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In this episode, you will learn about root cause medicine and recovering from complex, chronic conditions.

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About My Guest

My guest for this episode is Dr. Joe Mather.  Joe Mather, MD, MPH & TM is the Medical Director of the Ruscio Institute for Functional Medicine where he works with patients, mentors other Functional Medicine practitioners and helps conduct research to improve the knowledge and field of Functional and Integrative Medicine.  He graduated from the Tulane University School of Medicine and the Tulane University School of Public Health in 2011 and completed his residency in 2014.  He is passionate about delivering cost-effective and practical medical care with a focus on GI health and environmental toxicity, especially mold-related illness.  He spends a lot of time working with patients suffering from complex and chronic diseases.  When he is not working with patients you will find him chasing his three small children, exercising, or playing music.

Key Takeaways

  • Why are people sicker today than a decade ago?
  • What is the difference between IBS, IBD, and SIBO?
  • Is microbiome testing helpful in determining a clinical direction?
  • What are the root causes of SIBO?
  • How is constipation addressed?
  • Can the Carnivore diet be helpful for those with GI issues?
  • Is food sensitivity testing valuable?
  • How might one test their environment and their body for the presence of mold and mycotoxins?
  • Can remediation move the needle? What about air filters and fogging?
  • Should binders be matched to the mycotoxins present?
  • How might one optimize the sinubiome?
  • Does the presence of Actinomycetes change the treatment path?
  • What is the root cause of EDS and hypermobility syndromes?
  • How important is supporting the thyroid and adrenals in recovering health?
  • What should the therapeutic order be in treating complex conditions?

Connect With My Guest


Related Resources

Ashok Gupta Interviews Dr. Joe Mather

Interview Date

July 29, 2022


Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  


[00:00:01] ANNOUNCER: Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

The content of this show is for informational purposes only and is not intended to diagnose, treat or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health related decisions with your own personal medical authority.


[00:00:35] SCOTT: Hello, everyone, and welcome to episode number 170 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Joe Mather, and the topic of the show is Root Cause Medicine. Dr. Joe Mather is the Medical Director of the Ruscio Institute for Functional Medicine, where he works with patients, mentors other functional medicine practitioners, and helps conduct research to improve the knowledge and field of functional and integrative medicine.

Dr. Mather graduated from the Tulane University School of Medicine and the Tulane University School of Public Health in 2011 and completed his residency in 2014. He is passionate about delivering cost-effective and practical medical care with a focus on GI health and environmental toxicity, especially mold-related illness.

He spends a lot of time working with patients suffering from complex and chronic diseases. When he's not working with patients, you will find him chasing his three small children, exercising, or playing music.

And now, my interview with Dr. Joe Mather.


[00:01:44] SCOTT: I am excited today to have Dr. Joe Mather on the podcast to talk about complex chronic illness and how he explores these with more of a root cause lens to find solutions for his patients. Thanks for being here, Dr. Joe.

[00:01:57] DR. JOE: Happy to be here, Scott.

[00:02:00] SCOTT: What was your personal journey that led you to working with this patient population, more complex chronic illnesses and those people that you work with today?

[00:02:09] DR. JOE: It was really just curiosity and dissatisfaction with my conventional medical training. I remember distinctly at the end of my medical residency, the moment where I realized that the training that I just went through was just not enough to help most of my patients in the way that I wanted. And from there, I was just kind of down the rabbit hole through functional medicine and trying to discover what of the tools and functional medicine actually would move the needle for my patients. And I've really gone from there. My current position with Michael Ruscio, with the Ruscio Institute, and training with Neil Nathan, maybe two of the bigger pieces that really helped me along.

[00:02:53] SCOTT: Beautiful. Beautiful. You've observed, as I have, that people are far sicker today than 10, 20, 30 years ago. What do you think is the root of the increasing complexity that you observe in complex chronic illness patients?

[00:03:08] DR. JOE: Well, I think it's important that we're not the only one saying this, that the people who have been practicing medicine for decades are saying that patients are sicker now. We're seeing this pattern from multiple lines of evidence, epidemiological as well.

I think there's a short-term cause and I think there's a long-term cause. I think the short-term cause is the consequence of the pandemic. I think the fear, the social isolation, the collective trauma and life disruption that we've all been through, I think that's made people a lot more vulnerable. And I think we're just beginning to understand that now. I think that's one proximal cause. I think the longer term is that we are increasingly being poisoned by our environment. I think this is – I think the plastic exposure. I worry about heavy metals that I'm now seeing in patients eating organic food, right? Like, thallium burdens and patients eating spinach is horrifying to me, right?

I'm seeing – I think mold. I think the way that buildings have been built since we've tried to fix the energy crisis in the 70s has made us more susceptible. I think it's primarily the environment we're living in. And the fact that many of us, we live and work indoors, primarily. I think human beings were meant to be more dynamic and active. And we spend a lot of time these days in front of the computer. Those are some of the patterns, I think.

[00:04:38] SCOTT: We definitely do as evidence by our own conversation here. No, I totally agree. I mean, I think environmental toxicity is the primary issue that lots of people that have these microbial overgrowths, and Lyme disease, and all of these things. If we didn't have the toxic burdens, I'm not sure that we would be as sick as we are. So, I absolutely agree with everything that you just said.

I know one of your primary areas of focus is gut health. And so, I'm interested in how do you see the differences between IBS, IBD, SIBO? It seems like so many people now are dealing with these. They've become very common conditions. What do you think the root causes are that explain the high prevalence of these conditions today?

[00:05:20] DR. JOE: In terms of just putting our focus on GI health, I think the processed food diet that so many of us have gotten accustomed to is the primary driver. And I think one of the questions was, what are the differences here? Where do you like me to expand? I can maybe expand on a couple areas here.

[00:05:41] SCOTT: Yeah. So, how do you differentiate between, let's say, IBS, IBD versus someone who's presenting with SIBO or SIFO?

[00:05:48] DR. JOE: So, inflammatory bowel disease would be the most severe typically. And this is where someone is going to have profound bloody stool, weight loss, intense abdominal pain. It's characterized by extremely high fecal calprotectin. So, their biomarkers. Very, very high amounts of inflammation in the intestine. It can be there are different types of inflammatory bowel disease, and we generally talk about Crohn's or ulcerative colitis, or microscopic colitis is maybe some of the bigger categories. And generally, that describes some of the deeper patterns of inflammatory bowel disease. But we're typically talking really disrupted high levels of inflammation, lots of bloody stool, and inflammatory bowel disease. That would be a very different clinical picture than, let's say, IBS. So, irritable bower syndrome. A syndrome is a way that we describe certain collections of symptoms. In this case, the main symptoms will be stool irregularity, or diarrhea, or constipation, right? Abdominal pain and bloating. That's going to be a much milder presentation than the inflammatory bowel disease.

And SIBO, again, is a description of a clinical setting. It can manifest to gather diarrhea or constipation. But the hallmark, in my mind, is postprandial bloating, right? Bloating after we eat is the hallmark manifestation of SIBO clinically. For me, SIBO, right? Small intestinal bacterial overgrowth. The idea here is that the bacterial populations have risen to unhealthy levels in the small intestines.

What were supposed to have happen is stomach acid, bile, migrating motor complex, clean, and clear the small intestine. And for a variety of reasons, those things break or get worn down, and the bacteria then start growing where they're not supposed to. That's SIBO. And SIBO will then can cause irritable bowel syndrome. And to a lesser extent, inflammatory bowel disease can be triggers for those things. And when we fix the SIBO, sometimes the IBS just goes away.

The question is very open for how many patients with IBS actually have SIBO, right? It's one of those questions. If you look in the literature, some people say 5%. And I believe it's Mark Pimentel who says 80% of patients with IBS have SIBO. Or I’d have to say, it's probably about 50% in my experience. 40% maybe would be my read on that. Certainly, a lot of people who have IBS – Or the first things I learned in functional medicine really was that people with IBS, a lot of them just have SIBO. When you fix the SIBO, it goes away.

[00:08:43] SCOTT: Many functional medicine doctors think of starting with the gut. I know that our mentor, Dr. Neil Nathan, suggests that that's not always the place to start if someone's dealing with mold illness, mold exposure from water damage buildings. I'm wondering if you found it important to address the mold component before you can really move the needle with the gut. And that really ultimate impact on gut health that then has a more systemic, broader health implication.

[00:09:10] DR. JOE: There are very few people in the world. I respect them more than Neil Nathan. So, you'll never hear me say anything bad about the man. And I even hate to disagree a little bit. This is an area where I think we might be talking about maybe two different aspects of a mold patient. In my world, since I started aggressively treating the gut first in my mold patients, I've seen better outcomes. And maybe we can talk a bit about why I think that is.

In my mind, the gut has to come before the traditional mold treatments that we've learned from Neil, right? The binders, the antifungals, the MCAS support if needed. And that's what I do. And that's what I think works the best in my patients.

There is a group of patients, and maybe this is what Neil was referring to, that they have a predominant GI symptom pattern, right? They've got reoccurring diarrhea, and bloating, and heartburn, and irregular stools. And you do the normal GI treatments that seem to fix the other patients, but they just get stuck, right? You're going nowhere. And you're saying, “Okay, I see this breath test, and I see that they've done the diets, and we've worked with the probiotics, and they're still sick. What is going on here?” Many times, those patients have mold. They have mold colonization in the gut. And I believe that's disrupting the microbiome.

For those patients, it doesn't make any sense to keep hammering their gut, right? You're missing the mold. They're not getting better, because you're not treating the ultimate cause. I think that's probably what Neil would agree with if this was a three-way call. If not, he can call me and yell at me later.

[00:10:56] SCOTT: There are many different stool tests on the market that suggests they can characterize our microbiome. I'm wondering what your experience has been with those tests? Are they clinically helpful? Are they far enough along where they can provide meaningful clinical results?

[00:11:14] DR. JOE: I wish they were, but they're not. I think the tests that tell you they're going to map your microbiome are preclinical. They may be interesting, but they're not clinically relevant. They're not useful. At their worst, they're fraudulent. There was one microbiome company that was using dog poop as a reference. And telling people to do things based on what the dog poop says. We have to be very, very careful and very critical on some of the functional medicine testing, because people are doing these, they’re buying them, they don't have the wider clinical lens in which to interpret the results. And they're just going into town and they're saying, “Oh, my God, I have all these problems with my Bacteroides. And I don't have this much methanogens,” and they're driving themselves crazy, and they're going down dead ends, and they’re wasting lots of time, lots of money. I don't order them – I don't even open them when a patient sends them to me. I think that they are a waste of time at best and harmful to the patient at worse.

[00:12:27] SCOTT: Yeah. No. It's great to hear your perspective on these things. And we touched on this a little bit a few minutes ago, but many people think of SIBO as a condition where killing the bug is the solution. Taking all kinds of anti-microbials. I tend to think of that as more of the effect rather than the cause, where maybe the causes are more autonomic nervous system, migrating motor complex, vagal tone, bile flow, those things that you mentioned. I wonder if you can talk to us a little more about how you see SIBO? And what are some of the top tools that you have found helpful for your patients to bring a longer-term resolution? So many people are on Rifaximin or Xifaxan. They feel better, but they stop. And it tends to just kind of come back. What are your thoughts on SIBO?

[00:13:14] DR. JOE: There's definitely a time and a place to kill the bacteria. But so many of the patients who come to see us at the Ruscio Institute, they've already done all that. And there are very clear subset of patients who don't need more killing. They need more rebuilding, right? Their terrain is unhealthy. Their endothelial is diminished. They haven't focused on diet. They haven't fixed their sleep. They haven't done the very fundamental basics that will help the stomach acid return. They'll help the bile flow. And until they do those basics, they're going to be stuck. And they're going to be in this pattern of chasing their tail with neem, or berberine, Candibactin, or whatever it is the tool that they're using, or Rifaximin, and Neomycin, right? There's absolutely a time and a place for killing. But there's definitely patients who need a different approach. And there's enough patients out there. And when you do the fundamentals, they're just better, right? And so, you don't need to then put them through weeks of herbs.

For me, what works best for those patients is really making sure they've done their due diligence on a diet. I love the low FODMAP diet in SIBO. It works great. It's just fantastic. And usually, that's as strict as I need to go, right? We don't need to go into Specific Carbohydrate Diet. We don't need to go with GAPS. We don't need complex screen introductions. We can just do low FODMAP, three, four months, get them back online, use herbs if needed, right? And then get back to more of a whole food paleo type diet.

The other piece that has to go hand in hand in that is comprehensive probiotic therapy. And if you don't mind me getting on a soapbox, I think this is a big miss in the SIBO community in some areas. There still is this idea that, right, there's too much bacteria in the small intestine. So, we can't give probiotics. That's a compelling argument. It makes intuitive sense. It just happens to be wrong, right?

So, if you look at the clinical trial data, whenever you give an antibiotic and a probiotic, you get a better clearance rate. You just give probiotics. You can clear many infections. So, we know this from clearing H. Pylori. We know this from Candida. We know this from SIBO.

Dr. Pimentel has a study with Rifaximin and probiotics. When you give probiotics, you clear more. And the truth of this is, is that when you give comprehensive probiotics, all of the symptoms diminish. And we see breath tests just come back to normal. Not in every case, but in enough that it's really convinced us that this is a really needed way to help rebalance the microbiome.

The key here is that probiotics are working on a couple of levels, right? They're not just repopulating the gut. I think that they're instead working in two other mechanisms. One is they're teaching the immune system what is an appropriate type of bacteria to allow grow, and letting it focus on other more problematic bacteria.

And I think that the lysed probiotics, the cell walls, the dead probiotics, once they hit the stomach acid, most are dead, right? I think those have antimicrobial properties in and of themselves, and work like many antibiotics.

And so, we see using comprehensive, which to me means three different types of probiotics, right? Soil-based, Saccharomyces, and Lacto-Bifido blends, we see a lot of SIBO going away. When I say fundamentals, getting the bile back online, right? Getting stomach acid. Getting symptoms down. For me, that's making sure that the right diet for that patient is in place, plus comprehensive probiotics. That's a general starting point for almost every case that I see. Be it SIBO, inflammatory bowel disease, mold, chronic fatigue, right? It's just one of those fundamentals that has to come back online so other systems can then reboot later.

[00:17:16] SCOTT: Do you find that in your patients that are dealing with mast cell activation and histamine intolerance that you have to limit their probiotics early on to the histamine degrading probiotics? Or has that not been a problem?

[00:17:27] DR. JOE: Not been a problem. I tried this earlier on in my career. And I didn't see any difference when we went with the lower histamine probiotics. And so, my suspicion is, is that this may be a little of a placebo effect. We tell a patient who tends to be reactive, “I'm going to give you this specific probiotic. And it's not going to make you react because of histamine,” or whatever grease we put in there. And I think that that's part of the reason why some patients may have felt that it does better, quite honestly. But when I kind of give it to patients in a more just balanced way, and just observe, I haven't seen a difference.

And I think, quite frankly, that this is kind of going back to why the microbiome literature or the studies are just not to real time. You may have a Petri dish study that shows that Lactobacillus reuteri, as one example, may have a different histamine effect. But when you put that into the gut, it's very hard to then say it's going to have this effect in a person. And so, I think too much is made of the in vitro laboratory studies and not enough attention is paid to what actually happens when I give my patient that substance.

We find at the Ruscio Institute, not just me, right? But Dr. Scott, Dr. Hannah, Dr. Michael, we all find that when we give comprehensive probiotics, we see a diminishment of those histaminergic symptoms, right? And then often we don't even need the MCAS support. Sometimes we do, but – So, from my perspective, probiotics is one of the more powerful tools to drop that histamine threshold.

Do you mind if I – I'm kind of on a roll here. It’s one of the things that just gets me going here, because this is a cost effective, easy, safe thing that so many people can do but haven't because they've been told, for whatever reason, probiotics are not going to help you.

Histamine is not just a chemical that's released from a mast cell or an eosinophil. It's not just an allergic compound. It's produced as a bio signaling molecule from gut bacteria. When you have dysbiosis, your gut is making more histamine. When you have SIBO, you're making more histamine. If you can give probiotics imbalance and diminish those populations, your histamine goes down, right? That spicket. We can turn it down a couple notches, right? And that makes everything else easier. This is one of the one of the reasons why we find at the Ruscio Institute just really, really going hard on maximizing the gut because it makes the other stuff easier.

[00:20:06] SCOTT: Let’s talk a little more about migrating motor complex, about constipation, peristalsis. I think of constipation early on as kind of the enemy of detoxification. It's really difficult to move things forward, and particularly where some binders can be more constipating. I mean, really, to me is kind of a primary thing to address. So how do you support your patients that are dealing with constipation?

[00:20:29] DR. JOE: Okay. Well, will stop me if you've heard me say probiotics before diet. A lower fiber diet is really critical. And it's counterintuitive to a lot of patients who have been told by their GI doctor, “Just take a bunch of fiber. Or take some psyllium.” And the crude analogy is a highway that's backed up with a traffic jam. And you're just putting more cars on the highway with more fiber. A lower fiber diet can be awesome. Probiotics, fantastic. Elemental diet is amazing. Love elemental diet for constipation. Magnesium, to a lesser extent. I'm not as in love with it. I think some integrative doctors are. Laxatives, I mean, they work. And so, I think they're pretty important to keep on the table.

[00:21:17] SCOTT: So, let's talk then about the elemental diet a little more. Maybe even fasting in cases of SIBO or other GI dis-regulations. Do you think that these obviously elemental diet sounds like you're seeing good results with that? But how important do you think those are in SIBO?

[00:21:35] DR. JOE: Extremely important and underused. This is a game changer in a lot of patients. And I think that when elemental diets first came on the scene, they tasted awful. They're just terrible. And so, I think a lot of the GI doctors who may have tried them just shied away, and then ignored it for a while. But happily, now we've learned that semi-elemental diets are just as effective as elemental diets.

Let me back up a step. An elemental diet is like how – Think of like a protein shake, nutritional shake. It's a powdered mix that you'll mix in water. And all the proteins, fats, carbohydrates are broken down into small components, right? Small sugars, small amino acids, right? And so, that means that they're absorbed very quickly in the small intestine.

Within the first, I believe, two feet, you're really getting almost all of the absorption of all the nutrients you need. So, you get the calories, protein that you're going to need so you don't crash like some patients do with a fast, particularly our toxic patients. If we fast them, they're just going to go downhill. This is a really nice way to get nutrition in. And then rest 90% of the gut. Because so many of our gut patients will say, “Man, if I just don't eat, I feel better. I'm not bloated. And I can start thinking again. And my joint pain goes down,” right? They're giving their gut a rest.

The analogy we use, if you sprained your ankle, the treatment wouldn't be to run three times a day. It would be put your ankle up and rest, right? When patient has an inflamed gut, and SIBO, dysbiosis, SIFO, you got to give it a break. And so, elemental diet is a really nice tool to give the guy a break, give nutrients that can let it heal.

And I mean, clinically, it's unequivocal that it works. I mean, we see even extremely severe cases of SIBO can be taken care of within two weeks of elemental dieting. Just gone. Just clears the breath test. And this is not just us. This is in the literature. And we see it often. We tend to use it more sporadically these days. 14 days is a long time to use elemental diet. We tend to have patients do it for a burst, like two or three-day. We call it a reset. And we find that extremely helpful. And then we can just jump into the other therapies that we love to use. So, elemental diet, we love for SIBO. It's fantastic.

[00:24:01] SCOTT: You mentioned that low FODMAP was probably your favorite diet in terms of the clinical response. I'm wondering what your thoughts are around the Carnivore diet. Many people that I've talked to do find that helpful. And I'm interested if you think that that is a diet that has been helpful for your patients.

[00:24:17] DR. JOE: It has not. It has not. It's too restrictive. And today, we're seeing more and more patients come into our office with really unhealthy attitudes and thoughts about food. We're seeing a lot of orthorexia. We're seeing more eating disorders. And this is because of bad advice. And people are being harmed, and we're seeing more and more patients come in on for foods, and then it's a track to get them back to expand their diet to a normal place.

My feeling on the Carnivore diet, have I seen it clinically helpful a couple times? Yes. But the key here is that's a zero-fiber diet basically. You can achieve that with an Elemental diet. You can achieve that with a low FODMAP diet and maybe some intermittent fasting. There are ways that you can get around the need for fiber, that reactivity, without limiting your diet so severely. I don't like it because I see people harmed by it. And I think that the reason why it's working two things, right? Low fiber, and most people aren't getting enough protein to meet their metabolic needs, particularly chronic disease patients. Their immune systems are demanding so much protein, and they're not giving it to them. And so, they're getting a lot of fatigue as a result. They're not healing their gut as a result. And so, some people just feel great eating more protein. But you don't need to go carnivore to do that, right. So, I'm not a fan of the Carnivore diet.

[00:25:52] SCOTT: I love this conversation. I think you're a very deep-thinking disrupter. Meaning, putting some ideas out there that are maybe different from what many of us commonly hear. And so, I'm loving your perspectives on these things.

I want to hear a little bit about what are some of the foods that you commonly feel people need to remove from their diet to support their gut health? Do you find food sensitivity testing helpful? Or when you see a test that comes back that has lots of different food sensitivities, is that an issue with the foods? Or is that more likely a fungal overgrowth? Or a parasite issue? Or some dysbiosis? Or inflammation? Or leaky gut? What are those tests tell you if you even feel they're helpful?

[00:26:35] DR. JOE: Right. I don't use food sensitivity testing. They're just too inaccurate. And I think they're not reflecting what people think they are. When someone comes into my clinic and they have nausea and bloating, and they're having four loose stools a day, I know they have leaky gut. And if I do a food sensitivity panel, it's going to light up like a Christmas tree.

If I give them the right diet, and probiotics, and maybe our gut rebuild nutrients, and I test them again in a month, the food sensitivity test is going to be normal. So why would I do that test? Particularly because patients do that test. And then they remove foods from their diet for years or decades. I mean, I've seen patients who have said things like, “Oh, well, I really haven't eaten any tuna because I saw that on my food sensitivity list five years ago.” “Does tuna make you feel bad when you eat it?” “Oh, no, no, I feel fine. And I really liked it.” I think it's harmful, and it gives an inaccurate view of the patient.

Let's see, I suspect that if you were to take two or three of these samples on different days, you'd get very different results, right? And so, clinically, I don't use them. I don't like them because it makes people fearful of food. And it leads them to think that if they just restrict the tomatoes, and the kiwis, and wheats, that they'll be better. It's not that simple, unfortunately.

[00:28:18] SCOTT: Yeah. I would probably even put out that the more we then focus on those items that we see in those types of tests, the more we train the limbic system to become more reactive to things and increase our hyper vigilance.

[00:28:36] DR. JOE: I agree completely. That's gold right there. It's so true. My buddy Gavin Guard has a saying, “You don't want to major in the minors.” And food sensitivity testing is just a small potato deal. It doesn't give you that much insight. It makes your patient waste a couple 100 bucks. It gives them a bad idea in their head that they have to be restricting of foods that they don't need to be, right? They just do the gut. We see people reintroducing foods all the time without much trouble, right? And so, you don't want to major in something that doesn't make a big difference in your patients.

[00:29:10] SCOTT: I know that you work a lot with people with Lyme and coinfections as well. In the SIBO conversation, I've always been interested in the fact that Rifaximin, which is related to rifampin, which is commonly used for the treatment of Bartonella, that that's so helpful for many people with SIBO. And so, I'm wondering, do you think maybe there's a connection between Bartonella or other vector borne infections in some of these SIBO and other GI conditions?

[00:29:36] DR. JOE: Well, the truth is, I don't have an expertise in Lyme and coinfections. I have a lot of thoughts here. But I cut my teeth here in Louisiana. We just don't have very many ticks. We got mold, but we don't have very many ticks, right?

So, let me not get too far ahead and make comments on things I'm not as experienced. My clinical experience is that patients come in with a variety of expensive, positive Lyme and coinfection tests. But most of them really have mold as the underlying driver of why their immune systems cannot clear these chronic infections. That's my bias. And that's my suspicion. I don't see enough of these patients to be very confident about that. And I'm sure there are patients who need to have these infections cleared to get better. But I can just talk about the people I see. And the people I see are being disrupted by mold, which is really lowering their immune systems ability to clear chronic infections. When we deal with the mold, these things are not a problem anymore. They get better, and they don't have symptoms. And so, if they don't have symptoms, I just don't think that there are problems.

[00:30:48] SCOTT: Yeah. I mean, I definitely would agree. I mean, in my own experience with Lyme and coinfections, having figured that out a couple of years before figuring out the mold piece, I definitely think the mold piece was bigger in my own journey. And some people seem to not then need to treat Lyme and coinfections. I think there are still some people that do. But I would agree with your comment that that immune dysregulation that comes from the water damage building exposure then leads to a lot of these other pathogens becoming more pathogenic when many people have them and don't have any symptoms at all. Yeah, that's a very great perspective.

How does gut health impact skin health? If we look at acne, and psoriasis, and eczema, rosacea, all of those types of things, is it more gut inflammation? Or is it a microbial overgrowth in the gut? I know some people have resolution of their psoriasis by treating parasites, for example. Do you think that that plays a role? And how do you approach treatment when we're focused more on skin related conditions?

[00:31:49] DR. JOE: To me, when someone comes in with nodular acne, rosacea, those things are dysbiosis until proven otherwise. Because so many of them are better within a few months of fixing their gut problems. And if they have gut symptoms, right? If they have acne and bloating, then it's almost a sure thing, right? Take it to the bank. You fix the gut, they get better, right?

There is a very, very, very clear skin gut connection. Whether it's SIBO or dysbiosis, the fundamentals work the same. And so, absolutely, that happens all the time.

Actually, psoriasis. I remember early in my career, I used to run an internal medicine practice, and I had a gentleman with plaque psoriasis. And this guy had 80% of his skin was just covered in just horrible, itchy inflammatory, psoriatic plaques. I've treated him for SIBO. Got 50% better within a month, right? So, like, very, very quickly. Just treating the SIBO. Not doing anything for the psoriasis. It just faded. And I've seen that pattern a number of times, right? And so, without a doubt, in my mind, there's a very clear connection.

Now, is it that you fix the gut and the immune system then responds, which then means less inflammation in the skin? Is there another mechanism? Clinically, I just want my patients to feel better. And so, that is a fantastic way to do it.

Parasites. You can see, I have a Master's in Public Health and Tropical Medicine. Because in college and in medical school, I was kind of convinced parasites were going to be the reason why people were sick, and it just wasn't appreciated. I have worked abroad, Malaysia, in an infectious disease hospital. And it's almost never parasites in my opinion.

I did a lot of stool tests specifically. And then a lot albendazole, a lot of medications to try to clear parasites. And I just didn't see the kind of symptom resolution that I see when I work on the gut, when I work on mold, right? When I work on other issues. For me, it's usually not parasites. Unfortunately, I kind of wanted it to be early in my career. And that master's degree was expensive. But if you listen to your patients, they'll tell you what happens.

[00:34:19] SCOTT: Let's talk then about mold illness. And I think we both would agree that when we say mold illness, we're really talking about exposure to water damage buildings. That could be things even beyond mold. And mold is kind of a little more limited than all of the things we're potentially getting exposed to. And so, I'm interested in how you might start testing the person and the environment. Are you using urine mycotoxin testing for the person? Are you looking at the ERMI, HERTSMI-2, or EMMA? Or what tools are you finding more consistently helpful for you to kind of paint that clinical picture?

[00:34:55] DR. JOE: I rely on the RealTime Lab mycotoxin test as the primary tool. I think it’s the most accurate this time. It's not perfect. But I think it's the most accurate. And I find that symptoms tend to correspond the best when I see the mycotoxins going down. Almost all the time, 75% of time, I'm also seeing a corresponding drop in symptoms.

For me, that's the tightest connection I've seen for evaluating the body burden. It's not the end all be all. There's a lot of other pieces at play. That's for the body. For the home, man, this is so tricky. I rely on agar plate testing and plain old ERMI screening as how I recommend the most cost-effective way to check your environment. I don't have every patient test their environment. Some patients would be like, “I used to work in an office. And I was sick as hell when I was there. And then I moved and I was a little bit better. But I'm just not there yet.” And I can be pretty confident that we can treat them without obsessing about their home.

Other people will say things like, “I just am not sure about my home. But every single time I leave for vacation, I feel better.” And then as soon as I go back into my home, the joint pain and rashes begin again.” That's a case where I would say, “Look, you got to do some screening.”

Sometimes I will ask them to just hire or remediate right out of the gate. They're like, “Oh, there's mold under my sink. And when I go in the bathroom, it's here. And oh, yeah, that was that flood with the chimney,” right? It depends. But the ERMI is, I think, the most cost-effective based screening tool. It's about 250 bucks. You can buy it online. The plate tests, you can buy 10, I think, for 30 bucks. For under $300, you can get a pretty good idea. Am I looking at mold in my house? Or am I pretty confident it's not here and the exposure is somewhere else. I think that that's important, because that's 300 bucks, which is still a lot of money to some people. But the alternative is almost always $2,000 to $3,000 in air sampling, which are notoriously inaccurate.

I would much rather someone spend the $300. We get a basic idea of where a problem may be and then go from there rather than $2,000. And there is far too much testing done in functional medicine. And I think we have to be – This is one of the missions we have at my clinic at the Ruscio Institute. We have for physicians. And we just see patient after patient coming in having spent $10,000, $20,000, $30,000 in lab testing that may be unvalidated, right? Food allergy testing, adrenal testing, microbiome assays, and have gotten nowhere.

And so, I have this bias to doing as little testing as I can, unless I really think it's needed. I've seen so many people deplete all of their resources and then have nothing left to be able to actually treat them, right? And so, they don't have any money to buy the probiotics that would fix their SIBO. And you just see enough of those, and it makes you angry.

And so, I think that we as a field need to get much better at asking the question, “Is this test going to change what I do to the patient?” And if the answer is no, we can't order it, particularly if it's not validated, right? If we don't have any good way of saying, “I have this elevated marker. And this definitely tells me this.” If we're just guessing, we just got to be better about this. That’s my hobby horse for the field and something I'm hoping that we can all get better at.

[00:38:41] SCOTT: For the agar plate testing, are you using ImmunoLytics?

[00:38:45] DR. JOE: Mm-hmm. I am.

[00:38:46] SCOTT: Yes. Excellent. And then the only thing – And correct me if you have a different perspective. But for those people that are doing something like RealTime, maybe they did their first test. Maybe the second test is hugely higher than the first test. That's not always necessarily a bad thing, right? If there's symptomatic improvement, that could be an indication that they're now better able to start excreting some of these mycotoxins. And so, I think that your earlier comment was that we want to see them go down over time. But an early increase isn't necessarily something to get stressed about.

[00:39:19] DR. JOE: I agree completely. The first test in my mind is, is this a problem or not? Right? Do we have positive mycotoxins at very high levels? Or do we not? Okay, once you've gone from that and you've determined that mold is a problem, you want to make sure that you're moving the patient in the right direction. I'll typically repeat a test 3, 4, 5 months after treatment. But we're working through basics. We're adding binders. We're adding supportive treatments all along the way.

And yes, they're often feeling better, excreting more. And you see that second test go up, which is not a problem. What would be a problem is if you're not then seeing a drop. That makes me increasingly worried that they're still being exposed in their environment. And so, a lot of times, it's kind of that six-month mark where I have that second follow up. I'm really asking the question, “Susan, I'm really worried that we're not going to get you better if you're still being exposed to mold. We really have to just go back. And I know you've been remediated once. But the unfortunate truth is, I wonder if they missed something.” That's when we start really having to ask the hard questions.

Now, if they're getting better. Leave it alone, right? You don't need to obsess. If they're getting better, then you can just leave it alone. Because there's this idea that you need to be exposed to no mold to get better. And that's just false. It's just not true. Can you live in a horribly contaminated, old, sick building and get better? No. You can’t, right? Can you be exposed to some mold and get better? Absolutely. Will you need to go hang out with my friend, Ashok Gupta, to hang in there? Probably. But you can get better even with some old, right? And so, just important patients are working with, I think, someone who has some experience with the details here.

[00:41:16] SCOTT: In those patients where you do find an issue, do you find that the majority of people can remediate successfully enough to move the needle? Do you find that some people you just recommend they really need to move? And then building on that, where do you think things like air filters and fogging solutions fit into the conversation?

[00:41:34] DR. JOE: I can't give you hard and fast. Some people don't get better until they move. And it doesn't matter how much remediation they do. Their immune systems become so sensitized to an individual environment. Every single time they go in, within seconds, they get really sick. This happened to me in my medical office. I would walk into my office, it was a few years back, I became sick with mold. And within 30 seconds, panic, anxiety, joint pain, debilitating fatigue, horrible, right? Classic limbic response. My immune system had sensitized to that environment. And with a ton of work, I could make it through a clinic day there, but then collapse. There was no way that that was going to let me heal and get better. I had to close my physical office to get better. That's the case for some places.

For other patients, absolutely, remediation can work. And it doesn't have to be ripping up the whole house. It can be targeted work. Unfortunately, I see a lot of patients where remediation needs to happen two or three times because not enough was done. It’s a case by case basis.

In terms of other solutions, I don't like fogging. I've just seen too many patients who are already chemically sensitive be worse. And so, I don't like fogging. I do like the UV filters in AC units. That definitely reduces spore count significantly. I've seen that in a number of patients. I have one in my house. That helps quite a lot. But fogging. No. You have so many questions at once that I sometimes lose track of them. Did I get them all?

[00:43:16] SCOTT: I know that if Dr. Nathan's listening, he's going to laugh when you say that. Because that's what he always says too. I think you've got –

[00:43:22] DR. JOE: They’re all great questions.

[00:43:25] SCOTT: Air filtration is the other one. What do you find most helpful in that realm?

[00:43:29] DR. JOE: I think they help a little bit. Not a lot. And I think that if people are going to get an air filter, they can't expect it's going to be enough to completely help. But I have found that for people who, for whatever reason, can't get out of their home, getting a nice air filter in the bedroom. And really closing off that space and keeping that air is crisp and clean as you can. That can make a difference because it can improve the quality of sleep. And sleep is another hobbyhorse here. Because when you improve the quality of sleep, your healing goes up, your limbic system calms down, right? Everything gets easier. And if you're not protecting your sleep, that's really, really hard heal, right?

[00:44:11] SCOTT: Totally agree. We were in contact a couple of years ago when you were collaborating with Dr. Nathan, with Beth O'Hara, with Emily Givler on the precision mycotoxin detoxification concept. And so, I'm wondering when you then do the urine mycotoxin testing with real time labs, you have a sense for the mycotoxins that are affecting a specific patient, do you then use binders that research suggests might be helpful for that specific mycotoxin? Or do you have a different approach?

[00:44:41] DR. JOE: The project was a lot of fun. Yes. I actually learned a lot from that project. And that was been so much fun collaborating. I use a variety of binders. And the key point that I learned from diving into as many of those research studies that showed, if you take substance X, you can see this mold toxin drop. These are all animal studies, by the way. A lot of chickens studies, right? What can you feed chickens and see mold levels drop?

But the key here is that I think our understanding is really limited by the fact that most of these are animal studies, not human studies, that mold toxicity is not recognized by many physicians as a problem. And therefore, there's not a big research budget. The research dollars are coming in from agriculture, right? From the big farms that want to make money and keep their chickens and pigs healthy.

I use a variety of binders, because I think the truth is, is that binders often work on multiple toxins rather than we're saying charcoal works on trichothecenes and ochratoxin. I think charcoal works on a variety of things. The same thing with chlorella, clay, probiotics. This is something else I really learned.

Probiotics act as binders. And so, we've been taught classically that Saccharomyces boulardii will help bind gliotoxin, right? But in diving into the research, I learned that a variety of Lactobacillus species, not every Lactobacillus species, but about half of the ones you might see on a common blend of Lactobacillus will bind mold toxins. This is one of the reasons why I really, really advocate for aggressive probiotic treatment that the patient can tolerate early on, because I think we're binding toxins with probiotics.

Again, the three classes we use, Lactobacillus can bind mold toxins, right? Saccharomyces can bind mold toxins. Bacillus – So, I just found a study. Bacillus will make an enzyme that can degrade aflatoxin. This is almost certainly the tip of the iceberg, whether we're talking about probiotics or chlorella, they almost certainly do more things in bind more than we're aware of.

And back at the beginning of this interview, you discussed about how mold may be the tip of the iceberg of the things we're exposed to, right? I think that we are being exposed to a variety of plastics, and poison, and food dyes, and all sorts of environmental garbage that we don't have a good handle on, because we don't have testing for, right? But it's very likely that when you give binders, particularly comprehensive binders, multiple, that you're clearing toxic load throughout the body, which makes healing easier, which all of a sudden, eases those pathways that Beth, and Emily, and you and I discussed and thought about, right?

If you can lighten the load on those glucuronidation pathways, right? By pulling other toxins out, maybe the body can just work on the mold better. Very likely, it's almost certainly a lot more complex than we've portrayed out to be. But the clinical, if we always go back to what makes the patient better, in my experience, a variety of binders. It helps patients get better quicker. That's what I tend to do.

[00:48:05] SCOTT: I know some people would suggest that there's utility in the bovine immunoglobulin-based products for binding some of these mold toxins as well, is that something that you've had any experience with?

[00:48:15] DR. JOE: I don't believe they bind mold toxins. I think there's some misunderstanding of how those immunoglobulins work. Those immunoglobulins are generally made to specifically target bacterial species. I don't believe that they are specific to mold toxins. I think they're very keyed in to specific bacterial problems. And it's a great treatment for dysbiosis. And we do use that in the clinic. But I don't think it works for mold. It's my understanding.

[00:48:53] SCOTT: I've been of the opinion for a long time that detoxification and drainage really are the critical things to improve health. Coming back to the comments about environmental toxicants and all of the things, the chemicals, the pesticides, the plastics, all of those. And that we not only need binders, but we also need things to support the liver, the kidneys, the lymphatics, the extracellular matrix, the gut, the lungs, the skin, all of those, emunctories, or drainage pathways, or channels of elimination. I'm wondering, where do you see drainage fitting into the conversation? And what are some of your favorite tools in that realm?

[00:49:29] DR. JOE: You know, Scott, I love your podcast. And I respect the hell out of you. And so, when you say something like that, I believe it. This may be a blind spot for me. I don't use the Pekana drainage, or homeopathic, or lymphatic drainage. This is not something that I've ever had much experience with. And so, I'm going to give an honest answer. I don't know where they fit in. And I potentially could be missing a tool for my patients.

From my perspective, I don't know how important that is. But when I'm thinking of my sickest mold patient, there're just so many things that they need to do that I'm sometimes hesitant if I'm not sure about a tool about asking them to do it. Because if those patients need to be on probiotics, and be doing limbic retraining, right, and be taking mast cell support so that they can take their binders so that they can then take antifungals, that is so much, right? And having to do this myself, I'm just hesitant to ask people to do more than I think is absolutely necessary. And so, I could be missing the boat on that. That’s my answer.

[00:50:36] SCOTT: No. Fair. I love the conversation. That's great. Let's talk about the potential for fungal colonization in your mold-exposed patients. I'm interested in how commonly do you see that. I know lots of practitioners use binders and people get better. I know Dr. Nathan, in part because of the people that are attracted to his work, and they've probably tried lots of other things. The colonization piece is fairly common. Do you find that most of the time or much of the time you need to address gut and sinus fungal overgrowth or colonization? And if so, what are some of your favorite strategies for doing that? And how long might that process take?

[00:51:18] DR. JOE: The key here is that I think different doctors attract and see different patients. And so, when you hear a physician saying – You have to think about who is the type of patient they're seeing. I tend to see a lot of the patients that Neil sees. Those who come find me. And so, from my perspective, those patients need antifungal treatments to get better.

And what kind of antifungal treatment? That's a different question, right? Sometimes it's colloidal silver, Xlear nose spray and herbal antimicrobials. That does the trick sometimes, right? And if you can use oregano and get it done, great. It's awesome, right? It's easier for the patient. They don't need to go to their PCP and ask for a script. And that works. The patients I see generally need that. They generally have colonization. They're sicker. And they need the antifungals to feel better.

There are patients – And I love it. It just makes my day when I see a patient come in, and I do the basics, and I throw some binders at them. And they're like, “Oh, I'm better, doc.” And it's fantastic. I feel like I went to the candy store or something. It's just so much fun. That's my perspective. I think the sickest patients need the antifungal treatment. Yeah, give me the other question I didn't answer.

[00:52:35] SCOTT: Yeah. How long of a fungal colonization focus might you have in a treatment protocol?

[00:52:41] DR. JOE: Six months to two years. Kind of patients who need it, they're really sick, they're really vulnerable. They have lots of secondary issues caused by the mold. We go really, really, really slow.

[00:52:54] SCOTT: Let's talk then a little bit about, and we had some recent conversation on this as well, the idea that if the person is still exposed to their water-damaged building, is there a value in starting treatment for fungal colonization? And if that treatment ends before they have corrected their water damage building, how likely is it that they will become recolonized?

[00:53:21] DR. JOE: Some practitioners, I think, don't treat patients if they're still being exposed? I can't. I think that's not – I don't think that's the right call. I think we meet patients where they are and we do anything we can to help someone suffering. I absolutely treat patients even if they are still exposed, and they can't move, I will do my very best to help.

The truth is, is that if someone's truly mold toxic and living in a moldy environment, I can get them – There's kind of a ceiling on how much I can get them better. It's usually 20%. And then after they get that 20% improvement, they flounder, up and down, right?

And as long as we're honest, and I say, “Hey, look, I can get you a little bit better. It's going to take a lot of work on your end. But if you just can't or not willing to move, that's what we can do.”

[00:54:10] SCOTT: Yeah, if they're still in that environment that has some mold overgrowth, and they stopped the antifungal treatment, because they've gotten a little bit better. It's kind of beyond what you had planned. How likely is it then that they're going to become recolonized?

[00:54:25] DR. JOE: Yeah. This is was pretty well-described in some of Brewer’s papers, where he was giving antifungal intranasal treatments. The patients who stopped the treatments got worse, and their mycotoxins came back. And that that is I think the unfortunate reality of mold colonization, is if these guys hide behind biofilms. That they're very persistent. That they're deep and hard to treat. And we clinicians need to think of them not like strep throat where you give two days of antibiotics, of penicillin instead, right? It's more like tuberculosis, right? Where the standard of care would be a minimum of six months of antibiotics, right? Like, Mycoplasma. Right? Mycoplasma. These are these are chronic infections that you ask any infectious disease doctor, and they're saying, “Yeah, they may be on antibiotics for five years.” That is more of the perspective that I think is unfortunate. It's hard to swallow. It sucks.

I've been on Ampho B and Itraconazole, and I really wish I was not still on that. But I think the truth is, is that patients need these to feel better. They feel better when they're on the medications, and they have the potential to clear all the way on medication. Sometimes it takes six months. Sometimes it takes two years. I've definitely seen patients who get off the medications too early and relapse. And it's unfortunate. This is why I generally follow Neil's advice to treat for three months after you see a negative mycotoxin test. But people are people. And they're going to be re exposed. And so, sometimes we just need to treat again. Just like SIBO can come back, right? Sometimes you got to treat it again.

[00:56:15] SCOTT: The benefit that you get from probiotics has been very clear in our conversation. Those certainly can help with fungal colonization as well. I want to talk a little bit about the sinuses. So, Dr. Dietrich Klinghardt was the first person to turn me on many years ago to the idea of using nasal probiotics. I know some people are using things like megaspore nasally. There's another company out there that makes a spray with all the bacillus products. There's Lactobacillus sakei with the Lanto Health and the Sure Sinus, and a lot of these things that are kind of emerging. I'm wondering, do you use probiotics to work on the sinew biome? And if so, what are you using? What are some of your favorite sinus hygiene strategies?

[00:57:00] DR. JOE: Yeah, this is such a cool idea, because the same way that I see probiotics helping accelerate mold, that's what I expect to happen with nasal probiotics. I've got about a half dozen patients who I'm using Lactobacillus sakei, because that is – After reviewing the medical literature, that's the strain that has the most clinical outcome data. It’s got the most studies, right? So, that's the one I'm using. And it's inexpensive, and you're just swabbing a small amount in the sinuses. So, I have – The last patient I put on came in with an MRI, and her sinuses, it was just a nightmare of inflammation and swelling, right? And so, she got Lactobacillus sakei right out of the gate, right? Because that's a huge obvious problem. She's got tons of sinus headaches, and drainage, and pain. And so, it was a mess. I definitely use it.

But the truth is, is that I don't know – I haven't had enough of those patients come back yet to say it helped or it didn't help, right? And so, I'm still waiting. If you're one of my patients, and I've given you nasal probiotics, please tell me how they worked for you. My suspicion is that they're going to be extremely effective. And I'm very excited about it. It's extremely safe. There really can be no harm. It's very easy to do. And I suspect that what it's going to do is when you do things like Argentyn 23, or Xlear or Amphotericin B intranasally, that it's going to help those things work better. It's like we see in the gut. And that's going to help push them out and keep them gone.

I'm very enthusiastic. The jury is still out. One of the things we clinicians need to do is really not just be excited about the potential, but then really analyze it in our patients. And so, that, I'm still not sure. Because there's been a lot of treatments that I was so enthusiastic about. But when the rubber hit the road, it just didn't help, right? And so, I'm just always very careful that we don't want to placebo a patient. We want to give it a chance to try, right? But we got to be as discerning as we can if it's helping or not helping.

[00:59:12] SCOTT: I'm definitely excited about these products as well. Unfortunately, there aren't a lot of them out there yet. I wish more companies would start putting out nasal focus probiotics. I think that's probably what will eventually happen. But there's very few of them so far. But I definitely agree. I think it's going to be really interesting.

Years ago, before there were Lactobacillus sakei products available, that was when we were doing the nasal swabs with kimchi juice. And I got a little aggressive, put it into a nasal spray, and burned for about four days after I – Yeah, that was my first. That was probably 10 years ago. But that was not a fun experience.

[00:59:50] DR. JOE: Intranasal kimchi.

[00:59:52] SCOTT: Yeah, exactly. Let's talk a little more about the mast cell activation syndrome and that whole arena. What do you think in your patience is the kind of the underlying root causes of mast cell activation and some of the things that you're seeing work the best for that patient population?

[01:00:11] DR. JOE: It's mold, until proven otherwise, as the physical cause. And I think that your listeners probably understand the variety of substances that we can use to block the mast cell. So, we probably don't need to get into the Allegra, Pepcid, and quercetin, and AllQlear. There's about a dozen substances that we use clinically.

But I think that the key to me is really understanding how tightly interwoven the limbic system and the mast cell is. And I've seen a number of cases now where patients doing Ashok Gupta’s program, their mast cell reactivity just went away.

And here is why, right? The limbic system is the system that is constantly scanning the environment, “Am I safe? Am I safe? Am I safe?” And mold is so horribly poisonous that it's like a three-alarm fire. All of the sirens are blaring. The National Guard is out. We've got machine guns everywhere. The body feels very defensive. Feels very threatened.

And so, then the limbic system will send us a signal to the immune system to be on guard. And the mast cell is one of the main guardian cells, right? It lines the stomach, the esophagus, the small intestines, the mouth, and it's ready to explode at a moment's notice, right? These are the patients who are thinking that they are histamine intolerant, or oxalate sensitive, or sensitive to salicylates, or they have a problem with X food.

But the real underlying key is that they're poisoned by mold. Their limbic system is telling the mast cell, “You're unsafe.” And they're constantly then reacting to their environment because the body has mistakenly tried to protect them. This to me is one of the more exciting things that I've learned in the last year, is that mast cell – Physical reactivity of a mast cell can be fixed by meditation and cognitive behavioral work and the seven-step retraining program that Ashok teaches. That, to me, is so exciting. It's so interesting. And I think there's going to be a lot more advances in this area, in functional integrative medicine, over the next decade.

[01:02:36] SCOTT: Yeah, I totally agree. I personally did the DNRS system for about seven months in 2018. And I think that was before I really knew about Ashok Gupta’s work. I think his program is amazing as well. Unfortunately, I find there's a lot of resistance to these programs. Like people have that PTSD response back to when all the other doctors said, “Your illness is all in your head.” And then they kind of get the limbic system piece a little bit confused with the mental emotional realm and all of that.

For my observation, very similar to yours, I think it's been absolutely incredible for many people that are willing to explore it. But I don't find lots of people that are willing to do the work. And it does take some time. Building on the gut conversation, the mast cell conversation, I'm interested in whether or not you suggest using fermented foods. If there may be triggering for those with mast cell activation? And are they enough to move the needle in the positive direction?

[01:03:37] DR. JOE: Let me go back to the resistance to DNRS, or the Gupta program. Because I think this is really important. And if people are resistant to this, they really need to ask themselves why. And doing this myself has been one of the more beneficial tools of all of the things I've tried. And Ashok and I had a conversation, an interview that's on his website. And I would ask people to maybe listen to that. Because I talk about my experience and my experience with my patients getting better. And so, that may be one helpful piece for people. They need to know why they're doing it and if it's going to work. And I think if you can meet those two criteria, then a lot of that resistance goes away. Because people just want to stop suffering.

And so, they need to know that this is a tool that works. It's reproducible. It doesn't work just for me, right? It's worked for Michael Ruscio at our clinic. It's worked with Dr. Scott's patients. It's worked with Dr. Hanna's patients. All of us at the Ruscio Institute, we use this all the time with our patients. And it helps a lot. So, it's not made up. It's not just in your head. It's not just meditation. It's not just – You can't just be calm and not have your limbic system activate. You need to go deeper than that. You need to retrain that reactivity. And that's the same whether it's Annie Hopper’s program, which is excellent, or Ashok’s program.

And so, I would just encourage people to give it another chance. And do the free trial. Man, I'm selling his program. But there's a free trial. It just helps so many patients. And in today's world of fear and trauma, it's more needed than ever. The plug is over.

[01:05:21] SCOTT: And I’ll link that. I saw that interview that you guys did. And I'll link that in the show notes for people as well.

[01:05:27] DR. JOE: Yeah, thank you.

[01:05:28] DR. JOE: So, fermented foods.

[01:05:29] DR. JOE: Fermented foods, okay. Don't take it intranasally. I think it's the key here. The patients I see – This doesn't make a difference. I think it's healthy to do. I think if you're healthy and you're just looking to optimize your diet, then it can be helpful. But I've never seen someone with IBS eat enough kimchi, or sauerkraut, or yogurt and be better. I just don't see it enough. The dose isn't high enough.

[01:05:58] SCOTT: In the water damage building conversation, I think we're hearing more about Actinomycetes, this bacteria that may even play a bigger role than mold in some people's experience. I'm wondering if you look for Actinos? If you have people test them in their environment? How does it change your treatment approach? And do we know if those bacteria can also colonize or affect the body similar to fungal colonization?

[01:06:27] DR. JOE: I don't know. And I think the people saying that it's absolutely certain that we need to test and treat this also don't know. This is one of those things that I think you need to – It's an exciting idea. I think the assumption is, is that when someone's being exposed to mold, they're exposed to thousands of awful toxins, volatile organic compounds, pathogens. There's just a horrible toxic soup of things they’re exposed to. Actinomycetes is one of them. I don't know that we treat it any different. And that's not something I look for.

Again, we have to focus our patients on the things that are going to what we think we'll get them better. And I give an analogy with patients. We're trying to get from – I use stupid analogies. We’re going to get from point A to point B. And there's a path, right? And there's a bunch of pebbles on the ground. And there's a bunch of medium-sized trees that have fallen over. And there's huge boulders blocking away. But we can't go around like picking up pebbles and expect to get better. We just don't go anywhere.

We say okay “Look, your gut is a mess. We are going to work on moving this boulder.” “Oh, okay, we're better.” “Okay, we got to get this boulder on. And now we move the tree. We've got you on binders. Okay, there's another tree there. We're going to work on the MCAS. And okay, now we're here.” But I think that sometimes these ideas just get to – They're made more important than they are ahead of time. And so, follow the things that make people better, and you can avoid those traps, I think.

[01:07:56] SCOTT: No. And I like the analogy, because I think a lot of times people feel like they have to find all the pebbles as well. But once the boulders have been lifted and the body can find its balance again, honestly, the body's going to be the best healing tool that we will ever have, right? So, thank goodness. I think that's a very empowering perspective that we don't need to deal with all of the pebbles. Let's get the big things out of the way. And the body can deal with those things.

Ehlers-Danlos Syndrome, hypermobility syndromes these seem to be in the last few years emerging a lot more in conversations that I'm having with people seem to be a factor in many people with complex chronic conditions. I'm wondering, do you work with EDS and hypermobility syndromes? What do you think of as some of the root causes that negatively impact structural integrity? And then how do you deal with those conditions?

[01:08:48] DR. JOE: Yeah, this is boulder, right? This is this is something that if you miss, your patient is going to struggle. EDS is, I think, much more prevalent than I was ever taught in medical school, and especially in the people who are listening to this podcast who have been struggling with chronic illnesses. The chance that there's hEDS present goes way up.

Yes, I work with this. Yes, we screen our patients for this. And there are tools that can help, big time. Maybe one step backwards, hEDS is a tendency for connective tissue to simply be slightly weaker, more stretchy than a normal person's connective tissue. Connective tissue, like many things in the body is a spectrum, right? Your Drew Brees and your NFL players, they're going to have connective tissue that's like steel, right?

And then there's kind of a normal person and there's someone who might have hEDS, right? They’re double jointed. They can maybe rock their leg around their head. They tend to really enjoy Pilates, and yoga, and gymnastics, because they're more flexible. But over time, that tendency towards weaker connective tissue causes a lot of structural problems. The gut sags, right? Because the connectivity doesn't hold it up and it can pull on the vagus nerve, right? It can cause a lot of secondary hormonal problems. So, you see these patients have a lot of menstrual problems, unfortunately. You see a lot of joint pain, right? Their elbows are – You see my elbow kind of points slightly up to the ceiling. And these patients, the elbow goes down to the floor slightly, maybe just 10 degrees. If you have a patient whose elbow is pointing down, that's a big warning flag, right? And how do we fix it?

You can't give them different genetics to have stronger connective tissue. So, you need to work with the body as it is. One of the keys is keeping lots of muscle on your frame throughout your life to counteract the fact that your connective tissue is weaker. Can't make your connective tissue stronger. But you can build more muscle. That will help the joint health. That will help your bowel function if your lower back is strong, right? The deep muscles of the lower back will still trigger motility in the gut that can physically compress in the bowels, right? You can work with the body physically. You can wear compression hose to make sure that the blood vessels that have weaker connective tissue surrounding them. You can wear compression hose to the blood still gets to your head, so you don't get POTS, right? A lot of POTS patients simply have hEDS. There are lots of tools that we can use for this.

And so, this is why. This is one of the areas I'm thinking about more and more with my patients. I think of the of the four new patients I saw this week, three had hEDS, right? It's a big issue in chronic disease. And so, there's lots of tools we can use to help make these patients feel better so they can do the other things to get better.

The most miraculous thing I've ever seen in medicine is Frequency-Specific Microcurrent on hEDS patients. I've done it when I had a physical office. I did it in three patients. And every single one of those patients profoundly made better. In one case, the elbow literally went from hyper mobile to normal after an hour treatment. And you see improvements throughout the body that the microcurrent can heal, strengthen, temporarily repair. I don't know what it's doing, other than it seems to physically strengthen the connective tissue for a short period of time, about five days, right? And so, for patients who have hEDs, I would just highly recommend you look for a frequency-specific microcurrent FSM. I think you've had Carol. Have you had Dr –

[01:12:38] SCOTT: I have. Yeah. And I think we touched on that in that conversation as well. Yeah, I think – Gosh, one of the early ones. It's been a few years ago. But it’s still out there.

[01:12:46] DR. JOE: Okay. Yeah, she's kind of the goddess of this treatment. And amazing healer. And so, that's an amazing tool. And one of my dreams is to be able to do a clinical trial for that, because I've seen very few things in medicines that are that physically dramatic. And quite frankly, if I didn't see it with my, I would have thought it was made up.

[01:13:08] SCOTT: And I love that you're relaying that, because I've heard it as well and thought of it as a tool that could be helpful. But for you to relay what you yourself have seen, I think that is really helpful. And the nice thing is – And that was my understanding as well. That it didn't work permanently. But then people can get the FSM devices and do it at home themselves on a regular basis to get longer term support. So, definitely one of my top tools as well. I have a home unit that I've used for several years and think it is a fantastic option.

[01:13:39] DR. JOE: Yeah, it really is. I wish there was a way I could make these a bit more affordable and easier to access for patients, because I do think they can be a game changer when used the right way.

[01:13:50] SCOTT: Let's talk about the thyroid, the adrenals. A lot of people now are kind of suggesting that the mitochondria maybe is even more important in this conversation. So, I'm wondering, how important is thyroid adrenal support? How does it overlap with mitochondrial dysfunction? And what role does mitochondrial dysfunction play in your patients? What are some of the things that you're thinking about besides FSM, which can be great? But some of the things to support the power houses of ourselves?

[01:14:20] DR. JOE: These are the topics that I feel are going to get kicked out of the functional medicine club. I find that the thyroid is way overblown as a cause. I do not find thyroid support to be significant for the vast majority of my patients. I find it over-diagnosed. And I find a lot of people are harmed by chasing hormone ratios, trying to get more T3 in our system. And I think this really a big miss in our field.

I think this is one of the areas where conventional medicine gets it right. If your TSH is between eight and 10, we really need to think about hypothyroidism. I think that if your TSH is not above eight, then you need to really think hard about do you need a thyroid hormone. And when you take it, does it help you very clearly? And when you stop it, do you feel different? My bias is seeing a lot of patients come into my office, and they're coming in, and they were told by a practitioner that they’re hypothyroid, because their TSH was 2.5. It was not below 2.0. And they've been on Armour Thyroid for years.

The problem here is that they were placebos into an effect that they think it's making them better. And they think that if they can get the T3 to a certain place, that everything will snap into place. But they're still sick. And they also have anxiety, palpitations, and insomnia, and fatigue. And when it stopped their Armour Thyroid, that stuff all goes away. There are a lot of patients that are being inappropriately given thyroid hormone that don't need it and are being harmed by it.

And here's the kicker. This goes fairly deep. Michael Ruscio and I, we’re going back and forth this morning. We found a study that showed a relative risk increase for stroke in patients on Armour Thyroid. So, a T4, T3 ratio, right? Relative risk of 1.6. The relative risk of stroke in smokers is 2.0. I think we need to be careful. That's one study. Am I saying that every single patient on Armour Thyroid, it's in their head? No. Am I saying that more patients are being inappropriately treated with thyroid every day now more than a year ago? Yes, it's getting worse. And it's one of those pebbles that is distracting people. And instead of fixing their gut and dealing with environmental toxins and finding their sleep apnea, right? Dealing with their stress, all the things that they need to do to feel better, they're chasing ratios in their thyroid hormone and getting nowhere. This is this is an area I think we really need to do better on. We really need to ask ourselves some tough questions about whether that's a good therapy or not.

[01:17:08] SCOTT: And so, before we jump in then to adrenals and mitochondria, I agree with a lot of what you just said. I'm actually reading a book right now called The Thyroid Debacle by Dr. Eric Balcavage and Dr. Kelly Halderman. And I've had Dr. Kelly on the show before. She's incredible as well. And their premise for this book is that you need to think about the thyroid in the context of cell danger response. And if the body has some reason that it's going into a protective state, a hypometabolic state, putting the brakes on intentionally as an intelligent adaptation, and then we're putting thyroid hormone into the system, kind of pressing the gas pedal at the same time that the body is trying to put on the brakes, that that's not always going to be a good thing. And so, I think that's exactly what you were saying as well.

[01:17:55] DR. JOE: I agree with that, right? People are chasing, “Okay, why is this?” this T3 ratio and reverse T3. Okay, the reverse T3 three is high. The body is inflamed, and it's not producing a lot of thyroid hormone, right? It's doing that for reason. And to simply dump more thyroid hormone when the body is very clearly saying, “Please, let's not make more thyroid hormone right now, because we need to do other things,” I think is a recipe for disaster, particularly if people are being falsely diagnosed with hypothyroid based on made up lab values, right?

There is there is no consensus that once you get a TSH to what functional medicine often teaches is optimal, that there's really no consensus or outcome data showing that helps. And I think that's just really important that this is an opinion that's kind of taken over. And there are other opinions that I think have much more validation. And those opinions are what I see manifest in my patients, that more thyroid hormone is not the problem.

And here's one big piece. And this is maybe some context that might help. Early on in my career, I did IFM, Institute of Functional medicine training. And this is one of the big pieces that they recommended through their work, right? Optimize the thyroid ratio. Make sure you're not missing a T3 deficiency. And really go hard on an optimizing thyroid, your patients will get better.

I tried that for years. It didn't work. I was like, “Well, I must be really stupid here,” because I'm playing with all of these nutrients, CoQ10, and selenium, and iodine. And I'm really trying to optimize a ratio. And I've got them on this elimination diet. And I'm giving them all this stuff, right? And then I'm prescribing hormones, and they're still not better. What am I missing? Right?

I did this for a little while. And one patient, Kathy, came into the office. And she was such a sport, because I kind of started seeing her right after I'd done the IFM training. I did all kinds of conventional stuff. And for like a year and a half, we're just getting nowhere. She still feels like crap. She's fatigued. Her joints hurt. Her TSH and or ratios were abnormal. Trying Armour Thyroid. I'm giving T3. I'm doing all this stuff that I was taught to do. And she didn't get better.

Came across Michael Ruscio’s work, saying, “Hey, there's this gut-thyroid connection.” I put her on triple probiotics. I relaxed all the dietary restrictions that we had done. And then I treated her with herbal anti microbials. And her TPO, the thyroid peroxidase antibody, the main marker of Hashimoto’s, went from like 500, to 250, to 125 to normal. And this was after tracking this month by month, after all the thyroid dose adjustments, and all the diet and elimination, and everything else I could think of doing. The only thing that finally got her TPO normal and her to feel that, I was fixing gut.

When I see people coming in with thyroid medicine and they've got unresolved GI symptoms, in my mind, the best way to fix their thyroid is to lighten the inflammatory load by fixing the gut. You're going to fix the gut anyways, the thyroid function will improve. And we see this again and again in our patients who come in on maybe a small dose, let's say Armour Thyroid 630, NP thyroid. They’re on a little support from an integrative doctor.

Three to six months later, when we get their inflammatory bowel disease calm down, when we get their IBS or SIBO symptoms down, all of a sudden, they're not sleeping and they're getting palpitations, right? They don't need the medicine. Their guts better. Their inflammation is lower, right? I think that this is a distraction. And I think it's potentially really harmful for patients. So, that’s kind of our approach.

[01:21:40] SCOTT: How about adrenal exhaustion? Is that a distraction or is that a boulder?

[01:21:46] DR. JOE: Distraction.

[01:21:48] SCOTT: Okay. Yeah. All right. So then, it is your thought that rather than focusing on thyroid and adrenals, that we’re better to focus on mitochondrial support? How are you helping the patients to create more ATP?

[01:22:07] DR. JOE: I think anyone who tells you they can analyze how the mitochondria is behaving and how it improves is telling you a story. I think that the primary way we should be seeing as my patient’s fatigue better is simply asking them about their energy, their fatigue. If that improves, the body's better. It doesn't matter if this is inflammatory difference, if this is the ATP functioning better, or the mitochondria. Just kind of track their fatigue, right?

I would suggest we put the whole adrenal fatigue or adrenal exhaustion thing away, because I think it leads to too many dead ends. It's not that ashwagandha doesn't work great in some patients, because it does, right? It's not that we can't support the adrenal glands. But I just don't think measuring salivary cortisol four times a day repeatedly leads anywhere. In fact, it usually leads people to kind of focus on the things that are not boulders, right? “Only if we get a little a little more Rhodiola here. Maybe hydrocortisone here.” I think that's just we're not looking for fixing the gut. We're not fixing the diet. We're not fixing the sleep. We're not looking for toxins. And anytime you're not doing those poor things, you're leading your patients slightly off. So, that’s my perspective on it. And that's what we do in our clinic, is just try again, and again. Focus on the fundamentals, the big boulders. And then if there's still symptoms, then you can say, “What am I missing?” But when we think about mitochondrial support, adrenal fatigue, I think that those things too often will improve if you do the fundamentals.

Once you've done that, are there some patients with chronic fatigue who feel better on the nutrients that we believe help the mitochondria, right? Carnosine, CoQ10, right? Yes. But there's a time and a place. And you have to think about when you're giving those things. Help me understand if that landing or if that's making sense.

[01:24:10] SCOTT: Yeah, no, it makes total sense. And while I do think that some people can benefit from some mitochondrial support, I know Dr. Nathan's very excited about the TTFD form of thiamine that can be very helpful in supporting mitochondria. At the same time, I think a lot of the environmental toxicants are affecting the mitochondria. And that by detoxifying and getting a lot of these things out of the system, we're also removing the boulders that are affecting the mitochondria, right? And I think that's consistent with what you're saying as well, right?

[01:24:42] DR. JOE: Yeah, there's a time and place for all these treatments. But we just got to kind of order them in the most cost-effective path for the patient. TTFD, I'm also using in my patients. Neil has me on it, and it's working. I really think that that's making a difference in myself and several patients now.

[01:24:59] SCOTT: I happen to be on it as well.

[01:25:03] DR. JOE: I think that that's making a difference in my fatigue. And I've seen it in patients too. And so, I think that's a valid treatment, whether it's doing – Whether why that is I think is kind of up for debate a little bit. I just always want to make sure that we, in functional integrative medicine, are availing ourselves with the cost-effective, simple, easy wins, the low-hanging fruit before thinking about some of these other secondary or third level pieces, right?

If you're playing around with TTFD, but you haven't put someone on binders with mold, you're missing something. If you're playing around with ashwagandha while someone has recurring SIBO, you're really missing the boat. Can it be a helpful tool? Yeah, definitely.

How about this one for fatigue? This is a simple one that just really lights me up. The amount of protein people are getting is almost certainly vastly under what is needed for optimal functioning. Michael interviewed Dr. Lyons recently and put together a lot of pieces of things I've observed in parts all in one place. This is Dr. Ruscio radio podcast with Dr. Lyons. She'd be a great guest for you to have. Her suggestion is that the optimal protein intake is much higher than what we've been taught. So, we've been taught 0.8 grams per kilogram, whereas she would suggest it's probably one gram per pound, right? So, a big difference.

And I've been doing this in a lot of patients with chronic fatigue and seeing a big jump in energy. So, I'm wondering how much – Are we just not given enough protein for the immune system and the muscular systems to be optimal function? And getting more muscle on the body, less sugar cravings, better energy, less brain fog. Those help us for a very easy treatment get a lot farther ahead than maybe some of these other pieces. I'm doing this in a lot more patients early on and finding it to be really significant.

[01:27:14] SCOTT: No, and I think that's an important message as well. So many years ago, when I was still dealing with mold and Lyme, I lost a lot of my muscle mass. I started doing a daily power shake with protein and lots of other good stuff, and it made a huge difference. And so, I remember having a conversation with Dr. Nathan, where I said, “Yeah, I mean, this makes me feel so good. But I'm worried that it's going to overstimulate my mTOR and mess up my autophagy and all of this.” And he was like, “Do you feel better with it?” He's like, “I think you're getting too into the pebbles,” to use your analogy. And so, definitely, I feel much better when I have more protein in my routine.

You mentioned a minute ago kind of the order of these things. We've touched on gut, and mold, and some of the – Maybe Lyme, coinfections, other pathogens, environmental toxicants, maybe mitochondria. How do you kind of, at a high-level, order your treatment strategy? What comes first? And how are you navigating what usually is a fairly complex landscape? And then lastly, what do you mean by right place, wrong time?

[01:28:18] DR. JOE: Oh, awesome. Awesome. Thank you for asking these. Okay. I'm the Medical Director of the Ruscio Institute. So, Michael Ruscio and I had been working for years together. And we're really proud of what we're building at this clinic. We've got two rising stars in functional medicine seeing patients with us. So, there are four of us now. So, Michael, myself, and then Dr. Scott and Hannah are just fantastic practitioners. And what we're doing really specifically is focusing on what is the most cost-effective way that we can get people better quicker, right?

And so, that means you have to put away some of the pebbles to the side and really focus on the high-level areas first. So from us, it's a lifestyle first. I think maybe you won't be surprised at how many patients have been through a half dozen integrative and functional medicine doctors, but they have sleep apnea. They have iron deficiency. They are not moving. They’re giving crazy diets. The basic lifestyle pieces have not been applied correctly. And when you do that, it gets better. It's still sometimes amazing and shocking to me that there's so many obvious lifestyle misses. That's the first principle, right?

The second is the gut. The gut is often very easy to fix. And it's very quick to fix. So, if there are gut pathologies or problems supporting the gut, often gives you the most vantage forward, right? After the gut, it's the toxic issues, right? Particularly mold is a big focus of our clinic. And we find that if you really do to get the best results when you do lifestyle first, then you optimize the gut. Then you go into the detoxification, right? That's the high-level piece. I think it’s really important that I hope people can wrap their heads around and understand.

The right treatment, the wrong time is really interesting to me, because I think that there's so many – We need this creative application of talking about the mitochondria, and TTFB, and thymine, and adrenals. And you can't solve conventional medical problems by doing the same thing, right? So, you need new. But there has to be a higher degree of, I think, empiricism and skepticism in terms of is this actually helping my patients? Yes or no? And I don't think there's enough critical evaluation of some of these treatments. And therefore, practitioners get very confused on what to apply when.

If a patient is definitely responding positively, then you're on the right track. But too often, patients get put on treatment X, and they're not really sure if they're better. A practitioner tries treatment Y, and they're not really sure if they're better. And then they stack on treatment Z, right? And they're still not better. And then all of a sudden, they're on 12 supplements. And no one knows where to go.

For us, the order of operations becomes really important in terms of a checklist. We've done these basics first. Yes? No? Okay. Have we done the GI? Yes? No? Okay. Have we gone on to toxins? Have we evaluated that? Do we want to make sure – We want to make sure that we're missing adrenal fatigue before we fix sleep apnea? Definitely not. I think that it takes a critical clinical eye to really figure this out.

[01:31:48] SCOTT: With your more complex patients that are dealing with environmental toxicity, with mold issues, with different infections, what is the maintenance stage of their program look like? Like, do they graduate, and they're done, and they don't need to do anything else? Or once they have symptomatic relief, are there things they need to do long term to maintain the progress that they've gotten particularly given that maybe some of these microbes aren't ever fully eradicated from the system? What's the ultimate end game for many of your patients?

[01:32:20] DR. JOE: For all the patients who come in and work with us, either if it's Dr. Scott or myself, we're tracking where they are of baseline. On a zero to 100 scale, right? What is their overall quality of health? And we tell patients that we feel like we're bad doctors if we don't get them at least to 80%. If they're a younger, more resilient patient, we want them above 90.

And the time in which it takes to get there will depend on how resilient they are and what underlying causes we need to work on, right? We feel like we want to work with them to whatever issues are at play until we get to that point. Then we want to wean the tools that we need to get there.

Successful functional medicine treatment should not mean tons of supplements for the rest of your life. It should not mean an extremely strict diet. There has to be a process by which those tools are weaned away. When someone with SIBO, for example, comes in, they may need the low FODMAP diet for three months, right? Four months, right? But as their symptoms go away, and the bacterial load and dysbiosis drops, all of a sudden, their FODMAP tolerance goes up and they can start eating bread without problems, and they have no symptoms.

There has to be this piece of reintroduction as the symptoms go down so that people are not trapped in a sick mentality for the rest of their life. It's about making them feel better so they can get back to enjoying their life, right? They can go play guitar. They go hang out with their kids. They can go travel. They can do whatever it is that they want to do with their life without feeling like they need max supplements support and max dietary intervention.

There comes a time and treatment where you really need to be – And if you don't do this purposefully, and you purposely talked about your patients, they'll just stay on the stuff forever. You have to really communicate to them, that as you feel better, you have to broaden your diet. We have to say, “Okay, right now for treatment, you've got dysbiosis. It sucks, but you have to be on pre-probiotics. Because I think that that's what you need to feel better. But when you feel better, we can lower your dose right? We can get you from four capsules of each day to one for maintenance,” right? That's what it looks like in our clinic, is just a constant reevaluation of what do they need to feel their best with the goal being the broadest diet and the least amount of supplements to feel well.

Mold patients are a bit of a different animal, right? And so, that picture looks a little different. Mold patients tend to be more vulnerable long term, and they need a bit more support long term to be well. I found myself that when I stopped doing the Gupta program, I crashed. I need that support. And many of my patients find that they kind of need that support. I've already done my retraining today. And I'll probably do it another time, right? And that's just how it is for me to feel well. And I kind of wish I didn't have to do it. But I do. And that's okay.

Most of my patients will stay on binders for the rest of their life because they were so profoundly sick, that we just don't want to do anything that would get us close to that. The degree of suffering that can occur with patients with this degree of illness is just overwhelming. And so, I'm a bit more protective of these patients. And those patients generally remain on probiotics and binders for the rest of their life, if I can convince them. That unless I find evidence that those are bad ideas long term, which I don't think they are, that's going to be my answer, just because they're more vulnerable in a variety of ways. And so, we got to be a little bit more protective of them.

[01:36:05] SCOTT: You mentioned at the beginning of our conversation, the stress that the pandemic has created being a contributor to complex chronic health issues. I think it certainly is a huge limbic system trigger as well. But there's also the aspect now of long COVID, persistent COVID. Some people may be that still have ongoing virus. Some people then that have immune dysregulation that has activated other things in their system, maybe Epstein-Barr Virus, maybe Bartonella, maybe mycoplasma, maybe something else. I'm wondering how the pandemic from maybe a persistent or long COVID perspective has changed any of what we talked about. Is there anything different that you do in working with that patient population from what we already discussed?

[01:36:51] DR. JOE: The long COVID patients that I'm seeing are responding to all the things that we spoke about earlier. I think my guess – The jury is still out. My guess is the patients who are susceptible to COVID and who have more prolonged courses of COVID are our biotoxin patients. Biotoxin limbic. That's my best guess. That's what I'm seeing. Like, they get better when you give them protein, and you fix their sleep apnea, and you fix their gut, and you put them on binders, and you get them out of mold.

[01:37:24] SCOTT: Which is great, because we already know how to do those things.

[01:37:26] DR. JOE: We know how to do those things. Right. Yeah. And limbic retraining. There is a limbic piece here, definitely. Ashok has a study on long COVID in his program. And so, that's one of the big reasons why I do like his program. They're trying very hard to show research that this is applicable to a lot of patient patients. And so, if you have long COVID, I would do your very best not to freak out and just make your way to a doctor who's going to work with you in a practical way.

[01:37:57] SCOTT: My last question is the same for every guest, and that is what are some of the key things that you do on a daily basis in support of your own health besides limbic system retraining?

[01:38:09] DR. JOE: Well, you can see a guitar in the background. And that's the first thing that comes. There's a violin over there. I don't know if you can see it. For me, it's music. I love, love, love music. And I've been always wanted to be a really good slide guitar player. And so, for me, about six months ago, I just hung my electric guitar in the garage and I play every day. And that's been really helpful for me. Because when you've been sick by mold, or chronic illness, you'll have up days and bad days, right? And this is one of those things that consistently boosts me no matter how I'm feeling. When I'm feeling at my worst, I'll feel better when I play guitar for a little while. And if I find I've gone two days and I'm not playing guitar, that's a red flag for me. There's something wrong with my brain, right? Because the natural normal state of Joe will be I want to play on my brother’s band. I want to play slide guitar.

And if I am not wanting guitar, then usually I'm doing too much antifungal, too much exercise. I'm not getting enough rest. I'm not calming down. I've forgotten to do limbic retraining. And I'm pushing myself too hard. For me, that guitar has been a really nice tool in terms of saying, “Am I pushing too hard?” Because I tend to push too hard like most of my patients. Find what find what really lights you up, and try to do it every day.

[01:39:35] SCOTT: I love that. Amazing. This has been such a fun conversation. I was really looking forward to it, because I know you're a very deep thinker. And I love that the answers that you gave are maybe disruptive for some people. Maybe it's not what they were expecting you to say. And so, I really value your clinical experience. I know that you have the highest intention for your patients and just want to thank you for being here and sharing so much of your wisdom and experience today. So, thank you Dr. Mather.

[01:40:03] DR. JOE: Thank you, Scott. And I'll say that if anybody does not like what I said, feel free to email Michael Ruscio. I’m just kidding. No, thank you. It's been so much fun.

[01:40:16] SCOTT: To learn more about today's guests, visit RuscioInstitute.com. That's RuscioInstitute.com. RuscioInstitute.com.

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