Dr. Michael Ruscio On Probiotics for Mood, Thyroid Health, Energy Levels and More

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Content By: Ari Whitten & Dr. Michael Ruscio

In this episode, I am speaking with Dr. Michael Ruscio about probiotics for better gut health, resulting in improved energy, mood and thyroid levels.

Table of Contents

In this podcast, Dr. Ruscio and I discuss:

  • Which probiotics are proven to reduce IBS, improve depression, lower anxiety, alleviate SIBO and improve skin health
  • How probiotics can improve your resistance to flu and other viruses via the gut-lung axis
  • What’s the ideal timing to take probiotics for best results
  • How probiotics might help your thyroid medication work better
  • Bacteria based vs fungal based vs spore based probiotics – which work best?
  • Which brands are the best quality and safest?
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Transcript

Ari: Hi, everyone. Welcome back to the The Energy Blueprint Podcast. I’m your host, Ari Whitten. And today I have with me, my friend, Dr. Michael Ruscio, who is a doctor of chiropractic, a clinical researcher expert on the gut, and author of the bestselling book, Healthy Gut, Healthy You. And in my personal opinion, he is one of the top gut experts in the world.

He’s just a powerhouse of knowledge and truly evidence-based, not into fads, really straight by the evidence. And I really have a huge amount of appreciation and admiration for his knowledge and for his integrity on this issue. So, I’m incredibly excited to have him in this summit presenting on the topic of probiotics and gut health, and how it relates to your energy levels. So, I’ll hand it off to you, my friend, and take it away.

Dr. Ruscio: Well, thank you. As usual, you give me big shoes to fill, but I will do my very best. And thank you for that really warm intro. Yeah, probiotics are such an important part of gut health, and they seem to be so cloaked in confusion. Natural community members will have you believe that, for example, if you have SIBO, you should not use probiotics. And then conventional gastroenterologists will kind of hum and haw, well, they may be beneficial, but we’re not sure which ones to use. So instead use an antibiotic, and it’s really lackluster in terms of the opinions most people get on either end of the spectrum, conventional or alternative, which is really a travesty because we have pretty exceptional data in some areas for probiotics, with a minimal side effect profile. And if anything, they show side benefits like improved mood or improved skin. So yes, as you can tell, I’m excited about the topic and really looking forward to diving into the probiotic starter guide. So I guess we’ll just jump right in.

The gut lung axis and how it is involved in health

Ari: Yeah. Actually, on that note along the lines of what you just mentioned, I think we’re always constantly finding out all of the layers of interconnectedness of the body systems go beyond what we previously thought. And just literally two days ago because I’m learning so much about immune health, and that’s a big focus as it is for everyone right now with the coronavirus. There was a friend of mine who’s another gut expert who mentioned the gut-lung axis to me. 

And I had never even heard of the gut-lung axis. I mean, we know about the gut-brain access. There’s the gut-skin access. There’s the gut-mitochondria access, but I’d never heard of gut-lung. And so, I started digging into research on that, and sure enough, there’s all this research on different bacterial species microbes in the gut in relationship to lung health and risk of respiratory infections. And it’s just fascinating to learn about all these layers.

Dr. Ruscio: Right. And we might as well just kind of start there. I didn’t include that in this presentation. I probably should have. And I suppose what I can do is send you one or two summary slides after to be kind of included in after here, or maybe even superimposed on top of this. But I did do a review of the evidence. It published on our podcast last week, looking at the benefit of probiotics in different models, mainly of flu or influenza. And looking at the data, we have even top-shelf level Cochrane systematic reviews with metaanalysis. And what’s nice about the Cochrane Review is they do a very meticulous job of filtering out studies that may have bias in them. And so, we’ll look at a systematic review and or meta-analysis as the pinnacle of scientific evidence and then scrutinize even further to make sure that any data in that analysis that may have bias has been filtered out.

And then you have the coveted Cochrane systematic review. And even there, we see conclusions that probiotics can reduce risk of contracting influenza, the duration, or the severity of influenza, and even better yet still they can reduce the upper respiratory tract infections associated with influenza and subsequent needed antibiotics if there ends up being a secondary bacterial infection after having the flu. Now, that’s for the flu, but influenza and COVID19 or corona are both SARS family viruses. So I want to be careful not to make people overly confident that if they’re taking a probiotic, they can go and shake hands with someone who has COVID. Definitely not, but to your point, yes. These mucous membranes do seem to all share a relationship knowing that so much that the largest density of immune cells in your entire body is in your small intestine. It stands to reason that probiotics are one of a few things an individual can do to help decrease the severity of the pulmonary or the lung involvement along with SARS COVID.

So definitely something important. And I’ll send you over the references supporting that. But fortunately, we do have peer-reviewed papers looking at the clinical trial data, and those summaries do indicate protection from probiotics. And one other source, which is an interesting design, they looked at students who were under exam stress and also having interfered sleep or less sleep because of the exam stress. And they looked at varying levels of sleep and stress and the risk of contracting cold or flu. And they found that when they stratified—— So they matched the sleep and stress levels because that’s a big confounder for cold and flu. When they matched those, they found that the treatment group with probiotics had significantly less cold and flu than the control group, even when teared down and kind of making sure that we read out the variable of sleep and stress. So pretty compelling data that probiotics really help with lung health.

Ari: Yeah. Fascinating stuff. So I’m curious now that you’ve said all that, and we’ve kind of started this whole thing with a bit of a digression, but an important one, given current events. I’m curious if the practical recommendations that you’ll get to sort of probably at the end of this talk overlap in terms of the specific probiotics or strains of bacteria that are most beneficial for the aspects of health that you’re going to be talking about here, as well as for the gut-lung axis.

Dr. Ruscio: I will make a tie in when we get to kind of the specific recommendations in terms of where most of the research has been done. There’s a certain type of probiotic that has been looked at the most here that may be an artifact of certain types of probiotics chips that had more research published, and it’s not to say other types of probiotics have had published research that disproves their benefit, but rather, there’s this one kind of golden child of the research community. And that type of probiotic has the most research, but I will tie that indefinitely when——

Ari: Beautiful. Yeah.

Dr. Ruscio: Okay. And one of the things I should maybe mention for people, I just interviewed Dr. David Brady a couple of hours ago, and he made me aware of research finding that melatonin can inhibit this inflammasome. I believe it was NLPR3. An inflammatory cascade that leads to the acute respiratory distress syndrome in COVID-19. One of the first inflammatory dominoes, if you will, appears to be this NLPR3, and some research, preliminary research, I’m not sure if it’s outcome data or if it’s mechanistic, but is pretty promising for melatonin being able to reduce that inflammation and that inflammatory response. So just something for people to maybe consider and look into this further. I just was made aware of this the other day, so I haven’t had chance to fact check, but I certainly take Dr. Brady’s word for it, but just something else to put out there.

How gut health is linked to well-being

Ari: Yeah. I saw some of that same data just a few days ago as well. So yeah, I’ve done some deep dives on melatonin. It is a very impressive compound.

Potentially disturbs some people sleep like I’m actually quite sensitive to it. But there’s an amazing body of research on all kinds of health benefits and even like protecting the brain or from surgery or from toxicant exposure. And I mean, all kinds of really impressive findings around melatonin. So it’s really no surprise to me that it might be beneficial here as well.

Dr. Ruscio: Sure. Yeah. And whatever we can do to help people be as resilient against the infection if they do acquire it, then the better. So, yeah. And in that theme, gut health seems to be something that the healthier one has got is the better they tend to feel. And I think it’s somewhat safe to say, if you have improved gut health, you’ll be sleeping better. And there is some research to show that, and sleep helps with immune system generally as does gut health.

So with a probiotic starter guide here, we’ll go into some of the foundational pieces. We’ll talk about how do probiotics help you. We’ve already hit a little bit of that, but we’ll expand upon that—benefits of probiotics, how to simplify probiotics. And this, I think, will be really helpful because there are many products, but there’s actually a classification system where we can break pretty much any product on the market into one of three categorical types, which makes it much easier to navigate the landscape and create a protocol for your own gut. And look to—— which I call the three for balanced protocol, essentially using all three in conjunction.

And also, a note that you can take probiotics whenever it’s convenient for you, meaning we don’t have to be uber-meticulous with, well, this one with food, that one with fiber, or this one on an empty stomach. These things are inferences that are based upon mechanism, but it doesn’t seem that they really make a huge difference in terms of outcomes. And how do I know that? Pretty much every study, save maybe exceptional few, don’t give very specific recommendations in terms of when to take these probiotics. And you think about major medical research centers and the patients they’re seeing who are coming in, probably not even eating that healthy, or they’re just struggling to kind of get to step one. They’re not giving these people well, first thing in the morning, take this one, then wait 45 minutes, have some fat and take the other one. And then this other one take with fiber.

So we see in the research, people are given very loose recommendations in terms of how to dose these and what you know in pretty much all the studies, the trend line shows benefits. So we don’t need to make the dosing so meticulous that it’s hard you forget, and then you end up taking the probiotic half the time. You’re much better off doing what you’ll be consistent with rather than aiming for this perfect idealistic dosing recommendation. And also, quality. Quality actually does matter—something we’ll elaborate on. And I try to be sensitive, too, because sometimes quality is used as a supplement company ploy to get you to pay a higher list price for a probiotic or anything else. But here actually, when we fact check the data, quality does matter to a certain extent, and then a few specific product recommendations.

So going into how do probiotics help you? The Journal of Clinical

Gastroenterology and the journal, Trends in Microbiology offer insights into how probiotics make you healthier. And the references are down in the bottom right-hand corner there. But it’s been shown that probiotics can increase healthy bacteria levels in your gut, perhaps not due to directly colonizing you, but rather improving the health of the community and a healthy community fosters the growth of healthy bacteria. We know that an inflammatory milieu is discouraging of healthy players to grow, and a healthier milieu is encouraging for healthy players to grow.

Ari: The bit that you mentioned there and passing about perhaps not by directly colonizing you, I’m curious if that’s something you’re going to come back to later in the presentation or if not, I would love for you to address it now, as far as what you mean by that because most people assume they’re taking the bacteria it’s then going to live in their intestines and colonize and that’s how it inserts effects.

Dr. Ruscio: Yeah. I believe we will touch on it later, but we might as well just expand on it now. That is predominantly a misnomer. There are some probiotics that do colonize the individual. Yet it seems many or most don’t colonize an individual. And I think it’s important to kind of reset the expectation of probiotics. They don’t add to colonizing individuals for the most part. And this is actually a good thing. The mucosal microbiota is somewhat impervious to colonization, which is good, which means every time you eat something bad, it doesn’t get stuck in that ecosystem.

The ecosystem is fairly fixed, but these transient passerby’s, the probiotics as they’re making their way through your system, as one example here in the next bullet, fight harmful bugs. And as one example, if these probiotics are well, a few mechanisms, in this example, fighting bad bugs, reducing inflammation, reducing leaky gut, improving motility, then all these things lead to essentially healthier soil in the gut, which encourages the growth of healthier bacteria.

And this used to be a very important kind of contemporary way of looking at the gut. It’s not about just forcing bacteria in or forcing probiotics and trying to control the levels, but rather it’s trying to encourage the healthiest ecosystem that you can, and things that reduce inflammation and encourage healthy bacterial growth tend to really work well to restore the soil in the garden. That really is a good analogy because if you had a garden with dead soil, you wouldn’t just go force so much of fertilizer into it and think, well, now everything’s going to be well. You’d look at a multitude of variables as a way to improve the health of the soil and can cultivate the healthiest milieu that you could. So probiotics seem to work in the same way where most of them don’t colonize you, but as they’re making their way through the system, they exert a multiple of healthy benefits.

They fight bacterial overgrowth, fungal overgrowth. They are anti-parasitic, anti-inflammatory, reduce leaky gut, and help with motility. So yeah, definitely important to keep that in mind. And it also doesn’t mean that probiotics don’t work. And every once in a while, I’ll be confronted by a colleague who is a pretty intelligent colleague, and he’ll say, oh, probiotics, they don’t work. Why do you talk about them? And you follow up, well, why is it they don’t work? Well, they don’t colonize you. Okay, well, we can put down on one side of the ledger, and then multiple clinical trials showing reductions in IBS, reductions in IBD, reductions in joint pain, or least inflammatory markers of joint pain, or improvements in mood, and say, okay, well, if how you’re defining work is they colonize you, then okay, they don’t work. If it’s by reducing irritable bowel syndrome, reducing inflammatory bowel disease, reducing depression and anxiety, improving skin health, then I would submit that they do work.

Ari: Isn’t that hilarious that someone could even think a thought like that, that it’s like, well, they don’t work by the mechanism by which they were originally thought to work or which I thought they worked by. So I’m just going to ignore all of this vast expanse of data that shows that they do actually still work.

Dr. Ruscio: Confirmation bias, yeah. So I mean, great question. So hopefully, that helps people not get overly wrapped up in hoping they all stick around, but rather they have a transient benefit, which if we rewind the developmental clock back, ancestrally speaking, this may be part of the reason why probiotics are popular in so many cultures. And the observation that huntergatherer populations have a tremendous amount of exposure to bacteria in their day to day living seems to suggest that it’s more about constant exposure to these organisms than it is throwing in a bunch, and then hoping that they stick.

And that seems to do what the immune system likes more to it as one quick parallel. And I discussed this, and how they can help you. There are observations showing that those who grew up on farms have less allergy, but if you don’t live on a farm or grew up on a farm and then visit a farm, that could flare allergy. Well, why is that? If those bacteria are universally good, then visiting should be beneficial. Well, it seems that constant exposure is needed to recalibrate or better tune the immune system, and episodic exposure is not necessarily healthy. It’s not direct parallel to probiotics, but it illustrates the point that continual exposure to these bacteria in part helps to tune the immune system and prevent an overzealous response of these inflammation.

Ari: Fascinating. And not to digress too much, but doesn’t a developmental window probably matter there as well? So like if you’re being exposed to all of those different pathogens or microbes during childhood from the time you were a baby versus if you start your exposure as an adult.

The benefits of probiotics

Dr. Ruscio: Exactly. And that’s the exact point. It seems that well, yes. And so, two comments there. As an adult, continual exposure may be more well tolerated than episodic exposure, but the early development is probably the most prime window we have to intervene to lead to the best immuno development of an individual. Yeah, 100%.

Ari: Got it. Yeah.

Dr. Ruscio: Other data has found that post-antibiotic exposure that probiotics can help the adult microbiota return to balance more quickly. There was one study. I believe it may have been out of Israel that kind of countered this finding, yet there have literally been dozens of trials finding that probiotics do help the microbiota recover from imbalance more quickly, yet that one study got a ton of media attention. Do probiotics help you? New study finds maybe not. It’s just unbelievable sometimes how the totality of data will be overlooked for a soundbite. And I really feel bad for the health consumer because this is what you will be confronted with. And we wrote a rebuttal article to this that goes through all this, but we’re talking about summaries of clinical trials. I think in this one, there were 63, and then one study from a group that countered it, and then people write news reports about the one. So it’s no wonder that there’s confusion about these topics.

Ari: This is something you and I have addressed on past podcasts we’ve done together is, unfortunately, there’s not a lot of understanding in the general public around the hierarchy of evidence and an understanding of why one new study that might even be a limited study or not even a very good study doesn’t overrule or outweigh a large body of established studies that have been accumulating for years or decades that are maybe much better-designed studies, much more well-designed studies, much higher quality of evidence. And then people are just confused.

Last year, there was a really poor-quality epidemiological study that came out and said maybe eggs are bad for you after all. And it’s like, okay, well, these kinds of things need to be put in the context of the entire body of evidence. You can’t just evaluate each individual study, no matter how poor quality it might be as a standalone unit.

Dr. Ruscio: Amen to that. So, well, that’s why, I guess, we’re doing what we’re doing, which is trying to bring people a well thought out argument rather than sensationalism. Yeah. So to that point, recovering from imbalances seems to be facilitated by probiotics. So don’t skip out on a probiotic if you need probiotic for whatever it is. Also, it promotes a healthy immune response in your gut and potentially also, even in your lungs, looking at some of the data from influenza that we discussed earlier and reduces gut inflammation, reduces leaky gut. And all of this, to kind of conclude, unhealthy gut bacteria may equal inflammation and inflammation equals symptoms.

Now, I’m using the term inflammation kind of as a broad catch-all. It doesn’t mean that everyone with symptoms will have elevated C-reactive protein on their labs. And if they don’t have elevated C-reactive proteins, they don’t have any problems in their guts. But in general premise, unhealthy bacteria may be more prone to inflammatory milieu in the gut, and that means underlying symptoms. [Inaudible] but just a concept of try to unify us around this.

Okay. So the cell feeding cycle that some people can get stuck in, or I should back up. So that leads to a self-feeding cycle that people can get stuck in where, when you have inflammation, that causes gut permeability, that can lead to an immune response, further leaky gut, and then people get stuck in this cycle of perpetual damage. We can interrupt that when seeing some benefits. So here is a assigned spaced summary of the therapeutic benefits of probiotics. I’m kind of reiterating before, but going into a little bit more specific detail.

So there’s high level of scientific support for IBS, whether it’s gas, bloating, diarrhea, constipation, or abdominal pain. No huge surprise there, but unfortunate when some would say, well, if you have SIBO causing those symptoms, don’t use probiotics. It’s a real travesty because when you look at here’s the symptoms that the SIBO people care about, there’s excellent data showing that those symptoms can be quelled by using a probiotic.

Inflammatory bowel disease and Crohn’s, data here not as strong, but we certainly have multiple clinical trials, mostly showing prevention of relapse, some showing the ability to reduce inflammation, but really probiotics are going to be more of a preventative from relapse therapy than something that’s actively able to induce a remission. Also, meta-analysis summarizing clinical trials for depression and anxiety, which is kind of the gut-brain connection, which in my backstory, bad inflammatory issue from the gut leading to pretty terrible brain fog, which was part of how I got into this work. So definitely, the gut-brain connection is something to be mindful of.

Ari: Quick question for you.

Dr. Ruscio: Oh yeah, sure.

Ari: There’s something that I’ve read. There’s a few studies. I think that this is mostly pretty recent data. I’m sure you know a lot more about it than I do, but the idea of D-lactate overproduction as a result of probiotic supplementation. There was some data I think even coming out suggesting brain fog might be a symptom of excessive D-lactate production from using probiotics.

Dr. Ruscio: Yes, Satish Rao. I believe he’s at the University of Augusta, but on the podcast, I really like to teach, really respect most of his work. This study, he got some pretty harsh criticism in the research community for, and I think the other researchers who responded in an editorial follow-up essentially said that he was making false assumptions, meaning people who chronically had IBS, and who were taking probiotics, also had brain fog. And then they responded to coming off the probiotics and taking rifaximin, the antibiotic. And so, in that series of observations, to lay all of the culpability at the feet of probiotics is obviously a false assumption. People who have IBS and other gut imbalances are likely more prone to use probiotics because of their symptoms. And then when they take a strong antibiotic like rifaximin, which actually some data have shown that if you have SIBO, rifaximin plus probiotics is more effective in combating the SIBO than just rifaximin alone.

So they gave them the antibiotic and had them stop the probiotics. And then they concluded, well, the probiotics must’ve been causing the brain fog. I mean, for obvious reasons, there is way inadequate control there to be able to make that claim. But that was another example of here is one finding that really did not support the claim that probiotics cause D-lactate acidosis and, therefore, brain fog, yet media outlets ran with it. And this is something that the follow-up editorial kind of chided Rao for because he didn’t seem to be too quick to dismiss how the media was piling on that false hypothesis.

And again, I don’t think it was intentional by Rao. From every interaction I’ve had with Rao, he is an intelligent and well-intentioned researcher, but that was really disappointing to make that connection when the study design really didn’t lead to that conclusion being able to be generated. Now, are there some people who have negative reactions to probiotics? Yes. But that’s far from the majority, and that’s reflected by the majority of the research shows that adverse events are at zero or maybe at about 3%, which ends up being negligible.

Ari: Probably about as much as you’d expect from a placebo, I’d imagine.

Dr. Ruscio: Yeah. Essentially, you see it’s within statistical error compared to a placebo. So yeah. So again, I try to be open-minded, but certainly the totality of the data, as soon as you suggest a positive impact, at least on anxiety and depression, there’s not as good of data for brain fog. What you’ll see is some disease models like Alzheimer’s or cognitive decline, probiotics will show improvements in cognitive measures, but there’s, to my knowledge, no study that took otherwise healthy individuals who had brain fog, which has fuzzy definitions to begin with and then intervene with probiotics. So it’s not to say that probiotics have been disproven to aid with brain fog. It’s just we look at them and these other associated disease models.

Ari: Yeah. I think there’s very little evidence on brain fog and healthy individuals for anything.

Dr. Ruscio: Right. Yeah, exactly. But to the next point here, what made some of that brain fog could be SIBO, H pylori, candida, fungus, or other pathogens. And there’s some pretty compelling data showing that—— One example, a meta-analysis has found that probiotics can successfully decontaminate SIBO out of the small bowel. In fact, one study took a large group of IBS patients and half of the patients had SIBO, the other half did not, but they all had IBS, and they were all given probiotics. It was found that in the group that had IBS and SIBO, there was better symptomatic response than the group that had IBS without SIBO. So it was pretty powerful evidence showing the antimicrobial effect of probiotics. This likely ties into why we see the leaky gut improvements and then limited, but encouraging data for cognition, as we mentioned. Again, these are— and there’s only a handful of studies.

The link between gut and thyroid health

Sleep, there is some evidence showing that improvements in sleep can be garnered from probiotic supplementation. And one study that showed that in the probiotic treatment group, dose decreases of their medication actually occurred over time, whereas there was no dosage decreases that occurred in the control group who were just getting the placebo. So I don’t want to oversell that case. However, there is evidence showing that malabsorption of thyroid medication, mainly in those who had H pylori leads to inconsistencies in the dosage of the medication and or the TSH or T4 levels upon repeat assessment. And after clearing H pylori—again, this is what’s been studied the most—and ostensibly absorption has been improved, TSH and thyroid medication dose stabilizes.

So whether that same thing we found in SIBO, one trial that gave SIBO patients antibiotic, I believe it was rifaximin, did not find a reduction in medication. However, this study taking just thyroid patients and giving them a probiotic did find a decrease in thyroid medication. So the data here are not conclusive, and we probably need more and more trials to weed out any confounders and see where the trend is. But it certainly seems that if someone has poor digestive health, they may not be adequately absorbing their thyroid medication, of which it is absorbed in the small intestine. And then, by improving the intestinal tissue health, you may be able to better absorb and therefore see consistencies in your dose.

And then also, female hormones. This was in a model I believe of PCOS. So women who had elevated androgens, and they found that the androgens decreased in conjunction with inflammatory markers. And I believe that’s only one study, but exciting than the less, and autoimmune conditions mainly looked at in the model of RA. Only a few studies here, not great hard outcomes, meaning joint pain and function vastly improved, but some may show a decreased disability. Many of the studies looked at inflammatory markers, which is helpful, but I really prefer hard endpoints.

So if I told you, well—— If inflammatory markers are down and you said, yeah, but my knees feel the same, then at the end of the day you’re really after kind of the hard endpoint. And also, metabolism. The effect size of probiotics on things like blood pressure, cholesterol, and blood sugar is minimal, but it has been documented. So there’s actually pretty good trials looking at reductions in blood sugar or cholesterol levels, but the effect size is fairly small. So that’s why I say it’s limited evidence, not due to the amount of it, but rather the effect size has been found.

Ari: I just want to quickly jump in and make a few points to connect the dots in case it’s not clear to some listeners how this stuff connects with energy. So SIBO, gut dysbiosis, leaky gut, we know there’s plenty of research connecting this with chronic fatigue. There’s many mechanisms we can talk about how it affects the gut-brain access, how it affects mitochondrial function, causes chronic inflammation. Sleep is another thing you mentioned. Obviously, sleep ties into energy levels in some obvious ways. We all know that if we don’t sleep well, we’re going to be fatigued, but also sleep is incredibly important to brain repair processes, mitochondria repair processes.

Melatonin itself is one of the most powerful mitochondrial antioxidants known to man. So if you’re not sleeping well, melatonin’s not going to be optimal—lots of layers of the story there. Thyroid levels obviously really important to energy as well. And the mood issues, depression, and anxiety, mood, and energy are both interesting. They’re both these kinds of subjective things, but they actually have a lot of overlap with one another. And it’s rare to find someone who has great energy but is in a really terrible mood, for example. So there’s a lot of overlap, and I just want to quickly just kind of make these connections of some of these conditions that you’re talking about with energy levels specifically for everybody listening in.

Dr. Ruscio: Sure. No, I love it. And I love the piece that melatonin is a mitochondria antioxidant. That’s all the more reason to get as much sleep as you can. And then finally here, brain fog, and I will not misrepresent the data and say that probiotics are a cure for brain fog, just like others shouldn’t represent them as a definitive cause of brain fog. But I certainly think it’s much more tenable to say that the probiotics help with brain fog rather than exacerbate it. And this is a study that I mentioned earlier from the journal of Probiotics and Anti-microbial Proteins.

The IBS plus SIBO group, the top bar there, saw a 71% reduction in their IBS score, whereas the IBS without SIBO group saw a 10% reduction in their IBS score. And that’s just one study. But when we look at that study in the context of the numerous clinical trials summarized in that meta-analysis, corroborating these findings, it’s really hard to argue that if you have SIBO, you should start using the probiotics. It’s one of the most frustrating canards circulating in natural medicine because I mean, this is an area where we have clear evidence to answer the question, yet for a reason, I just cannot understand, most of the party line recommendations are to avoid. It’s changing slowly, thankfully. But there it is, nonetheless.

Okay. And then a little more probiotics for SIBO, just because I really want to arm people with enough knowledge to feel comfortable because all they’ve heard is the counter-argument that really the most truthful data-driven science-based evidence-based recommendation here is to use probiotics when you have SIBO. So data from 18 clinical trials were summarized in a metaanalysis, which concluded that probiotics are an effective treatment for SIBO. Specifically, probiotics reduced bacterial overgrowth, probiotics reduced hydrogen concentration. So that’s what the SIBO breath test. We’ll test hydrogen. SIBO patients who take probiotics experience symptomatic improvement. SIBO patients who take probiotics experience marked reductions in abdominal pain.

And also, that’s not either-or; two studies found antibiotic treatment for SIBO was more effective if subjects were also on probiotics. So again, it’s not to say that, well, I’ve got to choose between my gastroenterologists saying user rifaximin and don’t take probiotics and someone else like me, I guess, arguing use probiotics. They can be used conjunctively, and there’s really excellent data actually looking at how probiotics make antibiotics for H pylori more effective. So there’s multiple data points reinforcing that probiotics are antimicrobial, and it would make sense that when you pair probiotics as an antimicrobial with antibiotics as an anti-microbial, you’d see enhanced results in clearing whatever infection or imbalance you’re trying to treat.

Ari: Interesting. I have a quick question on this point. I’ve seen some people suggesting something to the effect of—— Our stomach acid, for example, is designed to kill most microbes. It’s designed to kill pathogens in particular, of which we may contact many types of pathogenic species of microbes, of bacteria, and things like that. So one layer of this is how effective is that system in killing the probiotics that we might consume in supplements or fermented foods and so on? And then the other aspect of this is I’ve even seen some people suggesting that it may not even matter that much if the bacteria reach our intestines in a living state, but even the dead bacteria may sort of have some effect on the gut microbiome or programming the immune system and things of that nature. I’m just curious if you have any thoughts on that?

Dr. Ruscio: Yeah. Well, the second point I argued in Healthy Gut, Healthy You with a model of heat-killed probiotics, and they were found to be beneficial also. So definitely I think your second point there’s some truth to that. And acid does seem to play a role in discouraging pathogens and overgrowth. Now, how do we account for the fact that stomach acid kills bacteria, and your probiotics seem to have benefit? I’m not exactly sure. What I’m assuming is that you’ll probably see a loss of some of the viability of the probiotic. Yet someone will still get through and have the positive impact and that there may be other factors that don’t require the probiotics to be alive and or colonize you in order for them to have their beneficial effect, as we discussed earlier.

So I think the mechanism there—— I mean, it’s a fantastic question you asked. Something that I wish we had a little bit better data on. And also, that question is what I think spawns’ recommendations to make sure you take them away from food, except for the soil-based, maybe more fat solubles, taking with that. And I used to make those recommendations for the obvious reasons, as you pointed out, which were absolutely logical connections to make. However, in the clinic, and also looking at the research studies, I just had people do what’s easier for them knowing that’s better for the clients, and we still seem to see the same outcome. So probably most of this comes back to the fact that they don’t have to be alive, nor do they have to colonize you to really have that benefit. So yeah, it’s a good question, but fortunately, it doesn’t seem to make a big impact in terms of the outcome that people report when using a probiotic.

Ari: Yeah, fascinating stuff. Fascinating.

Dr. Ruscio: It is. Yeah. It’s an excellent question. Okay. So benefits for leaky gut, two trials have found probiotics reduce leaky gut. One small clinical trial found that probiotics help to promote intestinal repair in humans. And another found positive effects of probiotics when used to treat impairment after GI infection. So post-infectious kind of leaky gut was attenuated by the use of probiotics. And here’s the thyroid people from earlier and the quote “LT4—just an abbreviation for levothyroxine—doses were increased six times in the control group and decreased four times in the study group” or the group receiving the probiotics. Again, that’s one finding.

Ari: That’s a pretty massive effect size.

Dr. Ruscio: Well, there’s a big disparity there, right? Now, I don’t know how prevalent that was. These may be outliers of strong responders on both sides. So I do think we have more there to learn, but certainly, I’ve noticed so many times it has made me want to pull my hair out that patients who have certain symptoms like fatigue, depression, and brain fog are oftentimes erroneously diagnosed as hypothyroid and put on medication to no avail. And many of these patients, we resend that diagnosis for them or provide them with the information to go back to whoever and kind of sort that out, and then get them on a gut healing program of whatever sort. Oftentimes, centered around probiotics.

And I am talking about patients who may be for years have been on thyroid hormone, on it mincingly, and not seeing improvements in their symptoms. And then in a couple of months, they see their symptoms vastly improved from improving their gut health, not always with probiotics, but certainly sometimes with probiotics. So, unfortunately, I think there’s another pandemic outside of the COVID one. And that is this incorrect diagnosis of hypothyroid. And it’s really bad. I mean, there are clinicians who read my monthly commissions newsletter, as we’ve discussed before, who have seen what I’ve been writing about, looked for it in their practices, found it, drawn up case studies where they have seen the same thing.

Susie Smith saw integrative doctor down the street on thyroid hormone for a year and a half, not feeling well the entire time. Came into our office, doublechecked the labs, undiagnosed them, healed their gut. Three months later, symptoms are gone, and they’ve sent those case studies to us, and we post them in the newsletter. So this is pretty rampant. So I don’t want to get too on my soapbox here, but it’s disheartening when you see people who’ve been going on with thyroxine, then Synthroid, then Cytomel, Nature-Throid, then Armour Thyroid and back to Synthroid. And I mean, they’re pinning the tail on the wrong end of the donkey so to speak, not to say that people are donkeys, but——

Ari: Yeah, I agree. I think it’s rampant that people are being diagnosed with that.

Dr. Ruscio: Right. So one study, a preliminary, but definitely interesting. And this is how I tie in some of the kind of categorical types of probiotics and thyroid. So those who have hypothyroid are more likely to have SIBO. There was a study looking at just over 1800 patients. And I think we may have discussed this in the past, Ari, but the researchers were looking for what factors were most associated with small intestinal bacterial overgrowth. And they were thinking most likely intestinal surgery, acid-suppressing drug use, immunosuppressive drug use. And out of all the factors they looked at, the most tightly associated was actually being hypothyroid. And so, we know that there’s a connection between hypothyroid and SIBO. And we also know that those with H pylori are more likely to have thyroid autoimmunity, and actually, other data, as we discussed earlier has found that if you have H pylori, that can interfere with thyroid hormone absorption.

And so, when we put that together, we realize that probiotics can combat both

SIBO and H pylori. Now, specifically the types—— So the Lactobacillus and Bifidobacterium blend probiotics, that’s the one there on the left, and the soilbased probiotics are the most studied in the application of treating SIBO and Saccharomyces boulardii has the most evidence in the treatment of H pylori.

Oftentimes, used synergistically with an antibiotic, but there it is nonetheless. And so, this is a good, in my opinion, cocktail, if you wanted to hit your gut from all the angles to rectify gut health as to have the best spillover benefit to thyroid health. So I just wanted to kind of contextualize that to connect all these dots for people in case that’s helpful.

Ari: Quick question. I mean, I’m sure you could answer this in a way that you could probably talk on it for an hour, but there’s a lot of people out there with gut protocols that are very anti-microbial focused with a large focus on killing the pathogens rather, and not just supplementing with either gut repair, gut lining repair stuff, gut, and probiotics, but the killing of bad bugs that are there. I know some people have mixed—— There’s different positions on that. Some people are very opposed to it. Some people are very in favor of it. What’s your take on that?

Dr. Ruscio: I have no opposition to it. I think it’s something that can be quite helpful. However, a big miss is using anti-microbials prematurely. And this is one of the reasons why I think so many people flounder, and they have to do multiple repeat doses of anti-microbials, or they feel they’ve only had a flicker of improvement from anti-microbials. Coming back to the ecosystem or the garden cultivation analogy, I look at diet and lifestyle as a foundational support encouraging that healthy balance. 

And then if that doesn’t get us to a point where balancing occurs, probiotics are another level of support, which are actually anti-microbial, but also so anti-inflammatory and anti-leaky gut. And with that addition, now you have a multitude of factors encouraging that healthy balance, healthy diet, healthy lifestyle, which those two are said quickly, but for someone to find the right diet for their gut, maybe a several week process. Nature lifestyle dialed in, maybe a month-long process.

Ari: I would say more, actually.

Dr. Ruscio: Yeah. Low ball——

Ari: I go really deep on the lifestyle stuff. So I mean, a lot of people say that they go through my program, which is on nutrition and lifestyle strategies. They go through it many times over even years in some cases and still pick up new stuff every time they go through it.

Dr. Ruscio: Yeah, I’ve been trying to optimize my sleep now for probably a year and a half. And I still feel like I’m not fully where I want to be. So, yeah, totally acknowledging that those are said quickly, but oftentimes easier said than done. But then the probiotics should be another level of support on top of that. If someone still is in need of support with all those factored in, and this is what I kind of codified an algorithm that I think is going to help you, then anti-microbials are a consideration and are likely going to provide a nudge to the ecosystem and allow kind of the equilibrium to be disrupted. And with all those healthy supports in place, now it can reset to a healthier equilibrium, at least, the way I look at this goes, whereas if someone didn’t do all those things and took anti-microbials, it’s kind of like pulling out a bunch of weeds from a sick garden and then getting mad when a month later the weeds are all back.

So I’m in agreement that we want to be careful with them, but it’s really more of a positioning problem or an order of operations challenge without the microbials. And, unfortunately, it’s easy to fall into the thinking of, oh, I’m bloated or XYZ. I just want to kill whatever’s down there. I understand that impetus, but it’s not so much about killing; rather, it’s about cultivation.

Ari: Got it.

How your gut is tied to your mood

Dr. Ruscio: Okay. So then coming to the benefits for mood, and again, Ari, I hope I’m not going too tedious with the studies here, but I really want to get people like here is the data so they can feel confident that when I say probiotics are helpful for mood. They can tie to the Journal of Affective Disorders publishing this meta-analysis of 10 clinical trials with over 1300 subjects and comparing the effect of probiotic versus placebo and finding “significant improvements in the moods of individuals with mild to moderate depressive symptoms” and unsurprisingly non-significant effects in healthy individuals. Meaning if you were already happy, you didn’t go to super happy. But if you were depressed, then you had an improvement in your mood.

Ari: Which is why this is not titled the superhuman happiness summit.

Dr. Ruscio: Right. But I mean, this is good data—10 clinical trials. Is it what we have for certain drugs? No. Could it be better? Yes, but it doesn’t change the fact that this is in the realm of high quality, and that participants had better sleep quality after six weeks of using a probiotic. And this is probably because of the gut-brain connection. And also, with food allergy, this is really interesting. The systematic review of 15 clinical trials found that probiotics can improve dairy tolerance. So for those wanting to get back to their cheese or their milk, there’s some good news. And then to simplify probiotics, really using probiotics does not need to be that complicated. You will sometimes hear, and I agree with the spirit of where this comes from. You’ve got to use the exact species and strains for your given condition. You’ve got to match a condition with a given probiotic strain, and that’s actually a misread of the data, which I’ll come to in a moment here.

Ari: Do we even have enough data to make claims like that?

Dr. Ruscio: We have some. I mean, there’s many a trial with probiotics. So I think we’re in the realm where we could do that, but it actually misses the forest for the trees, so to speak. It adds more complexity than—— So we can look at a body of data, and we can look to use that data as a way to draw a logical inferential conclusion, or we can look at it and try to make the most granular tedious recommendations that don’t actually try to impart any wisdom on the body of knowledge. And some go one way, some go to the other.

I prefer going to the way of let’s use this knowledge to become more wise and recommendations rather than making things more complicated. But yes, I’ll cite a couple of specific examples to support that in a second because it’s a really important question.

So there’s many different probiotic strains, but most formulas can be organized into one of three categories. And your category one, what you’ll see here is a predominance of Lactobacillus and Bifidobacterium strains. Now, the exact strains may vary from study to study, but what you’ll see, let’s take the model of IVs. You’ll see multiple different trials showing that some combination of predominantly Lactobacillus and Bifidobacterium strains improved IBS, improved IBS, improved IBS. So when you zoom out, while it’s tempting when looking at one data point really closely to say, well, you need to make sure that different bacterium infantis is included in the obvious mixture because that strain and Lactobacillus reuteri have the best evidence showing that they can improve IBS, but then another trial also improves IBS without the B infantis.

So if you get granular, you can come to false conclusions. If you look at the data in totality, any one of these things, well, this is the best probiotic for constipation. That was true when there was one study on constipation on probiotics, right? So to simplify things, predominantly, Lactobacillus and Bifidobacterium species blend is category one. Category two is Saccharomyces boulardii, which is just a healthy fungus. So different, not actually a bacteria, this is a fungus. And so, I’m sorry, backing up for a second. Category one has about 500 clinical trials, category two about 100 clinical trials, and then category three is the soil-based or spore-forming probiotics, getting a lot of attention in kind of the paleo ancestral community. And there’s about 14 trials here, depending on if you also include this body of studies from Asia, maybe about 30 trials.

And you’re looking at mostly Bacillus strains: Bacillus subtilis, Bacillus licheniformis, Bacillus clausii. Again, some of the trials had used one strain, some of had used two, some had used three, some had used five, and they’ve all shown various benefits, similar benefits. So it’s hard to say that we must have the one perfect species. And in fact, we recently had someone in our audience ask—— Actually, it wasn’t really ask. It was more tell us that you need to use only the specific strains. So we go from species, Lactobacillus acidophilus, and then you can designate all the way down to the strain.

So there might be Lactobacillus acidophilus arbitrarily here, H125,

Lactobacillus acidophilus, U1146. And someone told us that you have to use the specific strains that have been used in the research. So we went back and went through all of the studies, and this is a real pain because not only do you have to look at—— Let’s say there’s a meta-analysis. All the different formulas used in the meta-analysis, most of the time they don’t list the actual strains, maybe in the methods, or we had to actually email some of the authors, and we laid it all out. And what you see is in almost every study, whether it’s a different formula used. So let’s say there’s VSL#3, which is a popular lactobacillus blend. Let’s say there’s a different version of VSL#3 used. The strains are different. So as I was expecting from study to study, the strains differ.

Ari: And yeah, they all——

Dr. Ruscio: All showed, mostly showed, benefit.

Ari: —gut symptoms or mood symptoms.

Dr. Ruscio: Exactly. And so, as a parallel, we know that antibiotics work for small intestinal bacterial overgrowth—rifaximin, neomycin, azithromycin, Flagyl. So there’s multiple different antibiotics that have been shown to be beneficial for SIBO. So we can’t really say that one is the most effective. Now, rifaximin is poorly absorbed. So it may be more favorable from a side effect reduction perspective, but we know that there’s multiple medications that lower blood pressure.

And it’s kind of silly to say, well, this is the one best medication for blood pressure. So same thing here, but actually there’s better support for not needing to be so [inaudible] with probiotics because probiotics are not drugs. They’re not acting on a very narrow mechanism, but rather these organisms are transiently making their way through the gut, exerting their antiinflammatory benefit, their anti-leaky gut effect, their anti-microbial effect, anti-fungal, anti-bacterial, and anti-parasitic. 

So because they’re not these drugs with highly specific action, but rather they’re helping to improve this core cause of symptoms in your gut, it’s very easy to see how we don’t need this one specific probiotic that’s supposed to be helpful for constipation. If you have constipation because you have methane predominant small intestinal bacterial overgrowth, what you need is something that will rid you have of the methane SIBO, not the probiotic that just is like a laxative and causes you to poop more quickly. Does that make sense?

Ari: Yeah, absolutely.

The three steps to heal your gut

Dr. Ruscio: Okay. So those are the three categories that we can simplify this down to. And so, what’s nice about this is it means that you don’t have to try every probiotic on the market. This is something that really, I think, trips people up. And, unfortunately, people will sometimes try a category one; they’ll try VSL#3, and then they’ll try a lime. And then they’ll try something from Whole Foods, and all the while they don’t realize they’re taking the same thing. And they’re wondering why they are not getting a different result. Well, if you went through all the research studies, you’d see that these different probiotics have all shown similar effects surprisingly, but when looking at consumer-facing, you’re looking at a label. You can’t make that discernment. So what we end up with is what I recommend here in the three for balanced protocol, where if the analogy here is a stool, like when you would sit on, we want to support balance in the stool.

And so, three different legs of support are most akin to having, or most likely to have balance in the microbiota. So the Lacto-Bifido Blend is one category of these lactic acid-forming bacteria. The second one is polarities and healthy fungus. The soil-based probiotics is a non-lactic acid-forming type of probiotic. This is the most conducive to balance. Whereas one probiotic clearly can benefit people. I don’t want to make it sound like you must use all three because that would not be representative of what the data has shown. But for someone who feels like you need more help—— For the person who takes one probiotic and everything improves, awesome. You’re a simple case. Fantastic. But if you felt like you got a flicker of improvement, but you need more assistance, this is where the three-legged support underneath the stool example can really be more conducive to achieve and balance.

And we have drawn up case studies in our video newsletter where this has been the exact case. People come into the clinic, and they had been on paleo and then on low FODMAP, and they went from probiotic to probiotic, and then we just left their diet where it was kind of like a low FODMAP paleo-type diet, put them on three probiotics at once. And six weeks later, they saw an improvement they hadn’t seen in a year and a half. So these things do shake out this way in the real world.

So our goal is to achieve balance. The failure point is an inability to achieve and maintain balance in the microbiota. The cause in part is the probiotic merry-go-round instead of kind of getting a more comprehensive support. You keep putting one leg of support underneath the stool, and this stool is always wobbling. And you’re always wondering why. So what I’d recommend people do specifically is try a quality formula from category one, category two, and category three. So take a quality formula from each category.

Ari: And is that the recommendation you’d have for people who have let’s say everything from severe gut symptoms to no gut symptoms but are just looking to optimize who are mostly healthy?

Dr. Ruscio: Well, the healthier someone is, the less potential room for improvement that they have. And I definitely want to acknowledge that. On the other side of the coin, might they notice as healthy as they are, are they less impervious to let’s say when they fly, they get a little bit bloated? Maybe now, when they fly, they don’t get bloated. Or maybe if they have dairy, they have a problem. And now they won’t. So I would say this is something that anyone could try.

And even if you went to the lowest dose of all three, as a kind of gentle push, wouldn’t be a bad idea. And I myself use a dose of all three of these every morning. And I certainly consider myself pretty darn healthy, but I do notice, and those examples are from my own life. I used to get bloated when I would fly. It wouldn’t be bad, but it’d be annoying, and I’d have to be a little bit careful. If I had alcohol or too much, or I ate out a few times per week, I’d feel it in my gut. Now, I’m pretty impervious of those things. So even for me, as someone who was a train wreck, honestly way back in the day, I’m much better now. But even from where I was recently to where I am right now, I just have that extra level of resiliency against environmental and food-based insults. So for anyone, yeah, but I mean, the more symptomatic you are, the more potential you have for gain here, of course.

Ari: Yeah, beautiful.

Dr. Ruscio: And then number two, give yourself, or step two, give yourself three to four weeks on the protocol and then re-evaluate. Some people will notice improvements within days. Not everyone’s going to respond that quickly. So you give yourself three, maybe four weeks. And at that point, you’re looking to say, okay, yes, I’m moving in the right direction, or no, I feel no differently. Using reflux is one example. People with reflux will oftentimes notice a benefit, but they’re still not fully healed in that three weeks. And what’s so easy about reflux is especially with people who have food reactive reflux, they get a really fast response to a given food. And so, someone a month in with reflux may have no more reflux, but they go, yeah, but if I eat too much of this trigger food, I still have reflux.

Okay. You had reflux all the time. Now you only have reflux if you have too much of a trigger food. And if you go to month two or month three, you’ll likely start seeing less response to that trigger food. So there’s re-evaluation window one, am I moving in the right direction? And then the next point here is point three. Wait until you see a plateau until trying to kind of wean off the probiotics or find the minimal effective dose. And that’s the thing that I think eludes people. They see some improvement, and then they say, well, but it didn’t fully fix me, so I’m going to stop. Well, don’t stop and be patient. It may take three, four months until you plateau in terms of your improvements.

Once you plateau, wait there a little while and then try to find the minimal effective dose.

And a quick note on the minimal effective dose, this can be subtle because when you’re not feeling well, you’re really paying attention. Then when you’re feeling well, you kind of pay less attention, rightfully so. You should go out and live your life. But when you’re going through this kind of withdrawal and trying to find a minimal effective dose, you may come off the probiotic and notice nothing. And then four weeks later, you’re saying, I’m kind of bloated again. My stools are getting a little bit loose. Make sure to be paying attention to that so you connect back to the fact that there was a latency with the impact, and then try to go on a lower dose and see if you can find what the minimal effective dose is. For me, one dose every morning is enough to really keep me humming along. I can miss some doses, and I’m okay. But just a few things that guide people just pass the on-ramp. There’s the on-ramp. There’s re-evaluation window. There’s your peak. And then there’s your win. And so, those are a few things that kind of help guide people through that.

Ari: Great. So we have these three types, three categories, the lactobacillus, and bifido is one category—category one. Category two is specifically

Saccharomyces boulardii or does it also include something like, I don’t know, Saccharomyces cerevisiae, which——

Dr. Ruscio: Well, maybe. There’s really not great data with cerevisiae. I’m open to it, but I mean, someone could include it, but really the majority vast of the data is in Saccharomyces boulardii. So maybe in the future we’ll have a multi-strain fungal probiotic, but for right now that’s a bit too speculative. I’m certainly open to it. But S boulardii seems to be able to get you pretty far.

Ari: Got it. And then category three is the spore-forming bacteria. And you’re recommending to take all three. And do you have—— I think you have your own brand. Is that correct—of the probiotics?

Dr. Ruscio: The ones that I’ve listed on the slide here are the ones that I’ve used.

Ari: So just for people listening who are not seeing the slide, do you want to give them information on the brand and where they can get it?

Dr. Ruscio: So the brand is Functional Medicine Formulations. The three product names are Lacto-Bifido Probiotic Blend, Saccharomyces boulardii probiotic, and Soil-Based Probiotic. And I named the formulas in accordance with the categories just to make it really easy for people. If you just search my name and probiotic should come up really easily. And the thing here is you can really use any quality probiotic. I don’t want to make this sound like I have the magical probiotic. That would not be a tenable recommendation or statement for me to make. But we have made sure to clear the quality assurance measures. So yeah, here’s the quality assurance information. And so let me take a step back to kind of contextualize this. When we were putting together these formulas, we went through about 25 manufacturers that made probiotics. And all these 25, we filtered them for the quality assurance measures that we follow. And only five of 25 companies actually follow these criteria.

So that was a bit shocking to me. It’s important, I think, for the consumer to understand that not all, in fact, most companies are not following these assurance practices, and this is why, I mean, looking at the data—— So here a study found that 43% of probiotics assessed contained less than half the amount listed on their label. Another study of 26 commercial probiotics assessed found that none of them fully supported their label claims, and some of them even contained unacceptable micro-organisms. And then, another study found that only half the probiotics on the market examined had the specific strains listed on the labels. And there’s the references for you there. But certainly, quality assurance for probiotics is not where it should be majority of the time.

So I fully appreciate that we don’t want to hide behind quality assurance as a way to jack up the price, which some companies do. And it’s important to acknowledge that and call that out. And it also doesn’t mean that the most expensive probiotic is going to be the best, but the cheapest one—— Let’s say you’re looking at $40 and you find some that are $15, be very wary of that because you’re most likely not actually getting a deal. You’re most likely getting one of these formulas that doesn’t come close to even meeting the label claim. And so, the things to look for are independent laboratory analysis, and this will look at the dose being in the pill actually, also what’s on the label so they’re meeting their dosage claim and the strains or the species that are listed are actually the ones that are in the formula.

And that ties in with the genetic identification, just to make sure that what you think you’re getting, you’re actually getting and then free of major allergens. Some probiotics will use a fair amount of prebiotic filler, which for some people, is a real problem because they may be sensitive to prebiotics. So that’s something else to be considered. Validated potency and probably the least important, the most common, but the least important is good manufacturing practices. That is just the minimum bar to clear is GMP. And then from there, we need the potency, allergens, genetic ID, and independent laboratory testing.

Ari: And a genetic ID aspect is specific to probiotics to verify that it is the specific species and or strain?

Dr. Ruscio: Correct. I mean, you don’t have to do that for whey protein.

Ari: Yeah. I don’t have to. I mean, I have some supplements myself, and I don’t have to do genetic ID testing for any of that.

Dr. Ruscio: Right. And so, that will add to the cost. Now, again, it doesn’t mean that if most probiotics are going for $40, that the $80 one is the best, but it does mean that on the lower end, the corner is going to be cut somewhere here.

Ari: Yeah, awesome. Well, this is phenomenal stuff, Dr. Ruscio, I’ve loved this.

This has been educational for me, too, to really understand the broad categorization of how you break down these three categories. I think it’s brilliant. And it makes sense of, as you said, there’s just this vast expanse of a million different kinds of probiotics and competing claims and different species. And I think this is a really simple and brilliant way of breaking everything down for people in a practical framework.

So thank you so much for coming on. For people listening in who want to go get these probiotics, they can get them at—— You can Google Dr. Ruscio’s name and probiotics, or your website is—— What’s your website again?

Dr. Ruscio: Yeah. It’s just Drruscio.com, D-R-R-U-S-C-I-O.com.

Ari: Got it. Wonderful. Well, thank you so much, my friend. I really appreciate you being on. And I look forward to talking to you again in the near future.

Dr. Ruscio: It’s been a pleasure. Thank you.

Show Notes

The gut lung axis and how it is involved in health (02:00)
How gut health is linked to well-being (07:57)
The benefits of probiotics (18:18)
The link between gut and thyroid health (28:57)
How your gut is tied to your mood (47:40)
The three steps to heal your gut (55:55)

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