I recently listened to a webinar interview featuring Dr. Michael Ruscio, who has conducted a lot of clinical research in the area of digestion and been widely published in peer reviewed journals. He is the author of Healthy Gut, Healthy You and is a guest speaker at the Fatigue Super Conference. He discusses the importance of good digestion and ways to achieve optimum health through a healthy gut. From my own personal experience dealing with fatigue and energy issues, I was happy that he validated a lot of what I’ve been through and the research I’ve done to date. Here are some key points from his interview:

  • Energy and mood are inextricably linked. When you are tired, you feel depressed. This happens to me – when I have good energy levels, I feel like I can conquer the world. When I’m tired and fatigued, I get depressed and feel like the weight of the world is on my shoulders. This has to do with inflammation and the small intestine. The small intestine is the most immune-active area of the body with the largest density of immune cells. In the small intestine, the immune cells have to be well calibrated to deal with the external environment (coming from food) and the internal environment (the bloodstream). If there are disruptions in the flora with bad bacteria and fungus, the body will trigger inflammation as a response. These excess levels of inflammation affect centers in the brain and cause fatigue and depression.

  • Inflammation in the intestinal tract has an impact on cognitive function and energy levels. There is clinical evidence that probiotics can improve fatigue, anxiety and depression. Also, poor gut health will impact the proper absorption of nutrients leading to deficiency.

  • Inflammation is like the police – it is the enforcer of your immune system. Bad bacteria or viral pathogens are rescued by inflammation that is generated by the body to protect itself.  The right amount of inflammation is beneficial but if the gut kicks out excess inflammation, that’s when you will see a cross-system impact. The gut barrier is inflamed, and it impacts the blood brain barrier and the mitochondria. It alters the environment in the gut to make it hospitable for unsavory guests and creates a more pro-inflammatory setting.

  • Inflammation is not only isolated to the gut. For example, if you have an intolerance to gluten, it can manifest not only in the gut but on skin (acne, breakouts), joints (pain), and brain (fog).

  • Key influencers in digestion:  
    • A low FODMAP diet has been shown in patients with fibromyalgia to improve fatigue and pain. Traditionally used for patients with Irritable Bowel Syndrome (IBS), low FODMAP stands for low Fermentable Oligo-, Di-, Monosaccharides And Polyols. That means eliminating foods like: wheat, legumes, garlic, onions, milk, yogurt, cheese, figs, honey, mangoes, blackberries and low-calorie sweeteners, all of which contain high FODMAP.
    • Gut function and sleep are also linked.
    • Probiotics are a good intervention. They’ve been shown to help improve sleep under stress or those with small intestinal bacterial overgrowth (SIBO).
    • Other factors: stress and exercise, early antibiotic use, lack of exposure to natural environment to seed good bacteria (Cesarean births and non-breast fed infants), overly hygienic practices.

  • The gut is also impacted by hormones. Although the impact on male hormones is not very pronounced, female hormone mediated symptoms are more easily identified. The gut detoxifies hormones like excess estrogen and as a result, women may be more impacted by the gut hormone connection.

  • Dr. Ruscio believes that in this country, doctors over-diagnose low thyroid and under-diagnose gut issues. A lot of people may be getting a hypothyroid diagnosis due to fatigue, constipation, dry skin and depression even if they are within the normal range of hormone levels. Because patients that are ‘hypothyroid’ often take supplements and vitamins, make dietary and sleep changes in addition to their thyroid medication to improve their condition, it’s hard to separate out which variable is truly working. Symptoms of low thyroid can be very similar to a gut problem so it’s possible that the integrative doctors are overlooking gut issues when evaluating the symptomology of the patient. Acccording to Dr. Ruscio, about 10-15% of the US population has IBS-related issues whereas only about 4% of the population has true hypothyroid issues. This was a fascinating insight for me as I’ve been hypothyroid for years. I’m now working with my integrative physician who recognized this – we are evaluating the gut through a comprehensive probiotic/prebiotic program to see if this will improve my status.

  • From a dietary regimen standpoint, your family history, treatment history, and presentation of symptoms should tailor your diet approach – whether it’s being a carnivore or a vegetarian, the most viable diet is one that works for you. You should find out if you are eating too few carbohydrates, for example. Chronic fatigue patients often feel worse on a low carb/keto diet – I felt the same way when I tried the keto program. It made me feel like I had the constant ‘keto’ flu with low energy levels. It’s important to not ‘vilify’ proteins or carbs. Dr. Ruscio is not a fan of any extreme forms of diet but recognizes that different diets work for different people. Even the low FODMAP approach could be an issue for some – too much vegetable and roughage could cause a flare-up for some. I’ve tried just about every diet and after years of experimenting, I noticed that I tend to do best on a “pegan” diet (Paleo but limited meat/fish and lots of vegetables) with some carbs but not too much.

  • Dr. Ruscio cautions that labs are not an exact science – they are only indicators. Clinicians often get tunnel vision when looking at lab work and treat patients based on the numbers. They need to look at the patient’s symptoms and judge from clinical experience what the labs are telling them. He shared some astonishing examples of fraudulent companies that were exploiting lab data to drum up business. 
    • UBiome was under federal investigation for fraudulent practices like using 5-year old stool samples that have been stored in sub-standard laboratory conditions and using the data to give medical advice.
    • Neuroscience Labs and its sister company pled guilty to using unapproved and unvalidated normal lab ranges for tests and manipulating the test data to sell their supplements and nutraceutical formulas.

Regarding lab work as an indicator, I recently had this experience with my integrative MD.  One of my viral load test data wouldn’t budge no matter what I did. However, because my symptoms have improved along with other metrics of health, she decided not to worry about the lab result and to discontinue testing.

  • Probiotics can be put into three categories: The traditional lacto bacillus and bifido strains; yeast strains (Saccharomyces boulardii); and spore-forming strains (bacillus).  Dr. Ruscio has seen pockets of research for these strains helping different conditions. What he’s noticed is that in the Irritable Bowel Syndrome area where probiotics are most studied, there is a trend towards treating patients with multi-species formulas rather than a single type. He sees this as the middle-of-the-road treatment with single species at the low end, all the way up to a fecal transplant as the extreme. His analogy is the 3-legged stool and considers the triple therapy as the most robust and comprehensive way to apply probiotics. Probiotics are actually anti-microbial products and a standard treatment for Small Intestinal Bacterial Overgrowth (SIBO). Probiotics can clear the fungal infection, help with motility and reduce inflammation in a non-invasive way (as opposed to antibiotics). This was very interesting to hear as I am in the midst of a comprehensive probiotic program now under the guidance of my physician – I’ll be anxious to see how it will impact my health after the 3-month experiment.  

  • It’s important to work with a good functional medicine/integrative medicine doctor and build a dashboard of your history, conditions and symptoms to see and understand your response against each of the therapies.

  • If you are on your own and cannot see the doctor, where should you start? 

  • Consider the importance of dietary and lifestyle interventions. What you put in your mouth, how much you move/exercise and the state of your mind and sleep are all contributing factors to a healthy gut.    
    • Mild apnea or sleep disorder breathing can be caused by your gut. Also, congestion that is histamine-mediated is usually caused by problems in the gut. So breathing better will help you sleep better which will give you more energy. Some of your sleep issues can occur independently so not all emphasis should be on the gut.
    • If you’ve had orthodontics like braces and head gear, you may be at higher risk for sleep apnea because the oral archway has been compressed with sub-optimal respiration. If you think you have sleep apnea, you should get checked through a sleep study.
    • If you want to try a ‘self-check’, use the app Sleep Talk. It only records when you are making noises.

It’s a fascinating interview – my belief is that energy is KING and anything we can do to optimize and improve it will help us live with vitality.

Check out Dr. Ruscio’s website for more information about him and his practice.  


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