HGHY Great-In-8 FAQ Step 2

Great-in-8 Plan Contents

Healthy Gut, Healthy You

Step 2: Support

We will be adding answers to the most commonly asked questions about Step 2 of the Great-In-8 plan along with important information for troubleshooting this step here shortly.

Please post any questions or comments regarding this step below.

Q: Do your probiotics need to ship cold and be stored cold?

A: In short, no. Check out the video below for more details.

HGHY Great-In-8 FAQ Step 2 - DrR Video Play

Q: I’m afraid to try the pobiotic you sell and recommend bc of the INULIN. Is this as high in INULIN as eating garlic and onions? Or is it tolerated by some who don’t do well with this FODMAP group.

A: Great question – this comes up occasionally and is often misrepresented by companies trying to sell certain supplements. The amount of inulin in probiotics isn’t always significant. Ours has 450mg, which is an extremely low amount and the chance of reaction to this is very low. This is the probiotic he uses in his practice with patients, and he almost always sees good tolerance of it. Regarding the FODMAP component, If the probiotic sits well with someone’s microbiota, it may actually help improve their sensitivity to that category of FODMAPs and improve their symptoms. If you’re still concerned, you may want to make it the last probiotic you incorporate into the experiment so you can then isolate where the reaction (if there is one) is coming from.

Discussion

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!

359 thoughts on “HGHY Great-In-8 FAQ Step 2

  1. Hello I’ve read your excellent book and have began your programme. I’ve just completed the Reset and have a couple of questions,

    I think I may be a classic case of “leaky gut syndrome”. I’ve had a very long history of chronic fatigue (20 years) but was originally in that group of people without overt gut symptoms. When they did start to make themselves apparent, I took various steps to improve my diet. I’ve been eating more or less paleo for several years and the fatigue is hugely improved.

    However, I’ve become increasingly sensitive to foods. First was chocolate (of all things!); I’m fully and instantly allergic to that. Then a couple of years ago I had a really nasty reaction to oxalates (green smoothies!). That made my face swell, gave me ‘flu symptoms, huge fatigue and mineral deficiencies.

    I’ve experienced sporadic loose stools and bouts of exhaustion and, particularly since menopause, have put on weight that I cannot shift. I’ve tried various ways to identify food intolerances including two MRT tests to guide an exclusion diet but my symptoms can be vague and wax and wain so, I’m really none the wiser.

    I went off gluten 15 months ago following 3 separate fairly dramatic incidents when staying away from home. Each time 1 or 2 days of hotel/restaurant food produced severe bloating, vomiting and diarrhea, flu symptoms and severe fatigue. (I happened to be wearing a continuous glucose monitor on two of the occasions and interestingly my glucose plummeted to hypo levels).

    I feel a lot better gluten free but it’s obviously restrictive. I suspect gluten may be an issue of quantity but I’ve not dared to try it again to find my level. Instead I’ve been focussing on gut healing. I’ve been taking Zach Bush’s Restore for 9 months and your book is my next step.

    Question 1: Because I’ve generally been eating paleo and have had a hard time identifying intolerances I’ve decided to proceed to Steps 2 and 3. Should I do them sequentially or can I combine the two steps? I ask because I have 5 weeks before I have to work away from home for a 2 week period. Ideally I would like to be in a position to eat a bit more normally by then because I will be working on a trade stand with limited cooking facilities and limited access to GF restaurants/food outlets.

    Question 2: I managed a 3.5 day bone broth fast. I was ok on transition day, pretty good on days 2 and 3 and then was incredibly fatigued on day 4. I lost 6lbs which was great as previous attempts at IF yielded zero fat loss. My only success at improving body composition was with a trainer and eating 5 meals a day. Can I surmise that best for me would be to eat regular meals normally and then throw in periodic fasts but make them say 2 – 3 days in duration?

    Many thanks for your help.

    Diane

    1. Thanks Diane,
      Question 1: Make sure to follow the protocol in the book specifically. If you haven’t tried low FODMAP, try it. Also, this would mean perform step 2 before step 3. Please trust the wisdom of the protocol and don’t mix, match or alter 🙂

      Question 2: Glad this was helpful. This certainly seems reasonable, try it and see how it goes.

      Hope this helps

  2. Hi Dr. Ruscio,

    First, your book is a life saver….and by that I mean I’ve decided not to jump out the window. 😉 No, really though, I can’t tell you how appreciative I am of your words to relax, to not stress out, and to not kill myself by trying to reach for dietary perfection throughout the process. Those thoughts, repeated throughout your book, have taken a load off of me.

    I made it through the bone broth Reset (slightly modified). By the end of day 2 I had a splitting headache that would not quit no matter how much broth I drank, so I ate a small amount of FODMAP/SCD friendly food. That got rid of my headache and I was able to fast for an additional day and 3/4 before ending the fast.

    Now that I am finished with that step, I have a few questions:

    First, I know that I respond best (from past experience) on a low FODMAP/SCD diet. Anyway, given that knowledge, should I still eat that diet for a few weeks BEFORE I move on to Step 2, or should I just go ahead and start “Supporting” while on the diet, even though I’ve only been on the diet for a day?

    Second, from past tests and current reactions to various foods, I know I have SIBO, but I have no idea if I have any fungal overgrowth. Am I supposed to take the Saccharomyces Boulardii (I have no diarrhea) even if I don’t know whether a fungal or h. pylori overgrowth exists?

    Third, are you ok with this adrenal support supplement? ( https://drbenkim.com/sunshop/index.php?l=product_detail&p=89 ) It’s slightly different than the one in your shop, but since I already have it, I thought I’d ask. By the way, I have no problem buying the one from your shop if you prefer the ingredients.

    And last, a BIG thank you again for writing this book. It’s so nice to have all the information in one place. Maybe I can start throwing away my piles of articles, and stop stressing about not being able to see the doctor (you included) as often as I should!

    Many thanks,
    L

    1. Hi L,
      Glad to book has been helpful.
      1. You could go right into Step 2.
      2. Yes, follow the protocol as listed – don’t let prior lab tests or hypotheses distract you from following the Great-in-8 plan as outlined.
      3. I will leave that up to you 🙂
      Yes, I hope so!
      If you could write a review on Amazon, that would be much appreciated – https://www.amazon.com/Healthy-Gut-You-Michael-Ruscio/dp/0999766805/ref=cm_cr_arp_d_product_top?ie=UTF8
      Keep up the good work!

  3. Hi Dr Ruscio!

    Loved loved loved your book!

    I’m 24 and have problems with acid reflux. I have tried the paleo diet and while it worked while I didn’t eat non paleo foods, I couldn’t get away with ever straying from the diet occasionally without terrible heart burn and reflux. Along with this I had minor constipation issues; only going to the toilet every second day, sometimes with lots of blood in the stool.

    My partner and I tried the AIP diet which I successfully stuck to for 45 days prior to reading your book. However my constipation worsened dramatically while on this diet and when I went back through my food and symptom diary there was a strong correlation on days when I ate high FODMAP foods. Along with this we have been sticking to a maximum of 30g carbs per day (not including fibre), also known as keto. Some keto experts also say that some people experience constipation problems when they start keto. So we weren’t sure which might be the true cause. Any thoughts?

    We’ve just completed the 4 day modified bone broth diet (as of April 6) and have now moved on to the low FODMAP diet but are still steering clear of anything that was also on the AIP list and higher in carbs.

    My questions are:
    How long should I try the diet prior to moving onto step 2?
    In your book you outline that as part of step to, readers should take probiotics, digestive enzymes and adrenal support. If I already struggle with reflux and the diet doesn’t resolve this, how will I know if it is the digestive enzymes or something else that is causing my reflux?

    Also, back in Sep 2016 I had a blood test show that I am homozygous for the A1298C variant of the MTHFR gene. I don’t really know what this means and if it has any effect on the protocol I’m undertaking.

    Many thanks!

    Kind Regards,
    Megan Trotter

    1. Glad you liked it Megan!
      Stay on the diet until improvements plateau.
      If your symptoms improve after the enzyme, they are working. If symptoms don’t change, or get worse, then you can discontinue.
      MTHFR doesn’t tell us much.
      Hope this helps!

      1. Hi again! Thanks for the response. We’ve been sticking to the diet, and seeing some improvements. We ordered the supplements for Step 2 and they just arrived today.

        I have a question about the Lacto-Bifido blend. We ordered the capsules as the description read as though 1/4 tsp of the powder was equal to one capsule and each would thus give 100 billion CFUs. However, now that i’m looking at the bottle, it says one capsule has 25 billion CFU, meaning that I would need to take at least 8 capsules per day to meet the minimum dosage of 200 billion.

        Is this correct?

        At this rate, we’ll run out in 15 days! Given the time and expense of ordering supplements to Australia, this isn’t ideal. Can we take less than the 200-300 billion you recommend, or is that a waste of time? Or take the next best Lacto-Bifido blend we can find at over 100 billion CFU? Or should we just order some of the powder?

        My partner and I love your work and really appreciate you answering these questions. But we are a bit disappointed with this as we were very excited to get on with Step 2. Now we’re unsure what to do.

        The description on the online store should reflect the huge difference in CFU between caps and powder, particularly since the capsules are more expensive and you get 1/4 the amount.

        Thanks!

        1. The powder is a much better value, but some people reallllly wanted a pill form, so there it is 🙂 You could always use lowest end of dose range with pills, or just use the powder. Hope this helps!

  4. Hi Dr Ruscio!

    Loved loved loved your book!

    I’m 24 and have problems with acid reflux. I have tried the paleo diet and while it worked while I didn’t eat non paleo foods, I couldn’t get away with ever straying from the diet occasionally without terrible heart burn and reflux. Along with this I had minor constipation issues; only going to the toilet every second day, sometimes with lots of blood in the stool.

    My partner and I tried the AIP diet which I successfully stuck to for 45 days prior to reading your book. However my constipation worsened dramatically while on this diet and when I went back through my food and symptom diary there was a strong correlation on days when I ate high FODMAP foods. Along with this we have been sticking to a maximum of 30g carbs per day (not including fibre), also known as keto. Some keto experts also say that some people experience constipation problems when they start keto. So we weren’t sure which might be the true cause. Any thoughts?

    We’ve just completed the 4 day modified bone broth diet (as of April 6) and have now moved on to the low FODMAP diet but are still steering clear of anything that was also on the AIP list and higher in carbs.

    My questions are:
    How long should I try the diet prior to moving onto step 2?
    In your book you outline that as part of step to, readers should take probiotics, digestive enzymes and adrenal support. If I already struggle with reflux and the diet doesn’t resolve this, how will I know if it is the digestive enzymes or something else that is causing my reflux?

    Also, back in Sep 2016 I had a blood test show that I am homozygous for the A1298C variant of the MTHFR gene. I don’t really know what this means and if it has any effect on the protocol I’m undertaking.

    Many thanks!

    Kind Regards,
    Megan Trotter

    1. Glad you liked it Megan!
      Stay on the diet until improvements plateau.
      If your symptoms improve after the enzyme, they are working. If symptoms don’t change, or get worse, then you can discontinue.
      MTHFR doesn’t tell us much.
      Hope this helps!

      1. Hi again! Thanks for the response. We’ve been sticking to the diet, and seeing some improvements. We ordered the supplements for Step 2 and they just arrived today.

        I have a question about the Lacto-Bifido blend. We ordered the capsules as the description read as though 1/4 tsp of the powder was equal to one capsule and each would thus give 100 billion CFUs. However, now that i’m looking at the bottle, it says one capsule has 25 billion CFU, meaning that I would need to take at least 8 capsules per day to meet the minimum dosage of 200 billion.

        Is this correct?

        At this rate, we’ll run out in 15 days! Given the time and expense of ordering supplements to Australia, this isn’t ideal. Can we take less than the 200-300 billion you recommend, or is that a waste of time? Or take the next best Lacto-Bifido blend we can find at over 100 billion CFU? Or should we just order some of the powder?

        My partner and I love your work and really appreciate you answering these questions. But we are a bit disappointed with this as we were very excited to get on with Step 2. Now we’re unsure what to do.

        The description on the online store should reflect the huge difference in CFU between caps and powder, particularly since the capsules are more expensive and you get 1/4 the amount.

        Thanks!

        1. The powder is a much better value, but some people reallllly wanted a pill form, so there it is 🙂 You could always use lowest end of dose range with pills, or just use the powder. Hope this helps!

  5. Hi Dr Ruscio,
    I am currently doing step one but preparing for step 2 by looking into purchasing the supplements now. Do you have a UK supplier? Or are the supplements readily available in the UK?

    Thanks,
    Heidi

    1. Hi Heidi I live in the UK and had to ship via FedEx from the US. Far as I know there is no UK supplier. Expensive though it is, it is worth it. I bought two month’s worth.

  6. Your book was truly enlightening and I really appreciate your pragmatic and methodical approach.. i am in the middle of Step 2, following Autoimmune Palio and will likely move onto Step 3 as not 100% better. I have reeently been diagnosed with Hashimoto’s and am struggling to find a really good multivitamin as per your recommendation, without iodine and iron (I am post menopausal. Have you thought of making your own or could you recommend one? Also what are your thoughts on daily iodine dosage for Hashimoto’s?

  7. Hello,

    I truly enjoyed your book! I have used magnesium citrate to help with my IBS-C and SIBO symptoms to help regulate. In your book, this is not added to the protocol until after Step 3. I am currently in Phase 2 and was wondering if this is a supplement I could add now, or if I should wait until Step 3 if it is needed.

    Thanks!

  8. Hello,

    I truly enjoyed your book! I have used magnesium citrate to help with my IBS-C and SIBO symptoms to help regulate. In your book, this is not added to the protocol until after Step 3. I am currently in Phase 2 and was wondering if this is a supplement I could add now, or if I should wait until Step 3 if it is needed.

    Thanks!

  9. Hello!

    I am on week 4 of the step one protocol, focusing on paleo low-fodmap. Overall, I have noticed improvements with bloating on most days, but not all days. I also have not improved with the typical cramping and urgency before BMs, along with not having complete BMs. Should I do step one longer before moving to step two or move on and hope more symptoms improve? My diet has consisted mostly of meats and fruit, with about two servings a day of cooked vegetables. Not every day is perfect but I would say I’ve adhered to the diet 90% of the time.Carbs are typically around 100 g.

    Thanks!

    1. Hey Aeriel,
      The book should speak to this. You could consider escalating to the Low FODMAP with SCD diet, give that two weeks, and if it doesn’t provide full relief move to step 2. Just like the protocol advises 🙂

  10. Hello!

    I am on week 4 of the step one protocol, focusing on paleo low-fodmap. Overall, I have noticed improvements with bloating on most days, but not all days. I also have not improved with the typical cramping and urgency before BMs, along with not having complete BMs. Should I do step one longer before moving to step two or move on and hope more symptoms improve? My diet has consisted mostly of meats and fruit, with about two servings a day of cooked vegetables. Not every day is perfect but I would say I’ve adhered to the diet 90% of the time.Carbs are typically around 100 g.

    Thanks!

    1. Hey Aeriel,
      The book should speak to this. You could consider escalating to the Low FODMAP with SCD diet, give that two weeks, and if it doesn’t provide full relief move to step 2. Just like the protocol advises 🙂

  11. I’m getting ready to order your support supplements and notice the lacto-bifido probiotic blend is in a base of inulin. I’ve been doing paleo low fodmap and it’s helping! So I’m confused as to why I’d want to take a supplement with inulin now?

    1. The amount of inulin included is negligible and most people have no reaction to it. Hope this helps.

  12. Thank you for taking time to answer questions.. my only two symptoms which bother me on daily and most nights hourly are excessive burping and terrible bloating. I do not have diarrhea,pain, or anything else. I have had my gallbladder removed and tested very high for hydrogen in a breath test. I have taken the smart pill and had many other tests. The only thing that has been found was on the breath test. My burping is not just slight burps but long and excessive. I can press anywhere on my abodomen and a long burp occurs. It also occurs as soon as I eat oe drink anything. My abdomin is so bloated that I look 6 months pregnant. At night my burping is so intense I cannot sleep. My question is: based on theses two symptoms is there any changes that I need to make in following the great 8 in your book.?

    1. Hi Mary! I was having similar symptoms after doing 2 weeks of paleo low fodmap. I “took things to the next level” and did a combination of paleo low fodmap+scd and all of my symptoms cleared up! The primary difference for me is cutting out starches. Dr. Ruscio has a low fodmap+SCD diet combined list in the resource section.

  13. Thank you for taking time to answer questions.. my only two symptoms which bother me on daily and most nights hourly are excessive burping and terrible bloating. I do not have diarrhea,pain, or anything else. I have had my gallbladder removed and tested very high for hydrogen in a breath test. I have taken the smart pill and had many other tests. The only thing that has been found was on the breath test. My burping is not just slight burps but long and excessive. I can press anywhere on my abodomen and a long burp occurs. It also occurs as soon as I eat oe drink anything. My abdomin is so bloated that I look 6 months pregnant. At night my burping is so intense I cannot sleep. My question is: based on theses two symptoms is there any changes that I need to make in following the great 8 in your book.?

    1. Hi Mary,
      Just as the book lays out, the protocol can be used for a variety of symptoms and the path is adaptable to meet your needs. So, continue forward 🙂

    2. Hi Mary! I was having similar symptoms after doing 2 weeks of paleo low fodmap. I “took things to the next level” and did a combination of paleo low fodmap+scd and all of my symptoms cleared up! The primary difference for me is cutting out starches. Dr. Ruscio has a low fodmap+SCD diet combined list in the resource section.

  14. I enjoyed the book and have gained lots of valuable information. I started on a low FODMAP diet and noticed some slight improvement. I am now doing the probiotic protocol. When will the Saccharomyces Boulardii be back in stock?

    1. Hi Marybeth,

      Each one is different and should be spelled out in the relevant chapter in the book. Hope this helps!

  15. Is there a typo on Page 273? Under the Enzymes Protocol is says Lacto/Bifido Probiotic Blend 1/4 tsp. Can you clarify what it should be please?

    1. I also noticed that. I believe the product should be Digestive Enzyme with HCL. The dose should be 1-3 pills with each meal.

  16. I love the book, and am ready for step two. I’ve eaten a Paleo/Keto style for several months. I’m just finishing a Microbiome Labs Mega sporbiotic. Should I finish it before I start the step 2 supplements or can I just go forwards with it all. I am in cancer treatment (immunology) and I’m having a challenge finding things to eat in the morning that settle. So far butter coffee and matcha and MCT seem to work OK. I tried ghee instead of butter, but it gives indigestion.

  17. I’ve been loving your book so far and have found it really helpful! I’m about to move on to Step 2 but have a question about the adrenal support. It seems that I don’t tolerate nightshades (I’ve been on the AIP paleo diet for a while and nightshades seem to always cause a reaction). I noticed that both of the adrenal supplement options contain Ashwagandha, which is a nightshade. Do you know of any other adrenal support supplements without Ashwagandha that you would recommend I try? Thanks!

    1. Thanks!
      I would give our product a try, I haven’t noticed reactions often with it – irrespective of night shade tolerance. Or, you could try another formula but I don’t have a specific recommendation.

  18. Hi Dr. Ruscio,

    I initially reached out to Dr. Pearlmutter after reading his book “Brain Maker”. I was looking to find a doctor who is aligned with his views on the gut and he suggested you. I’ve read your book and listened to many of your pod casts and have found a ton of value in it all. Thank you for all of your work!

    I’m on step two of adding in your probiotics. My body is super sensitive, so I started at about 1/4 of the lowest suggested dosage for each. I’ve started seeing small improvements in sleep, energy, less body aches, and weight loss. However, I’ve also started having a lot of anxiety (in my body) which leads to tortured, sleepless nights, and adrenal crashes. I’ll have a day or two of the slight improvements then crashes for a couple of days. Could this be a histamine reaction from my seasonal allergies which also just started up? And if so, how can I reduce it? My body is so sensitive right now I’ve been afraid to take my normal Flonase. Are antihistamines a good thing to take if having these types of reactions?

    Thanks for all the work you do! I hope to work with you in person soon!

    Kris

    1. Thanks Kris.
      A few things to consider, check these with your doctor of course.
      -the low histamine diet**
      -trying the other probiotics to see if you can find one that has benefit with no reactions
      -the OTC antihistamine protocol laid out by Dr. Afrin last time he was on the podcast (yes, antihistamines are OK) https://drruscio.com/mast-cell-activation-syndrome-clinician-researcher-dr-lawrence-afrin/
      -continuing the book protocol

      Hope this helps 🙂

  19. Hi Dr. Ruscio,

    I initially reached out to Dr. Pearlmutter after reading his book “Brain Maker”. I was looking to find a doctor who is aligned with his views on the gut and he suggested you. I’ve read your book and listened to many of your pod casts and have found a ton of value in it all. Thank you for all of your work!

    I’m on step two of adding in your probiotics. My body is super sensitive, so I started at about 1/4 of the lowest suggested dosage for each. I’ve started seeing small improvements in sleep, energy, less body aches, and weight loss. However, I’ve also started having a lot of anxiety (in my body) which leads to tortured, sleepless nights, and adrenal crashes. I’ll have a day or two of the slight improvements then crashes for a couple of days. Could this be a histamine reaction from my seasonal allergies which also just started up? And if so, how can I reduce it? My body is so sensitive right now I’ve been afraid to take my normal Flonase. Are antihistamines a good thing to take if having these types of reactions?

    Thanks for all the work you do! I hope to work with you in person soon!

    Kris

    1. Thanks Kris.
      A few things to consider, check these with your doctor of course.
      -the low histamine diet**
      -trying the other probiotics to see if you can find one that has benefit with no reactions
      -the OTC antihistamine protocol laid out by Dr. Afrin last time he was on the podcast (yes, antihistamines are OK) https://drruscio.com/mast-cell-activation-syndrome-clinician-researcher-dr-lawrence-afrin/
      -continuing the book protocol

      Hope this helps 🙂

    1. No Lisa. We already have this category (category 3) probiotic covered with the Soil-Based probiotic. This is another formula that works for category 3. The one I recommend in the book is one of a few formulas I endorse.

      1. OK thanks Dr .Ruscio !
        It’s just that:
        1.) website is sold out of your formulation
        2.) from the fab endorsement on podcast i inferred we should use this product.
        Thanks 🙂

    1. No Lisa. We already have this category (category 3) probiotic covered with the Soil-Based probiotic. This is another formula that works for category 3. The one I recommend in the book is one of a few formulas I endorse.

      1. OK thanks Dr .Ruscio !
        It’s just that:
        1.) website is sold out of your formulation
        2.) from the fab endorsement on podcast i inferred we should use this product.
        Thanks 🙂

  20. Hi Dr Ruscio, I think you are doing a great job, your book is awesome.

    I have one question about the digestive enzymes mentioned in the book, but in general about digestive enzymes products.
    How long someone has to take the enzymes?

    My big concern is to know if taking enzymes for a long period of time at each meal could somehow affect the natural capability of enzyme production of the body by becoming “addicted” to them.
    What is your take on that?

    Thank you in advance.

    1. Thanks. I haven’t seen any evidence that suggests that is the case. If you follow the book protocol you will also find the minimum dose/duration and likely only use them for a short term. Hope this helps.

  21. Hi Dr Ruscio, I think you are doing a great job, your book is awesome.

    I have one question about the digestive enzymes mentioned in the book, but in general about digestive enzymes products.
    How long someone has to take the enzymes?

    My big concern is to know if taking enzymes for a long period of time at each meal could somehow affect the natural capability of enzyme production of the body by becoming “addicted” to them.
    What is your take on that?

    Thank you in advance.

    1. Thanks. I haven’t seen any evidence that suggests that is the case. If you follow the book protocol you will also find the minimum dose/duration and likely only use them for a short term. Hope this helps.

  22. I’m in step 2 and having trouble with the supplements. How far away from food can I take them? When I take them before bed, I get stomach pain alleviated with LOTS of water. I can take them first thing in the morning and wait an hour to eat, with no discomfort. Is an hour after a meal far enough away from food? Even though there is still food in my stomach (the taste of the meal is present in burps).

  23. I’m in step 2 and having trouble with the supplements. How far away from food can I take them? When I take them before bed, I get stomach pain alleviated with LOTS of water. I can take them first thing in the morning and wait an hour to eat, with no discomfort. Is an hour after a meal far enough away from food? Even though there is still food in my stomach (the taste of the meal is present in burps).

  24. Hi Dr Ruscio!
    I have a question about probiotics. I seem to do best on a low fodmap diet, that means I should stay away from inulin and FOS, both of which are often added in probiotic blends to feed those bacteria.
    How does that work, do these addatives even feed my bad bacteria if I have SIBO?

    Kind regards,
    Helena

    1. I have looked at similar products in Sweden. I have found a blend that contains all but two of your Probiotic blend. There are also 4 strains that are not in your blend. My question is are there any particular bacteria that absolutely should be in the blend and are there any bacteria that I better avoid?

      Kind regards,
      Helena

      1. Another question: Some studies have shown L Helveticus can reduce anxiety. Since anxiety is one of my main problems, should I add that to the probiotic step or is there a reason you have not included it in your probiotics protocol?

        Kind regards,
        Helena

  25. Hi Dr Ruscio!
    I have a question about probiotics. I seem to do best on a low fodmap diet, that means I should stay away from inulin and FOS, both of which are often added in probiotic blends to feed those bacteria.
    How does that work, do these addatives even feed my bad bacteria if I have SIBO?

    Kind regards,
    Helena

    1. I have looked at similar products in Sweden. I have found a blend that contains all but two of your Probiotic blend. There are also 4 strains that are not in your blend. My question is are there any particular bacteria that absolutely should be in the blend and are there any bacteria that I better avoid?

      Kind regards,
      Helena

      1. Another question: Some studies have shown L Helveticus can reduce anxiety. Since anxiety is one of my main problems, should I add that to the probiotic step or is there a reason you have not included it in your probiotics protocol?

        Kind regards,
        Helena

  26. Hello Dr. Ruscio,

    I’m just reading your book but I am confused about the handouts on the resources page, I was looking at the handout for the low FODMAP and Paleo diet and it includes potatoes and rice on the allowed list whereas in your book those are not allowed on a Paleo diet only in the low FODMAP diet, is this a typo?

    Thanks!

    1. Also meant to say that the handout included low FODMAP dairy and cream is on the safe list, which has lots of lactose so I’m very confused by the Paleo low FODMAP diet hand out! Your clarification would be greatly appreciated!

      1. Hi Alyssa,

        Potatoes + rice are low FODMAP and are now a part of many people’s paleo diet. If they work for you, great, if not, feel free to leave them out. The dairy items listed on there are low fodmap because with things like cream, it’s actually very low in lactose. Again, definitely avoid if they don’t work for you. Good luck!

  27. Hello Dr. Ruscio,

    I’m just reading your book but I am confused about the handouts on the resources page, I was looking at the handout for the low FODMAP and Paleo diet and it includes potatoes and rice on the allowed list whereas in your book those are not allowed on a Paleo diet only in the low FODMAP diet, is this a typo?

    Thanks!

    1. Also meant to say that the handout included low FODMAP dairy and cream is on the safe list, which has lots of lactose so I’m very confused by the Paleo low FODMAP diet hand out! Your clarification would be greatly appreciated!

      1. Hi Alyssa,

        Potatoes + rice are low FODMAP and are now a part of many people’s paleo diet. If they work for you, great, if not, feel free to leave them out. The dairy items listed on there are low fodmap because with things like cream, it’s actually very low in lactose. Again, definitely avoid if they don’t work for you. Good luck!

  28. Hi Dr Ruscio!

    I started Step 2 and have been trying to implement the probiotics. Prior to your probiotics, I was taking Betaine-HCL and Lipase. I was a little aggressive with the probiotic dosages and unfortunately started having bad acid reflux.

    I don’t know if this could be a “die-off” reaction or maybe the probiotics are helping my stomach produce acid on its own, and taking a Betaine-HCL supplement is now causing too much acid. Another thought was that maybe taking the probiotics away from meals is what’s causing the reflux.

    Anyway, I’m 99% positive that my health issues are caused from SIBO or other gut imbalance, could I start the step 3 supplements without the probiotics, and then add them back in a week or so into step 3?

    Thank you so much!

  29. Hi Dr Ruscio!

    I started Step 2 and have been trying to implement the probiotics. Prior to your probiotics, I was taking Betaine-HCL and Lipase. I was a little aggressive with the probiotic dosages and unfortunately started having bad acid reflux.

    I don’t know if this could be a “die-off” reaction or maybe the probiotics are helping my stomach produce acid on its own, and taking a Betaine-HCL supplement is now causing too much acid. Another thought was that maybe taking the probiotics away from meals is what’s causing the reflux.

    Anyway, I’m 99% positive that my health issues are caused from SIBO or other gut imbalance, could I start the step 3 supplements without the probiotics, and then add them back in a week or so into step 3?

    Thank you so much!

  30. Hello Dr Ruscio, thanks for your support.

    What do you suggest for people with histamine intolerance that doesn’t tolerate certain probiotic strains?
    I’m not 100% sure but seems that probiotics are causing me insomnia.

    Thank you in advance.

  31. Hello Dr Ruscio, thanks for your support.

    What do you suggest for people with histamine intolerance that doesn’t tolerate certain probiotic strains?
    I’m not 100% sure but seems that probiotics are causing me insomnia.

    Thank you in advance.

  32. I would really appreciate if you would answer my questions above about probiotica and the prebiotica they contain, regarding SIBO. THere is one from Garden of Life that is called Mood+ and it contains a good blend of probiotic strains but it also contains 675mg of potatostarch and acaciafibers. Would that feed my SIBO? Does it even feed fungal overgrowths?
    I am really looking forward to your answer!

      1. Does this include inulin? Inulin’s like a red flag regarding FODMAPS as far as I’ve always believed. Is Inulin also included when you refer to “prebiotics” (and that taking them under 1g is okay?)

        There’s a few questions about this now, as everyone who’s ever gone down the FODMAP path learns about inulin very early on in the piece! Please let us know. Cheers, Matt.

        1. Great question – this comes up occasionally and is often misrepresented by companies trying to sell certain supplements. The amount of inulin in some probiotics isn’t always very high. Ours has 450mg, which is an extremely low amount and the chance of reaction to this is very low. This is the probiotic he uses in his practice with patients, and he almost always sees good tolerance of it. Regarding the FODMAP component, If the probiotic sits well with someone’s microbiota, it may actually help improve their sensitivity to that category of FODMAPs and improve their symptoms. If you’re still concerned, you may want to make it the last probiotic you incorporate into the experiment so you can then isolate where the reaction (if there is one) is coming from.

  33. I would really appreciate if you would answer my questions above about probiotica and the prebiotica they contain, regarding SIBO. THere is one from Garden of Life that is called Mood+ and it contains a good blend of probiotic strains but it also contains 675mg of potatostarch and acaciafibers. Would that feed my SIBO? Does it even feed fungal overgrowths?
    I am really looking forward to your answer!

      1. Does this include inulin? Inulin’s like a red flag regarding FODMAPS as far as I’ve always believed. Is Inulin also included when you refer to “prebiotics” (and that taking them under 1g is okay?)

        There’s a few questions about this now, as everyone who’s ever gone down the FODMAP path learns about inulin very early on in the piece! Please let us know. Cheers, Matt.

        1. Great question – this comes up occasionally and is often misrepresented by companies trying to sell certain supplements. The amount of inulin in some probiotics isn’t always very high. Ours has 450mg, which is an extremely low amount and the chance of reaction to this is very low. This is the probiotic he uses in his practice with patients, and he almost always sees good tolerance of it. Regarding the FODMAP component, If the probiotic sits well with someone’s microbiota, it may actually help improve their sensitivity to that category of FODMAPs and improve their symptoms. If you’re still concerned, you may want to make it the last probiotic you incorporate into the experiment so you can then isolate where the reaction (if there is one) is coming from.

  34. Looking to start step 2 and wondering about what supplements I need to purchase. Do you pick one supplement from each category i.e 1 probiotic, 1 Digestive Enzyme, etc or do you need to take ALL of the supplements listed for each category?

    1. Hi Jenny,

      I’m just going through this now myself, and it is clear in my understanding that you take:

      a) Lacto/Bif Probiotic (either powder or caps) AS WELL AS Saccharomyces Boulardii AS WELL AS Soil-Based Probiotic = 3 supplements
      b) ONE of the two options for Enzymes (Dr. R. recommends the first one as a preference)
      c) Adrenal Support

      So you’ll be taking five supplements. Hope this helps.

  35. Looking to start step 2 and wondering about what supplements I need to purchase. Do you pick one supplement from each category i.e 1 probiotic, 1 Digestive Enzyme, etc or do you need to take ALL of the supplements listed for each category?

    1. Hi Jenny,

      I’m just going through this now myself, and it is clear in my understanding that you take:

      a) Lacto/Bif Probiotic (either powder or caps) AS WELL AS Saccharomyces Boulardii AS WELL AS Soil-Based Probiotic = 3 supplements
      b) ONE of the two options for Enzymes (Dr. R. recommends the first one as a preference)
      c) Adrenal Support

      So you’ll be taking five supplements. Hope this helps.

  36. I’m a little confused about the dosing. When it says the dose is 2 pills and the Times/Day is 1-2, does that mean you take 2 pills within a full day and can either take them together or split them up, OR is the minimum dose 2 pills, taken together, and the maximum dose is 4 pills, taken 2 at a time? I feel like between the

    1. Yes, this was a little confusing to me also.

      My belief is that it means the first scenario you proposed: “you take 2 pills within a full day and can either take them together or split them up”

      That’s how I’m approaching it after re-reading everything a couple of times.

  37. I’m a little confused about the dosing. When it says the dose is 2 pills and the Times/Day is 1-2, does that mean you take 2 pills within a full day and can either take them together or split them up, OR is the minimum dose 2 pills, taken together, and the maximum dose is 4 pills, taken 2 at a time? I feel like between the

    1. Yes, this was a little confusing to me also.

      My belief is that it means the first scenario you proposed: “you take 2 pills within a full day and can either take them together or split them up”

      That’s how I’m approaching it after re-reading everything a couple of times.

  38. For step 2, I order all 3 probiotics and choose 1 adrenal supplement and 1 enzyme? I stay on the adrenal support until I stop all supplements?

  39. the elemental diet contains milk. will it bother lactose intolerance individuals? seems like whey protein would in my experience. take digestive enzyme?

    1. Hi Brandon,

      The cold-extracted Whey Protein Isolate is casein-free and lactose-free. Many people who don’t tolerate dairy do just fine on it. But always listen to your body. Good luck!

  40. For step 2, I order all 3 probiotics and choose 1 adrenal supplement and 1 enzyme? I stay on the adrenal support until I stop all supplements?

  41. the elemental diet contains milk. will it bother lactose intolerance individuals? seems like whey protein would in my experience. take digestive enzyme?

    1. Hi Brandon,

      The cold-extracted Whey Protein Isolate is casein-free and lactose-free. Many people who don’t tolerate dairy do just fine on it. But always listen to your body. Good luck!

  42. Hi Dr. Ruscio,

    I am up to step 2 in your book and looking to order your products. I have a question about taking probiotics together. My chiropractor says that you shouldn’t take Saccharomyces Boulardii at the same time as other probiotics (in other words, taking them both first thing in the morning) because it won’t be as effective, but I can’t find any information to validate that. Your protocol doesn’t mention it, but I just wanted to double check. Thanks!

  43. Hi Dr. Ruscio,

    I am up to step 2 in your book and looking to order your products. I have a question about taking probiotics together. My chiropractor says that you shouldn’t take Saccharomyces Boulardii at the same time as other probiotics (in other words, taking them both first thing in the morning) because it won’t be as effective, but I can’t find any information to validate that. Your protocol doesn’t mention it, but I just wanted to double check. Thanks!

  44. question about your product: D3/K2:

    Why is K2 much lower dosed (8% RDA) than D3? I was looking for a balanced product instead of taking two.

    Best.regards
    Roswitha

  45. question about your product: D3/K2:

    Why is K2 much lower dosed (8% RDA) than D3? I was looking for a balanced product instead of taking two.

    Best.regards
    Roswitha

  46. Hello Doctor Ruscio,

    Just to clarify, we take all 3 probiotics listed in the book right? My mind initially thought that the soil based one was “optional” but after re-reading several times, that assumption I initially had seems incorrect. So just double checking before I buy!

    Thank you!

  47. Hello Doctor Ruscio,

    Just to clarify, we take all 3 probiotics listed in the book right? My mind initially thought that the soil based one was “optional” but after re-reading several times, that assumption I initially had seems incorrect. So just double checking before I buy!

    Thank you!

  48. Dr Ruscio, your book, blogs, site have been instrumental in helping me understand my GI issues. Here are two questions for you:
    1. If one has a positive 3hr lactulose breath test for both hydrogen and methane (but not severe), tried the low FODMAP diet, and now starts on the Lacto-Bifido Probiotics and finds the probiotics to work, do you have to proceed with anything else?

    2. If one has a redundant and tortuous colon, all else clear on colonoscopy and is a healthy eater and exercises, could that be contributing to gas and bloating? Some of the research suggests that is the case in an interview you did in 2015. If so, are there any other protocols you suggest? I think this may be especially valuable to those in the 70plus age range who may never have experienced GI issues until recently give age-related digestive changes.

    Thank you so much for all your valuable contributions which i have share with several others including docs.

    1. Hi Dee,

      So glad to hear Dr. R’s content has been helpful for you.

      I would follow the protocol exactly as written in the book until you feel better, and at that point, you’re probably good!

      Redundant colon can indeed cause bloating. I’m not sure if he has specific suggestions for it, but I’ll pass the question along to him in the hope that he’ll answer it in a future Q+A podcast.

      Good luck!

  49. Dr Ruscio, your book, blogs, site have been instrumental in helping me understand my GI issues. Here are two questions for you:
    1. If one has a positive 3hr lactulose breath test for both hydrogen and methane (but not severe), tried the low FODMAP diet, and now starts on the Lacto-Bifido Probiotics and finds the probiotics to work, do you have to proceed with anything else?

    2. If one has a redundant and tortuous colon, all else clear on colonoscopy and is a healthy eater and exercises, could that be contributing to gas and bloating? Some of the research suggests that is the case in an interview you did in 2015. If so, are there any other protocols you suggest? I think this may be especially valuable to those in the 70plus age range who may never have experienced GI issues until recently give age-related digestive changes.

    Thank you so much for all your valuable contributions which i have share with several others including docs.

    1. Hi Dee,

      So glad to hear Dr. R’s content has been helpful for you.

      I would follow the protocol exactly as written in the book until you feel better, and at that point, you’re probably good!

      Redundant colon can indeed cause bloating. I’m not sure if he has specific suggestions for it, but I’ll pass the question along to him in the hope that he’ll answer it in a future Q+A podcast.

      Good luck!

  50. hello – love the book –

    So here’s my challenge – I react to what seems like all supplements (in the form of capsules or pressed pills as I believe I am reacting to soy (and all derivatives) and gluten). I take a water based probiotic from the UK called Symprove which seems fine, and have in the past used Oregano oil, uva ursi and collodial silver as antimicrobials. But that only covers some of the protocol – How can I heal my gut if I can’t take anything and do all the steps…?

    1. Hi Lindsay,

      I believe the antimicrobials (Biota-Clear) are manufactured without soy or gluten.

      Hope this helps!

      1. Hi Drew

        I mean for the whole program – is it possible to heal the gut without using any of the supplements?

        Thanks
        Lindsay

        1. Hi Lindsay,

          I’m not sure what results you would get. You could always give it a try and see what happens. Doing the elemental diet and giving your digestion a rest is very healing for some people.

  51. hello – love the book –

    So here’s my challenge – I react to what seems like all supplements (in the form of capsules or pressed pills as I believe I am reacting to soy (and all derivatives) and gluten). I take a water based probiotic from the UK called Symprove which seems fine, and have in the past used Oregano oil, uva ursi and collodial silver as antimicrobials. But that only covers some of the protocol – How can I heal my gut if I can’t take anything and do all the steps…?

    1. Hi Lindsay,

      I believe the antimicrobials (Biota-Clear) are manufactured without soy or gluten.

      Hope this helps!

        1. Hi Lindsay,

          I’m not sure what results you would get. You could always give it a try and see what happens. Doing the elemental diet and giving your digestion a rest is very healing for some people.

  52. Dr. Ruscio I bought your book to help with SIBO/Dysbiosis and am ready to move on to Step 2. I plan on trying the probiotics and digestive support from your store. However, Adrenal support is part of it and although pattern is normal, I have very elevated Cortisol day/night (according to saliva lab) I react adversely to adaptogens/GABA support… they give me panic attacks or worsen symptoms. Is there something else I can do as part of Step 2? Thanks

    1. Hi Kimberly,

      I would just leave out anything you know doesn’t work for you. Managing stress is a key part too, so make sure you’re doing your best there as well 🙂

      Good luck!

  53. Dr. Ruscio I bought your book to help with SIBO/Dysbiosis and am ready to move on to Step 2. I plan on trying the probiotics and digestive support from your store. However, Adrenal support is part of it and although pattern is normal, I have very elevated Cortisol day/night (according to saliva lab) I react adversely to adaptogens/GABA support… they give me panic attacks or worsen symptoms. Is there something else I can do as part of Step 2? Thanks

    1. Hi Kimberly,

      I would just leave out anything you know doesn’t work for you. Managing stress is a key part too, so make sure you’re doing your best there as well 🙂

      Good luck!

  54. I was so excited to read this book because finally – all the info I need about healing my persistent stomach issues in one place. The diet – no problem, I have been some variation of paleo, low-FODMAP or low-carb for the past few years. However, I’m a little overwhelmed by the supplements. I just can’t afford all of those, especially in Canada with the shipping. I have ordered 2 of the probiotics on a Canadian website (closest approximation), as well as the digestive enzymes, but I can’t find any similar versions of the other supplements elsewhere. Plus there are the supplements for the next few steps. How long do I have to take everything? I am really concerned about the cost.

    1. Hi there,

      Thanks for your comment, and I totally understand about the cost. I wish I had a better answer for you on shipping costs to Canada. Maybe try iHerb for some things? I will say that the protocol was designed to be as cost-effective as possible, prescribing the minimum amount of supplements. This is also much more affordable than seeing a functional medicine clinician. Within each step there are optional add-ons that you can leave out if you like. Also, not everyone will need all 8 steps, some people just need a few, so it’s not guaranteed that you will have to go all the way through the protocol and purchase all of the supplements. Hope this helps and good luck!

      1. Thanks for your reply! I’m wondering what might be an equivalent supplement to the adrenal support and soil based probiotic supplement? Can’t seem to find anything similar.

        1. Unfortunately I’m not sure. Dr Ruscio chooses the ones he recommends in the book specifically because he knows those are what will work, and can’t make guarantees about the quality, ingredients, or effectiveness of any others. You may want to consider getting those from the US and paying for shipping/customs, and then getting other, more generic ones locally (like magnesium or vitamin D).

  55. I was so excited to read this book because finally – all the info I need about healing my persistent stomach issues in one place. The diet – no problem, I have been some variation of paleo, low-FODMAP or low-carb for the past few years. However, I’m a little overwhelmed by the supplements. I just can’t afford all of those, especially in Canada with the shipping. I have ordered 2 of the probiotics on a Canadian website (closest approximation), as well as the digestive enzymes, but I can’t find any similar versions of the other supplements elsewhere. Plus there are the supplements for the next few steps. How long do I have to take everything? I am really concerned about the cost.

    1. Hi there,

      Thanks for your comment, and I totally understand about the cost. I wish I had a better answer for you on shipping costs to Canada. Maybe try iHerb for some things? I will say that the protocol was designed to be as cost-effective as possible, prescribing the minimum amount of supplements. This is also much more affordable than seeing a functional medicine clinician. Within each step there are optional add-ons that you can leave out if you like. Also, not everyone will need all 8 steps, some people just need a few, so it’s not guaranteed that you will have to go all the way through the protocol and purchase all of the supplements. Hope this helps and good luck!

      1. Thanks for your reply! I’m wondering what might be an equivalent supplement to the adrenal support and soil based probiotic supplement? Can’t seem to find anything similar.

        1. Unfortunately I’m not sure. Dr Ruscio chooses the ones he recommends in the book specifically because he knows those are what will work, and can’t make guarantees about the quality, ingredients, or effectiveness of any others. You may want to consider getting those from the US and paying for shipping/customs, and then getting other, more generic ones locally (like magnesium or vitamin D).

  56. Hi! I am working through the book, but have recently been diagnosed with anemia. Can I take iron supplements and still expect to heal my gut through this program?

    1. Hi Hels,

      I would say follow the protocol as written (especially because fixing gut issues oftentimes helps anemia), unless otherwise specified by your doctor.

      1. Hi there, similar auestion about iron and othr supplements. I see on the gut protocol fasting handout, it says avoid supplements during the fast but resume when fast done. Is that correct or should we be avoiding during all steps while trying to resolve symptoms?
        Thank you

  57. Hi! I am working through the book, but have recently been diagnosed with anemia. Can I take iron supplements and still expect to heal my gut through this program?

    1. Hi Hels,

      I would say follow the protocol as written (especially because fixing gut issues oftentimes helps anemia), unless otherwise specified by your doctor.

      1. Hi there, similar auestion about iron and othr supplements. I see on the gut protocol fasting handout, it says avoid supplements during the fast but resume when fast done. Is that correct or should we be avoiding during all steps while trying to resolve symptoms?
        Thank you

        1. We advise to avoid other supplements while doing the protocol unless absolutely necessary.

  58. Hi,

    I am following currently on step one and planning ahead for step 2. My 2 year old daughter is also doing it with me (modified) so that I can try to heal her gut. She struggles with a lot of food allergies and eczema. Do you recommend that I give her all of the recommended supplements at a lower dosage or are there any that you wouldn’t recommend a 2 year old take?

    Thank you for your time.

    1. Hi Kayla,

      Dr Ruscio generally thinks the protocol is ok for children if you use 1/2 the dose of the listed protocols, but also strongly recommends consulting with their pediatrician before proceeding with the protocol.

      Also he tends to be very minimal with dietary restrictions with children.

      Hope this helps!

  59. Hi,

    I am following currently on step one and planning ahead for step 2. My 2 year old daughter is also doing it with me (modified) so that I can try to heal her gut. She struggles with a lot of food allergies and eczema. Do you recommend that I give her all of the recommended supplements at a lower dosage or are there any that you wouldn’t recommend a 2 year old take?

    Thank you for your time.

    1. Hi Kayla,

      Dr Ruscio generally thinks the protocol is ok for children if you use 1/2 the dose of the listed protocols, but also strongly recommends consulting with their pediatrician before proceeding with the protocol.

      Also he tends to be very minimal with dietary restrictions with children.

      Hope this helps!

  60. I have been on Step 2 for a couple of days. I have a few really basic questions. 1. I am mixing the powdered Lacto-Bifido blend in cold water. It doesn’t dissolve very well. Any suggestions for how to take it? Or, anything I should specifically avoid mixing it into? 2. I am starting on the lowest dose of the Step 2 supplements. If I see improvement, I should stop at the lowest dose? I should not increase the dose to see if the level of improvement increases? Thanks!

    1. Hi Mary,

      1. You don’t want to mix it in hot water, but maybe try room temp water and see if that helps?
      2. You can play around and see what works for you. If you’re feeling great, stay at that dose. If you still need further improvement, increase to the full dose.

      Hope this helps!

  61. I have been on Step 2 for a couple of days. I have a few really basic questions. 1. I am mixing the powdered Lacto-Bifido blend in cold water. It doesn’t dissolve very well. Any suggestions for how to take it? Or, anything I should specifically avoid mixing it into? 2. I am starting on the lowest dose of the Step 2 supplements. If I see improvement, I should stop at the lowest dose? I should not increase the dose to see if the level of improvement increases? Thanks!

    1. Hi Mary,

      1. You don’t want to mix it in hot water, but maybe try room temp water and see if that helps?
      2. You can play around and see what works for you. If you’re feeling great, stay at that dose. If you still need further improvement, increase to the full dose.

      Hope this helps!

  62. Is S. Boulardii safe to take when on a biologic (TNF inhibitor- Cimzia) or is that too ” immunocompromised”? Thanks!

    1. Hi Catherine,

      That’s definitely something you’re going to need to discuss with your prescribing doctor.

    1. Hi Catherine,

      That’s definitely something you’re going to need to discuss with your prescribing doctor.

  63. Hi Dr Ruscio,

    Firstly – thank you for your book. You’ve given me hope for the first time in several years.

    Quick question about Step 2 (& apologies if this has already been covered). I’m about to order the supplements from your website but there are 2 choices of digestive enzymes/acid. Which do you recommend for someone who felt 15% better following an AIP-low fodmap diet & has just experienced a flare up?

    Thank you so much in advance.

    1. Hi DJ,

      Glad you’re enjoying the book! We’d love an Amazon review if you feel up to it.

      As far as enzymes, you want to purchase the ones called Digestive Enzymes with Hcl. Hope that helps!

  64. Hi Dr Ruscio,

    Firstly – thank you for your book. You’ve given me hope for the first time in several years.

    Quick question about Step 2 (& apologies if this has already been covered). I’m about to order the supplements from your website but there are 2 choices of digestive enzymes/acid. Which do you recommend for someone who felt 15% better following an AIP-low fodmap diet & has just experienced a flare up?

    Thank you so much in advance.

    1. Hi DJ,

      Glad you’re enjoying the book! We’d love an Amazon review if you feel up to it.

      As far as enzymes, you want to purchase the ones called Digestive Enzymes with Hcl. Hope that helps!

  65. I have been following the plan for my 2 year old daughter for a couple months now and we just introduced the supplements. She takes the 3 probiotics easily but refuses to take the enzymes and adrenal support because of the taste (I have to take it out of the capsules since she can’t swallow capsules). I have tried mixing it in things, bribing, etc. Is there anything else I can do? Ideas, tips, tricks, give something else as a replacement? We’ve dealt with a lot of food allergies and eczema since she was born so I’m just wanting to heal her gut and let her live like a normal two year old.

    1. Hi Kayla,

      I’d probably say don’t force it. I don’t think the protocol will completely fail without those components, and kids seem to be very resilient. Maybe some other parents on the page can weigh in with any tips or advice.

  66. I have been following the plan for my 2 year old daughter for a couple months now and we just introduced the supplements. She takes the 3 probiotics easily but refuses to take the enzymes and adrenal support because of the taste (I have to take it out of the capsules since she can’t swallow capsules). I have tried mixing it in things, bribing, etc. Is there anything else I can do? Ideas, tips, tricks, give something else as a replacement? We’ve dealt with a lot of food allergies and eczema since she was born so I’m just wanting to heal her gut and let her live like a normal two year old.

    1. Hi Kayla,

      I’d probably say don’t force it. I don’t think the protocol will completely fail without those components, and kids seem to be very resilient. Maybe some other parents on the page can weigh in with any tips or advice.

  67. Question on the Lacto Bifido powder (1/4 tsp serving). The directions are not super clear on how to take it. I have just been stirring mine in about 2 oz of water and drinking it on an empty stomach. I just wanted to verify that the product is not getting “damaged” or “wasted” by mixing like this in water. Can you please comment?

  68. Question on the Lacto Bifido powder (1/4 tsp serving). The directions are not super clear on how to take it. I have just been stirring mine in about 2 oz of water and drinking it on an empty stomach. I just wanted to verify that the product is not getting “damaged” or “wasted” by mixing like this in water. Can you please comment?

  69. Hi Dr. Ruscio,

    Thank you so much for your book and the help that you are providing so many people. I have two questions I wanted to run by you:

    1) I find psyllium fiber supplements to be extremely helpful in managing my IBS. I know that your book states that you shouldn’t add fiber supplements until step 6, but given that I’ve already been using them and find them helpful, is it okay to continue taking these during the early steps of the protocol, or do you think that it’s necessary to stop them until Step 6?

    2) I take cabergoline for a prolactinoma that I’ve had for the past three years – do you know if any of the supplements in steps 2 or 3 have any interaction effects with this medication? I checked with my endocrinologist about this, but he was extremely unaware of the supplements that you recommend (even ashwaganda, which I think is fairly well known), so he wasn’t able to provide me with any information on this.

    Thank you again!

    1. Hi Amanda,

      1) I would follow the protocol as written (aka stop taking the fiber for now) for the best results.
      2) I’m not sure. I know drugs.com has a search engine that checks interactions which may be helpful.

      Good luck!

  70. Hi Dr. Ruscio,

    Thank you so much for your book and the help that you are providing so many people. I have two questions I wanted to run by you:

    1) I find psyllium fiber supplements to be extremely helpful in managing my IBS. I know that your book states that you shouldn’t add fiber supplements until step 6, but given that I’ve already been using them and find them helpful, is it okay to continue taking these during the early steps of the protocol, or do you think that it’s necessary to stop them until Step 6?

    2) I take cabergoline for a prolactinoma that I’ve had for the past three years – do you know if any of the supplements in steps 2 or 3 have any interaction effects with this medication? I checked with my endocrinologist about this, but he was extremely unaware of the supplements that you recommend (even ashwaganda, which I think is fairly well known), so he wasn’t able to provide me with any information on this.

    Thank you again!

    1. Hi Amanda,

      1) I would follow the protocol as written (aka stop taking the fiber for now) for the best results.
      2) I’m not sure. I know drugs.com has a search engine that checks interactions which may be helpful.

      Good luck!

  71. Hi,
    thanks again for a great book.
    I have some questions about probiotics.
    You recommend 3 classes of probiotics, one of them is soilbased and contains B Coagulans and B Subtilis. What about other kinds of soilbased probiotics, for example PrescriptAssist, that contain a mix of organisms that normally live in the earth (humus)? Can I try that in combination with the soilbased organisms you recommend?

    Kind regards,
    Helena

    1. PrescriptAssist recently changed their formulation and many people, including Dr R, no longer recommend it. I would try and follow the protocol as written as closely as possible.

  72. Hi,
    thanks again for a great book.
    I have some questions about probiotics.
    You recommend 3 classes of probiotics, one of them is soilbased and contains B Coagulans and B Subtilis. What about other kinds of soilbased probiotics, for example PrescriptAssist, that contain a mix of organisms that normally live in the earth (humus)? Can I try that in combination with the soilbased organisms you recommend?

    Kind regards,
    Helena

    1. PrescriptAssist recently changed their formulation and many people, including Dr R, no longer recommend it. I would try and follow the protocol as written as closely as possible.

  73. Should the digestive enzymes be taken with snacks in addition to meals? I usually have two snacks per day, each around 200 calories.

    Thank you!

  74. Should the digestive enzymes be taken with snacks in addition to meals? I usually have two snacks per day, each around 200 calories.

    Thank you!

  75. For Step 2: How many days do each bottle of product last, based on max dose?
    (as i am an international order and would like to make best decision on what my order will be)
    I do not see this in your book or in product description.

    1. Hi Samantha,

      That’s tough to say because these supplements should be continued until step 7, but not everyone will take the same amount of time to get to step 7. Some people need to do step 2, 3, 4, 5, 6, 7 – while others will skip from step 2 to 5. And some people will need to stay on step 2 longer than others, so it’s hard to tell you exactly how many bottles of each you’ll need. I would at least stock up on a few month’s worth.

  76. For Step 2: How many days do each bottle of product last, based on max dose?
    (as i am an international order and would like to make best decision on what my order will be)
    I do not see this in your book or in product description.

    1. Hi Samantha,

      That’s tough to say because these supplements should be continued until step 7, but not everyone will take the same amount of time to get to step 7. Some people need to do step 2, 3, 4, 5, 6, 7 – while others will skip from step 2 to 5. And some people will need to stay on step 2 longer than others, so it’s hard to tell you exactly how many bottles of each you’ll need. I would at least stock up on a few month’s worth.

  77. I have started the probiotics and take them first thing in the morning, well before breakfast, and with a full glass of warm water. Typically, I drink lemon water in the morning and wondered whether it is more beneficial for the probiotics to drink the lemon water before the probiotics or to hold off on the lemon water until breakfast a few hours later? Thank you.

  78. I have started the probiotics and take them first thing in the morning, well before breakfast, and with a full glass of warm water. Typically, I drink lemon water in the morning and wondered whether it is more beneficial for the probiotics to drink the lemon water before the probiotics or to hold off on the lemon water until breakfast a few hours later? Thank you.

  79. Hi, I’m not quite clear on how and when to introduce the supplements of Step 2. Do I introduce one probiotic at a time, each for a certain amount of time to determine effectiveness/tolerability? Or do I introduce all 3 probiotics at once then evaluate? How long do I take the probiotics before adding enzymes, or adrenal support? Or do I start ALL Step 2 supplements at once at lowest doses? I just can’t figure out the timing and recommended pattern for introducing the supplements. Thanks so much for your time and insight!

    1. You can start them all at once. If you feel you are getting some sort of negative reaction, you can play around with taking individual supplements out and seeing if that makes a difference. Hope this helps!

  80. Hi, I’m not quite clear on how and when to introduce the supplements of Step 2. Do I introduce one probiotic at a time, each for a certain amount of time to determine effectiveness/tolerability? Or do I introduce all 3 probiotics at once then evaluate? How long do I take the probiotics before adding enzymes, or adrenal support? Or do I start ALL Step 2 supplements at once at lowest doses? I just can’t figure out the timing and recommended pattern for introducing the supplements. Thanks so much for your time and insight!

    1. You can start them all at once. If you feel you are getting some sort of negative reaction, you can play around with taking individual supplements out and seeing if that makes a difference. Hope this helps!

  81. I just ordered the supplements for Step 2, based on the “Step 2 -Action Plan Summary” on page 273. I’m eager to move onto that Step! Looking at pages 272 and 274 however now I’m wondering if there is a typo on page 273? On that page in the Summary section, it says the Digestive Enzymes Protocol uses Lacto-Bifido Probiotic Blend. (I realized that it is the same product listed for the Probiotic Protocol so I figured it satisfied both protocols.) Now I see on the other pages it suggests “Digestive Enzyme with HCl” for the Dig. Enzyme Protocol. So which is correct, the Summary or the text? Thanks so much! I love the book and am very excited to hopefully heal my gut over the next several months/year. Already my bowels, my sleep, and my arthritis are somewhat better, thank you!!!

  82. I just ordered the supplements for Step 2, based on the “Step 2 -Action Plan Summary” on page 273. I’m eager to move onto that Step! Looking at pages 272 and 274 however now I’m wondering if there is a typo on page 273? On that page in the Summary section, it says the Digestive Enzymes Protocol uses Lacto-Bifido Probiotic Blend. (I realized that it is the same product listed for the Probiotic Protocol so I figured it satisfied both protocols.) Now I see on the other pages it suggests “Digestive Enzyme with HCl” for the Dig. Enzyme Protocol. So which is correct, the Summary or the text? Thanks so much! I love the book and am very excited to hopefully heal my gut over the next several months/year. Already my bowels, my sleep, and my arthritis are somewhat better, thank you!!!

  83. I have ordered the three probiotic supplements for Step 2. While listening to some lectures on oral health, I learned that probiotics can be good for the mouth as well. Are there any concerns for any of the three probiotics about swishing them around in one’s mouth before swallowing? Thanks so much!

    1. Hi Dave,

      Regular probiotics contain strains that are native to the gut. There is some overlap with what lives in the oral microbiome, but many of them are different. So I’m not sure how much it would help, but it probably wouldn’t hurt.

  84. I have ordered the three probiotic supplements for Step 2. While listening to some lectures on oral health, I learned that probiotics can be good for the mouth as well. Are there any concerns for any of the three probiotics about swishing them around in one’s mouth before swallowing? Thanks so much!

    1. Hi Dave,

      Regular probiotics contain strains that are native to the gut. There is some overlap with what lives in the oral microbiome, but many of them are different. So I’m not sure how much it would help, but it probably wouldn’t hurt.

  85. Also, does it matter if the probiotics are dumped out of the capsule and mixed in water, rather than swallowed in the capsule?

  86. Also, does it matter if the probiotics are dumped out of the capsule and mixed in water, rather than swallowed in the capsule?

  87. I am confused as to the dosing of Lacto-Bifido Probiotic Blend. The serving size on the bottle says ¼ teaspoon is 100 Billion CFU, however, in the book on page 270 you say that the dose is 200-300 Billion per day (equal to ¼ teaspoon). Which one is correct?

    1. Hi Sam,

      Sorry for the confusion – just follow the dose range (200-300 billion), whatever gets you to that amount of CFUs should be good.

  88. I am confused as to the dosing of Lacto-Bifido Probiotic Blend. The serving size on the bottle says ¼ teaspoon is 100 Billion CFU, however, in the book on page 270 you say that the dose is 200-300 Billion per day (equal to ¼ teaspoon). Which one is correct?

    1. Hi Sam,

      Sorry for the confusion – just follow the dose range (200-300 billion), whatever gets you to that amount of CFUs should be good.

  89. I have read the book and listened to podcasts about histamine. Symptoms are mainly itching, heart burn (on PPI’s), constipation and some tummy pain. For a few years I have been eating mainly paleo. I have had a hard time totally following health diets. On September 1st I joined Overeaters Anonymous and the step are helping me and I have been doing great eating very healthy. However my above systems have gotten worse and worse. I am now on a low FODMAP low histamine diet with no relief.

    1) I was concerned that the probiotics you sell would not work well if I do have histamine issues. So I orders some from another maker for now. Histamine Drs. have mixed views on soil based probiotics and s. B”. What do you think?

    2) My energy is OK so is it OK not to use the adrenal support?

    3) Can the itching be because I have lowered my carbs to much? I seem to have less itching with more carbs but then it would be feeding bacteria and other over growths?

    1. Hi Christine,

      I’m sorry you’re having such a tough time, feel free to set up a consult with Dr Ruscio if you’d like more personalized advice (you can do so here: https://www.drruscio.com/gethelp)

      1. It really depends on the person as everyone reacts differently. You could try it out and see how you feel.
      2. We recommend following the protocol in the book as closely as possible (including adrenal supplements.
      3. Not sure, but listen to your body and eat what makes you feel better. You don’t need to eat zero carbs to fix your gut issues.

      Hope this helps.

  90. Perhaps an odd question,but I’ll ask anyway. 🙂

    I’m in step 2 right now.

    I had a plantar wart for many years and the only thing that got rid of it was DIM (Diindolylmethane) powder taken orally for about 3 months.

    I’ve got another coming back and want to take Diindolylmethane for it again, but wondering if there are any negative effect on gut health. Haven’t found anything online.

    Are you able to tell me how Diindolylmethane may affect gut health?

    Thanks,

    -J

    1. Dr Ruscio generally thinks the protocol is ok for children if you use 1/2 the dose of the listed protocols, but also strongly recommends consulting with their pediatrician before proceeding with the protocol.

      Also he tends to be very minimal with dietary restrictions with children.

      Hope this helps!

  91. Two days ago, I took 1 cap of saccharomyces boulardii. After a few hours I started having a back pain where pancreas is located. My step 1 is dialed in. After step 1 I started with step 2 and started with saccharomyces boulardi and this happened. The pain has been there since 2 days now.

    What is going on? What do I need to do ? How do I reduce the pain. How do I move forward.

    I have been promoting Healthy Gut, Healthy you vehemently in India.

    1. Hi there,

      I’m not sure exactly what’s happening, but you may want to stop taking it and see if the pain goes away. Then you could slowly try and introduce it again to see if it was just a coincidence or if you were having a bad reaction to the s. boulardii. If it was indeed a bad reaction, discontinue use. Hope this helps.

  92. Two days ago, I took 1 cap of saccharomyces boulardii. After a few hours I started having a back pain where pancreas is located. My step 1 is dialed in. After step 1 I started with step 2 and started with saccharomyces boulardi and this happened. The pain has been there since 2 days now.

    What is going on? What do I need to do ? How do I reduce the pain. How do I move forward.

    I have been promoting Healthy Gut, Healthy you vehemently in India.

    1. Hi there,

      I’m not sure exactly what’s happening, but you may want to stop taking it and see if the pain goes away. Then you could slowly try and introduce it again to see if it was just a coincidence or if you were having a bad reaction to the s. boulardii. If it was indeed a bad reaction, discontinue use. Hope this helps.

  93. I need supplements to be shipped to India. I have special instructions for shipping. Please share your phone number and email address.

    Thank You.

      1. I sent an email. I am hoping to get a reply so that I can do further communication from that email id.
        How many days does it take to receive a reply?

  94. I need supplements to be shipped to India. I have special instructions for shipping. Please share your phone number and email address.

    Thank You.

      1. I sent an email. I am hoping to get a reply so that I can do further communication from that email id.
        How many days does it take to receive a reply?

  95. Hi,

    Dr. Ruscio recently introduced the Intestinal Repair Formula. I realize that the suggested use is for those who have not responded to other treatment but the benefits as listed might potentially be useful for anyone taking the program. Is it possible to incorporate it? And if so at what stage.

    The store also lists Gut Rebuild Nutrients product. At what part of the program should this be used, it’s not mentioned in the book. Thanks!

    1. Hi Dusan,

      Re: IRF – It would be added after the Great-in-8 program. Theoretically, one could use IRF at any time but Dr. R feels it important not to do too much at once, hence his advising to wait on IRF until after completing the Great-in-8 plan.

      Re: Gut Rebuild Nutrients – Theoretically, it can be used at any time. Specifically, Dr R would advise as an optional add-on during step 2. Or, after completing the full protocol.

      Hope this helps!

  96. Hi,

    Dr. Ruscio recently introduced the Intestinal Repair Formula. I realize that the suggested use is for those who have not responded to other treatment but the benefits as listed might potentially be useful for anyone taking the program. Is it possible to incorporate it? And if so at what stage.

    The store also lists Gut Rebuild Nutrients product. At what part of the program should this be used, it’s not mentioned in the book. Thanks!

    1. Hi Dusan,

      Re: IRF – It would be added after the Great-in-8 program. Theoretically, one could use IRF at any time but Dr. R feels it important not to do too much at once, hence his advising to wait on IRF until after completing the Great-in-8 plan.

      Re: Gut Rebuild Nutrients – Theoretically, it can be used at any time. Specifically, Dr R would advise as an optional add-on during step 2. Or, after completing the full protocol.

      Hope this helps!

    1. Hi Stian,

      This probiotic formulation uses a patented technology that forms a gel-like matrix when it hits the stomach, that surrounds and protects the probiotic bacteria. This action facilitates the survival of the probiotics while passing through the acidic stomach. In the small intestines, the shield dissolves to release high numbers of viable, intact probiotics to begin exerting their health-promoting functions. Hope this helps!

    1. Hi Stian,

      This probiotic formulation uses a patented technology that forms a gel-like matrix when it hits the stomach, that surrounds and protects the probiotic bacteria. This action facilitates the survival of the probiotics while passing through the acidic stomach. In the small intestines, the shield dissolves to release high numbers of viable, intact probiotics to begin exerting their health-promoting functions. Hope this helps!

  97. Hello Dr. Ruscio,

    I am beginning step 2 and have a few questions regarding Probiotic/digestive enzyme and adrenal support brand options. I live in Canada and after loading the shopping cart online with the necessary supplements my order total was more than 500 canadian dollars for one round of the support supplements. Seeing as this may only last a month or so it is definitely tough to make it sustainable financially. I am wondering if there are any brands that you guys would say could be used in place to help keep the protocol a bit more affordable for us international customers that have to pay a lot for exchange rate and shipping fees. I am definetely willing to buy the essential supplements from the website but perhaps a few options in Step 2 could be sourced locally. Please advise!

    1. Hi Ryan,

      I hear you – international shipping can be killer. Unfortunately, I’m not aware of what brands are and aren’t available in Canada, so I think your best bet would be to look at the ingredients and search for local products that have as close to the same ingredients/dosages as possible to our products. Hopefully, there should be some decent alternative options.

  98. Hello Dr. Ruscio,

    I am beginning step 2 and have a few questions regarding Probiotic/digestive enzyme and adrenal support brand options. I live in Canada and after loading the shopping cart online with the necessary supplements my order total was more than 500 canadian dollars for one round of the support supplements. Seeing as this may only last a month or so it is definitely tough to make it sustainable financially. I am wondering if there are any brands that you guys would say could be used in place to help keep the protocol a bit more affordable for us international customers that have to pay a lot for exchange rate and shipping fees. I am definetely willing to buy the essential supplements from the website but perhaps a few options in Step 2 could be sourced locally. Please advise!

    1. Hi Ryan,

      I hear you – international shipping can be killer. Unfortunately, I’m not aware of what brands are and aren’t available in Canada, so I think your best bet would be to look at the ingredients and search for local products that have as close to the same ingredients/dosages as possible to our products. Hopefully, there should be some decent alternative options.

  99. Hi, I purchased your book because I have SIBO and desperately want to get well. I’m on step 2 and it says to take probiotics. I’ve read that both probiotics and prebiotcs should be avoided if you actively have SIBO. What is your take on this? Can I take the probiotics and prebiotics? Or wait until the SIBO dies down? I’ve had a horrible flare up for about 6 weeks now…

  100. Hi, I purchased your book because I have SIBO and desperately want to get well. I’m on step 2 and it says to take probiotics. I’ve read that both probiotics and prebiotcs should be avoided if you actively have SIBO. What is your take on this? Can I take the probiotics and prebiotics? Or wait until the SIBO dies down? I’ve had a horrible flare up for about 6 weeks now…

  101. Hi Dr. Ruscio,

    I would just like to say how much I enjoyed your book and I want to emphasize how much hope it gave me! I feel so much more informed about my gut health and I feel so empowered on my road to healing now!

    I’ve been struggling with IBS and gut issues for the past 8 years. I just recently got diagnosed with SIBO which is why I read your book. My doctor prescribed Rifaximin for me (for 7 days) which didn’t seem to help. My bloating got worse (I looked five months pregnant) and I was very constipated both during and after the treatment. I then got very frustrated with my doctor who said she couldn’t really help with anything else besides taking a laxative for the rest of my life (I’m only 28 and thought taking a laxative the rest of my life couldn’t be the only solution).
    So I was recommended to read your book and finally felt a bit more positive for my recovery.

    So my question is….

    The past month I’ve been doing a mix of the paleo and low fodmap diet which has helped my system so much!
    I now am ready to start step 2 of the great in 8 and was wondering if you think I should follow the steps in the great in 8 to see how my symptoms are during the next couple weeks to evaluate which step to go through or should I plan on going through all of the steps (including 3 and 4) since I have been diagnosed with SIBO and don’t seem to have any relief after the round of antibiotics I took. Or would I go straight to including a prokinetic along with step 2 protocol? and then continue to step 5 after a while on the prokinetic?
    I live in Denmark but will be in the United States for a couple weeks so I would love to plan ahead and order all of the supplements while I am in the States (I know maybe this isn’t possible since your book seems to emphasize seeing how your body feels on each step).
    I’m sorry for the long question, I’m just a bit confused as to which direction I should go, and I am finding it impossible to find a doctor or anyone here in Denmark that will help me with all of this.
    Thank you so much for writing this book and taking the time to answer all of our questions! You have given so much hope to this community of people suffering with gut health!

    1. Hi Caroline,

      I’m glad to hear the low fodmap diet has been helping! Just to confirm that I understand your question – are you asking about potentially not doing all of the steps because you’re already starting to feel better and you may not need step 3? If that’s the case, then unfortunately i don’t have a clear black and white answer for you. You could buy supplements for all the steps just to be on the safe side (because like you said, your treatment didn’t seem to help), but there’s always the possibility that you won’t need them. The plan really counts on you assessing after each step to see how you feel. But if you’ve been struggling for 8 years, there’s a good likelihood that you’ll want to go through all the steps completely. Good luck!

      1. Thank you so much! I’ll plan on doing all the steps then! Just wondering how many pills would be the recommended dose for the lacto bifido probiotic if you buy the capsules instead of the powder? In the book its clear what to do for the powder but I’m just not quite sure the amount for the capsules.

    1. It should be fine, but if you’re concerned at all, you could take the enzyme/hcl at the beginning of the meal and the probiotic at the end.

  102. Hi Dr. Ruscio,

    I would just like to say how much I enjoyed your book and I want to emphasize how much hope it gave me! I feel so much more informed about my gut health and I feel so empowered on my road to healing now!

    I’ve been struggling with IBS and gut issues for the past 8 years. I just recently got diagnosed with SIBO which is why I read your book. My doctor prescribed Rifaximin for me (for 7 days) which didn’t seem to help. My bloating got worse (I looked five months pregnant) and I was very constipated both during and after the treatment. I then got very frustrated with my doctor who said she couldn’t really help with anything else besides taking a laxative for the rest of my life (I’m only 28 and thought taking a laxative the rest of my life couldn’t be the only solution).
    So I was recommended to read your book and finally felt a bit more positive for my recovery.

    So my question is….

    The past month I’ve been doing a mix of the paleo and low fodmap diet which has helped my system so much!
    I now am ready to start step 2 of the great in 8 and was wondering if you think I should follow the steps in the great in 8 to see how my symptoms are during the next couple weeks to evaluate which step to go through or should I plan on going through all of the steps (including 3 and 4) since I have been diagnosed with SIBO and don’t seem to have any relief after the round of antibiotics I took. Or would I go straight to including a prokinetic along with step 2 protocol? and then continue to step 5 after a while on the prokinetic?
    I live in Denmark but will be in the United States for a couple weeks so I would love to plan ahead and order all of the supplements while I am in the States (I know maybe this isn’t possible since your book seems to emphasize seeing how your body feels on each step).
    I’m sorry for the long question, I’m just a bit confused as to which direction I should go, and I am finding it impossible to find a doctor or anyone here in Denmark that will help me with all of this.
    Thank you so much for writing this book and taking the time to answer all of our questions! You have given so much hope to this community of people suffering with gut health!

    1. Hi Caroline,

      I’m glad to hear the low fodmap diet has been helping! Just to confirm that I understand your question – are you asking about potentially not doing all of the steps because you’re already starting to feel better and you may not need step 3? If that’s the case, then unfortunately i don’t have a clear black and white answer for you. You could buy supplements for all the steps just to be on the safe side (because like you said, your treatment didn’t seem to help), but there’s always the possibility that you won’t need them. The plan really counts on you assessing after each step to see how you feel. But if you’ve been struggling for 8 years, there’s a good likelihood that you’ll want to go through all the steps completely. Good luck!

      1. Thank you so much! I’ll plan on doing all the steps then! Just wondering how many pills would be the recommended dose for the lacto bifido probiotic if you buy the capsules instead of the powder? In the book its clear what to do for the powder but I’m just not quite sure the amount for the capsules.

  103. Hi,
    Is it still advisable to take a spore probiotic with meals if I am taking HCI betaine? Thanks.
    Regards
    Dean

    1. It should be fine, but if you’re concerned at all, you could take the enzyme/hcl at the beginning of the meal and the probiotic at the end.

  104. Are the instructions here for the low car high fat diet right for the larger batch? It seems to be exactly the same as the high carb one. The single serving size seems to be right though.
    https://drruscio.com/wp-content/uploads/2018/02/2bHomemadeElementalDietInstructions.pdf

    Option 1: Low Carb/High Fat
    Elemental diets offer nutrients in an easily digestible and drinkable form. Elemental diets have been
    studied for the treatment of Small Intestine Bacterial Overgrowth and found to be effective when
    taken in place of meals, 3 x day, for 2 weeks. ¹ *
    Ingredients:
    • 1000 gram bag Jo Mar Labs Amino Acids: Black Label Pure Form 21 Blend (use Jo Mar Labs
    search box to find)
    • 63-93 oz Honey (carbohydrate of glucose and fructose) Or 1 jar Now: Dextrose, 10 pound
    size (glucose)
    • 1575-1890 ml Oil (fat), such as medium train triglyceride, coconut, olive, cod liver
    • 1 bottle Pure Encapsulations: Nutrient 950 Multivitamin
    • 1 bottle Salt, preferably unrefined (ex. Real Salt, Celtic)
    • Optional: flavorings such as vanilla may be used in small amounts

    1. Hi Mike,

      Thanks for pointing that out. As it says on the top of the handout, we didn’t develop the info. Looking at it, it does seem to be a little off. I’d just go by the per day instructions – maybe you could buy a little less honey and if you end up running out, you can go pick up some more.

      1. Sorry, I think might not have been clear. The low carb version recipe, that is not a single serving, is totally the wrong recipe. It’s the high carb recipe instead.

        1. Yep, I understand 🙂 What I’m saying is that the “per meal dose” seems to be correct, so I would go based off that. You can probably buy less honey than the ingredients list calls for and on the off chance that you run out, just buy more. Does that make sense?

          1. Got it, surprised it’s still wrong on the site (and person) you got it from as well. Thank you for the clarifications.

  105. Are the instructions here for the low car high fat diet right for the larger batch? It seems to be exactly the same as the high carb one. The single serving size seems to be right though.
    https://drruscio.com/wp-content/uploads/2018/02/2bHomemadeElementalDietInstructions.pdf

    Option 1: Low Carb/High Fat
    Elemental diets offer nutrients in an easily digestible and drinkable form. Elemental diets have been
    studied for the treatment of Small Intestine Bacterial Overgrowth and found to be effective when
    taken in place of meals, 3 x day, for 2 weeks. ¹ *
    Ingredients:
    • 1000 gram bag Jo Mar Labs Amino Acids: Black Label Pure Form 21 Blend (use Jo Mar Labs
    search box to find)
    • 63-93 oz Honey (carbohydrate of glucose and fructose) Or 1 jar Now: Dextrose, 10 pound
    size (glucose)
    • 1575-1890 ml Oil (fat), such as medium train triglyceride, coconut, olive, cod liver
    • 1 bottle Pure Encapsulations: Nutrient 950 Multivitamin
    • 1 bottle Salt, preferably unrefined (ex. Real Salt, Celtic)
    • Optional: flavorings such as vanilla may be used in small amounts

    1. Hi Mike,

      Thanks for pointing that out. As it says on the top of the handout, we didn’t develop the info. Looking at it, it does seem to be a little off. I’d just go by the per day instructions – maybe you could buy a little less honey and if you end up running out, you can go pick up some more.

      1. Sorry, I think might not have been clear. The low carb version recipe, that is not a single serving, is totally the wrong recipe. It’s the high carb recipe instead.

        1. Yep, I understand 🙂 What I’m saying is that the “per meal dose” seems to be correct, so I would go based off that. You can probably buy less honey than the ingredients list calls for and on the off chance that you run out, just buy more. Does that make sense?

          1. Got it, surprised it’s still wrong on the site (and person) you got it from as well. Thank you for the clarifications.

  106. Hello Dr. Ruscio,

    I am currently in step 2 of the protocol. I had sourced probiotics locally as the shipping and international fees caused it to be very expensive to buy from the website. I have seen an improvement in my digestion and bowel movement consistency since starting the probiotics however after about 2.5 weeks on the probiotics I am now feeling very lethargic and have headaches. These symptoms have been present for about a week now and I am simply wondering if perhaps this could be a “die off reaction” or if you would recommend stopping with the probiotics. I am also wondering when would be a reasonable time to decide if step 3 would be necessary. Thanks for any advice.

    1. Hi Ryan,

      Glad you were noticing some improvements! Die-off reactions are addressed on page 271. The main difference between die-off and an actual reaction is duration. Die-off reactions will eventually go away. If you’re unsure, you could always stop taking them and see if the reaction goes away. Then add them back in and see if it comes back so you can accurately tell if the probiotics are causing your symptoms or not. Regarding your last question, check out the “Reassessing” section on page 274. Hope this helps.

  107. Hello Dr. Ruscio,

    I am currently in step 2 of the protocol. I had sourced probiotics locally as the shipping and international fees caused it to be very expensive to buy from the website. I have seen an improvement in my digestion and bowel movement consistency since starting the probiotics however after about 2.5 weeks on the probiotics I am now feeling very lethargic and have headaches. These symptoms have been present for about a week now and I am simply wondering if perhaps this could be a “die off reaction” or if you would recommend stopping with the probiotics. I am also wondering when would be a reasonable time to decide if step 3 would be necessary. Thanks for any advice.

    1. Hi Ryan,

      Glad you were noticing some improvements! Die-off reactions are addressed on page 271. The main difference between die-off and an actual reaction is duration. Die-off reactions will eventually go away. If you’re unsure, you could always stop taking them and see if the reaction goes away. Then add them back in and see if it comes back so you can accurately tell if the probiotics are causing your symptoms or not. Regarding your last question, check out the “Reassessing” section on page 274. Hope this helps.

  108. Question on Step 2 – I can’t find the animal sources of the digestive enzymes. Since I follow the biblical food laws, I don’t use porcine products. Are there any purely bovine sources of the digestive enzymes? Or alternatives?

    Thank you so much for the book. Awesome resource.

    -Heidi

    1. The pepsin in the digestive enzymes in our store is from a porcine source. You could try printing out the ingredients and take them to your local health food store to see if they have one that doesn’t contain porcine products. You could also see if they have a vegetarian alternative. Just make sure you look at the additional ingredients to make sure none will irritate your gut.

  109. Question on Step 2 – I can’t find the animal sources of the digestive enzymes. Since I follow the biblical food laws, I don’t use porcine products. Are there any purely bovine sources of the digestive enzymes? Or alternatives?

    Thank you so much for the book. Awesome resource.

    -Heidi

    1. The pepsin in the digestive enzymes in our store is from a porcine source. You could try printing out the ingredients and take them to your local health food store to see if they have one that doesn’t contain porcine products. You could also see if they have a vegetarian alternative. Just make sure you look at the additional ingredients to make sure none will irritate your gut.

  110. Step 2 questions!

    I was given the whole Bio-Botanicals protocol by a practitioner to take all together; I will instead break these down in stages and use to follow the HGHY protocol, if that works. (It was expensive and I’d like to make use of it all!)

    1) This is the soil-based probiotic I already have:
    https://biocidin.com/products/proflora-4r

    Think this one is OK to start with, then add in the Lacto-bifdo and the Saccharomyces (from your site) one at a time in?

    2) This is the adrenal support I already have:
    https://biocidin.com/products/biotonic
    Look OK for this stage?

    3) These are the HCl/digestive enzymes products I’ve been using for a while now:
    https://www.amazon.com/Doctors-Best-Betaine-Gentian-Digestion/dp/B000NRTXGW
    https://www.houston-enzymes.com/enzymes/no-fenol/
    https://www.houston-enzymes.com/enzymes/no-fenol/
    OK to substitute these? (not sure they have ox bile…)

    Thanks again, SO grateful for this forum! <3

    1. Hi Jessica,

      Thanks for your questions. I’ll do my best to answer them, but wanted to let you know that the protocol has been developed using the specific products that Dr R recommends. It doesn’t mean that other products won’t work, it just means we can’t tell you that they definitely will work, because those aren’t what Dr R uses in his clinical practice. So if you want to use what you have, you are certainly welcome to try, we’re just not as familiar with them and can’t offer much in the way of guarantees or recommendations.

      Regarding the probiotics, this product is fine for the most part, however it does contain marshmallow and aloe vera, both of which are mucilagenous herbs and can be irritating for many people with SIBO. You’ll probably want to make sure you add it in on it’s own and make sure you don’t react to it at all before adding anything else in.

      As far as the enzymes go, the only issue I see here is that it doesn’t look like there’s any support for fat digestion.

      Hope this helps.

      1. Thank you so much for answering my questions, Drew!

        1) Oh, yikes–I worried about the marshmallow and aloe vera, but was told this was a SIBO-specific product and was helpful for soothing! Argh, frustrating. Is there an order of adding them in you’d suggest? (soil-based first, or lactobacillus first, or?)

        I DO get it that it’s hard to recommend. But, at this point, I’ve spent so much money on the BIo-Botanicals–and a cabinet full of other–products, and having to rebuy all of yours now is stressful. (Right now I have $100 worth of the other probiotics on their way to me, and I fear taking them for a few days, reacting, and having to stop, adding them to the growing pile in the cabinet and wasted money….)

        2) Ooops–I linked the NoFenol twice instead of the one for fat digestion:
        https://www.houston-enzymes.com/enzymes/lypazyme/#HN007-120

        3) One more Step 2 question: I have been tested for D and know that I’m in a good range there, but my ferritin is very low, and iron supplementation has really helped with fatigue. Is it OK to add iron in at this stage, rather than D?

        Thank you so very very much, you are super helpful!

      2. Hmmm, I see that Dr. Ruscio actually *recommended* the Proflora-4R on a previous podcast (one that the makers sponsored, I notice). Any sense why he would do so if the ingredients were not indicated for SIBO folks?

        1. Hi Jessica,

          Not all of his patients have SIBO and it can be a helpful product for people that don’t have it. As I said above, if you want to use it, just give a shot, making sure you add them in one at a time so you can isolate for the effects of each supplement. Good luck!

  111. Step 2 questions!

    I was given the whole Bio-Botanicals protocol by a practitioner to take all together; I will instead break these down in stages and use to follow the HGHY protocol, if that works. (It was expensive and I’d like to make use of it all!)

    1) This is the soil-based probiotic I already have:
    https://biocidin.com/products/proflora-4r

    Think this one is OK to start with, then add in the Lacto-bifdo and the Saccharomyces (from your site) one at a time in?

    2) This is the adrenal support I already have:
    https://biocidin.com/products/biotonic
    Look OK for this stage?

    3) These are the HCl/digestive enzymes products I’ve been using for a while now:
    https://www.amazon.com/Doctors-Best-Betaine-Gentian-Digestion/dp/B000NRTXGW
    https://www.houston-enzymes.com/enzymes/no-fenol/
    https://www.houston-enzymes.com/enzymes/no-fenol/
    OK to substitute these? (not sure they have ox bile…)

    Thanks again, SO grateful for this forum! <3

    1. Hi Jessica,

      Thanks for your questions. I’ll do my best to answer them, but wanted to let you know that the protocol has been developed using the specific products that Dr R recommends. It doesn’t mean that other products won’t work, it just means we can’t tell you that they definitely will work, because those aren’t what Dr R uses in his clinical practice. So if you want to use what you have, you are certainly welcome to try, we’re just not as familiar with them and can’t offer much in the way of guarantees or recommendations.

      Regarding the probiotics, this product is fine for the most part, however it does contain marshmallow and aloe vera, both of which are mucilagenous herbs and can be irritating for many people with SIBO. You’ll probably want to make sure you add it in on it’s own and make sure you don’t react to it at all before adding anything else in.

      As far as the enzymes go, the only issue I see here is that it doesn’t look like there’s any support for fat digestion.

      Hope this helps.

      1. Thank you so much for answering my questions, Drew!

        1) Oh, yikes–I worried about the marshmallow and aloe vera, but was told this was a SIBO-specific product and was helpful for soothing! Argh, frustrating. Is there an order of adding them in you’d suggest? (soil-based first, or lactobacillus first, or?)

        I DO get it that it’s hard to recommend. But, at this point, I’ve spent so much money on the BIo-Botanicals–and a cabinet full of other–products, and having to rebuy all of yours now is stressful. (Right now I have $100 worth of the other probiotics on their way to me, and I fear taking them for a few days, reacting, and having to stop, adding them to the growing pile in the cabinet and wasted money….)

        2) Ooops–I linked the NoFenol twice instead of the one for fat digestion:
        https://www.houston-enzymes.com/enzymes/lypazyme/#HN007-120

        3) One more Step 2 question: I have been tested for D and know that I’m in a good range there, but my ferritin is very low, and iron supplementation has really helped with fatigue. Is it OK to add iron in at this stage, rather than D?

        Thank you so very very much, you are super helpful!

      2. Hmmm, I see that Dr. Ruscio actually *recommended* the Proflora-4R on a previous podcast (one that the makers sponsored, I notice). Any sense why he would do so if the ingredients were not indicated for SIBO folks?

        1. Hi Jessica,

          Not all of his patients have SIBO and it can be a helpful product for people that don’t have it. As I said above, if you want to use it, just give a shot, making sure you add them in one at a time so you can isolate for the effects of each supplement. Good luck!

  112. Hello,

    I’m currently in the throws of Step 1 and had a question regarding Step 2. Prior to the fast, I had to discontinue my probiotics and digestive enzymes to complete a stool test. I never resumed these supplements and wondering do I need to take these again or can I jump to Step 3, antimicrobials?

    Thanks,
    Caroline

    1. Hi Caroline,

      We’d recommend following the protocol as written, so going through step 2 as it’s laid out before moving on to step 3. Hope this helps!

  113. I’m looking at Step 2 with lots of supplements to take & lots of $$ to spend. Several years ago I was under the care of a Functional Medicine doctor and have tried all these supplements (including antimicrobials) and the AIP diet. Nothing has helped me feel better. I’m 66 and have had RA for 24 years.

    To figure out if any of these help me feel better I’d like to try one at a time.Your book mentions on p. 274 we can ADD in one supplement at a time. If I take one for 2 weeks and don’t notice any change, can I completely stop it and just try a different one? If I don’t notice feeling better with any of them, then what?

    I have a feeling you’re going to tell me to follow the protocol in the book. But, I’m interested to know what you suggest to folks who don’t feel better after all 8 steps.

    Thanks for your help!

    1. Hi Denise,

      The protocol was designed to have each step build upon the last. Many of the supplements end up working synergistically to give an effect that wouldn’t be possible with just one supplement at a time. I definitely understand the concern about cost. But please know that Dr R has done everything he can to design the protocol in a cost-effective manner, including making some supplements optional (e.g. vitamin D, magnesium). He also designed it to taper off of the supplements as quickly as possible. Hope this helps.

  114. I’m looking at Step 2 with lots of supplements to take & lots of $$ to spend. Several years ago I was under the care of a Functional Medicine doctor and have tried all these supplements (including antimicrobials) and the AIP diet. Nothing has helped me feel better. I’m 66 and have had RA for 24 years.

    To figure out if any of these help me feel better I’d like to try one at a time.Your book mentions on p. 274 we can ADD in one supplement at a time. If I take one for 2 weeks and don’t notice any change, can I completely stop it and just try a different one? If I don’t notice feeling better with any of them, then what?

    I have a feeling you’re going to tell me to follow the protocol in the book. But, I’m interested to know what you suggest to folks who don’t feel better after all 8 steps.

    Thanks for your help!

    1. Hi Denise,

      The protocol was designed to have each step build upon the last. Many of the supplements end up working synergistically to give an effect that wouldn’t be possible with just one supplement at a time. I definitely understand the concern about cost. But please know that Dr R has done everything he can to design the protocol in a cost-effective manner, including making some supplements optional (e.g. vitamin D, magnesium). He also designed it to taper off of the supplements as quickly as possible. Hope this helps.

  115. Hi there! I have had good luck with the soil-based probiotic (though sadly, it’s backordered in the store now, yikes!), but WOW, do I ever have a bad reaction to saccromyces boulardii! I tried to onboard it a few times, given that I’d heard it’s good for combating yeast overgrowth, but it has really backtracked me, sadly.

    I know you can’t diagnose over the internet, but I am wondering if those who tend towards fungal issues, have bad reactions to the yeast in saccromyces boulardii, as well as to mushrooms/fungus in the diet, might be indicative of a yeast allergy? Or just overgrowth issues?

    Thanks for everything!

  116. Hi there! I have had good luck with the soil-based probiotic (though sadly, it’s backordered in the store now, yikes!), but WOW, do I ever have a bad reaction to saccromyces boulardii! I tried to onboard it a few times, given that I’d heard it’s good for combating yeast overgrowth, but it has really backtracked me, sadly.

    I know you can’t diagnose over the internet, but I am wondering if those who tend towards fungal issues, have bad reactions to the yeast in saccromyces boulardii, as well as to mushrooms/fungus in the diet, might be indicative of a yeast allergy? Or just overgrowth issues?

    Thanks for everything!

  117. Hello — great book and thanks for putting this together.

    1) What is your take on the recent evidence that suggests megadoses of probiotics can cause excessive buildup of D-Lactic Acid? Is it really necessary to go above 100 billion CFUs in order to get the benefits?

    2) I’ve heard of other practitioners recommending that patients ‘pulse’ their probiotics, but I haven’t heard anything as to why they would do this, let alone the timing they recommend. What’s your opinion on this topic?

    3) I’ve been taking iberogast for a long time, to help with my symptoms. Seeing that it’s seen as effective for treating issues common to stomach acid dysfunction, are there any concerns being on it for too long, in the way that there is concern with being on H2 blockers for too long?

    1. Hi Henrik,

      So glad you’re enjoying the book. We’d love an Amazon review if you feel up to it.

      1) Check out this page: https://drruscio.com/stress-microbiota-episode-37/ and scroll down to the section titled “Probiotics and SIBO” to see his take on D-Lactic Acid.
      2) To my knowledge, Dr Ruscio doesn’t do this with his patients. I’m going to add this question to the list for an upcoming listener q+a episode of the podcast. Stay tuned!
      3) Per Iberogast’s website: “No cure has been found yet, but there’s no strict limitation on how long a patient can use Iberogast® to manage their digestive symptoms and bring reliable relief.” Though it could be worth trying to wean off of it in step 7 after going through the whole protocol to see if you really still need it.

      Hope this helps!

  118. Hello — great book and thanks for putting this together.

    1) What is your take on the recent evidence that suggests megadoses of probiotics can cause excessive buildup of D-Lactic Acid? Is it really necessary to go above 100 billion CFUs in order to get the benefits?

    2) I’ve heard of other practitioners recommending that patients ‘pulse’ their probiotics, but I haven’t heard anything as to why they would do this, let alone the timing they recommend. What’s your opinion on this topic?

    3) I’ve been taking iberogast for a long time, to help with my symptoms. Seeing that it’s seen as effective for treating issues common to stomach acid dysfunction, are there any concerns being on it for too long, in the way that there is concern with being on H2 blockers for too long?

    1. Hi Henrik,

      So glad you’re enjoying the book. We’d love an Amazon review if you feel up to it.

      1) Check out this page: https://drruscio.com/stress-microbiota-episode-37/ and scroll down to the section titled “Probiotics and SIBO” to see his take on D-Lactic Acid.
      2) To my knowledge, Dr Ruscio doesn’t do this with his patients. I’m going to add this question to the list for an upcoming listener q+a episode of the podcast. Stay tuned!
      3) Per Iberogast’s website: “No cure has been found yet, but there’s no strict limitation on how long a patient can use Iberogast® to manage their digestive symptoms and bring reliable relief.” Though it could be worth trying to wean off of it in step 7 after going through the whole protocol to see if you really still need it.

      Hope this helps!

  119. I have completed stage 1 now onto stage 2 ive just got all the supplements in front of me and in the book it mentions digestive enzyme with HC1 but I also have the Digestive Acid Hc1 in a separate bottle. Do I take these together with food? and I also have the pure phto-ADR but now I cant find why I have ordered that. What is this one for please. thank you

    1. Hi Christine,

      Digestive enzymes with HCl is what you should be taking as part of the protocol. If you’ve determined that you need extra HCl or for some reason can’t tolerate the enzymes, then you can take the Digestive Acid HCl. And yes, always with food.

      The second supplement you’re referring to is a vegetarian version of the adrenal support supplement. Usually people choose one or the other (Adrenal Support Complete or Phyto-ADR). You’ll find more info on both of these on page 272 of the book.

      Hope this helps.

  120. I have completed stage 1 now onto stage 2 ive just got all the supplements in front of me and in the book it mentions digestive enzyme with HC1 but I also have the Digestive Acid Hc1 in a separate bottle. Do I take these together with food? and I also have the pure phto-ADR but now I cant find why I have ordered that. What is this one for please. thank you

    1. Hi Christine,

      Digestive enzymes with HCl is what you should be taking as part of the protocol. If you’ve determined that you need extra HCl or for some reason can’t tolerate the enzymes, then you can take the Digestive Acid HCl. And yes, always with food.

      The second supplement you’re referring to is a vegetarian version of the adrenal support supplement. Usually people choose one or the other (Adrenal Support Complete or Phyto-ADR). You’ll find more info on both of these on page 272 of the book.

      Hope this helps.

  121. Hello,

    I’m currently in the throws of Step 1 and had a question regarding Step 2. Prior to the fast, I had to discontinue my probiotics and digestive enzymes to complete a stool test. I never resumed these supplements and wondering do I need to take these again or can I jump to Step 3, antimicrobials?

    Thanks,
    Caroline

    1. Hi Caroline,

      We’d recommend following the protocol as written, so going through step 2 as it’s laid out before moving on to step 3. Hope this helps!

  122. Is there a typo on Page 273? Under the Enzymes Protocol is says Lacto/Bifido Probiotic Blend 1/4 tsp. Can you clarify what it should be please?

    1. I also noticed that. I believe the product should be Digestive Enzyme with HCL. The dose should be 1-3 pills with each meal.

    1. Hi Marybeth,

      Each one is different and should be spelled out in the relevant chapter in the book. Hope this helps!

  123. I’ve been loving your book so far and have found it really helpful! I’m about to move on to Step 2 but have a question about the adrenal support. It seems that I don’t tolerate nightshades (I’ve been on the AIP paleo diet for a while and nightshades seem to always cause a reaction). I noticed that both of the adrenal supplement options contain Ashwagandha, which is a nightshade. Do you know of any other adrenal support supplements without Ashwagandha that you would recommend I try? Thanks!

    1. Thanks!
      I would give our product a try, I haven’t noticed reactions often with it – irrespective of night shade tolerance. Or, you could try another formula but I don’t have a specific recommendation.

  124. I’m getting ready to order your support supplements and notice the lacto-bifido probiotic blend is in a base of inulin. I’ve been doing paleo low fodmap and it’s helping! So I’m confused as to why I’d want to take a supplement with inulin now?

    1. The amount of inulin included is negligible and most people have no reaction to it. Hope this helps.

  125. Hi Dr. Ruscio,

    First, your book is a life saver….and by that I mean I’ve decided not to jump out the window. 😉 No, really though, I can’t tell you how appreciative I am of your words to relax, to not stress out, and to not kill myself by trying to reach for dietary perfection throughout the process. Those thoughts, repeated throughout your book, have taken a load off of me.

    I made it through the bone broth Reset (slightly modified). By the end of day 2 I had a splitting headache that would not quit no matter how much broth I drank, so I ate a small amount of FODMAP/SCD friendly food. That got rid of my headache and I was able to fast for an additional day and 3/4 before ending the fast.

    Now that I am finished with that step, I have a few questions:

    First, I know that I respond best (from past experience) on a low FODMAP/SCD diet. Anyway, given that knowledge, should I still eat that diet for a few weeks BEFORE I move on to Step 2, or should I just go ahead and start “Supporting” while on the diet, even though I’ve only been on the diet for a day?

    Second, from past tests and current reactions to various foods, I know I have SIBO, but I have no idea if I have any fungal overgrowth. Am I supposed to take the Saccharomyces Boulardii (I have no diarrhea) even if I don’t know whether a fungal or h. pylori overgrowth exists?

    Third, are you ok with this adrenal support supplement? ( https://drbenkim.com/sunshop/index.php?l=product_detail&p=89 ) It’s slightly different than the one in your shop, but since I already have it, I thought I’d ask. By the way, I have no problem buying the one from your shop if you prefer the ingredients.

    And last, a BIG thank you again for writing this book. It’s so nice to have all the information in one place. Maybe I can start throwing away my piles of articles, and stop stressing about not being able to see the doctor (you included) as often as I should!

    Many thanks,
    L

    1. Hi L,
      Glad to book has been helpful.
      1. You could go right into Step 2.
      2. Yes, follow the protocol as listed – don’t let prior lab tests or hypotheses distract you from following the Great-in-8 plan as outlined.
      3. I will leave that up to you 🙂
      Yes, I hope so!
      If you could write a review on Amazon, that would be much appreciated – https://www.amazon.com/Healthy-Gut-You-Michael-Ruscio/dp/0999766805/ref=cm_cr_arp_d_product_top?ie=UTF8
      Keep up the good work!

  126. Hi Dr Ruscio,
    I am currently doing step one but preparing for step 2 by looking into purchasing the supplements now. Do you have a UK supplier? Or are the supplements readily available in the UK?

    Thanks,
    Heidi

    1. Hi Heidi I live in the UK and had to ship via FedEx from the US. Far as I know there is no UK supplier. Expensive though it is, it is worth it. I bought two month’s worth.

  127. I love the book, and am ready for step two. I’ve eaten a Paleo/Keto style for several months. I’m just finishing a Microbiome Labs Mega sporbiotic. Should I finish it before I start the step 2 supplements or can I just go forwards with it all. I am in cancer treatment (immunology) and I’m having a challenge finding things to eat in the morning that settle. So far butter coffee and matcha and MCT seem to work OK. I tried ghee instead of butter, but it gives indigestion.

  128. Hello I’ve read your excellent book and have began your programme. I’ve just completed the Reset and have a couple of questions,

    I think I may be a classic case of “leaky gut syndrome”. I’ve had a very long history of chronic fatigue (20 years) but was originally in that group of people without overt gut symptoms. When they did start to make themselves apparent, I took various steps to improve my diet. I’ve been eating more or less paleo for several years and the fatigue is hugely improved.

    However, I’ve become increasingly sensitive to foods. First was chocolate (of all things!); I’m fully and instantly allergic to that. Then a couple of years ago I had a really nasty reaction to oxalates (green smoothies!). That made my face swell, gave me ‘flu symptoms, huge fatigue and mineral deficiencies.

    I’ve experienced sporadic loose stools and bouts of exhaustion and, particularly since menopause, have put on weight that I cannot shift. I’ve tried various ways to identify food intolerances including two MRT tests to guide an exclusion diet but my symptoms can be vague and wax and wain so, I’m really none the wiser.

    I went off gluten 15 months ago following 3 separate fairly dramatic incidents when staying away from home. Each time 1 or 2 days of hotel/restaurant food produced severe bloating, vomiting and diarrhea, flu symptoms and severe fatigue. (I happened to be wearing a continuous glucose monitor on two of the occasions and interestingly my glucose plummeted to hypo levels).

    I feel a lot better gluten free but it’s obviously restrictive. I suspect gluten may be an issue of quantity but I’ve not dared to try it again to find my level. Instead I’ve been focussing on gut healing. I’ve been taking Zach Bush’s Restore for 9 months and your book is my next step.

    Question 1: Because I’ve generally been eating paleo and have had a hard time identifying intolerances I’ve decided to proceed to Steps 2 and 3. Should I do them sequentially or can I combine the two steps? I ask because I have 5 weeks before I have to work away from home for a 2 week period. Ideally I would like to be in a position to eat a bit more normally by then because I will be working on a trade stand with limited cooking facilities and limited access to GF restaurants/food outlets.

    Question 2: I managed a 3.5 day bone broth fast. I was ok on transition day, pretty good on days 2 and 3 and then was incredibly fatigued on day 4. I lost 6lbs which was great as previous attempts at IF yielded zero fat loss. My only success at improving body composition was with a trainer and eating 5 meals a day. Can I surmise that best for me would be to eat regular meals normally and then throw in periodic fasts but make them say 2 – 3 days in duration?

    Many thanks for your help.

    Diane

    1. Thanks Diane,
      Question 1: Make sure to follow the protocol in the book specifically. If you haven’t tried low FODMAP, try it. Also, this would mean perform step 2 before step 3. Please trust the wisdom of the protocol and don’t mix, match or alter 🙂

      Question 2: Glad this was helpful. This certainly seems reasonable, try it and see how it goes.

      Hope this helps

  129. Your book was truly enlightening and I really appreciate your pragmatic and methodical approach.. i am in the middle of Step 2, following Autoimmune Palio and will likely move onto Step 3 as not 100% better. I have reeently been diagnosed with Hashimoto’s and am struggling to find a really good multivitamin as per your recommendation, without iodine and iron (I am post menopausal. Have you thought of making your own or could you recommend one? Also what are your thoughts on daily iodine dosage for Hashimoto’s?

  130. I enjoyed the book and have gained lots of valuable information. I started on a low FODMAP diet and noticed some slight improvement. I am now doing the probiotic protocol. When will the Saccharomyces Boulardii be back in stock?

  131. Perhaps an odd question,but I’ll ask anyway. 🙂

    I’m in step 2 right now.

    I had a plantar wart for many years and the only thing that got rid of it was DIM (Diindolylmethane) powder taken orally for about 3 months.

    I’ve got another coming back and want to take Diindolylmethane for it again, but wondering if there are any negative effect on gut health. Haven’t found anything online.

    Are you able to tell me how Diindolylmethane may affect gut health?

    Thanks,

    -J

  132. I have read the book and listened to podcasts about histamine. Symptoms are mainly itching, heart burn (on PPI’s), constipation and some tummy pain. For a few years I have been eating mainly paleo. I have had a hard time totally following health diets. On September 1st I joined Overeaters Anonymous and the step are helping me and I have been doing great eating very healthy. However my above systems have gotten worse and worse. I am now on a low FODMAP low histamine diet with no relief.

    1) I was concerned that the probiotics you sell would not work well if I do have histamine issues. So I orders some from another maker for now. Histamine Drs. have mixed views on soil based probiotics and s. B”. What do you think?

    2) My energy is OK so is it OK not to use the adrenal support?

    3) Can the itching be because I have lowered my carbs to much? I seem to have less itching with more carbs but then it would be feeding bacteria and other over growths?

    1. Hi Christine,

      I’m sorry you’re having such a tough time, feel free to set up a consult with Dr Ruscio if you’d like more personalized advice (you can do so here: https://www.drruscio.com/gethelp)

      1. It really depends on the person as everyone reacts differently. You could try it out and see how you feel.
      2. We recommend following the protocol in the book as closely as possible (including adrenal supplements.
      3. Not sure, but listen to your body and eat what makes you feel better. You don’t need to eat zero carbs to fix your gut issues.

      Hope this helps.

    1. Dr Ruscio generally thinks the protocol is ok for children if you use 1/2 the dose of the listed protocols, but also strongly recommends consulting with their pediatrician before proceeding with the protocol.

      Also he tends to be very minimal with dietary restrictions with children.

      Hope this helps!

  133. Everything I’ve read about the use of probiotics (all 3 that your store sells) during pregnancy points to them being safe to use. Can you confirm that or at least comment on the subject?

    1. To our knowledge, they are safe during pregnancy. However, you should run all supplements you plan to take by your OB-GYN first to get their final sign off. Hope this helps!

  134. I’ve been taking the Adrenal Support Complete since last summer, and I think it’s been very helpful. I discovered how much so when I ran out last week and became totally exhausted, in the hard-to-walk-across-the-street way that I had last year. Got better when I replaced it. So, it’s working for me.

    I did get concerned, though, reading things online (this is why I’m checking in!) about how taking adrenal extracts can cause your own adrenal glands to stop working, and that it takes months to get them working again after cessation. Yikes!

    My integrative NP just said “I’ve found that it’s best to rotate adrenal support and occasionally take breaks from Adrenal bovine glandulars (such as what is in this product).” Has this been true in your experience?

    1. Glad to hear it’s helpful! I’m not aware of adrenal herbs preventing your own adrenals from working, but it also seems like sound advice from your NP.

      1. Well, that was very specifically NOT the *herbal* formulas/ingredients, but the adrenal bovine glandulars. You/Dr. R have not heard of that before?

  135. Hi
    I just finished the book and implemented Step 1 with Low Carb diet. I have hashimotos, constipation and sometimes feel bloat/heavier after eating. So ordered and waiting for probiotics and HCL+Enzymes to arrive. I eat yogurt(L Casei) daily. Do I still need to take probiotics ?
    Will let you know how this goes?
    At what point would an appointment with Doctor be useful?

    1. Hi Venkat,

      Good question! Fermented foods are a wonderful source of probiotics, but it’s tough to get a therapeutic dose from food alone. Here’s some more info if you’re interested: https://wpruscio.staging.wpengine.com/can-you-get-enough-probiotics-from-food/
      An appointment with Dr can be made at any time, but they’re usually not necessary unless you’ve gotten through at least step 3, level 3 and not seen results. Hope this helps.

      1. Thanks Drew. Based upon my Genova GI effects stool test , I was advised to take betaine+HCL. I used to take 7 per day and later step by step reduce to 1 pill which is 1gram as I started feeling the burn, reduce 1 pill strategy.

        I got Dr Ruscio’s HCL+Enzymes and have been taking 1 capsule, yet I see floating stools. Now changed to 3 capsules with meal. Is that the right dosage? How can I fix my fat malabsorption?

        1. Hi Venkat, I would recommend following through with the HGHY protocol – it’s designed to fix many issues, including fat malabsorption.

  136. First, I want to say how much I liked the book. Very impressed and inspired a lot of confidence given all the research backing up each recommendation. Now, on to my question: I started on low doses of all three probiotics about a month ago. I wasn’t feeling much different after a few weeks, so I stepped up the dose a week ago to near (but not at) the top of the recommendation in the book. For the first four days or so my gas got worse, I was constipated, and I was really tired in the afternoons. The GI symptoms seem to be improving slightly, but I’m still exhausted after lunch. Since it’s been about a week, I’m confused if what I’m experiencing is die-off or a reaction to the dosage in one or more of the probiotics. Is it normal for a symptom like fatigue to last longer than a week if the probiotics are really having an impact…or is that unlikely?

    1. Hi Nick,

      Good question – it shouldn’t last longer than a week or so. If it does, I would either a) reduce the dose or b) take them all out and add them back in one at a time to see if it’s a specific one that’s causing the issue. Hope this helps.

      1. Thanks for replying. It was a bit late for me, but hopefully it will help somebody else in the future. I ended up cutting back my dosages and it helped a lot. I settled into the following: 1 does of L-B powder per day, 2 caps of SB in the AM and 1 at night, and 1 soil-based in the morning and 1 at night. Also, I’ve been experimenting with the low sulfur diet the past week or so and it definitely seems to be helping. Dr. Ruscio’s interview with Dr. Nigh was a great starting point, and I started some of those supplements last week as well.

  137. My first bath of probiotics batch is over and got the next one. My constiption improved and was getting to be hopeful,
    When suddenly one day I got the GI distress and discomfort. This was the first time in my life. Now I know what it fees and soon it became diarrhea. I stopped eating and just took Yogurt+Blackberries, and next day I had to take Imodium 4 pills a day for 3 more days. After 5 days the diarrhea kind got in control.

    Pls help me triage this – I did not take any outside food or outside mingling prior to this. Only thing is a day before Ihad taken the soil based probiotic 4 hours after lunch instead of immediately after. Could this be the cause?

    I had stopped all probiotics.
    Should I start the Sacchromyces Boulardi and Soil based probiotic again? Instead of Lacto-Bifido, we have probiotic yogurt which I consume everyday.

    Thanks

    1. Hi Venkat,

      I’m so sorry you’re struggling. It sounds like you may be a good candidate for a quick call with our health coach. There’s no waiting list and the cost is much lower than an appt with Dr Ruscio. You can find out more info here: https://drruscio.com/health-coaching/
      Keep us posted on how you’re feeling!

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