Hey, everyone. This is Dr. Ruscio. Let's today discuss a question regarding recurring SIBO, and I'd like to play you this question from one of our audience members. Hey, Dr. Ruscio. It's Mike in NYC. Just a quick question on SIBO. Do you find that SIBO is usually recurrent in your patients? And if so, does this suggest a deeper root issue than just treating the SIBO alone? In other words, if SIBO is recurrent, can you speculate on some possible root issues? Like what could be at the center of recurrent SIBO? Thank you very much. Okay, good question, understandable question. And there's a couple factors to address, even before answering that question, which is is this actually SIBO? Because I think we've come to a point now where people are blaming SIBO for more than SIBO is actually causing. And I think we've gotten to a point in the healthcare culture where SIBO has generated too much momentum. I've been very thankful for the awareness about SIBO, but now I think people are blaming SIBO for everything, even when they don't have SIBO, and it's almost become this mystical or somewhat mythical figure in healthcare. And it's important to have a accurate understanding of what SIBO is, what SIBO is not, and not just be attributing any flair of symptoms that you're having to SIBO. So let me put a few bullet points up here on the screen. First, identify, is this actually SIBO? A flair of digestive symptoms does not mean that you have SIBO. And a flair of digestive symptoms doesn't necessarily mean anything's wrong or broken, or even if you have a flair of digestive symptoms that correlates with the SIBO breath test being positive, it doesn't necessarily mean anything is wrong or broken, but rather there's an imbalance that can be rectified. And that's important to keep in mind because sometimes people have a fear of SIBO. So I want to make sure to clarify that if you do actually have a documented SIBO as a cause of your symptoms, don't get overly concerned about that. It's something that's very treatable and manageable. Yes, there are some severe cases, but for the most part what I noticed in the clinic is people have a far more than they likely should. So don't be afraid of SIBO. So if you do have a flair of symptoms or show a regression of SIBO lab work plus symptoms, again, sometimes it's just your symptoms flaring and it's not SIBO, or sometimes you may see lab work positive and your symptoms flaring. If that does happen, there's a few things that you can consider in terms of what you can do. And then I'll come back to what the underlying cause or causes may be. Level one would be to check in on your diet and lifestyle. And this is important because what happens sometimes is people have become too liberal with their diet or with their lifestyle. So if someone got themselves to a point where they were feeling well, they may have been eating a cleaner diet, getting more sleep, exercising, managing stress, and now they're feeling good. They're doing more, sleeping less, exercising less, eating out more, eating less healthy foods, which I think is a good thing. Don't get me wrong. I think that's a good thing to move in that direction. However, sometimes if you go too far for too long, you regress your gut because you've done too much. And I use this example often. It's like if you had a knee injury and you did rehab and you got yourself back to exercise or back to sports, but you overdid it, your knee may start to ache again.  Okay, so sometimes all you have to do is tend to your diet. That may mean that you're eating too much sugar, too much processed food. You might be, if you had done a paleo diet or a low FODMAP diet, you may be consuming too much non-paleo compliant foods or high FODMAP foods, and just simple adjustments there of reducing some of those things can be helpful in some cases. Now, level two can be support. Probiotics are probably the best support, both for initial kind of foundational support, both for cleaning SIBO out of the small intestine and for helping one to get to a point where they have less symptoms. So probiotics can be very helpful also, and there's a few different types of probiotics, and I'll come back to a tip on that in a moment. If that still doesn't work, then level three of therapy could be antimicrobials, and this could be herbal therapy or antibiotics, and level four what can be used preventatively to prevent SIBO from recurring if it is in fact SIBO, which it's important that you quantify that it actually is, then herbal or pharmaceutical prokinetic therapy can be helpful. So those are some things that can be helpful, and if you've already had SIBO and you're wondering about recurrence, then sometimes to put it quite simply, what can be helpful to prevent that recurrence is just a short re-visitation of the therapy that got you to a healthy position in the first place. So if a paleo diet plus probiotics got you healthy, you may just need to revisit paleo plus probiotics. If you had to do low FODMAP plus erbal antimicrobials, you might need to revisit a low FODMAP diet plus a small-dose short course of antimicrobial. So sometimes a solution is one that you have already discovered and just needs a re-visitation just like doing some of the rehab exercises for your knee if you were to have a flare. Regarding underlying cause of SIBO, use of acid lowering medications like proboscid, nexium have been shown at least loosely to increase one's risk for SIBO as have immunosuppressive drugs, as have certain types of intestinal surgery, and as has the the condition known as impaired motility and this is where things slow down in the intestines and this may allow SIBO to recur. I think that mechanism is actually over popular compared to how much the utility can actually serve for people, but those are some of the underlying causes. What you do about that is really quantified into that steps one through four that we just went through. Now also remember that you could be having a regression of your symptoms, an IBS-like regression of symptoms, not regression of SIBO, and for symptomatic regression diet, lifestyle, stress can all be factors that can lead to symptomatic regressions. And also for the symptoms specifically, pain signaling may be one factor that's an underlying cause of people who have sensitive guts. So sometimes it's something to blame SIBO and I think that gives us an overly narrow perspective on gut health. There are multiple factors that can lead to one's gut health. Someone who's hypersensitive to pain may lead them to have periodic regressions and there's a couple of solutions for that. Probiotics is one, LofopMap is another. Again, another reason why it's important to not think about your gut health exclusively through the lens of SIBO. So my advice would be to listen to your gut and work to provide the optimum environmental support to allow a healthy gut and a healthy gut ecosystem to exist. And this is much broader and less reductionistic than thinking about just one underlying factor, such as SIBO or such as SIBO being caused by a motility impairment and this is a this is a mistaken thinking. Trying to reduce the gut down to one thing that might be in vogue at the moment right now. It's definitely SIBO and SIBO certainly can be important, but we can't reduce everything in your gut.  We cannot reduce all that down to one thing. So while it can seem scientific and seem like a good idea to try to focus on SIBO and get really deep into one factor, I think the the best success comes when you look at your gut broadly. And so again, I'd recommend that you do not focus on just one thing, but rather what combination of environmental factors will present the best stimulus to your gut to have a healthy gut, healthy gut immune system and keep you devoid of symptoms. Now, this is really quantified in Healthy Gut, Healthy You, which is the book I've recently released that walks you through how to implement all these steps. And and so hopefully that answers your question and plus gives you some actionable data to move on. And remember, there's more to your gut than SIBO as important as SIBO is and these things can occur. That's not necessarily abnormal. And if you focus on a broad holistic approach to your gut health, then you should be able to come out on top, meaning you have a minimal, if no symptoms. And if you do have an occasional regression, that's actually okay. It's not a big deal. And sometimes we just have to revisit a therapy for a bit of a touch-up and it doesn't mean anything is wrong or broken. So hopefully that helps, Mike, and hopefully this helps you get healthy and get back to your life. Thanks.


There are three pure science crown research institutes in New Zealand GNS looks after geological phenomena knee-width studies water in all its various forms and Landcare research where I worked for four years is concerned with soils flora and fauna Maps play a really special role within that workplace and I'd often find some combination of of Garth and Pierre and Carolyn and Marino leaning over a roughly printed topographic map or a hand-drawn chart and Together we'd gesture and point and nod and disagree Tracing lines with our fingers and pointing out inconsistencies with ballpoint pens and by talking through the map We developed a shared understanding of our respective problem domains and Those graphical props they they really lived longer than a few hours Although on occasion a landscape profile sketched on the back of a pie packet proof so valuable that it would actually get filed away but the power of those artifacts was largely in their transience and Being ephemeral that it encouraged us to scribble and cross out and annotate all the while narrating our thought processes to one another Rebecca Solnit is Perhaps best known as a really insightful essayist, but she's also collaborated with cartographers on two published atlases This map of oil infrastructure and bird migration from her atlas of New Orleans is one of my favorites and last week I watched this YouTube clip of her Delivering a lecture where she made this statement that maps allow me to make prepositions about cities and places as nothing else does And it brought to mind my time as a scientist and how much my colleagues and I learned from the act of creating and talking about These throwaway data visualizations with one another and it made me reflect that with the possible exception of website analytics I don't see this happening to nearly the same degree within memory institutions like the ones that we work with in And that's not to say that it doesn't happen More that unlike in the sciences these activities tend to be clustered in Specific contexts or individuals rather than practiced by everyone as a matter of course And I wonder what it would look like if we folded these modes of inquiry and representation into our everyday practices of working with our colleagues and collections And these are some things that inspire me This is one entry from the wonderful data project where each week Georgia loopy and Stephanie Posovic they pick a theme and they spend a week collecting data and then creating a visual representation of some aspect of that theme and Send the other the result is of a visual data postcard and Here Stephanie is showing the individual items that have accumulated on the desk in her office workspace So something incredibly mundane and in each circle represents an object and the top ten types of items are assigned to color but what intrigues me is Stephanie's commentary when she observes that through the act of constructing this she realized that the items on my desk are more of an indication of my Personality hopes and insecurities than I'd ever realized Kate Hannah who spoke just a moment ago we together we just recently started something called the data poet society and Every couple of months we gather at the University of Auckland over drinks and food to share interesting data visualizations and learn from others Talk to one of us if you'd like to become involved Last week. I'm sorry last month Kate shared this lo-fi delight which has a gendered history of science prizes in New Zealand Presenting the data as a chart on a whiteboard allowed others to physically point at different parts of the plot making observations or asking for clarification and the interplay between the verbal narration and the pen-on-the-wall graphic provided insights into both the nature of the data and Intercate thinking processes and that's really valuable. I Think it's worth just quickly making a distinction between visual thinking and visual communication Because these modes of data of working with data they get confused, but I think that they're distinct Visual thinking which is what I'm talking about happens in private It's you alone or you and a colleague in the next desk or a small group crowded around a laptop It's tentative. It's messy and exploratory and values quick iteration over correctness Visual communication happens once you understand what you're working with and are ready to communicate this to an audience It's refined. It's reduced to a handful of dimensions and it's often performative Visual communications the realm of the professional designer, but I think that visual thinking is for everyone Sometimes I think about these sorts of working graphics as a sort of mental scaffolding In the act of rendering data or drawing our thoughts we assemble We assemble a construct to hang other concepts from So it's a construct that can be extended or modified or disassembled and turned into something new Scaffold of frameworks that help us to build more permanent structures and Graphics are a means to explore ideas and discover what we really think about something This talk came about because two nights ago I was reflecting on an exercise that digital New Zealand and the National Library online teams participated in earlier this year and he asked that each person Create a paper or a digital visualization of some aspect of our job or the collections or services that we work with We had one month to make something and at the end of that month we gathered and we shared the things that we'd made I explored some aspect of our system that had been bothering me and I don't know I put together some it was some like bloody scatterplot Hexbin thing And that was fine But the amazing moment happened right at the end where the last person up appeared really quite uncertain about what she'd made and She walked to the front of the room and she hung up this large piece of white butcher paper and Sorry, this is surprisingly emotional Because I was blown away she It was covered in a felt-tip pen rendering of our metadata harvesting system and It was seen from her perspective and it had these small little yellow post-it notes Where she traced the paths that the metadata documents where they move through the various systems and layers of technology and Puntuating this flow. She had indicated the various circumstances and contexts where a human might might touch that metadata and I played a really big role in designing the system that she was describing But I had never seen it like that I'd never seen it through the eyes of the person who was driving it and this graphic became this incredibly useful prop For her to narrate her experience and it was the space for her to convey the debt of my time's up But I'm gonna finish I got another minute in my head It was a space for her to convey the depth of her experience and to help the rest of the team Reach this shared understanding But there's something a little bit more than that Because you know when someone presents something and you can see that they're uncertain about how it's going to be received and then they get into it and What they are saying is absolutely fascinating to everyone in the room and and you feel your fellow kind of audience members Getting hooked in and the sort of glow comes off them and it pushes up to the speaker Which emboldens them further and then the talk gets better and better and this is what happened to this colleague of mine and something about giving the space Where she could demonstrate her mastery of the system and the integrity with which she treats her job It just blew me away and I hope that you can have similar experiences like that in your workplaces And I encourage you all just to make really rough graphics and explain them to one another. Thank you


Rwy'n digwydd am y ddweud y Cymru, gallwn wedi'i difyrddionysgau bod Leng Wray fel Llynydd. How are you sir? Very well, thank you very much. And you've just bought a season ticket for the very first time, haven't you? No, I was quite clapping. We want some friendly encouragement. So, when Phil Parkinson and his side kickoff... Who is that? Who's who? Is he the manager? Phil Parkinson. Yes, he's the manager. He's the manager. Alright. He's the special one, the chosen one. Alright, right, I thought that was that Chelsea fellow. Diolch yn rhywun. We've beaten them. We've beaten them. Don't worry about that. Na mynd i games do you get for that? 23 home games. Och! That's a bargain if I were her to buy that.


What's good job is what Ross back again with another video? So finally had a chance to check out the Hell in a Cell match between Roman Reigns and Raymond stereo on Smackdown I Was actually very confused by this. I don't know why they move this match to Smackdown If you guys know the actual reason why they move this match to Smackdown and not have it on the Hell in a Cell Comment down below. Let me know because I'm actually confused here. I'm gonna be honest with you It just it doesn't make sense to put this type of match on Smackdown I don't even think there's ever been a Hell in a Cell match on Like a on like just a regular brand show raw or Smackdown It's usually on a pay-per-view not just on the actual weekly television show. So that's a first I want to say that is the first time that's happened, but it doesn't make sense to do now. I know AEW had some type of cage match like a UFC UFC style cage match So I don't know if it was them trying to compete with AEW on that front But this match should have strictly happened on the Hell in a Cell pay-per-view not the like the day before two days before and They tried to go with the excuse like Roman Ray couldn't wait until Sunday, so he wanted to get his hands on Roman now and they moved up the match No, I've seen feuds blood feuds like intense feuds in WWE Where they were trying to kill each other on the weekly show and somehow They was able to wait till Sunday to get the match going So now all of a sudden if the wrestler wants to move up the match and just move it up like I don't know man So I did I wasn't a big fan of it being on smack now I just think that's something you should have put on a pay-per-view and I'm gonna really give my thoughts and opinions on this In match I took notes here and I'm gonna just kind of break it down or how I was feeling at the time and Kind of let you guys know on where I think the match could have been better and where they could have taken this storyline so All right, so the match starts off Ray starts using a steel chair You know trying to get in the early early shots in then Ray goes under the ring Uses a firing stinger chair then Ray hits Roman with a toolbox and then Ray starts hitting Roman with With the chair again against the ribs like Ray started off this match very aggressive It was very Ray dominant offense I even liked the segment where Ray had a Roman's head like you know in the seat of the chair He's just ramming it ramming him into like the the cell the the ring post like Ray was showing some aggressiveness and I was loving that Then he places the chair on Roman spine and hits a baseball slide I thought that was a nice little cool spot where Roman sitting on the apron Ray has the chair Propped up against his back and the ropes the bottom ropes and he hits a baseball slide. It was a nice little spot, man and Ray was starting to show the vicious side. This is what we should have been seeing This is what we should have been seeing outside the ring if you attack my son I'm not here to talk to you like I don't like any time I see you you could be doing an interview You could be walking in the hallway.  Oh, I'm gonna make sure I end you, you know So I was loving the vicious side from Ray and I put in my notes at this particular time I still don't understand why this match can't be on Sunday, but you know, I'm very confused by that Then Roman spears a table placed on the edge in the corner of the hell in the cell But Ray dodges it and Roman goes straight to the table. I was like, okay, like Ray is still getting the upper hand I like this little spot like Ray was trying to go for I want to say a her carana, but Roman was able to keep keep him in place He wasn't you know He didn't allow his momentum to be shifted and he started swinging Ray like just a just a sack of potatoes It's against the sale then against the other wall of the sale just over and over and then I like this nice little spot where I want to say He was about to like he lifts them up in a power bomb position But he ends up just throwing Ray against the hell in the cell It was a cool little spot Ray got a little bit of height and it works that Ray is the smaller guy Cuz they can do some, you know nicer spots They get back into the ring Roman starts hitting Ray with vicious knees vicious punches in the corner then Ray starts whooping his ass with the steel chair again He was going in then he places the steel chair on top of Roman while he's laying on his back goes to the top rope It's a frog split frog splash while Ray is while Roman is laying You know laying on the ground with the steel chair on top of them now Yes a cool spot, but Ray couldn't make the cover because he hurt himself Like I've always liked that spot, but I always knew that spot doesn't make sense for the person That's actually hitting the move because to be honest with you I think it hurts the person more that's jumping on to it because they're fully extended So there's really no way to soften the blow. You know I'm saying so I never really understood that spot, but Ray couldn't capitalize on the pin so he goes up to the top rope again. He's a one another splash, but for two count Roman then this is when Roman starts getting up in his offense man. This is when Roman starts getting in his bag I find this funny. It shouldn't be funny bro, but Roman throws Ray Mysterio Outside the ring like he did Dominic he just launches him into the cell wall He falls out of the camera shot and you hear Paul him and oh my god the announcers are selling it like Ray just got murdered. It's just a funny spot to me to see this grown-ass man throw another grown-ass man into oblivion So RP Ray at that moment He was he was with his son in the gulag Ray and Dominic were both in the gulag at this point man and Then he gets a Ray back in the ring. He applies to guillotine and Ray immediately taps out He doesn't pass out. They just have my man tap out.   I want to pull it out when I was watching this match I was like, this is this is an enjoyable match for sure.   No, it was with J. Uso and That match made sense for it to be in the hell in a cell because it was family related and that was it was it was Definitely more brutal more intense and I enjoyed that match a lot more than Ray versus Roman in hell in a cell This just didn't need it.  There's certain fugues and certain things that happen in wrestling We're like, I don't want no match with you. I'm not trying to follow the rules I'm trying to end your career. So, you know what? Let's have this stipulated match Whatever stipulated match and we go from there because you did something that is like now personal and I want to end you and That's would have been perfect, you know saying but instead they they wanted to go hell in a cell And then they decided to pull this match from the hell in a cell pay-per-view to put on smackdown And I just don't think it worked this probably and be honest with you Out of all the Roman Reigns matches. I've seen this will probably be my least favorite and it's not even a bad match It's not it's just I feel like the storyline was kind of rushed They didn't really build it as enough because they started with the Jimmy and Jay storyline So I was thinking they were going with that. They went with this and I really wanted more from Ray here in the sense of really getting pissed off and really trying to end this man's career like granted He did attack him. I want to say was it last week? He did attack him with the kendo sticking stuff and I thought that that was pretty cool and all this other stuff But at the same time, you know They kind of rushed into this to get ready for the hell in a cell pay-per-view and it wasn't even on the pay-per-view So and now that was the one match. I was looking forward to on the pay-per-view. There's not gonna be on the pay-per-view So I'm gonna be honest with you guys I don't think I'm gonna do a thoughts and opinions video on this pay-per-view. I'm just be honest with you I don't really care for a lot of the other matches, especially the the smackdown side of things Now I would be interested in seeing Sami Zayn and Kevin Owens just a little bit, but the smackdown side of the door I mean not smackdown the raw side of things I don't care for it smackdown side of things a little bit more interested in the only thing I really wanted to see was Roman versus Ray, but it's already happened So I'm not gonna do a thoughts and opinions video, but I think I want to switch it up for the first time I think I'm going to go live While the pay-per-view is live and I'm not gonna be able to show the pay-per-view footage obviously But I'll have it on in the background I'll go live with you guys and we'll just be in a chat Chopping it up with each other. Just you know watching the pay-per-view together. I Think that would be a much enjoyable experience for me personally instead of me taking notes on the pay-per-view I don't even really too much care about but you guys being in a chat We're being able to have a good time, you know joke around with whatever's going on in the pay-per-view and stuff like that I think it would make it a lot more enjoyable So comment down below Let me know if you guys want me to go live on YouTube for the first time to check out this pay-per-view With you guys if that would be something you guys want me to do I would definitely do that for you guys Just so we can have some type of fun and entertainment While we watch this pay-per-view because I'm gonna be honest with you I don't think it's gonna be that good. Especially that Roman is not even on the card I just don't I don't think it's gonna be that good in my personal opinion. So Comment down below. Let me know. Did you guys enjoy this match on Smackdown or would you guys have preferred this match to been on the Hell in a Cell pay-per-view and also comment down below Let me know if you guys would like for me to go live on YouTube So, you know, we can watch the pay-per-view together I would love your thoughts and opinions on everything I just talked about appreciate our love and support roll to 50k Appreciate y'all kicking me. I see y'all on the next one. Peace