The Healthy Gut Podcast Episode 12


the healthy gut podcast episode 12

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sleep and thyroid issues with sibo

From time to time we all become concerned about whether we are getting enough sleep, especially when we have SIBO as our bodies need time to rest and recuperate. It can be hard to know how much we need and why we need it.

In this episode of The Healthy Gut Podcast we investigate sleep and thyroid issues with Dr Michael Ruscio.

in today’s episode

In Episode 12 of The Healthy Gut Podcast, we discuss:

✓ Understanding the link between sleep and gut health
✓ Why too much sleep can be just as bad as too little sleep
✓ We look into the three key elements of sleep, duration, integrity and rhythm
✓ The impact of hormonal issues on sleep quality
✓ How to tackle low blood sugar at night
✓ The link between your adrenals and your hormones

resources mentioned in today’s podcast

connect with dr michael ruscio

Dr Michael Ruscio

Dr Ruscio gives smart, busy people suffering from symptoms like daily bloating, constant fatigue and unexplained weight gain, simple steps to start living a healthy, enjoyable life again, no matter how long you have been suffering for.

Specialising in autoimmune, thyroid and digestive disorders, Dr Ruscio has spoken at the SIBO Symposium Summit, Paleo FX, Ancestral Health Symposium, Sean Croxton’s Digestive Sessions, as well as many other International conferences and top health podcasts.

Find out more about his simple evidence-based approach to healing chronic illnesses here


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about the host

Rebecca Coomes

rebecca coomes

Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.

Read more about Rebecca >>

podcast transcript

REBECCA:  Welcome to the Healthy Gut Podcast Dr. Michael Ruscio. It’s great to have you here today.

DR. RUSCIO:  Great to be here. Thanks for having me.

REBECCA:  and I got to see you at the SIBO symposium in Portland in June of 2016 and I really enjoyed your presentation there and it is so great to be able to have you on the healthy gut podcast so that we can talk more around gut health and how it impacts something that is so important to all of us – sleep and also talking about adrenal fatigue today which I am really interested in. so it’s going to be great to have you on the show.

DR. RUSCIO:  Looking forward to digging in to some of the details.

REBECCA:  yeah. Now I would love to know like your story. How you came to be a doctor and why you have an interest in gut health?

[00:56] DR. RUSCIO:  Well I’ll give you somewhat the abridged version because it is a bit of a lengthy story but it takes us all the way back to my college years were I knew I wanted to help people and I was kind of trying to figure out exactly what I wanted to. I was pre-med. I wanted to into conventional medicine. I was thinking maybe about going to orthopedics just because I was an athlete. But in college I went from being an athlete that my whole life I had had boundless energy, always felt great, super optimistic, super happy all the time. Everything was great. And then over the course of maybe a month or two I started having really bad insomnia waking up like every 30 minutes which was maddening. Having cravings, I still remember this because I was so into health and eating healthy but I would wake up at 4 o’clock in the morning unable to sleep to sleep and craving chocolate. And I would get in my car and I would drive to the local gas station and buy a candy bar. The whole time, my inner dialogue is saying, “What the heck are you doing? Why are  you eating this junk food? You know it is not good for you?” but I couldn’t over ride my cravings and I would cave. And I also was having fatigue during the day. I was feeling cold for the first time in my life. I was in a lot of fatigue and also mood dips. And eventually I started having really and reactive brain fog were I would eat something and just feeling a fog for at least a couple of hours afterward.

I think that is most of the symptoms is a very unpleasant compendium there and clearly I knew something was wrong. And so thinking to myself, well I’ll go see a doctor and this is what doctors are for right I figured, go see one. They’ll tell me what is wrong. I’ll see one. They’ll fix it. I’ll get right back with my life and it will be no problem. And I ended up seeing three doctors and they all said everything is normal. And so I found myself in that very challenging position and I think, “A lot of people find themselves which is you know something Is not right but none of the doctors have anything that they have found wrong with you.”

And so I eventually found my way into the field of functional medicine and ended up seeing a functional medicine doctor that told me he thought I had a parasite. And I remember thinking to myself, “This guy is full of BS. There is no way. I have no digestive symptoms. I have never been out of the country. I don’t have the diarrhea one would associated with a parasite but I  figured, I’ve got nothing to lose.” So I will do a stool test which costs me $300 which to a college student feels like $10000 because you are on such a tight budget. But did the stool test. We found a very pathogenic amoeba that was causing quite a bit of damage to by gut and it was treating that infection that really got me better.

And there is another component to the story that I should mention which is, before i found that doctor, I did a lot of reading on the internet and did a lot of self-diagnosis and self-treatment. I thought I had adrenal fatigue. I thought I had hypothyroid. I thought I had low testosterone. I thought I had mercury toxicity. And I pursued different self-treatment options even some of these are based upon lab testing were I had clinical high mercury in my urine and I performed months of detox but felt no better. I went on an adrenal support program and got a little bit better for maybe a month and went back to where i was before. So I wasted a lot of time and a lot of money pursuing symptoms rather than getting to this thing that ultimately was the only treatment that gotten better which was treating the underlying issue of the gut.

And so I brought that experience forward with me into my clinic and it’s  been interesting. Over the past several years where I had seen patients going through the same thing that I went through. They think they had adrenal fatigue. They think they have food allergies. They think they have heavy metal toxicity. And they end up doing all these for their self-help treatments with very little effects. Sometimes something is affected but a lot of people are floundering because they have overlooked and underlying problem in the gut and the other thing that I think adds to this and I am sorry for being a little bit wrong ended is there’s so much information available on the internet now. People are paralyzed by options. What I have tried to do with my work is really focus on the things that are the most effective and what turned out to be most effective for me which was treating a problem in the gut turns out to be the most effective for the majority of patients. I wouldn’t say every patient. It’s not a pansy, it’s not a guarantee. But certainly if you are floundering with what to do in all these different options, starting off with a very good evaluation of your digestive health before you do anything else is a very safe way and a good way to proceed. And so that’s what I am doing now in addition to performing some clinical research and writing a book. Trying to better this field of functional medicine to make the treatments more efficient and more cost effective for patients.

[06:32] REBECCA:  and I think that is really good advice to people who are listening to podcast today that quite often we can be very focused on perhaps the output rather than what the underlying cause is. And starting at the core root of something. Like something so important to our health is the digestive system can often be quite fruitful. For myself as well, once I started to deal with my digestive health issues, a whole myriad of other conditions improved. Conditions which I had been told I would just stuff off forever. They were either it was a genetic condition that had switched on or a reproductive disorder like endometriosis. And now that my gut is better, I almost don’t experience any of those other conditions at all because my gut health has improved so much.

[7:27] DR. RUSCIO:  It is truly amazing the power of the gut. And as you are saying that, it reminds me of one of my patients that I was reflecting on this case recently. He initially came to my office with a quickly none digestive related symptom, as you were saying. Rheumatoid arthritis, joint pain essentially as what this manifest as and he had also done some self-testing and he was positive for MTHFR gene polymorphism and you see a lot of this in the internet. And to be a bit frank and truthful, I think this has very little clinical utility because we don’t really know how to treat it and you’ll see some…I say this with all due respect and I am not trying to offend anybody but trying to get into people straight, were we really don’t know how to treat that finding and so this is a finding that made to put it loosely imperia toxification. This gentleman came in thinking that this was the cause of his rheumatoid arthritis. Really he ended up having SIBO and when we treated his SIBO his joint paint responded beautifully and went away. It was in a few weeks.

So it’s a key point. There’s a lot of stuff out there and it’s easy to get distracted by a lot of these things and sometimes these thing that turn to distractions may be legitimate things that people want to pursue. But if we can organize all of these into a hierarchy that’s going to make things more efficient. And so I really think that the best place to start is with your digestive health see that through to completion and then reevaluate and see what symptoms are still left. In a lot of cases, most of these symptoms, if not all the symptoms are done by the time that you can prove someone’s digestive health.

[9:18] REBECCA:  Exactly. And I am smiling as you are talking about your patient with the rheumatoid arthritis because prior to my SIBO diagnosis and improving my gut health, I was starting to feel quite concerned that I was developing arthritis. And I have broken several fingers and I played a lot of netball and I would notice that my fingers would get very stiff and sore and achy and I was getting quite a lot of lumps in them. But since my SIBO has been treated and I have been able to get rid of SIBO and I have worked on healing my leaky gut I don’t have it at all. It’s not even like it’s just been diminished. I just don’t have it and I would never have connected the pains and aches in my fingers and joints to my gut.

[10:10] DR. RUSCIO:  it really is amazing. Again, it reminds me of a study, actually a study that this patient brought to me months and months after we had started working together. And this study showed that a SIBO treatment known as elemental diet which is a liquid diet was actually as effective as the anti-inflammatory drug Prednisone in treating rheumatoid arthritis. So here we have a simple, dietary solution that treats SIBO and was as powerful as this very strong anti-inflammatory drug. I should just maybe mention for people who are listening. If you have heard of her, look into the elemental diet, you may hear that they are these horrid tasting meal replacement type shakes. And so the elemental diets or semi-elemental diets are treating SIBO, one essentially does a short term fast on these liquid. So it’s kind of like a protein shake and you just subsist on that from anywhere, from days to even severe cases to weeks and you consume this meal replacement liquid. And the older versions did taste bad but there has been some developments in elemental and some elemental diets over the past year or so were the ones available now are actually quite palatable. And so I just offer that for the person who is searching for another option. Maybe they have tried other SIBO options and haven’t worked well. They didn’t hear an elemental or semi-elemental diet. They go read up in it. They see all these people commenting that I could keep it down. It tasted terrible and made me nauseas. True, but this is for some of the older versions. Again, there are some newer versions that are now available that are quite palatable.

[12:03] REBECCA:  I tried one of those newer versions at the SIBO symposium and it was actually fine. It was quite a pleasant taste and I thought. “Gosh what are all these people talking about?” Because that was the first time I had ever tasted the elemental and I thought, “I could survive off this. I might get a bit bored of the flavor after a 14 day period for instance.” But it was totally palatable which was really good.

[12:27] DR. RUSCIO:  I have learned to make that qualifier because a lot of my patients when I first recommend the elemental diet to them, they are scared to death because they don’t realize that there are newer versions available that don’t taste that bad.

[12:39] REBECCA:  Yeah. Definitely. I would love for us to now talk a little bit about sleep. Sleep is obviously something that we… you never hear someone say, “Gosh I had too much sleep last night.” We are always talking about not getting enough sleep and I would like to talk today around the impact of your gut health and how that influences our quality of sleep and how that can lead to disrupted sleep or even insomnia. So I would love for you to talk a little bit about sleep and gut health.

[13:14] DR. RUSCIO:  My pleasure. And I may be mentioned that there is some key component to sleep which is if you sleep not enough, consistently not enough or consistently too much, both of those have both been correlated with poor health outcomes. When we went through a very exhaustive review of all the published literature on sleep and how it correlates to different health conditions and it is very clear that if you are consistently getting less than 7 or more than 9 hours of sleep that is correlated with things like increased risk for heart disease, diabetes, obesity, depression or even what is called all- cause mortality which is detrimenting cause. So it’s not just not enough sleep is the problem. Too much sleep can also be a problem. This was surprising to me when I came across this, but I think the reason… this is me speculating now but I think the reason why consistently getting more than 9 hours of sleep has been shown to be a problem is those are probably people who are sick, are not sleeping well, and therefore have to sleep longer hours to try to get the same amount of sleep. And it’s the fact that they are having a longer sleep but a poor quality. That probably is why they have a decreased overall health.

Let me pause there for a second in case you have any questions on that specifically.

[14:45] REBECCA:  I am fascinated about that point that too much sleep can also be detrimental. And I think I am fascinated because I don’t think I have ever had that issue. I fall into the other category of not enough sleep. I am the eternal night owl and forever awake. And I often laugh and say, “if I could never sleep that would be brilliant because I could get so much don if I had more sleep.” Quite boring at times which is not good and it has been one of my focuses on getting well again is really working on getting more sleep every night. I am so interested by that and I am sure the listeners will be as well. And I do wonder and I guess I am just kind of putting this to wonder out there to the general world and I don’t know if you have the answer to it but whether people with gut issues are more likely to experience like not enough sleep or whether they fall in to that over sleeping category?

]15:46] DR. RUSCIO:  let’s define some parameters for healthy sleep. The duration is important. How many hours? We just covered that. 7 to 9. That is the duration that one should be shooting for. The intensity of sleep is also important because if you are waking up every 45 minutes then that is poor sleep intensity. And then the rhythm or the timing of sleep is also important. For example, night shift workers have been shown to have an increased risk of the detrimenting cause and other metabolic conditions like diabetes, obesity, and what have you. So it’s not just the duration of  7 and 9 hours but it is also how soundly you sleep or the intensity and it is also the rhythm of your sleep and it’s important to try that… have your day, night or your sleep wake cycles oscillate with the day and night rhythm meaning,  you should be sleeping at night time and you should be awake during the day. So all three of these components are important but to your questions, “Yes, people that have…” and this has been published in the medical literature, well documented that people that have gastrointestinal conditions especially gastrointestinal inflammation have been shown to have things like insomnia and that might manifest as a hard time falling asleep, a hard time staying asleep or both and that is exactly what I had. What was paradoxical to me was that i didn’t have….i wasn’t like I was waking up and grabbing my abdomen in pain. That would be very obvious. I had no digestive symptoms yet my insomnia was hellacious and the reason for this is because you could have inflammation in the gut but doesn’t necessarily cause you to win some pain but it is not because of internal pain response that inhibits your ability to sleep well.

And so yes, one of the more common symptoms that I see improve when we improve someone’s gut health is their ability to fall and to stay asleep.

[17:50] REBECCA:  that is very interesting and I am thinking back to my gut and the impact that it used to have on my sleep. I think the most common thing that I experienced was if I had eaten something for dinner and had left me feeling particularly bloated or gassy and I had very visible bloating. I looked pregnant. I just could not get a good night sleep. Internally I felt like everything was all over the place and I would notice that on those nights particularly I would sleep really poorly. It was a lot of awake periods during the night. A lot of restlessness, inability to fall into I guess a solid or a deep sleep. Often up and down to the toilet a lot and that has really improved for me. I have slept soundly through the night. It’s a general rule now which is good.

What’s the process for it to actually lead to poor sleep?

[18:52] DR. RUSCIO:  I don’t know if there is one pathway and we definitely can even say it’s one pathway compared to another but there are some things that are certainly very probable in being a cause of the poor sleep associated with digestive inflammation or imbalances or what have you. Probably the most fundamental is how this causes the body to be in a chronic stress response. And there are many different terms that can be used in this regard. But just to put it simply, when you have inflammation or leaky guts or SIBO, all these things kind of manifest together so I think it is important for the listeners not to be overly wrapped up in the diagnosis of mechanism is happening. But when you have problems in the gut to put it simply, this creates stress in your body. And when your body is under too much stress, it throws off your stress hormone rhythm and the stress hormone rhythm is such that we should have more stress hormones at released during the day and little stress hormones released at night.

But if you were to think about perhaps you are at a period of your life were you are under intense stress. Let’s say you are going through a break up or you got fired from your job or there are some other emotional trauma. If we think back most of us can probably remember a time where we are under immense physiological or psychological emotional stress and we probably notice we weren’t sleeping well. This is because stress can throw off your stress hormones and impede your ability to sleep well at night and typically what this can look like is an alteration of what is known as the HPA access which again I think is getting far too mechanistic than what is practical. But this is the access between your brain and essentially your adrenal glands and this can cause you to have elevated levels of stress hormones at night. So it can be that you have too much, for example, adrenaline in your system at 2 o’clock in the morning that you should. And when you have a lot of adrenaline in your system it wakes you up. This is why some people feel like they have this racing mind at night. They wake up at 2 o’clock in the morning and they are thinking about all the stuff that they have to do the next day. And they can’t shut their mind off. And it’s really the hormones that are driving them up.

Now you can test the hormones but again that doesn’t tell you how to fix the problem which is why I like the kind of gut first philosophy that I had been crafting throughout this call which is focused on the gut and then the things that happen secondary to the gut can get better. But back to your question and to answer more directly, one of the primary mechanisms or probably the primary mechanism is how the chronic stress and/or inflammation is caused by a gut problem can throw off your stress hormones and then that interferes with your ability to sleep.

[22:03] REBECCA:  I’m sure there are people listening to this podcast who are thinking, “Oh gosh I suffer from poor sleep or insomnia but I didn’t know I might have a gut issue.”

Is there a connection or statistics in terms of if you are experiencing insomnia or disrupted sleep the likelihood of you having a gut issue?

[22:26] DR. RUSCIO:  that is a great question and I should know this because I am writing a book at the moment and we go pretty in depth in to the section on sleep and we talk about a few studies that correlate inflammatory bowel disease and IBS, irritable bowel syndrome and much of IBS made by SIBO. We talk about how this or these groups of patients have an increased risk for insomnia but on top of my head I can’t recall…maybe that the researchers provide  a percentage but I don’t have a percentage in terms of its 30% of 50% or 60% according to what has been published in the medical literature. But what I can say is that in the clinic the vast majority of patients that come in with sleep disturbances get better and the important thing to keep in mind there is that they don’t all have digestive symptoms but many of them tend to be better when we go through things to improve their digestive health because remember, not every digestive condition manifest digestive symptoms. So in terms of an exact percentage I am not sure but certainly many patients when improving their gut health see their sleep improve.

Now there are some other things to be considered here also, something that can also happen that can contribute to insomnia is low blood sugar at night. What is normally known as nocturnal hypoglycemia. And a simple solution to this can be twofold. Most foundationally, you have to figure out and enumerate whatever the source of stress on your body is because chronic stress can cause habitual low blood sugar but eating frequent meals can help with that immensely. Different adrenal supports can also help because the adrenal glands regulate blood sugar.

And then something practical people can do is when they wake up at night, they can try having a snack because if they are waking up because of low blood sugar, then eating something will increase your blood sugar and will help you get back to sleep. So that doesn’t work for everyone but it’s certainly something that is worth trying. Something else that is worth knowing is that if you are a woman especially if you are getting near menopause or pre-menopausal years and you are having hot flashes at night then you want to seek some work that can help to balance your hormones. And there are many herbs that work very well to help balance out female hormones and there are also bioidentical hormones that can help to balance out hormones. So if someone is having hot flashes of course then they want to look into some hormone options but let’s not forget the fact that the gut has an impact on pretty much every system of the body and it’s not abnormal to see a woman’s female hormones. The levels improve, the balance improve. Once we heal the gut and this has many reasons for it. One of which is stress because chronic stress can throw off hormones. Another is inflammation because inflammation can throw off hormone levels. And thirdly, in the gut itself, there are bacteria that responsible for metabolism and detoxification of female hormones and when there is gut dysbiosis or imbalances in those bacteria, it can throw those things off as well.

There are a few different things here were sleep…I know I didn’t give you a quick answer to the percentage question but hopefully there are some helpful tips for people in terms of how to improve their sleep.

 [26:09] REBECCA:  Definitely, and what would your advice be to someone listening to the podcast who thinks. “That’s me. I’ve got disordered sleeping or insomnia.” What would be some practical and easy steps for you to give them on what they could do today?”

[26:23] DR. RUSCIO:  Sure. We went through a couple of them already. Eat small frequent meals, have a snack when you wake up at night. See if that helps. And if it is nocturnal hypoglycemia, low blood sugar at night then having a snack should help with that. And if you try it a few times and it helps, great! If it doesn’t help it’s probably something else. Some adrenal supports can be helpful and there are a number of things out there that can be helpful. You can just do an internet search for it and I am not overly meticulous about adrenal support. I think it is an area that has been a bit overhyped to be honest but just try adrenal support or try a couple of different ones and if you notice an improvement in your sleep from that, then that means the adrenals are probably implicated.

And investigate any sources of stress. These could be simple thing like not having enough down time. Having some sort of emotional or life stress that needs to be remedied. And then it can also be internal stress and the most common source of internal stress is someone’s gut. So there are some simple things one can do to start on the path of improving their gut health. And we talked about many diets. There’s Paleo diets. There’s a little FODMAP diet. There’s an autoimmune paleo diet. There’s the SCD diet. There’s the low FODMAP with SCD combination diet. All those can be helpful for sleep. And people can try over the counter natural agents that can help them get their sleep while their bodies are repairing like melatonin as a sleep aid can be very helpful for helping people to get to sleep.

So those are some of the more common things that can be helpful and simple tips for sleep.

[28:07] REBECCA:  And the other thing that I would like to talk around is the time that you go to bed. So you talked about trying to be awake and asleep in the, I guess, in the right cycles of the day and daylight and then asleep in night time. Is the time that you literally fall asleep important? So if you are still getting somewhere between 7 and 9 hours sleep, you are getting to bed at say at 9:30 at night versus 12:30 at night. Does that have an impact on the quality of sleep?

[28:41] DR. RUSCIO:  it does have an impact and the question is about 10 o’clock compared to 12 o’clock, does that make a big difference? In my mind this is what’s in my opinion and what you have seen published in the literature. In my mind that t ype of difference probably not a big deal. As long as you are getting to bend somewhere between 9 and 11ish for most of the nights, you are probably ok. Twelve might be pushing it a little bit. Is it going to  have a huge impact on your health? In my opinion probably not. But if you are going to bed at 4, 5, 6 o’clock in the morning or later, then that’s when we are getting into a problem where your sleep rhythm is going to  be pretty different from the day night rhythm. And that’s really what becomes a problem and a lot of this comes down to the fact that light stimulates things in our brain and hormones in our brain that are important for repair.

And so we think the main mechanism for which why not sleeping at night and being awake during the day is problematic is that you need that exposure to light during the day to tell your body to go into day mode and you need the darkness at night to tell your body to go into night and repair mode. And when you’re awake during night and asleep during the day, you don’t get that opportunity and it throws off these hormones and the rest of your body. This is likely why we see for example some literature showing that night shift workers have an increased risk of breast cancer. Probably because of the cascade of events that ensues that you don’t honor that rhythm.

So I would try to get to bed between 9 and 11. You have a little bit of leeway from there and you’re probably going to  be ok. But if you are someone who is working a shift like a night shift then I would say it would behoove you to try and change that as soon as you can to more reasonable shifts so as to not be awake at night and sleep during the day.

[31:01] REBECCA:  interesting. Another thing that you have touched on a few times is adrenal fatigue and I read things about adrenal fatigue. I see blog posts and things on social media all the time it seems. And I feel like adrenal fatigue has become the new kind of hot topic to talk about. I would really like us to talk about what it actually is and what are the symptoms and obviously it’s relation to the gut.

[31:30] DR. RUSCIO:  Sure. I probably have a different position on this than a lot of what people will read on the internet but I think adrenal fatigue is one of the more popular issues that you hear about out there in online health care land. But probably one of the more useless topics because the adrenal glands never malfunction unless something causes that malfunction. So it is truly one of the most primary symptoms that people chase down but it’s never really the cause at anything. And the adrenal glands more specifically are two hormonal glands that are located on top of your kidneys and they produce a number of hormones like cortisol a stress hormone, adrenal. They produce pregnenolone and DHEA, and estrogen and testosterone, and aldosterone which regulates blood pressure amongst others or sodium retention amongst other things.

So the main tie that people probably hear about the adrenals in regards to is the stress hormone of cortisol and how imbalances in that hormone can cause problems like fatigue, insomnia, weight gain, depression, lack of ability to focus. There are many symptoms. Those are all fairly common symptoms that most people are probably experiencing at least one or two or three. And so it’s easy to see how learning the concept of adrenal fatigue is. And again in my opinion about wanting to give it to people straight to prevent them from spending money on things that are not the cause of their problems. The adrenal pass and the adrenal treatments aren’t doing anything to treat the cause of the problem.

Adrenal support is a great idea because you can support this system that has been stressed out because of chronic bad diet or not sleeping enough or chronic inflammation in the gut or what have you… great to support the adrenals and there are herbs like ginseng and rhodiola can help with your energy and help give you a boost. But the problem is that if you go on adrenal support but you don’t fix the cause of the adrenal stress which is often times the gut, then as soon as you come off the adrenal support, you go right back to feeling the way you did before. And a test is not really going to , in my opinion, needed just to help people. It’s not really needed to guide the adrenal support.

Most of the studies looking at these herbs for example that are used for adrenal fatigue, most of the studies show these herbs have effect and they do help with things like energy and vitality and what have you. But they are never guided by testing. And so this is important because if someone has to spend $150 on an adrenal test and they go an adrenal program and they test again 2 months later and then again 2 months later, someone could very easily spend $500 on adrenal testing but it’s not telling you anything about what is cause the problem.

I have a different position on that many do but I think the tide is starting to shift or we are starting to realize that this is a very learning idea. As we are learning more about it, we are starting to realize that the adrenals are not the cause of the stress and that trying to blame everything on adrenal fatigue is a very misguided approach. The adrenals only malfunction because of chronic stress in the body. And so we have to find and identify and resolve that source of chronic stress. So the adrenals are never the cause of. But of rare, rare exception when someone has an adrenal disease which is like one in a thousand. The adrenals are never really the cause of the problem but rather a symptom of the problem. So I am not sure if that is the answer you are looking for but I think that is a very important point for people to be aware of because it is very easy to get sucked into this concept on the internet and invest in things that aren’t very fruitful.

[35:42] REBECCA:  I think it’s really great advice and I do feel saddened to see a lot of people chasing their symptoms rather than addressing the underlying cause of what is happening to get them sick. So I think it is really great advice what you are giving the listeners today around… you really need to be your own private investigator to look beyond the symptoms to see what’s causing those symptoms to play out.

How would you go about uncovering what is causing that chronic stress in the body to have potentially led to adrenal fatigue?

[36:23] DR. RUSCIO:  I think I have already given some hints as to answer that question throughout the body of this call. But starting with dietary and lifestyle basics are the foundation. So make sure you are eating a healthy diet and make sure you are eating regular meals, getting exercise, getting sleep, you are having some time for yourself, you don’t have a life that is incredibly stressful and imbalanced and just craving psychological havoc for you. These are really the foundational things. If someone hasn’t seem intended to all those, then start there.

The second step to get more into a system of the body so to speak would be investigating and optimizing your digestive health. And there’s not a 2 or 3 sentence answer to that question. I think that’s what a lot of your podcast is going to  be about. But there are many things in the digestive track that can be a problem. There’s IBS and there’s SIBO which is very closely associated with IBS. There’s fungal overgrowth like SIFO or small intestinal fungal overgrowth or candida, H. Pylori. There’s these bacterial and fungal imbalances that can occur. Those are fairly common. There are also things that are less common but important to be aware of. More like parasites. These are things like what I had again more rare but things like amoebas and protozoas. Again be careful with worms because you can find some circles on the internet were worms are blamed for everything and in this chronic thing you can never get rid of. But to be truthful. Worms are very easy to treat and they are not these things that are these mystery cause of your illness that you can never identify. Worms are pretty easy to address.

So there’s bacteria, fungus, and other organisms that can be a problem. And there’s also inflammation and autoimmune. And this will manifest as inflammatory bowel disease which has self-importance to it. most typically ulcer colitis in Crohn’s but there are other types and these can also be remedied by the good dietary and lifestyle foundations that we have talked about as can SIBO and IBS. But there are some unique treatments that are specific to SIBO and IBS. There are some unique treatments that are specific to inflammatory bowel disease. Those are probably some of the more common ones. There are less common ones like motility disorders were people don’t have proper contractility of the stomach or the esophagus or the colon. There are things like ulcers. There are deficiencies in things like hydrochloric acid and enzymes that are important to account for.

Those are some of the bigger items. And do you mind if I refer back to my website because there are some resources there that I think could be helpful for people. But I am not sure that is something that you allow in the podcast.

[39:17] REBECCA:  No, that’s absolutely fine. I’m happy to do that.

[39:20] DR. RUSCIO:  so there’s a lot of information on these different disorders on my website and people can use the search box there and they can search for different terms. But one of the things there that will be coming hopefully in March is my book that will take all these stuff and we organize it into a series of steps that are personalized and this I think is the real important part of the whole health action plan because you can go and find protocols all over the internet. But the thing that is important to determine success or failure is the right person using the right protocol at the right time and in the right sequence.

And that’s what I have worked very hard with putting together the book and the sequence of personalized actions that is in the book is it takes all these stuff like should I be low FODMAP; should I be gluten free? Should I be Paleo? Should I be using probiotics? Should I not be using probiotics? Should I be treating for SIBO? Should I not be treating for SIBO? Do I need hydrochloric acid? Do I not need it? Might I have an ulcer? Might I not have an ulcer? Might I have inflammatory bowel disease? Might I not? Should I try an elemental diet? Should I try fasting? Should I try adrenal support? Should I try vitamin D?

There are so many things and you have to have a method for working through these. If you don’t, you’ll end up doing what I did and what most of my patients have done. Or I should say, most and many of my patients have done before they come to see me which is just trying whatever it is you are learning about at the time. You are learning about adrenals because you are reading up on it and you try an adrenal program and then you go learn about the FODMAP diet and so you try it out. But there’s no overarching process guiding it and I think that is really the difference between knowledge and wisdom. You can get knowledge on Google in seconds. You can look at the protocol and try it. but wisdom is when you have been using protocols for years and years and years and you have come tom understand the best way to apply those protocols.

So you know I am very hopeful that the book will help people and I hope that it doesn’t sound too promotional. But what I have learned is people really need a way of applying these thousand and one things they can potentially do and you can’t really do that justice in an interview because you have to be able to personalize the recommendation and what I mean by that is some people may only need to take 2 steps in this process and then they feel great. So they are done. The other people may need to go through 7 steps. And so you have to have this kind of personalized process. Try this. How did it go? It went well move to step 2. If it didn’t went well move to step 3. And this sort of personalized process can help you navigate all the options and apply them in the most efficient manner.

So a gain I apologize that there is a long rant in response to promoting something that i put together but I really think it has a potential to be one of the most efficient methods for a patient to recover their health rather than just trying a bunch of stuff in a haphazard fashion.

[42:32] REBECCA:   I think of my own journey and I am exactly like what you described. When I first got my SIBO diagnosis, I have never heard of it. I didn’t even really know that much about the digestive system which is kind of embarrassing to admit to. But I knew food went in and it came out. But what happened inside, I wasn’t a hundred percent clear on. And I jumped into online forums and Facebook groups and someone would post something about a topic at the back, “OH that could be me, maybe that’s what I have got!” and i would go down the rabbit hole of reading every post and article and blog and everything I could find on the internet about that and I would think, “That sounds like me. That could definitely be me.” And I would go to my naturopath and say, “ I’ve been reading about blablabla and this could be what I suffer from.” And I think that is so common especially when you don’t have a healthcare team around you sort of supporting you and you are doing a lot of it on your own which sadly seems to be the case for a lot of people that they haven’t found the support that they need or the right kind of practitioners for themselves at this point in their journey. So they feel that they need to burden the process on their own and so they do a lot on their own whether it’s right or wrong.

So I think that your books are fantastic resources for people as they are going through their journey and hopefully it will answer a lot of questions that people have around what should I do next.

[44:01] DR. RUSCIO:  Well thank you and yes, that’s exactly my goal with the book. It was not to be some very interesting read that gave you a lot of cool facts but never gave you a plan. We cover a lot about the book and we learn a lot about the gut. And different treatments for the gut and the history of the gut and how the modern environment is throwing of your gut. All these things that are very important part of understanding it but then the last section of the book again it takes all these stuff and it says, “OK what do we do?” And so that’s a thing I think people are struggling with. There’s no shortage of information out there. What’s great about the modern information age is we have so much information at our fingertips. But we have to know how to apply it. I often think of like a financial adviser. You could have a financial adviser that has read every book out there. But unless they have spent time actually advising people or investing their own money and actually doing it, they are not going to  be able to get a really good result. And so if you just spent time reading about different stuff on the internet, different health care interventions but you haven’t spent time actually using them on people and figuring out who they work best for and at what time then it’s really really hard to be efficient in the application.

So thank you. I am very hopeful this will be the answer that a lot of people are looking for because it essentially walks in through this process. So I am very optimistic.

[45:38] REBECCA:  yeah. I look forward to reading it. and in terms of the adrenals, what are the sort of other common issues that you find that people have. is there a common link between say issues with the adrenals? Obviously gut health is a big one and chronic stress. But what about our connection with the thyroid as well?

[46:02] DR. RUSCIO:  there is a very interesting and multifaceted adrenal thyroid connection and they both have to be imbalanced for the system to work correctly. You can’t have adrenal levels that are high or low and expect your thyroid to function properly. And you can’t have thyroid levels that are high or low and expect your adrenals to function properly. So like anything else in biology, the key is balance and so the adrenals when high or low can throw off the conversion of thyroid hormone and act in the actual production of thyroid hormone. And then thyroid hormone actually sensitizes some of the receptors to adrenal hormones. So there’s this very intimate relationship in it too.

To get people some more practical answers in terms of what you can do, here’s a few common things that happen. If people have adrenal fatigue and I really don’t like that term because what it really means is the body is under prolonged stress and they are not able to produce and adequate amount of these hormones because of it. But I will use the term for simplicities sake. If someone has adrenal fatigue and then they go on a thyroid hormone that can actually make their adrenal fatigue worst. And what you will see here is people who go on a thyroid hormone, they feel no difference or they even feel worst. And here’s how this works. So if you have adrenal fatigue, you already don’t have enough adrenal hormones in your system. When you take thyroid hormone, thyroid hormone speeds up your metabolism and what it can do is it can speed up your metabolism of your adrenal hormones. So now you go from having low hormones, you increase your metabolism and you have even lower hormones.

So that’s one application and let me pause there. Does that make sense?

[48:01] REBECCA:  That makes sense. That’s quite insightful actually. I am having a real aha moment.

DR. RUSCIO:  the converse can also be true which is if someone is hypothyroid and they don’t know it they may go on every adrenal support known to man and still not really feel better because it is actually the hypothyroid that’s driving their problem. Now hypothyroid is also an area to be very careful with because there is definitely some fanaticism around hypothyroid were people are way over zealous when trying to treat the thyroid gland. And getting into the thyroid is a little bit beyond the scope of this call and I would say is if you are going to  work with someone on your thyroid make sure they are not a fanatic and you just want to look for people that seem to be conservative in their approach and they don’t seem to be aggressive or overly opinionated because usually the more opinionated someone is in my opinion the less they know.  Because the more you learn you don’t know and the more open minded you tend to be. So if someone is very hard driving or dogmatic, it probably means they don’t know a lot. Saying that respectfully but I’m just trying to cut through the BS and give people some things that are practical and helpful. So be careful with who you work with regarding thyroid because there’s a lot of overzealousness because if you are truly hypothyroid, then you are going to  most likely need some thyroid hormone replacement and that may be the solution to what looks like adrenal fatigue but never response in adrenal support. Because the problem is not the adrenal. It’s the thyroid. Those are a few of the more kind of salient or relevant points regarding… and there is a question which was the adrenal kind of how they are also tied with the thyroid and things for people to be aware of.

[49:50] REBECCA:  and I could now see just how inter linked every system is so that if you are currently dealing with SIBO that obviously can put enormous pressure on the system which can lead to other things such as adrenal fatigue. But until you have dealt with the underlying cause which is SIBO let’s say there’s not much you can do about your adrenal fatigue as I understand it. So I think that’s…

[50:18] DR. RUSCIO:  And the thyroid, a lot of what looks like hypothyroidism actually comes from problems in the gut. And we can make this conversation more complicated and convoluted if we need to and we can talk about how things like gut inflammation will decrease the conversion of T4 and T3 or increase or reverse T3. But ultimately, let’s keep it simple and just realize that before you chase down these other things, just start with your gut, see that through to completion and then reevaluate.

[50:48] REBECCA:  I spent years having my thyroid checked and it always came back absolutely fine. But doctors… and this was before I found my naturopath but doctors, general practitioners would say, “Hmm I think there might be an issue with your thyroid.” Now I understand that it was my gut that was the issue, it wasn’t my thyroid. But for such a long time they looked at my thyroid and I just thank God that if only they had known more about the gut and known about SIBO instead of pricking me with millions of needles and taking unnecessary blood tests, we might have got to that point and got me healthier a long time ago.

[51:27] DR. RUSCIO:  Yup, I was the same way. I had hypothyroid too when I was… because I had thinning hair, dry skin and I was feeling cold. All those are bulls eyes for hypothyroid. But again the cause in my case and in many cases isn’t actually the thyroid. It’s the gut and at least it’s good practice to start with the gut and again then reevaluate. It’s not to say that is a panacea but the gut problems are so common that it’s really the most efficient to start there and then reevaluate what symptoms are still present.

[52:01] REBECCA:  Definitely. Dr. Michael Ruscio, it’s been absolutely wonderful having you on the Healthy Gut Podcast today. I have learned a lot and I am sure my listeners have to. If people would like to  connect with you, what is the best place for them to go to connect with you?

DR. RUSCIO:  thank you. And the best place is my website which is and there are much information there. Newsletters, articles, podcasts, videos and then regarding the book that we mentioned earlier, we anticipate a publication date for that is going to be March 2017. We are currently working on a title. So I don’t have a title I can tell you.  But if you follow my website or plug into our newsletter, we will definitely put out ample notification there and then also if you are a health care practitioner, we are just on the process of launching a healthy care practitioner only newsletter that will be more of kind of the clinical side of this. How to efficiently apply functional medicine and not get trapped into dogma or excess and that information will also be available through just going through our homepage which is

REBECCA:  wonderful and I have got all of those links in the show notes as well. Thank you so much for coming on to the Healthy Gut podcast. It has been an absolute pleasure to have you on the show today.

DR. RUSCIO:  My pleasure. Thank you again for having me


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