In this episode of The Dr. Hedberg Show, I interview Dr. Michael Ruscio and we discuss non-celiac gluten sensitivity, prebiotics, probiotics, the microbiome, SIBO, FODMAPs and much more. You can read the transcript below.
Michael Ruscio is a doctor, clinical researcher and best-selling author whose practical ideas on healing chronic illness have made him an influential voice in functional and alternative medicine. His work has been published in peer-reviewed medical journals and he speaks at integrative medical conferences across the globe. Dr. Ruscio also runs an influential website and podcast at DrRuscio.com, in addition to his clinical practice located in northern California.
Dr. Hedberg: Okay. Well, welcome, everyone, to "The Dr. Hedberg Show." This is Dr. Hedberg. And I'm excited today to have a good friend and colleague on Dr. Michael Ruscio. We've known each other for quite a long time I think since I launched "The Infection Connection" back in around 2012, and Dr. Ruscio has a lot of expertise in the gut and the thyroid and autoimmune disease, so we'll be talking about some of that today. So, Dr. Ruscio, welcome to the show.
Dr. Ruscio: Hey, thanks, for having me on.
Dr. Hedberg: Great. Well, you and I have a lot in common in that most of what we do is driven by the literature and so why don't we jump in and talk about some of the latest work on non-celiac gluten sensitivity. Because gluten is really one of those... it's a big topic right now. A lot of people are avoiding gluten maybe unnecessarily. But why don't you talk a little bit about the latest research on non-celiac gluten sensitivity?
Dr. Ruscio: Sure. And you're actually right. It's an important issue because I'm sure that if... whether you're a clinician listening to this or a patient or just a healthcare consumer you've likely heard of gluten-free dieting. You've probably known someone who's gone gluten-free and reported that they felt better eating gluten-free. It's certainly something that can help people. I think where we have to be careful is when we try to tell everyone that they have to eat like they have celiac disease. And it's kind of this mistake of falling into extreme ways of thinking or dichotomous ways of thinking where it's either all or none, 100% avoidance or total, you know, unrestricted gluten in the diet. And for some people, that's absolutely true, for some people they have to be very diligent with gluten avoidance.
But, and I guess one could ask the question, "Well, if it's a potential problem, if gluten in the diet is a potential inflammatory or detrimental food then why not just avoid it?" Well, because that poses some psychological and psychosocial stressors on people. It can be difficult and I certainly see patients who come in afraid of food and it's causing an impairment of their social life because of it. And so these are serious things that do have documented influences on your health. Fear, stress and social connectivity or lack thereof have been documented to have truly profound impacts on various measures of health. So this is important to have a nuanced idea of what we should be recommending for gluten avoidance.
And there was a multicenter study performed in Italy, and a group of different physicians and gastroenterologists, essentially comprised a 60-point assessment for identifying and tracking those who had non-celiac gluten sensitivity and also correlating what other symptoms and conditions non-celiac gluten sensitivity was associated with. And just for the audience, you have celiac and then if you're not diagnosable as celiac but you still seem to have a negative reaction to gluten then you can be labeled non-celiac gluten sensitivity. And what they found was very interesting. They found that 0.3% of the population that was studied and rigorously evaluated trying to identify non-celiac gluten sensitivity, looking at symptoms, physical exam, lab testing. They found that 3% of the over 12,000 patients who are assessed, those were a large sample size, were reported to have non-celiac gluten sensitivity.
Now, people may say, "Well, in Italy, or in Europe, I've heard that there's less glycophosphate use and there's less actual gluten in some of the grains after processing. Doesn't this differ in the United States?" Well, on the same paper, they cite research showing that in the United States, the estimates of non-celiac gluten sensitivity have ranged from point six to zero point six. So I'm sorry from 0.6% to 6%. So even in the U.S, it's not something that seems to impact close to the majority but definitely some people. And so this is important because I'm not saying that non-celiac gluten sensitivity is some sort of fad. It's clearly an issue and something that people should do some self-experimentation to see what their relationship with gluten should be. Some of the other researchers now are using the term gluten-reduced diet and I think this may be a better aim for people who notice they have some reaction to gluten but they're not decimated by gluten.
Some people may notice they don't feel right for days after eating gluten. Other people may notice little to nothing in the way of symptoms. And so perhaps for those with mild symptoms they can practice a gluten-reduced diet. And one just final point here to piggyback on this, some people make the argument that gluten fuels this silent inflammatory process in the body with no symptomatic reaction potentially for weeks or years. And what was very interesting about this study, they found that over 90% of people who were found to have non-celiac gluten sensitivity had a discernible symptomatic reaction within 24 hours.
So that's actually very good news for us because it tells us that again the vast majority of people will have some type of symptomatic reaction after gluten reintroduction within 24 hours. Now, that reaction might be brain fog, it might be fatigue, it might be skin breakouts, it might be bloating. The types of symptoms can vary but any negative symptom that you see within 24 hours after gluten ingestion can tell you that you may have a problem with gluten. And if you don't experience that symptomatic reaction, the likelihood that you're doing damage to your body is fairly minimal.
Dr. Hedberg: You know, I'm really glad you brought that up about Europe. It's kind of an interesting thing that I've seen actually not just in practice but personally. A lot of patients will report that, you know, they go on vacation to Europe, and they eat gluten and they actually feel great the whole time. And I'm kinda the same way but it's hard to differentiate the fact that you're just so much more... you're so much better at digestion and just everything across the board is working better when you're on vacation.
Dr. Ruscio: Exactly.
Dr. Hedberg: You know, parasympathetic nervous system is just gonna be running along just fine.
Dr. Ruscio: Sure.
Dr. Hedberg: So I just have to wonder is it... is there a real difference in the gluten content or the type of wheat and... or is it just the fact that you're on vacation or is it a combination of both? What do you think on that?
Dr. Ruscio: I'm really glad you said because I've wondered that same question. And what I can say is this, is that there's a fair number of patients that come into my clinical practice, and when we have this discussion and they go and they reintroduce this gluten, there's a fair number of people, I would say the majority of people, notice that they can have some gluten and there's no sizable repercussion. Yes, there are...there is a small minority who had to be very careful, absolutely, but I think that it absolutely could be a byproduct of being on vacation and being less stressed. And I also think there's a degree of placebo here.
If people are expecting to have a negative reaction in the United States, and not in Europe, we know that for example in randomized control trials where we're trying to isolate out the effect of the placebo influence, trials and IBS show on average a 45% placebo effect even when we're trying to isolate out for it. So imagine if you're knowingly operating under some kind of external placebo effect, we can infer that the influence of the placebo might be as high as perhaps 80%. So yeah, I think all these things likely play a role but definitely being less stressed, being on vacation, and then maybe having that positive expectation of being able to eat gluten in Europe probably all congeal together to allow people to eat more grains, you know.
Dr. Hedberg: Right, because in the psychoneuroimmunology research it's just so clear that our beliefs can change how our immune system responds. And we can actually create and use an affiliate response to certain foods even though we don't have an actual clinical allergy to it, just if we believe it is strong enough.
Dr. Ruscio: Right.
Dr. Hedberg: You know.
Dr. Ruscio: And that's why I think it's so important that as clinicians and nutritionists and health care providers that we use caution in the surrounding language because I think up until now the narrative on gluten has been way overzealous and to integrate it with fear. And I think it's actually, you know, we've gotten to the point where we've made people aware of gluten as an issue but I think we have overshot the landing now and we're making people unnecessarily afraid of gluten. And I think we need to pull back a little bit and give people some more balanced recommendations here.
Dr. Hedberg: Right. And I hate to say this about my own profession but, you know, alternative medicine, functional medicine, it's really done a lot of harm to a lot of people by creating just unnecessary fear and anxiety about not just food but a lot of other things. And then you combine that with the internet and people are just bombarded not only from their practitioners but from the internet with,
