Healthy Gut, Healthy You: The Personalized Plan to Transform Your Health From the Inside Out: A Special Interview With Dr. Michael Ruscio

By Dr. Joseph Mercola

JM: Dr. Joseph Mercola

MR: Dr. Michael Ruscio

JM: Welcome, everyone. This is Dr. Mercola. Today we are joined by Dr. Michael Ruscio, who is a clinical investigator who focuses on gut health. Now, a lot of people are doing that, but he’s actually written a book about it called Healthy Gut and Healthy You: The Personalized Plan to Transform Your Health From the Inside Out. It’s a pretty good read, especially with all the focus nowadays on highlighting the connections between gut health and your total health. Welcome and thank you for joining us today.

MR: It’s a pleasure to be here. Thanks for having me.

JM: You can expand on your background a little bit so people have a better idea of what your clinical experience is and what you’re focusing on. And then we can dive into some of the details of the book.

MR: Sure. My experience started, like many in healthcare, with my own personal experience. When I was in college, I was in pre-med. I was en route to go into conventional medicine. I actually wanted to be a surgeon, or at least I thought I did. Unbeknownst to me, I ended up coming down with an intestinal parasite. Now, I didn’t know I had a parasite. I found out later. But the symptoms that really knocked me down were fairly debilitating insomnia. If anyone suffered from insomnia, they just know how that can bring your life to a screeching halt. It’s terrible. Very bad insomnia, waking up every 45 minutes, very difficult time to go back to sleep. Therefore, I was tired the next day. I was having brain fog and bouts of depression. No gastrointestinal (GI) symptoms. I got plugged into the conventional system. I did some evaluations and all the doctors said that I was healthy. I was left there with a number of symptoms that had no purported cause, and therefore, no solution, so I turned to alternative medicine. I actually ended up finding one of our mutual friends, Dr. Dan Kalish. He told me that he thought I had a parasite. I remember thinking to myself, “This guy is crazy. I didn’t go to Mexico and get food poisoning, and then all this started. I had never left the country. I had no digestive symptoms. I was only suffering from this insomnia, brain fog, depression and fatigue.” But I figured, “What do I have to lose?” I did the stool test and determined that I had a parasitic infection — an amoeba, actually — a very pathogenic amoeba, Entamoeba histolytica. Before I got into that point of the diagnosis, I did go online and read about adrenal fatigue, hypothyroid and heavy metal toxicity. I had done a litany of protocols for adrenal support and thyroid hormone conversion and for heavy metal detox and even testosterone support. Some of those things helped slightly for a short term, but nothing really gave me the lasting improvements in my health, until I determined I had the intestinal parasite and treated that parasite. That taught me a few very important lessons early on in my career. One is that if you’re treating symptoms, you’re never going to get any better. Two is that a gut problem can manifest solely as non-digestive symptoms. We’re seeing some of the contemporary literature start to reinforce this. I went into alternative medicine and did my training in alternative medicine. But when I got into alternative medicine, I found that there was more hyperbole and more dogma than I was comfortable with. Not in all cases, but there were these pockets that were very kind of unscientific and didn’t have the academic rigor that I was accustomed to and that I felt was important. There were many things that – In my clinical practice, I was saying, “I don’t quite buy this.” This is what has led to some of the clinical research that we’ve been doing. With just my general approach, which is open-minded but also skeptical in trying to find that right balance of progressivism, but also making sure that we filter these recommendations through a process of science to make sure that we’re maintaining the therapies that work and excising out the model therapies that don’t work. That’s kind of where I am today in the clinical practice, helping people with gut issues, their manifestations and trying to also determine what therapies we should be using and what therapies probably don’t have enough evidence or have evidence showing that they’re not very effective and therefore shouldn’t be used.

JM: Okay. Great. That’s a great intro. I neglected to mention in the beginning that I first met you at Paleo f(x)™ this year at Austin, Texas, which was the first time I attended. We were on a panel together. I was really impressed. Dr. David Perlmutter was out there too. I was actually – Afterwards, during one of the questions, I said, “Of course, one of the leading researchers here is Dr. Perlmutter.” But I realized that you had such brilliant clinical insights on this. I felt I dismissed your knowledge base. I apologized to you afterwards, and then you gave me your book. I said, “This is great. We’ve got to interview you.” I’m glad we connected. But I want to dive into the book now. There are a number of variables that contribute to longevity, which is one of my passions. I’m fastly approaching my 70s. But one of them is cellular senescence, another is nicotinamide adenine dinucleotide (NAD) levels. The third is inflammation. They’re probably all interrelated in some way. They’re some complex molecular biological systems. You wrote in your book that the digestive system is the leading cause of inflammation in your body. I mean if your gut gets inflamed, it can cause inflammation throughout your entire body. It increases many of these inflammatory cytokines, like nuclear factor kappa-light-chain-enhancer of activated B cells (NF-ΚΒ). Why don’t you expand on that? Because it’s quite a bold statement.

MR: Sure. I should frame that as it could be. It can be one of the leading causes of inflammation in your body. The connecting point to that is the fact that we have the largest density of immune cells in your entire body residing in your small intestine. The small intestine, specifically, is where we absorb about 90 percent of our calories. [It’s] this selective barrier between the outside world and the inside world. Food essentially travels from the outside world through your body in this tube that is your digestive tract. It’s essentially the outside world going through your body. Part of the foodstuffs should be absorbed into your body. That very important selective barrier is predominantly your small intestine. This is where 90 percent of caloric absorption occurs. The tool that’s used to help prevent things not getting in that we don’t want in is your immune system. It’s a very immuno-active barrier that needs to be selective in letting food in but keeping pathogens out. Of course, when that barrier’s malfunctioning, then you can have particles getting in that shouldn’t get in. This is where the immune system has to come into play to clean up the mess. This is likely why we see people who can eat a food and notice after that a symptom of inflammation in the brain, like brain fog, or inflammations in the joint, joint pain. Clearly, people have – and it’s been documented in some of the research literature – that you can have neurological, rheumatological or even dermatological reactions from foods that don’t agree with your gut, because of this very broad-acting inflammatory impact that can be initiated by problems in the gut. JM: Okay. Another thing I neglected to mention in my intro for you is that – it may not be clear if you’re watching this, because Dr. Ruscio’s video feed is not high-definition – but he walks the talk. He is very healthy. I did not have an opportunity to measure his phase angle, but I believe it’s probably in the high 8s, if not in the 9s. It’s such a pleasure to connect with individuals and healthcare professionals who actually apply what they know, because so many professionals are guilty of what I call FTI, failure to implement. You don’t appear to be one of them. Congratulations on that. But I wanted to expand on this inflammatory component and take a little side venture in that it’s widely known that the neurotransmitter, serotonin, is mostly produced in the gut. The thought was, “Well, that’s great. It’s conventionally converted to tryptophan, the melatonin, so it’s great for sleep. So you’ve got to increase that.” But as it turns out, I learned from Dr. Rhonda Patrick that virtually none of that serotonin crosses the blood-brain barrier. I’m wondering what your thoughts are on that. Similar with inflammation where you’ve got inflammation going on in the gut, but does that inflammation, by extension, translate to systemic inflammation? MR: Yeah. That’s a great question. I don’t know if we have all the molecular pathways fully mapped out yet. But what we do fortunately have is the end effects, at least in the preliminary fashion, mapped out. This is why, as an example, a recent prospective study was published looking at patients who have irritable bowel syndrome (IBS). They found that this IBS population, compared to healthy controls, had higher scores of anxiety, depression and fatigue. There’s likely something going on that affects the brain that occurs in the gut. Whether it’s direct or indirect, I don’t think we know. I’m not convinced it fully matters, at least not for the purposes of providing people with clinical recommendations. If we were trying to map out the mechanism for research purposes or textbook chapters, then we’d want to know all those particulars. But from a high level, looking at the observations and the interventions, it does seem that there are neurological conditions associated with IBS. And then even more impactfully, there’s been at least one, maybe two, meta-analyses. Metaanalyses are essentially summaries of what the available clinical trials have to say. A meta-analysis is, very arguably, the highest level of scientific evidence. [—–10:00—–] We have meta-analysis – one, maybe two – showing that probiotics are effective against anxiety and depression. Again, likely because of the gut-brain connection. Whether that inflammation in the gut makes its way into the brain or if it’s indirect, where inflammation in the gut causes a leaky blood-brain barrier and then circulation in the body could get into the cerebral circulation. I think there’s probably debate there. We may not have the question fully answered, but there is this connection between the two. I should also mention that the serotonin in the gut is relevant. This kind of bridges us into maybe something that we’ll want to expand upon more in a little bit, which is, sometimes, to fix problems in the gut, one may have to eat a diet that looks paradoxically devoid of healthy foods. Most namely, a low-fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) diet, which reduces vegetables and fruits predominantly that are rich in prebiotics that feed bacteria. A low-FODMAP diet has been shown to actually help resurrect serotonin cell density in the gut, as well as peptide YY (PYY) cells in the gut to make people who have digestive malady more likely to have healthy control. You may be able to resurrect local intestinal serotonin production via a paradoxical diet that reduces some of these foodstuffs. Serotonin regulates mortality and also regulates pain. People who have gas pain and bloating, this may be part of the reason why a lowFODMAP diet helps with both of those symptoms.

JM: Okay. Just a little point of clarification. The majority of the people watching this are not healthcare professionals. I understand everything that you’re saying, but many may not. We try to be careful with these terms, like IBS. There are a lot of people who don’t understand that IBS is irritable bowel syndrome, not to be confused with inflammatory bowel disease, which a lot of people confuse with. You had mentioned that earlier. And then when you talk about these things, I love it, but maybe – PYY, most people have no clue what that is. It’s great to mention, but maybe give a little brief description of what it is. Because otherwise, people, their head will be spinning, and they wouldn’t want to listen anymore. That’s not good.

MR: Sure.

JM: Let’s skip that for now. You talked about FODMAP, but why don’t we take a step back? Because the FODMAP is a dietary intervention. I want you to go into much more detail. But it has a purpose. It is, as you mentioned, a paradoxical purpose, because there is this infection called SIBO, which is short for small intestinal bacterial overgrowth. It’s sort of a bugger. In many ways, it’s similar to the standard case that most Americans have, in that they’re metabolically inflexible. They cannot burn fat for fuel. That’s why we recommend this aggressive ketosis, no-carb diet for short-term, until they do become metabolically flexible. And then they integrate normal foods into it. Similarly, it’s a condition that many people get. I want you to talk more about it and how they get it and how they know they have it. Because if they do, many of the healthy interventions don’t work. They actually make you worse. This is really an important point to understand. I’ll let you take it from there.

MR: Sure, sure. I think that’s a great point. There’s even maybe one preference point I would make, which is, in writing the book, I tried to make sure to reconcile disparities. I think this is one of the things the healthcare consumer is most challenged by. You go to a vegetarian website, and they will show you articles and studies showing that a vegetarian diet can be healthy. You’ll go to a keto website, and they’ll show you articles showing and documenting that a vegetarian diet can be healthy. The challenge is not to say one is better than the other, or one is the diet that you should use, but rather trying to reconcile, “Why is it that vegetarian can work sometimes and keto can work sometimes?” And, “How can we help people navigate this landscape in terms of – Perhaps, there’s a certain subset of people who would do very well on keto, and there’s a certain subset of people who may do better on a higher carb, vegetarianlike approach.” “How can we help guide people to find the intervention or sequence of interventions? Like perhaps a ketogenic diet, followed by a more moderate balance of macronutrients, maybe like a moderatecarb diet afterwards, after they’ve obtained some healing.” For those with SIBO, or small intestinal bacterial overgrowth, it’s a fairly common condition. It may underlie – Estimates on this vary, but some estimates show that it may cause the majority of cases of IBS or irritable bowel syndrome, which is typically constituted by altered bowel function, either constipation, diarrhea or a mix of the two, and abdominal pain and abdominal bloating. What happens in this condition, as the name kind of hints at, is you have an overgrowth of bacteria in the small intestine. What’s interesting here is it’s not an infection per se, because it’s not bacteria that shouldn’t be there, but oftentimes it’s bacteria that’s normal to the system, but it’s just overgrown. The analogy I use is, “You have bushes outside of your house. If those bushes overgrow or are so overgrown that they blocked your windows and are obstructing you from getting in and out the front door, then that would be a problem. You’d want to trim back the overgrowth. You wouldn’t necessarily want to rip out the bush and completely get rid of the bush, but we’d want to get the bush back to its appropriate balance.” In small intestinal bacterial overgrowth, SIBO, that’s our goal. One of the ways we can achieve that goal is by using a diet low in FODMAPS, which is essentially just a term, FODMAPS just essentially means prebiotics. These are just compounds that feed bacteria. Prebiotics feed bacteria. JM: Before we go there though, let’s go identify maybe some more symptoms and how someone, if they were suspicious they might have SIBO, how they would get it diagnosed and what’s your favorite test for that.

MR: Well, the classical symptom of SIBO, again, are altered bowel function. Some will have constipation. Some will have diarrhea. Some will have an oscillation between the two. And then oftentimes also, abdominal pain, bloating or discomfort. However, and this is the interesting thing about the gut, we’re now seeing SIBO associated to skin conditions, like rosacea; and neurological conditions, like restless leg. SIBO treatments have been shown to improve rheumatoid arthritis. There have been a few studies showing an association to either thyroid autoimmunity or hypothyroidism specifically. This is where it gets challenging, because we can’t put SIBO just in the digestive box. There may be someone who has a skin condition and a joint condition that is only attributable to their SIBO. I’d like to maybe paint this perspective for people in terms of how to navigate this. My philosophy is once you’ve taken some steps to generally improve your diet and your lifestyle, if you’re still floundering, I think the next best step for most people – it’s not a guarantee, not a panacea – would be taking steps to ensure you have optimal gut health. Because there’s not necessarily a constellation of symptoms that would say you have SIBO or you have another gut condition. But rather, I look at it more as a sequencing maneuver.

JM: Okay. We’re going to go into the diagnosis and what your best tips are so that I can listen to it next. But before that, I have a quick question for you while I’m remembering it. That is molecular hydrogen, which I’m sure you’re familiar with. I believe it’s probably it’s one of the best interventions out there for so many reasons. One of the primary ones is it stimulates a molecular pathway called NRF2, which optimizes the antioxidant responses from your body. It’s supposed to hermetically induce antioxidants. It’s not just giving indiscriminately large doses. The reason I’m tangenting to molecular hydrogen is there may be only one clinical condition, which predisposes molecular hydrogen from being effective. That is SIBO. I’m wondering if you have any experience with that.

MR: I don’t. With that specific treatment, I can’t say that I do.

JM: Okay. Because the reason is that these bacteria in SIBO tend to overproduce hydrogen gas. It may be too much of a good thing is the speculation. I just never had anyone who’s had a lot of GI experience experiment with that. Anyway, that was a tangent. Why don’t you head back now to the diagnosis?

MR: Diagnosis of SIBO? Sure. Regarding the diagnosis of SIBO, a breath test is arguably the best method of diagnosis. Essentially if someone goes through a preparation diet the day before, and then on the day, they proceed to collect a serial number of repeat breath samples. You can do this test with a solution where you drink lactulose before the test, or glucose. And there’s debate in terms of which one is better. I think you could really make a case either way. But essentially, someone would do a preparation diet the day before. And then the morning of the test, they drink a solution. Either lactulose or glucose predominantly are what’s used. And then they would collect a repeat breath sample usually every 15 to 20 minutes for about three hours. Essentially, what we’re looking for are the changes in the gas levels on those breath samples. Those can tell you if you have SIBO or if you don’t have SIBO. JM: Interesting. Have you ever used lactulose to treat hepatic encephalopathy? MR: I have not. No. [—–20:00—–]

JM: Okay. It’s a common – Hepatic encephalopathy is pretty much almost an end-stage disease, a liver disease, that some people get, primarily alcoholics. But it’s interesting, lactulose tends to turn it around. They go into a coma and they come out of it when you give them lactulose. Almost everyone who uses it clinically has no idea why it works. But we know the answer. Why? You know why now? It increases hydrogen gas.

MR: Well, what I’m thinking of there is I know there have been a number of trials showing that with non-alcoholic fatty liver disease, various probiotic cocktails have been shown to improve that condition and also lower liver enzymes. There’s definitely this gut-liver connection. I just hadn’t heard of that one improvement specifically. That’s very interesting.

JM: That may sound speculative, but they’ve done pretty interesting research where they actually kill the hydrogen-producing bacteria in the gut, and then administered lactulose, and it doesn’t work. They pretty much –

MR: They’re essentially using a really powerful prebiotic in that case to feed the bacteria.

JM: And it’s safe.

MR: Yup. Interesting.

JM: Alright. The next step is the treatment. You had started to discuss that FODMAP, which is sort of counterintuitive, because the diet – I guess you definitely want to focus on what it excludes, because it excludes a lot of healthy foods.

MR: It does. This is, I think, unfortunately for the healthier consumer, one of the most defeating thing to go through, where let’s say someone has a fair array of symptoms, especially digestive symptoms – Let’s say someone is fatigued or they have joint pain, they have loose stools and they have bloating. They say, “Okay. I’m going to go on a lower carb, kind of paleo diet. Lots of vegetables, lots of fruits, some healthy meats and fats.” A few weeks in and they say, “I feel worse.” I understand how defeating that can feel, but what can happen here is someone who is inadvertently eating higher levels of these FODMAPS, and they’re actually feeding the problem that underlies some of their symptoms. The problem, in this case, presumably, is SIBO. It’s not stating that SIBO is the only cause, but we’re talking about that one right now. It’s fairly common, until they eat more broccoli, more asparagus, more cauliflower and more apples. There’s a number of these healthy foods – avocados also – that one would eat more of on a lower-carb or paleo-type diet. But if that’s not the right maneuver for your gut, then that may make you feel worse. The analogy that I use in the book is one of ecosystems. We have various different ecosystems. We have rainforests all the way through your semi-arid, desert-like regions or climates of Northern and Southern California. Now, it would be foolish to say, “Well, rainforests are so beautiful that every ecosystem should have the same amount of rain that a rainforest has.” Because if you took that amount of rainforest rain and then forced that into a semi-arid, desert-like like climate, that would be decimating. It would cause mudslides and a lot of destruction. It’s not to say that every ecosystem needs the same inputs to thrive. Every gut is an ecosystem. Every gut does not require the same inputs to thrive. This is one phase where that ecosystem requires a reduction of – at least temporarily – higher FODMAP foods to allow things to rebalance. That can be step one for people. It’s to use either a low-FODMAP diet – Low FODMAP, you can do that plus or minus the rules of paleo. Meaning if you’re going to do a paleo, low-FODMAP diet, you’ll have no grains and you’ll have no dairy. Some people may prefer that, or some people may prefer the standard low-FODMAP diet, which allows some grains. There’s a time and a place, I think, for each. But that’s where you can start.

JM: I’ve got lots of other questions now. Grains, because, obviously, that’s a big issue for a clinician who’s focused on the GI system. You’ve got celiac disease or gluten intolerance. Of course, there’s a wide variety of tests that can screen for that. I’m wondering, in your experience, first of all, if you can comment on the prevalence. From your exposure, what is more common? Is it SIBO or gluten intolerance?

MR: You’re asking a very contentious question right now. What I’m starting to think is that gluten intolerance, and specifically the term that’s used is “non-celiac gluten sensitivity.” We should be careful with our language here, because there’s celiac and there’s no real debate on celiac. That answer has been vectored. It’s more so this: “I think I have a problem with gluten, but I don’t have celiac.” That’s this realm of gluten sensitivity or non-celiac gluten sensitivity, as it’s also termed. Yes, that is a legitimate condition. There are at least four, if not five, placebo-controlled clinical trials that have affirmed that. So, yes. But I fear that we’re starting to conflate everything underneath the window of non-celiac gluten sensitivity. We’re learning that there may be other things that are causing these reactions that we’re attributing to the grains or to the gluten. The two most common would be FODMAP sensitivity. The other would be histamine intolerance. Why this is important is because if we were living in an overly idealistic situation, then we could just wave a wand and say, “Okay, you’re going to go grain-free, dairy-free, low-FODMAP, low-histamine and low-carb.” But if you actually have to do that, things become much more challenging. What I have been seeing in the clinic is patients coming in afraid of food. They read about gluten, “Gluten’s bad.” They read about FODMAPS, “FODMAPS are bad.” They read about dairy, “Dairy is bad.” They read about histamine, “Histamine is bad.” And they come in afraid to eat anything. Some of these patients are literally making themselves sick because they’re trying to adhere to two, three, four or five diet rules all at once. This is really pushing me to kind of open my mind a bit on grains. I used to be much more antigrain. But noticing that some people had bigger dietary battles to fight, like FODMAPS and histamine. If they had to really focus on avoiding FODMAPS and histamine, we’ve got to give them some room somewhere else. For some of these people, giving them some room to bring back grains into their diets actually is quite helpful. Now, what does the research literature say? I’m sorry. Go ahead.

JM: Before we go there, because you’ve opened up a can of worms with histamine, which I don’t think most people understand is – I’m wondering if it’s histamine in the foods or if it’s actually mast cell activation that’s produced in histamine.

MR: Bem, provavelmente é uma combinação de ambos. Provavelmente é a histamina nos alimentos, e também é a maneira como esses alimentos interferem no nosso sistema imunológico.

JM: Ok. Bem. Histamina é, da sua perspectiva?

MR: A histamina é um composto neuroativo. Também é uma molécula de escolha para o sistema imunológico. Novamente, como uma dieta pobre em FODMAP, a pouca dieta com histamina pode parecer paradoxal. Na verdade, eu pessoalmente tive um problema com isso. Como parte de como abro meus olhos, onde os alimentos fermentados – não todos e não apenas -, mas os alimentos fermentados são tipicamente ricos em histamina. Seus kimchis, seus sauerkrats, seus kombuchas, seus kefirs, esses terão maior histamina. Além disso, abacates, espinafre, carnes curadas e muitos peixes são ricos em histamina. Eu estava comendo, a certa altura, o que chamei de “Dieta Paleo do Homem Preguiçoso. Eu teria uma lata de atum com um abacate. Isso é pouco carboidrato. É rápido e fácil. Eu o lavava com um chucrute e um kombucha. E então, no almoço, eu comia espinafre, talvez com salmão. Muitos dos convenientes alimentos paleo e com pouco carboidrato são bastante ricos em histamina. Lembro-me muito claramente de estar na minha mesa trabalhando um dia. Um lindo dia de sol, sem motivo para eu não ser feliz, e eu tinha uma névoa sobre mim. Eu estava muito irritado. Eu estava pensando comigo mesmo: “O que diabos está acontecendo?” Levei alguns dias para montá-lo, mas eu estava comendo uma comida com alto teor de histamina em todas as refeições. Eu estava saturando meu sistema com histamina. Eu só precisava fazer uma simples alteração no espaçamento desses alimentos ricos em histamina. Toda aquela neblina, toda essa irritabilidade desapareceu em questão de literalmente horas depois que eu montei isso. Parece meio complicado. Mas quando você resume tudo, há realmente duas coisas que você precisa alcançar, se você estiver tentando resolver o problema da histamina. Primeiro, encontre o corante que funciona bem para o seu intestino e não o irrita. Para muitas pessoas, isso pode ser uma abordagem do tipo paleo com menos carboidratos, potencialmente com uma redução do FODMAPS. E, ao mesmo tempo, reduza a ingestão de histamina na dieta. Há um guia muito fácil de seguir sobre alimentos com alta histamina para evitar e alimentos com baixa histamina para focar. A outra coisa legal sobre isso é que normalmente leva apenas duas semanas para perceber se uma dessas dietas está funcionando para você. É por isso que eu passo as pessoas no livro. “OK. Você começa aqui. Vamos testar esta dieta por duas semanas e depois reavaliar. Você pode ter terminado a dieta nesse ponto ou pode precisar fazer um ajuste e dar mais duas semanas. Não demora muito. Mas é uma série de auto-experiências para ver o que funciona melhor para o seu sistema. E depois que você se sentir bem, sabemos que recebemos a dieta que é melhor para o seu ecossistema intestinal único. [—– 30:00 —–]

JM: Do you ever used genetic analysis in polymorphisms to help fine-tune your system? The reason I mentioned that is I just had it done recently. I think they evaluated my 23andMe data, although there are better analyses now. It turned out that I was double homozygous for a pretty severe gluten snip, which is KIA1199. I mean I didn’t notice any symptoms, but it’s very clear I should not have gluten just from that polymorphism and genetic defects. I’m wondering if you ever are using that?

MR: I’ve been following the literature on gene testing. I do not consider myself a gene expert. But from what I’ve seen, I have not been impressed. There are a few very key contradictions. And then there’s an argument that underlines this also, which is [that] some clinicians look at mechanisms and they try to say, “Well, if this happens in the cell, we should do this in humans.” That’s all fine and good, but what I think the most sure metric is looking at the outcome data. First, you have this mechanism theory and you say, “Well, if we see this happening in the cell, that tells us people shouldn’t do this.” An example could be, “Genes for insulin sensitivity could predict someone who needs to be on a low-carb diet.” It just so happens that Christopher Gardner just published a DIETFITS trial, where they tried to custom tailor based on someone’s genetics, either a healthy low-carb diet or a healthy high-carb diet. They essentially found that the genetic testing did not provide any benefit in terms of outcome. There’s another trial looking at apolipoprotein E (APOE)-4 polymorphisms trying to predict their macronutrient intake, and if a gene-based diet would lead to better markers of cardiovascular health and, I’ll be acting, some of the markers are somewhat contestable. Again, they did not show that the gene testing predicted outcome. Further yet still, there was a study, a large study, done in Asia, giving folic acid to patients who had methylenetetrahydrofolate reductase (MTHFR) polymorphism. I believe there was a 30 percent reduction in stroke in giving people with MTHFR polymorphisms folic acid. Now, that was a folic acid-deficient population, so that may skew the data. They may have shown that if someone had two polymorphisms rather than one, the effect was less. There may be some wiggle room there for making the argument of those with the MTHFR polymorphism should only have folate rather than the folic acid.

JM: It may also indicate a flawed interpretation or application of the information because – I don’t know. You said folic acid, but you don’t want to give folic acid with someone with MTHFR. You’d want to give them folate, specifically methylated folate.

MR: That’s a theory. But in this study, they did give them folic acid.

JM: You do know that methylated folate can increase the mammalian target of rapamycin (mTOR)? It activates mTOR. Yeah. Many people don’t know that. It’s not that the implementation is wrong, necessarily, it’s just maybe incomplete. When you see a bigger part of the picture, you might be able to better apply it. But I can think of – One of my passions is electromagnetic field (EMF) and the dangers it does to our biology. The pretty well-accepted theory is through voltage-gated calcium channel receptors. It turns out you can get polymorphisms for that. People who have these polymorphisms turn out to be the canaries, the ones who are very sensitive to EMF. It seems to be a pretty good predictor in that subset of people. I think there’s great value to it. It’s just that sometimes the implementation is flawed, because we don’t know the whole picture. That’s the problem.

MR: I agree. I remain open, but also cautious. I guess the main reason I remain cautious is, to put it really plainly, what I see is people chasing down these still somewhat theoretical gene tests, yet there are some fundamental tried-and-true therapies that they are completely overlooking. That actually happens way more than you would think. People jump right through these exotic tests in the gut. Some of these gut bacterial mapping tests have pretty close to zero clinical utility, and yet people will spend a lot of money and years trying to treat those, only to find their way into our office. When I go through their history, they’ve overlooked four or five fundamentals. We walk them through a few of these fundamental tried-and-true treatments, and they feel great in a matter of months. It is a legitimate issue. I don’t mean to be anti-testing, but you have to use them at the right time and place. JM: Yeah. Actually, that’s a more cost-effective strategy also. Pick up your books. I always believed that books are one of the best values you can get. Because for literally 10 or 20 dollars, you can pick up 400 or 500 pages of information that took someone a few years to write and hundreds and hundreds of hours to compile, a good portion of their life. You get it for – it’s crazy – literally pennies.

MR: Unbelievable. Yeah. I really learned that. My book took me about three years to write. There are just under 1,000 medical references. There was a reflection of years and years of clinical practice trying to give someone the easiest-to-follow storyline and then the action plan to get them well. I said, “34 dollars? Gosh. It seems that this should cost thousands of dollars,” but yeah.

[inaudible 35:56]

value.

JM: Yeah, yeah. Some of these books do, like textbooks or scientific books. I mean they do cost hundreds of dollars, because their market isn’t that big. It’s the same logic. They put a lot of time, effort and energy to put it together. But anyway, the point is that most of these books are far less expensive than one test.

MR: Exactly.

JM: It could probably provide you with a high likelihood of getting some percentage of improvements. It’s a better place to start first.

MR: Yeah. One hundred percent.

JM: I like that strategy. Let’s see. You talk in the book about acid. And actually, one of my early mentors, Dr. Jonathan Wright, was a major pioneer, I’m sure you’re aware of. He has long been an advocate of what you’re talking about in the book, in that most people who have ulcers or acid reflux have too little acid, not too much. They’re put on these proton pump inhibitors (PPIs) and antacids. It actually makes the problem worse. He’s a big fan of tests. Maybe you had written about it in the book, but I don’t remember reading it. It’s the Heidelberg test, where they swallow this capsule and they actually measure the pH as it goes down, for a diagnosis. I think it’s a little bit excessive and maybe unnecessary because you can empirically treat it for a lot less and find out.

MR: I agree. JM: Why don’t you talk about that? Because that’s a really common problem. I think antacids, if I’m not mistaken, are one of the most commonly used over-the-counter drugs. I was a pharmacy apprentice before I went to medical school. Those drugs, I was an apprentice when they came out of the market. They were so restricted. This was cimetidine; Tagamet was the first one. They had precautions on there. You could not use them for more than two weeks. Prescribed for two weeks, that was it. Now, you can go on forever over the counter. It’s crazy.

MR: Yup. JM: And people do.

MR: Yeah. There are a few important nuances here, which is I don’t completely agree with Wright, but I don’t think he’s wrong either. There’s a little bit of a nuance. I will say that we did fact-check some of Wright’s references, or I should say, I fact-checked them. Some of his references, what he quoted them as saying and what they actually said didn’t match. Essentially, he makes this really –

JM: Thanks for doing your homework. Someone’s got to do it. MR: Yeah. I try to be very careful and very discerning. I’ve learned that there are a lot of false truths circulating out there. The only way that we update false truths is to fact-check those. Essentially, he makes one of many posits. But one is that low-acid causes a relaxation of the sphincter in the lower throat. If there’s not enough acid, the sphincter opens up. If you have more acid, it sends this acid-sensitive sphincter. It contracts. The references you see he quotes actually showed the opposite, where they actually showed increased lower esophageal sphincter tone after acid-suppressing medication. That mechanism, I don’t think is correct. Is it to say that the therapy of supplemental acid should be thrown out the window? No, but I don’t think that mechanism is correct. But there are a few important nuances here, which is not everyone has low acid, like the medical system thinks, and not everyone has high acid. You can look at context to help determine, “Are you someone who should be on supplemental acid or not?” Because that’s the question we’re trying to answer, right? “Should you be on it or should you not be on it?”

JM: Right. [—–40:00—–]

MR: When you look at the percentage of people who have documented ulcers, I would argue that ulcers are more so associated with high acid than low acid. I think that’s a little bit contestable, but 6.5 percent of the population has documented ulcers. If we juxtapose that with 2 percent who have documented low stomach acid, we see this picture starting to emerge that there may actually be more people out there with high stomach acid than there are people with low stomach acid. However, there’s an important nuance in context that helps you navigate this, which is, “If someone has a history of anemia or if they have an autoimmune condition, then their risk of low stomach acid is anywhere from 5 to 50 percent.” Now, be careful to state. It doesn’t mean that 50 percent of both anemias or autoimmune conditions will have low stomach acid. But you have a range from 5 to 50 percent. Now, age can also help you determine where you may fall in this range, if you have a history of chronic anemia or autoimmune condition. Essentially, the older someone is, the more likely they may have some impaired secretion of acid, so they may have low acid or lower acid, and they may do better with acid supplementation. There are definitely some nuance there. But it’s also important to bear in mind that not everyone does better with acid. Clearly, there are people who do worse from stomach acid supplementation. I talk about this in the book. Part of the subset that does worse with supplemental acid production are people who have immune reactivity and this kind of food-reactive and histamine-reactive sort of syndrome present, because we do know that histamine stimulates stomach acid. This is why there’s literally a drug class or a H2 antagonist, like your Pepcids, that actually block histamine receptors. They block the histamine H2 receptor, and that actually lowers stomach acid. There’s definitely a subset of people who fall into this, reacting to food and are histamineintolerant. They stimulate stomach acid production, who with giving them acid will let you make them worse. The answer there is not blocking acid. The answer is trying to remove the offending factor that’s stimulating acid production. There is evidence showing that a low-FODMAP diet – coming back to that – can lower histamine eightfold. There’s a number of people who likely have noticed that grains bother their reflux, dairy bothers their reflux, or maybe certain nightshades. Coffee and chocolate also are some foods that can be problematic. Just some simple observations of what your dietary triggers are can remove the stimulus that’s causing you to overproduce acid. I should also mention further yet still that there seems to be this circular reference game in natural medicine where there has only been a handful of studies done on supplemental stomach acid: hydrochloric acid or your betaine hydrochloride. These are from like from 1960. There’s not really a contemporary or any good contemporary research with these supplemental acids. I remain open to them. I do think that there are some people who can benefit from them. But I think they’re probably more so the minority than they are the majority. It’s important to keep all this in mind, because if someone’s taking something that’s not helping them, but they’ve been indoctrinated into thinking that they should, they could be, A, wasting money, but, B, damaging their system. And there’s also the pieces of enzymes, but I’ll stop there if you want to go over acid.

JM: Talk about enzymes and bitters too next. But I want to finish this discussion up, especially since we were talking about the acid, obviously the antacids and H2 blockers and PPIs. Are they available over-the-counter now? The PPIs?

MR: Probably.

JM: Or are they not?

MR: I don’t know if the PPIs are. I know that the H2 antagonists are.

JM: Okay. The H2s have been over-the-counter for a long time. The PPIs are still prescriptions. As a result, many, many people are on them. I think they’re one of the most commonly used overthe-counter drugs. We’ve long discouraged people from doing that, to the point – Because it really is like the perfect drug from a drug maker’s perspective, because it doesn’t do a damn thing to cure the illness. It treats the symptoms. Once you go off of it, once you’re on it, it makes it worse. It’s just perfect for them. You’re guaranteed to be on it for years and years and years. We advise a weaning schedule to go to a less strong one. If you’re on a prescribed PPI, go down to a Zantac, Tagamet or cimetidine, and then gradually lower the dose to off of it over a few weeks or so. I’m wondering if you would agree with that or of any alternative practical strategies.

MR: Eu faço. É engraçado. Estou trabalhando com esse paciente que precisa realmente de medoprazol. É um PPI. Ela teve um inferno de tempo para sair disso. Eu tenho alguns pensamentos sobre isso. Mas acho que existe uma defesa comum dos IBPs. Eles mostram uma taxa de cura de 80 a 90 por cento para úlceras quando usados ​​por quatro a oito semanas. Eu acho que é razoável se alguém tiver uma úlcera bastante avançada para nos dizer – JM: Documento. MR: Sim. Úlcera documentada, não presumida. E, especialmente, se eles precisam de algum alívio instantâneo, não sou contra usar isso como uma intervenção curativa de curto prazo, em conjunto com outras ferramentas, certo? JM: É assim que eles foram projetados para serem usados. MR: Certo, certo, certo. Mas absoluto ao seu ponto, se alguém tem refluxo e o PPI é uma solução de longo prazo, essa não é uma boa solução. Ele abre a porta para o crescimento bacteriano e potencialmente para – Existem crescimentos de tumores que foram mostrados. O resultado ou as possíveis minúcias desses tumores ainda não foram definidos, mas podem aumentar o crescimento do tumor, aumentar o crescimento bacteriano, aumentar a osteoporose e criar má absorção. Não é uma boa solução a longo prazo. Mas, a curto prazo, acho que eles podem fornecer alguma utilidade. Mas queremos tentar encontrar a causa subjacente dessa hiperacidez, dessa erosão. No curto prazo, posso vê-los sendo úteis. Agora, o que alguém pode fazer se estiver com refluxo ou úlcera e tentar se afastar? JM: Perfeito. Essa foi a pergunta. Essa seria a minha próxima pergunta. MR: Bom. É importante tentar descobrir quais são esses fatores subjacentes. Para algumas pessoas – existem algumas dietas diferentes que as pessoas podem experimentar. Na literatura de pesquisa, são conhecidas como dietas de eliminação de quatro, seis ou oito alimentos. Você pode começar com a eliminação de quatro alimentos, seis alimentos ou oito alimentos. Mas, essencialmente, esses são todos os tipos de encapsulados em uma dieta paleo ou autoimune, certo? Depende apenas de como você deseja chegar a isso. Se você quer ser agressivo, pode ir até a eliminação de oito alimentos ou a uma dieta auto-imune, do tipo paleo, e meio que corta tudo. Se você quiser tentar encontrar a quantidade mínima eficaz de alimentos a cortar, pode cortar alguns e ver como se sai. Recorte um pouco mais. Mas, basicamente, você precisa passar por algum tipo de eliminação e reintrodução de alimentos para tentar determinar o que você está provocando. Simplificando, se você deseja começar com o trato mais fácil – rastrear – desculpe, o trato seria um trocadilho – você pode começar com uma eliminação de seis alimentos ou uma dieta paleo. Se você deseja começar de forma mais agressiva, pode optar por uma eliminação completa de oito alimentos ou uma dieta paleo auto-imune. Mas você está basicamente removendo alimentos que podem irritar seu sistema e estimular a histamina. Essa estimulação da histamina está causando ácido. Agora, há uma ou duas outras perturbações que podem ser úteis. Alguns teorizaram que a SIBO, por meio da ativação do sistema imunológico e da histamina de que falamos, ou por causa dos gases produzidos por essas bactérias, e esses gases podem empurrar o esfíncter para abrir e permitir a ocorrência de refluxo, a SIBO pode estar subjacente refluxo. Portanto, uma dieta com baixo FODMAP também pode ser útil. Eu sei que isso parece um pouco desafiador, mas não queremos apenas dizer: “Bem, existem algumas abordagens alimentares diferentes. Não tenho certeza de qual tomar, então vou tomar um remédio. ”É pior do que passar por algumas experiências curtas para descobrir qual dessas dietas funcionará bem para você. Porque provavelmente, se você descobrir qual dieta funciona bem para você e resolver o refluxo ou a azia, provavelmente notará outras melhorias. Suas articulações podem parecer mais frouxas. Você pode ter melhor clareza mental. Vale a pena o esforço. Agora, algumas pessoas podem – JM: Um sintoma é um sinal de que algo fundamentalmente está errado. É uma pista para o seu corpo procurar identificar isso para que você não tenha sintomas piores e talvez morra prematuramente como resultado de não abordar a questão fundamental. MR: Exatamente. O [inaudível 49:10] usa com medicamentos, muitas vezes há efeitos colaterais. Com tratamentos baseados em causas, muitas vezes há benefícios colaterais, certo? Nesse caso, você pode ter vários benefícios colaterais. Mas para algumas pessoas, elas podem ter disbiose. Esse SIBO é um tipo de disbiose ou desequilíbrio nas bactérias do intestino. Ou pode haver Helicobacter pylori. É aqui que um protocolo antimicrobiano à base de plantas, especialmente quando combinado com um probiótico, pode ser muito eficaz. Eu coloquei isso no livro. Se uma dessas síndromes estiver presente, o protocolo do livro orientará você exatamente como executar. Isso também pode ser útil. E depois há uma ou duas outras coisas que estão entrando em todos os ângulos possíveis. Algumas pessoas podem se beneficiar do que é conhecido como procinético. Iberogast, eu acho, é o procinético natural mais bem estudado. Essencialmente, o que acontece em alguns casos – [—– 50:00 —–] JM: Iberogast. Você pode soletrar isso?

MR: Iberogast. Sim. IBEROGAST.

JM: Iberogast. Eu pensei que era “Ibero Gas”, GAS. OK. Iberogast é um medicamento, então?

MR: É um medicamento à base de plantas que está disponível em nossa loja online. No protocolo do livro, orientamos você sobre quando usá-lo. Porque o que eu não recomendaria que as pessoas fizessem era sair à vontade e comprar a Iberogast porque eles ouviram aqui. Você deseja usar isso no momento certo. Muitas pessoas não precisarão disso quando tiverem estabelecido os fatores fundamentais. Mas para algumas pessoas, um dos problemas subjacentes à questão, especialmente quando é refluxo, indigestão ou dispepsia, são os músculos que contraem os alimentos para baixo e não funcionam tão bem. Os procinéticos ajudam esses músculos a contrair e continuam empurrando a comida para baixo. Houve vários estudos mostrando eficácia clínica com Iberogast para esta síndrome do tipo azia-refluxo-indigestão. Existem outros procinéticos semelhantes por aí também, mas acho que o Iberogast, para essa aplicação, é o mais bem estudado. JM: Que tal algo básico físico e barato, que é uma terapia de cama inclinada, já que o refluxo tende a incomodar a maioria das pessoas à noite e prejudica sua capacidade de dormir bem, apenas elevando a cabeceira da cama cerca de 15 cm para que você suba cerca de 5 graus , e usando a física e a gravidade para ajudá-lo em vez de causar problemas. MR: Claro. Eu concordo completamente. E também não comer muito perto da hora de dormir também. JM: Esse é um componente tão profundo, mas simples. Não tocamos nisso aqui, mas no tempo e nos ritmos circadianos. Quero dizer, você precisa ser seriamente avaliado quanto à consistência mental se estiver fazendo grandes refeições três horas antes de dormir. É um hábito de saúde perniciosamente terrível. Não apenas para o refluxo ácido, mas também para a saúde mitocondrial. É como uma das piores coisas que você pode fazer. MR: Isso define a escalada de algumas terapias diferentes. Certamente, levante a cabeça quando você dorme e também não coma perto da hora de dormir ou algumas outras peças fundamentais que são muito importantes. E então as pessoas consideram algumas recomendações alimentares diferentes que eu expus antes. Eles podem considerar antimicrobianos. Os probióticos também têm pelo menos algumas evidências pulmonares que mostram a capacidade de ajudar com coisas como refluxo e indigestão. Isso também é uma consideração. JM: Deixe-me parar por aí, porque pode confundir algumas pessoas. Você disse antimicrobianos. Esse era um ponto que gostaria de discutir com você mais cedo, mas não tive tempo para isso. Antimicrobianos são produtos fitoterápicos naturais, tenho certeza de que você está se referindo, não antibióticos, que também são considerados antimicrobianos, o que realmente tornará as coisas piores. Você faz uma observação brilhante no livro sobre como, quanto mais jovem você é, quando toma antibióticos, pior vai dizimar sua saúde. Sinto muito por interromper seu fluxo, mas acho que é um ponto muito, muito importante para a saúde intestinal. É que estas são drogas potencialmente perigosas. Sim, eles poderiam salvar sua vida também, mas essas circunstâncias são poucas e distantes. O mais provável é que eles causem sérios danos. Eu acredito que eles devem ser usados ​​apenas em condições de risco de vida. Tenho certeza que você já viu muitos pacientes, talvez uma porcentagem significativa de seus pacientes que sofreram como resultado do uso indevido desses antibióticos.

MR: Sim. Quero dizer, eu concordo que queremos usar antibióticos discriminadamente. Acho que podemos defender o uso discriminatório de antibióticos para certas condições gastrointestinais. E então, eu acho, as rifaximinas têm algum decente –

JM: As pessoas querem –

MR: O que é isso?

JM: SIBO seria um deles?

MR: Sim. Mas é raro termos que recomendar um antibiótico em nosso escritório, porque há outras coisas que funcionam muito bem. Além disso, há o trabalho de Satish Rao, que tem realmente um trabalho pioneiro no crescimento excessivo de fungos no intestino delgado. Ele usa uma receita antifúngica conhecida como fluconazol. Estou aberto, mas aqui é onde acho que as ervas realmente superam as drogas. Você precisaria de um antibiótico e um agente antifúngico para obter o mesmo efeito que uma erva pode ter, certo? As ervas têm esse bom efeito contra bactérias, fungos e também protozoários. Eles tendem a ser um problema um pouco leve, causando algumas dessas reações do que os produtos farmacêuticos. Mas acho que o conceito geral aqui é que não queremos usar antibióticos indiscriminadamente e rotineiramente usar antibióticos, A. Mas também B, entenda que, às vezes, seja herbal ou farmacêutico, desde que você construa um caso Para um farmacêutico, o que esses antimicrobianos, especialmente ervas, podem fazer é ajudar a empurrar o ecossistema da microbiota. O que pode acontecer é que, se você não estiver saudável, se não estiver se alimentando bem e o sistema estiver inflamado, a inflamação tende a ser venenosa para as bactérias que você deseja. Tende a ajudar as bactérias que você não quer crescer. Você pode obter a inclinação das colônias em seu intestino. Às vezes, o que é necessário é o primeiro a lançar as bases para melhorar a saúde do hospedeiro: exercitar, dormir e melhorar sua dieta. Agora, essa colônia ainda está distorcida, mas a base do que mantém essa colônia no lugar foi removida. O passo final é dar uma cutucada no ecossistema com antimicrobianos, que agora permite que o ecossistema meio que entre nesse pequeno tumulto. Agora que você estabeleceu esses fatores fundamentais de saúde, ele redefinirá para um equilíbrio mais saudável. Essa é a melhor maneira de usar esses antimicrobianos. Uma vez que você construiu a base de um host saudável e de um ambiente interno saudável, se alguém ainda for sintomático, podemos dar uma cutucada na colônia. Esse cutucão deve voltar ao equilíbrio se esse cutucão for feito no caso de fatores ambientais saudáveis. JM: Sim. Um cutucão, não uma bala mágica. MR: Exatamente. É uma coisa que falo no livro. Isso é desanimador para mim. As pessoas geralmente procuram o produto mágico ou o protocolo mágico. Eles quase nunca os encontram porque não há protocolo mágico. O que existe é um processo sólido. O que descrevemos no livro é que não existem produtos ou protocolos mágicos, mas aqui está uma abordagem sólida para reconstruir seu intestino e equilibrar sua saúde intestinal – desprovida de dogmas, desprovida de gastos e desprovida de jargões de marketing. Mas como usamos essas diferentes ferramentas no lugar certo e na hora certa e as personalizamos em seu intestino. Se pudermos fazer isso, é aí que a mágica acontece. A mágica está no processo, não necessariamente no produto.

JM: Ok. Ótimo. Uma pergunta final, uma questão importante, é o uso apropriado de enzimas digestivas e como você descobriria isso. Além disso, estou particularmente curioso se você tem alguma experiência clínica no uso de bitters à base de plantas como alternativa ou como adjuvante das enzimas digestivas.

MR: Amargos. Eu uso bitters mais. Eu acho que os bitters são ótimos. As pessoas que precisam de mais secreções digestivas se tornam menos importantes se você estiver confiante em poder curar o intestino, porque o revestimento do intestino produz uma quantidade razoável de enzimas. Além disso, se você remover os encargos inflamatórios, pelo menos poderíamos especular que os outros aspectos da secreção digestiva devem operar com mais eficiência. Eu sei que há menos necessidade de suporte enzimático e digestivo, pois fiquei melhor na cura das entranhas das pessoas. Mas eu acho que, pelo menos nas fases iniciais da cura de alguém, e talvez eles não estejam produzindo essas enzimas com a mesma robustez que deveriam, então usar uma pequena dose de ácido clorídrico, um pouco de bile e uma mistura de diferentes enzimas pancreáticas pode ser útil. Com as enzimas biliar e pancreática, é aí que temos uma boa quantidade de pesquisas. Penso que é reconfortante, é tudo bem comentado que o teste é a resposta de alguém ao tratamento. Ou seja, outra área em que muitos testes não são realmente necessários, mas se alguém responder positivamente, isso indica que eles precisam do suporte enzimático. Mas há uma torção ou duas aqui. Eu disse anteriormente que, ao curar o intestino, você pode produzir essas enzimas. Vemos isso com várias coisas. Vemos isso na bile, embora a bile não seja produzida pelo intestino. É produzido pelo fígado e armazenado na vesícula biliar. No entanto, o SIBO pode desconjugar sua bile. Pode meio que desativar sua bílis. Isso pode permitir ou fazer com que você não seja capaz de usar sua bile com a mesma eficácia. Você pode restaurar a capacidade de alguém de usar bile, se conseguir se livrar do SIBO. CORTE [59:33] a [1:00:01] [—– 1:00:00 —–] MR: Se conseguirmos nos livrar da SIBO, podemos corrigir a capacidade de usar sua bile adequadamente. E também existem essas enzimas que são secretadas pelo revestimento do intestino. À medida que curamos o intestino de alguém, eles têm uma melhor capacidade de secretar essas enzimas. No curto prazo, as enzimas podem ser úteis. Eles também podem ser úteis a longo prazo, mas acho que é para muito menos pessoas. Porque, como os curamos, eles precisam menos deles. Também é importante ter em mente que, para algumas pessoas, especialmente a bile, pode realmente funcionar como um laxante. Publicamos um estudo de caso em nosso site, há alguns meses, sobre uma paciente que teve SIBO, que foi tratada com SIBO, seus sintomas voltaram e ela continuou tendo problemas. Ela veio ao nosso escritório para uma segunda opinião. O que estava acontecendo era que as pessoas a perseguiam na SIBO e disseram que a SIBO era o problema. A diarréia e a dor abdominal foram causadas exclusivamente por uma reação à bile suplementar. Ela estava tomando bile suplementar que irritava o intestino e causava diarréia. A única mudança que precisávamos agora era apenas para tirá-la da bile. JM: Isso seria bílis de boi? MR: Bile de boi. Sim. E há uma síndrome conhecida como má absorção de ácido biliar ou diarréia por ácido biliar. A bile deve ser secretada no início do intestino delgado e, então, escorre pelo intestino delgado, ajudando a absorver gorduras. No final, conhecido como íleo terminal, essa bile é reabsorvida. Se a bílis não for reabsorvida e chegar ao cólon, poderá funcionar como irritante e como laxante. Não é para dizer que ninguém deve usar bile, mas sou um grande defensor da descoberta da dose mínima eficaz.

JM: Ok.

MR: Se você pode encontrar a dose mínima eficaz, isso impede que você exagere.

JM: Sim. A pergunta final é o tempo necessário para curar isso. Por entender que as células do intestino, os enterócitos que revestem o intestino, eles têm uma meia-vida muito curta. Eles vivem apenas alguns dias. Devido a essa rápida rotatividade, você pode ver os resultados rapidamente. Essa é a sua experiência? MR: Bem, acho que depende – JM: Ou está mais relacionado à mudança de microbioma? MR: Acho que depende de como definimos “rapidamente”. As 72 horas para a taxa de rotatividade enterocítica? Isso seria um pouco rápido. Mas acho que semanas a meses é razoável. Algumas pessoas respondem ou começam a responder dentro de dias e são completamente curadas em semanas. Outras pessoas começam a responder após semanas e são curadas em meses. Provavelmente, porque há mais coisas acontecendo além do reparo das células intestinais. Existem as células intestinais. Existe o sistema imunológico local. Existe a microflora e o equilíbrio da microflora. Todas essas coisas precisam se integrar e se manter juntas. Algumas dessas coisas dão feedback um para o outro. Parece que não é algo que leva anos. Às vezes, você ouvirá essas representações. Eu devo mencionar para o público, tenha cuidado com o que você lê sobre a SIBO, porque alguns círculos fazem você acreditar que SIBO é essa condição crônica que você nunca pode curar. Eu acho que isso vem de um bom lugar. Mas acho que isso não é verdade para a grande maioria das pessoas. O prognóstico é muito mais esperançoso, penso, para curar o intestino do que a maioria das pessoas imagina. Mas sim, a cura pode ocorrer dentro de semanas a meses para a maioria das pessoas.

JM: Tudo bem. Ótimo. Muito obrigado pela sua informação. Se você quer mais, porque realmente só arranhamos a superfície. Você entra em muito mais detalhes em seu livro. Por que você não segura seu livro? Para que as pessoas possam ter uma idéia de como ela é e procurá-la.

MR: Intestino saudável e você saudável: o plano personalizado para transformar sua saúde de dentro para fora.

JM: Intestino saudável, você saudável. Esse é o livro para obter se as informações que o Dr. Ruscio, você achou útil. Eu certamente fiz. Espero que você considere isso se tiver problemas com o intestino, porque é um recurso relativamente barato para ajudar a melhorar sua capacidade de curar esses problemas irritantes. Também é tão comum. Obrigado pela informação. Nós realmente apreciamos isso.

MR: Sim. Foi um prazer. Obrigado. [FIM]

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