: Sure. Yeah, and if so, please reach out. I mean, this is what I and we at the clinic love to do, partially because I’ve had a lot of these problems myself, so I can help shorten the time to healing for anybody. That’s a huge gift and a huge win. drruscio.com, D-R-R-U-S-C-I-O.com. We have a blog, a YouTube, a book and the clinic. So yes, if people need help, we are more than happy to be part of their healthcare team.
Katie: Amazing. Well, I will put those links in the show notes for any of you guys listening on the go. That’s always at wellnessmama.com. I’ll also, of course, link to the resources you mentioned. I know you have a tremendous amount available to help people and I’ll make sure people can find those as well.
This has been such a fun conversation. I’ve learned so much and I hope we get to have more conversations in the future because you are so knowledgeable and so well-spoken on these topics. But for today, thank you so much for your time. This has been an absolutely fascinating episode.
Michael: Been a pleasure, Katie. Thanks for having me.
Katie: And thank you as always for listening and sharing your time with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of The Wellness Mama Podcast.
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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