HGHY Great-In-8 FAQ Step 4

Great-in-8 Plan Contents

Healthy Gut, Healthy You

Step 4: Rebalance

We will be adding answers to the most commonly asked questions about Step 4 of the Great-In-8 plan along with important information for troubleshooting this step here shortly.

Please post any questions or comments regarding this step below.

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!

34 thoughts on “HGHY Great-In-8 FAQ Step 4

  1. Good book. Very precise. I notice you don’t say anything about rotating prokinetics. Those of us with stubborn cases will be on prokinetics for some time. I’ve heard both Dr. Pimental and Allison Siebecker state that the problem with prokinetics is that they stop working after awhile. (Dr. Pimental is clearly knowledgeable in this area as he has followed patients with MMC problems for 10 years and more).

    I’m wondering if rotating prokinetics would alleviate this problem. After a year and three months of dealing with SIBO (much in the manner laid out in your book) I’m trying to be clear of bacteria long enough to tackle the autoimmunity that underlies my particular problem. I need to keep moving debris through my intestinal tract while my MMC is not functioning properly and am concerned about relying on prokinetics that don’t really work. Any thoughts on rotating them?

    thanks,

    1. Thanks Chris,
      This answer requires a longer explanation, I will tackle in a coming listener question podcast.
      But in short – I’m not sold on prokinetics being the only approach here, although I remain open. The low dose cyclic antimicrobial approach is the method I prefer.
      More to follow.

  2. Elemental Diet- Hybrid approach, Step 4

    One more quick question, you relate:

    “There have been two Cochrane systematic reviews that found a semielemental diet works just as well as the full elemental diet…This has been reinforced by clinical trials that compared these diets”.

    I believe that a semielemental diet greatly improved my SIBO. (This after a year of only nominally successful herbal antibiotic/antibiotic treatment). I thereafter embarked on a “hybrid” diet (two meals elemental, one regular easily digested, low fodmap meal) about 4 weeks ago. I am now relapsing (digestive and, sadly, joint pain symptoms). Perhaps this is bacterial overgrowth and I simply need retreatment or return to a full semielemental diet. On the other hand, I sometimes wonder if I could be reacting to the protein in my shakes. I have used hydrolyzed beef protein as my protein source throughout. (I had some concern about using whey based on a Cyrex test result and what I believed was a reaction early on).

    What have you seen in this regard? Do any of your patients react to the whey protein in the semielemental formula you recommend?

    Thanks again,

  3. The Great in 8 has me in great shape! I am ready to start the 4th step. I am not sure which prokinetic to choose. Is there an advantage to one over the other? they seem to be very different formulations. If you had to choose one, which would it be?

  4. About prokinetics: Fabulous book that brings all the info together in a very organized way!! I’ve done AIP and leaning toward more Paleo for 4-1/2 years, trying to heal from 23 years of rheumatoid arthritis. I worked with a functional medicine M.D. and I tried similar supplements to those you mention in your book up to Step 4. Still don’t feel great and can’t get off my medications. My question: I’ve had constipation my whole life and it has just gotten worse through the years. I’ve tried everything!! I found your info on prokinetics very interesting, as I had never heard of them. I’m considering taking MotilPro to get things moving. Do you think it would be a good idea to first do a liquid fast with Elemental Heal? Thank you for your reply and thank you for all your hard work/research for us!!

    1. An elemental diet can be helpful when other therapies have not. If your doctor gives the OK, you could try it. Also, ****remember this protocol is mean to be progressive and build upon itself, so it is in your best interest not to jump in the middle. You can, but I’d work up to step 3C and 4.

  5. Hi Dr. Ruscio,

    Thank you so much for this book. I’ve been working through the protocol, not seeing much progress until the second month of step 3. Then, I started feeling better than I had in years! I was very happy and moved on to this step with Motilpro. It’s only been about a week but I’ve seemed to taken a pretty big step backward. Yesterday was the first day I had a bit of reaction from motilpro with some burning for about 30 minutes. My diet has been very slightly eased. Can you advise if I should

    a) go back to step 3 (and the second month’s protocol which seemed to help so much, or

    b) switch to Ibergast, or)

    c) tighten up my diet again and give myself some more time with Motilpro? Thank you!

    P.s. I have an initial appointment scheduled with you at the end of August. I was inclined to postpone and continue with the book protocol as I was making progress but not sure. Do you have a suggestion here as well?

  6. Hi Dr. Ruscio

    In Chapter 19 of HGHY you talk about the ileocecal valve and how the use of Prokinetics may help improve the function of this valve. I have also heard others talk about “visceral manipulations”, essentially massaging of the abdomen in such a way (by a skilled chiropractor) as to physically restore ileocecal valve function. I have not looked too closely into this myself but curious if you might have an opinion on this, if it’s worth looking into as an additional helpful way of restoring overall gut health, if in fact one has a malfunctioning valve? Thanks.

    1. Hi Manuel,

      Visceral manipulation can be helpful for IC valve issues and/or if someone has SIBO due to adhesions. Good luck!

  7. 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.

    1. Hi Kayla,

      I’ve passed this question along for Dr R to hopefully answer in an upcoming listener q+a episode of the podcast. Stay tuned!

  8. After some real success with Step 3, level 2 (my skin cleared up and significant reduction in bloating), I completed Step 4 with Iberogast and really regressed. My gas and bloating is quite bad again and my skin is also starting to go back to where it was before.

    I am trying to decide if I should go back to Remove level 2 or try the elemental diet/level 3 this time.

    Despite the improvements in gas and skin, I had a really hard time taking all those supplements, and sometimes I would throw up. Maybe elemental would be easier on me?

    Thank you!
    Sarah

    1. Hi Sarah,

      Glad you experienced success with step 3, and don’t get discouraged, some regression is fairly common. It’s up to you what you do – check out page 289 of the book for advice on reassessing. The elemental diet could potentially be a good option for you, but check in with your doctor and make sure to listen to your body. Good luck!

  9. Good book. Very precise. I notice you don’t say anything about rotating prokinetics. Those of us with stubborn cases will be on prokinetics for some time. I’ve heard both Dr. Pimental and Allison Siebecker state that the problem with prokinetics is that they stop working after awhile. (Dr. Pimental is clearly knowledgeable in this area as he has followed patients with MMC problems for 10 years and more).

    I’m wondering if rotating prokinetics would alleviate this problem. After a year and three months of dealing with SIBO (much in the manner laid out in your book) I’m trying to be clear of bacteria long enough to tackle the autoimmunity that underlies my particular problem. I need to keep moving debris through my intestinal tract while my MMC is not functioning properly and am concerned about relying on prokinetics that don’t really work. Any thoughts on rotating them?

    thanks,

    1. Thanks Chris,
      This answer requires a longer explanation, I will tackle in a coming listener question podcast.
      But in short – I’m not sold on prokinetics being the only approach here, although I remain open. The low dose cyclic antimicrobial approach is the method I prefer.
      More to follow.

  10. Elemental Diet- Hybrid approach, Step 4

    One more quick question, you relate:

    “There have been two Cochrane systematic reviews that found a semielemental diet works just as well as the full elemental diet…This has been reinforced by clinical trials that compared these diets”.

    I believe that a semielemental diet greatly improved my SIBO. (This after a year of only nominally successful herbal antibiotic/antibiotic treatment). I thereafter embarked on a “hybrid” diet (two meals elemental, one regular easily digested, low fodmap meal) about 4 weeks ago. I am now relapsing (digestive and, sadly, joint pain symptoms). Perhaps this is bacterial overgrowth and I simply need retreatment or return to a full semielemental diet. On the other hand, I sometimes wonder if I could be reacting to the protein in my shakes. I have used hydrolyzed beef protein as my protein source throughout. (I had some concern about using whey based on a Cyrex test result and what I believed was a reaction early on).

    What have you seen in this regard? Do any of your patients react to the whey protein in the semielemental formula you recommend?

    Thanks again,

  11. The Great in 8 has me in great shape! I am ready to start the 4th step. I am not sure which prokinetic to choose. Is there an advantage to one over the other? they seem to be very different formulations. If you had to choose one, which would it be?

  12. 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.

    1. Hi Kayla,

      I’ve passed this question along for Dr R to hopefully answer in an upcoming listener q+a episode of the podcast. Stay tuned!

  13. About prokinetics: Fabulous book that brings all the info together in a very organized way!! I’ve done AIP and leaning toward more Paleo for 4-1/2 years, trying to heal from 23 years of rheumatoid arthritis. I worked with a functional medicine M.D. and I tried similar supplements to those you mention in your book up to Step 4. Still don’t feel great and can’t get off my medications. My question: I’ve had constipation my whole life and it has just gotten worse through the years. I’ve tried everything!! I found your info on prokinetics very interesting, as I had never heard of them. I’m considering taking MotilPro to get things moving. Do you think it would be a good idea to first do a liquid fast with Elemental Heal? Thank you for your reply and thank you for all your hard work/research for us!!

    1. An elemental diet can be helpful when other therapies have not. If your doctor gives the OK, you could try it. Also, ****remember this protocol is mean to be progressive and build upon itself, so it is in your best interest not to jump in the middle. You can, but I’d work up to step 3C and 4.

  14. Hi Dr. Ruscio,

    Thank you so much for this book. I’ve been working through the protocol, not seeing much progress until the second month of step 3. Then, I started feeling better than I had in years! I was very happy and moved on to this step with Motilpro. It’s only been about a week but I’ve seemed to taken a pretty big step backward. Yesterday was the first day I had a bit of reaction from motilpro with some burning for about 30 minutes. My diet has been very slightly eased. Can you advise if I should

    a) go back to step 3 (and the second month’s protocol which seemed to help so much, or

    b) switch to Ibergast, or)

    c) tighten up my diet again and give myself some more time with Motilpro? Thank you!

    P.s. I have an initial appointment scheduled with you at the end of August. I was inclined to postpone and continue with the book protocol as I was making progress but not sure. Do you have a suggestion here as well?

  15. Hi Dr. Ruscio

    In Chapter 19 of HGHY you talk about the ileocecal valve and how the use of Prokinetics may help improve the function of this valve. I have also heard others talk about “visceral manipulations”, essentially massaging of the abdomen in such a way (by a skilled chiropractor) as to physically restore ileocecal valve function. I have not looked too closely into this myself but curious if you might have an opinion on this, if it’s worth looking into as an additional helpful way of restoring overall gut health, if in fact one has a malfunctioning valve? Thanks.

    1. Hi Manuel,

      Visceral manipulation can be helpful for IC valve issues and/or if someone has SIBO due to adhesions. Good luck!

  16. After some real success with Step 3, level 2 (my skin cleared up and significant reduction in bloating), I completed Step 4 with Iberogast and really regressed. My gas and bloating is quite bad again and my skin is also starting to go back to where it was before.

    I am trying to decide if I should go back to Remove level 2 or try the elemental diet/level 3 this time.

    Despite the improvements in gas and skin, I had a really hard time taking all those supplements, and sometimes I would throw up. Maybe elemental would be easier on me?

    Thank you!
    Sarah

    1. Hi Sarah,

      Glad you experienced success with step 3, and don’t get discouraged, some regression is fairly common. It’s up to you what you do – check out page 289 of the book for advice on reassessing. The elemental diet could potentially be a good option for you, but check in with your doctor and make sure to listen to your body. Good luck!

  17. Moving on to Step 4 – I have issues with loose bowel movements. (Only diarrhea, never constipation.) Will the prokinetics exacerbate the loose bm’s? It seems like they are recommended for folks with constipation. Advice?

    1. Hi Louise,

      Good question! The short answer is not necessarily. I’m not sure what your specific health issue is, but to use the example of SIBO-D: If you have with SIBO, it’s due to an overabundance of bacteria in the small intestine, not an excessive amount of gastrointestinal motility in the small intestine. Once you fix the overgrowth issue, the motility issue will also be corrected. So in many case, a prokinetic is helpful. Of course everyone is different, so make sure to listen to your body. Good luck!

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