Your Diet Is Fine, Your Lifestyle Sucks | Michael Ruscio on Health Theory

On today's episode of Health Theory with Dr. Michael Ruscio, we talk about why non-gut symptoms may be caused by gut problems, the truth about gluten, why you need meaning in your life, and how to avoid diet dogma. Everybody, welcome to Health Theory. Today's guest is Dr. Michael Ruscio. He's a functional medical practitioner, clinical researcher, and best-selling author of Healthy Gut, Healthy You. And through his amazing podcast and public speaking, he's established himself as one of the most prominent voices in functional and alternative medicine. And what I want to talk to you about today is you will know I found you pretty early um in trying to deal with what was happening with my wife. And what I want to know, I know that originally you planned to be a traditional medical doctor, headed down that road. What was it that made you take a hard right and go into functional medicine? I was pre-med, and I was playing lacrosse, and feeling you're 23 in college, almost invincible, right? Tons of energy and and everything else. And then I started having fatigue, brain fog, insomnia, was feeling cold, um having mood dips, all of the sudden. And there was really no good dietary or lifestyle reason for it. I was eating a clean organic diet. I was doing what I loved. I was getting adequate sleep. I was exercising. And so I went and I saw three different conventional doctors, a GP, an internist, and an endocrinologist, and they all did their workups and said, "You're healthy." And I said, "Well, did you hear the part where I just told you all of a sudden I'm waking up like eight times a night? I can't fall back to sleep. Um I'm having these bouts of depression. I'm having fatigue that I've never had before." And they said, "You know, we're sorry. We don't see anything. There's nothing that we can do." And so I turned to alternative medicine, and he told me I think you have a parasite. And I remember thinking at first that this guy is nuts. I had really no digestive symptoms. They were They were more neurological in my case. But, I said, "Well, what do I have to lose?" And so, I did the stool test. I figured out I had a parasite. And nothing really improved my condition until I improved the health of my gut. And that totally opened my eyes to this whole wonderful field of alternative medicine. Just so happens now, years and years later, that I'm in practice for digestive ailments. I I really think alternative medicine is the most powerful line of intervention. It's really interesting cuz when when I was growing up, if somebody had said alternative medicine, I would think crystals and incense. It was cookie before, but it's it's gotten very scientific. It's kind of like the contemporary, more science-based application of of natural medicine. And seeing the whole body as one integrated organism versus the more sort of separated in acute way that I think of, at least, traditional medicine approach. Right. So, I We should definitely um draw that premise, which is natural and integrated medicine oftentimes are looking to the root cause and and how to treat that root cause with the most natural and minimally invasive treatments. And that's a counterpoint, but a necessary counterpoint to to conventional medicine, which may be looking for things that can kill you and things that need to be dealt with in a different, more reductionistic treatment model. So, they both definitely have their their time and their place, but I think if you have one in the absence of the other, then that really is a disservice to the patient because they're not going to be getting the full breadth of of therapeutic options they they have at their disposal. Mhm. Now, one thing that I really I'm so desperate for our listeners to understand is the importance of the gut. The importance of the gut was introduced to me at a moment of my highest arrogance. So, I was running a nutrition company, was insanely successful. Um I had transformed my own physique. I'd gone from 60 lbs heavier down to six-pack abs. I I just thought I had it all dialed in. I thought that I knew everything uh when it came to nutrition and then my wife one day just says, "I'm not feeling well." And then I'm not feeling well turns into projectile vomiting, turns into a year of basically eating four ingredients. It was crazy. Her hair started falling out, her nails were breaking. I was legitimately worried she was going to die. Like, you know, I mean, you you hear about that all the time. People get amoeboid dysentery and they basically just die of diarrhea essentially. That was when I realized, "Okay, I actually don't know anything." And so I started then researching the microbiome which I had never even heard the word before. So, what is the importance of the gut? Well, I I think there's there's probably three fundamental pillars we should we should establish to kind of support this conversation so that people don't get lost. One is that your gut can influence almost any other system or cause any type of symptom in your body. Brain fog, fatigue, insomnia, joint pain, thyroid problems, skin conditions, as well as of course gas, bloating, reflux, uh constipation, diarrhea. So, that's that's one thing that's important to keep in mind. The other thing that ties in with that is you can have a gut problem that is manifesting solely as non-gut symptoms. So, you could have inflammation in your intestines and have brain fog and insomnia like I did. Right? But there's no digestive symptoms happening. So, sometimes it eludes people because they go, "Well, I don't have a digestive problem. My bowels are fine." Well, it's not always that that simple. And then thirdly, if people are saying, "Well, gosh, there's all these things I read about, right? Thyroid, adrenal, toxins, Lyme, mold, uh food allergies. Where What do I do first? How do I sequence this?" After someone has taken reasonable steps to improve their diet and their lifestyle, if they're still not feeling well, the next thing they should do in most cases is take some steps to improve the health of their gut. This is not a kooky, super progressive, left-wing theory anymore. We have contemporary science showing that, yes, something like atopic dermatitis, which is a skin condition, or ataxia, which is a neurological condition, can be caused by a gluten reaction in the gut. Yet, there are no digestive symptoms occurring at that same time. Yeah, that that's where it gets really crazy. How do you in your book, you really break down how not to get lost in what you read on the internet or, you know, what the current trend is. But, how can people go about actually figuring out what's going wrong? Right. Well, I I think following that sequence of first, take some reasonable steps to improve your diet. So, go on a healthy diet, exercise, get sleep, uh pursue some meaning in your life, manage stress. And then, the next thing I would do is look into your gut health. And And the sequence is important because you can get lost in the internet. You could go and say, "I have these three symptoms." Look them up and it says it's hypothyroidism. And then, you go chasing down thyroid. But, many thyroid symptoms can be caused by a problem in the gut. So, looking at this stuff in a sequential order can help guide you to be most efficient. And then, in terms of what to do specifically for the gut, that's a little bit more challenging because there's high carb, low carb, high fiber, low FODMAP, probiotics, no probiotics, antimicrobial herbs, low lectin, low sulfur, low histamine, low oxalate, um you know, SIBO, candida, H. pylori, toxoplasmosis, inflammatory bowel. There are so many things that people have to juggle that it's a really a paradox of plenty, right? We have all this information at our fingertips, but people don't know how to apply it. And And that's I talk about this in the book, the difference between knowledge and wisdom. Right? We can all get knowledge on the internet, but the wisdom for how to use that knowledge is only accrued through study and reflection and time. And that's what I wrote into the protocol of the book, here is how you sequence the stuff. Cuz there's 15 things you could do, but here's the first thing that you should do, and then we'll re-evaluate, we'll check in, and depending on how you're doing, you're either done and we go to a kind of a maintenance mode, or we continue to escalate through that sequence that's that's kind of this wisdom-based protocol. You have this quote and I thought it was really powerful. There are methods and there are principles and there are probably a million-plus methods that you can go about something, but principles there are only a few, and the person who leads with methods is inevitably going to get lost. So, what are the like and that to me is the internet, right? Like and and the Dr. Russo, when I started trying to research what was going on with my wife, I was like I I have never felt more overwhelmed in my life. It was like I've had to learn some big topics before, that was crazy. I felt more adrift at sea when I started learning about the microbiome than I did when I started learning about business. And so, it just seemed like everything that I learned, it spiraled and spiraled. You talk a lot about lifestyle in the book and there are some really surprising things you bring up. But, just at a high level like when you say healthy diet, what does that mean? You mentioned something a minute ago which I really want to drill into, which is have meaning in your life. Which like that that's a so surprising if you don't know your world. I always like to picture these things in a a pyramid type model. So, you have your foundation of the pyramid and then you work up, right? You don't start with the apex, you don't start with the most exotic treatment. You start with the foundation. So, the foundation would be diet and lifestyle. Now, regarding diet, there are a number of different diets one could start with. I think the two best ones that have the highest probability to help the most people would be either a paleo diet or a low FODMAP diet. Now, a paleo diet does not have to be this CrossFit guy, lots of protein, lots of fat. It can be a very high vegetable fruit minimal protein diet. So, you can skew the macronutrient breakdown on a paleo diet to fit your preferences and what feels good to you. But, the the main tenant of the Paleo diet is avoiding inflammatory foods and processed foods. So, no grains, dairy, and soy will be the biggest shifts for most people there and and nothing processed, of course. And focusing on fruits, vegetables, meats, eggs, nuts, and seeds, um and potentially beans and legumes depending on the version of the Paleo diet that you subscribe to. And you can give that a couple weeks. And this is the beauty of the dietary piece, back to something that we were talking about before the cameras went on. You can give a diet 2 to 3 week trial. And if the diet's working for you, you you won't be healed in in 2 to 3 weeks, but you'll be able to say, "Yes, I'm feeling better." And if you are, ride that wave until you hit your peak level of improvement and then reevaluate, exactly like we described in the book. Now, after 2 to 3 weeks, the Paleo diet isn't helping you, then a low FODMAP diet may be a better maneuver. Now, what's paradoxical about the low FODMAP diet is you reduce some stereotypically healthy foods, broccoli, cauliflower, avocado, because these foods are powerful at feeding intestinal bacteria, which is not good or bad in isolation, it depends on the context of the person. If someone has a pre-existing bacterial overgrowth, then eating a diet rich in those FODMAP foods will provoke that existing overgrowth. Some other people also are hypersensitive to gas pressure. And if you feed bacteria as part of their metabolism, just like a car spits out gas in the in the exhaust pipe, these bacteria release gases as part of their metabolism. And so, some people are sensitive, hypersensitive to that gas pressure. And so, eating a diet that really produces these gases can be problematic for them also. And so, some people will go on a higher fruit and vegetable diet and feel worse. And they're like, "Why do I feel worse?" Well, you inadvertently are eating a high FODMAP diet and that doesn't work for your gut. And sometimes just identifying the vegetables and the fruits that are high in FODMAPs, avoiding those, and focusing on the ones that are low in FODMAPs can can do volumes for improving one's gut health. And you can figure that out in 4 to 6 weeks. Doesn't take forever. And then from a lifestyle perspective, time in nature is very important. We know that people who live near green zones, forests, or blue zones, oceans, have a higher life expectancy and a lower all-cause mortality, meaning death from any cause. We also know that if you take two groups of people and one takes a uh break and takes a walk in a city and the other takes a walk in the forest, it's only the group that walks in the forest that reports higher levels of subjective well-being and lower scores of fatigue, depression, and anxiety. So, there's something therapeutic about time in nature. If you had to guess what that is, what is that? I believe they're known as phytocyanides that are the part of what make up the scents from trees that lower blood pressure. So, there is something therapeutic about nature. Some evidence has shown that children who have allergic conditions of the skin tend to grow up in areas where there's less diverse plant life around them. And some of those bacteria from the plants get on the skin and they find that the more diversity of the plants, the higher diversity of the bacteria on the skin, the lower the amount of inflammation and allergy in the skin. So, some of this may literally be transfer of microbes from the natural environment. And then sun exposure is is another one. You don't want to burn, but it's clearly being shown that avoiding the sun is as bad for your health as smoking. Um and we do see that chronic sun avoidance is correlated with a number of health detriments. Constant, chronic, low-dose exposure to the sun, 15 minutes, 20 minutes on most days, is a pretty reasonable recommendation that has been correlated with decreased all-cause mortality as well as decreased incidence of breast cancer, I believe, non-Hodgkin's lymphoma, um a number of things. Um and then coming back to the exercise piece, people who have better fitness levels have healthier gut microbiotas. And even sedentary people who then change to a active lifestyle, and when we tracked their microbiotas, they become healthier. You are the environment in which these bacteria live. So, if you are doing things that are healthy for the environment, you now harbor the growth of healthy bacteria. And if you're doing things that are unhealthy for for the environment, you harbor the growth of unhealthy bacteria. Those are some of the foundational pillars for that first rung on our pyramid of diet and lifestyle. So, talk to me about when you said get meaning in your life, that that is so surprising and so in tune with just what I know about Right. emotional well-being, but I'm surprised that somebody in functional medicine would put such a fine point on it. I was seeing people come in, they were so afraid of gluten and they they were so afraid of some other foods that they were withdrawing from social activities. So, I'm not going to go to the restaurant with, you know, the girls on our monthly girls night because there might be gluten in the sauce and I've heard that because I have a thyroid condition, if I have any gluten that will upregulate inflammation in my thyroid gland for for up to 6 months, so I can't have any, and if there's any in the sauce, I don't want to go out to dinner. And so, now they become a bit recluse. And they spend more time on the internet researching, which by the way, time on the internet has is correlated with the with scores of depression and anxiety. As as time on the internet goes up, sense of well-being goes down. So, they're trying to make themselves healthier, but in doing so, they're kind of sabotaging their lifestyle. It's It's a good quote, don't make yourself sick in attempts to be healthy. Um, but how this ties into to purpose and meaning is you know, part of our part of our purpose is to have social connectivity. But one of the things that can make it more difficult to have the purpose of social connection or can distract you from what you're doing with your life is getting sucked into this black hole of dietary restrictions that can make your life much more difficult to live. And uh just as a final point here, there is some evidence showing that, coming back to the smoking analogy, another parallel has been drawn, that loneliness is as bad for your health as smoking. Um so, purpose and connectivity are are very important. And if your diet is unnecessarily restrictive, it makes all those components of your of your life more difficult. That's so fascinating to me. And you talked in the book about something I'd never heard before. I loved it the most, but I just got introduced to it, so I want to hear more about it. This whole notion that women need to tend and befriend. Yeah. And so, you talked about it in juxtaposition to men spend a little more time in fight or flight, women tend to befriend. And so, my wife is um doing this new initiative called Women of Impact, and they had this big dinner here, and it was amazing, and I was hiding downstairs because I'm not a woman of impact. And the night it wrapped, and there was four or five of them left, and I walked by, and it was a scene so foreign to me, the way that they were like they were on a heightened emotional level, they felt really connected, really safe. It's a different dynamic than men. Yes. Like what what is it about that? I was seeing that men would come in with problems, and they didn't seem as psychologically affected. And women came in with the same problems, and they seemed to be more psychologically affected. And then when I read Shelley Taylor's work, who essentially said that at times of stress, men are more physiologically wired to go into this kind of fight or flight, which is a bit more uh of a isolationary kind of reaction. Women would go into this more tend and befriend, where they, you know, under times of stress, women more so need that friendship and that connectivity. It may be mediated by this hormone called oxytocin, and estrogen may potentiate the effect of oxytocin, so it may be hormonally that this is driven. But the the travesty is if a woman is going through a a health challenge and she's reading on the internet about dietary restrictions and those are leading her to isolate herself, she may very much so be thwarting her health. In fact, one patient came in with a stack of labs after having had not gotten results with her last provider and it was a very challenging visit because she came in thinking, here's the expert, we're going to dig into this, it's going to be complex, it's going to be cerebral. And what I told her was, I don't think anything is wrong with you. What she wanted from me was, this is the problem, you got to diet harder, we need to fix this. But when you when I looked at her case, I could see that she overall was very healthy, but she was self-diagnosing with all these things she saw she thought she had from her internet readings. But when we got her to open up her life and and enjoy her life a little bit more, she came back 3 weeks later and she said, oh my god, I feel so much better in 3 weeks. Comes back to the point of not stressing yourself out about diet and making sure that you have that time for social connectivity because it's so fundamental for our for healthy existence. How do you deal with that in your practice? Well, so there's another really important layer to this, which is sometimes people try to force a dietary solution to a non-dietary problem. That was me, right? I I had an amoebic infection that was driving all this inflammation in my intestines. And it didn't matter how great I ate. If I if I moved to Nepal and only ate food that was grown by monks under a full moon and it was full organic and biodynamic, it wouldn't matter. Because if there's something actively inflaming and damaging your intestines, then diet alone may not be enough to allow someone to heal. So, that's why again in the book we move people through the diets, but if the diet doesn't work, we don't beat them over the head with more dietary restrictions cuz it's important to understand there may be another thing present and and most commonly what's present is some type of dysbiosis, which is an umbrella term that encapsulates any kind of imbalance in fungus, bacteria, or other like life in your gut. And so, for some people, that's where the the big miss is. And if they can address that dysbiosis, then they don't have to be so strict with their diet, and then they can eat more, and and now they're finally getting back to the person that they were before. Mhm. I want to get back to that notion of the zealotry and the being overly insane and restrictive and all of that through this exploration process of either somebody who's just trying to avoid getting sick or somebody that's already sick and is trying to recover. Um how do you walk people through that? What's your advice? And then certainly, as it relates to the way that people talk about gluten, for instance. We want to act. Yes, you know, we want to have someone start off with some dietary restrictions, right? But I I think the fundamental miss is that if the dietary restrictions aren't producing much benefit, then we want to move on to another type of therapy. A lot of the I I I I guess solution to that problem is just knowing how to get someone well, but also making sure that you coach the dietary recommendations in a non-overzealous fashion. Because when people feel like they're put in this box, and if they don't eat perfectly, they're making a huge transgression against their health, that creates unneeded fear and stress. And gluten is a great example. Um it is a clearly a helpful dietary change for people to make. Yes, but some of the media would have you believe what? 80, 90% of people should avoid gluten? Would you say that's maybe on the mark? So, um now, while I don't think we have incontrovertible data here yet, and there was recently a study done in Italy that I think was the best one to date on this topic. They looked at 12,225 patients. And a group of physicians came up with a 60-point assessment, lab tests, physical examination, symptoms, and they wanted to see what was going on with gluten sensitivity. How common was it? What were the symptomatic reactions associated with it? And what were the comorbidities that were encapsulated along with this condition? And they found that 3% of that study population had non-celiac gluten sensitivity. So, that's something, right? Yes, it is there, but is it 90%? No. That can help us take solace in eating some gluten and not think like we're totally sabotaging our health. Sometimes the argument is made, "Well, if you're eating gluten, you're fueling this inflammatory process that may not manifest symptomatically for months or years." But, they found that 90% of the people who had a reaction to gluten had a symptomatic reaction within 24 hours. So, that shoots a pretty big hole in that theory. And finally, the same study found that 30% of the people with a problem with gluten were able to eat gluten again if they addressed some underlying imbalance in the gut. So, as it pertains to gluten, right there, hopefully that can deprogram a lot of people's fear into thinking that if I'm not feeling well, I have to avoid gluten all the time. We want to heal someone's gut, get them feeling well, and then quite simply have them reintroduce gluten and see how they do. One final thing here, it's often said if you have any autoimmune condition, you should never have any gluten. The same study found that of that whole population, 3% were gluten sensitive. Of that 3%, 14% had autoimmune conditions. So, yes, there is a correlation, but is it the majority that the internet would have you believe? No. And why does this matter? Because if we force people or indoctrinate people into thinking that they need to eat more restrictive than they actually do, that makes their life more difficult psychosocially, emotionally, and and so that's an important thing that if we can unwind that or wind that back to a more reasonable position, then people will be able to get all the benefit from avoidance with none of the detriment. Yeah, I want to talk about that psychosocial issue, the stress. There's so much stress and pressure and frustration in this process for people. What are the effects of stress? Stress is very bad for your health. Um I mean, we I don't think there's any study that has looked at the effects of stress relative to whatever they're studying and found a benefit. If anything, it's always neutral or detrimental. What I don't get is how is it impacting the microbiome though? Like I remember when Lisa was first told you should meditate before you eat. I thought what? Like I It honestly, that was one where I was like, okay, I've just learned my lesson to not be arrogant about this and to think that I know something. So, hey, yes, let's try it. But I was like, I really don't understand. So, how how are they connected? Right. Well, coming back to our earlier point about the health of the host impacts the health of the microbiota, right? It's really quite as simple as that. Now, when we look into some of the mechanisms that underlie this, we do know that college students underneath exam stress or exam preparation stress have a skewing of their microbiota. They see a dwindling of I believe it's bifidobacterium populations and potentially also lactobacillus populations in the gut. So, we know that stress has a negative impact on the gut. Just like a circadian shift would. When you fly into a different time zone, that also causes a negative impact on the gut. Um So, it's trying to take as many stressors off the gut as we can. And a lot of this comes back to simple fundamentals of is this good for the organism as a whole? Yes or no? And then if if we were to look at what's happening in the microbiota at the same time, the things that benefit the host tend to benefit the microbiota and the things that are a detriment to the host tend to be detrimental to the microbiota. So, stress falls right in alignment with that. What I'm trying to piece together is a couple phenomena. So, one, if you are are nervous about something, it can give you diarrhea. Mhm. Why? Well, um there are reactions between your your nervous system and your intestinal tract, right? So, we know that some of these things can be psychosomatic, meaning the the brain manifests physically, and there are a lot of nerves in the gut. So, this is why some people may pee or poop themselves if there's a highly highly traumatic event. So, there is a connection between your brain, your emotions, your nervous system, and your gut. Um and it's part of this is hardwired, meaning the nerves that directly innervate down, and then some of this is more locally controlled by the enteric nervous system, or the nervous system of your gut, and then some of it's hormonally controlled. So, there's maybe three amongst other mechanisms that connect stress or psychology to one's gut. So, where this plays in is so, thinking about my wife and the things that really create problems for her, just, you know, trying to really think through every time she has an issue, I think one of the primary things that's driving it is stress. If we, before she eats, slow her down, Sure. get her to meditate, get her to clear her head, get, you know, into the parasympathetic nervous system, right? Um then she won't have the issue. Everyone's a little bit different in terms of their history, right? Some people have had a knee injury in college, and now every few months or a couple years, they've got to go back to rehab. Other people may have had emotional trauma when they were younger, and that sets the tone of their nervous system to very quickly kick into this kind of fight or flight, and so they may have to work a little bit more diligently at managing stress. And so, it seems that past traumas in our life can leave us with things that we just have to be mindful to. And and I would put a knee injury and emotional injury on a similar playing field, meaning as long as you're doing some some therapy, it doesn't have to be this big esoteric cathartic thing that that's going to dictate your life forever because sometimes when people hear about the the things that you did as a child to your gut or to your emotions can affect you later in life and they go, "Oh my god, I'm never going to be able to escape this." I would look at it very similar to a knee injury. Okay, you blew out your knee, right? So, now we're going to have to do some rehab every once in a while. Every once in a while it's going to ache. Is that a huge deal? No. Does it mean anything is wrong or broken with you? No. It's just you had a knee injury and so every once in a while you need some TLC. But, I think also framing it like that is very important because we don't want to make people think that there is more imbalance with them than there actually is. And And when I talk with doctors, I always tell them, "Okay, if you're going to have a visit with a patient and you can't get it perfect, you can either make them feel like they're more sick or less sick than they are. We want to shoot for making them feel like they are less sick than they are because one's sense of their health does have a measurable impact on the health outcome of that person." Talk to me about the impact of the gut on mood, which seems pretty extreme. Yeah, I mean So, there And this is what's exciting. We're seeing really solid scientific evidence documenting this connection between the gut and the brain or or mood or whatever. Um there was recently a trial published in IBS, irritable bowel syndrome. So, gas, abdominal pain, constipation, diarrhea. And they found that those with IBS have higher scores of fatigue, anxiety, and depression. Now, what's even more impressive is that meta-analyses have been published. So, a meta-analysis will look at all the available clinical trials and summarize the data. And there have been, I believe, two meta-analyses published to date showing that probiotics can alleviate anxiety and depression. It's one of the worst symptoms that one can have. You know, we could put you on a yacht in in the Bahamas, but if you were depressed, you wouldn't enjoy it. Anyone who's dealt with mood dips probably understands it it it and in part doesn't matter where you are what you're doing. You could be doing laundry and super happy whistling, right? Or you could have just gotten a huge bonus check from your work and be sad about it. And that's a in big part the gut-brain connection. It's very interesting. So, I'd love to get down to like what's going on at a neurotransmitter level. So, serotonin is the one I always circle back to. Uh that 95% of the body's serotonin is stored in the gut, not necessarily made in the gut, but stored in the gut. Um and that we're finding out maybe through the lymphatic system that serotonin actually can cross the blood-brain barrier. Um what's that? How does um dysbiosis or anything affect that? Yeah, there is a lot of nervous activity and a lot of um neurotransmitter production in the gut, clearly. Whether it's 95% or 90% or 98%, I'm I'm not sure. It clearly clinically impacts the brain. And one thing that I do think is interesting is serotonin helps to facilitate movement of food through the intestinal tract. And it also and it also and so that's important because if food doesn't move through the intestines at an appropriate pace, if it moves too slow, just like stagnant pond water will foster bacterial growth, stagnant food in the gut lumen can foster bacterial and fungal overgrowth. There's some preliminary evidence showing that a low FODMAP diet can help the density of serotonin cells in the gut become more like that of healthy controls. So, to a degree it seems that healing the gut may actually help with resurrection of serotonin production and perhaps that's part of the reason why as one heals their gut, they have better mood, focus, and and uh anxiety. Wow, that's I mean, it's just incredible. It's incredible like the whole enteric nervous system which one uh until sadly pretty recently I didn't even understand like how well developed it was, like how many neurons are in it. Um the whole concept of the second brain. Mhm. How do you think the two work in concert together in terms of directionality of the signal? Like how much is the brain talking to the enteric nervous system and and back from the enteric nervous system to your brain? Right. Well, there there's clearly a bidirectional relationship. They're they're cross talking to one another. Which one is more impactful? I don't think we know. Um there's some evidence suggesting, but again, I don't think the answer is clear at this point, that the the gut to brain may be more powerful than the brain to gut. But context is important here, right? For someone with prior emotional trauma, then you may need to work more hard at the brain to gut connection cuz there may be this underlying, you know, injury there for for lack of a better term. But I think the more injurious section of these two is the gut because we know that antibiotic use, cesarean birth, um not being breastfed or being formula fed, and just the environment that we live in in the West being so hygienic, all decrease how well the gut microbiota is is colonized, and that throws off the immune system in the gut. So, it may not be which one is more powerful, but which one is more prone to imbalance, and I think our our our environment is not good for either. But I think there's probably more insults on the gut. And so, in my mind, we can get more out of focusing on the gut. But we are doing a podcast series cuz I want to dig in a little bit more deeply with some people who are experts in the gut to brain connection, so I can try to suss this out cuz I haven't been happy with some of the answers I've got. Some of the Some of the people I've come across their writings, they seemed very overzealous. I I believe that dogmatism can only exist in the presence of ignorance. You can only feel so so strongly about something if you haven't read any of the contradictory research. And so, you know, there's a difference with speaking with passion but having an opinion that's dogmatic. I went through this evolution myself as a clinician. I used to think X and then all of a sudden I started reading this other data showing that Y was actually true. And then how do you reconcile that? Some people just choose to focus on X. I I chose to look at X and Y and and that's why the the book protocol, using diet as an example, there's no this one diet is best for everyone. But here's indicators we can use to help people find what dietary camp they should be eating from. And and so, um back to your question, I'm trying to get a better answer on that, but I I think there is a little bit of dogmatism that permeates some of those circles and and we're lining up some guests to come on the podcast to really try to drill down into that to get a good answer for how often do people need to be doing some kind of therapy for their brain if they're having a gut problem. That is really interesting. That whole concept of being dogmatic only being able to exist in the presence of ignorance, man, that is so good. And that's how I know that you're one of the people to really listen to because if you get a new piece of disconfirming evidence and you can see that it's really real that you'll change and and adopt that new belief, which I think is insanely powerful. Um talk to me about sleep. This is something that I think when people approach me as an entrepreneur and they hear how much I work, they think my punchline is, "Well, just stop sleeping." You know, "Don't be so weak." And my thing is, I prioritize sleep. I make sure I get sleep. Sure. Um why should people get sleep? This is one of the areas in the book where I was actually really surprised at how much research we have showing so many health conditions will become worse, significantly worse, if you don't get at least 6 to 7 hours of sleep per night on average. Heart disease, cancer, neurological conditions like Alzheimer's and dementia, obesity, weight gain, depression, high blood pressure. You cannot be optimally healthy if you don't sleep. Sure, there may be a short period where you have to grind, okay? But you then have to recover afterwards. You you you can't exist on chronically on less than 6 or 7 hours of sleep per night. It will negatively impact your health. We know that it has a negative impact on your gut through multiple neck mechanisms. One is probably because melatonin is helpful for the gut. This is why and you release melatonin when you sleep. Some trials in IBS have shown me give IBS patients melatonin and their IBS goes away. Um the other thing that was really interesting was was seeing that people who chronically sleep more than 9 hours of sleep per night also had impaired health. And That was interesting. And how we reconcile that is a little bit more difficult. I put forth the hypothesis in my book that perhaps these people have underlying health conditions that are requiring them to need more sleep. And so it's not actually the sleep itself, but it's it's a it's a artifact of the fact that they're hypothyroid and not being treated or or whatever and and it's skewing it's skewing the relationship. But if you chronically need more than 9 hours, you may want to investigate an underlying health element that's driving the need for that much sleep. All right, one thing that I really want to touch on that we've talked about before on the show. I'm really fascinated by it, but I'd never heard anybody talk about it like you do, which is fasting or more specifically to you modified fasting. Right. And then elemental dieting, which I I literally had never heard of till I read your book. Right. Um what are those, why are they useful, how can people put them to good use? So, part of the the step one in the book is meal frequency. And and there's debate here, right? You have the bodybuilding fitness community, eat every 3 hours, small meals. And for some people that works really well. But we're also learning that fasting or it's also known as intermittent fasting, essentially taking time without food, can be health promoting for your gut. And there's at least one trial in inflammatory bowel disease and one trial in IBS that have shown you can improve one's gut health by taking periods without food. Now, often times the question is asked, well, won't that slow down your metabolism? So, we reviewed this issue and most of the data shows no change in metabolism. There's a couple of studies that show metabolic benefits. So, the the data tend to show a neutral effect on metabolism or slight benefit. And so, what we recommend in the book is a modified fast where you have essentially bone broth or this cleansing lemonade, so they get some calories in because for some people doing a strict water-only fast, it's hard, right? They they they're they're under too much stress in other aspects of their life, so it's hard to do a strict water fast, although I'm totally open to that. But we give them a little bit of caloric caloric support and we have them start off with a 2-to-4 day liquid fast. And for some people it can be a very powerful reset for the gut. And if someone responds well to that, we have them experiment with larger, less frequent meals, like two larger meals a day, and this could be also labeled as intermittent fasting. Now, for some people that doesn't work and they eat more frequent meals. But that that is such an easy thing, right? No testing, no supplements to buy, just change your meal frequency. And will it fix everyone? No, but will it be significantly helpful for some? Definitely. For people who have failed out of everything else, an elemental diet can be very helpful. And an elemental diet is is essentially picture a protein shake, like that's a complete meal replacement. It's devoid of any colors or fillering or fillings. It's hypoallergenic and gut-friendly. And this can be used to both heal the gut and starve overgrowths of bacteria. And people can do this for anywhere from 2 to 4 days up to 2 to 3 weeks. Now, if someone has severe IBS or severe IBD, then doing a liquid-only meal replacement for 2 weeks can be a cathartic change for them. And it's not actually that hard to do. I've done 4 days exclusive on on the elemental formula that we put together, and I felt great. I had laser-like focus, didn't have to worry about shopping, cooking, eating, cleaning. Now, some of the elemental diet formulas in the market are horridly bad-tasting. And invariably, if someone goes on the internet and reads about one of these diets, they will hear, "Ugh, they taste it terrible." This is true for the more antiquated versions. But, there you know, the version that we recommend and we put together, which is Elemental Heal, but the Elemental Heal is very palatable. How many people make a shake, a smoothie in the morning, and just rush their way to work, right? So, it's not that foreign of a concept, really. And for some people, that can be um very, very helpful for for their gut. Um so, I just want to make sure I I add that in. Now, I'm actually glad that you brought that up. So, I was reading your book, I came across that section, and never heard of it, dove into it. I actually went and ordered um the Elemental Heal. Super excited to try it. This is in no way a commercial, by the way, but the whole notion of digesting food at some point is a stressor, and if you want to give your digestion a break, then give this a shot. And the reason I wanted to try it, all of a sudden, I started breaking out in like a little rash. And what was little at first became gigantic. Everyone was telling me that, "Oh, it's got to be your laundry detergent, or you know, something you you've come into contact with something." And because I'm so obsessed with the microbiome, I was like, "I'm telling you this is something I'm eating." But, I could not, for the life of me, figure out what it was. And so, I tried like pulling things out of my diet, reintroducing them, but never the the sort of mainstays in my diet, I thought, "Well, I've been eating them for years, so I didn't pull them out." Then reading your book, I come across foods that are high in histamines, and one of them is cured meat. And I eat a metric ton of cured meat. So, I was like, "This motherfucker." So, ta- talk about like I didn't even know that there was such a thing as high histamine food. That's probably one of the things that after you've gone through some of the other foundational pillars, that'd be on rung two or three of the pyramid. But, it can be problematic. And and essentially, histamine is a byproduct of fermented and cured foods. And some of these foods, again, are are paradoxically health- healthy. Um kombucha, sauerkraut, kimchi, avocado, uh canned uh tuna, or canned salmon. And you wouldn't think that they're unhealthy, and and they're not unhealthy per se, but we all have a different ability to drain histamine out of our systems. And so, if you're pouring histamine into the sink faster than the drain can clear, eventually you tip over. And then the the tip over symptoms can be neurological, brain fog, insomnia, dermatological, rashes, um flushing, and I had that as well. rheumatological, joint pain, or gastrointestinal. And I had that same problem, actually. And this happened to me maybe 4 years ago, where I was all sudden just having these these moments of cloudiness and irritability. And it's a beautiful sunny day, everything's going well, I'm sitting there on my computer writing an article that I'm passionate about, doing what I love, and I'm just feeling irritable. I'm just sitting there like, "What what the hell?" I'm just in a bad mood. And I figured out I was I was kind of eating the lazy man's paleo diet. Jerky, avocado, spinach, kombuchas, sauerkraut, and all those things were were high in histamine. So, I was just inundating myself with hi- high histamine foods. A simple maneuver of just reducing my histamine load, and in like a day, I felt better. Wow. So, sometimes these things aren't they're not as bad as you might think, right? You might be having a rash and you're like, "Oh my god, what's wrong with me?" And you're thinking, you know, what's what's going on and what could this be? Sometimes it's just a simple dietary observation and tweak that you can make, and then you're fine. Mhm. No, it's so incredible, dude. I really feel like we're the transitional generation. It's like when you live in a dingy apartment, you flick the lights on and the cockroaches suddenly you see them everywhere. It's like people just they all have these problems. It is nuts. Every time I people ask me what I do, it's I have this or my wife has that or my cousin has this or my father has that digestively. It it's amazing to me how prevalent these things are. Dude, it's crazy. And because it's embarrassing, people don't want to talk about it. And so, that was part of the driver behind the show was part of what was really bothering Lisa in the beginning was the shame. Right. She just had shame around it. When she finally got over that and was like, "I want to start talking about this openly." And then she started really impacting people and and it it's just it's so powerful, man. And I'm so excited about the way that you in particular approach this. Um and to that point, before I ask my last question, tell these guys where they can follow you online and really engage with you. This stuff is really powerful. Um so, thank you. It's nice to see people appreciating it because um if I can make someone feel better, in my mind, that's that's the biggest gift I can give to someone, right? I'd love to be able to make you a millionaire, um but if I could either have you be rich or feel good, I'd rather you feel good first. Then you'll have the energy to pursue becoming a millionaire. Um but everything can be accessed through drruscio.com, d r r u s c i o.com. The book is Healthy Gut, Healthy You. We have a weekly podcast, video, and article. And if you're a healthcare provider, we also have a subscription access monthly clinical training newsletter where we go into case studies and and research studies. Um you know, if you wanted to try to learn more about this and uh that's the long the long short of it. No, man, it's great and and yeah, people should definitely follow you. Um if you were going to make one recommendation that would have the biggest impact on somebody's health well-being, what recommendation would you make? Well, at the risk of of sounding self-aggrandizing, I would read my book. I took 3 years and and painstakingly tried to give someone the most complete resource I could give them for improving their gut health. Um so I I would say improve your gut health um or take steps to optimize your gut health. It's not a guarantee. It's not a panacea, but that would I think be the most impactful thing people could do. Um if it was non-health related, I'd say make sure you're pursuing your purpose cuz like that that Nietzsche quote I shared before, I always love to end with that, which is he who has a why to live can overcome almost any how. So if you have that why, that thing that you're doing that you're passionate about, it helps you get through some of the difficulties of not feeling well. And so make sure not to forget about the life that you're trying to to pursue and and your your mission and your vision at the expense of your health and and and keep that North Star in your in your vision. That is an amazing answer. Dr. Ruscio, thank you so much. Thank you. It was a pleasure. Guys, guys, guys, guys, when I tell you that if you've ever struggled with anything even remotely related to digestive issues, this is the man that you want to follow. This is the very first newsletter that I signed up. This is the first person that really gave me a sense of hope that there were answers out there. It has been incredible. I read that book. It is amazing. It is really simple, very accessible, and yet has the meat. It's robust enough for you to really get those principles. And that's what I love about his approach is he understands it comes down to there's only a few principles. And when you really understand those, when you really understand how this is all interconnected, how it's affected by diet, what choices you make, what the knock-on effect that they have is, then you can really begin to make optimal choices that help you no matter what your problem is. And the fact that he's able to talk about things like forest bathing and getting sun exposure, and he's not just trying to be pushing people down a funnel of this is my dogma, this is what I think, go do it. He's really looking at the peer-reviewed studies and making decisions based on that, but something we didn't even get to talk on is he's saying that there's even a level beyond that, and if something is working, it's working. And so, even not being afraid to go beyond what there's evidence for if you're getting something um experientially with it, to trust that, to trust your body, to really learn to listen to yourself, just incredibly powerful. Everything about his demeanor is just amazing. And I know how scary and frustrating it is when you feel lost in a health problem, and this man, more than pretty much anybody I have ever come across, is that beacon of hope. It's just super rational. It's just like you saw today, it is very even-keel, very direct, very straightforward. I think you will get a lot out of it. So, I hope that you will follow him. I hope that you will engage. I really think you're going to get a lot out of it. If you haven't already, be sure to subscribe. And until next time, my friends, be legendary. Take care. Man, dude, thank you. It was amazing. Thank you, guys, so much for watching and being a part of this community. If you haven't already, be sure to subscribe. 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