HGHY Great-In-8 FAQ Step 3

Great-in-8 Plan Contents

Healthy Gut, Healthy You

Step 3: Remove

We will be adding answers to the most commonly asked questions about Step 3 of the Great-In-8 plan along with important information for troubleshooting this step here shortly.

Q: How much Elemental Heal will I need?

HGHY Great-In-8 FAQ Step 3 - Elemental Heal

A: Elemental Heal contains approximately 480 calories per serving (360 without oil added). This info-graphic gives you a good estimate on how many bottles you may need for your needs. To view the full caloric chart from the USDA, click here. To get a custom recommendation of your daily caloric intake, try using this calorie calculator.

Q: Is it better to eat higher FODMAP during SIBO treatment to feed the bugs you’re trying to kill?

A: The simple answer is that my recommendation is to continue whatever diet you feel healthiest on during treatment. Eating to reduce inflammation will have a stronger impact on your treatment success than eating to feed bacteria.
  • If you’re trying to restore your gut ecology, then whatever diet makes you the healthiest is what’s best for restoring a healthy biome. If eating a diet higher in FODMAPs irritates your gut and causes symptoms, I would recommend not doing that. That will cause an inflammatory milieu, which will encourage the growth of unhealthy bacteria.
  • When someone follows a low FODMAP diet, they typically have less leaky gut, fewer inflammatory cytokines, and fewer symptoms. You have a better chance of clearing an infection if you have less of all of these. We also know that lowered inflammation helps in recovery of motility. See page 21 of HGHY for more information on inflammation.
  • While there was one study that did support feeding bacteria during the treatment phase, it’s only one, and it begs the question of whether or not the improvement was clinically meaningful. Additionally, the rules for treating with herbs are likely different than treating with prescription medication (which was used in the study).
  • Ultimately, everyone is going to be getting some fiber and some FODMAPs, because a low FODMAP diet isn’t a zero residue diet. The best thing to do is to eat what’s best for you, because you are the soil from the which these bacteria grow. Inflammation favors unhealthy bacteria, while healthy bacteria flourish in an environment with less inflammation.
  • For more information, see my podcast on the topic with Dr. Allison Siebecker.

Please post any questions or comments regarding this step below.

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!

417 thoughts on “HGHY Great-In-8 FAQ Step 3

  1. First off, thanks so much for all of your work. You’ve been a great help to me on my own health journey as well as helping to shape my vision for my future as a wellness practitioner. I do have a few questions regarding step 3 of the protocol, as I am already coming off two rounds of parasite cleansing (the first with Bio-Detox from Biotics Research and the second with Scram by Nature Force and diatomaceous earth). I currently feel like I’m in the 30-70% improvement range and wondering where I should enter the Great-in-8 protocol. I feel like it makes the most sense to start on phase 3 level two, since I’ve already had a couple less-than-satisfactory attempts at removal. But maybe level one would do the trick? I am also curious about the primary differences between Biota-Clear 1a/b and 2a/b. It seems like 2a/b might be more geared toward parasitic infections, in which case I wonder if I could skip 1a/b. On that note, how common is it to have multiple infections simultaneously; for example, if I have a parasite am I more likely to also develop SIBO (or vice versa).

    Obviously, money is a big concern for me, and supplement expenses stack up quickly (especially when you’ve been trying to fix yourself for two years). So I’m definitely looking to do this a cheaply as possible, but I also would like this to finally be the beginning of the end of spending a couple hundred dollars a month on supplements.

    Thanks again for everything you do,

    AC

    1. Thanks Antonio,

      I would start the protocol at the beginning to make sure you have not overlooked a foundational step. And I wouldn’t try to modify the protocol, it’s mean to adapt to you already so trying to modify it is moot as it is already meant to adapt as your progress through it.

      To conserve cost you can opt out of the additional ad ons. You can also use the lower end of the dosage ranges listed. I hope this helps 🙂

      Would you mind writing a review for the book on Amazon? https://www.amazon.com/Healthy-Gut-You-Michael-Ruscio/dp/0999766805/ref=cm_cr_arp_d_product_top?ie=UTF8

  2. First off, thanks so much for all of your work. You’ve been a great help to me on my own health journey as well as helping to shape my vision for my future as a wellness practitioner. I do have a few questions regarding step 3 of the protocol, as I am already coming off two rounds of parasite cleansing (the first with Bio-Detox from Biotics Research and the second with Scram by Nature Force and diatomaceous earth). I currently feel like I’m in the 30-70% improvement range and wondering where I should enter the Great-in-8 protocol. I feel like it makes the most sense to start on phase 3 level two, since I’ve already had a couple less-than-satisfactory attempts at removal. But maybe level one would do the trick? I am also curious about the primary differences between Biota-Clear 1a/b and 2a/b. It seems like 2a/b might be more geared toward parasitic infections, in which case I wonder if I could skip 1a/b. On that note, how common is it to have multiple infections simultaneously; for example, if I have a parasite am I more likely to also develop SIBO (or vice versa).

    Obviously, money is a big concern for me, and supplement expenses stack up quickly (especially when you’ve been trying to fix yourself for two years). So I’m definitely looking to do this a cheaply as possible, but I also would like this to finally be the beginning of the end of spending a couple hundred dollars a month on supplements.

    Thanks again for everything you do,

    AC

    1. Thanks Antonio,

      I would start the protocol at the beginning to make sure you have not overlooked a foundational step. And I wouldn’t try to modify the protocol, it’s mean to adapt to you already so trying to modify it is moot as it is already meant to adapt as your progress through it.

      To conserve cost you can opt out of the additional ad ons. You can also use the lower end of the dosage ranges listed. I hope this helps 🙂

      Would you mind writing a review for the book on Amazon? https://www.amazon.com/Healthy-Gut-You-Michael-Ruscio/dp/0999766805/ref=cm_cr_arp_d_product_top?ie=UTF8

  3. Thank you for your very clear book, Dr. Ruscio. You are a natural teacher, which many doctors aren’t!

    You recommend the semi-elemental diet for killing bad bacteria as well as for occasional, short-term use to relieve the gut. However, I have SIBO, and I am wondering about the amount of sugar in it (6g per serving). I have heard that the sugars in the elemental diet may worsen SIBO, especially if it is proximal SIBO. For this reason Integrative Therapeutics has recently come out with a dextrose free elemental that has less than 1g of sugar per serving. Yet I also see that, even with 6g/serving, your semi-elemental diet does not have dextrose or any sugar as an ingredient. I assume the sugar content is naturally occurring in other ingredients. This leads to 2 questions:

    (1 ) Do you consider your semi-elemental diet safe for use with proximal SIBO?

    (2) What do you consider proximal SIBO to be? On my most recent test, I still tested positive at the 80 min mark, but not before. Do you think the semi-elemental is safe for me?

  4. I am working through the REMOVE step and about to begin month 2. The book contradicts itself as well as the website with regards to Biota Clear 2a. The book says to “take 2 pills twice a day. This will require one bottle total”. Then in a chart on the same page of the book it says to take Biota Clear 2 pills twice a day and that 2 bottles are needed. The website where you order Biota Clear 2a it says “Suggested Use: 1 capsule three times per day or as recommended by your health care professional”. I understand that the website may not match up with the dose you prescribe in the book, but the website says that the bottle has 90 pills per bottle which is not enough for 2 pills twice a day, and 2 bottles will be too much for 2 pills twice a day. Can you please clarify the dose of Biota Clear 2a and whether 1 or 2 bottles will be required for the month 2 protocol of the REMOVE phase?

  5. I am working through the REMOVE step and about to begin month 2. The book contradicts itself as well as the website with regards to Biota Clear 2a. The book says to “take 2 pills twice a day. This will require one bottle total”. Then in a chart on the same page of the book it says to take Biota Clear 2 pills twice a day and that 2 bottles are needed. The website where you order Biota Clear 2a it says “Suggested Use: 1 capsule three times per day or as recommended by your health care professional”. I understand that the website may not match up with the dose you prescribe in the book, but the website says that the bottle has 90 pills per bottle which is not enough for 2 pills twice a day, and 2 bottles will be too much for 2 pills twice a day. Can you please clarify the dose of Biota Clear 2a and whether 1 or 2 bottles will be required for the month 2 protocol of the REMOVE phase?

  6. Dear Dr Ruscio,

    Is there a substitute for the Oregano oil? I seems like I may be having a bad reaction to it (knee pain, irritation at corners of mouth)
    Thanks,

  7. Hi Dr. Ruscio,

    Regarding the following statement in Chapter 17:

    “Unfortunately, I have found some of the most popular functional-medicine tests for pathogens and parasites to be highly inaccurate, which is likely why, in the clinic, we routinely find infections that other doctors have missed”.

    I am a SIBO patient who continues to relapse. Will be working shortly with a gastroenterologist to once again rule out IBD. Have tested three times already using FM tests to rule out parasites (namely Genova GI Effects and Diagnostic Solutions Lab). These haven’t found anything. Before I spend any more money on another stool/PCR test, can you share what testing you do in your clinic for pathogens/parasites that you feel is really reliable?

    thanks,

  8. Hi Dr. Ruscio,

    Regarding the following statement in Chapter 17:

    “Unfortunately, I have found some of the most popular functional-medicine tests for pathogens and parasites to be highly inaccurate, which is likely why, in the clinic, we routinely find infections that other doctors have missed”.

    I am a SIBO patient who continues to relapse. Will be working shortly with a gastroenterologist to once again rule out IBD. Have tested three times already using FM tests to rule out parasites (namely Genova GI Effects and Diagnostic Solutions Lab). These haven’t found anything. Before I spend any more money on another stool/PCR test, can you share what testing you do in your clinic for pathogens/parasites that you feel is really reliable?

    thanks,

  9. Is the dosing for NAC really 2700mg three times daily? Would you please tell me how you came to this dosing?

  10. Hey Dr. Ruscio,
    Absolutely loved Healthy Gut, Healthy You. Thank you for working so diligently to put together a succinct plan that anyone can implement. I have been working through your protocol for about two months now. My digestion has improved exponentially as well as my anxiety. I have become so much better at truly listening to what my body is suggesting as opposed to just trying to hit numbers or perfect timing.
    I have noticed immense relief in bloating/mood swings/gas from following the AIP/Low Fodmap approach. I am finishing up my second month of Oregano Oil and Berberines. Also taking Adaptogens for Adrenal Support, Lacto/Bifido/SBO/S. Boulardii, C, Multi, CoQ10, Turmeric, and gut support with some DGL/L-Glutamine/MSM/Sliperry Elm etc. My chief concern at this point is that I still have a nagging hard-heartbeat, that rises post-meal and excessively after mild exercise (like casual walking outside). I am not sure if it’s some type of histamine response to foods (even with the AIP/Low fodmap diet), or my bankrupt adrenals (very low cortisol and DHEA on CAR 6-point test), or my low T3 on thyroid panel, or just the damn 10 dysbiotic pathogens on my stool test (Giardia, E-coli, Clostridium, Enterobacter, Eneterococcus Faecium, Streptococcus, Provotella Copri, Candida…; all high on GI Map), or some type of nutrient deficiency caused by the infections (Selenium, Zinc, Iron, Thiamine?).
    28, 180lbs, 12% body fat, low-carb (because of carb malabsoprtion, digestion, and satiety not a low-carb bible thumper), getting my 8 hours of sleep before midnight, green tea only during day (helps with motility/also taking iberogast), and perceptively healthy to the outside world……perceptively…
    Any suggestions for heart palpitations/intensified heart-beat post meal and after very light exercise? Looking at Izaeblla Wentz’s work currently for some leads. Thanks Doc. Your one of the best in the game. Loved your chat on Mindpump and I’m a subscriber to Dr. Ruscio Radio as well. Keep fighting the good fight, you’re impacting more lives than you realize.

    1. Hi Ryan,
      Thanks and glad to hear your feeling better! You might want to perform a low histamine trial, or up your carb intake. I would also check in with a doctor to make sure your not experiencing a bout of hyperthyroid. If this is a symptom you have experienced previously, but all your other symptoms have improved, this may improve simply with time.
      Those are a few things to consider.
      Hope this helps!

  11. Hey Dr. Ruscio,
    Absolutely loved Healthy Gut, Healthy You. Thank you for working so diligently to put together a succinct plan that anyone can implement. I have been working through your protocol for about two months now. My digestion has improved exponentially as well as my anxiety. I have become so much better at truly listening to what my body is suggesting as opposed to just trying to hit numbers or perfect timing.
    I have noticed immense relief in bloating/mood swings/gas from following the AIP/Low Fodmap approach. I am finishing up my second month of Oregano Oil and Berberines. Also taking Adaptogens for Adrenal Support, Lacto/Bifido/SBO/S. Boulardii, C, Multi, CoQ10, Turmeric, and gut support with some DGL/L-Glutamine/MSM/Sliperry Elm etc. My chief concern at this point is that I still have a nagging hard-heartbeat, that rises post-meal and excessively after mild exercise (like casual walking outside). I am not sure if it’s some type of histamine response to foods (even with the AIP/Low fodmap diet), or my bankrupt adrenals (very low cortisol and DHEA on CAR 6-point test), or my low T3 on thyroid panel, or just the damn 10 dysbiotic pathogens on my stool test (Giardia, E-coli, Clostridium, Enterobacter, Eneterococcus Faecium, Streptococcus, Provotella Copri, Candida…; all high on GI Map), or some type of nutrient deficiency caused by the infections (Selenium, Zinc, Iron, Thiamine?).
    28, 180lbs, 12% body fat, low-carb (because of carb malabsoprtion, digestion, and satiety not a low-carb bible thumper), getting my 8 hours of sleep before midnight, green tea only during day (helps with motility/also taking iberogast), and perceptively healthy to the outside world……perceptively…
    Any suggestions for heart palpitations/intensified heart-beat post meal and after very light exercise? Looking at Izaeblla Wentz’s work currently for some leads. Thanks Doc. Your one of the best in the game. Loved your chat on Mindpump and I’m a subscriber to Dr. Ruscio Radio as well. Keep fighting the good fight, you’re impacting more lives than you realize.

    1. Hi Ryan,
      Thanks and glad to hear your feeling better! You might want to perform a low histamine trial, or up your carb intake. I would also check in with a doctor to make sure your not experiencing a bout of hyperthyroid. If this is a symptom you have experienced previously, but all your other symptoms have improved, this may improve simply with time.
      Those are a few things to consider.
      Hope this helps!

  12. Hi Dr. Ruscio,
    First of all – thank you so much for your book. I allready have some relieve after 27 years of symptoms, that over the last years got so bad, that I sometimes could not work. I’m from Germany and it seems even harder to find a doctor who knows about SIBO here. Though I found one, who even prescribes Rifaximin, I still have some questions. My dominant symptom was bloating and related pain. When I did the first round with Rifaximin (7 months ago), I combined it with Atrantil, as I learned from Dr. Siebecker. It was amazing, I felt absolutely great for three months, but than it came back. What didn’t change is the belching.. There is so much gas coming out upwards, that I feel really uncivilized at times!! It wakes me up at night, is really bad after getting out of bed and starts also about 15 minutes after eating – even when there are hardly any carbs in my food. When the bloating came back, I got Rifaximin again and this time I combined it with Allicin. It helped some, but again didn’t change the belching. That’s when I found your book. Now I tried low FODMAP and low Carb Diet along with the Probiotics and Enzymes and HCL. My digestion changed and constipation is gone -very happy there ! Sometimes I had pain in my stomach, so I stopped HCL, After four weeks Low-Carb I still had headaches, brainfog and fatigue, so I figured it could not be the die off anymore and then increased Carbs a little. That was somewhat better. BUT – and here is my question: the belching still remains really bad and I still have these brainfog periods, mostly before noon. The Thyroid labs are allright, Cortisol was a bit low once but not when they took another bloodsample in the morning. Since I have allready done two rounds off “removal” I’m hesitant to go ahead with the removal-step again- don’t want to destroy everything in my gut… After seven weeks of diet I also startet Iberogast two weeks ago, I thought it might move things a bit downward, so that the belching would decrease. Anyhow, so far it doesn’t change. So, I am a lot better than I was a year ago but since I’m not done with my recovery journey, I was wondering, if you have any idea, what to do next.

    I’m truly grateful and will write a most positive comment at amazon, but so far I’m waiting until I can say how far it took me. Thanks again to you and your team!!

    Sandra

    1. Glad to hear your feeling better Sandra. A few things to consider and/or discuss with your doctor;
      -another trial of HCl, intermittent fasting, 2-4 reset with elemental diet, rotation diet to detect food intolerances, and… TIME 🙂
      Hope this helps!

  13. Hi Dr. Ruscio,
    First of all – thank you so much for your book. I allready have some relieve after 27 years of symptoms, that over the last years got so bad, that I sometimes could not work. I’m from Germany and it seems even harder to find a doctor who knows about SIBO here. Though I found one, who even prescribes Rifaximin, I still have some questions. My dominant symptom was bloating and related pain. When I did the first round with Rifaximin (7 months ago), I combined it with Atrantil, as I learned from Dr. Siebecker. It was amazing, I felt absolutely great for three months, but than it came back. What didn’t change is the belching.. There is so much gas coming out upwards, that I feel really uncivilized at times!! It wakes me up at night, is really bad after getting out of bed and starts also about 15 minutes after eating – even when there are hardly any carbs in my food. When the bloating came back, I got Rifaximin again and this time I combined it with Allicin. It helped some, but again didn’t change the belching. That’s when I found your book. Now I tried low FODMAP and low Carb Diet along with the Probiotics and Enzymes and HCL. My digestion changed and constipation is gone -very happy there ! Sometimes I had pain in my stomach, so I stopped HCL, After four weeks Low-Carb I still had headaches, brainfog and fatigue, so I figured it could not be the die off anymore and then increased Carbs a little. That was somewhat better. BUT – and here is my question: the belching still remains really bad and I still have these brainfog periods, mostly before noon. The Thyroid labs are allright, Cortisol was a bit low once but not when they took another bloodsample in the morning. Since I have allready done two rounds off “removal” I’m hesitant to go ahead with the removal-step again- don’t want to destroy everything in my gut… After seven weeks of diet I also startet Iberogast two weeks ago, I thought it might move things a bit downward, so that the belching would decrease. Anyhow, so far it doesn’t change. So, I am a lot better than I was a year ago but since I’m not done with my recovery journey, I was wondering, if you have any idea, what to do next.

    I’m truly grateful and will write a most positive comment at amazon, but so far I’m waiting until I can say how far it took me. Thanks again to you and your team!!

    Sandra

    1. Glad to hear your feeling better Sandra. A few things to consider and/or discuss with your doctor;
      -another trial of HCl, intermittent fasting, 2-4 reset with elemental diet, rotation diet to detect food intolerances, and… TIME 🙂
      Hope this helps!

  14. Hi Dr. Ruscio!

    Thank you SO much for all of this information it is the first time I have felt hopeful in awhile. Here is my question is there harm in doing the elemental diet before trying the anti-microbials? I have been dealing with gut issues for over a year now, and have been on anti-biotics and protcols for a parasite as well as bad bacteria and tried all of the diets covered in the book. I have just at this point spent so much time and money and am still bloated and uncomfortable ever day! But I know it is because I most likely have SIBO or some other dysbiosis still going on given everything I have been through. I am ready to just clear everything out once and for all!

    So, just curious your thoughts on that. I am also trying to do the most affordable option at this point because I have spent SO much over the last year trying to figure this out. Any input would be amazing thank you!

  15. Hey Michael!

    Love the podcast (long-time listener) and now the book! I’ve been recommending it to as many people as I think would find it useful – which is a lot 😄 Just wish it’d come out last November when I began working with a naturopath – I’ve spent a lot on tests and treatments, and almost a year on elimination diets, and things just seem to be getting worse.

    I’ve done a couple courses of anti-microbials/anti-paracites. Some prescription like azithromecin for campflobacter and Ivermectin (even though parasites didn’t show up on my stool test). Some supplemental, very similar to what you’ve recommended in Step 3 (Biota-Clear 1a, 2a/Paracid Forte, Liposomal Biocidin and NAC in particular). This is alongside chealation, detoxes (including Dr. Bryan Walsh’s), many more supplements (probiotics, multivitamins, enzymes, aloe vera, glutathione, L-glutamine, etc, etc.), blood glucose testing, elimination diets (low FODMAP, AIP), etc.

    Having already followed a protocol quite similar to your step 2 and 3, I’m considering a meat-only/ZC diet (based on Mikhaila Peterson’s amazing results) or/and an elemental diet.

    – Do you think it’s worth going through your Step 2 and 3 *again*, with or before these diets?
    – Which diet would you try first?

    I’d love to hear your thoughts on ZC some day too, but the other questions are more urgent. Thanks for your help Dr. Ruscio and keep sharing the great work you do – you’re one of the best critical thinkers in this space, something we truly need right now.

    1. Thanks!
      I would try the ED next, then consider combining with Habx if they seem to help you. Some patients need hybrid ED plus low dose cyclical Habx, don’t miss this nuance. It is in the book. Give that a go, but clear it with your doctor first.

      1. Fantastic, thanks for the (quick) response! I’m presuming “Habx” are the antimicrobials you recommend at then end of Step 4.

        Would love to hear your thoughts on the ZC/carnivore diet someday – maybe a mini-episode of the podcast someday.

      2. I’ve just finished a 7-day water fast and home-made ED to transition from a beef-only diet to Step 2 (all supplements) & Step 3 (all 3 levels of Habx).

        Would you recommend reintroducing other foods over the course of (or before) those 2 months, or stick to beef-only until Step 5?

        Thanks for your help Dr. Ruscio!

  16. Good Morning Dr Ruscio,
    Thanks you for this book and your hardwork.

    I have a specific question about this step
    Of the process.
    My name is Alioune, i’m 25 y/o and I’ve been feeling sick since about 5 years with different digestive problems: bad digestion, constipation, acid reflux, heartburn, bloating and gas, brain fog and chronic fatigue. I also suffer from asthma sonce I was 2 y/o after I was filled up with antibiotics.

    After several tests during these 5 years, I’ve done a stool+blood+urine test, turns out I have a bad dysbiosis (no parasites) and candida in my blood plus a lot of food intolerances.
    Now I wonder:

    1 how is possible I have candida in my blood but not in my gut?
    2 is this systemic candida reversible?
    3 Can I heal candida in my blood using antimicrobials herbs of the step 3 ?
    4 I noticed I’m doing well with a FODMAP diet but, I’m not sure if I have to switch to a Paleo+FODMAP diet.

    1. I would continue to work through the protocol in the book. It’s much more thorough than any answer I can provide here. I tried to build into the book answers to your questions in terms of escalating to Paleo Low FODMAP or moving to step 3. If your not sure, try to diet, you can always do more later and go to step 3.

  17. Hi, I was working through step 2 and having some gut improvement with adding the probiotics (while on paleo low fodmaps, keeping carbs to 100-150 gm). I got an acute vaginal yeast infection and developed athlete’s foot. I have struggled with chronic candida for over a decade and been through many rounds of herbal and pharmaceutical anti-fungals despite eating low sugar. I want to move to Step 3 with the antimicrobials though my integrative doctor has prescribed 2 weeks of difucluan followed by a weekly suppressive. I realize the value to using the herbs as they will treat other pathogens and work on more modalities and I believe i need biofilm disrupters given my history (yeast markers show on various tests, but not in stool tests and I have many symptoms). So my questions:
    1. Can I do her 2 week diflucan protocol and then start your protocol?
    2. When I start yours, can I skip to the Level 2 and put the biofilm disrupters in right away
    3. Can I add the biofilm disrupters to aid the diflucan?

    Thanks!

  18. Hi Dr Ruscio,

    Great book. The advice to eat to control inflammation and blood sugar seems so obvious now, but previously I would be hesitant not to eat things like garlic and onion because I would be missing out on their health benefits. Now that I’ve read your book it’s obvious they have to be cut out for at least a period while things are being fixed.

    Anyway, I wanted to ask about step 3 – the dosing for NAC. The book lists two different doses for NAC.

    On page 280 in the left hand column it says take 1 capsule twice per day. On page 280 in the right hand column in the table it says take 3 pills three times per day. Which is right?

    Many thanks.

  19. I’ve been on a really clean and strict diet for over a year now trying to help my digestive problems, skin issues, and fatigue/brain fog. I’ve also been taking digestive enzymes/acid, adrenal support (Ashwaganhda), thyroid hormones, and Vitamins D/K/B-Complex.

    I’m better on the diet and supplements but still have all my health problems, just less severe. I even did a 3-day juice fast a month ago.

    My question is should I start with step 3 as I’ve already pretty much been doing steps 1 and 2 for the past year?

    Thanks!

  20. Hi Dr Ruscio, what is the cause of white tongue while on the semi-elemental diet and should I continue with this diet if my tongue has become white? Thank you for a great book!!

    1. Hi Becky,

      This is fairly common and usually goes away once the diet is completed and regular food is reintroduced.

  21. Wondering if ghee is an oil that would be acceptable to use with Elemental Heal? Food sensitivities to sesame and coconut oils make using Udo’s blend or MCT oil impossible. What other oils would work? Thanks.

  22. I’m one month into 1a & 1b. I’m finding that about 1 hour after eating, I feel flu type sick – skin achey, fatigued, muscle weakness. It goes away in an additional hour or so. Is this related to the gut healing process? I just started 2a & 2b today.

  23. Hi Dr. Ruscio,

    NAC dosing question:

    1.) Book says: 1 capsule twice per day.

    2.) Chart in book says: 3 pills 3 times per day with food.

    Please advise.

    Thanks for all !

    Lisa

  24. I have my son (21) doing the protocol from the book. We are looking at preparing for step 3 but he has a nut and shellfish/fish allergies I noticed the tree nut warning on Biota Clear 2B, maybe others too but are one of the options for this step 3 a nut/ shellfishfree option?

  25. Hi Dr. Ruscio,

    NAC dosing question:

    1.) Book says: 1 capsule twice per day.

    2.) Chart in book says: 3 pills 3 times per day with food.

    Please advise.

    Thanks for all !

    Lisa

  26. Hi, I just wanted to hear- how can the elemental heal be semi elemental – it does not seem to say that the whey protein you use is hydrolyzed.

    Also – is there any reason you have used maltodextrin and not glucose as the carbohydrate source?

    Thank you

  27. Hi Dr. Ruscio,
    I refer to your book often, it is so helpful. I have been on orthomolecular probiotic and am soon to start your step 3; Remove, to remove candida.
    I recently ordered the Just Thrive probiotic and was wondering if I can take it while on the Biota-clear 1a and 1b. If so, does timing matter? (take it away from the biota-clear?)
    Thanks,
    Leslie

  28. Hi Dr. Ruscio,
    I refer to your book often, it is so helpful. I have been on orthomolecular probiotic and am soon to start your step 3; Remove, to remove candida.
    I recently ordered the Just Thrive probiotic and was wondering if I can take it while on the Biota-clear 1a and 1b. If so, does timing matter? (take it away from the biota-clear?)
    Thanks,
    Leslie

  29. Dr. Ruscio,
    Your Elemental diet contains milk? Whats up with that? This part of the program not for lactose intolerance individuals? Or you take an enzyme with it?

  30. Hi Dr Ruscio,

    I had a few questions about the Elemental Heal as used for 1-3 weeks as treatment.
    Currently going through the 2nd month of step 3 on the antimicrobials, really interested in doing an elemental heal fast once finished.

    1) Would it still be effective to fast on both the Elemental Heal and homemade vegetable juice? Since the Elemental Heal is expensive (college student budget) I was thinking of only drinking half the recommendation daily intake of the shakes, and adding in 1-2 glasses of juice.

    2) Could I instead just drink only 1-2 servings of Elemental Heal a day instead of the full 3? It would be less calories, but I imagine still effective for the gut.

    Thank you very much!
    Also, I have my appointment set for March 29th to become a patient of yours, looking forward to it.

    1. Hi Cameron,

      I would recommend following the protocol in the book as closely as possible. Drinking fewer shakes is probably preferable to drinking veggie juice, but it also depends on how long you do the ED, as you don’t want to go too long without getting sufficient calories. Some people add MCT oil to the drink to add calories and stretch it further. Good luck!

  31. Hi Dr Ruscio,

    I had a few questions about the Elemental Heal as used for 1-3 weeks as treatment.
    Currently going through the 2nd month of step 3 on the antimicrobials, really interested in doing an elemental heal fast once finished.

    1) Would it still be effective to fast on both the Elemental Heal and homemade vegetable juice? Since the Elemental Heal is expensive (college student budget) I was thinking of only drinking half the recommendation daily intake of the shakes, and adding in 1-2 glasses of juice.

    2) Could I instead just drink only 1-2 servings of Elemental Heal a day instead of the full 3? It would be less calories, but I imagine still effective for the gut.

    Thank you very much!
    Also, I have my appointment set for March 29th to become a patient of yours, looking forward to it.

    1. Hi Cameron,

      I would recommend following the protocol in the book as closely as possible. Drinking fewer shakes is probably preferable to drinking veggie juice, but it also depends on how long you do the ED, as you don’t want to go too long without getting sufficient calories. Some people add MCT oil to the drink to add calories and stretch it further. Good luck!

  32. Hi There!

    I’m two weeks into Biota Clear 2a & 2b and I still have WICKED gas and bloating, and no real improvement in my skin issues. Is this a sign that there is something else going on here? I have seen real improvements in my energy and less brain fog, but the bloating was the main reason I started the program. I’ve been very consistent with all the supplements and as diligently Paleo/low-FODMAP as I can be while still getting enough calories.

    Should I try some dietary adjustments now to be more comfortable? I worry if I do that (going even lower FODMAP, for example), I would just be masking my issues and not really getting to the point where I can expand my diet.

    If my bloating and gas is still persistent and painful at the end of the second month of Step 3, Level 1, would that be a reason to do Step 3, Level 2?

    Thanks!

    1. Hi Sarah,

      Sorry to hear you’re not feeling better. Yes, I would proceed through the program and next steps/levels to see if you can get it ironed out. Good luck!

  33. Hi There!

    I’m two weeks into Biota Clear 2a & 2b and I still have WICKED gas and bloating, and no real improvement in my skin issues. Is this a sign that there is something else going on here? I have seen real improvements in my energy and less brain fog, but the bloating was the main reason I started the program. I’ve been very consistent with all the supplements and as diligently Paleo/low-FODMAP as I can be while still getting enough calories.

    Should I try some dietary adjustments now to be more comfortable? I worry if I do that (going even lower FODMAP, for example), I would just be masking my issues and not really getting to the point where I can expand my diet.

    If my bloating and gas is still persistent and painful at the end of the second month of Step 3, Level 1, would that be a reason to do Step 3, Level 2?

    Thanks!

    1. Hi Sarah,

      Sorry to hear you’re not feeling better. Yes, I would proceed through the program and next steps/levels to see if you can get it ironed out. Good luck!

  34. I have SIBO that hasn’t cleared after several rounds of herbal antimicrobials, both before and after starting Great in 8. I’m now on Day 1 of the Elemental Diet. I’ve paused all supplements as recommended and plan to add back the probiotics after a couple of days. Can you clarify whether or not it’s also recommended to add back in the Adrenal Support, or to wait until the ED is finished and then add it back with digestive enzymes when I transition back to food?

    Also, I experienced some burning with the enzymes. Is there an alternative that doesn’t contain HCL that you’d recommend, or should I just not take enzymes? It seems like they could still be helpful.

    Thank you!

    1. Hi Liz,

      It’s recommended to stop all supplements for the duration of the elemental diet (though it’s fine to keep taking any prescription meds).

      You can skip taking the enzymes, as they’re not a critical piece of the protocol.

      Good luck, hope this helps!

        1. Hi Brandon,

          Yes. If you follow the great-in-8 plan as laid out in the book, you’ll see that step 1 doesn’t involve any supplements. Probiotics aren’t added in until step 2.

  35. I have SIBO that hasn’t cleared after several rounds of herbal antimicrobials, both before and after starting Great in 8. I’m now on Day 1 of the Elemental Diet. I’ve paused all supplements as recommended and plan to add back the probiotics after a couple of days. Can you clarify whether or not it’s also recommended to add back in the Adrenal Support, or to wait until the ED is finished and then add it back with digestive enzymes when I transition back to food?

    Also, I experienced some burning with the enzymes. Is there an alternative that doesn’t contain HCL that you’d recommend, or should I just not take enzymes? It seems like they could still be helpful.

    Thank you!

    1. Hi Liz,

      It’s recommended to stop all supplements for the duration of the elemental diet (though it’s fine to keep taking any prescription meds).

      You can skip taking the enzymes, as they’re not a critical piece of the protocol.

      Good luck, hope this helps!

        1. Hi Brandon,

          Yes. If you follow the great-in-8 plan as laid out in the book, you’ll see that step 1 doesn’t involve any supplements. Probiotics aren’t added in until step 2.

  36. Hello! I have started the elemental heal today. I have had 12 scoops with oil. I typically eat 1200 calories a day so this should be sufficient for me. I have been drinking slowly all day, with breaks for water. But pretty much sipping all day. I am insanely hungry. Is this a normal adjustment to the diet? I am full of liquid but feel so hungry. Thank you so much.

    1. Hi Jen,

      Feel free to consume some more if you’re still hungry and/or add some additional oil if you tolerate it. It can be normal to feel hungry when not eating solid food, but you shouldn’t be starving the whole time. Hope this helps.

      1. Thank you my hunger did even out but on day 10 I am finding I don’t really want to drink any at all. I ma having abdominal pain and cramping. Is this delayed die off or typical side effect of the elemental heal?

        1. I would read the section in the book on reactions (pg 277-278) and see if that resonates, and use the process outlined for troubleshooting. Good luck!

  37. Hello, just wondering what the timing (with or without meals, etc) of taking the biota clear capsules should be? Cheers. Jen

    1. Hi Jenny,

      Empty stomach is preferred. This is addressed on page 277 of the book if you want to check it out for more info. Hope this helps!

      1. Thank you for your answer Drew. Today I’m wondering if I should pause taking the biota clear pills if I feel the symptoms of a tummy bug? Pain, nausea. I started taking them about 5 days ago with no problems, but today I feel fragile in the tummy.

        1. I’m sorry to hear you’re not feeling well. Are you sure it’s a stomach bug (vs a die-off reaction)? I would read the section in the book on reactions (pg 277-278) and see if that resonates, and use the process outlined for troubleshooting. Good luck!

  38. Hello! I have started the elemental heal today. I have had 12 scoops with oil. I typically eat 1200 calories a day so this should be sufficient for me. I have been drinking slowly all day, with breaks for water. But pretty much sipping all day. I am insanely hungry. Is this a normal adjustment to the diet? I am full of liquid but feel so hungry. Thank you so much.

    1. Hi Jen,

      Feel free to consume some more if you’re still hungry and/or add some additional oil if you tolerate it. It can be normal to feel hungry when not eating solid food, but you shouldn’t be starving the whole time. Hope this helps.

      1. Thank you my hunger did even out but on day 10 I am finding I don’t really want to drink any at all. I ma having abdominal pain and cramping. Is this delayed die off or typical side effect of the elemental heal?

        1. I would read the section in the book on reactions (pg 277-278) and see if that resonates, and use the process outlined for troubleshooting. Good luck!

  39. Hello, just wondering what the timing (with or without meals, etc) of taking the biota clear capsules should be? Cheers. Jen

    1. Hi Jenny,

      Empty stomach is preferred. This is addressed on page 277 of the book if you want to check it out for more info. Hope this helps!

      1. Thank you for your answer Drew. Today I’m wondering if I should pause taking the biota clear pills if I feel the symptoms of a tummy bug? Pain, nausea. I started taking them about 5 days ago with no problems, but today I feel fragile in the tummy.

        1. I’m sorry to hear you’re not feeling well. Are you sure it’s a stomach bug (vs a die-off reaction)? I would read the section in the book on reactions (pg 277-278) and see if that resonates, and use the process outlined for troubleshooting. Good luck!

  40. Dear Dr Ruscio

    I am so glad that I stumbled upon your work earlier this year, thank you for everything you do. I have your book and I can see that it’s a wonderful resource for treating various gut disorders. I have a question in relation to anti-microbial treatment and breastfeeding. I have d. fragilis and I am also breastfeeding my three month old, which I’ll probably do for the next two years. I would like to start getting my gut health in order and I feel that treating the parasite will be a crucial step. Do you have any information about the safety of the antimicrobial treatments for nursing mums?

    Thanks for your help
    Julia

    1. Hi Julia,

      Antimicrobial treatments aren’t recommended while breastfeeding. Also make sure to discuss anything you plan on doing with your OBGYN. Hope this helps!

  41. Dear Dr Ruscio

    I am so glad that I stumbled upon your work earlier this year, thank you for everything you do. I have your book and I can see that it’s a wonderful resource for treating various gut disorders. I have a question in relation to anti-microbial treatment and breastfeeding. I have d. fragilis and I am also breastfeeding my three month old, which I’ll probably do for the next two years. I would like to start getting my gut health in order and I feel that treating the parasite will be a crucial step. Do you have any information about the safety of the antimicrobial treatments for nursing mums?

    Thanks for your help
    Julia

    1. Hi Julia,

      Antimicrobial treatments aren’t recommended while breastfeeding. Also make sure to discuss anything you plan on doing with your OBGYN. Hope this helps!

  42. I have had amazing success with the Elemental heal! I feel better than I have in years. I am still drinking one shake (3 scoops of powder) as my first meal of the day as I am finding I feel better when I do this. I am slowly rebuilding and adding new foods in, going back on EH for 1-2 days when I have a negative reaction to a food (just say no to coconut). Are there any negatives I should consider for continuing to use Elemental heal as a long term part of my diet? To be honest I think I get way more vitamins and nutrients in a shake than the foods I am currently able to eat but want to be sure there are no negatives to continuing to drink it for what I see as a permanent part of my new diet as I rebuild.

    1. Hi Jen,

      I’m so happy to hear you’re feeling better! Dr Ruscio has multiple patients who use Elemental Heal in sort of a hybrid way (some ED, some solid food) long term for continued healing. Hope this helps!

  43. I have had amazing success with the Elemental heal! I feel better than I have in years. I am still drinking one shake (3 scoops of powder) as my first meal of the day as I am finding I feel better when I do this. I am slowly rebuilding and adding new foods in, going back on EH for 1-2 days when I have a negative reaction to a food (just say no to coconut). Are there any negatives I should consider for continuing to use Elemental heal as a long term part of my diet? To be honest I think I get way more vitamins and nutrients in a shake than the foods I am currently able to eat but want to be sure there are no negatives to continuing to drink it for what I see as a permanent part of my new diet as I rebuild.

    1. Hi Jen,

      I’m so happy to hear you’re feeling better! Dr Ruscio has multiple patients who use Elemental Heal in sort of a hybrid way (some ED, some solid food) long term for continued healing. Hope this helps!

  44. Hi,
    thanks for a great book! I read it and started doing the steps but since I was underweight and clearly had malabsorptoion I choose do to some testning for nutrial deficiences too. I was deficient in calcium, magnesium, zinc, glycine, lysine, vitamin D, among others. I have anxiety, depression, underweight, stomach aches and am a bit constipated but sometimes even get stools that are a bit loose, My stool test showed dysbiosis, too low butyrate, low SCFA, and too few Lactobacilli, low Roseburia and low ruminococcus. No parasites. No candida. I had normal levels of pancreatic enzymes but still a bit too high fat in my stools. My SIBO-test showed no elevated hydrogen levels but my methane was high even at the start sample (that is before I took the lactulose), start level at 28 ppm, then 16, 12, 18, 27, 21, 31, 17, 21 and 17. Some people say it could still be SIBO, do you agree? I have been under a lot of stress the recent years, taken many antibiotics, and also Omeprazol. I did an intolerance test showing 38 intolerances, among others dairy, many kinds of meat, egg white, ginger, corn and garlic.
    I would be really gratful for your opinion how to treat my condition. 1. Do you think it is SIBO(methane gas SIBO?) The proposed treatment is a mix of allicin, berberine and oregano oil. My antibodies agains IgG garlic was 33, is it still possible that I tolerate allicin? It also contains maltodextrose made of corn which I was also intolerant against, is it still worth trying or do you recommend the elemental diet with for example Vionexx instead? Or do you have other recommendations? Could it be possible to treat it with just the threee classes of probiotics plus Iberogast? Should I add HCL and pepsin since I have deficiencies in some aminoacids although I eat quite much protein? My stool test didn’t show any abnormalities in protein degradation products though. And how do I restore my gut dysbiosis?
    I would be so greatful if you could help me answer my thoughts around this. I have a doctor here but I think there are so many question left he seems not able to answer and I am a doctor myself and really would like a second opinion. I don’t want to do more harm than good to my gut bacteria. By the way, which is the least harmful to my gut microbiom: the elemental diet for a couple of week or the herbal antibiotics for 6 weeks(as proposed from my doctor here). Again, I would be so greatful for your advice here!
    Kind regards, Dr Helena Salomonsson

    1. Hi Helena,

      I’m sorry to hear you’re dealing with this. Unfortunately we are unable to give direct medical advice on this forum, but I will say that following the protocol in the book as closely as possible will hopefully be helpful in getting rid of whatever you have going on as well as restoring your gut health and flora. Many people who have issues with garlic can still tolerate allicin, and the maltodextrin is not usually an issue for people. That being said, definitely listen to your body and if something isn’t working for you, discontinue right away. Hope this helps!

      1. Hi,
        thanks for your answer! Is it also possible to answer the general question about elemental diet vs herbal antimicrobials? That is which of them is most “kind” to the gut microbiota you want to keep? In the case of SIBO, it seems that in some studies the elemental det is more effective than herbal antimicroblasand you don’t have to do that for so long time compared to herbal antimicrobials. What is the reason that you wait with the elemental diet as “the last option” instead of starting with that in case of SIBO for example?(especially if you know that you don’t have any parasites)

        Kind regards,
        Dr Helena Salomonsson

        1. The elemental diet tends to wipe out most everything, it doesn’t really discriminate between “good” and “bad”. Many people use the elemental diet as a last option because it’s typically the most difficult to stick to. Hope this helps.

          1. If you don’t tolerate allimed, I would recommend going with the original supplements he recommends, Biota Clear 1a,1b, 2a and 2b as none of those contain garlic.

          2. Thank you!
            I have another question:
            in your book it says you can try Atrantil, Berberine, Allicin etc if you don’t tolerate “Clear biota”. How can you combine these agents?
            FOr example, I treat a possible methane producing SIBO, I seem not to tolerate ALlimed(intolerant to garlic, haven’t felt well since I started treament with allimed 3 weels ago). I also use oregano oil and Berberine. Can I substitute Allimed for Atrantil? And still continue oregano oil and Berberine treatment or should I use any other combination, that is how do I preferrably combine those substances you have mentioned in your book?
            Kind regards,
            Helena

  45. Hi,
    thanks for a great book! I read it and started doing the steps but since I was underweight and clearly had malabsorptoion I choose do to some testning for nutrial deficiences too. I was deficient in calcium, magnesium, zinc, glycine, lysine, vitamin D, among others. I have anxiety, depression, underweight, stomach aches and am a bit constipated but sometimes even get stools that are a bit loose, My stool test showed dysbiosis, too low butyrate, low SCFA, and too few Lactobacilli, low Roseburia and low ruminococcus. No parasites. No candida. I had normal levels of pancreatic enzymes but still a bit too high fat in my stools. My SIBO-test showed no elevated hydrogen levels but my methane was high even at the start sample (that is before I took the lactulose), start level at 28 ppm, then 16, 12, 18, 27, 21, 31, 17, 21 and 17. Some people say it could still be SIBO, do you agree? I have been under a lot of stress the recent years, taken many antibiotics, and also Omeprazol. I did an intolerance test showing 38 intolerances, among others dairy, many kinds of meat, egg white, ginger, corn and garlic.
    I would be really gratful for your opinion how to treat my condition. 1. Do you think it is SIBO(methane gas SIBO?) The proposed treatment is a mix of allicin, berberine and oregano oil. My antibodies agains IgG garlic was 33, is it still possible that I tolerate allicin? It also contains maltodextrose made of corn which I was also intolerant against, is it still worth trying or do you recommend the elemental diet with for example Vionexx instead? Or do you have other recommendations? Could it be possible to treat it with just the threee classes of probiotics plus Iberogast? Should I add HCL and pepsin since I have deficiencies in some aminoacids although I eat quite much protein? My stool test didn’t show any abnormalities in protein degradation products though. And how do I restore my gut dysbiosis?
    I would be so greatful if you could help me answer my thoughts around this. I have a doctor here but I think there are so many question left he seems not able to answer and I am a doctor myself and really would like a second opinion. I don’t want to do more harm than good to my gut bacteria. By the way, which is the least harmful to my gut microbiom: the elemental diet for a couple of week or the herbal antibiotics for 6 weeks(as proposed from my doctor here). Again, I would be so greatful for your advice here!
    Kind regards, Dr Helena Salomonsson

    1. Hi Helena,

      I’m sorry to hear you’re dealing with this. Unfortunately we are unable to give direct medical advice on this forum, but I will say that following the protocol in the book as closely as possible will hopefully be helpful in getting rid of whatever you have going on as well as restoring your gut health and flora. Many people who have issues with garlic can still tolerate allicin, and the maltodextrin is not usually an issue for people. That being said, definitely listen to your body and if something isn’t working for you, discontinue right away. Hope this helps!

      1. Hi,
        thanks for your answer! Is it also possible to answer the general question about elemental diet vs herbal antimicrobials? That is which of them is most “kind” to the gut microbiota you want to keep? In the case of SIBO, it seems that in some studies the elemental det is more effective than herbal antimicroblasand you don’t have to do that for so long time compared to herbal antimicrobials. What is the reason that you wait with the elemental diet as “the last option” instead of starting with that in case of SIBO for example?(especially if you know that you don’t have any parasites)

        Kind regards,
        Dr Helena Salomonsson

        1. The elemental diet tends to wipe out most everything, it doesn’t really discriminate between “good” and “bad”. Many people use the elemental diet as a last option because it’s typically the most difficult to stick to. Hope this helps.

          1. Thank you!
            I have another question:
            in your book it says you can try Atrantil, Berberine, Allicin etc if you don’t tolerate “Clear biota”. How can you combine these agents?
            FOr example, I treat a possible methane producing SIBO, I seem not to tolerate ALlimed(intolerant to garlic, haven’t felt well since I started treament with allimed 3 weels ago). I also use oregano oil and Berberine. Can I substitute Allimed for Atrantil? And still continue oregano oil and Berberine treatment or should I use any other combination, that is how do I preferrably combine those substances you have mentioned in your book?
            Kind regards,
            Helena

          2. If you don’t tolerate allimed, I would recommend going with the original supplements he recommends, Biota Clear 1a,1b, 2a and 2b as none of those contain garlic.

  46. Hi Dr. Ruscio,

    How do you recommend taking Biota Clear 1a (oregano) and Atrantil (i’m sensitive when it comes to the other antimicrobials)? Can these be taken together at the same time, or should I take the oregano for a month, and then the Atrantil folowing, or vice versa? Or, are both not needed?

    Thanks in advance for your help!

    Best,
    Alexandra

    1. Hi Alexandra,

      Either is fine, though it’s probably preferred to take both for 2 months. Hope this helps!

  47. Hi Dr. Ruscio,

    How do you recommend taking Biota Clear 1a (oregano) and Atrantil (i’m sensitive when it comes to the other antimicrobials)? Can these be taken together at the same time, or should I take the oregano for a month, and then the Atrantil folowing, or vice versa? Or, are both not needed?

    Thanks in advance for your help!

    Best,
    Alexandra

    1. Hi Alexandra,

      Either is fine, though it’s probably preferred to take both for 2 months. Hope this helps!

  48. Hi Dr. Ruscio,

    I’m on week 3 of remove level 2. I was doing fairly well until week 2 when I started getting moody and irritable with variable sleep issues, just assumed it was die off and kept going. However about 3 days ago my sleep got even worse waking up around 2 am wide awake and not able to get back to sleep. Seems like a low blood sugar thing as I also get hungry. Then it progressed into bad anxiety/nervousness in my body originating in my gut with body aches and extremely low energy. It’s horrible! I stopped the antimicrobials today to see what happens. Any suggestions?

    I really appreciate all of your help! The book is great! Thank you, thank you, thank you!
    Kris

    1. Hi Kris,

      Sorry to hear you’re not feeling well. Some of what you’re describing does sound like blood sugar issues, so some things you may want to consider are if you’re eating enough in general and if you’re eating enough carbs. You may want to play around with that and see if it helps. Good luck!

  49. Hi Dr. Ruscio,

    I’m on week 3 of remove level 2. I was doing fairly well until week 2 when I started getting moody and irritable with variable sleep issues, just assumed it was die off and kept going. However about 3 days ago my sleep got even worse waking up around 2 am wide awake and not able to get back to sleep. Seems like a low blood sugar thing as I also get hungry. Then it progressed into bad anxiety/nervousness in my body originating in my gut with body aches and extremely low energy. It’s horrible! I stopped the antimicrobials today to see what happens. Any suggestions?

    I really appreciate all of your help! The book is great! Thank you, thank you, thank you!
    Kris

    1. Hi Kris,

      Sorry to hear you’re not feeling well. Some of what you’re describing does sound like blood sugar issues, so some things you may want to consider are if you’re eating enough in general and if you’re eating enough carbs. You may want to play around with that and see if it helps. Good luck!

  50. I’m attempting to place my order for supplements, but it appears that you don’t deliver to Thailand. Is that correct?

    How else can I get these supplements?

    Thanks

  51. I’m attempting to place my order for supplements, but it appears that you don’t deliver to Thailand. Is that correct?

    How else can I get these supplements?

    Thanks

  52. I’ve almost finished the second month of the remove step, and am pleased to report I have had an improvement in my chronic fatigue syndrome, and it could well be due to these antimicrobial herbs, not just a coincidence. My ibs(d) remains variable, but I haven’t been 100% strict on the paleo diet, being Christmas and all. (Ive been pretty good though!) I haven’t identified the foods that trigger diarrhea yet, the current main suspect is legumes. I wonder if the herbs are helping me due to an antiviral effect on the Epstein Barr virus, rather than through killing parasites in my gut. I’m kind of nervous to finish the bottle in a week – will I relapse, maintain my gains or continue to improve? I’m still a long way off healthy, I rate my energy score at about 6% of what I had previously. Still, it’s nice to feel a bit better. I shall reread the book, but I’m wondering if it’s ok to keep taking remove supplements long term, if I relapse or plateau after finishing the two months. Cheers 🙂 jen

    1. Hi Jenny,

      I’m glad to hear you’re starting to feel better! Yes, some people do take the antimicrobials for a longer duration (this is discussed on page 289). But I’d suggest moving on to step 4 and assessing how you feel before determining you need to be on them long term.

      Good luck!

  53. I’ve almost finished the second month of the remove step, and am pleased to report I have had an improvement in my chronic fatigue syndrome, and it could well be due to these antimicrobial herbs, not just a coincidence. My ibs(d) remains variable, but I haven’t been 100% strict on the paleo diet, being Christmas and all. (Ive been pretty good though!) I haven’t identified the foods that trigger diarrhea yet, the current main suspect is legumes. I wonder if the herbs are helping me due to an antiviral effect on the Epstein Barr virus, rather than through killing parasites in my gut. I’m kind of nervous to finish the bottle in a week – will I relapse, maintain my gains or continue to improve? I’m still a long way off healthy, I rate my energy score at about 6% of what I had previously. Still, it’s nice to feel a bit better. I shall reread the book, but I’m wondering if it’s ok to keep taking remove supplements long term, if I relapse or plateau after finishing the two months. Cheers 🙂 jen

    1. Hi Jenny,

      I’m glad to hear you’re starting to feel better! Yes, some people do take the antimicrobials for a longer duration (this is discussed on page 289). But I’d suggest moving on to step 4 and assessing how you feel before determining you need to be on them long term.

      Good luck!

  54. Thanks for your great book. As I’m planning step 3 (Remove), I was wondering if I would be doing something wrong with my protocol if:
    1. I start with the elemental diet straight away, skipping the antimicrobial approaches (level 1 & @ 2)
    2. Alternatively, if I start with the antimicrobials level 2 (skipping level 1) and then move onto the elemental diet if necessary.

    I have made many lifestyle changes and I’m on a low carb-low Fodmap diet. I’m taking supplements recommended in step 2. Though, I’m feeling better, I know I’m still not my 100%.

    Thanks once again

    1. Hi Anne,

      It’s recommended to follow the protocol as written as closely as possible for best results. Good luck!

  55. Thanks for your great book. As I’m planning step 3 (Remove), I was wondering if I would be doing something wrong with my protocol if:
    1. I start with the elemental diet straight away, skipping the antimicrobial approaches (level 1 & @ 2)
    2. Alternatively, if I start with the antimicrobials level 2 (skipping level 1) and then move onto the elemental diet if necessary.

    I have made many lifestyle changes and I’m on a low carb-low Fodmap diet. I’m taking supplements recommended in step 2. Though, I’m feeling better, I know I’m still not my 100%.

    Thanks once again

    1. Hi Anne,

      It’s recommended to follow the protocol as written as closely as possible for best results. Good luck!

  56. Loving this protocol and so grateful for all it took to write this book, Dr. Ruscio.

    I’m in month 3 of Step 3, adding in the biofilm dissolvers. Wow, dissolving my biofilms is really shaking things up. Several issues I’d like your advice on.

    1. Feeling high levels of fear alternating with depression. Is this a common response to die-off? Both have waned a bit, now that I’m on day 18 of month 3.

    2. I’m having sulfur smelling gas quite often. What causes this? Anything I should do about it?

    3. 5 days this month, I’ve had a bowel purge response at 4-5 pm, sometimes repeated and once I had 5 purges, lasting well into the night. Very liquid, bowel movement.

    I had been taking both Olive Leaf extract and Caprylic Acid instead of the Oregano Oil, and stopped the Caprylic Acid – no purge reaction yesterday.

    It’s interesting because I have not felt sick before or after the purge. But it has kept me close to home!

    Thanks so much for your help.

    1. Hi Natalie,

      I’m wondering if you’re eating something that you’re not reacting well to? Have you changed your diet much or tried to keep track of what you’re eating before you get diarrhea? With the gas, it’s possible that you still have some bacterial overgrowth that needs killing off, so I’d continue with the protocol and see if it helps. Good luck!

      1. My diet is the same as it was months 1 and 2 of the program. I do not believe this is caused by my diet.

        I think it’s related to intestinal flora – bloom or die off.

        The change that started the purge response is adding in the biofilm dissolvers.

        I’ve now had the purge reaction, around 5pm, 7 out of 20 days of biofilm dissolvers.

        I’m losing weight (already slim) and feeling more and more depleted.

        Natalie

        1. Got it – it sounds like it could be an intolerance reaction. You may want to stop the new supplements and see if it abates. And it might be a good idea to check in with your doctor as well.

          1. Thanks Drew. I reduced the biota dissolve to 1 twice a day for a day, no purge.

            Then upped it to 2, twice a day for 3 days, no purge.

            Last night I took 3 in the evening and had 2 purges.

            All other supplements have remained the same.

            Sticking with 2 twice a day, unless you’d advise otherwise.

            Unfortunately, I have no doctor who gets this stuff.

  57. Loving this protocol and so grateful for all it took to write this book, Dr. Ruscio.

    I’m in month 3 of Step 3, adding in the biofilm dissolvers. Wow, dissolving my biofilms is really shaking things up. Several issues I’d like your advice on.

    1. Feeling high levels of fear alternating with depression. Is this a common response to die-off? Both have waned a bit, now that I’m on day 18 of month 3.

    2. I’m having sulfur smelling gas quite often. What causes this? Anything I should do about it?

    3. 5 days this month, I’ve had a bowel purge response at 4-5 pm, sometimes repeated and once I had 5 purges, lasting well into the night. Very liquid, bowel movement.

    I had been taking both Olive Leaf extract and Caprylic Acid instead of the Oregano Oil, and stopped the Caprylic Acid – no purge reaction yesterday.

    It’s interesting because I have not felt sick before or after the purge. But it has kept me close to home!

    Thanks so much for your help.

    1. Hi Natalie,

      I’m wondering if you’re eating something that you’re not reacting well to? Have you changed your diet much or tried to keep track of what you’re eating before you get diarrhea? With the gas, it’s possible that you still have some bacterial overgrowth that needs killing off, so I’d continue with the protocol and see if it helps. Good luck!

      1. My diet is the same as it was months 1 and 2 of the program. I do not believe this is caused by my diet.

        I think it’s related to intestinal flora – bloom or die off.

        The change that started the purge response is adding in the biofilm dissolvers.

        I’ve now had the purge reaction, around 5pm, 7 out of 20 days of biofilm dissolvers.

        I’m losing weight (already slim) and feeling more and more depleted.

        Natalie

        1. Got it – it sounds like it could be an intolerance reaction. You may want to stop the new supplements and see if it abates. And it might be a good idea to check in with your doctor as well.

          1. Thanks Drew. I reduced the biota dissolve to 1 twice a day for a day, no purge.

            Then upped it to 2, twice a day for 3 days, no purge.

            Last night I took 3 in the evening and had 2 purges.

            All other supplements have remained the same.

            Sticking with 2 twice a day, unless you’d advise otherwise.

            Unfortunately, I have no doctor who gets this stuff.

  58. Thank you for your book! It was a page-turner. Coalesces so much information that has come to my attention in recent years, but was unwieldily. Your book makes sense of it.

    Most of my symptoms have been reduced with an auto-immune diet (plant-based), intermittent fasting, and attention to FODMAPS. I am nevertheless interested in implementing the full Remove Step, including protocol level 2, and am wondering if there are any drawbacks to going directly from the Support Step to Remove Protocol Level 2?

    In case it is helpful, the reasons for wanting to implement Level 2, even though most symptoms are already reduced, are that I have an auto-immune disorder, uveitis; have the antigen HLA B27; have noticed flare-ups of the uveitis after gastric upsets; and for these reasons suspect IBD in addition to IBS. Also, I have lived in developing countries, experienced malaria, etc. Thus, I’d like to knock out anything problematic that may be residing in the gut and have a fresh start.

    May I go directly from the Support Step to the Remove Step level 2?

    A secondary question is regarding the adrenal support, containing Ashwagandha. I am not religious about avoiding nightshades, but generally do so due to the auto-immune disorder, and am wondering whether to incorporate the adrenal support or leave it out?

    Thank you for your time and sharing your revolutionary work.

      1. Hi Victoria,

        Yes, you can add in the additional supplements from Level 2 right away if you want to.

        Regarding the ashwagandha, Dr R hasn’t noticed reactions often with it – irrespective of night shade tolerance, so it may be worth trying it out.

        Also make sure to keep your doctor in the loop on all of this.

        Good luck!

  59. Thank you for your book! It was a page-turner. Coalesces so much information that has come to my attention in recent years, but was unwieldily. Your book makes sense of it.

    Most of my symptoms have been reduced with an auto-immune diet (plant-based), intermittent fasting, and attention to FODMAPS. I am nevertheless interested in implementing the full Remove Step, including protocol level 2, and am wondering if there are any drawbacks to going directly from the Support Step to Remove Protocol Level 2?

    In case it is helpful, the reasons for wanting to implement Level 2, even though most symptoms are already reduced, are that I have an auto-immune disorder, uveitis; have the antigen HLA B27; have noticed flare-ups of the uveitis after gastric upsets; and for these reasons suspect IBD in addition to IBS. Also, I have lived in developing countries, experienced malaria, etc. Thus, I’d like to knock out anything problematic that may be residing in the gut and have a fresh start.

    May I go directly from the Support Step to the Remove Step level 2?

    A secondary question is regarding the adrenal support, containing Ashwagandha. I am not religious about avoiding nightshades, but generally do so due to the auto-immune disorder, and am wondering whether to incorporate the adrenal support or leave it out?

    Thank you for your time and sharing your revolutionary work.

      1. Hi Victoria,

        Yes, you can add in the additional supplements from Level 2 right away if you want to.

        Regarding the ashwagandha, Dr R hasn’t noticed reactions often with it – irrespective of night shade tolerance, so it may be worth trying it out.

        Also make sure to keep your doctor in the loop on all of this.

        Good luck!

  60. I am currently working through the protocol and about to start step 3. My end goal is to heal my gut before I start trying to get pregnant. I am off of all other vitamins/supplements aside from what is recommended at this point. My question is when would be an okay time to add in prenatals. I don’t want to add them in and them ruin anything but I also don’t want to wait to add them if I don’t need to.

  61. I am currently working through the protocol and about to start step 3. My end goal is to heal my gut before I start trying to get pregnant. I am off of all other vitamins/supplements aside from what is recommended at this point. My question is when would be an okay time to add in prenatals. I don’t want to add them in and them ruin anything but I also don’t want to wait to add them if I don’t need to.

  62. Hi Dr. Ruscio,

    Thanks for such a helpful book and protocol! After an OATS test from Great Plains Lab my naturopath suspected I had an issue with candida or SIFO and prescribed Diflucan in addition to level 3 supplements in your protocol. My breath test for SIBO was negative for both hydrogen and methane, and I don’t seem to be experiencing bloating of any sort with fodmaps, which made her think I didn’t have SIBO. I am currently about a month into step 4 and have had some of my health issues resolve, such as hand eczema, blurry vision, low energy/fatigue, etc… However my chief complaint or most bothersome symptom (perioral dermatitis on my face) has only progressively gotten worse. My naturopath approved all the supplements I took during level 3 from your book, and she added in a biofilm disruptor (Biofilm Phase 2 advanced) at the very end of level three, about a week before I was to be done with the antimicrobials. She then had me continue the biofilm disruptor and add in high dose probiotics (D-lactate free blend from Custom Probiotics) and Colostrum-LD from Soveirgn Labs. I was just curious as my rash seems to only be getting worse over the course of this last month if you had any feedback on Colostrum or this particular probiotic, or if you think I may need to do another round of antimicrobials? I am lactose intolerant and she insists that the Colostrum won’t bother me in any way because the lactose has been removed, however Sov Labs website even says it’s just been reduced, not removed. The only time I have seem improvement in this rash was when I first started the Diflucan (for about 72 hours), and when I initially stopped all the antimicrobials and before I started the probiotic and Colostrum. Any direction or insight would be helpful, thank you!

    1. Hi Jennifer,

      Most people don’t react to the dairy in colostrum, but you could always try taking it out and seeing if it helps your rash.

      It could make sense that the rash improved when you first started the anti-fungal, because fungus can be an underlying cause of PD – maybe something to discuss with your doctor? As I’m sure you know, stress also contributes to PD, so you may want to assess if you’ve been under more stress than usual lately and try to address that.

      Good luck!

  63. Hi Dr. Ruscio,

    Thanks for such a helpful book and protocol! After an OATS test from Great Plains Lab my naturopath suspected I had an issue with candida or SIFO and prescribed Diflucan in addition to level 3 supplements in your protocol. My breath test for SIBO was negative for both hydrogen and methane, and I don’t seem to be experiencing bloating of any sort with fodmaps, which made her think I didn’t have SIBO. I am currently about a month into step 4 and have had some of my health issues resolve, such as hand eczema, blurry vision, low energy/fatigue, etc… However my chief complaint or most bothersome symptom (perioral dermatitis on my face) has only progressively gotten worse. My naturopath approved all the supplements I took during level 3 from your book, and she added in a biofilm disruptor (Biofilm Phase 2 advanced) at the very end of level three, about a week before I was to be done with the antimicrobials. She then had me continue the biofilm disruptor and add in high dose probiotics (D-lactate free blend from Custom Probiotics) and Colostrum-LD from Soveirgn Labs. I was just curious as my rash seems to only be getting worse over the course of this last month if you had any feedback on Colostrum or this particular probiotic, or if you think I may need to do another round of antimicrobials? I am lactose intolerant and she insists that the Colostrum won’t bother me in any way because the lactose has been removed, however Sov Labs website even says it’s just been reduced, not removed. The only time I have seem improvement in this rash was when I first started the Diflucan (for about 72 hours), and when I initially stopped all the antimicrobials and before I started the probiotic and Colostrum. Any direction or insight would be helpful, thank you!

    1. Hi Jennifer,

      Most people don’t react to the dairy in colostrum, but you could always try taking it out and seeing if it helps your rash.

      It could make sense that the rash improved when you first started the anti-fungal, because fungus can be an underlying cause of PD – maybe something to discuss with your doctor? As I’m sure you know, stress also contributes to PD, so you may want to assess if you’ve been under more stress than usual lately and try to address that.

      Good luck!

  64. Hi Dr. Ruscio (or Drew),

    I’m approaching the end of week 2 of the elemental (heal) diet and feeling better. But still have symptoms of lots of gas in my gut plus anxiety in my body. I’m planning on continuing on with going all the way through 3 weeks total. My question is: would you suggest restarting the antimicrobials from “remove protocol level 2” during this last week of the elemental diet? My thought is why wait? Lets just destroy whatever is in there now while on the elemental diet by giving it a boost.

    Thanks as always for you and your teams work!

    Kris

    1. Hi Kris,

      Glad you’re starting to feel better. We don’t recommend taking antimicrobials during the elemental diet. The bacteria tend to “hibernate” during that time and aren’t as likely to be affected by the antimicrobials. Hope this helps!

      1. Super helpful! Thanks for the info Drew! One more question, do you suggest taking probiotics while on the elemental diet? Or should I give those a break as well?

  65. Hi Dr. Ruscio (or Drew),

    I’m approaching the end of week 2 of the elemental (heal) diet and feeling better. But still have symptoms of lots of gas in my gut plus anxiety in my body. I’m planning on continuing on with going all the way through 3 weeks total. My question is: would you suggest restarting the antimicrobials from “remove protocol level 2” during this last week of the elemental diet? My thought is why wait? Lets just destroy whatever is in there now while on the elemental diet by giving it a boost.

    Thanks as always for you and your teams work!

    Kris

    1. Hi Kris,

      Glad you’re starting to feel better. We don’t recommend taking antimicrobials during the elemental diet. The bacteria tend to “hibernate” during that time and aren’t as likely to be affected by the antimicrobials. Hope this helps!

      1. Super helpful! Thanks for the info Drew! One more question, do you suggest taking probiotics while on the elemental diet? Or should I give those a break as well?

  66. Hello Dr. Ruscio,

    Just finished your book – it was great, very well laid out and easy to follow. Thank you for sharing your expertise on digestive health. In regards to going forth with antimicrobial treatment, what if a comprehensive stool analysis has been done and it revealed no dysbiotic flora, no yeast, and no parasites. The only abnormality was low SCFA’s which can be treated with probiotic and proper eating hygiene (soluble fiber, for example). That being said, the patient is still symptomatic (severe IBS – gas, bloating, bouts of diarrhea). Do you still ‘treat the patient’ and run through an antimicrobial phase or just work on diet/lifestyle, probiotics, etc. and perhaps a mental-emotional connection?

    1. Hi Patrick,

      If you’re a practitioner and have questions, I would recommend joining Dr R’s Future of Functional Medicine Review where he personally gives guidance and answers each question posted (https://www.drruscio.com/review). If this is about you, I’d work through the steps in order. There’s a roadmap laid out in the book for how to proceed based on how the patient is feeling after each step. Good luck!

  67. Hello Dr. Ruscio,

    Just finished your book – it was great, very well laid out and easy to follow. Thank you for sharing your expertise on digestive health. In regards to going forth with antimicrobial treatment, what if a comprehensive stool analysis has been done and it revealed no dysbiotic flora, no yeast, and no parasites. The only abnormality was low SCFA’s which can be treated with probiotic and proper eating hygiene (soluble fiber, for example). That being said, the patient is still symptomatic (severe IBS – gas, bloating, bouts of diarrhea). Do you still ‘treat the patient’ and run through an antimicrobial phase or just work on diet/lifestyle, probiotics, etc. and perhaps a mental-emotional connection?

    1. Hi Patrick,

      If you’re a practitioner and have questions, I would recommend joining Dr R’s Future of Functional Medicine Review where he personally gives guidance and answers each question posted (https://www.drruscio.com/review). If this is about you, I’d work through the steps in order. There’s a roadmap laid out in the book for how to proceed based on how the patient is feeling after each step. Good luck!

  68. Hi Dr. Ruscio and Drew, would you mind letting me know if you have any special considerations – diet choices, etc. – for vegans going through the anti-microbial protocol? I take supplements for the primary concerns – B12, D with K and C, and algae-based Omega-3 DHA. For protein, I sprout legumes and nuts and seeds and also use nutritional yeast and tempeh. For the protocol, I did attempt incorporating meat – made bone broth and was also using some gelatin and eating liver. My body responded well in some ways, and not in others; and ultimately I didn’t feel comfortable with that path. I am heeding the protocol otherwise, so want to be as true to the removal step as possible. Thank you.

    1. Hi Victoria,

      We don’t have any personal biases around a vegan diet one way or another, but it can admittedly be very difficult to follow during the protocol, since many of the foods are high in fodmaps and other compounds that can irritate the gut. My best advice would just be to listen to your body. If you choose to incorporate some of the things that aren’t technically paleo, but are low fodmap (tofu, quinoa, etc), just pay close attention to how you feel. If your gut doesn’t seem to be improving, try taking them out and seeing if that changes anything. Good luck!

  69. Hi Dr. Ruscio and Drew, would you mind letting me know if you have any special considerations – diet choices, etc. – for vegans going through the anti-microbial protocol? I take supplements for the primary concerns – B12, D with K and C, and algae-based Omega-3 DHA. For protein, I sprout legumes and nuts and seeds and also use nutritional yeast and tempeh. For the protocol, I did attempt incorporating meat – made bone broth and was also using some gelatin and eating liver. My body responded well in some ways, and not in others; and ultimately I didn’t feel comfortable with that path. I am heeding the protocol otherwise, so want to be as true to the removal step as possible. Thank you.

    1. Hi Victoria,

      We don’t have any personal biases around a vegan diet one way or another, but it can admittedly be very difficult to follow during the protocol, since many of the foods are high in fodmaps and other compounds that can irritate the gut. My best advice would just be to listen to your body. If you choose to incorporate some of the things that aren’t technically paleo, but are low fodmap (tofu, quinoa, etc), just pay close attention to how you feel. If your gut doesn’t seem to be improving, try taking them out and seeing if that changes anything. Good luck!

  70. Hello 🙂 I prefer to blend up all of my Elemental Heal shakes at the beginning of the day, but on the bottle it says to consume within 4 hours. Why is that? What happens after 4 hours?

    1. Hi Dave,

      What you’re doing is fine as long as you keep it refrigerated. The container says that just to help prevent spoilage.

  71. Hello 🙂 I prefer to blend up all of my Elemental Heal shakes at the beginning of the day, but on the bottle it says to consume within 4 hours. Why is that? What happens after 4 hours?

    1. Hi Dave,

      What you’re doing is fine as long as you keep it refrigerated. The container says that just to help prevent spoilage.

  72. Thank you very much for putting all this information into a book! I had been waiting for it since last year when I first encountered your website!

    Here is my situation: I am a 44 year old female with possible SIBO diagnosis (by a very poorly administered test last year). I am pretty healthy, very active (long distance runner), active musician with a secure and fulfilling job in academia, happily married, surrounded by a healthy community of interesting artistic people.

    I started a low-carb (at times keto) Paleo with low FODMAPs and sadly no nuts and seeds diet about 5 weeks ago and have had some improvements: my bms are perfect, gas is almost completely gone, wheezing and sinus congestion gone, mood and motivation improved, lost about 6lb of fat in 5 weeks with no effort.
    However, my lower belly still gets very puffy and painful after almost every meal and during exercise (mostly easy trail running). It’s almost flat when I wake up and blows up by evening. It feels inflamed even thought the gas is gone. I have already done Xifaxan twice – the first by itself about a year go, the second time together with Neomycin about a month ago with very little improvement. I’ve also done Oil of Oregano, Berberine and Interfase Plus, and Atrantil protocol on my own last year, again, not much improvement (although I may have been taking too little of each of them).
    I should also mention I had a hysterectomy in 2015, so no uterus, but still have functioning ovaries.

    My question is this: should I still try the Level 1 protocol of step 3 or should I jump to the Artemesinin and NAC protocol at this time and skip Biota Clear 1a and Biota Clear 1b altogether? My concern is that it may be too close to the antibiotics I took, as well as questioning the efficacy of taking more Oil of Oregano and Berberine.

    Thank you very much for any insight you may be able to offer! I will hang out on step 2 for a while until I figure out what to do next.

    1. Hi Vessela,

      It’s up to you, but it’s totally fine to jump straight to the level 2 protocol of step 3 – though just to clarify, that’s not in place of the biota clear, it’s in addition. Hope this helps!

  73. Thank you very much for putting all this information into a book! I had been waiting for it since last year when I first encountered your website!

    Here is my situation: I am a 44 year old female with possible SIBO diagnosis (by a very poorly administered test last year). I am pretty healthy, very active (long distance runner), active musician with a secure and fulfilling job in academia, happily married, surrounded by a healthy community of interesting artistic people.

    I started a low-carb (at times keto) Paleo with low FODMAPs and sadly no nuts and seeds diet about 5 weeks ago and have had some improvements: my bms are perfect, gas is almost completely gone, wheezing and sinus congestion gone, mood and motivation improved, lost about 6lb of fat in 5 weeks with no effort.
    However, my lower belly still gets very puffy and painful after almost every meal and during exercise (mostly easy trail running). It’s almost flat when I wake up and blows up by evening. It feels inflamed even thought the gas is gone. I have already done Xifaxan twice – the first by itself about a year go, the second time together with Neomycin about a month ago with very little improvement. I’ve also done Oil of Oregano, Berberine and Interfase Plus, and Atrantil protocol on my own last year, again, not much improvement (although I may have been taking too little of each of them).
    I should also mention I had a hysterectomy in 2015, so no uterus, but still have functioning ovaries.

    My question is this: should I still try the Level 1 protocol of step 3 or should I jump to the Artemesinin and NAC protocol at this time and skip Biota Clear 1a and Biota Clear 1b altogether? My concern is that it may be too close to the antibiotics I took, as well as questioning the efficacy of taking more Oil of Oregano and Berberine.

    Thank you very much for any insight you may be able to offer! I will hang out on step 2 for a while until I figure out what to do next.

    1. Hi Vessela,

      It’s up to you, but it’s totally fine to jump straight to the level 2 protocol of step 3 – though just to clarify, that’s not in place of the biota clear, it’s in addition. Hope this helps!

  74. Hi, I have allergy to milk protein (not just lactose intolerance). Would you still recommend Elemental Heal? Thanks.

  75. After a little more than a week on Elemental Heal exclusively, and having had diarrhea the entire time, I gave up. At first I thought it might have been because of the MCT oil I paired with it, but even after switching to olive oil and then no oil the diarrhea persisted. So I have a few questions. Have you ever dealt with someone else where this was the case? Can you tell me what the problem was? Any other thoughts/advice?

    1. Hi Dave,

      I’m sorry it didn’t go well. There are a couple possibilities: 1) you don’t do well with added fat, no matter the form. Some don’t digest fat that well, especially with impaired digestion, and any sort of added fat or oil causes them diarrhea. If that’s the case, you could test out drinking the shake with no added fat. I know you said you tried that, but it could take your stomach a while to recover if from the added oil if that’s what the issue is. 2) you may be having some sort of reaction. Unfortunately there isn’t one therapy that’s going to work for every single person and this may not be the right one for you. If that’s the case and you still want to do the diet, you could try another brand like Integrative Therapeutics and see how that goes. 3) This could be just how you react on the diet. You’re consuming much less fiber than you likely normally do. There are other people who have diarrhea the entire time they are on the ED, there are some who go to the bathroom much less frequently, and some who have completely normal bowel movements. Everyone is different. I’d listen to your body to determine if you should continue or not. Some questions to think about – are you losing weight rapidly? are you staying hydrated? Are you eliminating the same amount as usual but it’s just not solid? Hope this helps.

      1. Thanks. That gives me some things to think about. I ended up crashing and eating a whole bunch of rice, which thankfully coincided with an immediate end to the diarrhea.

        Unfortunately I’m not so good at listening to my own body, so I think there will just have to be a lot of hard lessons there. But it did seem to me that I was actually having a problem with something in the Elemental Heal formulation itself. The diarrhea seemed too insistent, too frequent and came with too much uncomfortability. But also weight loss, and feeling very thirsty and unsatiated were a consistent part of the experience.

        That said, I’ve decided to give it another shot as part of a hybrid pseudo-reset diet. I’m staggering the Elemental Heal “shakes” with bone broth to see what effect that has. I’m also using Udo’s Oil this time around. If it handles better, maybe I will try doing Elemental Heal again exclusively. If not I will give the homemade version a go.

        Any thoughts about taking the probiotics during a pseudo-reset?

        1. Hi Dave,

          Here are some tips on how to get in tune with your body: https://www.mindbodygreen.com/0-11660/what-does-listen-to-your-body-actually-mean.html

          Also, if you think you’re having a reaction to the elemental diet mixture, there’s no reason to force it. There are other options laid out in the book (e.g. bone broth or master cleanse).

          And no need to take probiotics during the reset, just follow the protocol in the book as written.

  76. After a little more than a week on Elemental Heal exclusively, and having had diarrhea the entire time, I gave up. At first I thought it might have been because of the MCT oil I paired with it, but even after switching to olive oil and then no oil the diarrhea persisted. So I have a few questions. Have you ever dealt with someone else where this was the case? Can you tell me what the problem was? Any other thoughts/advice?

    1. Hi Dave,

      I’m sorry it didn’t go well. There are a couple possibilities: 1) you don’t do well with added fat, no matter the form. Some don’t digest fat that well, especially with impaired digestion, and any sort of added fat or oil causes them diarrhea. If that’s the case, you could test out drinking the shake with no added fat. I know you said you tried that, but it could take your stomach a while to recover if from the added oil if that’s what the issue is. 2) you may be having some sort of reaction. Unfortunately there isn’t one therapy that’s going to work for every single person and this may not be the right one for you. If that’s the case and you still want to do the diet, you could try another brand like Integrative Therapeutics and see how that goes. 3) This could be just how you react on the diet. You’re consuming much less fiber than you likely normally do. There are other people who have diarrhea the entire time they are on the ED, there are some who go to the bathroom much less frequently, and some who have completely normal bowel movements. Everyone is different. I’d listen to your body to determine if you should continue or not. Some questions to think about – are you losing weight rapidly? are you staying hydrated? Are you eliminating the same amount as usual but it’s just not solid? Hope this helps.

      1. Thanks. That gives me some things to think about. I ended up crashing and eating a whole bunch of rice, which thankfully coincided with an immediate end to the diarrhea.

        Unfortunately I’m not so good at listening to my own body, so I think there will just have to be a lot of hard lessons there. But it did seem to me that I was actually having a problem with something in the Elemental Heal formulation itself. The diarrhea seemed too insistent, too frequent and came with too much uncomfortability. But also weight loss, and feeling very thirsty and unsatiated were a consistent part of the experience.

        That said, I’ve decided to give it another shot as part of a hybrid pseudo-reset diet. I’m staggering the Elemental Heal “shakes” with bone broth to see what effect that has. I’m also using Udo’s Oil this time around. If it handles better, maybe I will try doing Elemental Heal again exclusively. If not I will give the homemade version a go.

        Any thoughts about taking the probiotics during a pseudo-reset?

        1. Hi Dave,

          Here are some tips on how to get in tune with your body: https://www.mindbodygreen.com/0-11660/what-does-listen-to-your-body-actually-mean.html

          Also, if you think you’re having a reaction to the elemental diet mixture, there’s no reason to force it. There are other options laid out in the book (e.g. bone broth or master cleanse).

          And no need to take probiotics during the reset, just follow the protocol in the book as written.

  77. On page 276, it says “you’ll take Biota-Clear 1a three pills twice a day and “This will require three bottles total.” The chart on 277 titled “Remove Protocal Level 1 Month-One Antimicrobials” says that you need 2 bottles. Additionally, the bottle has 120 gels. So, if I take 3 gels twice a day, that would be 6 needed per day. That means, that 1 bottle would last 20 days, and therefore, you would only need two bottles. Why would you need three?

    1. Hi Sam,

      He explains in the next sentence “You will have a few extra, which you can take with the month-two protocol until the bottle is empty.”

  78. On page 276, it says “you’ll take Biota-Clear 1a three pills twice a day and “This will require three bottles total.” The chart on 277 titled “Remove Protocal Level 1 Month-One Antimicrobials” says that you need 2 bottles. Additionally, the bottle has 120 gels. So, if I take 3 gels twice a day, that would be 6 needed per day. That means, that 1 bottle would last 20 days, and therefore, you would only need two bottles. Why would you need three?

    1. Hi Sam,

      He explains in the next sentence “You will have a few extra, which you can take with the month-two protocol until the bottle is empty.”

  79. Is it possible that working through this protocol makes food intolerance more evident? I worked through step 1 (general paleo) and step 2 pretty easily and tolerated all of the probiotics without a problem. Then about two weeks into step 3 I have started to get some unusual symptoms, or unusual for me. For about two weeks, I have had on-and-off nausea and minor diarrhea. It got bad enough that I quit all the supplements, then started adding them back and did not get to the antimicrobials before I noticed the nausea come back. I seem to have nausea with certain food, corn and eggs specifically. I have bouts of serious bloating (more than before I started). (Then I had a 24 hours of vomiting and diarrhea that seems more like plain old viral stomach flu. I’m attributing that to whatever’s going around the school more than anything else.)

    This seems like a lot to attribute to die off. I am having a hard time parsing out the different factors here. Nausea has never been a problem for me before. The specific nausea that may be related to corn or eggs is new to me (though I have rocky relationships with both those foods and mostly cut them out). I’m having a hard time just getting back to a stable paleo diet plus probiotics.

    1. I did my best to reconstruct events (I haven’t been writing down food or supplement introductions), and then I did a little experimenting, and I can definitely say I’m having a reaction to the oregano oil (1a). I’d describe it as a “bowel purge response” like Natalie says above. It took only one caplet to trigger day-long nausea followed by purging. So…. I won’t be doing that again!

      1. Hi Mary,

        Tracking can definitely be helpful in terms of isolating what’s causing a reaction. Definitely leave that one out for now – hope you’re feeling better.

        1. My issue may not be Oregano Oil after all. To stabilize everything, I quit all the supplements for a while and then started adding them back one by one. I had no problem with the digestive enzymes or any probiotics, but the adrenal support formula triggered a reaction.

          I’m sharing this here for FYI in case anyone else may be helped. I took the adrenal support for about 8 weeks, twice a day, with no problem. When I started to react, it was mild nausea (which happened to coincide with adding antimcrobials but that may have been a red herring). The severity of reaction got worse each time after the initial nausea.

          Now, the pattern is clearly that about 90 minutes after taking the adrenal support, intense nausea, vomiting and diarrhea. The reaction lasts 2-3 hours and the settles enough to take bone broth with a bit of salt.

          Drew, I’d be curious if you’ve seen this kind of delayed reaction in the clinic? (Meaning the reaction starting weeks after apparently tolerating the supplement.) Wasn’t expecting this!!!

  80. Is it possible that working through this protocol makes food intolerance more evident? I worked through step 1 (general paleo) and step 2 pretty easily and tolerated all of the probiotics without a problem. Then about two weeks into step 3 I have started to get some unusual symptoms, or unusual for me. For about two weeks, I have had on-and-off nausea and minor diarrhea. It got bad enough that I quit all the supplements, then started adding them back and did not get to the antimicrobials before I noticed the nausea come back. I seem to have nausea with certain food, corn and eggs specifically. I have bouts of serious bloating (more than before I started). (Then I had a 24 hours of vomiting and diarrhea that seems more like plain old viral stomach flu. I’m attributing that to whatever’s going around the school more than anything else.)

    This seems like a lot to attribute to die off. I am having a hard time parsing out the different factors here. Nausea has never been a problem for me before. The specific nausea that may be related to corn or eggs is new to me (though I have rocky relationships with both those foods and mostly cut them out). I’m having a hard time just getting back to a stable paleo diet plus probiotics.

    1. I did my best to reconstruct events (I haven’t been writing down food or supplement introductions), and then I did a little experimenting, and I can definitely say I’m having a reaction to the oregano oil (1a). I’d describe it as a “bowel purge response” like Natalie says above. It took only one caplet to trigger day-long nausea followed by purging. So…. I won’t be doing that again!

      1. Hi Mary,

        Tracking can definitely be helpful in terms of isolating what’s causing a reaction. Definitely leave that one out for now – hope you’re feeling better.

        1. My issue may not be Oregano Oil after all. To stabilize everything, I quit all the supplements for a while and then started adding them back one by one. I had no problem with the digestive enzymes or any probiotics, but the adrenal support formula triggered a reaction.

          I’m sharing this here for FYI in case anyone else may be helped. I took the adrenal support for about 8 weeks, twice a day, with no problem. When I started to react, it was mild nausea (which happened to coincide with adding antimcrobials but that may have been a red herring). The severity of reaction got worse each time after the initial nausea.

          Now, the pattern is clearly that about 90 minutes after taking the adrenal support, intense nausea, vomiting and diarrhea. The reaction lasts 2-3 hours and the settles enough to take bone broth with a bit of salt.

          Drew, I’d be curious if you’ve seen this kind of delayed reaction in the clinic? (Meaning the reaction starting weeks after apparently tolerating the supplement.) Wasn’t expecting this!!!

  81. I started Biota-Clear 1a/1b about a week ago. My urine has turned a dark orange in the last few days. Is this a common side effect of the supplements or should I be concerned that it’s something more serious?

    Thanks,

    -J

    1. Hi Jeff,

      This is not a side effect of either of those supplements that I’m aware of. Are you taking any other supplements, like DIM, curcumin, or B vitamins? Are you having any other issues?

      1. Thanks for the reply Drew.

        I was taking DIM powder. I stopped everything for a day and urine returned to normal. I’ve resumed all supplements except for DIM and urine is still normal. Sounds like I was taxing my liver a bit with the DIM on top of everything else.

        Victoria – BMs have been pretty normal.

        1. Hi Jeff,

          I can’t speak for your situation specifically or offer personalized advice, but I will say that in general, DIM supplements or DIM-rich foods can change the color of one’s urine. The darkened urine, as a result of DIM intake, is often tea-colored or dark brown. While this can be an alarming side effect, it is a natural result of increased consumption of DIM and isn’t necessarily indicative of a problem in the liver. Again, definitely talk to a doctor for advice on your specific situation. Hope this helps.

  82. I started Biota-Clear 1a/1b about a week ago. My urine has turned a dark orange in the last few days. Is this a common side effect of the supplements or should I be concerned that it’s something more serious?

    Thanks,

    -J

    1. Hi Jeff,

      This is not a side effect of either of those supplements that I’m aware of. Are you taking any other supplements, like DIM, curcumin, or B vitamins? Are you having any other issues?

      1. Thanks for the reply Drew.

        I was taking DIM powder. I stopped everything for a day and urine returned to normal. I’ve resumed all supplements except for DIM and urine is still normal. Sounds like I was taxing my liver a bit with the DIM on top of everything else.

        Victoria – BMs have been pretty normal.

        1. Hi Jeff,

          I can’t speak for your situation specifically or offer personalized advice, but I will say that in general, DIM supplements or DIM-rich foods can change the color of one’s urine. The darkened urine, as a result of DIM intake, is often tea-colored or dark brown. While this can be an alarming side effect, it is a natural result of increased consumption of DIM and isn’t necessarily indicative of a problem in the liver. Again, definitely talk to a doctor for advice on your specific situation. Hope this helps.

  83. Hi Drew,

    Thanks for all of your hard work answering all of our questions! I think it’s safe to say we all really appreciate it.

    I made through 1a 1b biota-dissolve and 2 rounds of Artemesinin. I had to reduce it all by 1/2 for about 5 days due to my body reacting but then went back to full dose and completed that first round (all of 1a 1b artemisinin biota dissolve). I felt better and my symptoms were reduced but still far from normal. Now I’m working on trying to get through the 2a 2b biota dissolve. Week 1 went well, week two my body got totally reved up (nervous system, adrenals, ?) with the worst being at night, so very little sleep. I tried going down to 1/2 dose for one week but symptoms did not improve. Now I’m wondering what to do?

    Should I try the Intestinal Repair Formula? And if I start that should I also be trying to use antimicrobials or just the Intestinal Repair Formula alone? Also if I try the Intestinal repair should I use it in conjunction with MotilPro? BTW-I’ve also tried 3 weeks of the elemental heal and had good results and reduced symptoms but again, far from feeling normal. I feel like I’m running out of options.

    Thanks again for all of your teams support! I have my first appointment with Dr. Ruscio later next month and I”m just trying to hold it all together and continue making progress until then. 🙂

    Kris

    1. Hi Kris,

      I’m sorry you’re having a hard time. Unfortunately, I can’t give you the sort of in-depth advice you need on this forum. I wouldn’t necessarily start anything new like the IRF until you have your appointment. Try and hang tight until you see Dr R, when he can take the proper time with you and look at your case in detail. Good luck and sorry I don’t have a better answer for you.

  84. Hi Drew,

    Thanks for all of your hard work answering all of our questions! I think it’s safe to say we all really appreciate it.

    I made through 1a 1b biota-dissolve and 2 rounds of Artemesinin. I had to reduce it all by 1/2 for about 5 days due to my body reacting but then went back to full dose and completed that first round (all of 1a 1b artemisinin biota dissolve). I felt better and my symptoms were reduced but still far from normal. Now I’m working on trying to get through the 2a 2b biota dissolve. Week 1 went well, week two my body got totally reved up (nervous system, adrenals, ?) with the worst being at night, so very little sleep. I tried going down to 1/2 dose for one week but symptoms did not improve. Now I’m wondering what to do?

    Should I try the Intestinal Repair Formula? And if I start that should I also be trying to use antimicrobials or just the Intestinal Repair Formula alone? Also if I try the Intestinal repair should I use it in conjunction with MotilPro? BTW-I’ve also tried 3 weeks of the elemental heal and had good results and reduced symptoms but again, far from feeling normal. I feel like I’m running out of options.

    Thanks again for all of your teams support! I have my first appointment with Dr. Ruscio later next month and I”m just trying to hold it all together and continue making progress until then. 🙂

    Kris

    1. Hi Kris,

      I’m sorry you’re having a hard time. Unfortunately, I can’t give you the sort of in-depth advice you need on this forum. I wouldn’t necessarily start anything new like the IRF until you have your appointment. Try and hang tight until you see Dr R, when he can take the proper time with you and look at your case in detail. Good luck and sorry I don’t have a better answer for you.

  85. Thanks again for the great book – I’m currently on stage 2, considering entering stage 3 soon. I was a bit concerned though because lots of advice on the internet advices against starving SIBO, evidence seeming to suggest that feeding the overgrowth along with sibo along with the antimicrobials is more effective as this helps to prevent the bacteria from going dormant. What do you think of this?

  86. Thanks again for the great book – I’m currently on stage 2, considering entering stage 3 soon. I was a bit concerned though because lots of advice on the internet advices against starving SIBO, evidence seeming to suggest that feeding the overgrowth along with sibo along with the antimicrobials is more effective as this helps to prevent the bacteria from going dormant. What do you think of this?

  87. Amazing book!

    I am currently on the second week of stage one in the removal process. I am a vegetarian (6 years) and I’ve been on the low FODMAP diet for about two months. My biggest problems are bloating and constipation. So far I haven’t seen much improvement with the bloating, I am super bloated almost all the time. And I just ordered magnesium so we will see how I do with that for the constipation. I have a few questions, do you think having a vegetarian diet could be contributing to my digestive issues? And is there anything else you would suggest I do for the bloating? I plan on continuing the protocol until I feel better but I was wondering if you had any other suggestions to aid in the process? It can be very hard to stay positive when you don’t feel as good as you should.

    Thanks!

    1. Hi Alexa,

      I can’t speak to your situation specifically, but in general, many patients find that a vegetarian diet aggravates gut symptoms. If you’re open to it, adding some pasture-raised meat to your diet could be something to trial to see how you feel.

      The magnesium will most likely help with constipation.

      I’d also add that it’s important to stay consistent and follow through with the process. You’re on week 2 out of a 2-month removal protocol, it’s still early days! Many people have had digestive issues for a very long time, it’s normal that it takes a little while to sort them out. Keep working through the protocol as written in the book and hang in there 🙂

  88. Amazing book!

    I am currently on the second week of stage one in the removal process. I am a vegetarian (6 years) and I’ve been on the low FODMAP diet for about two months. My biggest problems are bloating and constipation. So far I haven’t seen much improvement with the bloating, I am super bloated almost all the time. And I just ordered magnesium so we will see how I do with that for the constipation. I have a few questions, do you think having a vegetarian diet could be contributing to my digestive issues? And is there anything else you would suggest I do for the bloating? I plan on continuing the protocol until I feel better but I was wondering if you had any other suggestions to aid in the process? It can be very hard to stay positive when you don’t feel as good as you should.

    Thanks!

    1. Hi Alexa,

      I can’t speak to your situation specifically, but in general, many patients find that a vegetarian diet aggravates gut symptoms. If you’re open to it, adding some pasture-raised meat to your diet could be something to trial to see how you feel.

      The magnesium will most likely help with constipation.

      I’d also add that it’s important to stay consistent and follow through with the process. You’re on week 2 out of a 2-month removal protocol, it’s still early days! Many people have had digestive issues for a very long time, it’s normal that it takes a little while to sort them out. Keep working through the protocol as written in the book and hang in there 🙂

  89. Just started Elemental Heal today and am wondering if you can have caffeine free herbal tea? And i believe you take no supplements during this time.I didn’t feel any better with Biota 1a and 1b for a month, tried 2a &2b about a week or so and decided to move on the Elemental Heal do I try the probiotic and Biota’s clear again and then move on to the Prokinetics or should I have tried level 2 protocol first, I had forgotten about that step until just now? I started this whole journey 1/1/19 and the only real change I felt was that my smelly gas was gone but still have lots of gas, bloating, cramping, back and forth from constipated to loose. I ate paleo for 6 years before I started this protocol, the first 6 months on Paleo was great but then became slowly more problems again.
    Thank you!!

    1. Hi Elizabeth,

      We recommend following the protocol as laid out in the book, step 3 level 1 and then step 3 level 2. I would recommend going in order and completing each step fully to give yourself the greatest chance of success.

      On another note, if your gas is particularly smelly, it’s possible that’s an indicator of hydrogen sulfide SIBO (not guaranteed, just a possibility) and you may want to trial a low sulfur diet for a little while and see if that helps at all. https://drruscio.com/low-sulfut-diet/

  90. Just started Elemental Heal today and am wondering if you can have caffeine free herbal tea? And i believe you take no supplements during this time.I didn’t feel any better with Biota 1a and 1b for a month, tried 2a &2b about a week or so and decided to move on the Elemental Heal do I try the probiotic and Biota’s clear again and then move on to the Prokinetics or should I have tried level 2 protocol first, I had forgotten about that step until just now? I started this whole journey 1/1/19 and the only real change I felt was that my smelly gas was gone but still have lots of gas, bloating, cramping, back and forth from constipated to loose. I ate paleo for 6 years before I started this protocol, the first 6 months on Paleo was great but then became slowly more problems again.
    Thank you!!

    1. Hi Elizabeth,

      We recommend following the protocol as laid out in the book, step 3 level 1 and then step 3 level 2. I would recommend going in order and completing each step fully to give yourself the greatest chance of success.

      On another note, if your gas is particularly smelly, it’s possible that’s an indicator of hydrogen sulfide SIBO (not guaranteed, just a possibility) and you may want to trial a low sulfur diet for a little while and see if that helps at all. https://drruscio.com/low-sulfut-diet/

  91. I am almost done with the two months of Biota 1a and 1b and I still have constipation problems. I tried the magnesium citrate and the taste gives me a strong gag reflex. Can I take miralax? I have been on it daily for years and it is the only thing that helps a little?

    1. Hi Jennifer,

      My understanding is that Miralax is currently under review by the FDA because of reports that it causes neuropsychiatric problems in children. Continued research (and anecdotal evidence) has linked the polyethylene glycol in this drug to side effects like paranoia, aggression, anxiety, and depression.

      Have you tried mixing the magnesium in with something (juice, tea, etc) to make it more palatable? You can also purchase magnesium citrate products that are flavored and less intense-tasting.

      Hope this helps.

  92. I am almost done with the two months of Biota 1a and 1b and I still have constipation problems. I tried the magnesium citrate and the taste gives me a strong gag reflex. Can I take miralax? I have been on it daily for years and it is the only thing that helps a little?

    1. Hi Jennifer,

      My understanding is that Miralax is currently under review by the FDA because of reports that it causes neuropsychiatric problems in children. Continued research (and anecdotal evidence) has linked the polyethylene glycol in this drug to side effects like paranoia, aggression, anxiety, and depression.

      Have you tried mixing the magnesium in with something (juice, tea, etc) to make it more palatable? You can also purchase magnesium citrate products that are flavored and less intense-tasting.

      Hope this helps.

  93. Hi, one more question, I am in the last week of Biota 1a and 1b and I haven’t changed anything about my diet or lifestyle and I am following all of the medication protocols as directed, but in the past couple of days I have been experiencing extreme nausea, diarrhea, bloating, gas, and I can feel gas bubbles all in my intestines moving. I don’t understand why I am having such a severe reaction after being on these meds for a while now with no reaction. Have you ever had patients go backwards like I am and start having negative reactions?

    I would like to troubleshoot my next course of action because I can’t go on with these symptoms. Do I have to stop everything for a few days and then try each med, even the meds from step 2, one day at a time to see if one of them is the culprit? Could one of the pills over any of the others be causing a reaction this late in the treatment? If I do take out every pill and reintroduce them slowly, should I not bother with 1a and 1b and try 2a and 2b since I am so close to the end of the first part of step 3?

    Thanks for your help!

    1. Hi Jennifer,

      I can’t give you a definitive answer since there’s a lot I don’t know about your condition, medical history, etc. But I would say it’s possible that it’s a die off reaction. I’d see if you can tough it out for a couple days to see if it passes. If it passes, it’s hopefully just die-off. If it doesn’t, it is possible you’re reacting to something, though as you mentioned, it’s not super common for it to happen after being on the supplements for so long. Do you have an intuitive feeling about any of the supplements in particular that could be bothering you? If so, you could try taking that one out and seeing if it helps. Depending on how far you got (I know you posted this message a few days ago), you could probably move on to 2a/2b assuming you got pretty close. Hope this helps.

      1. Thank you for getting back with me, I was able to stick it out for seven days total and even on the seventh day I was experiencing severe diarrhea, nauseousness, and fatigue. I decided to stop all medication except the three probiotics to give myself time to heal for a few days and to eat food and rehydrate. The book states that die-off reactions should last 3-5 days and that if you go past that then you are having an allergic reaction. Is this pretty accurate or do some people experience longer die-off reaction periods? I am going to start reintroducing the meds again in a few days. If I was experiencing a die-off reaction (and not allergic) at the end of the 1a and b pills (I made it to day 28 of 30) instead of the at the beginning, does that mean my system is just starting to deal with the bad stuff that 1 a and b are supposed to fight? Should I start a whole new cycle of 1a and b pills or should I move onto the 2 a and b pills? I really appreciate the support because I have never experienced feeling that badly for that amount of time and it was scary and I just want to make sure I don’t screw up my gut and make anything worse.

        1. Die-off can be frustrating, but shouldn’t be “scary”. I’m thinking what was going on with you may not have been die-off. Once you feel better, I’d probably just move on to 2a/2b. If you think a reaction is a possibility, go slowly. Start with a small dose of just 1 of the supplements. Then work up to the full dose. Then add a small dose of the second supplement before working up to the full dose. Pay close attention to how you feel and look out for any reactions. Good luck!

  94. Hi, one more question, I am in the last week of Biota 1a and 1b and I haven’t changed anything about my diet or lifestyle and I am following all of the medication protocols as directed, but in the past couple of days I have been experiencing extreme nausea, diarrhea, bloating, gas, and I can feel gas bubbles all in my intestines moving. I don’t understand why I am having such a severe reaction after being on these meds for a while now with no reaction. Have you ever had patients go backwards like I am and start having negative reactions?

    I would like to troubleshoot my next course of action because I can’t go on with these symptoms. Do I have to stop everything for a few days and then try each med, even the meds from step 2, one day at a time to see if one of them is the culprit? Could one of the pills over any of the others be causing a reaction this late in the treatment? If I do take out every pill and reintroduce them slowly, should I not bother with 1a and 1b and try 2a and 2b since I am so close to the end of the first part of step 3?

    Thanks for your help!

    1. Hi Jennifer,

      I can’t give you a definitive answer since there’s a lot I don’t know about your condition, medical history, etc. But I would say it’s possible that it’s a die off reaction. I’d see if you can tough it out for a couple days to see if it passes. If it passes, it’s hopefully just die-off. If it doesn’t, it is possible you’re reacting to something, though as you mentioned, it’s not super common for it to happen after being on the supplements for so long. Do you have an intuitive feeling about any of the supplements in particular that could be bothering you? If so, you could try taking that one out and seeing if it helps. Depending on how far you got (I know you posted this message a few days ago), you could probably move on to 2a/2b assuming you got pretty close. Hope this helps.

      1. Thank you for getting back with me, I was able to stick it out for seven days total and even on the seventh day I was experiencing severe diarrhea, nauseousness, and fatigue. I decided to stop all medication except the three probiotics to give myself time to heal for a few days and to eat food and rehydrate. The book states that die-off reactions should last 3-5 days and that if you go past that then you are having an allergic reaction. Is this pretty accurate or do some people experience longer die-off reaction periods? I am going to start reintroducing the meds again in a few days. If I was experiencing a die-off reaction (and not allergic) at the end of the 1a and b pills (I made it to day 28 of 30) instead of the at the beginning, does that mean my system is just starting to deal with the bad stuff that 1 a and b are supposed to fight? Should I start a whole new cycle of 1a and b pills or should I move onto the 2 a and b pills? I really appreciate the support because I have never experienced feeling that badly for that amount of time and it was scary and I just want to make sure I don’t screw up my gut and make anything worse.

        1. Die-off can be frustrating, but shouldn’t be “scary”. I’m thinking what was going on with you may not have been die-off. Once you feel better, I’d probably just move on to 2a/2b. If you think a reaction is a possibility, go slowly. Start with a small dose of just 1 of the supplements. Then work up to the full dose. Then add a small dose of the second supplement before working up to the full dose. Pay close attention to how you feel and look out for any reactions. Good luck!

  95. Hello! I’m looking to follow the Remove protocol for blastocystis. In a comment elsewhere I noticed Dr. R said he doesn’t use anti-biofilm agents for blasto, but in the book with the protocol I feel like it sounds like you would add that in in level 2. Just looking to clarify, thank you so much.

    1. Hi Grace,

      You only go to level 2 of the Remove step if you don’t improve after level 1. So no need to add in the anti-biofilm agents to start. Hope this helps.

  96. Hello! I’m looking to follow the Remove protocol for blastocystis. In a comment elsewhere I noticed Dr. R said he doesn’t use anti-biofilm agents for blasto, but in the book with the protocol I feel like it sounds like you would add that in in level 2. Just looking to clarify, thank you so much.

    1. Hi Grace,

      You only go to level 2 of the Remove step if you don’t improve after level 1. So no need to add in the anti-biofilm agents to start. Hope this helps.

  97. Dr Ruscio,

    Thank you very much for putting your book together, I love how it ties together all the incremental fixes together that can be found online, and gives them structure.

    I’ve had IBS for 5 years and when unmanaged, is very disruptive to my personal and work life. I take full responsibility for the condition of my gut. I’m currently in ‘step 4’ and after 4 weeks, am planning to move back to 3 with the additional layer of supplements as I have regressed.

    I’m keeping a healthy lifestyle, walk to work, gym 3 times a week and meditate most mornings. I manage my stress, eat only whole foods, abstain from coffee and alcohol, drink only mint tea and water and give myself only the occasional cheat when I feel I’m being a little too hard on myself 😉

    My question: After speaking with my doctor a while back, I was advised that it was okay to vape cannabis (within moderation). I find it’s a great way to unwind on the weekend and is a means to get a little loose with my wife, friends etc. However I recently read a study that a link has been observed between this habit and IBS, particularly in white men.

    https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Bfd43c6f4-62df-4d90-9c3a-d120678a2cdd%7D/long-term-cannabis-use-increases-risk-for-ibs

    What would you advise? I’ve quit for now however would really appreciate your input on this.

    Kind regards,

    Mark.

      1. Hi Mark,

        Just heard back from Dr R on this study, and he’s not particualarly concerned. This kind of data isn’t really helpful unless they perform some type of regression analysis to see if people who were eating unhealthy food and drinking more were also using more cannabis (which is likely where this association comes from). This is also sometimes referred to as the unhealthy user bias. Hope this helps a bit.

  98. Dr Ruscio,

    Thank you very much for putting your book together, I love how it ties together all the incremental fixes together that can be found online, and gives them structure.

    I’ve had IBS for 5 years and when unmanaged, is very disruptive to my personal and work life. I take full responsibility for the condition of my gut. I’m currently in ‘step 4’ and after 4 weeks, am planning to move back to 3 with the additional layer of supplements as I have regressed.

    I’m keeping a healthy lifestyle, walk to work, gym 3 times a week and meditate most mornings. I manage my stress, eat only whole foods, abstain from coffee and alcohol, drink only mint tea and water and give myself only the occasional cheat when I feel I’m being a little too hard on myself 😉

    My question: After speaking with my doctor a while back, I was advised that it was okay to vape cannabis (within moderation). I find it’s a great way to unwind on the weekend and is a means to get a little loose with my wife, friends etc. However I recently read a study that a link has been observed between this habit and IBS, particularly in white men.

    https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Bfd43c6f4-62df-4d90-9c3a-d120678a2cdd%7D/long-term-cannabis-use-increases-risk-for-ibs

    What would you advise? I’ve quit for now however would really appreciate your input on this.

    Kind regards,

    Mark.

      1. Hi Mark,

        Just heard back from Dr R on this study, and he’s not particualarly concerned. This kind of data isn’t really helpful unless they perform some type of regression analysis to see if people who were eating unhealthy food and drinking more were also using more cannabis (which is likely where this association comes from). This is also sometimes referred to as the unhealthy user bias. Hope this helps a bit.

  99. With the homemade elemental diet can I add things like Cinnamon or Ginger?

    When you say “Clear Honey” do you just mean filtered?

    I would rather use your semi-elemental first to test but my concern is that a) its semi-elemental and b) its not organic and therefore potentially contains pesticides / POPs which I know I am highly reactive to. Any thoughts on this?

    As far as the multivitamin recommended can I just continue to take my own supplements?

    Thanks for all your hard work.

    1. Hi Alex,

      There’s no hard and fast rule about adding flavorings. Some pracitioners allow it, while others don’t. My gut reaction (no pun intended) is to keep them out, just to be safe. But it’s up to you – neither of them are high in FODMAPs. You could always try it and see if you can stomach the taste without them before testing out adding them in.

      Yes, filtered honey.

      There is clinical evidence to support that patients can derive just as much benefit from the semi-elemental diet as the elemental diet. Regarding it being organic, that’s hard to say for sure. You could always order one container to test it out and if you have a bad reaction, you can return it for a refund.

      Re: multivitamin, you’ll want to make sure there aren’t any added ingredients that could possibly be irritating to the gut.

      Hope this helps!

  100. With the homemade elemental diet can I add things like Cinnamon or Ginger?

    When you say “Clear Honey” do you just mean filtered?

    I would rather use your semi-elemental first to test but my concern is that a) its semi-elemental and b) its not organic and therefore potentially contains pesticides / POPs which I know I am highly reactive to. Any thoughts on this?

    As far as the multivitamin recommended can I just continue to take my own supplements?

    Thanks for all your hard work.

    1. Hi Alex,

      There’s no hard and fast rule about adding flavorings. Some pracitioners allow it, while others don’t. My gut reaction (no pun intended) is to keep them out, just to be safe. But it’s up to you – neither of them are high in FODMAPs. You could always try it and see if you can stomach the taste without them before testing out adding them in.

      Yes, filtered honey.

      There is clinical evidence to support that patients can derive just as much benefit from the semi-elemental diet as the elemental diet. Regarding it being organic, that’s hard to say for sure. You could always order one container to test it out and if you have a bad reaction, you can return it for a refund.

      Re: multivitamin, you’ll want to make sure there aren’t any added ingredients that could possibly be irritating to the gut.

      Hope this helps!

  101. If I have hydrogen sulfide SIBO, do the recommendations in Step 3 here generally work for that, or is another protocol recommended?

  102. Also, have the hydrogen sulfide cases shown improvement from just the probiotic protocol, as Dr. Ruscio has indicated happens with other SIBO patients?

    1. I don’t know the answer to this. I’ll pass along the question for him to hopefully address on an upcoming Healthy Gut Healthy You listener q+a podcast.

  103. If I have hydrogen sulfide SIBO, do the recommendations in Step 3 here generally work for that, or is another protocol recommended?

  104. Also, have the hydrogen sulfide cases shown improvement from just the probiotic protocol, as Dr. Ruscio has indicated happens with other SIBO patients?

    1. I don’t know the answer to this. I’ll pass along the question for him to hopefully address on an upcoming Healthy Gut Healthy You listener q+a podcast.

  105. The wording for the Remove Protocol Level 2 for taking artemisinin says to take it for week one, then not for weeks two and three, and then take it for one more week (week four). Then you are done for good. This makes it sound like you only take it for the first month. Is that right, or are you supposed to take it for weeks five and seven as well?

  106. The wording for the Remove Protocol Level 2 for taking artemisinin says to take it for week one, then not for weeks two and three, and then take it for one more week (week four). Then you are done for good. This makes it sound like you only take it for the first month. Is that right, or are you supposed to take it for weeks five and seven as well?

  107. I am currently doing the homemade elemental diet and on day 4. It is rough for me with incredible amounts of fatigue and I have had some not so pleasant bowel movements. I am assuming this is a herxheimer’s reaction so I want to at least give it until day 5 before considering to start to reintroduce food.

    That is my real question, how do you go about reintroducing food. What foods are recommended? How slow or fast? Any info you could point me too?

    Additionally, whats the deal with the motilpro? Is this a must?

    1. Hi Alex,

      For the elemental diet, make sure you’re getting enough calories. Fatigue can be a common side effect, but you want to make sure it’s not due to calorie restriction.

      As far as re-introducing food, this is covered on page 283 of the book.

      Prokinetics are addressed in the Step 4 section of the book and should have full explanations. If you don’t want to take motilpro, some alternatives (such as Iberogast) are listed.

      Hope this helps!

  108. I am currently doing the homemade elemental diet and on day 4. It is rough for me with incredible amounts of fatigue and I have had some not so pleasant bowel movements. I am assuming this is a herxheimer’s reaction so I want to at least give it until day 5 before considering to start to reintroduce food.

    That is my real question, how do you go about reintroducing food. What foods are recommended? How slow or fast? Any info you could point me too?

    Additionally, whats the deal with the motilpro? Is this a must?

    1. Hi Alex,

      For the elemental diet, make sure you’re getting enough calories. Fatigue can be a common side effect, but you want to make sure it’s not due to calorie restriction.

      As far as re-introducing food, this is covered on page 283 of the book.

      Prokinetics are addressed in the Step 4 section of the book and should have full explanations. If you don’t want to take motilpro, some alternatives (such as Iberogast) are listed.

      Hope this helps!

  109. I read above where someone noted a contradiction about the instructions for taking Biota Clear 2a during Month 2. I just noticed a different discrepancy that I need to get resolved, as I am currently in the Remove – Level 2 stage of treatment. It involves the instructions and the graphic for taking Biota-Dissolve. I didn’t see this addressed anywhere, so sorry if it’s a duplicate. But the instructions say to take 2 capsules twice per day, and the graphic shows a dosage of 3 capsules twice per day. Can you clear this up for me? As both things indicate that only 2 bottles will be needed, I’m currently working under the assumption that it is the former.

    I’d also like to know, since I’m taking 3 Biota-Clear 1a, 2 Biota-Clear 1b, 3 Artemisinin, and 2 Biota-Dissolve (10 pills) all together on an empty stomach; how much water should I take down with that? Will more or less have any effect, such as dilution or delaying digestion?

    1. Hi Dave,

      Biota-Dissolve is 2 pills 2x per day. That’s been corrected for the second edition of the book.

      The amount of water doesn’t matter.

      Hope this helps.

  110. I read above where someone noted a contradiction about the instructions for taking Biota Clear 2a during Month 2. I just noticed a different discrepancy that I need to get resolved, as I am currently in the Remove – Level 2 stage of treatment. It involves the instructions and the graphic for taking Biota-Dissolve. I didn’t see this addressed anywhere, so sorry if it’s a duplicate. But the instructions say to take 2 capsules twice per day, and the graphic shows a dosage of 3 capsules twice per day. Can you clear this up for me? As both things indicate that only 2 bottles will be needed, I’m currently working under the assumption that it is the former.

    I’d also like to know, since I’m taking 3 Biota-Clear 1a, 2 Biota-Clear 1b, 3 Artemisinin, and 2 Biota-Dissolve (10 pills) all together on an empty stomach; how much water should I take down with that? Will more or less have any effect, such as dilution or delaying digestion?

    1. Hi Dave,

      Biota-Dissolve is 2 pills 2x per day. That’s been corrected for the second edition of the book.

      The amount of water doesn’t matter.

      Hope this helps.

  111. If I’m trying to take the Remove Level 2 supplements on an empty stomach, how do I know when it’s ok to eat again? It takes my stomach a very long time to clear – I have pretty severe delayed stomach emptying. So it can take over an hour (maybe much longer?) before a burp doesn’t smell/taste like oregano. Do I need to feel hunger pangs first for it to be “safe” to eat again? Or does it matter if food mixes with the supplements as long as I give them a head start?

    1. Hi Dave,

      An hour before food is great, but don’t stress, the most important thing is that you take them. If you end up eating sooner than that, it doesn’t mean they won’t work. Try not to stress about it to much and hang in there!

      1. Thanks, Drew. I appreciate the encouragement. I’m doing my best. Hope it’s okay to keep hitting you up with questions, because this journey’s a bit of a bumpy road!

  112. If I’m trying to take the Remove Level 2 supplements on an empty stomach, how do I know when it’s ok to eat again? It takes my stomach a very long time to clear – I have pretty severe delayed stomach emptying. So it can take over an hour (maybe much longer?) before a burp doesn’t smell/taste like oregano. Do I need to feel hunger pangs first for it to be “safe” to eat again? Or does it matter if food mixes with the supplements as long as I give them a head start?

    1. Hi Dave,

      An hour before food is great, but don’t stress, the most important thing is that you take them. If you end up eating sooner than that, it doesn’t mean they won’t work. Try not to stress about it to much and hang in there!

      1. Thanks, Drew. I appreciate the encouragement. I’m doing my best. Hope it’s okay to keep hitting you up with questions, because this journey’s a bit of a bumpy road!

  113. Already got my next question: Same thing with the Saccharomyces Boulardii and all of the Remove Level 2 “empty stomach” supplements? No big deal if I just take them all at the same time? At first I tried giving the SB a half-hour head start, but my schedule doesn’t really allow for that most days.

    1. It’s totally fine. From page 277: “The antimicrobials can be taken at the same time as your probiotics; however, if you can leave a thirty-minute window in between, the antimicrobials may be slightly more effective. For example, you could take your probiotics first thing in the morning with a glass of water. Then take the antimicrobials a little later, before breakfast. If this feels daunting, take them all together. Keep it simple, and do what is easiest for you.”

  114. Already got my next question: Same thing with the Saccharomyces Boulardii and all of the Remove Level 2 “empty stomach” supplements? No big deal if I just take them all at the same time? At first I tried giving the SB a half-hour head start, but my schedule doesn’t really allow for that most days.

    1. It’s totally fine. From page 277: “The antimicrobials can be taken at the same time as your probiotics; however, if you can leave a thirty-minute window in between, the antimicrobials may be slightly more effective. For example, you could take your probiotics first thing in the morning with a glass of water. Then take the antimicrobials a little later, before breakfast. If this feels daunting, take them all together. Keep it simple, and do what is easiest for you.”

  115. So this next one is pretty gross and strange. I’ve had this happen numerous times now since starting the removal protocol. I’m now in week 4. So at certain times I’m able to take the oregano and other herbal antimicrobials on a completely empty stomach. I think that is related to when this happens. When it comes out the other end (I’m so sorry) it still smells potently like oregano and I can see small floating globs of the oil on the toilet water. It’s always diarrhea too. Any idea what’s going on? Do other people have this happen?

    1. Hi Dave,

      My advice would be to experiment with changing it up to see things improve. You may want to try taking the oregano oil with food. You may also want to try taking a smaller dose. If none of these things help, you may not tolerate oil of oregano very well and you could consider switching to a different antimicrobial.

  116. So this next one is pretty gross and strange. I’ve had this happen numerous times now since starting the removal protocol. I’m now in week 4. So at certain times I’m able to take the oregano and other herbal antimicrobials on a completely empty stomach. I think that is related to when this happens. When it comes out the other end (I’m so sorry) it still smells potently like oregano and I can see small floating globs of the oil on the toilet water. It’s always diarrhea too. Any idea what’s going on? Do other people have this happen?

    1. Hi Dave,

      My advice would be to experiment with changing it up to see things improve. You may want to try taking the oregano oil with food. You may also want to try taking a smaller dose. If none of these things help, you may not tolerate oil of oregano very well and you could consider switching to a different antimicrobial.

  117. You guys are out of the Biota-Clear 2a! What should I do if it doesn’t come in time? Take more of the leftover Biota-Clear 1?

    1. Hi Dave,

      It should be back in stock this week, so hopefully you’ll get it in time. If not, then yes, continue with what you’ve got until you’re able to get it delivered to you.

  118. You guys are out of the Biota-Clear 2a! What should I do if it doesn’t come in time? Take more of the leftover Biota-Clear 1?

    1. Hi Dave,

      It should be back in stock this week, so hopefully you’ll get it in time. If not, then yes, continue with what you’ve got until you’re able to get it delivered to you.

    1. Hi Jessica,

      Since those products aren’t in the protocol, all I can do is give you my best guess, which is this: assuming that the two biocidin products are meant to be complementary, you could try them together (in whatever way or dosage the label or website recommends) and then do two of the biota-clears for the next month. I would review the ingredients in the biocidin products and choose whichever biota-clears look the most different, so you’re hopefully covering all your bases.

    1. Hi Jessica,

      Since those products aren’t in the protocol, all I can do is give you my best guess, which is this: assuming that the two biocidin products are meant to be complementary, you could try them together (in whatever way or dosage the label or website recommends) and then do two of the biota-clears for the next month. I would review the ingredients in the biocidin products and choose whichever biota-clears look the most different, so you’re hopefully covering all your bases.

  119. Really random, nerdy question: why are soil-based probiotics recommended to be taken with food? (vs others on an empty stomach)

    Nothing urgent there, just genuine curiosity about how it all works 🙂

    1. It’s actually not critically important, however, current thinking suggests soil-based probiotics may not be affected by digestive secretions. So to make things easier it can be taken with food.

      1. OH! OK, that actually makes things easier–sometimes I wonder if I could take it in fasted state, or need to take it with food (as with minerals like iron that can cause stomach upset). Thanks, that’s helpful!

  120. Really random, nerdy question: why are soil-based probiotics recommended to be taken with food? (vs others on an empty stomach)

    Nothing urgent there, just genuine curiosity about how it all works 🙂

    1. It’s actually not critically important, however, current thinking suggests soil-based probiotics may not be affected by digestive secretions. So to make things easier it can be taken with food.

      1. OH! OK, that actually makes things easier–sometimes I wonder if I could take it in fasted state, or need to take it with food (as with minerals like iron that can cause stomach upset). Thanks, that’s helpful!

  121. Somehow I ended up with extra Artemisinin. Are there any known issues with taking another round (bottle) of it? I also ended up drawing out the whole protocol. Should I be concerned with extended use of any of the Step 3 supplements?

    1. Hi Dave,

      Generally, I wouldn’t be too worried about extending step 3. That being said, you probably don’t want to take more of the step 3 level 2 supplements than you need, and taking a break would be a good idea. If you need more personalized guiance, you can apply for an appointment with Dr Ruscio here: https://www.drruscio.com/gethelp

  122. Regarding the homemade elemental diet, I have a simple question that doesn’t seem to be addressed anywhere (and I mean ANYWHERE): Can the amino acid powder be encapsulated (gelatin capsules) and taken that way to avoid the unpleasant taste and make it easier to tolerate?

  123. Somehow I ended up with extra Artemisinin. Are there any known issues with taking another round (bottle) of it? I also ended up drawing out the whole protocol. Should I be concerned with extended use of any of the Step 3 supplements?

    1. Hi Dave,

      Generally, I wouldn’t be too worried about extending step 3. That being said, you probably don’t want to take more of the step 3 level 2 supplements than you need, and taking a break would be a good idea. If you need more personalized guiance, you can apply for an appointment with Dr Ruscio here: https://www.drruscio.com/gethelp

  124. Regarding the homemade elemental diet, I have a simple question that doesn’t seem to be addressed anywhere (and I mean ANYWHERE): Can the amino acid powder be encapsulated (gelatin capsules) and taken that way to avoid the unpleasant taste and make it easier to tolerate?

  125. I am progressing through Step 3 and need to reorder the Soil-Based Probiotic, but noticed it is back-ordered. Would you recommend Megasporebiotic as a substitute? It has a couple of additional strains, HU36 and CL-307.

    Thanks,

    1. Our soil-based probiotic will be back in stock in just a couple weeks. If you can’t wait until then, Megaspore is a suitable alternative.

  126. I am progressing through Step 3 and need to reorder the Soil-Based Probiotic, but noticed it is back-ordered. Would you recommend Megasporebiotic as a substitute? It has a couple of additional strains, HU36 and CL-307.

    Thanks,

    1. Our soil-based probiotic will be back in stock in just a couple weeks. If you can’t wait until then, Megaspore is a suitable alternative.

  127. I seem to be doing somewhat better on just the oregano (1a) and Biota-Dissolve. Do you think it’s likely that I need to take a break at some point, or can I continue with these long past the 2 months? Does it ever become unsafe?

    1. Hi Dave,

      Biota-Dissolve is not meant for long-term use. But on page 289 of the book, you’ll see Dr R talk about how long-term low-dose antimicrobial therapy may be appropriate for some. Hope this helps!

  128. I seem to be doing somewhat better on just the oregano (1a) and Biota-Dissolve. Do you think it’s likely that I need to take a break at some point, or can I continue with these long past the 2 months? Does it ever become unsafe?

    1. Hi Dave,

      Biota-Dissolve is not meant for long-term use. But on page 289 of the book, you’ll see Dr R talk about how long-term low-dose antimicrobial therapy may be appropriate for some. Hope this helps!

  129. Good Morning Dr Ruscio Team,

    I am confused as to the best time to take 1a/1b/2a/2b. The book mentions “best w/o food”. Since we have food in our stomachs for upto 4 hours, does it mean we take these supplements after 4 hours?
    Since I do 3 meals a day, spaced at 4 hour intervals, my stomach always will have food in it.

  130. Good Morning Dr Ruscio Team,

    I am confused as to the best time to take 1a/1b/2a/2b. The book mentions “best w/o food”. Since we have food in our stomachs for upto 4 hours, does it mean we take these supplements after 4 hours?
    Since I do 3 meals a day, spaced at 4 hour intervals, my stomach always will have food in it.

    1. Hi there,

      Since they are taken twice a day, when you wake up and just before bed should be fine.

  131. Since starting the Remove step 2 Level 2, I have been having more constipation and skin issues.
    Why is this happening? What should I do?

      1. Hi there,

        Check out pages 277-278 on how to distinguish between die-off symptoms and a bad reaction.

        1. Thank you. Can you please give me the section title?
          I have the kindle version of the book and there are “locations” on the book instead of page numbers.

          1. It’s in Chapter 26 (Step 3: Remove). The paragraph is titled “reactions”

  132. Since starting the Remove step 2 Level 2, I have been having more constipation and skin issues.
    Why is this happening? What should I do?

      1. Hi there,

        Check out pages 277-278 on how to distinguish between die-off symptoms and a bad reaction.

        1. Thank you. Can you please give me the section title?
          I have the kindle version of the book and there are “locations” on the book instead of page numbers.

  133. Been on a strict keto diet for about 6 months and saw dramatic improvement. Can’t tolerate antimicrobials. Will following the elemental diet negate the benefits of the keto diet by kicking me out of ketosis due to it’s high carb content (and thus, stopping me from being fat-adapted)?

    1. Hi Jake,

      I’m not an expert in keto, but my guess would be that you will be kicked out of ketosis since the elemental diet is fairly high-carb, but if your body is fat-adapted, it will remember what to do once you go back to solid foods and eating low carb. Another option is to make the lower-carb version of the homemade elemental diet. Hope this helps.

  134. Been on a strict keto diet for about 6 months and saw dramatic improvement. Can’t tolerate antimicrobials. Will following the elemental diet negate the benefits of the keto diet by kicking me out of ketosis due to it’s high carb content (and thus, stopping me from being fat-adapted)?

    1. Hi Jake,

      I’m not an expert in keto, but my guess would be that you will be kicked out of ketosis since the elemental diet is fairly high-carb, but if your body is fat-adapted, it will remember what to do once you go back to solid foods and eating low carb. Another option is to make the lower-carb version of the homemade elemental diet. Hope this helps.

  135. I have hypoglycaemia and been tested for everything! Insulinoma etc Ive had 3 72hour fasts in hospital 3 endoscopies I’ve been to Switzerland for special pancreas scan. Then 1 year ago I went for a hospital sibo test. I am positive to hydrogen sibo. Some experts say sibo can cause hypoglycaemia and some say not. But I have got to try and see if the hypos go when the sibo goes so I am doing the great 8 and now about to go onto part 3 with the antimicrobials. Before I do I have been very pleased to say where I had sugar drops every afternoon they have really improved. When the sugar level goes down now it stops at 4 whereas before it would continue down into a hypo.
    My question is do you think sibo can cause hypoglicemia?
    And as I have had so many tests do I need all the biota clear pills as I know I don’t have h pylori etc I just have sibo to get rid of as I get a bloated stomach if I was to eat garlic etc. I am very healthy with no other symptoms thank you

    1. Hi Christine,

      I’m sorry this has been so hard to figure out and I’m glad to hear you’re slowly improving. I would say that it’s possible. Blood sugar issues and SIBO is a bit of a chicken or the egg scenario (meaning it’s not always clear which one came first), but the inflammation caused by SIBO can likely lead to blood sugar instability and insulin resistance.

      In terms of the supplements, I would still do the full protocol. There are ingredients in all of the biota-clears designed to address SIBO. Additionally, it’s possible that there are other digestive issues that haven’t been tested for that are contributing factors that the protocol will address.

      Hope this helps.

  136. I have hypoglycaemia and been tested for everything! Insulinoma etc Ive had 3 72hour fasts in hospital 3 endoscopies I’ve been to Switzerland for special pancreas scan. Then 1 year ago I went for a hospital sibo test. I am positive to hydrogen sibo. Some experts say sibo can cause hypoglycaemia and some say not. But I have got to try and see if the hypos go when the sibo goes so I am doing the great 8 and now about to go onto part 3 with the antimicrobials. Before I do I have been very pleased to say where I had sugar drops every afternoon they have really improved. When the sugar level goes down now it stops at 4 whereas before it would continue down into a hypo.
    My question is do you think sibo can cause hypoglicemia?
    And as I have had so many tests do I need all the biota clear pills as I know I don’t have h pylori etc I just have sibo to get rid of as I get a bloated stomach if I was to eat garlic etc. I am very healthy with no other symptoms thank you

    1. Hi Christine,

      I’m sorry this has been so hard to figure out and I’m glad to hear you’re slowly improving. I would say that it’s possible. Blood sugar issues and SIBO is a bit of a chicken or the egg scenario (meaning it’s not always clear which one came first), but the inflammation caused by SIBO can likely lead to blood sugar instability and insulin resistance.

      In terms of the supplements, I would still do the full protocol. There are ingredients in all of the biota-clears designed to address SIBO. Additionally, it’s possible that there are other digestive issues that haven’t been tested for that are contributing factors that the protocol will address.

      Hope this helps.

  137. So even after 6 months of taking antimicrobials, adrenal support and probiotics while following the protocol mentioned in the book as strictly as possible, my symptoms didnt reduce but infact increased by leaps and bounds, they increased in the 1st month only but I still continued for 3 months. What do I do now? resort to pharmaceutical anti microbials?

    1. Hi there,

      I’m so sorry to hear this, I’m sure it must be incredibly frustrating when you feel like you’re doing everything right. It sounds like you may be a tough case who needs personalized guidance. I would recommend making an appt with Dr Ruscio so he can assess you personally. The fact that you’ve already gone through the protocol will provide him with helpful information in terms of how to direct you. You can do so here: https://www.drruscio.com/gethelp Good luck!

  138. So even after 6 months of taking antimicrobials, adrenal support and probiotics while following the protocol mentioned in the book as strictly as possible, my symptoms didnt reduce but infact increased by leaps and bounds, they increased in the 1st month only but I still continued for 3 months. What do I do now? resort to pharmaceutical anti microbials?

    1. Hi there,

      I’m so sorry to hear this, I’m sure it must be incredibly frustrating when you feel like you’re doing everything right. It sounds like you may be a tough case who needs personalized guidance. I would recommend making an appt with Dr Ruscio so he can assess you personally. The fact that you’ve already gone through the protocol will provide him with helpful information in terms of how to direct you. You can do so here: https://www.drruscio.com/gethelp Good luck!

  139. Dear Dr Ruscio,

    Is there a substitute for the Oregano oil? I seems like I may be having a bad reaction to it (knee pain, irritation at corners of mouth)
    Thanks,

  140. Hey Michael!

    Love the podcast (long-time listener) and now the book! I’ve been recommending it to as many people as I think would find it useful – which is a lot 😄 Just wish it’d come out last November when I began working with a naturopath – I’ve spent a lot on tests and treatments, and almost a year on elimination diets, and things just seem to be getting worse.

    I’ve done a couple courses of anti-microbials/anti-paracites. Some prescription like azithromecin for campflobacter and Ivermectin (even though parasites didn’t show up on my stool test). Some supplemental, very similar to what you’ve recommended in Step 3 (Biota-Clear 1a, 2a/Paracid Forte, Liposomal Biocidin and NAC in particular). This is alongside chealation, detoxes (including Dr. Bryan Walsh’s), many more supplements (probiotics, multivitamins, enzymes, aloe vera, glutathione, L-glutamine, etc, etc.), blood glucose testing, elimination diets (low FODMAP, AIP), etc.

    Having already followed a protocol quite similar to your step 2 and 3, I’m considering a meat-only/ZC diet (based on Mikhaila Peterson’s amazing results) or/and an elemental diet.

    – Do you think it’s worth going through your Step 2 and 3 *again*, with or before these diets?
    – Which diet would you try first?

    I’d love to hear your thoughts on ZC some day too, but the other questions are more urgent. Thanks for your help Dr. Ruscio and keep sharing the great work you do – you’re one of the best critical thinkers in this space, something we truly need right now.

    1. Thanks!
      I would try the ED next, then consider combining with Habx if they seem to help you. Some patients need hybrid ED plus low dose cyclical Habx, don’t miss this nuance. It is in the book. Give that a go, but clear it with your doctor first.

      1. Fantastic, thanks for the (quick) response! I’m presuming “Habx” are the antimicrobials you recommend at then end of Step 4.

        Would love to hear your thoughts on the ZC/carnivore diet someday – maybe a mini-episode of the podcast someday.

      2. I’ve just finished a 7-day water fast and home-made ED to transition from a beef-only diet to Step 2 (all supplements) & Step 3 (all 3 levels of Habx).

        Would you recommend reintroducing other foods over the course of (or before) those 2 months, or stick to beef-only until Step 5?

        Thanks for your help Dr. Ruscio!

  141. Hi Dr. Ruscio!

    Thank you SO much for all of this information it is the first time I have felt hopeful in awhile. Here is my question is there harm in doing the elemental diet before trying the anti-microbials? I have been dealing with gut issues for over a year now, and have been on anti-biotics and protcols for a parasite as well as bad bacteria and tried all of the diets covered in the book. I have just at this point spent so much time and money and am still bloated and uncomfortable ever day! But I know it is because I most likely have SIBO or some other dysbiosis still going on given everything I have been through. I am ready to just clear everything out once and for all!

    So, just curious your thoughts on that. I am also trying to do the most affordable option at this point because I have spent SO much over the last year trying to figure this out. Any input would be amazing thank you!

  142. Thank you for your very clear book, Dr. Ruscio. You are a natural teacher, which many doctors aren’t!

    You recommend the semi-elemental diet for killing bad bacteria as well as for occasional, short-term use to relieve the gut. However, I have SIBO, and I am wondering about the amount of sugar in it (6g per serving). I have heard that the sugars in the elemental diet may worsen SIBO, especially if it is proximal SIBO. For this reason Integrative Therapeutics has recently come out with a dextrose free elemental that has less than 1g of sugar per serving. Yet I also see that, even with 6g/serving, your semi-elemental diet does not have dextrose or any sugar as an ingredient. I assume the sugar content is naturally occurring in other ingredients. This leads to 2 questions:

    (1 ) Do you consider your semi-elemental diet safe for use with proximal SIBO?

    (2) What do you consider proximal SIBO to be? On my most recent test, I still tested positive at the 80 min mark, but not before. Do you think the semi-elemental is safe for me?

  143. Hi Dr Ruscio,

    Great book. The advice to eat to control inflammation and blood sugar seems so obvious now, but previously I would be hesitant not to eat things like garlic and onion because I would be missing out on their health benefits. Now that I’ve read your book it’s obvious they have to be cut out for at least a period while things are being fixed.

    Anyway, I wanted to ask about step 3 – the dosing for NAC. The book lists two different doses for NAC.

    On page 280 in the left hand column it says take 1 capsule twice per day. On page 280 in the right hand column in the table it says take 3 pills three times per day. Which is right?

    Many thanks.

  144. Hi Dr Ruscio, what is the cause of white tongue while on the semi-elemental diet and should I continue with this diet if my tongue has become white? Thank you for a great book!!

    1. Hi Becky,

      This is fairly common and usually goes away once the diet is completed and regular food is reintroduced.

  145. Good Morning Dr Ruscio,
    Thanks you for this book and your hardwork.

    I have a specific question about this step
    Of the process.
    My name is Alioune, i’m 25 y/o and I’ve been feeling sick since about 5 years with different digestive problems: bad digestion, constipation, acid reflux, heartburn, bloating and gas, brain fog and chronic fatigue. I also suffer from asthma sonce I was 2 y/o after I was filled up with antibiotics.

    After several tests during these 5 years, I’ve done a stool+blood+urine test, turns out I have a bad dysbiosis (no parasites) and candida in my blood plus a lot of food intolerances.
    Now I wonder:

    1 how is possible I have candida in my blood but not in my gut?
    2 is this systemic candida reversible?
    3 Can I heal candida in my blood using antimicrobials herbs of the step 3 ?
    4 I noticed I’m doing well with a FODMAP diet but, I’m not sure if I have to switch to a Paleo+FODMAP diet.

    1. I would continue to work through the protocol in the book. It’s much more thorough than any answer I can provide here. I tried to build into the book answers to your questions in terms of escalating to Paleo Low FODMAP or moving to step 3. If your not sure, try to diet, you can always do more later and go to step 3.

  146. Hi, I was working through step 2 and having some gut improvement with adding the probiotics (while on paleo low fodmaps, keeping carbs to 100-150 gm). I got an acute vaginal yeast infection and developed athlete’s foot. I have struggled with chronic candida for over a decade and been through many rounds of herbal and pharmaceutical anti-fungals despite eating low sugar. I want to move to Step 3 with the antimicrobials though my integrative doctor has prescribed 2 weeks of difucluan followed by a weekly suppressive. I realize the value to using the herbs as they will treat other pathogens and work on more modalities and I believe i need biofilm disrupters given my history (yeast markers show on various tests, but not in stool tests and I have many symptoms). So my questions:
    1. Can I do her 2 week diflucan protocol and then start your protocol?
    2. When I start yours, can I skip to the Level 2 and put the biofilm disrupters in right away
    3. Can I add the biofilm disrupters to aid the diflucan?

    Thanks!

  147. Wondering if ghee is an oil that would be acceptable to use with Elemental Heal? Food sensitivities to sesame and coconut oils make using Udo’s blend or MCT oil impossible. What other oils would work? Thanks.

  148. I have my son (21) doing the protocol from the book. We are looking at preparing for step 3 but he has a nut and shellfish/fish allergies I noticed the tree nut warning on Biota Clear 2B, maybe others too but are one of the options for this step 3 a nut/ shellfishfree option?

  149. I’m one month into 1a & 1b. I’m finding that about 1 hour after eating, I feel flu type sick – skin achey, fatigued, muscle weakness. It goes away in an additional hour or so. Is this related to the gut healing process? I just started 2a & 2b today.

  150. Hi, I just wanted to hear- how can the elemental heal be semi elemental – it does not seem to say that the whey protein you use is hydrolyzed.

    Also – is there any reason you have used maltodextrin and not glucose as the carbohydrate source?

    Thank you

  151. I’ve been on a really clean and strict diet for over a year now trying to help my digestive problems, skin issues, and fatigue/brain fog. I’ve also been taking digestive enzymes/acid, adrenal support (Ashwaganhda), thyroid hormones, and Vitamins D/K/B-Complex.

    I’m better on the diet and supplements but still have all my health problems, just less severe. I even did a 3-day juice fast a month ago.

    My question is should I start with step 3 as I’ve already pretty much been doing steps 1 and 2 for the past year?

    Thanks!

  152. Dr. Ruscio,
    Your Elemental diet contains milk? Whats up with that? This part of the program not for lactose intolerance individuals? Or you take an enzyme with it?

  153. Hi there — looking at trying the elemental diet. On the label, it says one serving is 300 calories, and then it recommends adding one teaspoon of oil, which would come to about 340 calories total. Meanwhile, the infographic above says that one serving is 360 calories, and 480 with oil added (presumably one tablespoon and not one teaspoon). Which information is correct? Thanks,

    Henrik

    1. Hi Henrik,

      The label is correct. The infographic reflects the dosing from our previous formula. We’ll get it updated – thanks for pointing that out!

  154. Hey Guys, First off thanks for the amazing book and help! 2 Questions: 1) Do I need to be taking any type of binder between meals while taking the herbal antibiotics to help with “die off” such as an activated charcoal/clay supplement or is this not necessary? 2) What are your thoughts on drinking raw milk if tolerated during phase 3 (herbal antibiotics) or the entire protocol in general, specifically raw cow colostrum? I found a good grass fed source, but was thinking it may make sense to cut it out completely while doing the protocol. My thought for drinking it was to help heal my gut and immune system? Thanks in advance for the help!

    1. Hi Gary,

      Glad you’re finding the book to be helpful! We’d love an Amazon review if you feel up to to it. To answer your questions:
      1) No
      2) It’s up to you. It’s definitely not necessary, but if you tolerate it and enjoy it, it’s your choice to include or not. For people who still need extra help healing after the antimicrobials, we often recommend our Intestinal Support Formula, which contains immunoglobulins (similar to colostrum but different): https://store.drruscio.com/products/intestinal-support

      1. I will definitely leave a 5 star amazon review! One follow up: For someone that workouts a lot and needs a moderate amount of carbs, what carb sources should I include? I was relying on sweet potatoes everyday but found out that they spiked my blood sugar from 80 to 200 1 hour post meal, so I cut them out. I was using the ketomojo ketone/glucose blood meter to monitor. Are there specific low inflammatory carb choices that would work better with the protocol? Thanks for the help!

          1. Thanks Drew! So I realize I should be limiting/avoiding dairy. What are your/Dr. Ruscio’s thoughts on including raw cow kefir and/or raw cow colostrum during the protocol if I tolerate it well? Would it be optimal to just avoid during the protocol even if I tolerate it? If it is ok to include, does the timing of consuming these raw dairy products matter as far as when I am taking the herbal antibiotics and or probiotics? Thanks for the help!

  155. Hi – two questions

    1. I have been on immunoglobulins, and they have really helped heal up some symptoms. Can I stay on these while on the elemental diet, or do they interfere?

    2. I was advised of some research that suggests going on an elemental diet can actually worsen food reactions associated with dysbiosis (as opposed to SIBO). Though I have been tested for both SIBO with a SIBO breath test and large intestine health via GI-MAP, the results seem to be inconclusive. Are you familiar with any research that indicates that an elemental diet would worsen food reactions associated with large intestine dysbiosis?

    Thank you so much!

  156. Hi! Question about the “Herx die-off reaction.” I am on day 12 of the protocol and following it to a T with all the additionals such adaptogens, NAC, etc. I felt great the first 5 days, but then slowly started to feel some brain fog and lower energy from about day 6-10. Then yesterday, Day 12 I literally felt like I have the flu with intense body aches, bad headache, and low energy. I was surprised how strong these symptoms are. Is this normal to get the die-off reaction so many days after starting? Is there anything I should add/do differently (add binders like clays, activated charcoal, etc) or should I just ride it out? I have read it can last 3-7 days? You guys are the best! Thanks for the help

    1. Hi Gary,

      Sorry for the delayed response – this may no longer be relevant, but it sounds like you may be having a negative reaction to one of the supplements. If you’re still feeling like this, you could try taking out the supplements and adding them back in one at a time to see if you can isolate a reaction to one of them. Let us know how you’re feeling when you get a chance.

  157. Hey Guys, Question about following the Step 3 antimicrobial protocol and a Mold detox protocol that was recently discussed on the podcast. Great podcast by the way! The Mold protocol mentioned is activated charcoal and GI Detox binders, liposomal Glutathione, and Phosphatidylcholine. I know for a fact that years ago I was living in a house that had black mold and thinking back this is around when my symptoms started, which then could have caused my gut issues. Should I wait to finish the gut protocol (I just started month 2 of the Biota-Clear 2a & 2b, Biota Dissolve, NAC, and adrenal support) or can I start the Mold protocol mentioned above now? If it is ok to start mold protocol now, when would it be best to take the binders? Thanks for all of your support!

    1. Hi Gary,

      Glad you enjoyed that episode of the podcast and great question. The short answer is there are no hard and fast rules – you’ll have to make the decision you feel is best for you. The longer answer is that we typically recommend that people finish the HGHY protocol first before moving on to more niche protocol, because the gut drives a lot a symptoms and can potentially cause things that you may attribute to something else (e.g. mold). But again, it’s a case by case basis. Hope this helps – if you’d like some more personalized guidance, you’re welcome to set up a consult with our health coach, Aimee: https://drruscio.com/health-coaching/

  158. Hey Drew, quick follow up regarding stool quality. When should I have an improvement with stool quality, during or some time after the protocol is complete? Background: I have always had very consistent 1 bowel movement in the AM, but have had loose/muddy stool (bristol 6) for about 10 years. I am in my last week (week 8) of step 3 of the protocol with the added NAC, biota dissolve, and adrenal support) and am now having 2 bowel movements in the AM and the quality is a little more formed, but still light and still probably bristol 6. When should I expect to improve to say a bristol 5, and even bristol 4 quality? I really appreciate your help!

  159. I just ordered the Biota Dissolve (and some other things). The front of the Biota Dissolve advertises “hypoallergenic”, but the bottle notes it actually contains egg, which is the only thing I have a true diagnosed food “allergy” to. I’ve never had an acute reaction to egg. How likely is it to cause a problem? Otherwise I’ll just initiate a refund…

    1. Hi there,

      The lysozyme in the product (from egg white) does have the potential for allergic reaction so isn’t recommended for patients with history of egg allergy (IgE mediated hypersensitivity). So if you have a true allergy, it seems like a refund would be the best option. Hope this helps!

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