Resetting the Microbiota of the Small Intestine

Increased diversity of the intestinal microbiota (world of bacteria) generally appears to be a good thing. Can we achieve increased diversity by administering agents that kill bacteria? Can antibiotics or antimicrobial herbs increase diversity? Let’s discuss an important but often overlooked concept.

Dr. R’s Fast Facts

Resetting the Microbiota with Rifaximin as it Relates to SIBO (Small Intestinal Bacterial Overgrowth)

How Does Rifaximin Help Treat or Reset the Microbiota?

  • By administering an antibiotic like Rifaximin you may be able to increase the diversity in your small intestine.
    • The job of Rifaximin (along with other herbal antimicrobials) is to limit the “bad guys” (bad bacteria that is overgrown) allowing the “good guys” (helpful bacteria) to grow, thus increasing your diversity.
  • While it may seem to make sense to increase diversity in the gut by adding Prebiotics and Fiber to your regimen, for many people with SIBO, this makes the symptoms worse.

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Resetting the Microbiota of the Small Intestine

Dr. Michael Ruscio: Resetting the small intestinal microbiota with rifaximin. Hi, this is Dr. Ruscio, and you’ve likely heard of SIBO, or small intestinal bacterial overgrowth, which can oftentimes manifest as the symptoms of IBS—gas, bloating, constipation, diarrhea, loose stools, abdominal pain. In fact, in some cases, the majority of IBS may be caused by this SIBO, this small intestinal bacterial overgrowth, and there is an antibiotic called rifaximin that has been shown to be very effective in treating this small intestinal bacterial overgrowth.

Recently a paper was published discussing an interesting concept in how rifaximin helps to treat this bacterial overgrowth in the small intestine, and what it may actually do is allow the small intestinal microbiota to reset. Now, allow me to expand on exactly what that means. In small intestinal bacterial overgrowth, of course, you have too much growth of bacteria in the small intestine. When you have an overgrowth, what can happen is one group of bacteria can change the environment in such a way that it crowds out other bacteria, and this can have a negative effect on the whole bacterial colony.

One of the things that is often recommended that we try to do is increase the diversity of the microbiota, and while not all data are consistent on this, there does seem to be a general trend that more diversity—more types of trees and life, to use a forest analogy—in your intestinal bacteria is healthy. Because we’re observing this, oftentimes the recommendation is to reach for things like fiber and prebiotics that increase diversity. Now, this is not necessarily a bad idea, but in some cases it can be a bad idea because, you see, if you do have small intestinal bacterial overgrowth, there’s a chance that fiber and prebiotics will actually make you worse.

But—and here’s where rifaximin ties into this picture—if we can remove or kill off the overgrowth of bacteria, that changes the environment in the small intestine and allows the other populations that were dwindling to grow, thus increasing your diversity. So while it sounds a little bit counterintuitive, by administering an antibiotic or an herb that has antimicrobial activity, you may actually be able to increase the diversity in your small intestine because you’re going to limit the bad guys that are pushing out the other good guys, allow the good guys to grow, and thus increase your diversity.

This is an interesting concept I wanted to introduce especially because sometimes with the microbiota literature we get a little bit confused in terms of how to arrive at the increased diversity. What I’ve seen clinically is that more often than not, interventions that tend to get rid of bacteria that shouldn’t be there tend to cause patients to feel the best. Part of what may be happening underneath the surface there is they are actually increasing their microbiotal diversity and thus healing their gut, even though they’re increasing their diversity using something that actually kills bacteria. It sounds counterintuitive, but it seems to be a very sound clinical treatment.

Anyway, this is Dr. Ruscio, and hopefully this information helps you get healthy and get back to your life. Thanks.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

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!

100 thoughts on “Resetting the Microbiota of the Small Intestine

  1. Hey Dr. Ruscio,

    Very interesting article. Does this also apply to herbal treatments for SIBO such as Oil of Oregano and Artemesia?

    If a patient has a multitude of issues–adrenal fatigue, intestinal parasites, SIBO & intracellular pathogens–what would be your preferred order of treatment?

  2. Great info! I really appreciate and understand your work and posts. 🙂 Which herbs do you believe could potentially work like rifaximin in killing the bad bacteria, thus allowing the good guys to flourish? Do you believe Oil of Oregano could be a good one, or does it kill the beneficial bacteria too? What is your opinion on Samento (Cat’s Claw, Peruvian – free from TOC)? These are often suggested for help destroying the Lyme bacteria and co-infection, as you are likely award.

    1. Hi Doreen,
      Thank you! I think herbs have the same effect, and there are many that work like Rifaximin to treat SIBO. Samento has a time and place, the patient context is really what dictates. Hope this helps! 🙂

  3. Hi Dr. Ruscio,
    This is very interesting information and I truly appreciate your hard work in getting this knowledge out to us who suffer with SIBO C. What do you do with a patient that is unable to tolerate antibiotics such as Rifaximin, herbal antimicrobials and/or the Elemental diet. I was diagnosed with SIBO C two years ago and have not been able to address it due to severe reactions to antibiotics, herbal or otherwise. I also suffer with an irritable bladder that flares when I have attempted the elemental diet. I control my symptoms by eating only chicken, fish, beef, liver, green beans, a little rice, duck fat, olive oil and that’s it. I have tried probiotics but break out in a rash. I am wondering if I should try the Silvercillin and at what dosage? I would truly appreciate any advice you could offer! I have been to all sorts of medical professionals, Naturpathic, Wholistic, Functional, Oriental medicine but so far nothing has helped.
    Thank you very much!
    Jutta

    1. Hi Jutta,
      There are different version of the ED that can be done, experimenting here might be worth while. Alternatively, you may need to perform some detox or methylation support before you will be able to tolerate GI treatment. If you contact my office we could start looking into the gut side of things and if it appears detox/methylation is needed we could refer you to someone for that also. Hope this helps! 🙂 Hang in there!

    1. Kristin, there is some discussion in the SIBO community that the generic/cheaper version of Rifaximin might be OK. The jury is still out but once this is firmed up I will report in.

  4. Hey Dr. Ruscio,

    Very interesting article. Does this also apply to herbal treatments for SIBO such as Oil of Oregano and Artemesia?

    If a patient has a multitude of issues–adrenal fatigue, intestinal parasites, SIBO & intracellular pathogens–what would be your preferred order of treatment?

  5. Well, I believe it all makes perfect sense. My understanding is that all people with SIBO have some degree of malabsorption. Especially of carbs. So bacteria are exposed to lots of glucose fructose and starches, which as we know feed only some strains which are best adapted and those are not the ones we want to be there, or not the only ones that we want there.

    P.S.!!!! You definitely need notification function for comment section!

  6. Great info! I really appreciate and understand your work and posts. 🙂 Which herbs do you believe could potentially work like rifaximin in killing the bad bacteria, thus allowing the good guys to flourish? Do you believe Oil of Oregano could be a good one, or does it kill the beneficial bacteria too? What is your opinion on Samento (Cat’s Claw, Peruvian – free from TOC)? These are often suggested for help destroying the Lyme bacteria and co-infection, as you are likely award.

    1. Hi Doreen,
      Thank you! I think herbs have the same effect, and there are many that work like Rifaximin to treat SIBO. Samento has a time and place, the patient context is really what dictates. Hope this helps! 🙂

  7. Hi Dr. Ruscio,
    This is very interesting information and I truly appreciate your hard work in getting this knowledge out to us who suffer with SIBO C. What do you do with a patient that is unable to tolerate antibiotics such as Rifaximin, herbal antimicrobials and/or the Elemental diet. I was diagnosed with SIBO C two years ago and have not been able to address it due to severe reactions to antibiotics, herbal or otherwise. I also suffer with an irritable bladder that flares when I have attempted the elemental diet. I control my symptoms by eating only chicken, fish, beef, liver, green beans, a little rice, duck fat, olive oil and that’s it. I have tried probiotics but break out in a rash. I am wondering if I should try the Silvercillin and at what dosage? I would truly appreciate any advice you could offer! I have been to all sorts of medical professionals, Naturpathic, Wholistic, Functional, Oriental medicine but so far nothing has helped.
    Thank you very much!
    Jutta

    1. Hi Jutta,
      There are different version of the ED that can be done, experimenting here might be worth while. Alternatively, you may need to perform some detox or methylation support before you will be able to tolerate GI treatment. If you contact my office we could start looking into the gut side of things and if it appears detox/methylation is needed we could refer you to someone for that also. Hope this helps! 🙂 Hang in there!

    1. Kristin, there is some discussion in the SIBO community that the generic/cheaper version of Rifaximin might be OK. The jury is still out but once this is firmed up I will report in.

  8. Well, I believe it all makes perfect sense. My understanding is that all people with SIBO have some degree of malabsorption. Especially of carbs. So bacteria are exposed to lots of glucose fructose and starches, which as we know feed only some strains which are best adapted and those are not the ones we want to be there, or not the only ones that we want there.

    P.S.!!!! You definitely need notification function for comment section!

  9. I recently had all my amalgams taken out. The difference in digestion has been very noticeable. So I searched to see if I was crazy or this had happened to others and found this:

    Digestive problems were very common among participants. They can be caused by many factors, but amalgam removal demonstrates a strong positive effect on these problems. The mercury released from the amalgam fillings combines with the saliva, forming extremely poisonous methyl-mercury in the mouth, stomach and colon. The composition of digestive bacteria is changed as a result, and mostly mercury-resistent bacteria survive. Thus, many bacteria essential to healthy digestion are destroyed. A new study indicates that people with amalgam fillings have many more strains of penicillin-resistant bacteria than those without amalgam fillings.29

    From: http://www.lichtenberg.dk/symptoms_before_and_after_proper.htm

    My digestion was never going to improve until 100% removal of mercury. The change happened in less than 1 week. So basically I was throwing time and money away on fermented foods for years. More emphasis needs to be placed on dealing with mercury 1st then moving on to other issues.

    1. Hi Cindy,
      Thanks for sharing your experience, I’m glad that you figured this out. I think your case in the exception rather than the rule. I say this after spending years doing detox with patients with minimal results and then spending years focusing on the gut first and seeing most health problems resolve. After an exhaustive review of the literature, it does appear a small subset of people truly need mercury detox – you must be one of these people. However, for most people addressing a gut issue should be done first. 🙂

  10. I recently had all my amalgams taken out. The difference in digestion has been very noticeable. So I searched to see if I was crazy or this had happened to others and found this:

    Digestive problems were very common among participants. They can be caused by many factors, but amalgam removal demonstrates a strong positive effect on these problems. The mercury released from the amalgam fillings combines with the saliva, forming extremely poisonous methyl-mercury in the mouth, stomach and colon. The composition of digestive bacteria is changed as a result, and mostly mercury-resistent bacteria survive. Thus, many bacteria essential to healthy digestion are destroyed. A new study indicates that people with amalgam fillings have many more strains of penicillin-resistant bacteria than those without amalgam fillings.29

    From: http://www.lichtenberg.dk/symptoms_before_and_after_proper.htm

    My digestion was never going to improve until 100% removal of mercury. The change happened in less than 1 week. So basically I was throwing time and money away on fermented foods for years. More emphasis needs to be placed on dealing with mercury 1st then moving on to other issues.

    1. Hi Cindy,
      Thanks for sharing your experience, I’m glad that you figured this out. I think your case in the exception rather than the rule. I say this after spending years doing detox with patients with minimal results and then spending years focusing on the gut first and seeing most health problems resolve. After an exhaustive review of the literature, it does appear a small subset of people truly need mercury detox – you must be one of these people. However, for most people addressing a gut issue should be done first. 🙂

  11. Why does Dr. Seibecker say biofilms showed no difference in treating SIBO? It seems like it is controversial among many doctors. When do you feel they are necessary? Can herbal antimicrobials reset the SI Microbiota or just Xifaxian?

    Also, if symptoms are much improved but vitamin deficiency, mild/moderate yeast and bacteria and fat malabsorption still shows on NutraEval test do you recommend keep at the antimicrobials? Or work more on repopulating the gut?

    1. Hi Tracey,
      I can’t speak for her but it’s in part a clinical observation. It also may be that biofilms are less likely to form in the harsher environment of the SI. Using antibiofilm agents will be addressed in an upcoming podcast 🙂 Yes, I think herbals can certainly achieve the same thing. To your last question it really depends on the context of the patient.
      Hope this helps!

  12. Why does Dr. Seibecker say biofilms showed no difference in treating SIBO? It seems like it is controversial among many doctors. When do you feel they are necessary? Can herbal antimicrobials reset the SI Microbiota or just Xifaxian?

    Also, if symptoms are much improved but vitamin deficiency, mild/moderate yeast and bacteria and fat malabsorption still shows on NutraEval test do you recommend keep at the antimicrobials? Or work more on repopulating the gut?

    1. Hi Tracey,
      I can’t speak for her but it’s in part a clinical observation. It also may be that biofilms are less likely to form in the harsher environment of the SI. Using antibiofilm agents will be addressed in an upcoming podcast 🙂 Yes, I think herbals can certainly achieve the same thing. To your last question it really depends on the context of the patient.
      Hope this helps!

  13. When should one introduce probiotics after stopping the herbal antimicrobials and what type do you recommend for constipation dominant IBS

  14. When should one introduce probiotics after stopping the herbal antimicrobials and what type do you recommend for constipation dominant IBS

  15. Can you recommend practitioners that specialize in methylation issues? I really need some help in this area and don’t know who to go to for this issue. I also have gut issues, adrenal issues. Thanks!

    1. Hi Anita,
      If you have GI issues I would start there as they can exacerbate methylation problems. Dr. Amy Nett might be a good place to start for Methylation work. If you need gut help, feel free to reach out to my office.

  16. Can you recommend practitioners that specialize in methylation issues? I really need some help in this area and don’t know who to go to for this issue. I also have gut issues, adrenal issues. Thanks!

    1. Hi Anita,
      If you have GI issues I would start there as they can exacerbate methylation problems. Dr. Amy Nett might be a good place to start for Methylation work. If you need gut help, feel free to reach out to my office.

  17. Hi Dr Ruscio, I recently eliminated high FODMAP foods d/t some serious GI distress, and w/in 24 hours of doing so, I am symptom free. I would like to purchase a home SIBO test and would like a reputable/reliable company to purchase from. What are your recommebdation(s)? Thank you, Rachael

    1. Hey Rachel. Sounds like you are of to a good start! Right now we use the lab at NCNM SIBO center. CommonWealth is also good. I have just heard of Aero Diagnosticis (spelling?) and they seem like they might be great also, we are currently evaluating them. Any of these should be a good place to test.

  18. Hi Dr Ruscio, I recently eliminated high FODMAP foods d/t some serious GI distress, and w/in 24 hours of doing so, I am symptom free. I would like to purchase a home SIBO test and would like a reputable/reliable company to purchase from. What are your recommebdation(s)? Thank you, Rachael

    1. Hey Rachel. Sounds like you are of to a good start! Right now we use the lab at NCNM SIBO center. CommonWealth is also good. I have just heard of Aero Diagnosticis (spelling?) and they seem like they might be great also, we are currently evaluating them. Any of these should be a good place to test.

  19. I wondered if I have a severe case of leaky gut, is it then bad for me to take the antibiotics? Will they to just leak through and be another toxic burden going through my body? Thanks. Therese

    1. Hi Therese. This all depends on context; what Rx, for what infection and in what type of patient. There is no generic answer here. If you have symptoms of leaky gut you should consider a thorough GI evaluation with a competent FM GI doc, or as I teach in my seminars, or follow the steps in my coming book. Its critical you address the cause of the leaky gut, what is used to achieve this depends on what is causing the leaky gut. Hope this helps!!

  20. I wondered if I have a severe case of leaky gut, is it then bad for me to take the antibiotics? Will they to just leak through and be another toxic burden going through my body? Thanks. Therese

    1. Hi Therese. This all depends on context; what Rx, for what infection and in what type of patient. There is no generic answer here. If you have symptoms of leaky gut you should consider a thorough GI evaluation with a competent FM GI doc, or as I teach in my seminars, or follow the steps in my coming book. Its critical you address the cause of the leaky gut, what is used to achieve this depends on what is causing the leaky gut. Hope this helps!!

  21. I am currently on rifaximin and feeling a lot of relief from gas, stomach pain, reflux, etc. I am in a quandary as to which probiotic to take. I understand we don’t want to continue to overgrow the bacteria that we are trying to eliminate so I am confused which product to take. It appears that most probiotics have some prebiotics and thus would feed the bacteria ever more. Is there a specific brand or strain I can purchase? I am working with a naturopath but I’m not sure how much experience she has had with treating SIBO. Thanks for all your podcasts, and You Tube videos they all help tremendously.

  22. I am currently on rifaximin and feeling a lot of relief from gas, stomach pain, reflux, etc. I am in a quandary as to which probiotic to take. I understand we don’t want to continue to overgrow the bacteria that we are trying to eliminate so I am confused which product to take. It appears that most probiotics have some prebiotics and thus would feed the bacteria ever more. Is there a specific brand or strain I can purchase? I am working with a naturopath but I’m not sure how much experience she has had with treating SIBO. Thanks for all your podcasts, and You Tube videos they all help tremendously.

  23. I am confused. Does Refaximin more favorable outcomes than antimicrobials? I pre-ordered your book but Amazon has advised me there is a delay in shipping.

    Does chicory exacerbate SIBO?
    Thank you for your diligence.

  24. Thank you for your very informative website. I appreciate how generous you are with your knowledge.
    The treatments for SIBO (both antibiotic and herbal) result in a very severe die-off reaction. Usually a week of what feels like a terrible flu. Then maybe a month of relief from SIBO symptoms. Not sustainable! Might be a malfunctioning valve from bad food poisoning?
    What do you recommend for after care from treatment that will halt the Re growth besides defensive diet (already doing that).
    Thank you so much.

  25. Ok, I’m confused. I thought SIBO was not really an issue of overgrowth per se, but instead growth or migration of bacteria in the WRONG place….you know, not getting swept out properly.

    Ok, I can hear the answer now.: “When the bacteria doesn’t get swept out, that causes the overgrowth.” But if that’s the case, then what does killing that bacteria do in the long run? If it’s a sweeping issue, won’t we just end up right back in the same situation?

    1. Similar to Elle’s question because for the past few months have been combining ileocecal valve massage and taking Pancreatic Enzymes at 2-5 am when usually wake up anyway so that’s about the most empty my stomach will be and it’s has cut the bloat and terrible smelling gas to almost zero – but if I miss a does of the Pancreatic it’s back the next day (this new for me after years of taking digestive enzymes with food with good but not total results.)

    2. Hi Elle,
      You are assuming that lack of ‘sweeping’ is the ONLY cause if SIBO, which is not the case. Dysbiosis seems to fuel dysbiosis, hence the value of a ‘reset’.

  26. I am confused. Does Refaximin more favorable outcomes than antimicrobials? I pre-ordered your book but Amazon has advised me there is a delay in shipping.

    Does chicory exacerbate SIBO?
    Thank you for your diligence.

  27. Thank you for your very informative website. I appreciate how generous you are with your knowledge.
    The treatments for SIBO (both antibiotic and herbal) result in a very severe die-off reaction. Usually a week of what feels like a terrible flu. Then maybe a month of relief from SIBO symptoms. Not sustainable! Might be a malfunctioning valve from bad food poisoning?
    What do you recommend for after care from treatment that will halt the Re growth besides defensive diet (already doing that).
    Thank you so much.

  28. Ok, I’m confused. I thought SIBO was not really an issue of overgrowth per se, but instead growth or migration of bacteria in the WRONG place….you know, not getting swept out properly.

    Ok, I can hear the answer now.: “When the bacteria doesn’t get swept out, that causes the overgrowth.” But if that’s the case, then what does killing that bacteria do in the long run? If it’s a sweeping issue, won’t we just end up right back in the same situation?

    1. Similar to Elle’s question because for the past few months have been combining ileocecal valve massage and taking Pancreatic Enzymes at 2-5 am when usually wake up anyway so that’s about the most empty my stomach will be and it’s has cut the bloat and terrible smelling gas to almost zero – but if I miss a does of the Pancreatic it’s back the next day (this new for me after years of taking digestive enzymes with food with good but not total results.)

    2. Hi Elle,
      You are assuming that lack of ‘sweeping’ is the ONLY cause if SIBO, which is not the case. Dysbiosis seems to fuel dysbiosis, hence the value of a ‘reset’.

  29. Hi Dr Ruscio
    I am being treated with Berberine for SIBO by a nutritionist in Britain. I don’t understand why I am losing so much weight. I have been tested for malabsorption and it’s not a problem. My stomach acid is very low hence I think this reduced my B12 and Vit D. I am now taking HCL and apple cider vinegar.
    I’m finding your site very helpful and about to download your book.

    1. Hi Sallie,
      If you are on a very restrictive diet, you might be losing weight because you are not eating enough and/or are too low carb. My book can provides some insights for this. Adding in a elemental shake is an easy way to add in some calories also 🙂

  30. Hi Dr Ruscio
    I am being treated with Berberine for SIBO by a nutritionist in Britain. I don’t understand why I am losing so much weight. I have been tested for malabsorption and it’s not a problem. My stomach acid is very low hence I think this reduced my B12 and Vit D. I am now taking HCL and apple cider vinegar.
    I’m finding your site very helpful and about to download your book.

    1. Hi Sallie,
      If you are on a very restrictive diet, you might be losing weight because you are not eating enough and/or are too low carb. My book can provides some insights for this. Adding in a elemental shake is an easy way to add in some calories also 🙂

  31. Why do md’s tend to dislike the use of probiotics for sibo and natural drs strongly recommend them. Dr. Pimentel posted a study last week on Twitter showing that Align contributed to bacteria growth. Will there ever be a consensus on this matter?

  32. Why do md’s tend to dislike the use of probiotics for sibo and natural drs strongly recommend them. Dr. Pimentel posted a study last week on Twitter showing that Align contributed to bacteria growth. Will there ever be a consensus on this matter?

  33. Hello Dr. Ruscio,

    My 9-year-old daughter has a bone marrow disease and has to take Jadenu to chelate iron. It has basically caused her to have constant stomach pain. She is now refusing to eat. Before we take her off this important medicine (iron in the bloodstream and organs can be very dangerous) do you think that giving her herbs and other treatments to try to help her gut could help?? And do you ever work with children?? Thank you!!! It is very devastating to watch your child be in pain constantly.

  34. Hello Dr. Ruscio,

    My 9-year-old daughter has a bone marrow disease and has to take Jadenu to chelate iron. It has basically caused her to have constant stomach pain. She is now refusing to eat. Before we take her off this important medicine (iron in the bloodstream and organs can be very dangerous) do you think that giving her herbs and other treatments to try to help her gut could help?? And do you ever work with children?? Thank you!!! It is very devastating to watch your child be in pain constantly.

  35. I have significant digestive problems since an unintended stress induced weight loss about six Years ago. I trying to figure out what the problem is I also discovered that I am dq 8 positive. I cut out all gluten and was able to gain weight back but I have plateaued about 5 lbs less than where I want to be I have petite very fast metabolisms and athlete. my digestive issues consists of very rapid transit iBS d. symptoms of SIBO.SIFO (have nail fungus and angular chelitis recently as well) I eat about 2500 calories a day but Cleary don’t feel I am absorbing everything I eat. I see a very large (formed) stools usually which is relieving but few times a week have several very large unformed stools with lots of food fragments in it. I do eat a very clean Whole Foods diet so that could be a function of high fiber.
    I take one drop oil or oregano daily with dinner, Paul d Arco tea with lumbrokinease and lypo gold before breakfast to break up biofilms and 3 grams lysine 600 mg nac to help with gut. its odd that my b12 and d 3 levels are actually high that would indicate that I am not Mal absorbing but im convinced I have SIBO that is eating up the nutrients I take in. If I can get my Dr to prescribe xifaxin what is the optimal course I have read two three week course of 3x/day? also is berberine considered most effective for SIBO on empty stomach. Im on your new patient wait list now any question or suggestion you can answer in meantime to optimize gut health would be great. (I do take l Reuteri and custom probiotics 6 strain d lactate free powder) are probiotics contradicted in possible SIBO case?

    1. Hi Amy,
      Glad to hear you’re making some forward progress. You might need two things; 1) reduce the fermentation load in your gut, 2) use an effective course of antimicrobials AND select probiotics. Dysbiosis is know to cause limited response to a gluten free diet and by implementing 1 and 2 you can rectify this. See https://drruscio.com/getgutbook/ for specific protocols.

  36. I have significant digestive problems since an unintended stress induced weight loss about six Years ago. I trying to figure out what the problem is I also discovered that I am dq 8 positive. I cut out all gluten and was able to gain weight back but I have plateaued about 5 lbs less than where I want to be I have petite very fast metabolisms and athlete. my digestive issues consists of very rapid transit iBS d. symptoms of SIBO.SIFO (have nail fungus and angular chelitis recently as well) I eat about 2500 calories a day but Cleary don’t feel I am absorbing everything I eat. I see a very large (formed) stools usually which is relieving but few times a week have several very large unformed stools with lots of food fragments in it. I do eat a very clean Whole Foods diet so that could be a function of high fiber.
    I take one drop oil or oregano daily with dinner, Paul d Arco tea with lumbrokinease and lypo gold before breakfast to break up biofilms and 3 grams lysine 600 mg nac to help with gut. its odd that my b12 and d 3 levels are actually high that would indicate that I am not Mal absorbing but im convinced I have SIBO that is eating up the nutrients I take in. If I can get my Dr to prescribe xifaxin what is the optimal course I have read two three week course of 3x/day? also is berberine considered most effective for SIBO on empty stomach. Im on your new patient wait list now any question or suggestion you can answer in meantime to optimize gut health would be great. (I do take l Reuteri and custom probiotics 6 strain d lactate free powder) are probiotics contradicted in possible SIBO case?

    1. Hi Amy,
      Glad to hear you’re making some forward progress. You might need two things; 1) reduce the fermentation load in your gut, 2) use an effective course of antimicrobials AND select probiotics. Dysbiosis is know to cause limited response to a gluten free diet and by implementing 1 and 2 you can rectify this. See https://drruscio.com/getgutbook/ for specific protocols.

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