RHR: Practical Steps for Healing the Gut—with Michael Ruscio

In this episode, we discuss:

• Michael Ruscio’s new book: Healthy Gut, Healthy You
• The importance of gut health
• Improving the gut without relying on medical testing
• The role of the gut as the second brain and technology addiction
• Linking gut health to a good night’s sleep
• The biggest mistakes people make when addressing gut health
• Listening to your gut and consolidating all probiotics into a few categories

Show notes:

• Michael Ruscio’s new book: Healthy Gut, Healthy You

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Hey, everybody, it's Chris Kresser. Welcome to another episode of Revolution Health Radio. This week, I'm very happy to welcome Dr. Michael Ruscio as my guest. He is a Functional Medicine practitioner, clinical researcher, and international lecturer. He's a leader in the movement to make integrative medicine and natural health solutions more accepted and accessible, and his practice is located up here in Northern California, right by me. Dr. Ruscio is a friend and a colleague. I've known him for several years and I've always appreciated his very balanced and sensible approach, which is a little unusual, I find sometimes, in this field. He has a really smart way of looking at the research and separating the wheat from the chaff, and, as I just mentioned, he's very passionate about making Functional Medicine and integrative medicine accessible and avoiding unnecessary and expensive lab testing, and just focusing on the basics. And I think it's very easy to overlook the importance of the basics despite how much we talk about them, especially when you dive into the Functional Medicine rabbit hole. So, I'm really looking forward to talking with Dr. Ruscio today. Let's dive in. 

Chris: Mike, it's always a pleasure to talk to you. Thanks for coming and joining us on the show.

Michael Ruscio: Absolutely. My pleasure. Thanks for having me.

Chris: So, we're gonna talk about the gut, one of my favorite topics, and I know yours.

Michael Ruscio: Yup. [chuckle]

Chris: We're both big fans of the quote from Hippocrates, "All disease begins in the gut." He knew that 2,500 years ago. We forgot, but it seems like we're starting to relearn that, even in mainstream conventional medicine, huh?

Michael Ruscio: Yeah. Absolutely. I'd agree. There's definitely a gut renaissance occurring, thankfully.

Michael Ruscio’s new book: Healthy Gut, Healthy You

Chris: So you have a new book about this topic, of course, Healthy Gut, Healthy You. And tell us a little bit about why you wrote this book. There's obviously a lot of info out there on the gut and gut health. What inspired you and motivated you to put this out there?

Michael Ruscio: Sure. Well, there's a number of things, but I think the few that are the most salient were, I wanted to write a book that would help people with the things that I saw all my patients grappling with. And this is kinda the A to Z companion, everything from your relationship with food, where I'm sure you see some people that are really making themselves sick out of becoming overly neurotic about their diet, and they're very confused about their diet. And some of that kinda pseudo-orthorexia, if you will, stems from the fact that there's so many conflicting opinions out there on diets that people flounder. All the way through, "Okay, I think I have SIBO, do I use probiotics? Do I not use probiotics? Do I use antimicrobial herbs? What if I used herbs, felt good for a while, then I relapsed, what do I do? Should I use a prokinetic? Should I not use a prokinetic? When can I reintroduce food?"

Michael Ruscio: So you have this litany of questions that people are really encumbered with, and I wanted to write a guide that would really hold someone's hand through a self-help protocol, a step-by-step to really help them improve their health. And part of that was because I was frustrated with some of the books that I saw out there that I think are all written with a good intent, but from my estimation, you got one book that was all about gluten free and another book all about probiotics, or another book all about how important it is to feed your gut bacteria. Which can all have a very positive impact on people, but they don't work for everyone because they're not giving you kind of the whole picture. So I really wanted to write a book that would walk someone through the process of healing our gut health that is all encompassing, that's intellectually honest, that's evidence-based, but not evidence-limited, and could really help someone walk away from the read feeling empowered and educated, and not feeling confused and kinda fear-mongered into avoidance. Those are a few of the things that come to mind. [chuckle]

All disease begins in the gut.” Hippocrates knew that 2,500 years ago, but we forgot. Dr. Michael Ruscio wants to get you back on track by helping you transform your health from the inside out with his new book: Healthy Gut, Healthy You

Chris: That's all super important and it's something that you and I have always connected on. And a reason I loved your approach is your evidence-based emphasis, but not being, as you said, evidence-limited. I love that term. And also your focus on practical application, which really makes a difference when it comes ... When the rubber meets the road, and you're working on the stuff either in your own life or with a practitioner. But let's step back a little bit. Most of the people who listen to my podcast are well aware of the connection between gut health and overall health and why gut health is so important. But let's assume maybe that we're talking, there's some newer listeners and they're not as familiar, why is the gut so important? Why should everybody be thinking about their gut health, and what have we learned about that over the past 20 years?

The importance of gut health

Michael Ruscio: It's a great question. And that's exactly part one of the book, which is entitled "The Importance of Your Gut," to kind of establish this premise. And I think one of the most important overarching concepts to connect is that you can have non-digestive symptoms that are driven by a digestive problem. And I actually learned that when I had my health challenges, now about 15 years ago, when my predominant symptoms were brain fog, very, very bad insomnia, fatigue, feeling cold, and also having mood dips. And I went from feeling really well to experiencing all these problems, and all the dietary and lifestyles boxes were ticked, meaning I was getting enough sleep, I loved what I was doing, I was exercising, I was eating a healthy diet.

Michael Ruscio: And so I learned a lot from that process in terms of I didn't have gas, bloating, diarrhea, some of the typical gastrointestinal symptoms, but I did have a diagnosed amoebic infection in my intestines that was driving all of these symptoms, and I was chasing down, I thought it was metal toxicity, I thought it was hypothyroid, I thought it was low testosterone, I thought it was adrenal fatigue. And I chased down all those different symptoms and conditions and corresponding treatments. And I saw flickers of improvement, but nothing really long-standing. And so kinda fast forward, we're now really coming to understand from a modern scientific evidence perspective, that yes, there is a gut–brain connection, there's a gut–skin connection, there's a gut–immune and autoimmune connection. There's a gut–metabolism connection.

Chris: And here's my newest one, the gut–eye connection. We're working on an article on the connection between the microbiome and ocular health. [chuckle]

Michael Ruscio: That makes ... Yeah.

Chris: It's getting kind of ridiculous. There's a gut–everything connection at this point.

Michael Ruscio: Right. Exactly. And so that's why my general posit has always been, once you've somewhat adequately, or taken the best step you can with your diet and lifestyle and tried to get those in halfway decent order, if you're still not feeling well, the next evaluation should be into your gut health. It's not to say it's a panacea, it's not to say it's a cure-all, but before you go looking into other things, I would recommend starting with the gut, optimizing your gut health, and then reevaluating, because as you're alluding to, there's a wide array of symptoms that may rectify after you've improved one's gut health.

Chris: I wanna pause here and kinda reiterate this because I think it's such an important point and it's very often missed. Maybe we can both share a couple of examples from our practice. So, imagine parents that are struggling with maybe a four- or five-year-old child who has a lot of behavioral issues. They've been diagnosed on the autism spectrum or with Asperger's or perhaps they have ADHD, it's a lot of the problems which unfortunately have become so common these days in our society. I mean, we all ... All of us who have kids or are around kids we know, maybe ourselves, we have kids who are dealing with these kinds of problems. I get so many of these kids in my practice, and very often the parents are not necessarily thinking about the gut. These kids may have gut symptoms, or they may not. But just in conversations with friends and family members who don't follow this stuff and who are more kinda part of the general population, if they start ... If the kid starts experiencing these symptoms, what's very often gonna happen is they'll get taken to a primary care provider, they might get referred to a psychiatrist or a specialist in these areas, and they'll be a prescribed medication, and nobody is thinking about or talking about the gut as a contributor.

Chris: And yet, if you look in the scientific literature, there is tons of evidence linking changes in gut health, everything from intestinal permeability, to dysbiosis, to microbial shifts and overgrowth, to SIBO, to these mental and behavioral and mood disorders, and yet that information really has not percolated down into standard primary care or in the general public.

Michael Ruscio: Yeah. I agree with you 100 percent. And it's something that I tried to be very diligent in referencing. Every point that I make that's not common sense in the book, I reference. And that's why there's just under a thousand references. And, you know, if I'm being fully candid here, sometimes people get into a muscle-flexing contest with references to see who can put the most references in the book. But the real key is, how relevant are those references? And so I pride myself in that fact that in the book, the vast majority of the references are clinical trials, or even better than clinical trials, systematic reviews, or even better yet still, meta-analyses. So this means all the data is either a study in humans to see what happens, or a study that's summarized all the available studies in humans to summarize what the available evidence in interventional trials in humans shows. It's much different than saying, "This happened to a group of rats," or, "We noticed this happened in the cell culture, or we noticed this observation." That type of evidence can oftentimes mislead. And that's where I think a lot of confusion comes from. And that's actually something else I talk about in the book, which is why levels of evidence are important, because you can be really misled.

Michael Ruscio: But back to your point about examples. And absolutely, with children, one of the things that I've seen is just simple interventions foundationally, like improving one's diet, getting them off of inflammatory foods and using something like a probiotic, can be vastly beneficial. Sometimes in children you'll see things like histamine intolerance, which unfortunately happens with some parents who go through the regulars of going on like a GAPS diet, which has a lot of fermented foods in it. But sometimes children especially are sensitive to these fermented foods. And we've seen some miraculous changes by reducing dietary histamine in combination with treating dysbiosis. And to your point about literature, there was one study recently, I believe the findings, I'm paraphrasing here, were essentially that there was a higher incidence of fungal overgrowths in children with autism.

Michael Ruscio: And so, we certainly see, yes, there is evidence here. There was another study that showed that patients with urticaria, or hives, had a high incidence of infections, mainly a protozoa known as Blastocystis hominis, and more importantly, after treating these infections or imbalances, there was an improvement in their urticaria, or their hives. In the book, I detail a patient case study where he came in with rheumatoid arthritis and was on pretty powerful anti-inflammatory drugs, and we found SIBO, even though he had no digestive symptoms, treated the SIBO, and he was able to come off of his ... I believe he was on Humira, a very strong medication. So, yes. You're absolutely right. I think we're in full agreement on this. The literature is littered with examples of this. And then clinicians are littered with their case studies that support this. So it's definitely an idea that I think the time has come.

Chris: Let's give some other examples, just because I think that helps people to bring this to life. It's easy to say, "Oh, the gut's connected to everything." But when it really affects people personally, I think that's when they really ... when they start to get it in a different way. Skin conditions are another very common example. We often, we'll see patients with psoriasis or eczema, and they might not have any gut symptoms. So they go to the dermatologist, the dermatologist gives them a steroid cream or something like that to put on their skin, it might help a little bit, but it doesn't go away or get better. We know that in people with celiac disease, especially silent celiac with no gut symptoms, about 50 percent of them have extra-intestinal skin manifestations like eczema, dermatitis. That's something that again, most people in general public and dermatologists, even, are not even thinking about. Now, what are some other examples from your practice of people who have had gut issues, that didn't ... maybe they didn't even have gut symptoms, but it was the gut that was driving that?

Michael Ruscio: Right. And again, that's such a key connection to make, which is you can have a gut problem that's not manifesting as gut symptoms but that is causing whatever external symptom, whether it be brain fog or skin issues or what have you. Two just come to mind. And a lot of these ... We've published patient conversations on our website where I sit down with someone and we talk through their cases. It's not like cramming a camera in someone's face, and saying, "Tell me how good you feel," [chuckle] testimonial. It's more so, "Let's talk through what you came in with and what we did, how you felt going through this." Because I do try to pull the curtain back into my clinic and let people see what some of these results look like in practical terms. There was one patient that came in, and I wasn't even really sure if I could help her because the presentation was so unique. She had this chronic condition of swelling and chapping of her lips. And that was the only symptom that she had, everything else looked fairly unremarkable. And I told her, "Well, we certainly know that the gut–skin connection does exist. I can't say I've just seen this before, but we could certainly do a work-up, see if we find anything out of whack, and perform some interventions to improve your gut health."

Michael Ruscio: And it turned out that she had some dysbiosis in her gut. I wanna say she also had a protozoa. I'm not sure what the exact pathogen or dysbiosis was. But she had an imbalance in the gut that's not very hard to treat. And a lot of this, again, is covered in the protocol in my book, so I don't want people to think they have to go through this elaborate testing to figure out exactly what they have. Foundationally, you can go through a number of steps to rectify imbalances, absent of lab testing. But since she was in my clinic, we had the ability to fairly easily run some lab testing, we found, again, I believe it was a protozoa. And I was shocked that a month later, her lip swelling completely went away. So something I wouldn't even have thought was connected was absolutely connected. And another patient, and we also published a case study on our website for this gal. She was doing really everything right. And actually, there's a friend of mine in town here who does similar work, and he said, "I'm gonna refer you this patient because she's too smart for me." [laughter] He said, "She knows more than I do, because she's very, very well educated." And she came in, she was doing everything right. She was in your Paleo, low-carb diet, exercising, getting adequate sleep, doing some supplementation, yet she was about 50 pounds overweight.

Michael Ruscio: And in her case, we found a fungal overgrowth that was resistant to treatment because it was likely protected by a biofilm, so we had to treat again with agents that break down this protective fence that certain bacteria and fungus can build around themselves to make them somewhat impenetrable to treatment. And the only thing we did was treat that problem in her gut. She lost, over the course of about six months, a little over that 50 pounds that she was wanting to lose. And she also was sleeping better. And so, this stuff is legitimate, and it's not a, "Here is the next weight loss panacea," because I think unfortunately, the gut–weight loss connection has been way overexploited for marketing purposes. But you can see some people definitely lose a notable amount of weight if they're overweight. And at the other end of the spectrum, some patients come in and they're losing weight and they don't know why. And that's because their gut is malabsorbing nutrients. And so ... Those are a few examples that come to mind.

Improving the gut without relying on medical testing

Chris: Yeah. And there's so many, we could go on and just talk all about that. But I wanna come back to something that you just hinted at because I think it's an important topic. There's no doubt that Functional Medicine testing for the gut can be extremely helpful, and even necessary, in some cases, but there's also no doubt that a lot can be done to improve and heal the gut. Without that, in some cases, we're relying too much on that testing. I know that this is something you are pretty passionate about. So let's talk a little bit about that.

Michael Ruscio: Yeah. [chuckle] Something I'm very passionate about. And it's for multifold reasons. One, I think that it doesn't help healthcare practitioners. I think too much testing and an overreliance on testing actually makes it harder for a practitioner to get results. And the short story behind that is, there are a fair number of tests that haven't been clinically validated, meaning the results have no real utility. And so when you're trying to treat a lab that doesn't have any clinical utility, you're adding a variable into the clinical process that's meaningless. And so you're adding another non-meaningful variable into an already variable-rich process, thus making it much harder to produce results. And microbiota assays, I think, are one of the best examples of this, where a patient may have, let's say they have bloating, abdominal pain, and loose stools.

Michael Ruscio: And they do a stool test and it shows that you're deficient in some of these good bacteria. And so the doctor ... And I see a case study like this at least once or twice a month. The doctor gives them fiber and prebiotics supplementation, and the person ends up getting more bloated, having looser stools. And what's happening underneath the surface there, is the lab company is trying to replicate something that's being done at a research center using a microbiota assay, where they essentially map all the bacteria in the gut. But what the lab is using and what the research center are using are two different methods of technology, although similar, and they're using them outside of the context that was used in that research paper. And so if you look at the clinical literature, and this is where the levels of evidence I was mentioning before come in and are very important, you see that oftentimes where people with digestive maladies, they need to undergo some type of bacterial and/or fungal reduction strategy, at least in the short term. And so rather than treating their “labs,” we may wanna look at the condition that the person has and the symptoms they present with, and treat those instead.

Michael Ruscio: So instead of giving them the fiber and the prebiotics, we may put them on a low-FODMAP diet that actually starves bacteria, and potentially, if that doesn't get all the result, you may perform a round of herbal medicines that can clean out bacterial and fungal overgrowths. And I had to say that, the better I get, the more experience I obtain in the clinic, the less testing that I do. And this is what I've also tried to incorporate into the book, which is, there is a whole lot you can do without needing lab tests. Especially if you perform an intervention and then reevaluate at the end of that intervention how you're feeling, and then you can kinda go one way or the other. And so what I've written is kind of a “choose your own adventure” guide, if you will, where there's not necessarily one path, but there's ... There's one main path, but there's divergent paths in there, depending on how someone responds.

Michael Ruscio: And at the risk of being long winded here, [chuckle] I think the most ... One of the fundamentals that's important here is the more symptomatic someone is, the more cautious they'll probably wanna be with strong bacterial feeding interventions right out of the gate. And the healthier someone is, the more likely they can undergo a bacterial feeding intervention like prebiotics and fiber right out of the gate and respond favorably. So I built this into the algorithm of the steps, so that a healthy person can do maybe three steps. An unhealthy person will do more steps because they're gonna have to first go through that bacterial reduction phase before going to the bacterial feeding phase.

The role of the gut as the second brain and technology addiction

Chris: Yeah, that's really important to understand. We hear the recommendations to eat four tablespoons of resistant starch a day. And I've had patients who unfortunately took that at face value, who had very compromised gut and ended up going to the hospital because they thought they were having appendicitis or something like that. [chuckle] It was essentially gas pain from the fermentation. This stuff really does need to be personalized, so I love that you do that in the book. Let's talk about ... something I've been really, over the last couple of years, has really come front and center for me and my awareness in working with gut issues is the role of the gut as the second brain or as essentially a big bundle of nerves. And there's much more serotonin in the gut than there is in the brain, there's a lot more melatonin, and it really is, either you could see it as an extension of our nervous system or even a second nervous system. And I found in a lot of cases, especially with patients who have done a lot of the right things in terms of addressing the microbiology, taking antimicrobials or taking probiotics and prebiotics and cleaning up their diet, and they're still experiencing gut issues. My experience and my belief in many of those situations is that it's actually a nervous system dysregulation that's driving the gut issues. So I know you covered this a little bit in your book. Just curious to hear your take.

Michael Ruscio: Yeah, it's another really fascinating area, and there's a lot to be said there. [chuckle] Where to begin? [chuckle] I think from looking at an overall kind of global autonomic tone, meaning are you sympathetic or parasympathetic? That's one very important aspect of trying to make sure that the enteric nervous system, the nervous system in your gut, is having the appropriate feed-ins for someone to be healthy. And so there are a number of things that we can do to improve that dysautonomia, if you would, that imbalance in your nervous system that trickles down into the inputs in your gut nervous system, specifically. And a couple of these are actually very simple, but they may be subtle changes for someone to make, but they may have profound implications. And one is understanding that modern data does show the more time you spend on the internet, the worse you will feel. And unfortunately, what's tending to happen, if you look at some of the observational data here, is people are spending more time on the internet and on social media, and that is causing them to spend less time in nature, and less time with friends and family.

Michael Ruscio: And so what can end up happening ... I'm sorry. So time with friends and family, social interaction, has been shown to have a direct correlation to overall subjective well-being. And time in nature has also been shown to reduce your overall chance of death and increase the sense of subjective well-being. There are certain Asian researchers, or in Asia, certain research groups that are looking at what's known as “forest bathing,” that essentially shows that if you can take a leisurely walk in the woods, there's something about that that is very health promoting. And there's another stroke here that's been published by a researcher named Shelley Taylor, who ... She has put forth the theory that men more so have a fight-or-flight response, but women more so have a tend-and-befriend response. Meaning that in times of stress, it's more important for women to have connection. And this may have to do with some of our evolutionary background, where in times of stress it was more ... men would more so have to go out and fight, hunt, what have you, and that was to some degree a little bit more isolating, and women would have more of a predilection toward coming together and tending and befriending, and part of this may be mediated by a hormone called oxytocin, which is potentiated by estrogen, so that may be a reason why we see a sex discrimination with this.

Michael Ruscio: So, it really boils down to a simple concept, which is if people are excessively researching on the internet how to improve their health at the expense of things like time and nature and connectedness, they could really be doing themselves a big disservice in terms of their healing. And there are other deeper things we could get into mechanistically, but I think that's one that's often overlooked, that is free and fairly easy to implement, but holds pretty sizable potential for people to improve from.

Linking gut health to a good night’s sleep

Chris: Absolutely. I think technology addiction is ... or not even addiction, just overuse, which in some cases is driven by work and other cases it is more of an addictive thing, is a huge part of this constellation of factors that contributes to nervous system dysregulation and can definitely affect the gut. And along those same lines, we have more than a third of Americans not getting enough sleep, and that of course torpedoes the nervous system. I think in terms of my own history with gut issues now that I have ... As many people know who are listening to this, I had multiple parasitic illnesses in my early 20s that evolved into a much more chronic problem. And at this point, I'm through the worst part of that, but my gut is still sensitive because of everything that I went through, not only the parasites, but the treatments that I had to do to get rid of them. And I think sleep at this point is the most noticeable trigger for me. If I don't sleep well, my gut is gonna be the way that I know that ... I mean, obviously you know in other ways, by just my gut the next day is not gonna function very well, so tell us a little about that. I know you've explored the connection between sleep and gut as well in the book.

Michael Ruscio: Yeah, so there's a really fascinating connection there, and I believe we both had an Entamoeba histolytica infection, so maybe somehow that changes you and makes you wanna go deeper into healthcare, but I wouldn't recommend self-inoculating if it's not an area you wanna get into. [chuckle]

Chris: There are easier ways.

Michael Ruscio: Yeah. [chuckle] What's fascinating about sleep is there's definitely this bidirectional relationship between sleep and the gut, and gut and sleep. And one of the most common things that I see that people, I think, don't expect to see when improving their gut health is their sleep improves. And so if people have a hard time falling asleep, or they're very wakeful, or they're always waking up an hour before their alarm goes off, or they need excessive amounts of sleep, which seems to be defined as chronically getting over or needing over nine hours of sleep, then it's very possible there's a problem in the gut that's causing that. And part of this may be due to melatonin, as you noted earlier, there are, many of these chemicals are made in the gut. Melatonin is one, and that is needed for sleep. So there's definitely this gut-to-sleep connection, and improving your gut health can improve your sleep. But then there's also this massive amount of research showing that if one is not getting adequate sleep or if they're chronically getting too much sleep, and again, the research suggests that at a minimum, six to seven hours, and a maximum nine hours.

Michael Ruscio: Consistently falling within that window is important, but if someone is constantly not getting enough sleep, then that is gonna be a huge deterrent to their health and to their healing also. The amount of data ... I think this is the one area that we have probably the most compelling data showing that, again, if you're chronically undersleeping or chronically oversleeping or having your sleep interfered with, that almost every measure that has been evaluated will worsen, meaning your chance of cardiovascular disease, your chance of dementia, your chance of all-cause mortality, meaning death from any cause, your chances of depression, literally every measure that has been studied, and usually we're looking at a systematic review with meta-analysis, so these studies are looking at a number of studies and summarizing the results—all conclude that if you're chronically getting or needing more than nine hours of sleep or unable to get a consistent six or seven hours of sleep, you are, in fact, increasing your chances of a number of diseases or morbidities.

Chris: So true. And of course, gut issues are one of the most ... one of the main ones because of how inexorably intertwined the gut is with the systems that are affected by sleep.

Michael Ruscio: Absolutely. And there's one other thing I just wanna sneak in there really quick before we leave this, which is ... and I take a small tangent in the book on this because for some people, it is very important, which is sometimes subtle female hormone imbalances will interfere with sleep. Now, most notably, if a woman is having hot flashes that wake her up, of course, that's one. But I have found that some women, they're waking up and maybe only feeling a little bit warm. And it's almost a subclinical hot flash, if you will. And many of the factors that we outlined in the book of simply improving one's gut health will improve these female hormone-mediated symptoms, but we also make a few recommendations for simple and safe herbal interventions that require no testing, that can help to balance out female hormones and can help with sleep. And not only sleep—there's some evidence to show that women with constipation, maybe because of progesterone receptors in the gut, can also improve their bowel regularity by using some gentle herbal medicines that help to coax the female hormones back into balance.

The biggest mistakes people make when addressing gut health

Chris: So what do you think the biggest mistakes are that people make when they're trying to address their gut health?

Michael Ruscio: Well, I think the most foundational is people don't listen to their own response, and they may go on a low-carb blog and hear all these success stories, and think they have to go low carb. Or they may go to a fiber enthusiast blog and become somewhat indoctrinated into thinking they have to eat a high-fiber, high-prebiotic diet. But they're not really listening to the fact that, "Geez! When I don't eat enough carbs, I feel tired." Or, "When I eat too much prebiotic-rich foods, I feel bloated. But I heard this PBS special with credentialed doctor so-and-so telling me how important feeding our gut bugs is." Which is true, but it's just not true for everyone. And so that, as you mentioned earlier, that personalization is left out and/or people are misled into not listening to their own bodies because they're rather listening to the expert opinion. So that's definitely one.

Michael Ruscio: And I think it dovetails in with another point that I really try to develop in the book, which is oftentimes, some of the standard party line, I guess, if you will, recommendations for gut health, are very centered around what happens in the colon, but they miss the small intestine. And the small intestine represents over 56 percent of your gastrointestinal tract, so it's the largest anatomical contributor to the intestinal tract. And that's where 90 percent of calories are absorbed, and it's the largest density of the immune cells in the entire body. And so I think some of the confusion stems from exciting research looking at what's happening in the colon with some of the stool testing. They’re doing research looking at the microbiota, the world of bacteria in the gut, and those stool tests predominantly assess the colon, or the large intestine. But if you're making all your decisions based upon maybe 20 to 30 percent of the gastrointestinal tract, the colon, and you're not looking at the recommendations for the small intestine, which comprises the majority of your gut, and the majority of your calorie absorption, and the majority of your gut immune system, then it's easy to be misled.

Chris: Yeah, and also, confusing in that the interventions in some cases that you would do to support the small intestine might be opposite to what you would do to support the large intestine.

Michael Ruscio: Exactly, exactly.

Chris: So there's a sequencing thing that needs to happen sometimes, in terms of when to address which part of the gut and in what order.

Michael Ruscio: Exactly, yeah, you're absolutely right. And that's one of the concepts I try to develop in the book to help throw people a lifeline, which is, "Are you confused about [chuckle] all these different recommendations that seem to be at odds with each other?" Well, it's because we have to contextualize these into a sequence of steps so that you're doing the right thing at the right time. And it brings up maybe another common mistake that I see people make, which is looking for the magic protocol, and people protocol-jumping. They go from one protocol to the next to the next, and they oftentimes, they don't get the result they're looking for because the magic, so to speak, is not in the protocol, it's really in the process. The right protocols used in the wrong process will lead to failure. But the right protocols used in the right process will lead to success. And that's what's often left out, is you get a snippet of this or a snippet of that, a protocol here, protocol there, but not how to sequence these and personalize these in the correct order. And that's another thing I try to really build into the action plan in the book.

Chris: Yeah, that's ... I would add impatience [chuckle] is also a common pitfall. And it's understandable. I've been there. Mike, you've been there.

Michael Ruscio: Oh, yeah.

Chris: We know what it's like to suffer from these conditions, and it's natural to wanna get better as quickly as possible, but the strategies that we're talking about are not overnight cures. And unfortunately, in conventional medicine, in many cases, it's conditioned us to expect immediate results from a sledgehammer-type approach of using medication. But in these cases, if you're talking about rebalancing an ecosystem that consists of trillions of microbes, that's not gonna happen overnight, right?

Michael Ruscio: Absolutely agree with you. And by the other side of the token, the other thing that I've seen that sometimes happens in more natural medicine-minded communities is people are told you have to be ... Oftentimes it happens with diet, you have to be on a given diet for months before you're gonna experience improvement. And we walk people through diets in the book, there's a few different times to evaluate, the average time someone has to be on a diet, according to the protocols I lay out, is two to three weeks. And it's not to say you're gonna experience all of your improvement in that two to three weeks, but after two to three weeks you should know, "Hey, I'm feeling better," or, "No, I feel exactly the same or even worse." And when you navigate the dietary protocols that way, you can get through the handful of diets that would be recommended fairly quickly, rather than saying, "Oh, the autoimmune protocol ... " Nothing against it, it's one of the protocols that I recommend people considering in the book, but you have to be on it for six months, because there's layers of healing and what have you, and I'm open to there being a time and a place for that, but usually what I find is, again, a few weeks to know if you're in the right ballpark, and if not, let's keep you moving forward so we can find what will actually work for you.

Chris: Yeah. I definitely agree with that diet. There are always exceptions, we're just laying out general guidelines, but it's certainly true, and I've seen people on ... kind of bludgeoning themselves to stay on a certain diet that's not working, for a long period of time, just getting worse and worse. And often if they go on to the sort of online communities that are centered around those diets, the feedback that they'll get is just do it more, harder, faster. [chuckle]

Michael Ruscio: Exactly. Yeah.

Chris: You're at 99 percent, but if you just got to 100 percent ... That's the other thing, is people assume that they need to follow something 100 percent in order to get any benefit at all, and I don't think that makes sense, physiologically. It's certainly true that being more rigorous will ... you need to reach a certain threshold to get a benefit, but I don't think that's 100 percent.

Michael Ruscio: Again, we're [chuckle] on the same page as we are for many things. And I think what happens is people actually ... I tell people, be ... shoot for about 80 percent because I expect there's gonna be a time or two when you have to deviate slightly, and that's okay. And I think to go from that 80-ish percent to 100 percent, the amount of negatives far outweighs the amount of positives you would get from going through the extra rigors to become 100 percent compliant compared to 80 percent compliant. That's a key, key point.

Chris: And it's not just in terms of quality of life, it's actual, physical symptoms, I mean we just talked about how stress can tank the gut. [chuckle]

Michael Ruscio: Right, exactly.

Chris: So it actually can backfire going from 80 to 100 percent, not only not improve you, it can make you worse.

Michael Ruscio: I completely agree.

Listening to your gut and consolidating all probiotics into a few categories

Chris: Yeah. Now of course, there are people out there who are listening to this who have experienced that benefit going stricter, but that's where listening to your body comes in, as you've mentioned, Mike, that's one of the first, probably the biggest mistake that most people make is not listening to their bodies. And again, it's easy to understand how that can happen, there's so much conflicting information out there, when your body is sending you a lots of different messages, it can be hard to tune in and know what's going on, but ultimately trusting your intuition and trusting your gut, so to speak, is a really important thing to learn how to do as part of the healing process.

Michael Ruscio: There's another area that people don't listen to their gut, and this is kind of exacerbated by confusion in the field, which is regarding probiotics. Gosh, there's probably hundreds or more probiotic products out there, but when you really look at the research literature, you can consolidate all probiotics into three to four categories. Some research papers suggest five categories, I think more practically three to four. And when you understand this, you don't have to try the hundreds of products, but rather say, "Let me try a probiotic from category one and see how I do, let me try a probiotic from category two and see how I do." And then when you do that, you cut through all this confusion of, "Oh, I heard about this one and someone told me about that one," and you'll keep trying the same product, just with a mild derivation of the same product ... I'm sorry, of a similar product in the same category forever, and it can be maddening, but again, if you understand that here are the categories ... And just briefly, the main categories in my opinion, but I think this is fairly well reflected in the research literature, is a Lactobacillus–Bifidobacterium species predominated blend, meaning you'll have multiple strains, but the majority of those will be different strains of Lactobacillus and Bifidobacterium, category one.

Michael Ruscio: Category two would be a Saccharomyces boulardii probiotic, technically a healthy fungus. Category three would be predominantly E. coli Nissle 1917, and this is a healthy form of E. coli, which is actually one of the most common residents in the gut, so not all E. coli is bad. It's not something that there's a lot of applicability for in the US because it's not available in the US, and actually I should probably classify E. coli as category four, and then category three would be soil-based or spore-forming probiotics. And there's a few different formulas here, and there's some derivation and some detail there, but essentially this is predominantly Bacillus strains probiotics, and those are your three or four classes. And I would try each one of those, and sometimes people do not do well on any probiotics and that's okay. And so they shouldn't keep beating themselves over the head with a probiotic because they keep reading about how good they are. Try each category. If you respond, great. If you have a negative reaction, then move on to something else.

Chris: Fantastic. Mike, it's been such a pleasure. The book is Healthy Gut, Healthy You: The Personalized Plan to Transform Your Health from the Inside Out. Where can they go to get it, and where can they find out more about your work?

Michael Ruscio: They can get the book on Amazon. They can also learn more at HealthyGutHealthyYouBook.com, and if they wanted to learn more about me, my website is DrRuscio.com, which is D-R-R-U-S-C-I-O dot com.

Chris: Been a pleasure as always. Look forward to seeing you at Paleo f(x) for our annual meet-up.

Michael Ruscio: Yeah. We'll have another talk over some barbecue. Thanks, Chris. It was great being here.

Chris: All right, take care.

Michael Ruscio: You too.

The post RHR: Practical Steps for Healing the Gut—with Michael Ruscio appeared first on Chris Kresser.

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