 So, one of the things that's really cool is recently, we had a lot of people that have been just incredible feedback on our 30 days of coaching. And a lot of people were wanting to share it and pass it along. And so, Doug actually opened it up so they didn't have to wait for the email to get dripped over 30 days. So now, when you go to the 30 days of coaching, you basically get all 30 days at right up front, you get the glossary right away. So, if there's specific topics that you want to learn about, and we cover everything. And you can learn it at your own pace. It's really, it was, you know, I like that we did this because there were so many people that, number one, were like, hey, I got through the first topic, or I got through the third topic, I want to be able to do more in one day. So, now you can do that if you want to learn about all those topics, you get to learn them right away. And also, like Adam just talked about, it's much better to share it that way. So, it's still free. It's 30 days of coaching. It's at mindpumpmedia.com. All you got to do is opt in and you're set. If you want to pump your body and expand your mind, there's only one place to go. Mind pump. Mind pump. With your hosts, Sal DeStefano, Adam Schaefer, and Justin Andrews. Oh my god, you do it better than Justin. Another handsome devil in this. You know what? We got to stop with all these good-looking people. It's making me insecure. It is. Talking about Dr. Michael Ruscio. Yes. Another stud. So, he was referred to us by Rob Wolf. Rob Wolf actually said to us. Came highly recommended. You need to talk to this guy. He's like the gut health expert, like the man. And I tell you what, I've met with quite a few gut health experts. He blew my mind on a few different things. Really shared some information. You're going to hear in this podcast about everything from gut health, inflammation, how to use probiotics properly, and why they're probably working, and why some may not work for you, and why others may, and the individual variances. Like there's a lot of information we talked about in this podcast with him that I did not know about that we've never shared on mind pump. So, if you really want to learn about gut health, this is the podcast to listen to. So, it's Dr. Michael Ruscio. You can find him on Instagram at Dr. Ruscio. That's DR for doctor and then R-U-S-C-I-O. His website is www.drruscio.com. He's also another speaker at Paleo FX. Yes. So, we'll get a chance to see him again there, which I'm really excited we're going to run into him there. So, he's speaking there. He's right down the street from us. So, I bet you're going to hear more of him on this show. I mean, I think he'll become after the time that we spent, you never know, even though he came from Rob Wolf and he told us all the great things about him until you get here and we get time to spend with him. We hit it off big time, shared so much information with us, and I like the way that he delivers the message to, which I mean, when you're talking about something like- He's not dogmatic at all. No, not at all. Just of course, we should have known coming from Rob because Rob is definitely like that too. Another awesome dude. So, really excited. I know that Taylor got a chance to shoot some stuff with him in Whole Foods as far as picking out some different things. And I know that'll end up dropping on our YouTube channel too. So, make sure if you guys are not subscribed to the YouTube channel, you guys go to Mind Pump TV, subscribe. This is the type of stuff you're going to start seeing more often is we'll get these guests involved in their specialty and get it out there. Do you guys- Give you guys some practical tips and tools you can use and apply. So, you guys find that on the YouTube channel Mind Pump TV. So, here you go. Here we are talking to Dr. Michael Ruscio. We're part of Italy's your family from, Mike. Calabria. Oh, shit. I'm Sicilian. Cool. So, we're not too far. We're close. Tan skin, right? Down south. You guys have hard heads. That's what I remember about the Calabresi. What Italian doesn't, though, I guess, right? That's the point. That's true right there. You came highly recommended by Rob Wolfe, who we respect greatly. We went and met with him. How many months ago was that now? It's like a few months? It's like two. Yeah, it's like about two. We had a great time with him. And after we were done, he's like, you got to talk to Dr. Ruscio. He's like my dude when it comes to gut health and stuff. I pay him for that endorsement. I'm just going to ask you about that. He has that title, my dude. How did you get into gut health? Now, I'm looking at you, obviously, workout. So, you're in fitness. Have you always been into- He sizes everybody up as they come in. Yeah. I was, you know, when I was young, I was tired of getting picked on and my lunch money getting stolen. So, I decided to start working out now. I was always an athlete and always really into health. Actually, there's kind of a circuitous but interesting story that leads up to this that I think showcases some of the stuff that needs to be updated in the fitness industry. So, at first, coming back to the hard headed Italian, I wanted to go into law, only because I really liked arguing. And how I'm going to hit it off. And talk with my hands, right? Right. Excellent. So, I went into pre-law and I thought I was pretty good at it, but I saw the negative aspects of my personality kind of getting pulled out and I was like, this is not a path that I want to go down because it just, I didn't like where I was going. So, I then went into biology because I figured, well, why not just go into science? And so, I was working as a personal trainer at Bailey's and also getting my degree in biology. And I remember, I'll never forget this. I was at a meeting with the regional head of personal training and he was kind of, you know, going around giving everybody feedback, reviewing their files, their sales, whatever. And he said, you know, this kind of year is Melanie. You're doing a really great job with her. Melanie was, I think, 31, obese, sweet as a peach, just like the nicest girl. And she was losing weight, she was doing great. And he said, you know, she's really been progressing nicely, but why don't you slow things down with her a little bit because we could have her here for a year instead of six months. Wow. And I was just like, what the F are you, like, is this guy talking about? So, I started to really to see the ugly side of the fitness industry. And I was complaining about this to my cousin who was actually a former WCW wrestler. And he said, why don't you just go into the medical end of things? If you don't like the whole fitness, why not go into the really scientific side of it and go into medicine? I had never thought about it, but it clicked because I was always a guy who was making workout routines for my friends or dietary plans just through my own, you know, reading of like Polyquin or Czech or whatever. So, you know, that was a big thing that kind of put me down the path. How old are you right here? Right now? No, no, no, at this time in your life. Um, God, no, freshman in college. So what's that like? Would you like 21, 22? I think you're a little younger than that. Maybe 19, maybe. So, 1920. So, you know, I was, I was pretty young, but that was a pretty big, cathartic moment just kind of figuring that I could go into this. I never had thought about, you know, trying to become a doctor or do anything with medicine. But as soon as he said that, I was like, you know what, this is what I was, I've kind of been interested in. And, you know, from there, you know, I was telling you guys some of the other story, which was I was in college and I thought I wanted you go into orthopedic medicine at first because I knew I wanted to go into medicine, but I didn't know just what I wanted to do. So everyone would say, well, you're kind of a a burly guy. You should be an orthopedic surgeon because those are usually. So I was like, sure, that sounds good. How do you, how do you, there was a joke in the medical world. How do you keep, how do you hide something from an orthopedic surgeon? Oh, hide it in a book. Apparently, no, you know, these are other doctors have told me this joke because they're apparently the jocks of the medical world, right? Yeah. So I got lumped into that and rightfully so, whatever. So, you know, I'm trucking along and super type A, you know, trying to keep my GPA up, trying to do all that stuff. And all of a sudden I start having insomnia, fatigue, depression, feeling cold, feeling tired. And I'm saying to myself, what the hell is wrong with me? Right? Because at this point, I'm like 23 and I'm used to feeling kind of invincible. I played lacrosse in college. I was a guy who could get like laid out, pop right back up and almost feel like I had more energy because of it. You know, you're young and just a nut. Oh yeah. And then all of a sudden I can't sleep and I'm feeling tired and I'm feeling cold. And I'm saying, what the hell is going on? So I went to see three conventional doctors and they all said, yeah, you're super healthy. You've got a low body fat. You, you know, all the standard stuff checks out. And I'm saying, well, okay, but do you remember what I said before? I was feeling great like three months ago and now I'm feeling kind of shitty. And they said, well, you know, there's really, maybe it's too much stress or, you know, whatever. And none of that was salient because I was leaving enough time for sleep, even though I wasn't sleeping well. I was eating really well. I loved what I did. I, you know, I wasn't overstressed. There wasn't anything way out of sorts. So long story short, ended up finding a functional medicine provider. He said, I think you have an intestinal parasite. I remember thinking this guy's full of shit. Like I don't have diarrhea. I never went to a foreign country and got food poisoning, anything like that. You know, that, that can't be. But it turns out that when I did a stool test, I had amoeba histolytica, which is one of the more pathogenic amoebas that you can have. And it wasn't causing any digestive symptoms, but only causing non digestive symptoms like fatigue, depression, insomnia, what have you. Well, and that was a huge cathartic for me. And it changed the direction I wanted to go. And I went into alternative medicine in light of that experience. And now it's that sort of thing I helped my patients with. And it's been a great shift ever since. How long did you stick around with the ballet thing? How long were you a trainer there for? A few more months, I think. And I just, I was learning some of the trainers that were the busiest were just the best salesman. And some of the best trainers were the ones that weren't, weren't as busy. And I remember listening to some of these guys just like, now Samantha, this total cheese dick salesman lines. And like these people are just like eating it up. And I'm like, I know that this guy who is making the sales pitch doesn't know anything scientifically or from a fitness perspective, but he had a full book of business. And so I said, you know what, this, this is just not the environment that I want to be in. Like if I'm the best person at misleading and selling people, I'm going to be quote unquote the best trainer. And so I just, I just, the part of it's hilarious because we literally, this is what we just, this was, this was, this was us in our 20s. And this is a lot of what inspired mind pump was all three of us worked for 24 hour fitness I did for 10 years. I mean, we grand open clubs and ran some huge teams. And what you're saying is 100% true. And we, we talk about, you know, that's part of what it's tough. We, I was that guy. I was the top in sales. I was a terrible trainer. If I'm being completely honest with myself and I've shared this on our, on our podcast. No, and this is what bothers me, but you know, in the defense of, you know, trainers that are in their early 20s that are doing this, like they're being fed the information for the company. So all the, so all the info, all the information that I was getting were the meetings and the education that they were providing for me, which was all things to help them sell supplements, sell more personal training, keep clients longer. It wasn't necessarily what's in the best interest of my clients. And so through my 20s, I was focused on the dollar and focused on making more money and doing that. And so, and in those types of companies, that's what people attribute to being a good trainer, which is the complete opposite. So, you know, later on, when we started learning and reaching beyond, you know, our small little world inside the fitness community at 24 fitness or ballies, gyms like that. And you know, it's, it's why we speak so passionately is, man, there's so many people have no idea that there's so much more information out there and the stuff that they're being fed is, is to poke at their insecurities, man, to sell them or get them to buy something. It's really, really unfortunate. So it's, you put that together a lot earlier than we did. Mike, would you, would you say a lot of the information that people read about their own health, the information that's put out there to the public? Would you say a lot of it's false bullshit? Well, we're really opening like a huge can of worms on this one. But as a preface to my answer on that, the same thing happens in health medicine, in my opinion. And I think this is what has helped me, I think do a pretty decent job in my space now, which is alternative and functional medicine, is because I put those things together early in the fitness industry, went into the health industry and I saw the same stuff repeating. And so it really helped me kind of pierce through the BS pretty quickly. But yes, I do think that a lot of the same stuff happens. And I think it may not be kind of as like Machlivalian or, you know, this, this, this conspiracy theory sort of, as sometimes people put it out to be, I think there's just, there's well intention people that don't know how to use science to update their opinion, but rather they have an opinion and they use cherry picked data to reinforce their preexisting belief. And that kind of by definition is dogma. And one of the things that's been very freeing for me is to learning from these experiences, approach things objectively and almost assuming anything that I think going into, you know, a analysis could be wrong. Because I've been wrong before. I used to be that guy totally sold on whatever it was back in the fitness industry, only to learn that that was totally wrong. So when you do that, you can try to look at all the data on an issue and look for a trend in the data. And that's, and so then you can use data to update your opinion and craft your opinion, rather than just say, well, I believe everyone should be low carb. Let me find every low carb study out there and use that to reinforce. But it's so freeing if you can just say, let me look at what studies have shown a high carb diet can be beneficial. And then holy shit, there's a ton of studies showing that there can be some benefit here. So how can I be that dogmatic in my views or how can I be that strong my views? And it reminds me of a quote that I love, which is dogmatism can only exist in the presence of ignorance. And I don't mean ignorance in an insulting way. The true definition of ignorance is just not knowing about something, right? So in my opinion, people can only be hard driving on an opinion if they're ignorant to the contradictory information on that opinion. And so I think what ends up happening is in the field, you have people that have one position and they, there's this wealth of science that can support that position. But the problem is they're not looking at the wealth of science that refutes that position and trying to craft a well informed opinion from all the data. So yes, it's pretty common, I think. You work, you say alternative health, but you also work in more traditional Western health as well. Or do you look at all those, when people hear alternative health, they think of Chinese medicine, Ayurvedic medicine, that kind of stuff. Do you work with all of that? Or how would you explain or define kind of the methods that you use? Sure. Well, the most official description, I guess, is functional medicine. But if you're not familiar with functional medicine, another proximal term could be naturopathic medicine, which is very similar. But to put it really simply, what I try to do is have a very science-based, efficient and practical application of natural medicine that also borders in some areas on conventional medicine. And it's not about saying your conventional doctor is wrong and we're right. It's really about looking at the evidence in natural medicine, conventional medicine kind of on that line. And then usually the frontline therapies we're going to use are going to be more from the natural camp because that's people's preference. I'd rather cure my IBS with a probiotic than a laxative. Understandable. So we're going to look at the evidence on both sides and try to best understand what's the best way to apply the natural medicines are, but also when we want to integrate in with the conventional system and not turn a blind eye to some of those things that can be very helpful. And maybe using thyroid autoimmunity as an example, another area that I work in when people have thyroid autoimmunity like Hashimoto's and thyroid autoimmunity is a primary driver of hypothyroidism in Westernized countries. Those people are also at elevated risk, not a high elevation, but they're at a small elevated risk for thyroid cancer. So we want to make sure that they're continuing with their follow-ups with their endocrinologist to keep tabs on the thyroid tissue to make sure that there's no cancerous or pre-cancerous lesions forming so that they can be detected early. So it's not to say, you know, I like natural medicine and I think it can cure everything under the sun. And I'm going to turn a blind eye to the fact that, hey, no matter how good I am, you may get thyroid cancer. And I'd be an absolute idiot if I delayed the diagnosis of that by five years because of my philosophical beliefs. So you want to take all those views? You know, it's interesting you talk about thyroid autoimmunity. It wasn't that long ago that if you went to the doctor and got tested and they tested your thyroid hormone and it looked okay, but you had all these symptoms of, you know, thyroid issues that they'd be like, you're fine. You're absolutely fine. Is it being, is it more accepted now to test for things like antibodies and, you know, to find, you know, if somebody has autoimmune issues with their thyroid? I think it is becoming more accepted. There's a few important things to understand with thyroid autoimmunity, which is conventional medicine doesn't see a strong treatment for thyroid autoimmunity itself. So rightfully so, they're not over the concern about tracking thyroid autoimmunity in a lot of cases because there's not a direct treatment for that. But rather they want to check thyroid function to determine if you need thyroid hormone replacement therapy and also keep tabs on the thyroid structure to make sure you don't have nodules or other aspects that could become, you know, a more serious medical issue that requires an intervention there. But there is some data that is showing that certain shifts potentially in diet or certain gut health interventions or certain vitamins can help with thyroid autoimmunity. But to be honest, the data there isn't incredibly strong. So looking at selenium as an example, probably the most common nutrient you'll hear recommended for thyroid autoimmunity, selenium vitamin D. So let's look at selenium. When you look at the high level of science, you do not see agreement in terms of what the data shows for selenium. And then the most notable is a recent Cochrane database systematic review with meta-analysis. So the Cochrane database essentially analyzes studies for bias to make sure there's not bias in the study. And then a systematic review with meta-analysis is it sounds complicated, but it's actually quite simple. It's like surveying a bunch of people who went to a restaurant, right? Let's say there's a new restaurant down the street. We want to figure out, should we go there or should we not go there? So we find out that there have been 100 people that went to the restaurant. So we're going to survey each one of them. And that's like a systematic review. It's surveying all the people that went to the restaurant or all the studies that I've done on an issue. And then the meta-analysis is just calculating a numeric score in terms of what the rating was. So a 70 out of 100, right? So a systematic review with meta-analysis is really just doing something that we all do all the time, which is let's see if we can get a bunch of data in terms of what people think on the restaurant and give that a score, right? It might be four out of five stars or 70 out of 100, whatever. So this is really helpful because when you look at this higher level science, you get a summary of what most of the clinical data says. So it's basically a study on the studies. It's a summary of the studies. So you get a consensus. Exactly. Which is important because one study can be misleading. So with selenium, there are some studies showing benefit. There are some studies showing no benefit. When we put them all together, we show no consistent or overly favorable benefit with selenium supplementation, which may sound odd to some people listening. However, if you read this study more closely, you see that most of the benefit with selenium was achieved by at three months of supplementation, less so at six months. And after six months, the benefit completely drops off. So what that probably tells you or what that should tell us if we draw an inference here is that there's probably an aspect of short-term selenium repletion that's helpful for thyroid autoimmunity, but outside of that window, there's no more benefit. And why that's relevant is because people may read about selenium being good for thyroid health and take it every day for the rest of their life when they really don't need to. So it's kind of coming back to that theme of trying to be progressive but conservative. Let's not just fall off the deep end with selenium and give everyone selenium high doses for the rest of their life, but realize that there's this reasonable window of maybe three to six months that it has its primary utility for. So I've had a few clients in the past who've had symptoms of thyroid autoimmunity have gone to traditional doctors, gotten tested and found that their thyroid hormone was fine. What are some of those symptoms? So I was going to ask, what are some things that people can look for because obviously if you go get tested and like, hey, you've got your thyroid hormone is fine, but you've got all these symptoms that could point to an autoimmunity there. What do they look like? Well, that's a challenge with symptoms in some cases, especially with thyroid. They're very nonspecific. So there could be fatigue, waking, constipation, dry skin, feeling cold, thinning hair. Those are depression. Those are probably some of the most common and symptoms can be suggestive, but really there are many other things that can look like a problem with thyroid. So here's kind of the general way I would approach thyroid, generally speaking. Have a standard evaluation to see if you have frank hypothyroidism because that's easy to detect and that's easy to treat. So if someone has frank hypothyroidism, that means that they'll have, according to the conventional range, high TSH, low T4. If that's the case, they want to go on a medication. There's a bait as to whether or not a straight T4 medication or a T4-T3 combination medication are better. The consensus does seem to show that most patients prefer a T4-T3 combination. So that may be something for people to try first. If their doctor doesn't want to do that, say, okay, I'll start with the T4, give it a few months, but if I'm not feeling totally well, I'd appreciate it if you would humor me and add T3 into the mix. I think that's totally reasonable. So check off that box. Am I frankly hypothyroid and required medication or not? If you're not hypothyroid, meaning if your thyroid levels are normal, according to the conventional ranges, I would then look to another cause of the symptoms. And oftentimes, and as I found myself, I had hypothyroid-like symptoms that were being driven by a problem in the gut. So if you're not frankly hypothyroid, the next thing I would do would be to investigate your gut health because that may be where, and I should preface, I'm assuming your diet and lifestyle are already dialed in. That's always the first step. Sure. I'm so tired. I only sleep two hours every night. Exactly. So assuming you're getting sleep, getting some time outside, getting some exercise, managing your stress, assuming those basics are in place and you're still not feeling well and you've checked the box, meaning you're not hypothyroid, I would then recommend looking into your gut health, not to say that gut health is a panacea, but gut problems are very common and they can cause many of the symptoms that look like hypothyroidism. Excellent. What are your thoughts on, when I hear you talking about T3, T4 right away, it pops in my head, a lot of supplements that are out there to manipulate these things. What are your thoughts on that? What are your thoughts on supplements like T3, T4, and are there risks to taking that and are they at any value whatsoever? Does it really benefit anything? I know a lot of people use that to try and lose body fat. I think that argument is most salient when people are trying to use thyroid hormone, so prescription thyroid hormone, they get their levels back into the normal range and there is some data that shows that if people are in the upper half for T4 and T3, they may feel a little bit better. The supplements that help with conversion of T4 to T3, they may be mildly beneficial, but usually what I found is there's a cause of that problem. There's a cause for the non-optimal conversion or the symptoms that you think are because of the non-optimal conversion. In other words, it's not treating the root. You're just putting a band-aid on. Exactly. These natural agents that help with conversion of T4 to T3 or help to boost T4 or T3, I tried them. I had a lot of patients that come in to me after trying them. They may garner some benefit, but I think it's really, those things are more an end of the line therapy and it's better to start off with diet lifestyle and then gut health because that can actually in itself cause problems with the levels of T4 and T3, especially conversion of T4 to T3. That's what I was wondering. Autoimmune disorders and diseases in particular seem to be on an explosive rise over the last maybe 20, 30 years. Is that because we're diagnosing them more accurately? I'll throw all of autoimmune issues, including food allergies, which I have kids. When I was a kid, I remember I think one kid who had a peanut allergy and now you've got entire classrooms that are peanut and egg-free and all these different things. Are they really on a rise or is it just because we're diagnosing aware of them? There's probably a component of it that has to do with increased diagnostic capability, but clearly, autoimmune conditions are on the rise and it's likely because of the environment that we live in and said simply, the hygienic environment that we live in now also combined with the use of antibiotics, which can be lifesaving in certain applications, the unintended side effect of that is partially impairing the development of the immune system, which then opens the door for the increased prevalence of autoimmunity. It's like this inverse biological scale where if you go to a hunter-gatherer population, they're going to have a shorter life expectancy and higher infant mortality, but no autoimmunity. You come here and it all flips. Longer life expectancy, lower infant mortality, more autoimmunity. I think it's just important to keep that in mind because sometimes people, when they have an autoimmune condition, they beat themselves up, like it's something that they did. Oftentimes, it's a genetic hand that you've been dealt and that combined with the environment that we're in today. Well, classic studies have demonstrated that kids that grow up on farms far lower rates of autoimmune disorders, why? Probably because they were exposed to animals and more bacteria and dirt and that kind of stuff. The other side of that is they tend to take less antibiotics. In our generation, we grew up, antibiotics were given out like candy. I mean, for every single thing that we had. How about some of the stuff that we eat, like they're finding now artificial sweeteners, altar gut flora and glyphosates, which are found in genetically modified foods, altar gut flora and stuff like that. Do you think those play a role? There's been some published evidence showing that emulsifiers, which are oftentimes found in processed foods, do have a correlation to autoimmunity. But I think it's hard to parse out is that because Western societies are already more processed foods or is the processed food consumption directly in and of itself. I do think there's some plausibility to that argument that emulsifiers in processed foods are driving autoimmunity because the emulsifiers can partially irritate and break down the lining of the gut. I do think that that's plausible and it comes back to a simple principle, which is avoid processed food as much as you can. The artificial sweeteners piece is interesting. There's so much to say about so many of these things. There's so much to say about thyroid autoimmunity. There's so much to say about artificial sweeteners, but a few broad strokes with artificial sweeteners. Do they affect our microbiota? Yes, they do. There's been one very interesting study where they found people to be either artificial sweetener responders or non-responders. What they did was they gave two groups of people artificial sweeteners and they noticed that one group had negative changes in their blood glucose and the other group didn't. The people that had the negative changes were labeled as artificial sweetener responders, meaning they had this negative kind of response, and the others were non-responders. The researchers then looked at their microbiotas and found there was a change pre and post artificial sweeteners in their microbiota. The people that had the negative glucose changes, your insulin resistance, your fasting blood glucose, they had a change in the microbiota that correlated with those negative metabolic changes. Then they took the microbiotas from each group, transplanted them into mice, and it was only the mice from the negative responding group that saw also negative responses in their blood glucose, whereas the other group did not. It's something to do with certain groups of people have this predisposition to have their microbiota negatively affected, and that seems to be causal in causing problems with glucose. That's just one study. Coming back to my earlier point of not just looking at one study, what does the larger body of evidence show regarding artificial sweeteners? The body of evidence shows there does not seem to be any benefit to artificial sweeteners in terms of preventing weight gain or aiding in weight loss. There's no clear benefit and some data, not conclusively, but some data suggests there may actually be a detriment. When you look at the fact that there's no clear benefit and a potential detriment, I think the conclusion to draw there is fairly clear, which is the conservative use of artificial sweeteners. There was one study in particular that really looked at this. It was called the San Antonio Longitudinal Study on Aging. They prospectively broke people into two groups, meaning they said, this half will have artificial sweeteners, this half won't. Then they tracked them over time. That partitioning is important because part of the reason why we may see some of the data showing that artificial sweeteners correlates with weight gain is because people who are overweight are drinking more of them. They factored out for that and they had an equal allocation of this group. They showed that the people who consumed artificial sweeteners over the course of, I believe it was nine years, saw a 3.1-inch circumference gain in their waste compared to the other groups saw 0.8 who are not using. Artificial sweeteners make you fatter. They found and they actually also found a dose-dependent relationship. The more that the people in the use of artificial sweetener group were drinking, the higher their waste circumference became. This is huge for a lot of our listeners because a lot of our listeners are in their gym rats. They work out. They want to build muscle, burn body fat. A lot of the products that they use, all the products that they use are sweetened with artificial low-calorie option. That's right. I want to take a protein powder, but I don't want anything but protein in it or I'm going to take this pre-workout and I want to have zero calories. They're all artificially sweetened. If you work out five, six days a week and you take a pre-workout supplement, you take one or two protein shakes a day and a protein bar day, it's a lot of artificial sweetener that you're taking for a long time over the course of some of these people decades. Is that one of the things you recommend to your patients eliminate when they're coming with get issues? Yeah. I don't make that direct recommendation, but we put them on diet plans where that's implicit in the diet. Certainly, constant use of artificial sweeteners is not doing you any favors and potentially harming you, so why would you do them? They even showed in that same study, the other group, they were drinking regular sugar sweetened sodas and they gained a lot less weight. So clearly the benefit from artificial sweeteners has been overstated. Which I think that's a big point because I think the argument that most people use to justify that is the calorie thing. Is that, oh, well, it's saving me 200 calories plus a day by me having these sugar-free drinks or these foods that are sweetened with artificial sweeteners and in reality, they were better off probably having something that's got real cane sugar in it versus trying to avoid a couple hundred calories to save them. That's a conclusion you see made in many of the research papers. When you have to use a sweetener, use a natural sweetener like juice or agave or sugar, try to use it minimally, but that is probably better than the artificial sweetener. What's interesting about when we talk about gut health, it's kind of becoming a big thing now. There's lots of now conventional studies in science that is showing just how important your gut health is and your microbiome is to everything almost. I mean, they're connecting it to people's emotions and state of mind even. I remember reading a study where they had women go in and get a fMRI, which is a functional MRI machine where they can see actual function in the brain and they had them take a probiotic and they could see changes in the way that the brain actually worked after taking a probiotic. There's obviously an influence there with even in the mind. It's this big thing now. One thing that a lot of people don't realize is when we tested food additives and sweeteners, especially those of the past three, four decades, we didn't even know to test them against the microbiome because we didn't even know that that was important. Is there anything else people should look out for like dyes and preservatives? Do we see any changes in microbiome from those things? Yeah, maybe the easiest way to paint this would be just to make what sounds like a simple recommendation, but it's probably the most profound, which is eat a diet as devoid as you can of processed foods or artificial sweeteners or anything synthetic or chemical and just focus on whole fresh foods. You can get into some nuance in terms of diet from there, low-carb, moderate-carb, high-carb, low-fob-map, paleo, what have you. We can talk about some of those if you want, but that's really probably all people have to be worried about. You can get so sucked into the rabbit hole with all these details only to eventually detail your way back to that simple recommendation. I would say that's a hugely important thing. The other thing that I would throw out there is remembering that it's not the microbiota is driving every disease. You create an environment with the stuff that you do in your day-to-day, and that environment is the environment that houses the microbiota. The better you create your internal environment, the healthier your microbiota will be. They've shown, for example, that exercise improves the health of your microbiota irrespective of diet. Sunshine can help improve your microbiota irrespective of diet. Even things like type 1 diabetics who don't make insulin, but need it when they start insulin therapy, that improves your microbiota. Stress can either have a negative or positive impact on your microbiota. Sleep can have a negative or positive impact. If you wash your dishes with a sponge or use a dishwasher, that can have an impact. There's a little bit of overzealousness forming about the microbiota driving every disease. You really have to take a big step back and remember that it's not to say that the cause of every disease is the microbiota. There's an equal input and output from the microbiota. Keep your diet generally healthy and keep your lifestyle generally healthy. That's going to be the foundation. From there, then we can get into some more clinical interventions for improving your gut health. You have to be careful going down that rabbit hole because you can get so deep in it. I read most of these abstracts and they all come back to the same core group of fundamentals. Healthy diet, healthy lifestyle, and then things are still alright. Look into working with the clinician who can help you sort out where the imbalance is in your microbiota because an imbalance can create it can create this self-fulfilling imbalance where if you have an overgrowth of one thing, that overgrowth poisons the other good guys. Until that bad guy is knocked out, the good guys can't flourish. Start with the foundation and then get clinical from there. It's truly a symbiotic relationship. It goes both ways. Yeah. 100%. Do you seem to like, so when I'm coaching a client and I'm always trying to help them connect the dots and be more aware of what they're intake and consuming. So I make them track and I say, don't change the way you're eating. Just eat how you normally eat and we're going to track it together. We're going to look at it. And for me, one of the biggest culprits I see is this over consumption of just sugar in general. Do you see a common theme in people when you look at their diet as far as like culprits that could be affecting their gut negatively that tend to help them in general like, hey, most people tend to do this and this is probably not ideal for our gut. Do you see something like that? Yeah. I mean, a lot of this depends on where you're coming into the conversation. If you haven't even really changed your diet much, then just shifting to some type of healthy diet plan, you're going to see a lot of benefit. So that could be Mediterranean. It could be paleo. It could even be vegetarian, even though I'm not a huge advocate of vegetarian diets. If you're coming from the standard American diet, shifting to a healthy diet plan that avoids added sugar to your point and processed foods, you're going to see a lot of benefit. We can talk in a second if you want about the comparative studies looking at these different diets to see what diet actually has the edge to be the healthiest. But there's something else that may be salient for athletes and this has to do with or exercise enthusiasts. This has to do with how exercise impacts the microbiota. And I'm being a little bit speculative here, but I think this is somewhat well-reinforced of an argument. We see in athletes that are overtraining or training excessively, increased risk for infection. I'm sure you guys have heard of that. Part of this, let me take a step back and say, so too much exercise can increase your risk of infection. But some exercise can actually increase the diversity of healthy bacteria in your gut. And why this probably is is because exercise can be a little bit immunosuppressive. And so in the right dose, it can prevent your immune system from killing the good bacteria in your gut, having it too overzealous of an immune system. So a little bit of immunosuppression good, too much. Now you're so immunosuppressed, you haven't increased risk of infection. But the problem can be too much exercise may downregulate the immune system in the gut to a point where it allows small intestinal bacterial overgrowth to occur or other like imbalances. I use the example of SIBO or small intestinal bacterial overgrowth because it's pretty in vogue right now. And so some athletes are really noticing that their digestion is not great, right? Probably because of overexercising also maybe because of some of the garbage and the powders and the pills and whatever. And then they're finding benefit in diets that restrict foods that feed bacteria. And this is known as a low FODMAP diet most typically. And what's interesting or maybe counterintuitive about these diets is at face value, they seem healthy, right? These foods that are restricted by the low FODMAP diet seem healthy asparagus, right? Cauliflower, aren't those healthy foods? Well, it depends. If you have bacterial overgrowth, those foods have a lot of prebiotic in them that feed bacteria and they may actually make you feel worse and increase inflammation in the gut, increase the bacterial overgrowth. So some athletes are finding benefit from going to these low FODMAP diets to kind of help rebalance this altered gut flora. So that may be something a little outside of this typical, you know, healthy diet recommendations that could be salient to your audience is that a low FODMAP diet for those with IBS like symptoms, gas, bloating, constipation, loose stools, abdominal pain, reflux may be helpful because of an underlying imbalance that's been driven by that kind of exercise slash athlete lifestyle, lots of exercise, potential immunosuppression, and then some of the other garbage that is in the supplements. Now, is this why you're not a huge fan of vegan diet? Is that why? Yeah, that's part of the reason. I think the vegan diet may be a little bit extreme where if you look at our evolutionary history, you know, there's not a strong argument for a vegan diet. And this is someone who I really appreciate looking at evolution. And if you look at our evolution, there's actually a few pivotal points in time that have steered us away from a vegetarian type diet and a vegetarian type gut. And I'll bore you with some details about early hominid history, but there were two competing ancestors, hominids, at the same time. And one of them would become us and the other one would go extinct. You had Pranthopys boisei, which was like a gorilla, right? A really big hominid, lived predominantly on the ground, had very strong jaw structure and could just eat nuts and roots and this very tough vegetative matter, like a cow almost, right? And he had a very long intestinal tract to help break that down. So he was a specialist in the stuff that was just right there on the ground. He was competing with Homo habilis, who was more like us. He was omnivorous. He could climb up in a tree and eat honey. He could scavenge off of a kill and eat some meat. He could eat some fruits or berries. But he was a omnivorous and the other was more of a vegetarian specialist. Now, at some point, and we believe it's when the Himalayan mountains form that changed the global climate to where Africa, where these hominids were, became much more arid. And so a lot of the vegetation died, right? And so with that, Pranthopys boisei, who only ate vegetation, became extinct. But the clever, crafty, adaptive, omnivorous Homo habilis lived on. And part of his diet was a diet that allowed him to survive on things like, yes, honey and ripe fruits, but also a heavy amount of scavenging off carcasses that involved a lot of meat consumption. And that actually changed the anatomy of our intestines where we became more dependent upon the small intestine and less dependent upon the fermentative large intestine, which is more of like a vegetarian diet centered intestinal tract. So there's a lot of evolution suggesting that we shouldn't be strictly vegetarian. But when you look at the comparative studies, like coming modern day and trying to filter this through clinical trials, we have had studies done that look at a low carb diet next to a vegetarian diet for numerous conditions. And to put it simply, studies generally compare low carb, vegetarian and paleo in some of these setups. And compared to no diet at all, all the diets show benefit. It's important to establish that because your vegetarian friend may say, well, what about this study? Yes, they're out there. But the comparative studies that have compared one to the other to see if one has a slight edge show general favorability of either a low carb diet or a paleo diet. Again, they all work, but there seems to be a favorability toward a lower carb diet or a paleo diet according to the best evidence that we have right now. Yeah, I think in modern times, you can eat vegan and be perfectly fine, but it takes a lot more planning. It's very difficult to get certain nutrients. It's just a fact. You're not going to get as bioavailable forms of iron, you're not going to get certain B vitamins. When you give creatine to vegans, it's a new tropic. It actually boosts their IQ a little bit and you give it to an omnivore and it doesn't really do that. And that suggests that there's a little bit of a deficiency in creatine, which you get from meat products. And again, I respect people's moral reasons for eating vegan, but when someone says, it's the healthiest way to eat, I usually shake my head and roll my eyes a little bit. Yeah, it's really if you're objective, it's not supported to say it's the healthiest. It's a healthy way to eat compared to no diet at all. But if you're going to be objective, it's not the healthiest. And we tend to tell people like, pay attention to what you were doing before you switched over to that. Because it might be more about what you're not eating anymore than what you're eating more. Exactly. I mean, most people that go vegan after not doing anything whatsoever were grossly under eating vegetables. And it's like, man, it's amazing when you all of a sudden start introducing four or five servings of vegetables in a day. How great you feel. And that's probably why people feel better on virtually any diet plan when they're coming from no diet at all. But there's one other point that I think is interesting here that may help satisfy some of the debate in terms of carbon take. So Christopher Gardner is a PhD researcher over at Stanford. And he did a great study called the A to Z weight loss trial. He compared Ackens, Pritikin, Ornish, and Zone. So kind of low carb all the way up through high carb. And what he found is that all of the groups saw a weight loss or a weight reduction and an improvement in their blood lipid profiles. But there was a slight edge for the Ackens diet. So he said to himself, why is it that everyone's responding but the Ackens has a slight edge. So he did a sub analysis. And in the sub analysis, he was able to figure out that while some people can respond to any diet, there are some people that only respond to a low carb diet. And it's the people that have the worst insulin sensitivity who will only respond to low carb people with good insulin sensitivity will respond to any diet. That's important to factor into our conversation here because it cuts through the this diet is better because it worked for Suzy Smith, but it didn't work for me. It's yes, because not every diet is going to work for everyone. People with good baseline insulin sensitivity can go on any of these plans and have success. People with compromised insulin sensitivity will probably only find success in a lower carb. And so if you, I mean, just for the layman, you take a thousand average Americans and a good chunk of them, a large chunk of them, we're going to have insulin issues, which is why low carb work seems to be work best for most people and not for everybody, but for most people, because a lot of people have naturally fight it in the studies like we just talked about. Yeah. Exactly. So you've got a little bit of that. That was that quote I call it self selection or that selection bias or whatever because of the sample size. I wanted to ask you a little bit about leaky gut syndrome. It is not accepted yet by I say yet, because I think it will be eventually, I'd like to know your opinion on it by, you know, Western medicine. I hear people laugh at it sometimes when I talk about it. What is leaky gut syndrome and what is your opinion on it and what are some of the symptoms? Well, I partially see where more conventional medicine is coming from with kind of chastising leaky gut syndrome because in some circles it's almost used as a term kind of like adrenal fatigue where people just use it as a descriptor. Just a blanket. Oh, my adrenal fatigue today. That's not really, first of all, like, you know, the whole concept of adrenal fatigue is being seriously questioned right now. And the method of testing that is being seriously called in the carpet. So, you know, it's one of those things that's kind of like this self-feeding prophecy where people just blame, oh, my leaky gut today is really, so I mean, I understand where they're coming from. There's a couple of different ways to assess it. There's the latulose manateal test, which can produce a false negative or false positive if someone does or does not have SIBO. So I don't like that test. And then there's antibodies against things like zonulin and occludin. And to tell you the truth, I don't really do any leaky gut testing because to the degree to which someone is ill, especially if they have digestive symptoms, I'm assuming they have a degree of leaky gut. Now, to your question, what is leaky gut? It's essentially when your gut is letting too much stuff through, right? That put it really simply. Your gut is this selectively permeable membrane that wants to absorb things like nutrients and wants to keep out things like parasites and toxins and what have you. So it's a selectively permeable membrane. And when there's damage in the gut or inflammation in the gut, you can let too much stuff through. That can cause an over-activation of the immune system. And this has been correlated with autoimmune conditions. But then the question is, what do you do about that? And that's really where I jump in, right? I'm assuming if you have autoimmunity, if you're ill, if you have IBS, if you have IBD, if you have depression, if you have insomnia, fatigue, I'm assuming your gut health's probably not great. So I don't necessarily need to quantify that. What I do need to quantify are the things that we can treat that will improve the leaky gut. So I just make that recommendation because a lot of patients come in reading about leaky gut and thinking that there's some leaky gut test that then has this corresponding leaky gut treatment. And what it really has is a bunch of supplements that may help with leaky gut but don't fix the underlying problem of the leaky gut. And so a lot of people come in spinning their wheels, not realizing that you don't have holes in the bow of a ship just because, right? You're sailing in rough waters or your wood is rotting, you have termite infection, right? So leaky gut doesn't happen just because. So I kind of circumvent and then go right to what the cause of leaky gut could be. So it's definitely something that I think has validity to it and has been correlated in some of the research literature with different conditions. It's just, in my opinion, it's just an intermediary between disease and an underlying deeper cause and effect. Hearing you say that makes me, I have to ask you then, how frustrating or how often do you get this where something comes out like leaky gut and it becomes popular and then before you know it, there's a supplement to treat this symptom versus, you know, is this something you see a lot of? Is it something that just recently, something that has just came up recently that frustrates you? How often does this piss you off? Stuff like this happens all the time and, you know, admittedly, I may come off a little bit jaded or passionate about this sort of issue because I see so many patients that come into my clinic and they've taken so many supplements and they've done so many self-tests and they've just wasted so much time and so much money. Leaky gut is a shining example of that. Adrenal fatigue is a shining example of that. Many of the thyroid conversion supplements are another shining example of that. And these are all things that I did. I'm not criticizing. These are things I did myself when I was in college not feeling well. The same thing, right? When on the internet took the thyroid symptom quiz, thought I had hypothyroid, so I went to Whole Foods and I bought the iodine kelp supplement plus the Google Lu thyroid conversion compound with selenium, right? I get it. It makes a lot of sense cognitively. But, you know, there's this simple kind of analogy where if your car broke down and we let you into the machine shop, could you fix your car? You have access to all the tools. Do you know how to use them? No, you don't know how to use them. Chances are you're going to waste a lot of time and money in the machine shop trying to fiddle around and fix your car if you don't know how to use the tool. So I would say I spend probably 30% of my time talking people out of a disease they think they have, or from doing a test I think they need to do, or from taking a supplement they think they need to take. Because in clinical practice, these things tend to be pretty simple. It's a lot of complexity in terms of analysis, but then what you do ends up being kind of simple. So yes, things like this irritate me all the time in terms of people, you know, doing these self-tests and self-treatments. And I'm all for self-education. But if you've done a little bit of tinkering and you haven't gotten anywhere, it's really going to be in your best interest, in my opinion, to turn things over to a clinician because in the long run, they'll save you time and money. And what kind of tests do you run to figure these things out for people? Are there stool sample tests? For a gut workup? So for a gut workup, what I like to do in most cases, there's some nuance here, but I almost always will perform a SIBO breath test. Now, let me just preface by saying most of the people coming to my clinic have already done some dietary tinkering, their lifestyles in somewhat decent order. And so we're not going to start there. We're going to kind of go to level two, right? If someone comes in, which occasionally someone comes in. Because you're not usually the first person they see. Exactly. Or they've done a little bit of research and they said, oh, the paleo diet, let me try this. Or let me try a probiotic. So if someone comes in like that and they haven't even gone on the paleo diet, I'll say, Fred, take this book home with you on the paleo diet. I'll see you back in 30 days and we'll check in. And oftentimes, 78% of improvement is yielded just by that. But for the people that have done some dietary tinkering, I'll almost always do a SIBO breath test. And it's a three hour lactulose hydrogen methane assessment via a breath test. And then I'll usually do a stool sample, depending on their insurance. If we can go through lab corporate quest, that's great. Then we'll do a combination of stool, blood, breath and urine. And all those markers are looking for different things in the gut. You can look for antigens in the stool, antibodies in the blood, certain organic acids in the urine and then an H. pylori assessment via the breath. And so I'll usually do that kind of work up. Now, if I'm suspicious of inflammatory bowel disease, then we'll add in some inflammatory markers that are consistent with inflammatory bowel disease. But that's generally the work up. And then in conjunction with that, we'll do kind of a general core wellness panel where we'll do a preliminary thyroid screening for overt hypothyroidism, look at vitamin D, screen for anemia, look at liver and kidney function. But the initial assessment, while thorough, it's not excessive. And that's, I think, an important thing for the healthcare consumer to be cognizant of is, I think, with only good intentions, sometimes functional providers or even your conventional doctor who's trying to get into more alternative medicine, maybe is getting information that's a little bit biased by lab company or supplement company educational materials. And so you end up with a testing or supplement model that's a bit excessive. So you mean someone goes home with 15 different bottles of 15 bottles of supplements or like thousands of dollars worth of lab testing. Now, if you have no health insurance, your lab bill, your initial lab bill being between $900 and $1500 isn't unreasonable if you have no insurance at all. But if you're using insurance in maybe a hybrid model where you can get some test covered and some test not, you should be looking at maybe a few hundred dollars. So somewhere between a few hundred and maybe $1500 is, in my opinion, the max for what a reasonable initial lab bill should be. But it's fairly common for people to be spending in excess of three, four, five thousand dollars on their initial lab testing evaluation. And I know that there can be a time and a place for that. But I think that's a very excessive model that needs to be reexamined because it can end up doing more harm for the patient than good because it creates financial stress. Also on the clinical end of things, if you have too much information, it's very hard to analyze that data and know what's helping and what's not helping. So it's better, I think, to use what's termed as a horizontal differential diagnosis compared to a vertical differential diagnosis rather than a horizontal. Horizontal means you're going to attack everything at once. Vertical means you're going to organize a hierarchy based on the person's presentation and say, we're going to start with items one and two. We're going to see those through to fruition and then reevaluate. If everything's improved after one and two, we're done. If not, we move on to three and four or five. So when you go through these things in a vertical kind of hierarchical fashion, you make the treatment much simpler, much more cost effective, and much less excessive. So those are some of the tests that I do initially. And I'm always kind of looking at the person in kind of this vertical model, because if those things don't work, there's these secondary and tertiary and questionary fallbacks that we look into. Now, when you came in here, you were, what was it called? The Sony digital paper. The Sony digital paper, you were reading some studies. And by the way, that's really cool. We'll make sure to put that in the show notes. But I love to ask someone like you who's got a specialty like this, what are you reading right now that has got you excited or very intrigued in this world as far as the gut? And what are you diving into right now or learning? Well, the gut histamine piece is interesting. Let me pin a pin there for one second, because there's something non-gut related I think is really important, which is thyroid autoimmunity. So this autoimmune epidemic, I think many people have heard about it. And there's just a few important things for thyroid autoimmunity. I think it's important for people to understand because it can potentially save them heartache, fear, what have you. So if you're reading up on this, you figure out that Hashimoto's is an autoimmune process that causes hypothyroid and that Hashimoto's is important to treat and to monitor and what have you, which yes it is. But there's some nuance. So the main lab marker that's used to track Hashimoto's is a antibiotic called TPO, a thyroid proxidase, right? You can get it lab core quest, any doctor can do it for you. Now, anything above usually 35 is considered positive, right? So oftentimes people will have this test done and they'll see that they, yes, they have Hashimoto's, their antibodies are elevated. But the level of elevation dictates risk. Why this is important is because if people are above 500, then they are increased risk. But if people are below 500, they're at minimal risk. So why is this important? Because when people come in initially, they may be at 800, 1200, 1400, 1500, right? Very high. But then they make some healthy diet and lifestyle changes, maybe use some vitamin D, maybe use some selenium, maybe investigate a problem in the gut, treat that problem. And they're feeling at the end of all that much better. We retest our antibodies and their antibodies are now 225. Now, depending on the type of clinician that you are and how you're trained, you can take that and manage that conversation one of two ways. One way, the way I would not recommend, you still have autoimmunity. There's still a problem. We still have to treat you. We still have to do stuff. And you still need to be afraid of this chronic internal inflammatory burden. And people get really fearful about that. And they walk around every day thinking that there's a smoldering fire of autoimmunity in their body that's going to be problematic. However, if you look at some of the contemporary studies with a critical and conservative eye, you see that when people are between 100 and 300, really kind of below that 500 mark, they are at minimal risk for any kind of regression of the disease. And it's what I would term a clinical win. So why that's important is because there's a lot of people walking around with positive TPO antibodies, but in the lower end of the range, that don't have to be fearful anymore about their autoimmunity and can just kind of focus on living their life. I think that's something that's really important because I see a lot of patients that come in and they think that there's still something wrong with them when there's probably not. So that would be one important thing that I've been reading up on and seeing this trend in the literature that it's not like a light switch on or off and maybe looking at diabetes, right? Your blood sugar shouldn't be above 99, but if you come in at 103, we're not going to scare the bejesus out of you, right? If you're 203, different story. Same thing with the thyroid antibodies, right? If you're just over the edge there, 200, not that big of a deal. If you're 1200, 1900, okay, we need to start looking into this more deeply. So that's one thing. Now in terms of nutrition, you know, we talked a little bit about paleo and vegetarianism and do you, is it beneficial for people to vary their, not only the foods that they eat, but their macronutrient profile to foster a more diverse microbiota? Does it do that? Or is it okay to stay? Is it better to stay in one way? Like if I, like for me, for example, I for sure have gut issues and have had them for a long time. And I just feel at my best at a very, very low carbohydrate kind of higher fat diet. But I also found over time that when I throw in days where I'd have more starches or I eat, even, I even have a vegan days that I'll do for myself that I seem to feel much better. Is it because am I promoting a better microbiota? Or does it have nothing to do with that? Well, I think there's some benefit to variability. And that's probably just replicating kind of like the, the feed fasting and food variability cycles that we experienced when we were hunter-gatherers, right? It wasn't always going to be the same. So I definitely think there's some plausibility to that. It's also important to keep in mind that globally, the hunter-gatherer diet changes from equator to the poles. And this has been well confirmed in the, in the publicist anthropology literature, the closer you are to the equator, the more of a high carb diet you should, and I don't mean if you're living there currently, I mean if your genes evolve there, of course. So if you're of genetic lineage of an Ecuadorian, then you probably do better on a high carb diet. If you're of Irish descent, you're probably going to do better on a low carb diet. Because what we see is at the equator from about zero to 30 degrees of latitude, it tends to be a higher carb, lower fat diet. Then from the 30 to 40, where are we? Mediterranean. Guess what you have? Kind of an intermediary between high carb and low carb. Then you go plus 40 and you have a lower carb type of diet. So there's definitely this variability built into the system in terms of who will do best on what kind of macronutrient composition. To your question, I think variability definitely has some plausibility to it. But you know, there's another point here which is now that we're learning that the microbiota is important and having kind of a diverse microbiota is important and that fiber, carbs, and probiotic can feed your microbiota. There's this erroneous assumption forming that essentially states that if you want to have a healthy gut, you need to eat a lot of carbs, fiber, and prebiotics. And that's wrong. And it's wrong because the people who have the worst gut health will do the worst on those interventions. So the highest risk of a negative reaction to fiber and prebiotics are those of the IBS and IBD. That's me. Clearly been shown. And part of this may have to do. You're feeding the bad stuff maybe. Well, it may not even be the bad stuff. Part of it may have to do with the fact that your commensal microbiota, this stuff that should be there, your immune system is not well calibrated to manage that. So even if you have a growth of the good guys, your immune system isn't getting along with the good guys to begin with. So if you go and you feed the good guys, you're feeding what is pissing off your immune system. So I think that that is one of the things that underlies that. Now, there's so many levels of complexity to this argument because we see in healthier populations, generally higher diversity. So in people with IBS and IBD, we see lower diversity. So it's easy to draw the inference that we should be giving people with IBS and IBD lots of fiber and lots of prebiotics. But it's not that simple. This is a biological system. And I think what happens is the immune systems in IBS and IBD are forming an adaptative response to try to kind of diminish the commensal population because the immune system doesn't get along well with the commensals. And there's the clinical data reinforces that. The observational data reinforces eat a bunch of fiber and prebiotics. But when we do that with people, when we take people who have Crohn's disease, for example, and we put them on a high FODMAP diet, we see they have more inflammation, more disease activity, but yet their microbiota starts to look healthier and they have more short chain fatty acids, which may be healthy. So we see these glaring discrepancies. There have also been some studies showing that after the administration of certain antibiotics, we can see diversity increase. And that may be because to your earlier comment that we're killing off some of the bad guys that have been poisoning the good guys from growing. So dysbiosis and inflammation can kind of poison the environment and make it harder for the good guys to grow. So it's not just to say we have to feed the good guys. Sometimes it's looking at this more from an environmental perspective of trying to figure out what the ecosystem needs. And the analogy I like to use is different ecosystems require different parameters to be healthy. So if we say that carbs, fiber, and probiotics are like rain because they feed stuff. So Southern California, too much rain causes mudslides and kills people, right? So we shouldn't say because there's such pretty vegetation in the rainforest, every geographical climate should have a lot of rain. No, like, do you see how stupid of an assumption that is? But we do that where the African hunter-gatherers eat lots of fiber and have healthy guts. So we should all do that. Well, no, we shouldn't do that because if your ecosystem, like in your case, if your immune system hasn't been ideally calibrated to deal with your commensal microbiota, then we're going to try to feed that, you may have more inflammation because we're feeding the thing that the immune system is struggling to keep in check to begin with. This was something that we talked about with Rob. It's just so ironic that Western medicine doesn't take anthropology into consideration when diagnosing. I just find that so fascinating that we don't take that into consideration. It just seems so obvious when you use analogies like that. It seems like anybody can benefit from getting their gut tested and just kind of finding out like how you respond best to it. I wrote an e-book called Start with a Gut that kind of talks about this because I've seen over so many years this concept is completely reinforced, which is once you get your diet and lifestyle in order, if you're not feeling well, the place that's most efficient to start is the gut. It's not a guarantee, it's not a panacea, but there are other things that are less common that you want to make sure you do after the gut and only after the gut. So, Lyme disease, mold of mycotoxin, toxicity, having mental toxicity, I think any expert in those areas will agree, get your gut healthy first because it's going to be easier to heal from this once you have that in order. So, I think that's the one message to take away from this podcast of nothing else is start with your gut. I was just saying, I had an interesting experience more recently over the past few years where I've had to take antibiotics a couple times and with my antibiotics, I'll separate and I've read that this is the way you're supposed to do it. I don't even know if this is accurate, but I'll take my probiotic in the morning and four hours later, I'll take a probiotic, obviously because I'm trying to protect my antibiotic and probiotic. Excuse me, antibiotic and probiotic. And my gut health is amazing when I do this. It's like I'm on an antibiotic and then I have the best gut health ever and then I go off the antibiotic and then it takes like two to four weeks and then I go back to my old self. What's going on? I must have something that's overgrowing or you know, that I'm killing with the antibiotic but then comes back. So, I've got to get you a copy of my book which hopefully it'll be out late this year or I'll just kill myself because at this point it's been so long that I'm just getting sick of writing it. But we go through a process exactly for those types of people because there's definitely a subset of people that kind of always feel better on some type of antimicrobial approach. Now, that might be a low carb diet, it might be a low carb low FODMAP diet, it might be cyclical use of herbs that are antibacterial in nature. Like what, by the way, which ones? Oregano, grapefruit seed, berberine, alicinol and garlic. There's a whole bunch that can be used but there's definitely a subset of people that need to kind of work to keep their microbiota in check. So, there's other foundational things that may preclude you from meeting ongoing antimicrobial. The right probiotic regimen and the right dietary regimen may get you there but there are definitely people that notice they feel better when they're on antibacterial type treatments. So, what that may mean in your case, you may fit kind of a more standard moderate IBS sort of presentation where you need to kind of keep the shrubs trimmed. And so, an analogy I like to use is we pull weeds and we trim shrubs. And so, sometimes people have a hard time thinking, well, don't we not want to kill stuff in the gut? Well, it's not all about killing, sometimes it's just about trimming. And so, sometimes when people are learning about SIBO or Candida, they're saying, well, don't I want to completely eradicate my SIBO? Well, it's not that you want to eradicate those bacteria because those bacteria should be there and the fungus and Candida should be there. It's just you don't want them to be overgrown. Just like the same way to trim your shrubs, you don't rip them out, you trim them. So, some people need this kind of ongoing trimming approach to keep things in balance. Shit, that might be me. So, along these lines too, we talked. Don't mow that long. I don't trim. After the podcast, Taylor mentioned wanting to take you to Whole Foods and you suggested something. I want you to kind of share with what you suggested and why you suggested that. I think it's an awesome thing that was about probiotics. Yeah. Yeah. So, you can get really, I think one can get easily confused regarding probiotics because there's so many different formulas out there. But I think an easy way to approach probiotics is to try to organize them generally into classes. And there's about four classes of probiotics. You have your lactobacillus, bifidobacterium mixtures. So, when you look in the label, you'll see predominantly lactobacillus and bifidobacterium listed. That's class one. Another class is saccharomycespillarity, which is a healthy type of fungus. And on the label there, you'll see just saccharomycespillarity. A third is known as soil-based organisms. And you'll see here mostly bacillus-type species on the label. And there'll be many of them, but you're going to see bacillus-bacillus-bacillus-bacillus-bacillus-bacillus prominently. And then the fourth, you can't buy it in the U.S., but you can't go on the Internet and buy it from Canada or wherever. And this is E. coli-nissil1917. And people sometimes think, oh, E. coli isn't that bad. Some E. coli, yes. But one of the major gut commensals, good guys, is actually E. coli. So, you want to have robust E. coli in your gut naturally. And this E. coli1917, trade name is mutaflora. There's one other brand, but mutaflora is probably the most well known, is kind of the fourth class. And so what you can do is just try a probiotic of each one of those classes. If you're sensitive, I would try them one at a time so that you can preempt or determine easily where a reaction is coming from. I was just going to ask, do you want to take them all together? Well, the healthier you are, the lower your probability of a reaction, so you can take them all together, right? But if you're more sensitive, you notice you're more reactive, I do them one at a time so you can parse out where reaction is coming from. Because while they're, in my opinion, is an overwhelming number of literature that probiotics can help everything from depression to SIBO, not everyone is going to have a positive response. There's a small subset that will have a negative response. The most common negative response is bloating. Now bloating for a couple of days, not abnormal, things are adjusting, right? But if after three, four, five days, you're still having persistent bloating or other negative symptoms, then that probiotic may not be for you. Try the others. And if after trying all the probiotics, you can't find any that work well for you, you may just be, as a general class, a probiotic non-responder and you don't want to use them. I was just going to ask you, because I've used most of those. I bought the soil-based one, Perscript Assist, I think was the brand, and the Lactobacillus Bephida one that I'll use is Ultimate Flora. And I tried the, what was the second one you named? It was a fungus, Saccharomyces Blardy. Saccharomyces destroyed me. I would take it and I'd have horrible gastro issues from it. And I tried it a few times and it was just horrible for me. And so you're obviously, I stopped taking it. And so that means very simply, not for me. Probably not the right one to take. Yeah. And so two things I should maybe mention really quick. With probiotics, you want to be careful that your probiotic does not have a high level of prebiotic in it. So you want to shoot for- So it does not. Does not have a lot of prebiotic. That's funny because some of them include prebiotics saying it's better for it. Right. Well, theoretically, yes, because the prebiotic feeds the probiotic. Right. But for people with IBS and IBD, they're more prone to negatively react to prebiotics. So I'd recommend- Again. I recommend you shoot for underneath a thousand milligrams. You know, a thousand, underneath a thousand milligrams is probably going to be okay. Most of the studies have shown that you can get away with three to five grams without risking a lot of negative reactions. But that's something to be condensate of, for example, that saccharomyces bilarity, if it had two, three, four, five grams of inulin in it, that may have been what you're reacting to. So just try to do your best to isolate for the probiotics with a lower level of prebiotic. And start with a low dose, like you said. Now, how hard is this to find in just whole foods? Where can- Shouldn't be too hard. Just you want to read the label and maybe ask the person there, you know, are any of these things prebiotics? And then look and see if the milligrams listed. And- Well, the lactobacillus and bifidol ones you can find easily. The soil-based ones, I had a tough time finding. I had to go online. Oh, I'm sorry. I thought you were asking how to determine the level of prebiotic in them. In terms of finding the formulas, yeah, the lactose and the saccharomyces probably at most health food stores. The soil-based probably online. And then the E. coli, or tread name, mutaflora, definitely online because you can't buy that here. Now, here's another thing that I observed with myself is that I'll take lactobacillus and bifidobacillus probiotics for a while. And they'll be great. And then after a while, they seem to affect me negatively. And I'll have to switch to the soil-based one. And then I'll do great on that one. And then that will affect me negatively. And then I'll have to switch again. What's going on with that? Am I getting overgrowth? Well, it is possible that you're overdosing. And so you may need just a cyclical dosing of it, or you may just need less of a dose of the ones that you are getting. And I don't think we have an answer here scientifically. So experimentation in your own response as a barometer would be what I would use. However, I'm inclined to think that consistent dosing may be better just knowing the way the immune system works. It seems that consistent exposure is more synchronistic for the immune system, whereas episodic exposure may be problematic. So maybe you cut your dose lower, or you do like three days a week, but you try to use all the probiotic classes at once in a lower dose and maybe a little less often rather than cycling. Now with the probiotic, because when people take them, they take them all the time, is that showing that it's more of a band-aid than anything? Because it's not populating your gut or it's not really changing anything that you've just kind of taken it to deal with your symptoms? Well, probiotics, most probiotics do not colonize you, so that's important to establish. Now, okay, so I'm glad you said that. Let's talk about that for a second. So what do you mean by that? It doesn't actually help populate your gut with what you're taking? Yeah, that's a misnomer. Probiotics don't colonize you. Most don't. And they've even done studies using what's called heat-killed probiotics, where they heat up probiotics till they're dead, and then they administer them, and they've shown benefit with even those. So there may be more to the probiotics than a live probiotic may not be essential for some of the benefit. Probiotics do a couple of things. They transiently, because they're mostly in transient nature, they don't populate you, they release antibacterial peptides, so they can actually kill SIBO, kill fungus. So part of what they may be doing is combating overgrowth. So they are antibacterial. They are also anti-inflammatory and immunomodulatory, so they dampen the inflammatory and immune response in the gut. They help with leaky gut by doing that. They may also partially degrade biofilms. They help make the microbiota less skewed by antibiotic use, and they actually even have been shown to enhance the effectiveness of certain antibiotics when used for the treatment of certain infections. So there's many benefits of probiotics, but they tend to be somewhat transient. Now, the way I would recommend using a probiotic is using them in more of a clinical application while you're trying to get your gut rebalanced, and then try to find the minimum dose needed in the long term. In my print book that's hopefully coming late 2017, we go through the whole story, like all the stuff we've been talking about, but then the end codifies all the information into an eight-step process that's personalized. So at the end of every step, we reassess and you either go one way or the other. If people respond optimally at step one, they go right to step five and finish. If they respond optimally at step two, they go right to step five and finish. If they aren't there by step two, they go through steps three and four, which are built to be together, right? But things like your response, which are you feel better on antibiotic, but then you regress afterward, those are factored into the plan. And it really is, it's just kind of this algorithm that I go through in the clinic. And so what I recommend in the book and just as a general practice is try to be a little bit more robust in your intervention in the short term, see if we can get your microbiota to balance back out, and then wean off the interventions in terms of supplements or whatever, and then also try to broaden your diet. So at the end, the end game is minimal use of supplements, maximally broad diet, and that's what we do kind of in the long term. Awesome. Lastly, I wanted to ask you about fermented foods. What role do they play in? That ties back to your histamine question, so I'm glad you asked that so we can tie back into that. So fermented foods can be great for your gut. They're a food form of probiotic. So like kombucha or kombucha, kimchi, sauerkraut, yeah. So they can definitely be helpful for fermented yogurts, and there's definitely some studies showing that these types of foods can be helpful for various conditions, including gastrointestinal conditions. However, there's one important caveat with fermented foods, and that is there are some people and some estimates come in at maybe 22% of patients with digestive symptoms may have what's known as histamine intolerance. Now what is histamine? Histamine is a byproduct of the form from bacteria, right? So in fermented foods, because there's a lot of bacterial activity, you're going to have a lot of histamine. And for some people, what I notice is they go to a kind of like paleo lower carb type diet, and they inadvertently start eating lots of histamine. Probiotic rich foods like fermented foods, plus things like spinach, avocado, fermented meats like jerkies and canned salmon, things like that. They all have a pretty whopping dose of histamine in them. Now for most people, it's not a problem, but if you're histamine sensitive, it can start manifesting as a histamine sensitive reaction. And there's a few things that can happen there. There's neurological symptoms, brain fog, irritability, there's skin reactions, hives, rashing, flush feeling, also cause insomnia, can cause things like joint pain, and can also cause gastrointestinal distress like bloating or loose stools as some of the most typical, and maybe even joint pain. So some of the key things there are if people notice they feel worse when they eat lots of fermented foods, then they may be histamine sensitive. And then you can look up a low histamine diet, try following that diet for a few days, and usually it only takes maybe a few days to start at least getting an inkling in terms of if you're histamine sensitive or not. And this actually happened to me. I was eating lots of histamine foods. I was eating tons of avocados and spinach and jerky because it was all so convenient, and then washing a lot of that down with the kombucha. And I'd be at my home office on like a beautiful sunny day, no reason not to be perfectly happy. And I'd be like, what the frick? Like I'm pissed off. What am I mad about? Right? And I felt foggy and irritated and I finally did some reflecting. And I'm like, wow, like there's been a lot of histamine in my diet lately. And so I cut out all those high histamine foods and I quickly figured out that I am a little bit histamine sensitive. So now I can have those foods. I just can't have a high histamine food like every meal for like days on end. That's interesting because I'll, especially if I take really hot showers, I'll get some hives sometimes. And I notice if I take like Claritin or, you know, anti-histamine type medication, my gut will feel better. And your higher risk. So the IBS population is at higher risk for that histamine sensitivity. Son of a bitch. It's horrible. You're playing. Yeah. Now you know. Well, this has been great, man. It's been awesome talking. I'm excited you're close. I didn't realize how close you were. So we'll definitely have to do this again. I'm pretty pumped. I'm excited to go to the store with you right now and talk a little bit more about what, you know, products and stuff people should look for and what they should get and whatnot. So excellent. Listen, go to mindpumpmedia.com. 30 days of coaching is still available and it's still absolutely for free. Also check us out on Instagram at Mind Pump Media. You can find my personal page at Mind Pump Style. Adam is at Mind Pump Adam and Justin is at Mind Pump Justin. Thank you for listening to Mind Pump. If your goal is to build and shape your body, dramatically improve your health and energy and maximize your overall performance, check out our discounted RGB Superbundle at mindpumpmedia.com. 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