Answers to Your Gut Health Questions - Dr. Michael Ruscio, DC

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Do you want to start feeling better?

Yes, Where Do I Start?

Answers to Your Gut Health Questions

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Medically reviewed & fact checked by a
board-certified doctor
Medically reviewed & fact checked by a
board-certified doctor
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Gut Health Q&A: Akkermansia & Probiotic Misconception

Tune in for an installment of my gut health Q&A, where I answer your questions about all things gut health.

This installment is a probiotic edition, where I’ll touch on probiotic foods, dosing, side effects, and talk about whether the hype around Akkermansia is warranted.

Be sure to tune in!

And if you have any questions you would like answered in a future installment, let me know in the comments!

Is the hype about Akkermansia muciniphila probiotics warranted? 

We do know that lower levels of akkermansia are associated with obesity, type 2 diabetes, and IBD. However, based on human trials, the benefits of akkermansia are similar or inferior to other probiotics. In fact, the research shows that a lactobacillus-bifidobacterium blend probiotics outperformed akkermansia in regards to fasting glucose and insulin resistance.  

What are the best probiotics to take for improving IBS? 

A 2023 meta-analysis found that many different probiotic formulas were effective for IBS. We also see that different strains of the same probiotic species all show benefits, so you don’t have to worry about getting too strain-specific here. What I recommend is to take at least one type of probiotic (saccharomyces, lacto-bifido, or soil-based), but if you want something more effective, I would stack on another probiotic type or two. We refer to this as the triple therapy approach and we aim to publish on this soon. 

Can you tell me why you only recommend taking probiotics for 2-3 months? What should I do after that?

2–3 months is the minimum duration to assess efficacy. In some studies, peak effects weren’t seen for 6 months. So I recommend trialing probiotics for 2–3 months until the benefits plateau, and then you can start to ween down to find your minimum effective dose. (Essentially, you’ll take less and less until you notice symptoms, which will signal that you’ve gone too far.) I break this down more in this article, if you’d like more detail. 

Can probiotics be replaced with fresh sauerkraut, yogurt or kimchi? Or is there a reason to go for the supplements?

Fermented foods are an adequate source of probiotics. There is a caveat here in that the dosing is going to be inconsistent depending on food type, manufacturing, and how often you’re eating it. That’s where supplements can be handy, to fill in where there may be gaps. The other big caveat is that many probiotic foods can be reactive to sensitive guts due to FODMAP and/or histamine content. This is another case where supplements can be preferable. 

What if the probiotics make the symptoms worse? I can’t tolerate even small doses.

I see this in the clinic quite a bit. However, it’s extremely rare that someone can’t tolerate at least one type of probiotic. It’s important to remember that there are three types of probiotics (saccharomyces, lacto-bifido, and soil-based), so it may be that you’d benefit from moving to a different category. 

Other factors to consider are additives that may be causing reactions, so be sure to check for dyes, allergens, and prebiotic content. 300-500 mg of prebiotic content should be good for most, but some probiotics have a much more generous inclusion. Lastly, it could be die-off which should subside after 4–7 days. 

What type of probiotic do I take if I’m having histamine intolerance? Aren’t some strains known to produce more histamine in the body?

This was me. I avoided probiotics for this reason, but I wish I had started them sooner. I now know from looking at the research extensively that probiotics have a net-histamine-lowering effect. And the difference between histamine-containing probiotics and non-histamine-containing probiotics is negligible. So I would suggest trialing a probiotic from each major probiotic category, keeping what works and putting aside what doesn’t.

Why does everywhere on the internet say that lacto-bifido blends are bad for SIBO because it worsens the overgrowth? Is this true? 

In short, no, lacto-bifido is not bad for SIBO. A large part of why this narrative exists is that experts in the space refer to early, poor-quality observational studies when we now have much more research that demonstrates just how effective lacto-bifido can be for SIBO. I actually dedicated a whole episode to this topic that you can watch here.

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Gut Health Q&A: Constipation, Bloating, Eczema & Parasites

If your gut health isn’t where you want it to be, today’s Q&A will likely be of use to you. 

I’ll be covering some great question submissions like: 

  • I’ve tried water, prunes, and fiber, and nothing works for my constipation. What should I do? 
  • My bloating and constipation are slowly getting better with your protocol, but are not resolved. What else can I do? 
  • I have eczema, rosacea, and loose stool. I was wondering if my skin symptoms could be caused by a gut imbalance? 

To hear answers to these questions and more, please join me. 

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How to BEST Use Probiotics: Expert Answers to Your FAQs

This Q&A is answers to your questions about probiotics, like:

  • Do you need to rotate probiotics?
  • What’s the best way to take probiotics?
  • What if probiotics make me feel worse?
  • Do I have to worry about probiotics if I have SIBO?
  • And more.

If you have any questions about probiotics, please join me for what I hope are helpful insights.

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Clearing SIBO Confusion: Answers to FAQs About SIBO & GI Issues

If you have any unanswered questions about SIBO or unresolved GI issues, today’s episode is for you.

I’ll be answering questions from listeners like yourself, looking for gut guidance.

Today’s questions include:

  • How do I know if I have SIBO?
  • Can I do a hybrid carnivore/elemental diet for SIBO?
  • How long can you take antimicrobials for SIBO?
  • What’s causing my abdominal distension?
  • And more.

Please join me. And if you have any questions you’d like answered on the next round, you can submit them here:

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What Are the Optimal Ranges for Thyroid Labs? & More Listener Questions

What are the optimal ranges for thyroid labs? Today I’ll answer this and other listener-submitted questions about thyroid health.

Tune in to hear answers to questions like:

  • If my labs are normal could it still be a thyroid issue?
  • How do I know if I need thyroid hormone?
  • How can I wean off thyroid medication?

And more.

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You Asked How to Improve Fatigue and Energy Levels—Here's the Answer

Patients and listeners alike have been asking how to improve fatigue and energy levels a LOT recently. So in this episode, I address seven different listener questions about this, and I bet one will help you conquer your fatigue and increase your energy levels.


I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!