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.