491: Functional Medicine, Probiotics and Gut Health with Dr. Michael Ruscio

Podcast Transcription: If I Was Starting My Journey in 2022, This Is What I Would Do Instead  

Ted Ryce: Dr. Michael Ruscio, so excited to have you back on the podcast. Thanks for coming back, man. It’s been a couple of years since you’ve been on, and looking forward to it.  

Michael Ruscio: I know, how time flies, yeah, same here.  

Ted Ryce: And a lot has happened in these past couple of years. 

Michael Ruscio: I know. Boy, where to begin, right?  

Ted Ryce: Where do you begin? Well, you are the gut health guy. When someone asked me about gut health, your book is the first one that I refer them to. And there’s a very sound—well, I think it’s a great reason because I’m biased—and I’m biased towards using the best evidence we have, and so are you.  

And the best evidence we have for making calls about what to do with gut health, in addition to other things, is using randomized control trials. But at the same time, we’ve got to have people who think for themselves and can work with sound clinical reasoning, to get their patients, in your case, or my client’s results, in my case, and you’re that guy.  

So, really excited to dive back in today and catch up and talk about all things, gut health, immunity, inflammation, and how someone right now who’s concerned about their health, because of COVID, it’s been such a big wake up call for so many people, like what we can do, the best things to do, so that we can all be healthier.  

Ted Ryce: Yeah. Well, thank you. I appreciate that. And I just want to echo really quickly how much I appreciate that, because the more I am in this space, and I look around at the other people I’m in some cases feeling like a messaging against, I realized that to some extent, when you don’t fall into the trap of just telling people what they want to hear, the specious arguments, the thing that sounds really appealing on the surface, but it’s actually underlined by pretty paltry evidence. 

When you really hold yourself to a high scientific standard, you’re only willing to tell people what the evidence supports, or what the truth is, rather than just getting swept up in confirmation bias or dogma. 

And people are—I think sometimes rightfully so—stereotyped as charlatans because charlatans, they’re not checked by anything, there don’t seem to be anything that moors them. And that’s why the charlatans and the snake oil salesmen are oftentimes lumped in together, because they’ll make strong claims, “Yes, everything will be better when you do this one thing because of one data point I saw one time and it helped a few people and who cares about all the people it didn’t help, I’m going to focus on people that it did.”   

And it sounds good to a lot of people. But the more evidence-based and precise and circumspect perspective isn’t necessarily the sexiest, but it is what’s more conducive to health. And I’m really trying to bring that to people and contend with the marketers out there or whoever. So, when someone does find merit in that, I really appreciate it. So, thank you so much for that.  

Ted Ryce: Yeah. 100%. I’m in the same boat, although what we do is fat loss, we help people in terms of, “Hey, what is your gut health? Let’s run these specific gut health tasks.” And you’re into the probiotics and all this other stuff. 

I’ve got to tell you, my business partner was experiencing a problem, gastroenterologist called it gastritis, they did an endoscopy, I believe it’s called, looked around and they just said, ‘Well, you look okay, you don’t have any H Pylori infection or whatever, but you just have this gastritis.” 

And based on what we learned from you, we put her on an elimination diet of a FODMAP, low FODMAP diet, and it changed things around for her and her symptoms cleared up quickly. So, this is something that can really make a huge impact.  

Because people are like “Well, hey, I eat the right things. I’m eating watermelon and all these other good fruits and vegetables,” and then they have problems, and they don’t understand why, they’re exercising, they’re eating right and still having these problems.  

Michael Ruscio: Like I was, yeah, that was me 10 plus years ago, eating all the healthiest foods, doing all the stuff and feeling pretty terrible, and, yeah, that’s what led me here. So, yeah, it’s great when you can help people uncover that. Because what a travesty when you’re doing everything right, you’re putting in the effort, you’re buying the better food, you’re doing the things and you’re not feeling like you’re improving. You really deserve to feel better, because you’re doing the work. So, yeah, it’s always nice when people like us can help others find those things that unlock that potential for them.  

Ted Ryce: Absolutely. And I want to start off this conversation because I feel like especially in today’s political climate in the United States, we’re in a situation where your credentials… I mean, we have doctors who are saying things – and I want to keep this conversation obviously focused on what we’re talking about – but you have doctors saying a lot of things that just goes against the evidence. 

 

It doesn’t mean they’re wrong, but when there are 200 studies and meta-analyses and those types of things, going against what a person is saying, even though they have a medical degree, we’re in this weird situation where it’s not about what the degree is, it’s about who’s using the best evidence, why they’re making the claims that they’re making? 

And you call yourself a functional medicine person. I personally like that, but I also have friends in the fitness space who are like, “Oh, that’s the first thing you that you know,” or “that’s a red flag, rather, about when someone is a charlatan like you talked about.” Now, there’s some gray area here.  

Can you help a person listening right now who maybe hear someone making strong claims on the functional medicine side, but also hear someone like my buddy, Dr. Karl and his brother, Spencer Nadolski, saying things like, “Oh, yeah, the functional medicine docs…” Let’s help unpack that a little bit.  

 

Michael Ruscio: Yeah, it’s a challenging time that we’re coming up on, because the bifurcation that had already existed is becoming even more exposed, which is, there are two extreme camps, if we’re going to paint them with the broadest brush possible. There’s conventional medicine, and there’s alternative medicine. And there are some people who only exist and believe in and follow the dictates of either group.  

 

There are people who say, “Well, if your medical doctor didn’t say it, it doesn’t matter what the evidence is, whatever the medical doctor says, is the gospel.” And that’s sometimes right, and it’s sometimes wrong. And on the other end of the coin, or end of the spectrum, there are the natural doctors or those who are more integrative. And there are some people who are anti-vaccine, anti-medicine, anti-surgery, and they want whatever the medical people are saying, to follow the exact opposite of that. And those people are also sometimes wrong.  

And what I’ve observed is, there is this kind of newer cohort of individuals who care less about credentialism and more about the content of someone’s arguments, and also the demeanor through which they make their argument. So, if we go to the extremes, there could be the medical doctor who says, “Well, natural medicine is poppycock.” 

And there could be the alternative doctor who says, “All medicine is a corruption by the Illuminati to make you sick and make you sterile.” And it’s like, okay, both of those are very extreme statements. And you can tell it that person just by reading how they say what they say, likely is not entertaining any nuance in their thinking.  

So, I think that the best antidote to this is really not credentialism, but it’s rather looking at the merit of someone’s arguments, and edition through which they make the argument, do they seem dispassionate, measured? Will they say things where the statement will say, “Well, there are some data supporting this, but then there’s also some data refuting this,” and they kind of acknowledge and you can see in their thought process, they’re honestly interrogating the evidence base and looking to tease out what the trend line is?  

And to the Nadolski Brothers, who are on the conventional side, they’re probably seeing a lot of things that are right and so things that are wrong. And I’m probably saying I hope a lot of things are right, but some things that are wrong. But I think what’s more important, rather than comparing credentials, is the content of their argument and the way the argument is delivered.  

 

And that’s how I think you find the people who have the most truthful argument because you will find people with excellent credentials who are biased, and there’s so much information now that people have more of a chance to be amenable too biased. And I do think that as the education level increases, bias probably decreases.  

But there are some shining examples of that being violated. If you don’t mind me just sharing one quick story, because I tend to fall more on the side of, those who have committed themselves to study of a body of work typically have what Ray Dalio would call, “believability-weighted decision making.” Meaning those people know more about a field so we should weigh our believability toward them because of all the study they’ve done in that field.  

 

But there was this expose on probiotics by 60 Minutes about a year ago, maybe two years ago now. And I believe her name was Patricia Hebert, she was a professor of infectious disease, a medical doctor at some major medical university. And this, for me, was a pretty cathartic moment because I really saw how incorrect an expert could be.  

Now, this person was an expert in infectious disease, and it’s also possible that their knowledge of probiotic literature was fairly minimal. Just because you studied infectious disease does not mean you’re reading most of the clinical trials and meta-analyses on probiotics.  

But when the host of 60 Minutes asked her, “Is there any evidence showing that probiotics can help with IBS – Irritable Bowel Syndrome.” She looks point-blank and says, “No,” no nuance, no discussion, no acknowledging the position papers by the American Journal gastroenterology finding merit, the numbers of meta-analyses finding benefit, the numbers, and numbers of clinical trials finding benefit.  

Now, sure, there are some holes you could poke and you could say, “Well, there’s not total consensus in terms of what’s the best dose or what’s the best product.” So, you could poke that hole. But that is in no way the same as saying there is no evidence.  

When you’re talking about hundreds of clinical trials, and handfuls of meta-analyses, that are generally concluding benefit for people with IBS from using an inexpensive and safe treatment that also has other side benefits, then that’s really misleading people. And that was a shining example to me, of how people who are in a position of authority may rest on their laurels.  

And I really find that scientifically mentally odious, that someone would use your trust in them and use that as a veil behind the fact that they haven’t put in the time reading a body of evidence and give a bad answer. If someone says, “I don’t know,” you have a lot of my respect. If they give you a BS answer, you lose most of my respect instantaneously.  

And we wrote a response article – if anyone wanted to look that up, they looked up my name probiotic, and 60 Minutes, they could probably find it and we just make the evidence case, here’s Hebert statement, here’s all the evidence that contradicts your statement, meta-analysis, clinical trials.  

So, that’s just one example of where credentialism can fail us. Again, I don’t think it always does. And the trend line probably falls toward the direction of credentialism being more right than it is wrong, but I don’t think it’s 100%. And so because of that people should make how they judge arguments based upon the content of the argument, if they’re not sure about the content, because they have a hard time with the science and judging it, then look at the tone through which they make their argument.  

Ted Ryce: Well said, Michael, and just to throw another follow-up example there, because that one is a really important one that you made where someone just didn’t know, they didn’t say, well, let’s talk about the studies that were done, and this came and showed this, but this other study, they didn’t talk about the different findings and the studies that were done. There was just, “No.” 

Michael Ruscio: That was very absolute and the evidence is not absolute, so they’re very big dissonance there.  

Ted Ryce: Well said. And then there are some situations where we can’t always rely on trials, unfortunately. An example of that would be I hope a lot of people with back pain, unfortunately, learned the hard way about it and I’ve gone over the evidence. And one of the things that this position paper said was that there’s no conclusive evidence showing that massage, for example, can help with back pain.  

And man, I have a disc herniation, it’s been a long journey, trying to deal with it. And certainly, some massages help, because there are different types of massages, there are different levels, with the practitioners and how to tease all that out, and just say something like that with a study. We can’t always expect studies to answer those things.  

Now, maybe they will, but maybe not in our lifetime, or you know what I mean? So, we need people, like you said, not just to weigh the evidence and to get in that gray area and work through the nuance, but we need people to be results-focused and hopefully, the people doing that as well.  

I try to be cognizant of the placebo effect and things, you know, but that’s another thing, I don’t want to turn this into a discussion all about evidence and credentialism, but it’s like, well, maybe it’s okay to be aware of the placebo effect, but how do we even use that to help people, it is a question that is worth asking and I think there… 

Michael Ruscio: Yeah, two quick responses: I think the placebo effect, that can be harnessed in some simple ways, just by having a positive outlook and prognostic conversations with the patient, meaning, “We think you’re going to do well” framing things positively and not doing it in a crazy way, like “Your cancer will be gone in two weeks, yeah,” that’s way too far.  

But having a positive outlook, as opposed to – and this is something that I heavily criticized my field for – we’ve got to do all these tests, and then we do all these tests, and here are 17 things that are wrong with you. Most, by the way, are absolute BS and they haven’t been validated because I would argue over half the tests used in functional medicine have not gone through the requisite scientific validation to substantiate their use, but they’ll still show positive, high, low. And patients will internalize that and doctors will leverage that and say, “Well, you have this thing and that snip and this polymorphism and this is low and that is high.”  

And that’s a negative placebo effect or nocebo effect. So, that’s an example of where inverse placebo is used the wrong way and we can use it the right way by having a positive expectation and a positive framing for our patients. And then to your earlier point, there are definitely areas where there’s not ample evidence to disprove something.  

 

So, I think it was Chris Kresser, who I heard say this a few years ago, which was, “Lack of proof does not mean disproof.” Now with probiotic research, there’s a lot of proof. And so I think it’s a different animal. But as it pertains to massage for back pain, I don’t know the body of literature there. But it’s possible that there could be a paucity of studies.  

 

And so the only conclusion that they could come to was, there’s a lack of data substantiating massage. But if you’re talking about very, very small, randomized control trials, where different forms of massage were used in each study, then you may be able to accurately conclude there’s no evidence supporting massage, but there’s not really enough evidence to disprove massage.  

And that’s what I think is sometimes left out of some of the conclusions. Again, if you’re one of the skeptics, and you want to dismiss everything, and that’s why I think looking for someone who has a tone, where they’re curious and open-minded on the one hand, but also they want to filter out unproven therapies on the other.  

And it’s a needle to thread, but that’s what I think all people want, you know, we’re going to hunt for whatever we can do to make you feel better and we’re also going to be careful not to get swept up into a placebo or shenanigans, or whatever.  

Ted Ryce: Yeah, again, great point. And let’s get into that a little bit, because people who listen to this show like that approach, they’re looking for really what we’re talking about here, when we’re talking about a nuanced approach is really, what is the best approach? How do we get the best results so that we’re not wasting time with things that just don’t stand on a solid bed of evidence?  

Let’s talk a bit about gut health inflammation. I know this could be like a whole year course, so we’ll have to narrow it down. But what do people need to know about the gut health thing? I mean, we’re sanitizing ourselves sanitizing everything, that was something that you wrote about in your book.  

Now, that was pre-COVID by the way, now, we’re just spraying everything with these anti-microbial. What do we need to know about this current environment that we’re in, the health of our gut, inflammation, and really what so many people are concerned about us their immune system?  

Michael Ruscio: Sure. Well, I mean, there are many directions and points we could build upon there. There is evidence not for COVID, but there are a number of trials that have found that probiotics reduce the incidence and severity of upper respiratory tract infections. And I believe recently, there was a clinical trial that showed reduced severity of COVID when using probiotics.   

Now, just to clarify, is that going to be enough to take a high-risk individual who’s unvaccinated and allows them to have a good outcome? Probably not. But is it one thing that can be a number of things that we can use together to improve the health of the host and give you the best outcome possible? Yes, I think it’s important to make that clarification. 

As it pertains to COVID directly, I don’t know that there are any gut centric therapeutics that have a lot of promise there, I would say they’re all adjunctive meetings, we would do these things irrespective of COVID because we want to have better energy, better sleep, healthier-looking skin, clear cognition.  

But there is some evidence that you will see a reduction in the incidence and severity of certain types of infections when using probiotics. So, again, not a standalone therapy, you shouldn’t take a double dose of probiotics and think that you can go out into a COVID-laden environment if you’re a high-risk person who’s unvaccinated and you’re going to be okay. But it is something that may be helpful, it’s just a degree of health that I think we have to be careful to clarify.  

Ted Ryce: Yeah, and I just want to ask this since you brought it up. So, a lot of people with the vaccination thing, so you are in support of vaccination based on the evidence that you’ve seen?  

Michael Ruscio: Well, I’m really probably not the person to answer this question, because for someone to give a qualified answer, they should have really gone through a fairly robust review of the evidence. I have a few thought leaders who I follow on different parts of the spectrum, if you will, and the consensus I’ve been able to spackle together is the pro/con analysis is pretty heavily favored in the direction of getting the vaccine, meaning there’s much more to gain than there is potential harm from having the vaccine. 

But as someone who this is not my area of focus and so there may be things that are missing, but from the people again, who I follow, who are going through the evidence and weighing it, that’s the consensus that I’ve come away with.  

Ted Ryce: Yeah, thanks for being willing to answer that. I know, it’s like, “Oh, man, really, you’re going to ask me this question.” But since you brought it up a couple of times… someone asked me the other day, and I’m certainly less qualified to talk about it than you are. Mike, most of what I learned about these days is psychology, habit change, and neuroscience of habit creation, that’s what I’m learning about. I’m so far away from it, what’s the immune response and the incidence of side effects for vaccination?  

But, yeah, thanks for that, I’m in the same boat. But I definitely appreciate people’s concerns about it as well, I’m not one of those people who… it’s so obvious, I think there’s a lot of distrust in this environment, which goes back to the first part of our conversation, it’s like, man, who do we trust the credentialism and then people saying things with great credentials, but going against the body evidence, weird times.  

 

So, let’s get back into the gut health thing. So, there are certain things that you said that… first of all, if you haven’t read Dr. Ruscio’s book, you’ve got to read it, because it’s the standalone…don’t read anybody else’s book on gut health, it is at least the only one based on a lot of human trials, especially human trials, not talking about what happens to mice, whatever. 

 

Michael Ruscio: Yeah, just under a thousand references in that book and most of them are either clinical trials or meta-analyses. Yeah, so thank you, it was a lot of work to do that and to fact check and be diligent. So, again, thank you, it’s really appreciated, because all that work took a lot of time and, it’s nice when people appreciate that.  

 

Ted Ryce: Oh, man, it’s so easy to throw up content if you don’t pay attention to the details and make sure it’s really sound. But going back to your book, just make sure you get it, and if you need to listen to a podcast first, go back and listen to E341: Healthy Gut, Healthy You, with Dr. Michael and he talks about this focally, we had a great conversation in that episode. Again, that’s Episode 341: Healthy Gut, Healthy You.  

 

And Michael, you told me that there have been some new things that have come out since your book was released since your book was released. Of course, evidence is always coming out, new information is always coming out. What are some things that you think are important to know, especially in the current situation that we’re all in, with being worried about our health? 

Dr. Michael Ruscio: Yeah, well, thank you. One thing that I’ve become increasingly interested in, and we’re doing some testing now and therapeutics at the clinic for this, is identified as sleep apnea. And I know that may not sound very sexy or attractive, but consider this: I think most people in the health sphere make some sort of comment that sleep is one of the most important levers you can pull on in order to improve your health. And we all talk about pre-bed routine, reducing blue light, reducing stimulation, not having caffeine too late, and those are all great. 

But what if when you go to sleep, you’re having multiple episodes, where the tissues in your throat are sloughing and blocking your ability to get oxygen. And so your O2 levels are dropping, and to compensate, your heart rates going up, up, up, up, up, up, up, and I’m talking above 100, sometimes 120 beats per minute.  

And if anyone snores, they’re at heightened risk for this. And what’s mind-boggling is that I, at one point, not knowing much about this area of health care was under the impression that if you had apnea, you need a C-PAP, and that’s almost like a form of torture, just this big brain like device you have to wear. 

But it turns out that there are alternatives: one, myofunctional therapy, which has med analyses level data showing its efficacy, which is essentially exercises, like physical therapy for your palette, for your tongue and for your throat. In a matter of weeks, can have a high degree of effectiveness for apnea, and can be game-changingly beneficial for people with this non-responsive fatigue, cognitive problems, moodiness.  

And another thing that can be used as known as a mandibular advancement device, it’s like this mouth guard that pushes your lower jaw forward to open up the airway when you sleep. And that was actually found in the met analysis, or at least a clinical trial to be as effective as C-PAP. 

So, this is exciting because in any doctor’s office, there’s going to be this small group of patients who just don’t seem to respond to the typical therapeutics that other people will respond to, and this is where we’re starting to run these simple home sleep tests, they cost a couple hundred bucks, you take this device home for a night, disposable, you wear it to bed once. 

It’s a watch like device, that has a pulse ox and the finger, and a sticky note of the chest to listen for breath sounds. And over the course of one night, you can get fairly accurate diagnostic data if you have this sleep impediment that’s really causing your 8 hours to be functionally more like perhaps three or four. 

And just imagine the deleterious effect from an inflammatory perspective, from a cognitive perspective, from a gut health perspective that that can have, and how easily that can be remedied, either by having someone see a dentist, and have this M-A-D device fitted to their mouth, or doing a self-study course for myofunctional therapy, and doing these simple tongue exercises for 5 and 10 minutes per day for 4 weeks, and then they have better breathing, and sometimes better smiles, no more snoring and much better sleep. 

So, that’s one thing that I haven’t heard it discussed when sleep comes up in any of our groups discussions on sleep. And it’s not hard to necessarily diagnose, it’s not expensive, and the treatment isn’t expensive or difficult either. 

And so, maybe a piece of low hanging fruit for…I believe the stats on men who snore are 20 to 40%, in women I believe it’s 10 to maybe 20, as a rough approximation. Now snoring doesn’t mean you have apnea, but it’s a risk factor. But if anyone is struggling with non-responsive fatigue, brain fog, cognitive problems, and potentially weight gain, although it’s a little bit of a chicken and the egg debate regarding do people gain weight and then have apnea?  

Or do they have apnea and then weight gain? It’s probably a little bit of both, but certainly, I don’t think it’s going to do any favors for someone’s body composition, because poor sleep has been shown to cause problems with cravings, and that’s probably going to make dietary compliance much more difficult, and also exercise compliance much more challenging. So yeah, that’s one thing that I’m a pretty excited about. 

Ted Ryce: Yeah, that’s great. And you said it wasn’t that sexy. As soon as someone mentioned something sexy, infrared light on the genitals, for example, it’s just like really man, like… 

Dr. Michael Ruscio: Testosterone boosting miracle, yeah. 

Ted Ryce: Yeah, exactly. It’s not that I’m against those things, but what you start to realize when you—and I’d be happy to hear your perspective on this, but when you work with clients, you’ve got to look at like what you mentioned, the lowest hanging fruit. What are the big foundational principles that we can use here that are going to shift someone’s health in a positive direction?  

And probably 20 minutes of riding on a bike, a stationary bike, is probably going to do a lot better than infrared light on whatever area of the body. And yeah, so it’s great to hear that. And if you’re a person who’s struggling with sleep apnea, I actually had a client not too long ago, who was…this is worth looking into, I’ve never heard that either.  

So, that’s great to know that there are these other alternative therapies that are available. Is this coming out, or are you working on a book or something? Where would people get this information? 

Dr. Michael Ruscio: Well, it actually started because I started tracking my sleep with an aura ring, and I noticed that my sleep score specifically was always a high C, low B, meaning like 76 to 82, which was okay, but with all the stuff I do, and being an overachiever, I wanted to get a 90 or above. 

And at the same time, we’re always looking for people on the podcast. So, we had a guest on the podcast about airway development, and there there’s this move within orthodontics and dentistry that’s really calling out that these braces that pull the teeth backwards are setting kids up for apnea later in life, and they call it oral airway friendly dentistry in orthodontics, that will expand the teeth to make room for a full arch, rather than maybe pulling a tooth out and then pulling everything back in, like braces and headgear do. 

And so, that got me thinking, “Well, hmm, I had braces, I had head gear, let me go see a oral airway friendly dentist and see what they think.” And this led me down this rabbit hole of some good advice and some bad advice. But I picked up a number of things that were the simple low-hanging fruit, because even in this realm, there’s a heretic, that were like, “Well, you’re going to need this surgery, because this anatomical finding is abnormal,” and “Oh my God!” Then, okay, I learned there’s heresy everywhere.  

But I also learned, hmm, WatchPat home sleep test, fairly accurate, costs 200-ish dollars, you wear it one night, and it gives you some evidence in terms of, does this person potentially have apnea? And studied more and found that myofunctional therapy 5, 10 minutes per day, can resolve apnea in a number of weeks, as can something like playing a woodwind instrument. 

And when we looped that together with wow, one of the main symptoms is chronic fatigue and brain fog, and said, hmm, we have some patients in the clinic that respond so wonderfully to gut health therapies for their fatigue and their brain fog, but a small subset who don’t.  

We started running the testing on these individuals, and started seeing that yeah, there was this group flying underneath our radar, and so we’ve been doing this at the clinic. Not necessarily a book or anything, but just a finding that we’ve been integrating into our clinical model. And it’s been helping the people who haven’t been able to find answers elsewhere. 

Ted Ryce: Right, and if you do want to check out Dr. Ruscio’s clinic, go to Ruscioinstitute.com. That’s R-U-S-C-I-Oinstitute.com. And if you’re interested in perhaps doing a consultation or working with him or his group of five other doctors, I mean, if you’re struggling with something, don’t try to do this stuff on your own, is what I would tell you, find the best people to work with, hire them.  

You’re going to learn a lot more, you’re going to get specific feedback to you and what you’re dealing with, not what might be good for you, or might have helped someone else with a completely different story. When people have the experience and have seen situations or circumstances like you’re in, it just makes a world of difference when it comes to getting the results that you want. 

Dr. Michael Ruscio: It really does, I mean, I’m very meticulous about—we have an entire intake process, and or we gather data, a lot of data about the individual, and all of that data is used to help us navigate the clinical model, right? Where every question we ask is either ruling in or ruling. Apnea, a gut issue, a thyroid issue.  

And what I think really sets us apart from other clinics is that many clinics will say—and I think this is something that people should be aware of. If your doctor tells you, we need testing to figure out what’s wrong with you, I think that’s a pretty bad sign. Because again, a lot of the testing’s not accurate…  

Now sure, there are some tests that are accurate, but unfortunately what I think is happening in the functional medicine model, to some of the critics of functional medicines point, is that the lab companies, the supply companies have become very influential in the educational model in functional medicine. 

And so, what you see is this routine 3, 4, $5,000 of lab testing, and all this promise that, we can help you if we just have the tests.  

And I fell into this earlier in my career, but it never felt quite right to me, and as I fact-checked various tests, I came to find like, hmm, micronutrient testing, not helpful, not validated. Many of the functional medicine values for diagnosing hypothyroidism, complete BS, no evidence for those and adrenal testing, same sort of thing.  

And so, we’re throwing all these things out of our model, and we’re replacing them with, okay, what are simple symptomatic presentations, and simple validated tests that can be used to indicate there could be a problem. And this is all part of why I think it’s so important to work with a clinician who is experienced, because that’s what you should get.  

What you shouldn’t get is yep, we can help you, just need to do $4,000 worth of tests, because that’s really not where the health care system is. But if you can listen carefully, and someone says, “Well, I went paleo, I lost some weight, but I’ve had diarrhea ever since.” Hmm, that’s a bullseye for someone who may benefit from low-FODMAP, as one example.  

And if you have seven pages of questions like that, right? Before you even see a patient, and before we even see a patient at the office, we already have this differential list fairly well built out with a moderate level of confidence, in terms of what problems may be affecting this person in the order of probability, based upon all these questions that have been honed over time.  

And that I think it’s the paradigm they really need to go towards, which is, not this testing centric model, but rather this model that’s based upon, what therapeutics help what people? What simple clusters of symptoms indicate that may be going on? And what historical factors can we look to? 

Like again, the paleo community provides such a nice example of that, because you’ll see this sub-grouping of people that go paleo, and some stuff improves, but other stuff really falls off the rails, and that’s because not everyone does well on a really higher fiber diet.  

Or lower carb is another good example, especially women, they seem to be—and you probably know this, I think more than most, that there are some women who go too low carb for too long, and they crash, and they’re having fatigue, and mood swings and hormonal issues, and ironically, if they just manipulate their macros, a lot of those symptoms go away.  

And neither the low FODMAP diet working for someone, nor the need to up their carbs shows up on testing, right? So, there’s a lot of holes in the testing paradigms.  

So, not to go too on and on about that, but I just had a patient the other day who they had come in from seeing a different clinic before us, and she said it was $1,600 for the first visit or two, and then they wanted $2,600 for the testing. And I was like, geez, that’s a lot of money, and it’s not unusual to hear that, and it really doesn’t need to be that way. 

Ted Ryce: Yeah, thanks for pointing that out, because it’s so interesting, because there are so many people I guess, who are maybe a little bit antiestablishment, where it’s like, “Don’t trust the doctors, they’re just trying to sell you pills, they don’t care about…”  

Yeah, I used to be one of those by the way Michael, and I’ve moved away from that, because I realized, man, well, you’ve got 20 minutes or less with a person, giving them a talk about how they need to change their lifestyle, it’s easier to give a pill, right? Especially if you’re not even trained in that particular thing, which doctors aren’t, right? 

There are some people who are trying to make a difference, there’s one guy who’s really great, Jason Satterfield, who is part of, I think San Francisco, I forget what the name of the hospital there, is where they train doctors, but he’s trying to create a mind, body, medicine model, using the bio-psycho-social approach. But that’s not coming out, your average American is not going to be getting that anytime soon, it’s going to be decades away. 

Dr. Michael Ruscio: So, people like yourself who were kind of anti-traditional medicine, they will go into the functional medicine community as people who are really motivated, willing to spend the money. But what’s such a travesty is, most people by far and away do not need to spend that money, because most of those tests aren’t validated.  

And sometimes, people end up getting help, but it’s like, do we need to do three grand of lab testing to change your diet, put you on a probiotic or fish oil, have you exercising, maybe do an elimination diet, and use a handful of other supplements, right? It’s such a wasteful model. But what’s insidious about it is, if people benefit in this really bloated model, because of two things that you did of the eight, people would still come away with, “Well, it’s helping patients.” 

And so it becomes a little more challenging to get some of the doctors to see that. But I think most people and most clinicians are really starting to get sick of how much they flounder. And maybe just to pivot over to one other thing I think is noteworthy to share, regarding thyroid. There was a med analysis published, looked at about 1,100 patients recently, it was published in the journal thyroid just this year.  

And they found that 34% of individuals were incorrectly diagnosed as hypothyroid, and could successfully come off of their medication and maintain normal thyroid hormone levels.  

And I think this is important because it indicates two different things that are happening. One in conventional medicine, what may happen is, some people who have what’s known as subclinical hypothyroid, it’s this drifting up of TSH, nothing else changes, but TSH strips up a little bit. They maybe too readily given thyroid hormone medications, and the real travesty is then going forward, other doctors just seeing their chart, hyperthyroid, and no one thinks to question it. 

And so, all those people just are out there on lifelong medication, and so what this research group did, and I think it was a great study, is they said, “Well, let’s go back and check, and see what the incidents rate of people who are incorrectly given medication that don’t need it is.’ 34%, that’s pretty high, it’s one in three.  

And on the other side of the fence, in functional medicine, there’s the conventional ranges for thyroid hormone levels, but functional medicine says, ‘Well, you should be in these narrow ranges. “And this is really incorrect, and it harms people, and this is where I think the other people are coming from, is because they’re coming in with TSH that’s not incorrect according to lab corporate quest, but according to some of the more contemporary thinking and integrative medicine, there are hyperthyroid. 

And I understand when someone’s not feeling well, they’re looking for a solution; totally get it, I’m on your side. But what I think is being missed is, let’s say you have fatigue, depression, and constipation. You could say, ooh, you’re hypothyroid, because your TSH is just a tick higher, it’s not perfect. So, some people will really reach and call that hypothyroidism.  

But hypothyroidism is less than 1% of the US population, estimates range between 0.5 up to 1%. Whereas IBS, Irritable Bowel Syndrome affects 10 to 15% of individuals. And we know that some with digestive center will have these other symptoms, like fatigue, depression, and constipation.  

So, you have a 10 times more likely situation of your gut is driving fatigue, depression, and constipation, than your thyroid is, right? IBS 10 to 15%, hypothyroidism, 1%. And this isn’t poppycock, there are med analyses that have shown that anxiety and depression can be improved by probiotics. And there’s a number of trials finding various treatments for IBS will improve fatigue. 

And this is what’s upsetting, is when you start looking at the stats, you see that people are really readily given the hypothermia diagnosis and thyroid medication, because clinicians are trying to help their patients, and I don’t think any clinicians are doing this with malicious intent, like they’re being paid by the drug companies.  

Yeah, I don’t think that’s what’s going on at all, I just think there’s some educators who have these really spurious hypotheses, and it makes a lot of sense, and the clinicians are sitting there at the seminars, or reading the books, and saying, oh my God, like this may be why my patients are not responding, and they want to help their patients, and that’s great, that desire to help people is good, but I think it’s being misdirected, and what ends up happening is they get put on a medication that they don’t need. 

And we’ve documented a number of case studies now where this has happened. And when we actually listen a little more deeply, we’ll say, “Well, your initial diagnosis was based upon this lab, and this is not the diagnostic criteria for hypothyroidism. You also have some gut symptoms, and you haven’t really done much for that, and you haven’t responded to the medication that you were on.  

So, let’s go in a different direction here, let’s take care of your gut health,” which again, 10 times more common you’re going to find an issue in the gut, and we’ve documented…And we even have some people in the office break down crying, and say, “Oh, the last year and a half, I was feeling like shit, and in two months now, I’m feeling measurably better.” 

And they just felt understandably frustrated that they spent so long trying different thyroid hormone medications, adjusting their dose, following up, going back to lab corp, and just spinning their wheels. 

And then when they got to the right camp of thinking, in this case, start with your gut, not about being a gut fanatic, but knowing how common those problems are, let’s start there and then reevaluate. The suspected thyroid problem went away, vice-v the other symptoms clearing. 

Ted Ryce: I love stories like these, because there is someone listening right now who’s struggling with something like that. And they’re not getting the answers, or probably the results is a better way of saying it, getting the results that they’re looking for. 

And unfortunately, a lot of people like that, they start to say, “Well, I’m just broken, no one can fix me,” when it’s just a matter of working with the right person who asks the right questions, and has the experience to dive a bit deeper, and get a bit more nuance.  

And it’s a great time, because there’s people like you. I’d like to consider myself a person who is nuanced thinking like that, when someone has a problem that I can’t deal with, I find someone else to take care of them, or we figure it out by going through these nuanced inquiries. 

But it’s also a hard time, because I don’t know that many people who are taking the time to do this thing, they’re kind of promoting a one size fits all model, or like you said in your area, a lot of testing that just isn’t backed up. So, so many things we could talk about Michael, and I’ve had such a great time, man.  

We’ve just got to get you back on this show, because there’s a couple of things I wanted to ask about with gut, and a couple of stories about some people who talked to me and asked me some questions about the spontaneous disappearing of all these symptoms after they did a special cleanse, a heavy metal detox medication cleanse.  

And I would love to have you back on and talk about some of those things, and just to dive into this a bit further, because there’s not too many people who I feel like can shed the light that you can, not just with your due diligence that you’ve done with knowing about the research, but also your clinical experience. So, let’s make that happen again soon. 

Dr. Michael Ruscio: Yeah, let’s do it sooner rather than later, absolutely. 

Ted Ryce: Yeah, we just got knocked off a bit by the Rona, but if you’re enjoying this conversation, make sure you go back to Episode 341: Healthy Gut, Health You with, Dr. Michael Ruscio. And if you’re enjoying this conversation, and want to get more information about what they do at the clinic, go to Rusioinstitute.com. Sorry Michael, I know you told me how to pronounce it at the beginning. 

Dr. Michael Ruscio: It’s a tough one, it’s okay. 

Ted Ryce: But it’s R-U-S-C-I-Oinstitute.com, that’s R-U-S-C-I-Oinstitute.com. But seriously, we are very careful about the guests that we have on this show, especially in this day and age. We get pitched all the time. Our download numbers are really good. We’re very happy about it, but it brings a lot of unwanted attention and pitches from people who just have such crazy pitches that they’re not congruent with the values that we have here at the show. So, it’s so awesome to have you back on, and get into this, and can’t wait to have you back again, Michael. 

Dr. Michael Ruscio: Yeah, same here. I just want to quickly echo what you said, that if someone’s not feeling well, there are answers out there, and I think I was there, I’m not sure if you were there at one point, I felt like I was going crazy, but if you can find the right person, you can heal. So, yeah, don’t lose hope if you’re struggling, or you’re floundering, because just finding that one right perspective can lead to changes fairly quickly. And so yeah, I just want to leave people with what I think you said, which is awesome, which is just that echo of hope. 

Ted Ryce: Absolutely. Thanks so much, and looking forward to the next one. 

Dr. Michael Ruscio: Yeah, same here. Thank you.