November 24, 2018

Podcast from: https://bengreenfieldfitness.com/podcast/digestion-podcasts/healing-sibo-leaky-gut/

[0:00:00] Intro

[0:01:00] Guest and Topic Introduction

[0:01:40] Podcast Sponsors

[0:04:20] Previous Podcasts with Dr. Ruscio and Why He’s Back

[0:06:47] Concept of Bacterial Overgrowth

[0:12:30] How SIBO Affects the Thyroid

[0:22:18] Recommended Tests for SIBO

[0:25:31] The Elemental Diet

[0:28:31] Podcast Sponsors

[0:31:56] continuation of Elemental Diets

[0:32:36] The African vs. the Westerner Microbiota

[0:39:08] Modern-Day Example of Sardinia

[0:43:08] Plant Life Around Our Home

[0:44:57] Comments on Probiotics

[0:54:00] E. coli as Therapy

[0:56:31] Why We Would Be “Surprised” About Dietary Fiber?

[1:03:36] Whether or not melatonin can help with leaky gut

[1:05:46] Closing the Podcast

[1:07:03] End of Podcast

Ben:  I have a master's degree in physiology, biomechanics, and human nutrition. I've spent the past two decades competing in some of the most masochistic events on the planet from SEALFit Kokoro, Spartan Agoge, and the world's toughest mudder, the 13 Ironman triathlons, brutal bow hunts, adventure races, spearfishing, plant foraging, free diving, bodybuilding and beyond. I combine this intense time in the trenches with a blend of ancestral wisdom and modern science, search the globe for the world's top experts and performance, fat loss, recovery, gut hormones, brain, beauty, and brawn to deliver you this podcast. Everything you need to know to live an adventurous, joyful, and fulfilling life. My name is Ben Greenfield. Enjoy the ride.

Hey, folks. Ben Greenfield here. I have Dr. Michael Ruscio, I can't say his name without rolling your R's, baby, on the show today. One of my favorite guys when it comes to all things gut. We didn't mention this during the show so I figured I'd mention it now. All of his products, not only his books but also all the things that he recommends to his patients for things like the elemental diet that we talked about in this show, things to fix IBD, IBS, small intestine bacterial overgrowth. He's cutting all of my listeners a discount. So, I'm going to put that over in the show notes. If you go to the show notes for this podcast, those were at BenGreenfieldFitness.com/healthygut.

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When people ask me the number one book I recommend for all things gut related, it is hands down a book called, “Healthy Gut, Healthy You.” It's written by Dr. Michael Ruscio. He's been a guest on my podcast before. We did a big podcast on how to differentiate between all the different types of carbohydrates and what type of carbohydrates were good and what type of carbohydrates were bad and a high-carb diet and a low-carb diet. He also came on and did a big podcast with me a few months ago about why healthy people, in particular, get broken guts and what to do about it. And I'll link to both of those in the shownotes for this episode, which is going to be over at BenGreenfieldFitness.com/healthygut. That's BenGreenfieldFitness.com/healthygut.

The reason that I brought Dr. Ruscio back was because at the time I recorded those two episodes, he hadn't yet released this book. He sent me the book and I read it and I've just been recommending it right and left to pretty much everybody who–well, who has a small intestine and large intestine and asshole and spleen and liver. So, if you have digestion, you should read the book. I actually have a few things. You know, whenever I interview somebody about a book, I don't like to just give you guys exactly what's in the book but take a deeper dive into some of the things in the book and kind of explore them and unpack them, so to speak.

So, that's what Dr. Ruscio and I are up to today. Dr. Ruscio's practice is in Northern Cal. You're in–which city are you in? I forget.

Michael:  It's Walnut Creek right in the–well, you've had on Judson Brandeis and so his pump kind of male health enhancement clinic is in Walnut Creek as is a cryotherapy center. So, we got some stuff to do next time when you're in town.

Ben:  I know. That's crazy. Why Walnut Creek? I don't even know why it seems to be such a hot spot for, I guess —

Michael:  It's a nice suburb outside of San Francisco. If you're looking to get out of the city but not too far and have kind of like a nice affluent area that's clean and well-kept, a lot of people end up in Walnut Creek.

Ben:  Yeah. That's why there are so many things that you got a lot of rich bored people. That makes sense.

Michael:  Yeah.

Ben:  Okay.

Michael:  Yes.

Ben:  They want to do penis injections and sit in cryotherapy chambers. So, I'm going to speak– anyways though. So, there are so many places in the book that we could start but where I'd like to start is this concept of bacterial overgrowth. It's probably one of the least understood areas of digestion for a lot of people who get gas and bloating and think they've got whatever parasites or yeast or fungus or something going on in the colon but it turns out in some cases it is this thing called bacterial overgrowth. So, can you define that? And then, I also would like to hear, specifically, about how that affects the thyroid because that was a little-known fact to me in the book. So, can you get into SIBO or bacterial overgrowth, what it is, and then specifically, its effect on the thyroid?

Michael:  Yeah. I mean, there's a lot there to unpack which I think is super interesting and very actionable for people. So, the inception of kind of my foray into the importance of small intestinal bacterial overgrowth dates back to maybe five years ago when I think we really saw the initial burst of interest in the microbiota. This is when you started hearing all this cool research being published where African hunter-gatherers had more diverse bacteria in their guts and that seemed to correlate with healthier people in general. And so, there's a lot of excitement regarding the first healthy intestinal bacteria and the potential utility that we may be able to garner from taking sick people and improving the health of their bacteria. So, that was great but what can happen is when you're looking at things observationally, those observations don't always clearly translate into what you do in the clinic. And so, what you were seeing being suggested in terms of inferences were pretty much the opposite of what any experienced clinician would recommend and do for most patients. And so, I was confronted with this quagmire where some of the microbiota research was suggesting we need to undergo all these interventions to increase bacteria. Yet, I was seeing so many patients who clearly did not do well with that type of approach, and actually only seem to improve when we underwent interventions, ironically, that would decrease bacteria.

And this is one of the things I talk about in the book. When you make a delineation between the large intestine and small intestine, you actually start to sort out where some of these discrepancies come from. And essentially, the long story short is we go to Africa, we do these stool samples of hunter-gatherers and they have really rich large intestinal diversity. But what I suspect is being missed there is the impact of the small intestine which is much harder to assess. And, although, yes, there's a correlation between the large intestine and the small intestine, I don't think we really get a good read on what's going on in the small intestine with a stool test because it's right in the middle of everything that's kind of hard to get to.

Ben:  Yeah. And by the way, I mean that was like a study just a couple of weeks ago that showed that the bacterial status of the large intestine in no way reflects what's going on in the small intestine which kind of sucks for a lot of these biome tests that are testing stool and not getting a reflective evidence of what's going on up in the small intestine.

Michael:  Exactly, exactly. And so, that's why one of the main premises I develop in the book is a lot of the previous gut advice was very large intestine centric, but the problem is the small intestine represents over 56%. So, the majority of your intestinal tract is the most prone to leaky gut. It's the most immunoactive and it's where 90% of your calories are absorbed. So, it's a huge mess. To miss the importance of the small intestine is a huge mess. And here's what it kind of bottom lines to. You can twist observations to support almost any hypothesis where the–really gets called is when you go to the interventional or clinical trials. This is why I really harp on the importance of clinical trials because you can–again, you can cherry-pick and mislead with observation data and with mechanism data but when the rubber really hits the road is when you say, “Okay. We have a group of 100 people. They are sick. We are going to do this in half. We're not going to do that in the other half. We'd give them up a SIBO and then see what happens.” And when you look at the outcome data, you start leaning back toward the interventions that seem to favor the small intestine.

So, long prelude here because the answer of what is bacterial overgrowth, most namely small intestinal bacterial overgrowth which is what I think is the most relevant, is where you have either an overgrowth of or the wrong type of bacteria in the small intestine. There should be some, not nearly as much as there is in the large intestine and what can happen is you can have an overgrowth of bacteria in the small intestine. And again, sometimes it's native bacteria, sometimes it's bacteria from the large intestine growing upward into the small intestine, sometimes it's oral bacteria from the nasopharyngeal cavity that gets down into the large intestine, or sometimes it may even be the native small intestinal bacteria that just simply overgrow.

But the point is that this is not something like a parasite, which is I think a lot of the older like last generation gut advice was test for parasites and get rid of parasites. And there was some truth to that and I am an example of that. I had a parasite but I think what's much more common now is an overgrowth of bacteria that are native to your system. It's just they've gotten decompartmentalised or they are in the correct compartment but there's just too many of them in that compartment. So, that's essentially what SIBO is.

Now, the tying to the thyroid I think is fascinating. I'll just say this very plainly that there may be a lot of people who think they have a thyroid condition who actually don't. And I'll come to a study in a moment that actually found that 60%, 6-0 of people who had an ambiguous thyroid diagnosis when they were rechecked, 60% of them actually were not hypothyroid. And I think this is because the symptoms of not only small intestinal bacterial overgrowth but problems in the GI, in general, can manifest as symptoms that look like hypothyroidism.

Just as one example, there was a study looking at patients with IBS, so irritable bowel syndrome, gas bloating abdominal pain, altered bowel function, and they found a significantly higher incidence of fatigue, depression and anxiety in that cohort. Now, fatigue and depression are oftentimes attributed to hypothyroidism. So, we certainly can see that problems in the gut may manifest as what looks like a thyroid problem. But, specifically, there are a couple of key points that have been published over the past maybe two years. One only about six months ago with a study, I believe was in Russia. It was either in Russia or in Poland. And essentially, they found that patients with SIBO, small intestinal bacterial overgrowth, had about three times higher the level of TPO antibodies which are the antibodies that underlie Hashimoto's.

Now, I also should be careful in saying that three times sounds like a lot but this is where–I don't want to contribute to some of the overzealousness of functional medicine and I want to be a little bit discerning. So, the control group had a level of 39, which is considered just above normal. Usually, the cutoff for TPO antibodies to a–thyroid autoimmunity is about 35. So, the control group, the non-SIBO group had–I'm sorry, so the control group had a value of 6 and then the SIBO group had a value of either 39 to 94. So, it's actually more than a three-fold.

But, here's where the details do matter. While that is a significant elevation of thyroid antibodies in the SIBO group, I wouldn't say it's a huge elevation because when you look at thyroid antibodies, in my experience, they have to really be over 500, and there's some literature that supports this, to really denote a clinically meaningful elevation. So, yes, there is evidence showing that one may have a worsened thyroid autoimmunity situation if they have small intestinal bacterial overgrowth, and that's something you can act on and may help. But, I don't want people to think that this is a hugely impactful issue, at least not from the preliminary literature. So, it's one thing that can help but I wouldn't lose sleep over it per se.

And the mechanism there may be that when bacteria in the small intestine overgrow, they seem to sequester selenium. And if they're using selenium at the expense of you, the host, we know that selenium does dictate thyroid autoimmunity. So, what may be happening–again, this is more so my speculation than there is any solid evidence to support this. I don't think there's really an answer to those questions so I'm just inferring based upon what we do know.

Ben:  Okay.

Michael:  But what may happen is that you have someone with a genetic predisposition to thyroid autoimmunity, they develop small intestinal bacterial overgrowth. The small intestinal bacterial overgrowth starts essentially binding to their selenium making someone a bit selenium insufficient, and then that may exacerbate the thyroid autoimmunity. So, that's one mechanism but here's what I think is the most important data we have regarding thyroid autoimmunity and SIBO.

There was one study looking at over 1,800 patients and they were looking to see what were the most associated conditions to small intestinal bacterial overgrowth. So, a group of researchers looked at 1,809 patients, specifically, and they were looking at immunosuppressive drug use, acid lowering medication use, prior intestinal surgery, and they were expecting one of these to really associate to and increase the risk for SIBO. What they found was very surprising. The two most correlated conditions associated with SIBO were being hypothyroid or being on thyroid medication. So, there's clearly a high association between SIBO and small intestinal bacterial overgrowth.

And then, just to finish this thought, and this ties into something that I've seen in the clinic, patients come in and they're pursuing what they think is the cause of their symptoms. So, they might be depressed, a bit overweight, their cholesterol is a little bit high, and they're fatigued. And they may or may not have digestive symptoms because you don't always have digestive symptoms that accompany gut inflammation. Sometimes the gut inflammation is silent and only manifesting in other non-intestinal symptoms.

Ben:  Right. Like neurological fatigue or brain fog.

Michael:  Right, exactly, exactly. So, these patients come in and they may have been on levothyroxine for six months then they tried levothyroxine plus Cytomel. So, you have your T4 plus T3. So, it's more like a custom medication. And they may even have gone and tried Armour or WP Thyroid or whatever, and they never really got the traction that they were looking for. And so, what I've been saying now for close to a year is I've been criticizing that in the progressive realms of natural medicine, functional medicine, whatever you want to call it, I think we're doling out hypothyroid diagnoses too quickly, and certainly not with near the level of circumspection that we should be using.

And when I've gone back and actually checked, I found that some of these patients were never hypothyroid. You may have been able to nitpick and say, “Well, their TSH is an optimal. Their T4 is an optimal.” That's a big difference from being hypothyroid and the clinicians, probably in an unintentional way, didn't clearly explain this to the patient that they were not hypothyroid yet there may have been a little bit of functional low thyroid status. Nevertheless, they went on a medication and they come to see me five years later. And when I checked their initial lab work, it's clear they were never hypothyroid. They never felt fully improved from the medication yet they've been on it for five years. This leads me to this most recent study that looked at–and sorry for being a little long-winded here but this is something —

Ben:  No, this is super interesting.

Michael:  Okay. So, in this study, they documented exactly what I've been seeing in the clinic. Two hundred and ninety-one patients who didn't have a firm hypothyroid diagnosis were then tested at baseline, taken off their medication for six to eight weeks, and then retested. Sixty percent of those patients were not hypothyroid. That is a huge deal. And the title of the study was essentially Hypothyroid, a Timely Diagnosis. Meaning, it's a diagnosis now that's in vogue so it's being handed out more quickly, which it really shouldn't be.

And so, a couple of things from the study that are important that the antibodies, nor someone's weight, nor their time on medication dictated whether they had a higher chance of actually being hypothyroid or if they were normal thyroid. So, that's just some important context. Ultrasound findings did seem to be somewhat predictive. So, that's something that someone may be able to use to kind of sort this out. But say quite simply, if you haven't had a definitive diagnosis of hypothyroid and you're on thyroid medication, you may want to speak with your doctor about revisiting this issue to double-check if you are hypothyroid or not.

And I would say, and I'm not sure how to say this as tactfully as I'd like to, but if your diagnosis was made by someone, not in the conventional medicine community, I would be more prone to have a double-check. In no way, I mean that to be disparaging of functional integrative or natural medicine. But, I do think that there's been some misrepresentation of the data to this community where some of the clinicians in this space I think have been led to believe that hypothyroidism is more common than it actually is.

And so, yes, there is this association between SIBO and hypothyroidism. In my experience, it's one of the chief causes of someone who thinks they have a thyroid problem but actually don't and their symptoms are actually coming from a problem in the gut. And you may be able to get some people off of thyroid medication and fix a problem in their gut. And also, it's a little point where they're on no thyroid medication and their symptoms are now clear.

Ben:  That's super interesting. Now, if somebody wanted to actually test and see if they had SIBO, do you have go-to tests? Because I know that there's been in the past some talk–I think you even mentioned this to me that many of the SIBO tests might not be reliable.

Michael:  Yes. And I should maybe back up and just say for people who want to run the thyroid test, what you want to do is test your TSH and your free T4. And what you're looking for is if your TSH is in the conventional normal range and your T4 is in the conventional normal range, then there's an extremely high likelihood that you are not hypothyroid and you don't need thyroid medication. Now, might there be a minor problem with conversion? Sure. But is a solution to that lifelong administration of thyroid hormone? No. The solution is diet, stress. And I would argue, in large part, your gut.

So, just to get people the parameters there, because this is one of the things that leads to the erroneous diagnosis of hypothyroidism, is using these ranges that are too narrow. And, that's a whole nother conversation maybe to get into some of the particulars regarding why some people say that your TSA should be below 2.5, but that's when you're diagnosing the condition that's —

Ben:  You know, let's focus on SIBO for now.

Michael:  Yeah. But that is one important thing just to give people a note on if they want to run this test of their thyroid status.

Now, regarding SIBO, there is some debate on what the best test is. Really, I think you have two practical options, both are breath tests. One uses glucose, the other uses lactulose. You can make a case for either. And I think there's pretty good evidence to make a case either way. The Rome Foundation, the largest body and gastroenterology in the world, recommends glucose. The North American Expert Consensus recommends lactulose. So, you have two large, well-credentialed bodies recommending these two different tests. I think as long as you are using the lactulose test —

Ben:  And this is, just to clarify, you drink a bunch of lactose or any of these other sugars that you get sent with the test to your house, then you breathe into this tube and it tracks how much gas the bacteria produce over a few hours.

Michael:  Exactly. Well said. Yup. And so, there's debate on which test is the best. One of the challenges is the lactulose test may lead to false positives, meaning you may see a positive on your test but you may not actually have SIBO. If you make your interpretive time window from the start of the test to 90 minutes and only look at that window, with the lactulose, you seem to safeguard against those false positives. So, there's a fairly easy way, at least in my opinion, to get around that. But really either one can work. Either breath test can work. They're cheap. They're like $200 even if insurance doesn't cover them. Many insurances will cover them and they can give you some data to move on.

Ben:  Cool. Now, one of the things that I know, I've seen you recommend for SIBO, and I've tried this diet out and it's actually–it's pretty good. It's called an elemental diet. And usually, it has some kind of a meal replacement powder. I've done it and used Thorne MediClear and blended it with like stevia and ice and actually a bit of bone broth and thrown in a little bit of oil in there, a little bit of extra amino acids and you just like drink that for breakfast, lunch and dinner for a while like up to 30 days. I don't know if I just bastardized the elemental diet but ultimately, I'm curious if you can explain the elemental diet and how it would work for something like SIBO or inflammation or IBD or anything else.

Michael:  Sure. Now, I don't know if that application would actually classify or qualify as an elemental. I think it'd be pretty close and could probably work. The elemental diet is essentially a hypoallergenic. So, it's to avoid common allergens and gut-healing meal replacement shake. And one of the things that this elemental diet will do is it absorbs in the first couple of feet of the small intestine. So, the rest of the small intestine and the large intestine all get a break from digestion. And, if there are overgrowths, those overgrowths don't have the fuel, the food in your diet to help continue to fuel the overgrowth. So, it, in effect, will starve overgrowth. And this is why we see one clinical trial showing quite impressive benefits in small intestinal bacterial overgrowth. A number of trials had an ability to decrease autoimmunity and inflammation in the gut in inflammatory bowel disease. Some evidence shows it can help with what's known as eosinic esophagitis or eosinophilic esophagitis which is essentially an inflammatory condition of the throat. And one study is showing benefit with rheumatoid arthritis, so joint inflammation.

So, it can be very, very helpful. It's not actually as hard to do as it sounds or it sounds like a liquid only diet would be tough. I've done this exclusively for four days as a guy who is 6'1″ and like 215 and fairly muscular needs a lot of food. I wasn't hungry at all. I actually had a great mental clarity and focus.

Ben:  Yeah. You can make a lot of these shakes taste pretty good, too.

Michael:  Yeah, yeah. And I should also mention that the older generations of elemental diets tasted kind of like postage stamp glue. They were horrid. And I say that as someone who could chew on almost anything and even, I was like, “Gosh, these are terrible.” There's a newer generation of elemental formulas that are actually quite palatable. One of which we have released that I'm really proud of and the feedback that we've gotten from our patients and people who have gone through the book protocol has been fantastic, and our formula is called Elemental Heal. And it's one of these newer generation formulas and this one, thankfully, is available without a prescription that actually tastes pretty good and you won't feel like you want to gag, which is always nice.

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I'll link to that in the show notes. If people want to try out this diet, I would recommend you don't just like willy-nilly jump into it and try it. It'd probably better to do like the breath test for SIBO, for example, that Dr. Ruscio was talking about. It's kind of a simple, clean, easy way to–again, like you mentioned, kind of keep the bacteria from having something to feed on.

And you had mentioned briefly, Michael, the idea of these African hunter-gatherers’ microbiota and how it might be different than the westernized diet. But there's also–you know, there are people like Jeff Leach, for example, was made famous–not made famous but he became a little bit famous for his experiment where he did the fecal microbiota transplant of the stool of a hunter-gatherer. He hung himself upside down in the middle of a village, I think it was in Hadza, and just basically replaced his colonic bacteria with that of a hunter-gatherer. And then, I think he went off and wrote an article on it. I'll see if I can find the story and link to it in the shownotes. But what do you think about that? Because you talked a little bit about the microbiota of these African hunter-gatherer tribes in the book. And I'm curious what would happen if we were to all do that like go way back to our roots and just put the bacteria of our ancestors into our current westernized bodies?

Michael:  Well, it's a great question and I don't know exactly what would happen if we all did FMTs from an African population, like an African hunter-gatherer population. But, a lot of the mismatch between the research, or I should say, the observational inferences that were being taken from Africa and what the actual clinical science says that I kind of opened our conversation with came from this research in Africa. And these cross-cultural comparisons are always very challenging because it's really bad science and bad practice to take an entire culture that's different in a vast array of ways and try to excise out from that culture one thing and then replicate that and almost force that item into a totally different population.

And so, the African hunter-gatherer groups that have been studied really provide a compelling example of that where they eat, in many cases, a fairly high-grain diet, a high-carb diet, and a diet that's usually about half the calories as many of us in the west. And they have vastly different immune systems and vastly different lifestyles. Many of these tribes are highly parasitized. Meaning, almost all of them have worm infections. We're learning that those worms may actually have benefits–

Ben:  Or even not be parasites because secondly, the definition of a parasite is it has to be kind of opportunistic and feed on them and a lot of these things are just kind of like–as in the west, it's called helminthic therapy but a lot of people now will use tapeworms and whipworms that are safe to actually affect, for example, a more robust immune system.

Michael:  Yup. So, it's absolutely synthetic and I do think we should be rethinking how we label some helminths or some worms as potentially not truly parasitic. It's incredibly well said. But all that being said, it does appear that the microbiomes of the Africans are adaptations in part to their environment. And when we see similar adaptations in the west, the void of their environment, they actually might be pathogenic. And methanobrevibacter smithii, which I expound upon in the book, provides what I feel would be one of the best examples of this. Methanobrevibacter smithii is like a cousin to bacteria. It's technically classified as an archaea. This organism is interesting in the sense that it slows down motility or the movement of food through the intestines. And by doing so, helps to extract more calories from the food and it helps with more robust breakdown and extraction of calories from food.

So, in an African population that's eating a highly dense, highly fibrous diet, and also a lower calorie diet, this is a beneficial adaptation. You slow down the rate at which this food moves through the intestines and you extract more calories from it. So, you have more of a chance to extract calories from this dense, hard to break down food, to begin with, that works for the Africans. When we see this overgrowth in the westerners, it's accompanied by constipation and it's been fairly highly associated to weight gain, high cholesterol and high blood sugar.

So, what works for the Africans doesn't really seem to work so well for us. So, this is why we have to be careful in trying to replicate the diet of the Africans because they have this whole environment that's adapted to allow them to thrive on that diet and with that bacterial ecosystem. So, we have to be cautious in just replicating that. And this is part of the scientific process. We see those observations and then we formulate hypotheses and then we test those hypotheses. And only after we've tested those hypotheses in clinical trials should we act.

Unfortunately, the translation from what Leach is doing to clinical practice isn't often made with caution and you have people jumping from observation to clinical recommendations. And this is where you can seriously get yourself in trouble. So, we should continue to watch this body of evidence and learn what we can from it but we want to be careful with how closely we replicate our effort in hunter-gatherer contemporaries.

Ben:  Yeah. So, if like a carb, high-carb, prebiotic, super fiber-rich diet works for Africans but you're a westerner and you've got issues that diet might be the exact opposite what you need. Like it might feed bacteria, for example, if you have SIBO, or it might feed bacteria that your immune system is attacking, or create more issues rather than fix it.

Michael:  Exactly, exactly. Obviously, the high-carb, high-fiber I think requires a little bit of contextualization, which is if someone's going from the standard American diet to any kind of healthy diet, they are likely going to increase their fiber and prebiotic intake. Just the question is how far do you go on that spectrum? For some people, a low-carb paleo diet may be enough to make them feel totally fine. If they go to the extreme of going more proximal to a vegetarian diet which is even higher in carbs and fiber and prebiotic, then they may start to have some serious problems with their gut.

Ben:  Now, one of the other things you talked about in regards to kind of like westernized versus non-westernized societies is how non-westernized societies have less inflammatory and less autoimmune and less allergies because they're living in less sterile environment so they might have stronger, more robust immune systems. And I thought it was really interesting how you outlined this with a modern-day example of Sardinia. Can you explain what the Sardinians did and how this affected their immune system?

Michael:  Yeah. This is an interesting story that I had heard anecdotal reports about. And like many things in the book, I really fact-checked them because one of the things I think is not helping the field of integrated medicine as great as it is is just parroting these things that we've been told and not fact-checking anything because if you don't fact-check, then you never catch errors and you're never able to get rid of the errors and update. So, I really did fact-check pretty much everything in the book and you can tell by the referencing in the book there are just under 1,000 references.

So, I checked into the Sardinian issue because I wanted to make sure this wasn't just some kind of lower from natural medicine. It turns out that this does check out and I believe it was in the 1950s that Sardinia went through this anti-malarial campaign because there's a fairly high incidence of malaria in Sardinia. And what ended up happening years after that was the incidence of multiple sclerosis and Sardinia started to go up to one of the highest in the world. And what the researchers who have been tracking this are now positing is it was a–or the malaria was a–or I should say, the Sardinian immune system learned to evolve under the pressure of malaria and it kind of required that little bit of tension in the immune system from the malaria for the Sardinian's immune systems to be optimally healthy.

Once that was taken away, the Sardinian immune system that was always kind of used to having this little bit of tension with malaria, once that was gone, it's almost to say the Sardinian immune system didn't know what to do with itself. And it was so used to being a little bit turned on to guard against the malaria then when the malaria was gone, it was kind of like having a bored army, right, and then the soldiers would get drunk, going to town, start picking fights. And you see this by-standard autoimmune effect. And so, sometimes things that we don't think are good may actually be good especially if the immune system has evolved to be in harmony with those. And the same thing applies to the helminths as you alluded to earlier where helminths or worms are a fairly common part of the guts in those who are hunter-gatherers. And one of the things that may lead or have led to the increased prevalence of autoimmunity in the west is the anti-worm campaign that was initiated in the U.S. where now almost no one has worms but those worms may have actually provided a little bit of background tension against our immune systems to prevent autoimmunity. And now that they're gone, the immune system tips into autoimmunity.

Ben:  Yeah. I wrote an article about this a couple of months ago. I actually inoculated myself with tapeworms and whipworms just to kind of experiment with how my immune system felt. And ultimately, the biggest change I found was far less susceptibility to getting sick and it seemed to even reduce the symptoms of jetlag when I was traveling all across the globe. So, it seemed to kind of modulate the immune system in some way. I'll link to that article in the show notes. If you guys want to read it, I'll put it over at BenGreenfieldFitness.com/healthygut. But it's a perfect example, this malaria eradication example of why we may want to keep our immune system slightly challenged.

Another thing that I thought kind of reflected kind of a good practical tip was this idea of increasing our bacteria externally, especially like our skin bacteria and doing so with naturally occurring plant life. I've talked about the NASA Clean Air Study before and how my wife and I have placed house plants around the house that naturally cleaned the air based on many of the plants like English Ivy and Peace Lily that they identified in the NASA Clean Air Study. But then you kind of take this to the next level as far as plant life. Can you explain what's going on when we have plants in our home or surround ourselves with plants?

Michael:  Well, I'd talk about a couple of studies in the book and that were interesting. Most namely, there was one cohort study that looked at children growing up in environments where there was a high diversity of naturally occurring plant life around the home compared to children in environments where there was a low diversity or just a low amount of naturally occurring plant life around the home. And what they found was very interesting. The diversity of plant life correlated with the diversity of bacteria on the skin of these children, which was inversely related to inflammation in the skin. So, the higher the plant life, the higher the bacterial diversity on the skin, the lower the inflammation in the skin, and that led to a lower amount of things like atopic dermatitis or just skin allergy of various sorts. So, there does seem to be some kind of benefit from having a diversity of plant life around your home. Whether we can replicate this by buying plants and putting them in the home, I don't know that that's been shown but I wouldn't think that would harm in any way, and certainly could only be neutral to hopefully beneficial.

Ben:  Yeah. It was really interesting takeaway. And then you kind of get into the realm of probiotics, and this is a big one for a lot of people especially in light of that new research I talked about earlier that found that I think the primary takeaways are large intestine bacteria don't necessarily reflect what's going on in the small intestine even though all these microbiome tests are testing the large intestine, the stool. And then, I think the other takeaway was that many of these probiotics, even though they seem to have some kind of an effect on things like IBS and IBD and depression and many of the things that probiotics have been studied to be somewhat efficacious for, they don't appear to actually kind of seed or populate the gut.

So, there's a lot of confusion out there regarding probiotics and you have some really good sections of the book on probiotics, but what's your take on them? I mean, do you use them? Do you prescribe them? Do you think they even work? Do they stay in the gut? I mean, what's going on with probiotics in that respect?

Michael:  Well, you're right. And one of the–I think, most I guess counterintuitive things that is important to mention regarding probiotics is that most probiotics, with the exception of a few, do not colonize you. And this kind of throws a monkey wrench in the previous philosophy of, well you need to, like you said reseed the gut and repopulate with healthy bacteria. And that doesn't really seem to be the way this plays out. I think a better way to think about probiotics is you have this bacterial colony in your gut. And with stress, with poor diet, with environmental insults, with the fact that we grow up in an environment that's fairly sterile, and if you were not breastfed or if you were cesarean birth, all these things are negative knocks against that bacterial community in your gut.

What I think probiotics can do is they can provide a nudge to the microbiota that can help reset it to a healthier equilibrium. And if we pair that nudge with the appropriate diet and lifestyle inputs into the gut then we can help that nudge to maintain this eubiosis or this balance in the longer term. So, a healthy diet and lifestyle foundation paired with a nudge from probiotics seems to be able to help reset the microbiota to a healthier equilibrium. And so, I should mention that one of the things that probiotics do that I think is underappreciated is they're actually antibacterial, antifungal and anti-parasitic, perhaps using the term parasitic loosely but they do seem, probiotics that is, to be able to combat things like small intestinal bacterial overgrowth and Candida.

So, a properly used probiotic can have a lot of benefit for reducing overgrowth and also helping to reduce inflammation, repair leaky gut, and help with a number of symptoms. But it's not to say that they will repopulate your gut with these missing bacteria but rather, again, if you have these imbalances, the probiotics can help to kind of dislodge some of these imbalances and reset you to a healthier equilibrium.

Ben:  Now, what about when to take them? Because you mentioned the use of probiotics in kids. My kids eat a wide variety of fermented foods around the house like kimchi and coconut yogurt and sauerkraut and miso and things like this but they don't take a probiotic per se. I think they have some of the SmartyPants probiotics upstairs and they have access to my probiotics. But do you think it's beneficial for kids to be using probiotics?

Michael:  Well, there have been a number of studies showing that probiotics can be helpful for children. And one of the first things I wanted to look at was how early can we go with probiotics? Is there some sort of time we need to wait before we give a probiotic? And could a probiotic, perhaps given to an infant, be detrimental in some way? Even if you look at children in the NICU or preterm infants, there is a benefit derived from taking probiotics.

In fact, one study found that administration of probiotics before 27 days of life decrease the incidence of type 1 diabetes. And if the probiotics were administered after 27 days of life, there was no impact on type 1 diabetes, which is an autoimmune condition. So, that's just one study but there does seem to be this trend. And to state it simply, the earlier an antibiotic is used, the more detrimental it is. And the earlier a probiotic is used, potentially, the more helpful it is.

Now, probiotic foods, how do they interface in here? It's hard to say. I would assume that probiotic foods or supplemental probiotics would have a similar impact. I don't know that we have great research yet looking at fermented foods in infants and toddlers. We do have those studies with probiotics and we do see benefit. I would assume the same thing would happen with a probiotic. So, I would say for a child, you can use either. If you're a pre-food, then obviously, a probiotic would be the way to get there or at least the mother taking it. So, hopefully, she gets some crossover benefit into the child. And then, as they're growing up, I would say use either fermented foods or probiotics or a little bit of both.

Ben:  Yeah. I mean really, probiotics would be almost more targeted delivery though because when you look at live microorganisms, assuming you're not eating like a heat pasteurized probiotic like a lot of these store-bought sauerkrauts, for example, are. The thing is they might not be necessarily reliable as a source of beneficial effective bacteria if you're trying to target your body with a specific strain of bacteria. But, if you want just kind of that shotgun approach of a wide diversity of bacteria in your system, I think that regular use of those and then targeted use of probiotics seem to be somewhat effective.

And, in terms of targeted use of probiotics, there is this concept of like survivability and whether a probiotic can actually survive the acidic journey through the digestive system and make it, for example, through the colon. I've seen some folks now talking about like newer probiotic strains that might actually seed the gut. That's even the name of one of them that people are talking about is this company called Seed that's making probiotics that they say actually survive the acidic environment in the gut and populate the gut. Have you looked into strains like that at all that have enhanced survivability?

Michael:  I've looked to some extent into these enteric coated probiotics and my thinking here is the consumer needs to be very careful with the claims regarding probiotics. I remain very open but I think there's much more hyperbole than there is here actually actionable or helpful advice. I think what you're going to see because probiotics are a market that many companies want to get into, you're going to see progressively more outlandish claims made to market a product because the more people are marketing, the more marketing claims are made, now you have to market even harder. You need newer more noble pathways and mechanisms to market.

So, I can tell people that with the simple three-category probiotic system that I use with the three probiotics that I recommend in the book, which are good clean probiotics that have the appropriate ingredients and the appropriate dosing, but with those, we have been able to take people who have positive Candida and SIBO on their labs, and the only thing they needed to do is to use a probiotic protocol. And this does make a difference.

I remember most succinctly or distinctly with Robb Wolf, he had done all types of gut protocols, obviously because Robb Wolf knows everybody. He finally pulled me aside and said, “Hey, do you have anything I should try?” So, I gave him this probiotic protocol. And there were two categories of probiotics in my three-category system that he hadn't tried and that was a huge game changer for Robb, not using the newest novel probiotic which he was doing I think for a while and getting pulled in the bells and whistles, and just understanding that it's important to present the gut with this diverse array of probiotics using all three of the categories, and that was able to make a substantial impact. So, I'd be cautious because this is something that you're going to see more and more of. And then, I watch a literature and if there is something significant there that needs to be acted on, I'll be one of the first people to adopt. But I am highly suspicious that the consumer is going to be just bombarded with all these different claims.

Ben:  Yeah. I think with that Seed company, they're using some kind of like a–they're using algae as a delivery mechanism and I think they're somehow coating the bacteria with algae and they say that it survives transit through digestion but I don't know. I was just curious if you'd use anything like that. But the other thing you talk about is also this deal with using E. coli as a probiotic. And that surprised me because a lot of people think E. coli is just found in bad hamburgers and is going to make you sick. But you actually talk about E. coli as therapy, as gut therapy. Where does E. coli fit in when it comes to probiotic supplementation?

Michael:  Yeah. Great question and very interesting because there are pathogenic E. colis like enterohemorrhagic E. coli. But also, a fairly prevalent member of your healthy commensal bacteria are different types of E. coli. And so, I mentioned earlier the three-category system of probiotics. Well, there technically is a fourth which I mentioned in the book but for most conversations like this, I don't discuss the fourth because the fourth isn't really available in the U.S. for weird regulatory reasons that I don't quite understand. While these probiotics are available in Europe and in many other countries, they are, for some reason, not available in the U.S.

Even though there have been a number of clinical trials showing benefit, there's one trade name as Mutaflor which is E. coli Nissle 1917 and it's a strain of E. coli and it's been shown to have quite impressive benefit like the other probiotic. So, I think all good probiotics of Category 1 through 3 or this Category 4 can be highly beneficial. So, for someone who hasn't tried an E. coli probiotic, it's something to consider. And yes, there are healthy strains of E. coli that can be beneficial and there have been a number of trials, mostly in inflammatory bowel disease showing benefit with some of these E. coli-based probiotics.

Ben:  Interesting. And you can actually look on the label and you can actually find E. coli as an ingredient on the label.

Michael:  Yeah. Yup.

Ben:  Interesting. And so, when people get a gut test and it says that they have E. coli, those could actually be beneficial strains of E. coli.

Michael:  Oftentimes, that's what you see. It's helpful to understand that E. coli is a natural resident of the gut. And so, unless it's identified as a pathogenic E. coli, many times this just tells you that you have, just like lactobacillus or bifidobacterium, you have E. coli growth in your gut which isn't a bad thing.

Ben:  Now, you also say in the book that we would be surprised about what you found in your research for the book about dietary fiber. We'd be surprised about dietary fiber. What is it that people would be surprised about when it comes to dietary fiber?

Michael:  Well, I guess to say it concisely, the benefit of dietary fiber I think has been vastly overstated but we have to paint one I think important background nuance, which is a low-fiber diet that's high in sugar, high in trans fat and high in processed foods is not healthy. But when you leave that SAD diet, which I'm sure no one listening to this has done probably in a long time, when you leave the standard American diet and go to pretty much any healthy diet from low-carb all the way through a healthy vegetarian diet, you're probably okay in terms of your fiber intake. There's a fairly large swing in terms of the fiber intake from a low carb diet all the way through a vegetarian diet but it doesn't really seem to matter, and this was the most difficult part of the book to write because I was presented with 167 pages of abstract summaries on the research regarding fiber. This was the point of the book where I literally almost gave up. There were so much data. And having to try to parse through the data and essentially say, “Okay, here's 167 studies, we have to weight these by importance and we have to also divide these by studies that show fiber has a health impact compared to fiber has no health impact,” and that was quite difficult.

But, after going through that daunting process, the conclusion that emerges is fairly clear, which is there has been no consistent benefits shown from a higher dietary fiber intake. And even some studies using diets that are relatively lower in fiber to some of the studies that they've been compared against and showing actual benefit, for example, one study looking at a paleo diet next to a Mediterranean diet in the prevention of colorectal adenomas, showed similar ability to prevent occurrence of those.

Ben:  Now, when you're saying high-fiber versus low-fiber, what are we talking here in terms of the number of grams of fiber?

Michael:  Well, that's the actual convenient thing, which is it doesn't seem that we have to be highly prescriptive with this recommendation because it does get complicated. You have soluble fiber compared to insoluble fiber, you have fiber from fruits, you have fiber from grains, you have fiber from vegetables. So, it's been looked at in all different ways but the trend that emerges–and if people want the deeper dive, they can read the book to go through this on a study by study level. But the trend that you see is that higher fiber intake, there are some studies showing benefit from higher fiber intake, which is what a fiber enthusiast will cherry-pick in sight when they're trying to support the argument that you must eat a lot of fiber. But they will leave out the other evidence showing that higher fiber–and this will vary in terms of how much fiber and the type of fiber, but numerous studies also show no benefit from a higher fiber diet.

So, that's important to factor in. And then also when we look at studies that compare something like a vegetarian diet to a paleo diet or a Pritikin-type diet compared to maybe a low-carb-type diet, you actually see equivalent results, and even specifically for metabolic conditions, a slight favoring for benefits in metabolism from a moderate to lower fiber intake. So, there's not a specific gram that one needs to shoot for to say that they're high-fiber, moderate-fiber or lower-fiber, but rather I would say whatever diet you feel best on anywhere from low-carb which tends to be a little bit lower in fiber, all the way through high-carb which tends to be a little bit higher in fiber, feel okay about that because there's no consistent evidence showing that you need to be eating higher fiber to have a healthier colon or just be healthier overall.

Ben:  You hear that a lot from people now who are following the carnivore diet, eating a lot of meat, and grain and meat has a little bit of fiber in it but they're not eating a lot of fiber yet seeing in some cases reversal of a lot of gut issues and inflammation and IBD. Have you looked into the carnivore diet at all or thought about that when it comes to fiber?

Michael:  I've had some patients who have fooled around with it. Some have done very poorly on it and some have done really well on it. And my thinking is that the carnivore diet is almost like an extreme elimination diet because we know that plant foods contain a number of things that can be noxious. Lectins, saponins, oxalates, some sulfur, FODMAPs, and even just fiber in and of itself, especially vegetable fiber and insoluble fiber can all be irritants to the gut.

And so, what I think is happening is in part, this is just like taking everything, or not everything but many things that could be problematic to the gut and just wiping them all off the table in one fell swoop when you go in the carnivore diet. So, I like it from–I don't know if I would say, “I like it,” but I see the plausibility of it as an initial elimination diet. And then, one should heal after a while on that and then try to move to the broadest diet possible.

Ben:  Yeah. I have the same opinion. By the way, I don't think that it has anything magical to do with eating a copious amount of meat every day. I think it's the fact that you just simplify the diet to the extent where you just aren't eating barely anything that could cause gut inflammation. But at the same time, this might offend some people but I think it's almost like a lazy diet. It's kind of similar to the elemental diet. It's like I'm just going to eat the same thing for breakfast, lunch and dinner and screw food, food prep cooking, learning more about the wonderful world around me, eating a whole foods diet like kind of a Weston A. Price's diet where you're actually learning and building a relationship with food versus just like throwing another slab of meat on the grill for breakfast, lunch and dinner. I just think it's almost like a little bit of a myopic, overly restrictive diet that's kind of like a lazy way out but that ultimately if you eat that way your entire life, I suspect you get pretty bored. Like most people have talked to you about it. They're like, “Yeah, I love [01:03:00] ______.” But after a month or two, they're just like, “I'm getting kind of tired.”

Michael:  And I agree. I would be prone to think that this diet would show some type of deleterious impact in the long term. Just like we in the paleo-ish camp or one in the paleo-ish camp loves to criticize the vegetarian diet for the potential for nutrient deficiencies. I think the same logic applies here that a diet that's too extreme in what it limits opens the door, increases the likelihood of some type of nutrient deficiency in the long term.

Ben:  Yeah. I wanted to ask you one other question, and this was just like a little anecdote from your book that I found very interesting, and it was this idea of melatonin actually being something that could help with a leaky gut. And I'm curious if that is, literally, like just supplementing with melatonin or if it is more related to sleeping more or sleeping better or what's the deal with melatonin in the gut?

Michael:  Well, I would definitely say that the optimum choice would be to have your sleep be adequate and quality to try to use the melatonin pathway for gut health. But there has been at least one trial showing an ability to improve IBS symptoms with supplemental melatonin. And melatonin does seem to have an anti-leaky guts mechanism to it, perhaps due to its antioxidant capacity. So, I mean, it's certainly something that you could tinker with. It's not something that I use for the application in the clinic. If someone's having a hard time sleeping, then I think melatonin is definitely a supplement to consider because it has secondary health benefits. So, I see it having applicability there.

But, if someone's having a hard time sleeping, I would say, “Look into the health of your gut,” because it has been fairly well-identified that inflammation in the gut can lead to insomnia. So, there's kind of this closed-loop circle where problems in the gut may lead to insomnia, that insomnia may decrease melatonin, that melatonin may make their gut worse and they're stuck in this self-feeding cycle. So, yes, melatonin can help with leaky gut.

Ben:  Did they say in any those studies do you remember how much melatonin was being used?

Michael:  You know, I don't. I'm assuming it's probably anywhere from 5 milligrams a day to 10. Probably, somewhat standard dose, a little bit on the higher side there. I would say use a probiotic way before you use melatonin for healing leaky gut.

Ben:  Interesting. I just thought that that was a kind of a cool anecdote was the use of melatonin. So, I'll link to some of the research on this, and also everything that we talked about if you just go to BenGreenfieldFitness.com/healthygut. That's BenGreenfieldFitness.com/healthygut. We kind of only scratched the surface in terms of the actual book but I consider this to kind of be, to a certain extent, almost like a cookbook for if you have like gas constipation, bloating, SIBO. You've noted something on your gut test results that you want to take a deeper dive into. The book is a really good resource, almost like a coffee table resource for your guts.

And, Dr. Ruscio also has a podcast that's really good that has a lot of really good research-based science on the gut, which is what I really appreciate about Michael is he actually has research to back everything up, like there are over 1,000 different studies just referenced in this book alone. He also puts out a newsletter that's pretty good when it comes to keeping your gut dialed in and getting access to the latest research on the gut. So, the book is “Healthy Gut, Healthy You.” I'll link to it and everything we talked about over BenGreenfieldFitness.com/healthygut. And Michael, thanks for coming on for a three-peat on the podcast.

Michael:  Yeah. Thanks for having me. It's been a lot of fun.

Ben:  Awesome, folks. Well, I'm Ben Greenfield along with Dr. Michael Ruscio signing out from BenGreenfieldFitness.com. Have an amazing week.

Want more? Go to BenGreenfieldFitness.com or you can subscribe to my information-packed and entertaining newsletter and click the link up on the right-hand side of that web page that says, “Ben recommends,” where you'll see a full list of everything I've ever recommended to enhance your body and your brain. Finally, to get your hands on all of the unique supplement formulations that I personally develop, you can visit the website of my company, Kion, at getK-I-O-N.com. That's getK-I-O-N.com.

These days, when people ask me what the #1 book I recommend for all things gut, it is, hands down “Healthy Gut, Healthy You” by Dr. Michael Ruscio. This book takes a deep dive into topics such as:

• How the gut works and its role in your body,
• Practical diet and lifestyle advice to support your gut health,
• Simple and actionable tools to repair your gut, and
• An innovative, user-friendly plan to heal, support, and revitalize your gut.

This is Dr. Ruscio's third appearance on the podcast.

The first one, titled Why Healthy People Get Broken Guts, And What You Can Do About It talked about why apparently healthy people, especially athletes and exercise enthusiasts, get broken guts, and what they can do about it.

Then, the second podcast, titled Good Carbs, Bad Carbs, High Carbs, Low Carbs & More: Clearing Up Carbohydrate Confusion, was an in-depth discussion on carbs and their effect on your body.

What will his third appearance on the podcast reveal???

Quite a bit, as you will hear.

About the guest:

Michael Ruscio is a doctor, clinical researcher and best-selling author whose practical ideas on healing chronic illness have made him an influential voice in functional and alternative medicine. His work has been published in peer-reviewed medical journals and he speaks at integrative medical conferences across the globe. Dr. Ruscio also runs an influential website and podcast at DrRuscio.com, as well as his clinical practice located in northern California.

During my discussion with Dr. Ruscio, you'll discover:

-What small intestinal bacterial overgrowth (SIBO) is…6:40

• Ruscio's interest in this goes back 5 years.
• Focused on improving the health of bacteria.
• Observations don't always translate into practical action inside a clinic.
• You differentiate the discrepancies when you separate the large and small intestine.
  • What's going on in the large intestine isn't indicative of the small.
  • A lot of “gut advice” is large intestine-centric.
  • Small intestine comprises 56% of gut activity.
    • Most prone to leaky gut
    • Most immuno active
    • Where 90% of calories are absorbed
  • Bacterial overgrowth is either an overgrowth of or the wrong type of bacteria in the small intestine
    • Not a parasite
    • Native to your system; either in the wrong place or too much of it.

-How SIBO affects the thyroid…12:33

• Many people who think they have a thyroid condition actually do not.
• 60% of people who were rechecked were found not to be hypothyroid.
• Symptoms of hypothyroidism can be mistaken for other problems in the GI tract.
• Study done on people with IBS (irritable bowel syndrome)
  • Higher incidence of fatigue, depression and anxiety found
  • They were not hypothyroid
• Another study looking at 1800 patients
  • Looking for drug use, medication use, prior intestinal surgery; expected these to increase risk of SIBO
  • Two most correlated conditions: being hypothyroid and being on thyroid medication.
  • 290 were taken off medication and retested; 60% were not hypothyroid
  • Neither antibodies, nor weight, nor time on medication dictated whether were hypo or normal thyroid.
• Speak with your doctor to confirm whether you're hypothyroid or not.
• Be wary if you were diagnosed by someone outside of conventional medicine.

-The testing and protocol for SIBO Dr. Ruscio recommends…22:15

• For testing thyroid: test TSH and Free T4
  • If within normal range, you likely don't have a thyroid problem.
• For SIBO, two practical options; breath tests.
  • One uses glucose, the other uses lactulose

-About the elemental diet. What it is and how it works…27:30

• Hypoallergenic, gut-healing meal replacement shake.
• Absorbs in the first part of small intestine
  • Rests the remainder of the small and large intestine
  • Starves overgrowth
• Not as difficult as it may sound.

-The African vs. the Westerner microbiota, and whether or not it's a good idea to try to mimic our ancestors…32:20

• Scientist Gives Himself Fecal Transplant To Try A Hunter-Gatherer's Microbiome
• Challenge lies in excising just one element out of an entire culture, and inserting it into a totally different population.
• Many African tribes have parasites in their bodies.
• Hard to replicate their diet because their bodies have adapted to their specific environment.

-What happened when the Sardinians tried to eliminate malaria…39:07

• Back in 1950's, Sardinia had a high rate of malaria; cases of MS skyrocketed.
• Sardinian immune system learned to function with malaria.
  • Once taken away, the immune system didn't know what to do. Created unforeseen adverse consequences.
• The malaria may have actually strengthened their immune systems.
• Article: Why Ben uses tapeworms and whipworms

-Why we should have more naturally occurring plant life around our home…43:05

-Dr. Ruscio's comments on probiotics…44:55

• Most probiotics do not colonize you.
• Can help reset the microbiota to a healthy equilibrium.
• Works in tandem with a healthy lifestyle.
• Think of it as a “nudge” to complement your lifestyle to reset to a healthy equilibrium
• Should kids use probiotics?
  • The earlier an antibiotic is used, the more detrimental; the earlier a probiotic is used, the more beneficial it is.
• Can probiotics “seed” the gut?
  • A lot of outlandish claims to market the product.
  • The more a product is marketed, the more claims are made about it. May be unsubstantiated.
• Ecoli used as a probiotic?

-Why we would be “surprised” about dietary fiber…56:30

• The amount of data Dr. Ruscio had to sort through almost made him quit writing his book.
• There have been no consistent benefits shown from high dietary fiber intake.
• Fiber enthusiasts cherry pick the data from which they make their claims to its efficacy.
• Carnivore diet: Results are varied on patients Dr. Ruscio has treated who have used it.
• Focus more on simplifying your diet. A “lazy” diet.

-Whether or not melatonin can help with leaky gut…1:03:37

• Focus on sleep quality.
• Use melatonin carefully, to supplement healthy lifestyle.

Resources from this episode:

-Dr. Ruscio's new book “Healthy Gut, Healthy You”

–Dr. Ruscio's website – use code BEN to get 15% discount on your purchase

–Thorne Mediclear SGS

–DirectLabs for SIBO testing (2-Hr Glucose/Lactulose)

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