The Natural Evolution Podcast

Season 2

Episode 31

S2E31 – Finding Balance & Understanding Overtesting within Functional Medicine with Dr. Michael Ruscio

Dr. Michael Ruscio is an experienced doctor, clinical researcher, and author in the field of functional and integrative medicine. His mission is to take a progressive but cautious approach to healing while also keeping in mind the important factors of cost and practicality by providing people with a reasonable voice backed up by provable research sources, clinical trials, databases, and case studies.

In this episode, Dr. Michael Ruscio discusses the common misunderstandings surrounding lab testing, how overtesting in functional medicine can harm health outcomes, and the ins and outs of genetic testing. By the end, Dr. Ruscio is able to provide a clearer picture of which lab tests are helpful and which are ineffective at giving you the information you need.

If you’re a patient, interested in working with Dr. Ruscio, learn more here.

If you’re a practitioner, interested in the future of functional medicine review, learn more here.

Or follow him on Instagram, Twitter, Facebook and Youtube.

Head over to https://rebelhealthtribe.com/kit to get a free download of our loaded quick start guide to help you along your healing journey.  If you like us, subscribe, review, and share us with your friends, and come join our Rebel Health Tribe group on Facebook.

Listen to Episode #31

Dr. Michael Ruscio discusses the common misunderstandings surrounding lab testing, how overtesting in functional medicine can harm health outcomes, and the ins and outs of genetic testing. By the end, Dr. Ruscio is able to provide a clearer picture of which lab tests are helpful and which are not.
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About our Guest

Michael Ruscio is a doctor, clinical researcher, and author working fervently to reform and improve the fields of functional and integrative medicine. With his clinical and research teams, he scours existing studies to inform his ongoing clinical research, patient care, and guidance for health seekers and fellow clinicians around the world.

His primary focus is digestive health and its impact on other facets of health, including energy, sleep, mood, thyroid function and optimization.

Dr Ruscio’s research has been published in peer-reviewed medical journals, and he speaks at integrative medical conferences across the globe. While actively seeing patients in his clinic, he also runs an influential blog and podcast, as well as a newsletter for functional medicine practitioners.

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Dr. Michael Ruscio

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Podcast Transcript

Michael Roesslein: And we’re live. I’m excited for this one. This is somebody I’ve wanted to talk to and chat with for a long time. I admire your work and it never worked out. And here we are. So I’m excited. I’m here today with Dr. Michael Ruscio. Welcome Dr. Ruscio.

Dr. Michael Ruscio:

Thank you. Yeah, it’s great to be here.

Michael Roesslein:

Yeah, it’s going to be fun. Our audience is probably pretty well versed on you and your work. They are self-proclaimed gut nerds and microbiome nerds and you’ve been in that space talking about that stuff for quite a while. So I’m guessing most everybody listening to this is going to be somewhat familiar with your writing and your website and your blog and all the teaching and everything that you do. But for those who don’t, we’ll get a quick intro out of the way and then we’ll jump in. We’re going to talk about a bit of a different subject today than I think anyone’s ever covered in any interview I’ve ever done. So it will be fun.

But Dr. Michael Ruscio is a doctor, clinical researcher and author working fervently to reform and improve the fields of functional and integrative medicine. With his clinical and research teams, he scours existing studies to inform his ongoing clinical research, patient care and guidance for health seekers and fellow clinicians around the world. His primary focus is on digestive health and its impact on other facets of health, including energy, sleep, mood, and thyroid function and optimization. I actually was watching one of your videos the other day on male health and probiotics, some stuff I hadn’t seen before. Dr. Ruscio’s research has been published in peer-reviewed medical journals, and he speaks at integrative medical conferences across the globe. While he’s actively seeing patients in his clinic, he also runs an influential blog and podcast as well as a newsletter for functional medicine practitioners. And I’m sure there’s plenty that was left off here, because you’re a very busy man. So thanks for making the time to chat. Thanks for doing all that work.

Today we’re going to talk about lab testing and how in the functional medicine world it’s, I think a lot of people think more testing is better. The more labs I run on myself, the better, the more information… And practitioners too, if you’re listening too. If I run these 12 tests, it’s way better off than if I run these four tests because then I’ll get the whole picture of information, I’ll know everything. What’s the problem there and why might that be a little bit misguided of a stand?

Dr. Michael Ruscio:

Well, first let me say that this is something that I embodied for many years, especially early in my practice. You go to all the seminars, you learn all the stuff and you practice the model. But if you look closely, many of the seminars are funded by either supplement companies or lab companies. So we start seeing a little bit of the sketching in the background in terms of how we end up at the current state of affairs, which is that I think we could safely claim more than half of the tests used in functional and integrative medicine have not been validated and therefore, are inaccurate. And when we understand that, we realize that a test, I don’t want to say it’s useless, but it’s pretty close to useless. If a test has not been validated and you’re treating that test, you might as well just flip a coin and decide what am I going to do?

And the one example, not to come out of the gate too hot here, but uBiome, for years, patients came in with this microbiota mapping test, uBiome, “Doc, what do I do about uBiome? These populations are low, these populations are high.” My answer was always very tactful and academic. Well, this has not been validated for clinical use. It’s useful for research purposes, but you should not be making any clinical recommendations based upon this test. Comes out later, after they’re shut down by the FBI for insurance billing fraud, that they literally used dog poop to help establish the normative ranges for humans. So the test was literally dog shit. And what’s so upsetting about that is I knew this. I steer patients off of this path onto a better path using validated tests or, God forbid, using clinical trials that tell us how to treat people instead of treat numbers, and this has worked very, very well.

So this is just one example of a litany of tests that are not accurate. And it’s crucially important we understand that just because you see a high or a low or a green or a red does not mean that means anything. And again, over half the tests we could roughly estimate in functional medicine are not validated. And if you treat those labs, you will get worse results. And if you can only treat the select few labs that are validated and then make the core of your model about treating the person, who are you, what’s your family history, how did your symptoms evolve, what are they, what have you done in the past, what’s worked, what hasn’t worked, all this patient-centric information, that’s when we can really start moving the needle and helping people at less cost and in less time.

Michael Roesslein:

I think less cost and less time is something that most everyone could get on board with. It’s almost blasphemy in the functional medicine space to be saying less testing. And I did get, I remember the uBiome stuff, people asked us about it all the time. About five years ago too, it was like the hottest thing, “What do I do with this number?” And I wasn’t quite as tactful as you a lot of the time. And I was like, “Probably throw it in the trash.” You keep saying validated, what does that mean? Just for the laypersons out there that aren’t part of the lab world. What does validated mean and who validates what?

Dr. Michael Ruscio:

It means that a test can successfully discriminate between some sort of disease cohort and healthy controls. Said another way, if you have a test and a bunch of healthy people are positive for the thing, then that’s not a very good test. If 80% of people who are healthy are positive for dysbiosis and 87% of people with IBS or flagrant GI symptoms are also positive for dysbiosis, then your dysbiosis test isn’t telling you anything valid. Because if healthy people look about the same as sick people, then what is that test telling you? It’s almost like an accountant who says a millionaire and a guy who’s broke has the same amount of money in the bank after he does his P&L for his business. It’s like, well then you’re a crappy accountant because one of these people is wealthy, meaning they’re healthy, one person is broke or sick. And if your calculator can’t distinguish between the two, why in the world would you ever use that calculator. Similar concept for validated versus non-validated testing.

Michael Roesslein:

Okay. That makes sense. I’ve run into that quite a bit too, of people saying like, “I don’t feel any symptoms or anything, but I got this lab test and it looks terrible. So I feel like I should be taking actions on this.” And so you’re saying it’s actually quite possible that if they start taking actions on those lab tests, they might end up feeling worse than they did when they went into the testing.

Dr. Michael Ruscio:

And IBS, and those with digestive symptoms, is such a hallmark example because what you’ll see oftentimes is low diversity or low scores on certain bacteria. And that leads to the erroneous next conclusion, which is, well, you need more fiber, more prebiotics, supplement with prebiotics. And this has been shown to flare individuals who have sensitive digestion. Yes, there’s some evidence showing that if you’re eating a low fiber standard American diet and getting to a normal level of fiber intake will help you. And there’s some evidence showing that prebiotic supplements can help. But there’s a more general churn trend, especially for this population that’s very educated and probably on a good diet baseline, that if you have low diversity scores, and you have symptoms, gas, bloating, abdominal pain, indigestion, you run the risk of flaring yourself if you eat much higher fiber or take a much higher intake of supplemental prebiotics.

So this is one example of where the test literally leads you in the wrong direction and can make people worse. And we would see this and we still do all the time into clinic. Someone does one of these tests, has low diversity and then they try to force feed themselves more fiber or more prebiotics. They flare and get worse. They come in the clinic. Have you seen all the literature that shows the opposite of this? Something like a low FODMAP diet can improve your symptoms and that the higher fiber and the higher prebiotic diet is more likely to flare you. And you went and you saw a doctor, did a test, got worse, spent, depending on how many tests you did, maybe thousands of dollars and you wasted six months. We could turn that for you, in a lot of cases, around instantaneously, without even running one test, just saying, what are your symptoms?

Okay. We know for people presenting with these symptoms, these things work. Let’s do that first, no need to try to quantify it with three grand worth of lab testing. It’s getting insane. I try to be a thoughtful and tactful scientist, but it’s gotten so bad now. So much of our clinical practice is just this and it doesn’t need to happen. So that’s why I’m passionate about it because people, they get worse. They spend money, and sorry I don’t mean to monologue here, but they then start thinking, I’m really sick because I treated a test and I got worse. This must be worse than I thought it was.” And it fuels this unhealthy psychology. And so I just feel so bad for the people that are subjected to this because it’s a negative from a health perspective, from a mental health perspective and from a financial health perspective, if it’s done the wrong way.

Michael Roesslein:

Yeah. It’s not cheap. I haven’t worked one on one with clients. I did a lot of functional health coaching and I was able to run labs and things. I haven’t done that in about four years, five years. But I know in the four or five years since I stopped, I get an email about once every month or two, of somebody asking me about some new test they just learned about at this conference or at this thing or on this podcast and what I think about it, whatever. And I can’t even keep up with all of it actually.

Dr. Michael Ruscio:

It’s a business. It’s a lucrative business for labs.

Michael Roesslein:

It’s true. And you mentioned insurance fraud, especially if they can get their hooks into that world and start getting the insurance to pay for some of them.

Dr. Michael Ruscio:

And if these labs can successfully educate patients to ask their doctor for the tests, then this is putting pressure on the doctors from the patients. So it’s really important. I think for patients to understand this too. You want to find a doctor who seems well educated and reasonable, and anything north of $1,000 of lab testing out of the gate, with perhaps some exceptions, it’s not an absolute rule, but that would be a partial red flag.

And then patients have to do a better job of being scrupulous and not taking labs word for it. I think this was built upon your definition of healthcare 20 or 30 years ago, where your conventional medical doctor would be very in the box. And okay, you can criticize them for not ordering a lot of tests. And maybe sometimes that feels lack cluster. But the other side of that was the tests they were using oftentimes, had good validity. So there was a lot of trust, I’m diabetic, I’m hypothyroid, I’m anemic. And that trust has been carried over to all these other tests that haven’t done the scientific validation to have earned that trust.

Michael Roesslein:

That makes sense. And that sounds actually like the strategy of another industry I’m aware of who markets directly to the consumer to try to pressure the doctors, to use certain things in their practice.

Dr. Michael Ruscio:

Exactly.

Michael Roesslein:

And the people who are more on the functional side, both the laypersons and the practitioners, they rail against that. And it’s not really that much different. I guess it’s really not that much different. And it’s like something I didn’t realize here is that, I just moved to Europe for those that are listening, and there’s rules around marketing here in commercials. Drug companies don’t have commercials on TV here. And, in a lot of European countries, marketing that is deemed to be geared directly towards children is not allowed on TV. And so that reminds me of kids breakfast. I remember growing up and you get those commercials and the toy or the gizmo in the box. And you’re like, “I need that box of sugar.” And then you get the box, dig the arm in there to get the thing. And then you have to eat the cereal because it’s there.

Dr. Michael Ruscio:

Absolutely.

Michael Roesslein:

But marketing straight to the kids to bypass the parents, to get the kids to pressure the parents is the same as… This is not a new tactic.

Dr. Michael Ruscio:

It’s effective. Yeah, it’s effective and that’s why it keeps happening.

Michael Roesslein:

And the practitioners are overloaded and they’re busy and they get the patients to come in and they know of this new lab test, well, I should probably know of this new lab test. So I should probably use this test because I’ll look dumb if I don’t know about this test or I’ll look this or that.

Dr. Michael Ruscio:

And that’s what we’re trying to change. We’re trying to give patients and providers something different they can rally behind. And it’s been really nice to see the level of adoption of this paradigm. Once people can kind of get out of that understandably, kind of fearful mentality, I’m not feeling well, I want answers, this lab is proclaimed to be the answer, I want that test. I get that and I’ve been there, I’ve had hellacious brain fog and insomnia, so I’m not pointing the finger. But I also spent months and months and months and months spinning my wheels, treating all these labs to get no better until I figured out what the root cause of my health issues were. And now that I’ve been in the clinic for a while, I just see how endemic this is. So it’s not to say there’s not solutions. There’s actually great solutions, but they’re not as simple as a test, one treatment.

It’s a clinical model where here’s all the things that work and now we’re going to put that model next to all this information about the individual. And that’s going to really personalize and inform the model to them. So it’s built upon hundreds and hundreds and hundreds of clinical trials. How do we look at my symptoms? Well, and quick example if you don’t mind, Mary Sue has had IBS and she’s been struggling with, let’s say food reactive brain fog like I had, and that’s also causing insomnia and depression. And so she reads about low carb. Goes low carb, helps a little bit. Then she reads about low histamine. So now she’s low carb and low histamine. Then she reads about low lectin. So now shes low carb, low histamine, low lectin.

And that helps a little bit. But now when she comes into the office, her sleep is really bad. She’s got no energy and she’s quite depressed. And you read some of these symptoms and you go, “Oh, she’s also reporting some orthostatic hypertension.” When she stands up quickly, she gets lightheaded. And she’s not sleeping well, and she’s on an uber restrictive diet. And she’s complaining about being a little bit underweight. This person probably needs to eat more carbs. And so we’ll probe. “How does rice feel to you, Mary Sue? Oh, it feels good. But I read that it can cause type 1.5 diabetes.” It can be so simple in some of these cases.

Michael Roesslein:

I see that so much, “When I eat this, I feel really good, but I know I’m not supposed to so I don’t.” And I’m like supposed to. What is supposed to?

Dr. Michael Ruscio:

Exactly. So maybe we bump her carbs up, we give her some electrolytes. That may not solve everything, but she’s going to get 30% improvement almost instantaneously. And then we can start personalizing some of the evidence based therapies to her gut. We get another 30 to 60%. And that’s more than half of the improvements right there, so easy, such low hanging fruit.

Michael Roesslein:

Yeah. And the carbs there and the electrolytes, if somebody has more energy and feels more clearheaded and all of that and sleeps better, making the other changes is then easier. Because when somebody’s in that pit where they have no energy and they can’t sleep and their brain foggy, you give them a list of stuff to do and it’s like, whoa. Let’s start with one thing. And then the individualized look at it is that people want a cookie cutter thing. Practitioners want it, the patients want it. They want to know like, if I have this symptom and my lab test shows this, I need to take this supplement and eat this food. And I think it’d be really cool if it was that simple. And then we could get everybody better right away, nobody would be sick. This would be really easy work.

But unfortunately, the body is infinitely complex and each person’s unique. I’ve even worked with people in the past who eating certain like red meat would spike their blood sugar more than eating some carbs and they’d have weird glycemic reactions. And they’re like, “Well, I’m supposed to be on low carb for my blood sugar.” I’m like your blood sugar goes to 200 when you eat that steak, let’s talk about what’s going on for you. I think that’s a brilliant approach with that.

We’ve talked about how people waste a lot of money and energy and then focus on the wrong things, and you’ve spoken that you think there are some lab tests that are really worth the money and that you use in your clinic and that you think are solid. What are those, in your opinion, and in your experience, if there’s a few of them that you’d say fit under that $1,000 threshold.

Dr. Michael Ruscio:

Sure. And some of these are probably basic, but I think worth pointing to. I’m not claiming that if your doctor says you’re diabetic to be like, “Well, lab testing is not accurate. I’m not going to.” So there are some tests that are very well vetted, your blood sugar testing, your hypothyroid testing. Although, you have to be careful about the functional ranges and that’s something we can tackle in a moment if you want. But the conventional ranges for diagnosing hypothyroid are very accurate. Looking at anemias, so a lot of the things you’ll see in a standard blood panel. And that would be a good core. Now, there’s some gut testing that’s also validated, of course.

And this would be something looking at parasites, ova and parasite. There’s newer tests that are using the DNA PCR technology. That’s also been validated. I think they’re overused. As someone who had a parasite myself, if anyone would be biased in the direction of testing for parasites, it would be me. But I can say, after maybe five years of running two stool tests on people in tandem, it’s not very often that you actually see parasites. But that’s one test that has been validated, probably overused. And a SIBO breath test has also been validated and it can discriminate healthy controls versus those who have symptoms of bloating, abdominal pain and altered bowel function, whether it’s constipation, diarrhea, or an oscillation between the two. Probably also overused, but validated.

And then dysbiosis, this umbrella term under which we can organize, not necessarily overgrowth, but imbalances in the ratios of the bacterial communities, that’s been validated by one test out of Norway. It’s called the GA-map, not to be confused with the US GI map. And the GA-map is built into the doctor’s data stool testing profile, in a measure called the dysbiosis index. But here’s where it gets a little bit, I don’t want to say tricky, but maybe counterintuitive. That test has been shown to discriminate dysbiosis does, is not present in health controls. It is present in those with IBS and a different form is also present in those with IBD. So they’ve done the validation studies to show that their tests will show dysbiosis when you have a problem and not show dysbiosis when you don’t. However, they haven’t gotten to the point yet where they’ve shown the ability to say, “Well, this diet works best for dysbiosis or this treatment works best.” So you can say to the person, “Well, you have dysbiosis.” And the guy who’s crapping seven times a day might say, “No shit.”

Michael Roesslein:

How actionable is it?

Dr. Michael Ruscio:

Exactly, how actionable are these tests? So this is why I take such issue because we know of a myriad of treatments for SIBO that don’t necessarily require a test and we know of a myriad of treatments for dysbiosis that also don’t require a test. Sure, you could quantify it, but too much of the field is acting like researchers and not realizing it, where they’re doing all this pre-post testing that’s not impacting treatment and they think it is. But what they’re really doing is acting more like a researcher, like, “I wonder what happens when we treat as such and then do a retest.” I say that because this is some of what we’re doing at our clinic is we’re doing enhanced data collection on some cohorts of patients to try to show what happens pre and post, but we’re not making the mistake to think that this test tells us how to treat.

And this is very relevant. If you want to go to our homepage, it’s ruscioinstitute.com. On the bottom, there’s a three part video series where I really outline this. But suffice it to say, the majority of data, clinical trials that have been published, show you how to treat an individual, not how to treat a lab marker. And as an example, there’s, over 1,000 I believe, clinical trials on how to treat IBS. There’s only one trial, and this is with probiotics specifically. So probiotics for IBS. I think there’s 749 trials that have studied how do we use probiotics for those with IBS. There is literally one study that said, or studied baseline stool test, and then give personalized probiotics based upon that.

That should be shocking to people because all too often, clinicians will say, “Well, you’re low in Bifidobacterium infantis. So supplement that. But don’t supplement Lactobacillus acidophilus, because you’re sufficient in that.” That’s not how the scientific process has informed the use of probiotics, 749 trials compared to one. But the majority of the field is mistakenly thinking that you have to personalize probiotics based upon stool testing. I hope I’m not getting too detailed, but these are the things that people need to understand.

Michael Roesslein:

No, you’re not.

Dr. Michael Ruscio:

Okay. These are so important for people to understand, because once you wrap your head around this, you understand that there’s a lot of trials on what does someone’s symptomatic picture look like and what probiotics work best for that. Not guided by labs. And once you see this, there’s that old saying, once the mind of man is expanded by a new idea, it can never again return to its original dimensions. So once you understand this, it’s really hard to go back to the lab paradigm, but it is a paradigm shift. And again, not to say all labs are bad, but the majority here probably are.

Michael Roesslein:

You’re saying that what you see with a lot of different types of probiotics and the positive results they could have is based more on the presentation of the individual and the symptoms and the history and what they’re dealing with that would align with what you’ve seen with certain classifications or types of probiotics, versus any of the tests that try to peg them directly and say, take this, take this, take this.

Dr. Michael Ruscio:

Exactly. That’s why we say treating people, not numbers.

Michael Roesslein:

Yeah. I’ll throw another one under the bus that people brought to me a lot, when it first came out was Viome. And people brought that to me and they were like… Their marketing was so slick that the user, not even the practitioner, the patient level person, was coming to me with word for word, bullet point, talking points from their marketing. It was, this is a revolutionary technology in the field of da, da, da, da, da. I’m like, “Really? You came up with that? That’s your opinion on this?” And then they would send me a link and then those bullet points would be right there. That was a few years ago, that was super hyped and super hot. And it’s not anymore.

Dr. Michael Ruscio:

And I’m surprised they haven’t been shut down for making egregious claims that are not supported.

Michael Roesslein:

Extreme claims.

Dr. Michael Ruscio:

And I’m not about well, you can’t claim a probiotic treats depression because a probiotic’s not a drug. I think that’s BS and needs serious reexamination. But it’s also, you shouldn’t go around saying this test holds the key to unlocking your metabolic optimization and resolving all your digestive symptoms. The claims were so strong it was laughable.

Michael Roesslein:

Yeah. We were getting people emailing us and emailing questions in for webinars we’ve done and other stuff with word for word talking points on it, like they’re going to tell me exactly what to eat and it’s going to give me exactly these things. And I have a couple friends that are microbiology types and researchers, and I was like, “Can you look into this for me?” And they did. And they said they don’t disclose anything that they do. There’s no way for us to even look into this because there’s no backing to it. And I was like, “I’m done with that. I’m not even going to waste more minutes on it.” But yeah, I’ve seen companies get in trouble for staying way less, actually, than what they said. So that’s interesting.

And I love that you mentioned, and I could relate to this because I actually found myself doing this when I was working with clients, and then I stopped doing it when I realized it, was running a battery of labs, giving them instructions, protocol, diet, recommendations, lifestyle stuff, running the same battery of labs, looking at the differences and then basing what we were doing on that. I started to realize that I wasn’t making recommendations that were very different to most of the people that had similar presentations of what was wrong with them. I noticed that like 90%, at least of what I was recommending to these people, wouldn’t have changed based off the labs. And I was like, “Why do we even do this?” And I started to ask some people and I think it’s less now, but I know that was out was, there was no way to track progress unless your lab markers move.

Dr. Michael Ruscio:

In all fairness, the field it’s a younger field and it’s going to go through some growing pains. And so I think the pendulum swung really far in this direction in part, because it’s a new field and also because, and I’m really empathetic to this, natural minded providers want to be taken seriously and looked at as scientifically valid, just like conventional medicine is. And so the allure of a lab marker makes you feel like you’re more scientific and more credible, but that’s incredibly specious. And we very much so have to rethink that because it’s actually a scientific.

And again, that video that I mentioned earlier, we give a side by side in terms of here’s a treatment, here’s how many studies are in existence that have used a lab to guide it, in this case, priobiotics for IBS, one. Here’s how many studies are in existence using the patient’s symptoms that guide it, 749. And you go through these and it’s really insightful to see how often we don’t need lab testing to inform care. And if we can just use the scientific evidence, we can still be science based. The connection between labs and scientific-

Michael Roesslein:

These interventions tend to result in these physiological changes. Without needing to see your count on this thing is this, or your count on this thing is this. It’s people with this symptom presentation takes this intervention and then their symptom presentation is less.

Dr. Michael Ruscio:

And that’s what people want. People don’t want to see a normal lab and still feel like crap. They want to see their symptoms improve. Again, there’s a small number of bio biomarkers that you can use. But especially in gut care, most of these tests are not offering anything and I’d argue more often than not, again, they’re taking up time, money, and also leading to much more fear and an unhealthy psychology. So it really does a lot of benefit for someone to mitigate these as much as possible.

Michael Roesslein:

Interesting. And you say, we are trying to change this. Now you do education for practitioners too, correct?

Dr. Michael Ruscio:

Yes.

Michael Roesslein:

Yeah. Can you talk a little bit about that, what you guys are doing there?

Dr. Michael Ruscio:

Well, there two operations. There’s a clinical practice and then there’s the website with the podcast and the blog and there’s a lot of cross pollination between the two. A lot of what we learn at the clinic, we then share in our clinician’s newsletter on drruscio.com. And we’re working to develop this more so into a database where we have position statements on what stool test should be used, how should they be used, what SIBO test should be used, how should it be treated. We have a thyroid algorithm in terms of how to interpret thyroid antibody labs and blood work and how to treat because there’s just so many questions that providers have. So we’re trying to really take what we learn in the clinic, both through reviewing the research, doing some of our own research and also treating patients and learning from them and database it on the website so providers have somewhere to go as a resource.

And it’s not where I’d like it to be ultimately, but there’s a lot of great information there. Especially with the case studies, you can see exactly what we do in terms of visit one, here’s the symptoms, here’s the history, here’s the labs that we did. It’s not eight, it’s usually one or two. And then here’s how we followed up with the patient, took what they said and used that to steer our next recommendation and really showcases this patient centric model rather than a model that’s just treating tests and numbers and so on.

Michael Roesslein:

That’s really fascinating. And I’m glad that resource is there. I’m seeing more and more of the leaders in the field start to turn towards educating practitioners and providing education for practitioners. I think that’s how the thing shifts, that’s how things move in the positive direction in the industry is when those resources are put in front of the people who… Because I don’t want to come across like definitely me, I’m not trying to throw anybody under the bus for how they work or what they do. It’s a lot to juggle a practice and education and keeping up on the newest this and this and going to this conference and doing this. It’s a lot. When people blow up about how their conventional doctor that they see for 10 minutes doesn’t know about the new thing that functional medicine figured out or whatever, I was like, keep in mind that guy sees 80 patients a day for 10 minutes and is exhausted and does that six days a week and might have a shift at a hospital.

My wife’s an ER nurse, so I know about how even family doctors and GPs tend to have shifts at hospitals and they do that and they’re over there and they’re doing this thing. When do you think they’re going to learn the new? And so I want to be respectful too on that and acknowledge that. And the easier and more distilled, I think the information can be like, you’re talking about making these position papers and here’s our statement on this thing, that’s something somebody can read, boom, here, quick, easy.

Dr. Michael Ruscio:

Doctors [inaudible 00:31:12] executive summaries essentially.

Michael Roesslein:

That’s it, yeah. Like how they do for book reviews for executives and little things like tell me about this 400 pages in 20 minutes. And then they can take deeper dives into the things that really relate to they have a niche or they have a specialty, they can do that. But yeah, I think that’s brilliant. I appreciate it. And your podcast, you have a podcast, you have blog. There’s two websites, we’ll put the links both below. The one you mentioned earlier for patient-centric stuff, I saw some really good guides on there for people to get started, like quick things to check out right away. That’s the ruscioinstitute.com. And then your other website, that’s the blog and the podcast is drruscio-

Dr. Michael Ruscio:

.com. Yep.

Michael Roesslein:

Yeah. We’ll put both the links down below, but I wanted to have that out there, audio for people that are only listening.

Dr. Michael Ruscio:

I really appreciate your point. I just want to echo it that even though there’s a lot of work we have to do to improve the field. I feel everyone is doing the best they can. So it’s not a finger point at patients or at providers. I think there’s been some perversion of the education and those who are there learning, they’re not they’re not saying, “I’m doing these labs because I want to make money on my patients.” I really find that sort of criticism very distasteful. I don’t think any clinician is ordering a lab test because they’re trying to, quote unquote, make money on it. They’re trying to help but I think the paradigm has swung to where providers feel too dependent upon lab testing and not enough upon their clinical skills. So I’m right there with you. Very important to say, I think we’re all on the same team. We all have good intentions, but there’s definitely some areas where we can improve.

Michael Roesslein:

Okay. Yeah. That’s a appreciated point. I know a lot of practitioners and I’ve never heard a single one try to be like, “Hey, I found this new lab test. If we sling a bunch of these, we’re going to make.” That’s not how it works. And people don’t realize how small the margin actually is on those.

Dr. Michael Ruscio:

I was just going to say that.

Michael Roesslein:

Practitioners are making like 10%, maybe 20% on those tests. It’s not big.

Dr. Michael Ruscio:

They just cover their staff. Yeah, the staff cost.

Michael Roesslein:

Yeah. It’s the people who have to take the test for you, send you the results, do all that, answer your questions. Nobody’s getting rich off selling lab tests, I promise that.

Dr. Michael Ruscio:

Except for the labs.

Michael Roesslein:

The labs. Yeah, the labs are doing great. But the practitioners, nobody’s getting rich on selling labs. I think the people who are running 12 lab tests really think that the best way to help their patients and their clients is to run 12 lab tests.

Dr. Michael Ruscio:

Yes.

Michael Roesslein:

So before we run, you’ve mentioned that there’s some pretty simple interventions that you’ve seen that aren’t really lab test dependent a lot. And this could go in a lot of different directions depending on if somebody has autoimmune or if it’s gut related or what the situation is. But for those out there listening with standard presentation of just like, “I feel bloated and gassy and terrible when I eat most anything or I eat what everybody else seems to eat. Why can’t I eat like everybody else? Or I go out to eat with my family and then I’m the one who feels like hell for two days,” what are a couple starting points? Now I know everything’s individual and this relates on the personal level.

Dr. Michael Ruscio:

You’re right. Yeah.

Michael Roesslein:

But what are some needle movers, that you’ve seen in your experience, that generally be like a start here kind of, try this out and I’ve seen this move the needle for a lot of people?

Dr. Michael Ruscio:

Yeah, definitely. And while personalized medicine is where we’re trying to go and make everything based upon the individual, there are almost like a decision tree. So the person comes in and there’s three different diets they can go down. And you’re looking for historical clues in terms of which one works best for them. So it’s not to say it’s this infinitely complex, so many options. It’s just there’s kind of this loose sketching of a cascading decision tree model and we have to figure out which person… Almost like, remember the Plinko from The Price is Right?

Michael Roesslein:

Yeah.

Dr. Michael Ruscio:

What Pinko path is going to be your best path. And there’s only a few of them, so it’s not terribly complicated. So fasting, I’m sure you’ve talked about some degree of intermittent fasting to provide a rest window for the gut. We want to be careful not to go super far where people are fasting so much they start losing too much weight and not sleeping well and being tired. But some intermittent fasting can be helpful. And I’m assuming people here are probably on some sort of ancestralish diet, minimal processed food and focusing on fresh. So that pseudo-elimination diet, food quality as your primary benchmark is a great place to start. I’m assuming many in the audience are already there.

From there, where I think this audience misses a lot is with the low FODMAP diet, F-O-D-M-A-P. And this reduces some seemingly healthy foods that are high in prebiotics and can actually make some of these underlying gut symptoms and imbalances worse. So you would reduce things like broccoli, cauliflower, asparagus, avocado. And that’s why I think it eludes so many people, is because these are seemingly and generally speaking, healthy foods. But in some cases, reduction of these foods has been shown in reduced inflammation, leaky gut, and most importantly, improved symptoms.

So a low FODMAP [inaudible 00:36:24] on the diet is one other place to start. And then two other things, an elemental diet reset, which is kind of like this rescue therapy, predigested, hypoallergenic meal replacement can be used if someone’s in really rough shape. They essentially make these meal replacement shakes, that again, are predigested and hypoallergenic. And this has a fasting impact on the gut, but it’s not a caloric deficiency. So it allows people to do it. In theory, if everyone could do a three day fast, that would help. But very few people have enough vitality and aren’t exercising enough or under enough stress to where they could buffer that. So this is where the elemental diet gives you a gastrointestinal fasting like effect, but it doesn’t cause a metabolic stress of being very low calorie.

And then we use probiotic triple therapy, and this is something we’re currently studying in the office. Said simply, you take three different bottles of probiotics, three different formulas, and you put them all in one so you have this kind of triple dose.

Michael Roesslein:

I saw it. I saw your-

Dr. Michael Ruscio:

The sticks?

Michael Roesslein:

Yeah, yeah, yeah. It’s a good formula.

Dr. Michael Ruscio:

Yeah. Thank you. So we essentially took three capsules of a VSL#3-like traditional probiotic, plus two capsules of Saccharomyces boulardii, healthy fungus, plus two capsules of a soil-based probiotic and put that all into a single serving care stick. Because we were having patients do the three different probiotics, but it’s kind of annoying opening three different bottles and dosing them all.

Michael Roesslein:

And taking seven pills.

Dr. Michael Ruscio:

Right, right. And so that’s another great starting point. And you can get pretty far with applying those. I think really important concept one step at a time and listening to your body. Not thinking that any one of those may resolve everything. But can you pick up 10% from some intermittent fasting? Can you pick up 20% from a elemental heel reset, liquid diet for a day or two? And then can you pick up 30% with low FODMAP? And then the finishing touch could be another 30% with the probiotics. And you’d be amazed at how well that works when you have the paradigm of okay, one thing at a time so I learn from my body and then sequential integration of these. Not thinking, “Well I tried low FODMAP. Yeah, I felt better, but it didn’t cure me.” It’s like, well, that’s the wrong way of looking at it. Right? Did you see an improvement? Yes. All right, let’s keep that constant for a little while. Let’s layer in therapy too.

And that’s usually a lot of what we end up doing at the clinic where the people who do one thing and everything is gone, don’t need a doctor. But those that do are oftentimes, are looking for the one thing that’s going to cure everything. And you go back to the treatment history and it’s like, “You’ve done all this stuff and it’s all helped. Why did you stop? Well, I wasn’t sure if it was working or didn’t fully resolve my issues.” And it’s like, I kind of get that, but that’s where the sequential approach can really get you over that hump of healing. And then once you hit that, less dietary restrictions, open up the diet and less supplements and kind of the downhill backside.

Michael Roesslein:

Yeah. I like that you mentioned less dietary restriction. I’ve met people who’ve been on uber restricted of everything for years at a time. And it’s like, man, that is… That’s another thing that’s been educated to the public that take these 16 food classes out of your diet, you’ll feel great, and then just never eat those things ever again. And then that presents itself with all kinds of issues in the long run. So I like that you mentioned that’s temporary and the goal is to rediversify the diet. And I like that you prefaced with the fasting, stick with what you can do. I usually recommended people, just when they first started, just eat your dinner a little earlier, eat your breakfast a little later, see how that feels and then kind of go from there.

I’ve seen people jump right into, “I didn’t eat for two days, but then I felt terrible.” And I was like, “Yeah.” I do a three day water fast every six to eight weeks or so and I feel great. I actually started doing it after I had a chat with Dr. Kharrazian about brain inflammation and all kinds of different symptoms I have from having concussions in my life and activated glial cells and all these types of things, and ways to basically clean out the brain.

Dr. Michael Ruscio:

Right.

Michael Roesslein:

And I started doing a three day water fast every six to eight weeks and I was public about it. I said, “I’m doing this.” And my mental clarity was great, I felt awesome. Everything was really cool. Once I got through like the ragey part, then I felt awesome. But then I had a whole bunch of people in our audience go and try to do a three day water fast right away.

Dr. Michael Ruscio:

That’s a tall order, yeah.

Michael Roesslein:

I was like, “Oops, I didn’t say the right words. I should have prefaced that this is not something to jump into.”

Dr. Michael Ruscio:

That’s a great point. And I think this is another thing that health educators have to be more cognizant of. Gluten free, I think is another example of this, where some educators in a very well intentioned way will be talking about how gluten can be a problem for people. But they won’t disclose that the prevalence of non-celiac gluten sensitivity, the various studies have shown a prevalence of around three to 6% of the population. So it’s not to say everyone has to avoid gluten. But if you don’t give, what’s the risk assessment on this, then everyone starts avoiding gluten. And to your point, plus carbs, plus lectins, plus histamine. They’re trying to diet their way out of what might not be a diet problem, or what’s not completely a diet problem, and that can be really dicey. Yeah.

Michael Roesslein:

Perfect. All right. Well, thank you Dr. Ruscio. This was tons of awesome information and I’m really grateful for the work you’re doing, both in your clinic and for just bringing such, I mean you produce a prolific amount of content and information and knowledge that’s shared out there. And it’s not just for the practitioners, you have patient facing stuff too. And it’s definitely one of the most prolific educators out there in the functional medicine space. And you write. I know what goes into writing books, so I don’t know how you juggle all of these things. But you probably have a pretty awesome team.

Dr. Michael Ruscio:

Amazing team.

Michael Roesslein:

That’s there. Because people see this especially, and I hate using the word brand, but in brands that are revolved around one individual, like it’s DrRuscio.com, people ask me, “How do you think they do all that?” I’m like, “They have an awesome group of people that work with them.” And we know each other’s, couple of each other’s people on our team. So shout out to your team too, because I know that there’s a lot of moving pieces there, a lot that’s going on and I can tell that it’s really done from a genuine place of really wanting to shift the industry and help as many people as possible.

Dr. Michael Ruscio:

Thank you.

Michael Roesslein:

I just want to applaud that. And it’s been a pleasure to chat with you finally. And I learned some things about lab tests I didn’t know. And it kind of backed up some intuitive little pieces that I felt about them from time to time, but I didn’t do as much research as you did on them. And it just didn’t feel right sometimes, like, is this really the way to do this? And then I’d have people who didn’t run any labs get really better too sometimes. And I was like, is this necessary? But thank you so much. I’d love to chat more in the future and I hope we run into each other more and just thank you for all that you’re doing.

Dr. Michael Ruscio:

Thank you so much. Been a pleasure.

Michael Roesslein:

We did mention the sites. I just want to give them one more shout. We mentioned them early. Usually we do that at the end, but then we kept talking. So we have the ruscioinstitute.com. That’s the patient focused one, the clinic. And then DrRuscio is the blog and the podcast, and we’ll have both of them down below. It’s DrRuscio.com. Is there a hyphen in there?

Dr. Michael Ruscio:

No, it’s just DrRuscio.com.

Michael Roesslein:

Okay, DrRuscio.com. And that is the blog and the podcast. We’ll have the links down below. There’s really cool guides on the Ruscio Institute site. And a lot of just start here type information that’s readily accessible for you. And then the blog and the podcast, there’s more content there. And then your YouTube channel too is pretty solid. That’s where I found the video on men’s health and the probiotics I was watching earlier today. So cool, just thanks so much. I really appreciate it. It was great connecting and look forward to chatting more in the future.

Dr. Michael Ruscio:

Absolutely. Thanks so much. It’s been a pleasure.