IBS and SIBO Treatment Strategy (Interview with Dr. Ruscio)

Video Transcript

Introduction, Stress in IBS, and Relapse

Josh (00:04)

Hello everyone, this is Josh from survivor and super excited to be joined by Dr. Michael Ruscio. A little background on Dr. Ruscio, so a lot of you might know him. He’s pretty well known functional medicine practitioner online and in the gut health community. A little bit about his medical background. So He’s a functional medicine practitioner. He’s a lead researcher in a pending ibs study. He’s a post-doctoral continuing education provider. He has a doctor of chiropractic degree from the life chiropractic college west and his undergraduate degree was a bs in exercise kinesiology from the University of Massachusetts. So he has a wide background and just from reading his bio it seems like he came to kind of helping people with their health issues from a functional medicine perspective, just from his own personal health journey as well when conventional approaches didn’t work effectively.

Josh (01:12):

And a lot of times that’s what you see in some doctors and patients as well, they go down the conventional route and you know, they’re given things to try and just not working so they need to figure something else out. So I’m excited to talk to Dr. Ruscio about gut health, specifically SIBO and IBS and what people can think about and maybe talk to their doctor about if some of the conventional methods maybe aren’t working, what else they need to look at. So, first I want to talk to you about your experience dealing with patients that don’t respond to typical treatment approaches. Like I said, maybe they’ve tried diet, antimicrobials, and other treatments for IBS and SIBO but just aren’t getting better or maybe they’re relapsing. So I guess to start off with, what underlying issues or causes come to mind to investigate in patients who have IBS and/or SIBO and just aren’t getting better. And do you ever look outside of the gut?

Dr. Ruscio (02:19):

Yes. Sometimes we look outside of the gut. It’s not highly often that we’ll find something outside of the gut that’s manifesting as IBS or SIBO symptoms, but you will sometimes see stress… stress is one that you’ll occasionally see someone who is doing well and then all of a sudden they switched to night shift work or they’re going through a divorce or something changed at work or they had a child, I’m sorry, that’s just thrown a lot of stress onto their system and all of a sudden their GI regresses a little bit, and I should mention that sometimes when people regress, they start to freak out and I get it. It’s really unpleasant to not feel well, but I’m here trying to throw a lifeline to people and telling them that if you freak out, you’re not helping yourself. Right? Because it happens to the best of us.

Dr. Ruscio (03:21):

Even some of the most brilliant clinicians I know who know everything there is to know about gut health, have moments of relapse because we are human, right? So there’s, there’s this naturally expected kind of oscillation in how you’re feeling, so don’t freak out if you’re having a little bit of a downturn and sometimes what’s needed to get yourself out of that downturn is quite simply tightening back up what you’re doing. A little more rest, maybe a little bit less exercise. If you’re exercising a lot and not sleeping and under a lot of stress, some attempts at stress management. Maybe instead of exercising six days a week for an hour, now you’re going to take a walk in nature or with a friend and just kinda talk and vent about whatever it was bugging you and get that time to be in nature and have some social activity a few days a week.

Dr. Ruscio (04:07): 

So sometimes the solutions aren’t that difficult. Occasionally you’ll see something like. There was one, one case I’ve talked about before of reflux and the reflux we got under control, but they got gerbils for their daughter and the mother actually was allergic to gerbils and it was predominantly manifesting as reflux in her case. And so this ties in with histamine and histamine signaling and how histamine effects stomach acid. So in this case, unfortunately they had to get rid of the gerbils and once they got rid of the gerbils, the, the environmental insult, then the, you know, recurrence of the reflux went away. So sometimes the solutions are nothing to really be alarmed about, okay. Especially if it’s something due to environmental or lifestyle stress and just try to remedy that stress as best you can and understand that these regressions are sometimes normal and part of the game and freaking out and falling into this pool of despair isn’t, isn’t going to help you.

Dr. Ruscio (05:13):

Right? And I understand how sometimes it can be easy to fall into that pool because you go on the Internet and you read, Oh, SIBO is a chronic relapsing condition. You read these, you know, very negatively painted prognosis, which I don’t agree with by the way. And it’s easy to kind of fall into that. But what I would offer people is that it’s okay to have a relapse. Now there are also sometimes things that you can do, for example, if you found the line of therapy that’s worked for you in the past, then sometimes all that’s needed is a brief touch of that therapy. Again in the future, and again, I know that may sound kind of obvious, but for some patients they get really distraught when they have a relapse and I think that something is wrong or broken and the analogy I often use is if you sprained your knee really bad in college, every once in a while that knee may shift and the muscles around it may shift out of balance and so you may have to do some corrective exercises and some stretches and some foam rolling to get yourself back to balance.

Dr. Ruscio (06:16):

Would that mean, oh my. You know, my knee has this big issue with this, this smoldering chronic, underlying esoteric thing. I can’t figure out. No, you had an injury and sometimes that joint is gonna need a little tlc. If your gut got a little bit inflamed every once in a while, your gut may need a little tlc, and that doesn’t mean that there’s necessarily any huge underlying problematic factor. There are some other things to consider too, like anemias and hypothyroidism, although you have to be very careful with hypothyroidism because to be quite honest, it’s a highly marketable condition. So everyone in functional medicine who is trying to build a practice is marketing about thyroid and what ends up happening is you have these way over inflated claims about thyroid that simply aren’t true. I don’t think any of the practitioners are doing this with a maniacal intent, but the functional medicine community is too overzealous with treatment it’s too marketable. Um, and so it leads to unfortunately this, this ethos where many people are made to or led to believe they have a thyroid problem and they actually don’t. But if you do have true hypothyroidism, then addressing that can be helpful. So those are a couple things that come to mind in terms of if people are relapsing, where they may want to start with trying to turn the ship.

Josh (07:37)

You do see though that, you know, like everything, right, stress does play a role in the function of the gut. Right? So it’s important for people to minimize stress.

Dr. Ruscio (07:48):

Yep. And I mean that’s been documented and we know that stress can provocate ibs, irritable bowel, gas, bloating, abdominal pain, altered bowel function, ibd, or more loosely term just functional gastrointestinal disorders. So yes, we also know that stress, for example, one study has shown that college students under pre-exam stress show a skewing of their Microbiota, um, those who exercise too much tend to have immunosuppression and more of a tendency toward overgrowth and infection. So yes, stress and its multitude of forms can negatively impact your gut.

Thyroid Issues vs Functional Thyroid Issues

Josh (08:24):

I guess my other question kind of coming off of that is do you ever see a link between a hormonal issue or something in the endocrine system that can be causing the chronic fatigue or something to that degree?

Dr. Ruscio (08:41)

Well, thyroid is one that would come to mind in that case. And this is where having a fairly standard evaluation for a thyroid problem, and I want to touch on female hormones also, but just really quick in the thyroid, you know, you want to know as a patient, are you truly hypothyroid or do you have some kind of functional imbalance in your thyroid hormones. The functional imbalance typically means that nothing is wrong with the thyroid. You’ve got to clean up stress and inflammation somewhere else in the body. Oftentimes the gut, so it means nothing’s wrong with the thyroid. Even though some thyroid markers may skew the source, the problem isn’t the thyroid, it means the thyroid glands making hormone just fine, but when that hormone gets out into circulation because there’s inflammation, the hormones aren’t working properly, so that can be called a thyroid problem, but it’s really not a thyroid problem or the gland that makes the hormone is just fine. It’s just in the periphery of the body where the hormones are metabolized. If there’s inflammation present, their metabolism is thwarted, so it’s. It’s important to delineate the difference because one, if you’re truly hyperthyroid, usually requires thyroid medication. The other usually requires cleaning up and inflammatory or stress issue oftentimes, but not always coming from the gut.

Josh (10:00):

So in that case where you’re talking about the inflammation coming from the gut, right, so that would be more of a case where maybe the gut would be kind of causing the issues, right. Instead of the thyroid having actual production issues which are causing the problem.

Dr. Ruscio (10:15):

Precisely, precisely so you can have thyroid symptoms that are ultimately being driven by a problem in the gut and and we’ve on our website, published a number of case studies where patients have come in thinking that they have a thyroid problem on thyroid medication and and they need to do the more involved thyroid assessment or be in a different, better form of thyroid medication, which I’m open to, but we took some time to clean up their digestive health and I believe that we’ve documented at least two, maybe three cases where people have been able to reduce their thyroid medication at the same time, have better fatigue, better body composition, joint pain and digestive symptoms because we got rid of the insult to the gut that was thwarting their absorption of the medication firstly and then secondly diminishing their ability to effectively metabolize that medication and once it got into their system, so yes, it is possible to have thyroid symptoms.

Dr. Ruscio (11:19):

Again, these are very broad and nonspecific anyway. That may ultimately come down to a thyroid problem and if someone is truly hypothyroid, that’s fairly easily sussed out looking at the conventional ranges. Conventional ranges for TSH and T4 if TSH is high paired with a low t4, then you’re hyporthyroid. If that’s not there, then the problem is likely somewhere else and there’s also female hormones which you do see a fair number of cases where the female hormones seem to be a bit imbalanced, and this is why in my book, even though the book was all about gut health, there was one break off section about the female hormone gut connection because I’ve seen a number of females that their digestion and their female hormones both go south and when you support the gut and give the female hormones a gentle push with some herbal medicines than everything tends to respond together really nicely and we do know that female hormones do affect motility in the gut and there’s a fair number of progesterone receptors in the colon and that may be one reason that someone would have constipation and it’s definitely something that is easily observable.

Dr. Ruscio (12:31)

If you notice that your digestive symptoms get worse, you know when, when you’re in the premenstrual time of your cycle. So there’s definitely that connection there also.

Josh (12:40)

Awesome. So I’m just curious, just since you mentioned it, your book is called? Healthy Gut. Healthy, gut healthy you. Awesome. I actually haven’t read it yet. I’m going to read it soon. So, uh, next, next question here. Just continuing on kind of, you know, maybe someone’s tried the conventional therapies, right? And they are looking for other things to help them along the healing journey. So what other tools or you know, type of treatment options have you found helpful when normal methods aren’t working?

SIBO and IBS Treatment Strategy Foundation

Dr. Ruscio (13:15):

You know, one of the things that I’ve found that might sound basic, but you know, as someone who sees quite a number of my patients who have seen a few conventional doctors and a few alternative doctors and still haven’t gotten to where they want to be, you know, I, I can say that sometimes the solution to these problems is not something exotic. Rather just revisiting, well firstly, understanding what the tried and true therapies are and then knowing how to apply them in the correct fashion for a patient. And so sometimes what people do is they start with the therapy that has all the craze about it on the Internet and they’re putting the last treatment first in the hierarchy. And they’re not succeeding because of that. Right? And to use a trite example, if you build your roof before you build your foundation, what kind of house would you have?

Dr. Ruscio(14:09):

Right? So sometimes getting the sequencing correct is literally the difference between success and failure. And, and so we want to start with a foundation of diet and lifestyle. And I outlined this all in the book. Again, we want to start with the foundation of Diet and lifestyle. Now, the lifestyle piece, not that hard. Most people have heard of the main tenants of a healthy lifestyle. The Diet might be a little bit less clear cut. Uh, you have a few options. I’m sure you’ve probably discussed these. You have Paleo, you have autoimmune escalation, autoimmune Paleo, and the other track you have low fodmap, and then perhaps what I call a Paleo low fodmap. And then maybe at the apex, you have kind of a combination of both of these tracks, which is your low fodmap with Scd Diet. And you know that, that sounds maybe like a lot, but you really only need two, maybe three weeks to evaluate if the diet is helping.

Dr. Ruscio (15:05):

It’s not to say that diet will produce all of the potential impact in two to three weeks, but after two to three weeks you should be able to say, yes, I’m clearly feeling improved or no, I don’t really feel any better. If you don’t feel any better, move on to the next diet. If you move at that cadence, then you can run through all the major available diets I just outlined in a number of weeks and figure out what diet might be best for you, and then from there you move onto kind of the second, I always picture in my mind kind of this pyramid model and so we started the foundation and then we build upon that and then we build upon that and you keep building until you get someone to the level of improvement that they’re looking to effectuate. There’s one other dietary twist I should mention you guys have probably talked about, which is the low histamine diet and low histamine can be helpful for some of those cases that they really haven’t seen the traction with any of the other diets. Researching dietary histamine can also be very helpful and with all these diets, there’s good news in that you don’t have to be on them forever. Typically people are able to reintroduce and broaden their diet after a number of weeks or months on the Diet plus or minus perhaps some other therapies to, to continue the gut healing, but the longer term objectives should be and you should be able to get to a point where you’re expanding your diet.

Josh (16:30):

Gotcha. So, um, it’s really important to, like you’re saying, to build that foundation. Right? And you’re saying, do you see in a lot of patients that, you know, diet is very individualized or maybe they will have to test, two or three different diets and you know, kind of come up with a range of foods that are healthy that suit them. Is that what you see a lot?

Dr. Ruscio (16:49):

Yeah. It’s, it’s very individualized. I think that that’s one thing that trips people up is they’re so focused on the rules of a given diet they’ve been told to do or think they should do that. They start following at the exclusion of looking to their own experience and their own reactions or lack thereof, and these diets are just navigating pillars to help you run through, okay, I’m going to focus on this group of foods and see how that goes and I’ll probably learn from doing that. There’s a number of foods that I’m fine with, but a few triggers I’ve identified. Great, take that move forward. You don’t have to continue doing that diet and the next diet and the next diet, but you want to use each diet to help you identify what your triggers are so you can then create customized plan quite simply just eating the things that don’t bother you and being careful with the things that do bother you.

Dr. Ruscio (17:47 ): 

And so sometimes it’s just the ability to be okay with violating one diets rules because they’re going to another or kind of hybridizing them is totally fine. Uh, and then there’s one important kind of backdrop there, which is if you’ve done a decent shake with these diets and you still don’t feel like you’re where you want to be, then we have to intervene further. And so we don’t want to wallow in diet for too long because sometimes there’s a non dietary solution that needs to be initiated or implemented. So we want to give diet, it’s shake, but if we’re not where we want to be, then we fairly quickly moved to other therapies.

Josh(18:22):

Gotcha. So after the foundational diet and lifestyle is really the foundation of all treatment right? And then what’s kind of, what are the next steps above is that when you get more into the, you know, the antimicrobials or the elemental diet and things like that?

Probiotics for SIBO Treatment

Dr. Ruscio(18:39):

Well, you know, I think that unfortunately, probiotics have not been given they’re just deserves and we’ve in our clinicians newsletter have published three cases where a patient with IBS and kind of a confection of symptoms because you typically will see, let’s say loose stools, abdominal pain paired with fatigue and joint pain. Very rarely is it just digestive symptoms, but you have this, this confection of of different symptoms and what I had been doing for awhile was on day one having them test and then immediately after they collected their tests and while we’re waiting for the results, they would then go on a probiotic protocol and I break all probiotics down into three categories, so I gave them one formula for each category, so they have a nice broad probiotic stimulus, which by the way are powerful antimicrobials. Probiotics, ironically, and when we saw the patient back anywhere from four to six weeks later, we found in all these cases, some type of dysbiosis, whether it was SIBO or Candida or Sibo and Candida or blasto or blasto and h pylori, whatever it was, all their symptoms were now gone after being on the probiotic protocol for a month.

Dr. Ruscio(20:07):

Making the lab results kind of obsolete and making the need for direct antimicrobial therapy obsolete. So, you know, I do think unfortunately the, the probiotics are being overlooked and I think some of that comes from a community I love very much the SIBO community that you know, there’s, I think there’s some realms of opinion in the SIBO of community that would have one believe that no one with SIBO should use a probiotic even though that is a direct contradiction to what the best evidence tells us. There’s a number of clinical trials showing that probiotics can combat SIBO. In fact, one novel trial showing that if you take two groups of patients, they all have ibs, one has ibs and Sibo. One has ibs without SIBO. It’s a group with ibs and SIBO that sees the better results from probiotics compared to the other group, so you know where, where the thinking that you shouldn’t use probiotics if you have SIBO comes from is beyond me.

Dr. Ruscio (21:14):

Now, does that mean that everyone with SIBO will respond well to probiotics? No. No one will respond well to probiotics you see, positive or negative. That’s not the point. The point is leaving out or not leaving out a therapy that can be very helpful for SIBO because it theoretically, it doesn’t make sense. Meaning, why would you give bacteria in the syndrome with too much bacteria to begin with? Well, because these bacteria, these probiotics actually function quite antibacterially. Um, so, probiotics is one important piece to make sure that you’ve tried, um, a category, what I call one, two and three, a lactobacillus bifidobacterium blend predominated probiotic, a saccharomyces Boulardii probiotic, and the soil based probiotic and outline all these specifics. I’m not sure if you want me to refer to the book or not, but I’m just trying to steer people going through it kind of fast here.

Dr. Ruscio (22:14)

But if you want to know what the exact formulas are and what the dose and the duration all that’s outlined in the book, I’m just trying to run through this from high level so people know what hook to grab if, depending on where they are in the process.

Josh(22:27)

So I guess one question going off of that, about the probiotics is do you recommend any specific strains or is it just mainly one from each category to try?

Dr. Ruscio (22:39):

And that’s also another great question. Um, and, and one of the things that you’ll see is that there are, so there, there’s a study on one probiotic formula and then the manufacturer of that probiotic tells you why that’s the best probiotic, but they’re leaving out that other similar probiotics have shown similar effects, right? And, and so, and in part I get it right.

Dr. Ruscio(23:05):

These supplement companies are trying to generate sales and that’s fine because probiotics are getting way better and way more affordable and so it’s okay to be a business trying to generate sales, trying to bring up the quality and down the cost. There’s nothing wrong kind of that, that capitalistic driver of a supplement company. But what becomes challenging is when you as a consumer are using all this info marketing to inform what probiotics you use, right? And so it’s kind of silly to get your education from the company who’s making the product. Right? Um, so what I found to be helpful for people is going through an intermediary, like some kind of healthcare professional to help you navigate and parse through what the research shows. What the research shows is that these probiotics, different formulas all tend to perform pretty well. Um, so I think it’s a mistake to say one formula is vastly better than the other, but you do see this trend emerge where you know, there’s a handful of lactobacillus and bifidobacterium formulas that you want to make sure to include in your category one probiotic.

Dr. Ruscio (24:18):

And then category two, saccharomyces Boulardii is just saccharomyces Boulardii. And then category three, the soil based probiotic, there is maybe, you know, two to five different strains of the species you want to make sure are utilized in that formula. So, you know, there’s a number of products for each one, and in the book, I lay out the ones that, that I use and that I like, um, but the more important thing, and I think where we lose people, is if they don’t understand the category system, they ended up trying a category one probiotic called, you know, gut healer five. And that gives them, you know okay results. Then they try another probiotic called healing probiotic seven. It’s the same exact category and have the same results and then you go to another probiotic with a different name, so all the while they’re trying different formulas of the same category, never trying a category two and category three, so understand the category system. You can try one formulation with category one, see how you do either keep it in your regimen or get rid of it if you have a negative reaction, move on to category to potentially keep it and then build yourself a personalized probiotic protocol and it’s either one or a combination of the three categories.

Josh (25:29):

Gotcha. Last question about the probiotics. Do you see patients that do bad with probiotics? What are the signs someone should know if probiotics aren’t right for them at that time?

Dr. Ruscio (25:47)

Well, what you’re looking for is any kind of negative symptom that occurs proximal to when you start taking the probiotic formula. It’s not to say there’s one symptom that denotes this, some people might get constipated, some people might have loose stool, some people might have abdominal pain, some people may notice that they have some reflux, some people may notice that their histamine symptoms are getting worse, meaning their, their brain foggy and irritable. So it’s not to say that there’s one symptom, but if you see the symptom occur proximal to when you started taking the probiotic, then that tells you that that obviously the probiotic is a source of the problem. Now you want to give yourself three, four, five days before you fully make that adjudication because you can have a little bit of turbulence at first. That’s transient, that’s not abnormal, right?

Dr. Ruscio (26:37):

This is sometimes termed as a die off, so you don’t want to rush to drawing that conclusion. You want to give it three to five days and if you’re someone who’s highly sensitive, I would start the probiotics one at a time. You know every three to five days or so, you start on one fully run that course until you can say it’s helping or it’s causing a negative reaction. If it’s causing a negative reaction, wait a few days until you feel like you’re back to baseline and then add in the next one and if you do it that way, it’s very easy to see where benefits are coming from, where reactions are coming from and proceeding accordingly, and that’s actually another important tenant in functional medicine, which is simplifying your treatment because it and especially if you’re a sensitive patient, if you do too much, if you do multiple lines of therapy at once and there’s a reaction, very hard to know where the reaction is coming from. Very hard to learn from that negative reaction. If you’re doing things one thing at a time, you can figure out what works. Learn from that, what causes reactions, learn from that and learn someone’s system in a stepwise fashion. So it’s a little bit more of a tortoise approach than it is the hair, but you know, we all know what happens at the end of the tourist ends up winning with the slowest approach.

Josh (27:49)

Yeah. So you want to basically want to conduct it like a science experiment and control the variables that you can find out results based on one variable. So I guess lastly, kind of just to finish off the, you know, the pyramid, what are the last stages? The foundation is diet and lifestyle then you get to probiotics and then what’s after that? The last things that you usually test or tweak.

SIBO Treatment Strategies After the Foundation

Dr. Ruscio(28:17)

So there’s a few other things to escalate through. Antimicrobials are one and a few thoughts regarding antimicrobials. If you’re new to antimicrobials then I would just run an antimicrobial protocol. We have one that what we call for in the book, which is essentially two formulas for the first month we switched it to different formulas in the second month, and for many people that’s going to be helpful. Now, for some people that will only be partially helpful or they will notice they regress right when they come off of the antimicrobials, and so in that case you can then do another round of antimicrobials, but escalate to the addition of antibiofilm agents. Now antibiofilm agents with SIBO, there’s no documentation other than one retrospective chart review that we performed at our office. So we were able for the first time ever to document that the administration of antibiofilm agents, which help break down this coating over SIBO and other bacteria and fungus, the co administration of antibioflim agents that breakdown that film along with the antimicrobials had better efficacy than just antimicrobials alone.

Dr. Ruscio (29:23):

Now that’s just one study, but you know, we weren’t able to show a statistically significant impact from, from doing that. Um, and also some people semi habitually notice that when they come off antimicrobials, they regress. And I think for those people they need to revert to a lower dose, longer term kind of tale of antimicrobials. And there’s controversy about that. Some, some providers think that when that occurs there must be a motility issue present and you’d have to go hard into motility. I am open to that, but I have not been impressed with, um, other than a small number of cases, the utility of aggressive post antimicrobial prokinetic therapy when compared to a low dose antimicrobial therapy, uh, and the stronger you get with the prokinetics, I mean the potential more side effects there may be, although I do think prucalopride or Aka resolor is a fairly safe drug with a fairly minimal side effect profile.

Dr. Ruscio (30:33):

Um, if I look at that drug compared to two pearls of Oregano oil per day, I’d rather have someone on two pearls of Oregano oil per day rather than having them on a prokinetic. I’m open on both, um, but my, my kind of no bs candid take here is that one of the preeminent researchers in SIBO, very smart gentleman who I respect and appreciate his work very much. He’s also a motility researcher. So I think it kind of skews the narrative to be very centered around motility, which again, it’s not to say it’s right or wrong, but I think because he operates in that, in that motility vertical, that you see much more the recognition skewed around motility, which I think is probably the issue for much less people than we’ve been led to believe. And I’ve been testing that theory in clinic and it seems to me that patients do really well with just a simple tale of low dose herbal antimicrobials.

Elemental Diet for SIBO and IBS

Dr. Ruscio (31:35):

We are trying to do a study looking at herbal prokinetics in the prevention of SIBO recurrence. We hit a few roadblocks in being able to get that off the ground, but we are dangerously close to starting that at our office soon. And um, I’ll be very curious to see what we show. And another strategy that can be used is also an elemental diet. Um, and just briefly on the elemental diet, I also expound upon this in the book. You don’t have to only use the elemental diet in a two to three-week exclusive application as it’s been discussed for SIBO. Um, now why I think you get that narrative on the Internet is because in the one study in SIBO, it was used for two weeks plus. Okay, great. Um, but in the, in the wealth of studies looking at this for inflammatory bowel disease, there’s a much more kind of liberal use and even something known as the hybrid application, which we also detail in the book, which is essentially you do your short course of exclusive elemental anywhere from two to four days up to two to three weeks.

Dr. Ruscio (32:41):

And then once you’re feeling better and you’re ready to get back on whole foods then transition to a hybrid approach where you can use the elemental meal replacement shakes for roughly half your calories in the day and then have the other half from whole foods. And for some people this gives them a nice kind of break for their digestion while they’re having a liquid meal. And then they have some whole foods. And if you think about it, this shouldn’t sound like a foreign concept, how many people wake up in the morning and they have a smoothie on the way out the door, right? So we’re essentially doing that same thing. It’s not like this is some weird quirky concept. Many people have a quick liquid breakfast in this case with the elemental formulas. These are just hypoallergenic formulas that are also very gut friendly and the newer crop of elemental formulas of which we’ve actually released one that I’m very proud of, are very, very palatable. So don’t get pushed off the recommendation because someone told you that they taste really bad. That’s true for the older versions, but the newer versions are actually quite easy to take.

Josh (33:46)

Yeah, that’s a great point because I’ve even used that strategy myself a little bit just because you know, stuff flares up or anything. That’s one of the easiest ways to kind of get back on track was just allow your gut some rest and give it some time to recover. Um, awesome. So I think that’s a good point to wrap it up on a ton of great information. And I think my audience can learn from, um, lastly. So, your website is Dr Ruscio.com. Correct. And then, what’s, what’s the name of your book again?

Where to Find Dr. Ruscio’s Resources

Dr. Ruscio(34:20):

The book is healthy gut, healthy you. It’s available on Amazon both as paperback and kindle and then yes, the websites is DrRuscio.com.

Josh (34:30):

Awesome. And then the elemental diet supplement that you created?

Dr. Ruscio (34:35):

That’s called Elemental Heal.

Josh (34:37):

Awesome. Cool. Well thanks so much for joining me Dr. Ruscio and really appreciate you coming on to share your knowledge.

Dr. Ruscio(34:43)

Definitely, it’s been a pleasure thanks for having me.

SIBO Treatment Interview Summary

  • Stress can be a major factor in the healing journey for people with IBS and/or SIBO
  • We are all human and our symptoms will fluctuate throughout time
  • It’s OK to have a relapse. Sometimes all that’s needed in a relapse is to tighten things back up a bit with diet and stress management
  • There’s a difference between being truly hypothyroid and having a functional imbalance in your thyroid hormones. Functional imbalance usually means nothing is wrong with the thyroid production but that inflammation in the body can be thwarting thyroid metabolism. For a functional imbalance, this means cleaning up inflammation in the body while a true thyroid issue requires medication
  • If someone is truly hypothyroid you can determine this looking at the conventional ranges. If TSH is high paired with low T4 then you are hypothyroid
  • If you’re a female and digestive symptoms get worse in the premenstrual section of your cycle this could mean a hormonal issue
  • Understanding the tried and true therapies and implementing them in the correct sequence can be the difference between success and failure. Build a strong foundation with diet and lifestyle then move to more targeted therapies.
  • 2-3 weeks of diet implementation should give you good feedback
  • You don’t have to be on a strict version of a diet forever. The longer-term objective is to expand your diet
  • Probiotics have been overlooked. They are a recommended treatment option to try before antimicrobials in people with IBS and/or SIBO. Probiotics can function as powerful antimicrobials. Dr. Ruscio recommends trying a probiotic from 3 different categories: (1)Lactobacillus and Bifidobacterium blend, (2) Saccharomyces boulardii, and (3) a soil-based probiotic
  • Start a probiotic alone for 3-5 days and monitor
  • Take a slower and more scientific approach to treatment testing each variable one at a time while listening to your body for reactions
  • Sometimes a low-dose antimicrobial regimen for a longer time can be a good option for people who relapse quickly after therapy
  • An elemental diet can be used as a hybrid approach using elemental shakes along with whole foods