In treating SIBO with the botanical protocol, do you take any special precautions among highly sensitive patients, such as those with fibromyalgia, atrial fib[rillation], excessive blood clotting, IBD, [or] IBS? In such patients, do you consider introducing one botanical at a time? If so, what is your recommended order?

This is a good question because I think, more often than not, our patients are pretty sensitive, even not necessarily with, like, a disease or a diagnosis that makes us more cautionary, but even just the patient, like, self-reporting has said “I can’t tolerate any supplements” or “I’m very limited in my diet,” [or] “I have histamine reactions to just about everything.” Those are pretty common concerns for the majority of our patients, so I always recommend that patients do one botanical at a time even if they don’t necessarily report that they’re sensitive, so a couple of different scenarios. One, the patient is not known to be very sensitive. There’s really no diagnosis to be concerned about, then, I usually have them separate each botanical supplement by two to three days. Get started on one, give it two to three days, make sure you’re tolerating it well, and then you can add in the next one, and usually, I have them add them in at the lowest dose if I’m not concerned. So start the lowest dose for two to three days, [and if] you’re tolerating everything well, great; add the next one in the lowest dose and so on and so on, and then once they’re on everything at the lowest dose, they can start to incrementally increase each supplement every couple of days. Some patients dive right in and they do fine, and it’s not an issue. I would say, though, that [for] the majority of patients that try to do that, we end up having issues or they have problems with just too much too fast, [and] die-off happens really quickly. They don’t feel well, and in that case, we usually have, like, a 15-minute appointment and we kind of talk it out and talk about how to rearrange the protocol, stopping everything, restarting, so there’s lots of different options. The way that I usually recommend introducing things is I usually have them start with InterFase Plus like the biofilm disruptor and then Lauricidin. The GI-Synergy is always last. So, for me, the GI-Synergy or the big heavy-duty antimicrobial, [and] I always have them do [that] last. I think it depends. There’s always a lot of different variations, so if they’re on a probiotic or going to be on a probiotic as part of the protocol, I’ll have them start that first. I think that’s usually well tolerated; get a nice base and if they’re going to be on, like, a beater or a digestive enzyme, I also have them start that in the very beginning before we add in any of the other antimicrobials. I think they’re well tolerated. If you’re going to have them on, like, a promotility enhancer or something with constipation, I like to also get that on board before I do any of the antimicrobials because it’s really, as you guys know, really important for the detoxification process to make sure that we are moving those endotoxins out of the body, as we’re lysing open these cell walls and killing pathogens and mobilizing toxins. It’s really important that we’re keeping the bowels moving. So GI-Synergy last, for sure. Probiotics, digestive enzymes, beaters, [and] promotility enhancers [are] the first ones that I introduce, and then Lauricidin, InterFase Plus are kind of right in the middle. If the patient is very, very sensitive, then I will have them go very, very slowly. I’ve even had patients where I check them three to four months to ramp up on the protocol. It seems like a long time, but I encourage patients and say this is why I have found the best success when we take it slowly and we go very, very low, and it’s much better than overshooting and having to stop everything and wait for symptoms to kind of reside and then restart. Most people are pretty open to it and they’ve said “I’ve been here this long and I’m here to work on this” and they’re usually pretty open, so it is a little bit of an adjustment, but I would say very, very slowly, giving at least, like, seven to 10 days in between the introduction of each new supplement is kind of what I recommend, and even sometimes opening the capsules and doing a very little amount or doing, like, one or two pellets of the Lauricidin just to kind of see how they do, and if they have trouble with one, put it aside, let symptoms resolve, and then start again with the next one on the list. So it’s not a perfect answer. There’s a lot of, kind of, movement, and it really depends on what the patient is dealing with, but I hope that kind of gave you an idea of what we normally do in the clinic.