This week’s Gluten Free School Podcast chats with Dr. Michael Ruscio on how gut infections could trick you into believing that you have other conditions which never improve when treated.
Plus we dive in deep to talk about why Functional Medicine is so expensive and how you as a patient can realistically bring down the costs to suit your budgetary needs.
Gut Infections + How to Save Money on Functional Medicine with Michael Ruscio, DC
The following points were discussed:
00:31 — Introducing Dr. Michael Ruscio and how mysterious ailments at age 23 lead him away from conventional medicine to study gut health and functional medicine.
03:44 — How gut dysbiosis and inflammation can mimic thyroid issues and the importance of finding the root cause of health issues.
06:29 — The various types of gut infections, on all ends of the spectrum, and their different symptoms.
10:41 — Jennifer’s experience with parasites, why she wears shoes even inside her home and how to tell if your health issues are food related or something more, like a gut infection.
13:59 — What type of health care provider to approach for proper diagnosis, information and care.
15:33 — Why seeing a functional medicine provider can be expensive, and how to find a cost-effictive practitioner.
19:26 — Conventional and natural options to treating parasites and other gut issues, and why Dr. Ruscio recommends one over the other.
23:12 — Saving money using standard tests, covered by health insurance providers and how a functional care provider can work them into your overall health care plan.
25:31 — Once a proper diagnosis is reached and treatment starts, here’s when you can expect to start feeling noticeably better.
26:50 — The connection of leaky gut, gluten intolerance or celiac disease with gut disorders, and why leaky gut is not always the root cause.
29:21 — How to get more information and contacting Dr. Ruscio, no matter where you live.
Then take a moment and leave a review on iTunes sharing what you’ve learned and why others would benefit from subscribing as well!
Jennifer: Welcome back to the Gluten Free School Podcast. I’m your host, Jennifer Fugo. Today, we’re going to talk about gut infections, dysbiosis and SIBO and how they might be causing you to still not feel well regardless of whether you are gluten-free or not.
Now, I’ve got a really great guest who’s decided to join us today. His name is Dr. Michael Ruscio and he is in clinical practice in northern California where he specializes in functional medicine.
He’s a member of the Post-Graduate Continuing Education Faculty at Life West and he’s currently working on a book on hypothyroidism and lectures to doctors nationally on functional medicine.
Welcome to the podcast, Dr. Ruscio.
Dr. Ruscio: Hey, Jennifer. Thanks for having me.
Jennifer: So why don’t you give us a little bit of background on yourself and how you got so interested in this topic, in this focus we’re going to talk about today.
Dr. Ruscio: Sure, sure. It’s actually a really interesting story. I think a lot of clinicians have their own kind of experience that guided them on their path and I was certainly no exception to that.
In my undergraduate studies, I was a pre-med planning on going into conventional medicine. I wanted to go into orthopedic surgery. It just seem to kind of fit. I was always pretty athletic. I played college lacross.
So I’m kind of cruising along in life. I’m about 23 years old, I was a personal trainer, I was eating all-organic food, gluten-free, sleeping, exercising. I’m doing everything the way one should. And all of a sudden, I started having really bad insomnia.
I would wake up five times a night. It would be incredibly difficult to fall back asleep. I was fatigued during the day. I started having bouts of depression, irritability. I started noticing that I was getting cold, which I was always the guy who was hot. I was always the guy turning on the fans or the air-conditioning. And all of a sudden, I started feeling cold. I started noticing my skin was kind of getting dry, my hair was getting thinner.
At 23 years old, you can only track those things up to age. So I knew something clearly had to be wrong.
I went and I saw my endocrinologist, my internist and my GP. None of them found anything.
I found myself in that very precarious situation a lot of people find themselves in, which is you know something is wrong with you, but all of the health experts say nothing is wrong with you. And so you feel you’re kind of banging your head against the wall.
And then it wasn’t until I found a DC that specialized in functional medicine as I do now that I actually figured out I had an intestinal parasite. That was what was really causing all of my problems. It was a little bit of a journey getting all that sorted out, but it taught me a really valuable lesson, which is you can be doing everything right, but if you still have a disorder in your gut, that can cause really still be ill.
And so that’s what led me to go into functional medicine. I’m very passionate about this topic, specifically within the scope of functional medicine because of my own experience. And now I have the great fortune to be able to help other people who are in a similar situation recover their health.
Jennifer: Well, I’m curious because the symptoms that you were describing – you were saying you’re cold and you’re losing your hair, they almost sound like a thyroid issue.
Dr. Ruscio: Right! The interesting thing is is that the gut has such far-reaching effects that it could cause symptoms that look like so many other sorts of conditions.
I had some symptoms of low testosterone because I was tired, I was getting grumpy and my libido was always going down. I had some symptoms of hypothyroidism – thinning hair, dry skin, fatigue, feeling cold. I had some symptoms of just depressive disorder or major depression.
A lot of that comes back to how if there is an imbalance in the gut, that can cause inflammation and how inflammation can just have such a devastating effect.
So in my case, the thyroid gland was fine, but all the inflammation coming from the digestive tract, the parasite that was in the digestive tract was interfering with the ability of my thyroid hormone to work properly.
It’s a common problem that is found with people where their thyroid gland itself is okay, but the thyroid gland produces hormone and that hormone then has to be metabolized in the body in order to have an effect.
Inflammation can blunt that process. So people can have normal functioning thyroids, but they could have symptoms of hypothyroid because of inflammation.
Jennifer: Wow! Really interesting stuff. And so this all guided you down this path and now you work with patients that are struggling with this whole slew of symptoms – you know, as you’re describing that, I’m like, “Okay, it looks like you got that and you got this one…” and we just keep checking off the boxes of what you might have, but in reality, there was one key problem. So that in essence underscores the necessity and the importance of really determining what is the problem.
Dr. Ruscio: Absolutely! Absolutely! And one of the things I learned from it was I went out and I did a lot of research on the Internet and I kind of self-diagnosed myself with hypothyroid and low testosterone and all these other things.
And so I started trying some of these natural treatments for adrenal fatigue or for low testosterone or for hypothyroid. Some of these were marginally helpful, but nothing really fixed the problem.
To your point, I wasn’t finding the cause of the issue. And so all the self-treatment stuff I was trying to do was really in vain and really wasted a lot of money because unless you’re treating the cause of an issue, you’re just really using a band-aid approach, which is only going to work in the short-term.
Jennifer: And so you said you had this issue in the gut. There are different types of gut infections that folks out there can get, yes?
Dr. Ruscio: Yes.
Jennifer: What are some of the gut infections that people can get?
Dr. Ruscio: Well, we won’t be able to pin in to kind of this compendium. At the one end, you would have just the normal stuff in the gut that’s gotten out of balance known as dysbiosis. I’ll come back to that in a minute.
And then at the other end of the spectrum, you could have an overt parasite infection. That organism shouldn’t be there and will just cause harm.
So you kind of have these two ends where you can have on the one end, let’s say we all have healthy fungus in our gut – maybe you’ve heard of it as Candida, Candida or fungus. They’re what’s called symbiotic. They do good stuff for the host and so in exchange for that, we allow them to reside inside of us and offer them shelter and food and water. That symbiosis is a mutually beneficial relationship.
But sometimes, those fungus or bacteria that participate in these mutually beneficial relationships can get out of balance, they can overgrow or they can grow into parts of the intestinal tract where they shouldn’t be. And so then they can start causing problems.
Now, Candida or fungal infections are fairly well-known. That’s when the healthy Candida or the healthy fungus can, again, overgrow. They can cause things like fatigue, brain fog, bloating, intolerance to carbohydrates. Some of the most keynote symptoms. For some people, bad breath, body odor and even rashes can be caused by Candida.
And then there’s also when the bacteria can overgrow. This is a condition known as small intestinal bacterial overgrowth (SIBO). This is where the bacteria in the colon outgrow into the small intestine. They can cause significant damage when they get into the small intestine because they shouldn’t be there.
For these people, the classical symptoms can be gas, bloating, abdominal pain, constipation or diarrhea or both. And for some people, it can also even have weight loss. So that’s small intestinal bacterial overgrowth.
And then on the other end of the spectrum, you have things like the parasite I had, which was amoeba histolytica, which can cause really bad diarrhea – and diarrhea so bad that in third world countries where they don’t have the ability to rehydrate people, it can cause dysenteric death or death secondary to dehydration.
It doesn’t always manifest that severe of an extent. When I had this parasite, I didn’t really have many gastrointestinal or digestive symptoms, but all my symptoms were the byproduct of the inflammation that that organism was causing.
This particular parasite causes inflammation because it actually cuts into your intestinal tissue. It’s called histolytica – histo means tissue, lysis means to cut. And so that’s why it has this name, amoeba histolytica because it actually cuts into your intestinal tissue and it can travel where ever it wants to in the body.
So it’s a pretty significant infection to have. And then there’s other things like maybe Giardia, which you can get from drinking contaminated water or Cryptosporidium or toxoplasmosis, a number of infections.
And sometimes, the symptoms are predominantly digestive in nature. So you may have abdominal discomfort, bloating, flatulence, abdominal pain, diarrhea, constipation. But in a lot of cases, there are some of those digestive symptoms going on, but there’s also these other symptoms like I was mentioning I had before, which could be fatigue, low libido, thinning of your hair, feeling cold – some of these symptoms that look like a thyroid disorder or a hormonal imbalance.
So hopefully that, in a long-winded way kind of answers your question a little bit.
Jennifer: Well, yeah. And I actually wanted to add that – so when I found out that I was gluten sensitive, I was off gluten for about eight weeks. And at that time, I had decided to then go and take a trip down to Costa Rica. I unwisely decided on this trip to walk through a stream, a fresh water stream barefoot because my shoes were slippery. It’s slipping on the rocks.
When I got home, I had all these digestive problems all over again and I couldn’t figure out what food – I was like, “Maybe I’m getting glutened, maybe it’s other food.” I did all these eliminations and I was like really anal about keeping gluten out.
It turned out (because I eventually gave up and had to go back to a nutritionist to figure out what was going on) was that I had a parasite. I had gotten a parasite through my foot walking on that stream, which is apparently very common. The foot is one of the major entry points for parasites. I have come to learn since then that especially if you have dogs and cats, ones that go outside and then come inside, they track in parasites a lot of times, which is why I wear shoes inside my home because I have two cats.
But it’s really interesting that a lot of people think that they figured it out, “Oh, I’ve got to be gluten free. I’ve got it nailed. I know what to do.” And then you just don’t feel better. That’s not always the problem. Or like you did, you go on the Internet and you self-diagnose, but you still don’t feel better.
So what is someone to do? How do you even begin to start figuring out if maybe one of these issues is really your issue or maybe one of the problems?
Dr. Ruscio: Well, I think definitely the most important first step is to clean up your diet. If it is a dietary issue, you want to address it there and not have to go any further into the medical system to get it figured out. So I think a good, prudent first step is to go on the Paleo diet or maybe even better, go on the Autoimmune Paleo (AIP) diet for 30 days, which is the Paleo diet with a few more restrictions.
Essentially, the big picture is what you want to do is you want to come off all foods that may be inflammatory for about 30 days and see if you feel better. If you feel better, you know that the issue is food-related. If you don’t feel better, then you have to move on.
That’s where I think some people get caught up. They keep going around and around and around on the food merry-go-round and like you were saying (and I did the same thing), I kept such a detailed journal of the foods I was eating and how I felt.
So if you get to that level where you’ve already cut out gluten, dairy, grains, maybe eggs and nuts and seeds for 30 days, you really cleaned up your diet and you’re not feeling any better, then you should move to step two, which would be looking into some kind of gut infection.
Jennifer: And who would be a good person – I mean, obviously, they could see you. But if someone is in a community and they’re saying, “Okay, should I go to my primary care doctor?” Who do you even go to to begin down that path because I think a lot of times, people have no clue where to even start?
Dr. Ruscio: Right! In my own experience, as a testament to that, I saw three conventionally trained doctors and didn’t really get anywhere, so it’s a great question.
My clinic does offer phone consultations. So if people did want to try to contact my office, that is one option for them. That is something that we can accommodate if people need some help there.
Secondary to that, if you want to work with someone more local to you, you can look for a functional medicine provider. Functional medicine is kind of this new alternative medicine movement that – to put it really succinctly – is this is really trying to treat the cause of disease in the most natural way possible.
Different sorts of doctors can practice functional medicine. You can have a conventional medical doctor practice, you can have a naturopathic doctor practice, you can have a PhD practice, you can have a doctor of chiropractic practice, you can have a licensed acupuncturist practice, you can even have a nutritionist practice.
Usually, they affiliate with another doctor so they can do lab testing and do that kind of stuff integratively, because lab testing is an important part of functional medicine.
So you want to look for someone that practices functional medicine, but I want to provide a really important qualifier. This is something that we talked a lot about when we were at the PaleoFX Conference together.
Not all functional medicine providers are sensitive to trying to keep their care cost-effective. I think that’s a key issue because when the patient presents to a doctor’s office (kind of like we’ve been talking about), you come in with symptoms that could be thyroid, it could be male or female hormone, it could be neurological, it could be digestive.
So the patient presents with symptoms in multiple systems. A really astute clinician will be able to determine where those problems are coming from, what system is the system responsible for all these other symptoms.
They will do testing to be able to figure out exactly what it is and then treat that factor. And then if you treat the one causitive issue, all of the other secondary symptoms will go away.
And why I say that relevant is what some patients have expressed to me and one of my concerns with functional medicine is sometimes, the patient will be presented with a whole litany of tests. That may rack up a bill over a thousand dollars.
I’ve had patients come to me after working with a doctor like that —and not to say that the doctor has any bad intentions, that’s not what I’m trying to say at all— but I think sometimes as clinicians, we’re so concerned with the scientific aspect, we forget that, “Hey, there’s a price tag attached to each one of these tests. What can I do to try to be as conservative as possible?”
So the caution I would make for the person who is trying to find a functional medicine provider is try to find someone who seems like they have this conservative approach where they’re going to try to find the one or two problems that are causing all the symptoms.
And if you start getting a narrative or a description from the doctor or from the doctor’s office that you have to sign up for lots of testing and it’s going to be very expensive and it’s thousands of dollars to get started or you have to sign up for this care plan that’s a lump sum of x amount, I would really caution to maybe look somewhere else because you may be able to do it in a more cost effective manner.
Jennifer: And a lot of times, functional medicine physicians don’t take insurance. So for folks, especially those who are not on the upper end of the financial scale, it can be challenging. I know you said it’s like a thousand dollars. Well, I think it was well over a thousand dollars for me to find out my food sensitivities in 2008. I would imagine it’s probably more now.
So I too, I do caution people of being very careful and judicious about what they choose to do because you can go down rabbit holes that don’t necessarily serve people at the end of the day. You may have just spent a lot of money to know nothing.
And so I do recognize that. I think that for these types of issues where there is, like you said (the conversation started there), the signs and symptoms look like so many other things. It becomes frustrating to figure that out. And then you end up at a doctor’s office who then charges you $2000 or $3500 or $5000 and you have no answers at the end of the day. That’s very frustrating and it leaves people no money, no space to afford food.
Dr. Ruscio: Right, right. Right.
Jennifer: Like you said, starting a nutritional protocol might be a good way to go from the get-go and then you could actually bring that information to your doctor, to this person and say, “Well, this is what I’ve already done and this is not working.”
So as far as gut infections are concerned – I definitely want to make sure that people know that they are solvable – what are the easiest ways to go about or maybe the most typical ways to go about resolving them should you find out that you have a parasite or SIBO, for example?
I mean, I don’t want people to leave this conversation going, “Am I stuck with a parasite for life?” It’s kind of horrifying to think of that.
Dr. Ruscio: Sure. Well yes, they’re actually treatable. There’s maybe two sides to the treatment plan. There’s the more conventional medicine side and there’s the more alternative medicine side.
Of course, the alternative medicine side is the side that I more so practice in and resonates with me, but I always like to give patients information on both sides. So really, what you have to achieve is you have to use some kind of agent to eradicate the infection.
Now in conventional medicine, antibiotics are what’s administered. Now, depending on the type of infection you have, you may use Flagyl, like an anti-worm agent or albendazole or a statin for a fungus or Rifaximin, another antibiotic for small intestinal bacterial overgrowth.
So depending on the infection you have, there will be some sort of pharmaceutical antibiotic that’s able to treat that infection.
But the other side of that coin is many of these organisms now are building up resistance to antibiotics because of over-utilization of antibiotics. Also, antibiotics tend to cause some collateral damage. Some antibiotics can cause rebound fungal infections or rebound bacterial infections.
So while in some instances, I do think it’s a good recommendation for patients to use an antibiotic, usually I prefer to go the more natural route. That’s where you have herbal antimicrobials, I like to call them. They’re just herbs that have antibiotic properties. They tend to take a little bit longer to work, but they don’t cause the collateral damage.
So you kind of think of a pharmaceutical antibiotic like dropping a grenade and you can think of the herbal antibiotics like a sniper team. Now the sniper team may take a little bit longer to get there, identify the target, kill the one target and get out, but they’re just going to kill that one target, whereas the bomb or the grenade is going to do it quickly and maybe easily, but it’s going to cause significantly more collateral damage.
The other thing about the herbs that I like is many of the herbs, in addition to not only being able to kill a bacteria or a fungus or a worm, many of them help to lower blood sugar and have anti-inflammatory effects as well.
So infections are definitely treatable. There’s a range from pharmaceutical to botanical or herbal interventions. And depending on the person and the case and their situation, either one can work, but I think for most people, the herbs tend to be a little bit better all things considered.
Jennifer: And do you find that in determining some of these things, maybe some of the standard tests that you could get through your local physician’s office (like a stool test), some of those other things, do you find them to be effective in determining if folks have parasites and such?
Dr. Ruscio: Well, I’m really glad you asked that because I think most functional medicine providers, their answer to that would be you have to use a specialty lab in order to figure these things out. You have to use a specialty lab that doesn’t take insurance and that’s the best way to handle this.
That’s the old paradigm. That’s actually how I was originally trained in my functional medicine training. But I’ve really been questioning that belief and I’ve been using the functional medicine specialty labs that usually, you have to pay out of pocket for alongside the insurance labs that will accept the patient’s insurance.
I have to say, the results in a lot of cases have been equivalent. So it is possible to have a lot of these tests done through insurance. I will use Lab Corp or Quest Labs that are probably two largest reference labs in the country. Any conventional physician will have familiarity with both of those labs and will have the ability to order these labs.
The question is though, are they going to be familiar with the markers, are they going to be familiar with what tests to run and are they going to be comfortable with doing that? Because if you go see your primary care physician and he doesn’t really know much about gastrointestinal infections and you want him to do a full work-up that would test every infection that might be probable, well he just may not know what they are.
So the markers are there. The lab can do the markers, but he may not know what all the markers are. So there is the ability to do it through maybe your primary care or your GI doctor or your endocrinologist, but they may not be comfortable with it or they may not have the familiarity with it.
But a good functional medicine doctor should be able to incorporate some of those insurance tests into your testing plan so as to help mitigate the bill.
Jennifer: And once you go through the test, you get some straight answers and you’re like, “Okay, I’ve got to deal with a parasite” or whatever it is that comes up, how long does it usually take to feel better, some change that’s noticeable if say you have a parasite or you have SIBO? Is it a few weeks? Is it a couple of months? What can people expect?
Dr. Ruscio: For some people, it can be as fast as one or two weeks. For other people, it can be a few months. It really depends with what’s happening underneath the surface.
If it’s something like a fungal overgrowth, oftentimes those respond very quickly. As soon as the fungus is gone, they stop producing so much gas and metabolic biproducts. Your bloating gets better really quickly. Your brain fogs after meals gets better really quickly and so does your fatigue.
If it’s a parasite that’s causing a lot of damage to the intestines like the one I had, once the infection is cleared, you don’t feel a lot different right away because it still takes weeks and weeks and weeks for all that damage to heal itself.
So depending on the kind of infection you have, it can be one or two weeks or a few months. But usually, worst case scenario, usually after one or two months, someone is starting to feel better, if not significant better.
Jennifer: And one last question because I do think this is important for people to know. If you’ve got leaky gut (so you’re gluten sensitive, you have Celiac disease or whatever you’ve got that is contributing to this leaky gut issue), do you think that that makes one more susceptible to end up with one of these problems?
Dr. Ruscio: Yes. Let’s say you’re gluten intolerant and you’re eating gluten, that will cause suppression of the immune system in your intestines and damage to your intestines that will make you more susceptible to infections, so absolutely.
And then the other part of that whole conversation is oftentimes, patients come in concerned about leaky gut, but really leaky gut is usually a symptom of the infection. So patients come in saying, “I have leaky gut, that’s why I have all these food allergies,” but really, what may be happening is you have an infection that’s causing leaky gut and that leaky gut is causing the food allergies.
So the key is not necessarily to treat the leaky gut, but it’s to treat the cause of the leaky gut. I’ve had some patients who have gone out and they’ve spent so much money on supplements, they’re taking a bagful of supplements that cost them $300 a month, and they’ve been doing this for four months and they still haven’t gotten any better, well at that point, you really have to say, “Okay, maybe I need to try a different approach to get this moving in the right direction.”
Jennifer: And I think that’s a really valid point. I talked about leaky gut on the blog. I’ve had other people on the podcast who talked about leaky gut, but at the end of the day, you’re right. If you don’t know what the root cause or the reason for the leaky gut is, it’s no different. Leaky gut then is no different than saying, “Oh, I have a stomach ulcer.” You don’t really know the why and the why is really so critical.
Dr. Ruscio: Exactly.
Jennifer: That’s something I want to stress to everybody. Even though we get a leaky gut diagnosis, that’s not the end point. There could be other reasons behind that and it’s important to know why because how much L-glutamine, slippery elm and all these other gut-sealing and healing type of supplements you can take and spending, like you said, hundreds and sometimes thousands of dollars on different therapies and supplements and such, it’s not going to resolve the underlying problem if leaky gut is just a symptom of the problem.
So thank you so much, Dr. Ruscio for joining us. I really appreciate that. This was clarifying and actually very enlightening because not many folks talk about the cost-effectiveness and how there can be a sense of overzealousness in just to test, test, test, test, test and you drive someone into a really deep financial hole.
So I really appreciate all the information that you shared. Thank you so much for joining us.
Dr. Ruscio: Absolutely! My pleasure.
Jennifer: So everybody, please stay in touch with Dr. Ruscio at DrRuscio.com and also, PaleoThyroid.com. He’s got great information over there. And like Dr. Ruscio said, if you’d like to reach out to him, you’re more than welcome to do so. He does see clients no matter where you live.
Remember to subscribe, rate and review this podcast and then head on over to Gluten Free School and leave your comments and questions on this podcast about whatever you like – maybe it’s a topic we’ve talked about today or you have some other question you’d like to ask Dr. Ruscio about.
Thank you, guys so much for joining me and I look forward to seeing you the next time. Bye bye.
The links referred to in this episode are: