How Food Poisoning Can Rewire Your Gut: Understanding Post-Infectious IBS

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm diving into a topic that affects a decent number of people but often flies under the radar: post-infectious IBS. If you've ever had a nasty bout of food poisoning or traveler's diarrhea and then felt like your digestion just never fully bounced back, even with multiple rounds of treatment like Rifaximin or herbal antimicrobials, this might explain it. We're going to explore how common gut infections like Campylobacter, Salmonella, E. coli, and Shigella can permanently alter your gut. These infections have the potential to actually rewire your gut, and not in a good way. We'll talk about the science behind how these pathogens can trigger autoimmunity, particularly the production of antibodies that attack the nerves that control gut motility. And I'll walk you through what you can actually do about it, including treatments like prokinetics, immunoglobulins like my SBI powder, microbiome restoration strategies, and one possible cure. So stay tuned to the end for that. But first, if you haven't yet subscribed to or followed the podcast, be sure to do that now. And if you want to get transcripts of the podcast and my free ebook, Finding Your Root Cause Through Stool and Organic Acids Testing, head to highdeserthealthcoaching.com and sign up for my newsletter, which is now coming out on Substack. So just note that you'll get a welcome from there when I add you to that before the next newsletter comes out. Now on to the show. Most people know what IBS is, irritable Irritable Bowel Syndrome. It's a functional GI disorder characterized by symptoms like bloating, abdominal pain, diarrhea, constipation, or both, often without any clear structural problem showing up on tests. It's estimated that 10 to 15% of people in the US have IBS, and for a significant chunk of them, their symptoms began after a bout of food poisoning or an acute gastrointestinal infection. This is what we call post-infectious IBS, which is really post-infectious SIBO, or small intestine bacteria bacterial overgrowth. You might have had some bad food, 24-hour episode of gastroenteritis, or what we often call the stomach flu, or Montezuma's Revenge you caught while traveling. You got over the fever, vomiting, and acute diarrhea, but things just never felt quite right again. Your gut developed a new normal, and not in a good way, with changes in bowel movements, gas, bloating, and urgency, and food sensitivities. There are multiple infections that can trigger it, but the main culprits in post-infectious IBS are Campylobacter, Salmonella, Shigella, and E. coli. But do note that there are beneficial strains of E. coli as well as pathogenic ones. These infections don't just wreak temporary havoc on your gut. They can trigger long-term changes to how your intestines function. So later on in the podcast, I'm gonna discuss some specific research on this topic. But as a whole, research has discovered that these pathogens can confuse your immune system into launching an autoimmune response. So when you get food poisoning from these 4 bacteria, your immune system makes antibodies to fight off a particular bacterial toxin present in them called cytolethal distending toxin B, or CDTB for short. But with an ongoing exposure, your immune system can get a little trigger happy and it sees something that looks like CDTB in your own body, a protein called vinculin, which plays a role in the nerves that control gut movement, and then it starts attacking that too. This is called molecular mimicry. In this process, the body mistakes its own tissues for invaders, and the result is that you produce anti-vinculin antibodies, which damage the interstitial cells of Cajal, which are the pacemaker cells that keep things moving through your gut. Without these nerves functioning properly, motility slows down or becomes uncoordinated, and you develop symptoms like bloating, constipation, or alternating diarrhea and constipation. This is why post-infectious IBS is in fact SIBO, and SIBO is estimated to be the cause of IBS 60% of the time. This is more likely true in the case of loose stool or diarrhea, or with a mixed presentation alternating between constipation and diarrhea, than with pure constipation. Although I have seen one case of pure constipation that was post-infectious IBS. If you're not familiar with Dr. Mark Pimentel, he's the executive director of the Medically Associated Science and Technology Program at Cedar CINEM Medical Center in Los Angeles and one of the world's leading experts on IBS and SIBO. He was the first to uncover how food poisoning can trigger long-term digestive dysfunction through an autoimmune mechanism, more specifically how your immune system can start attacking the gut's nerve cells after certain bacterial infections. Because of impaired motility, bacteria entering with your food that should be swept into the large intestine are never flushed into the large intestine through the cleaning waves of the migrating motor complex. So they remain in the small intestine where they ferment your food, especially the fermentable fibers known as FODMAPs, and create gas, bloating, and inflammation. Think stagnant pond. This is particularly common with hydrogen-dominant SIBO, where bacteria like E. coli and Klebsiella pneumoniae tend to dominate no matter the original offending bacteria. And if you have Klebsiella pneumoniae, in addition to bloating and diarrhea, you may also experience histamine reactions or allergic-like reactions when eating foods with high histamine levels or that feed the Klebsiella. If you want to hear more about SIBO and its subtypes, I talk about this on episode 131 for a good baseline understanding. Dr. Pimentel's team went one step further in investigating this phenomenon. They tested the theory in reverse in animal models, injecting just the CdtB toxin without any bacteria, and found that the rats still developed SIBO and IBS-like symptoms. That was the proof they needed that the toxin itself and the resulting autoimmune reaction was enough to cause long-term gut dysfunction. Dr. Pimentel is also behind the development of Xifaxan, generic name Rifaximin, one of the first FDA-approved antibiotics for treating SIBO. If you've ever been prescribed it and it wasn't covered by insurance, you likely know about how expensive it is. The currently listed cheapest price on GoodRx is $2,327 for a 2-week course. I just checked and it won't go off patent until late 2029, unfortunately. I'll speak more later on treatments though. Dr. Pimentel's lab also developed a blood test called IBS-Smart, which measures anti-CDTV and anti-vinculin antibodies. Vibrant Labs also has a version of this test now, and theirs includes Candida antibodies as well. If you're dealing with persistent SIBO symptoms despite treatment, these tests can help confirm whether a previous food poisoning event set off your current symptoms, which will give you clarity about whether you're dealing with post-infectious IBS a recent bacterial infection, or just an incomplete treatment regimen. If your CDTB antibodies are elevated, your food poisoning incident was likely more recent, although these antibodies can stay elevated for years, especially if you developed post-infectious IBS. The most important question, however, is whether your vinculin antibodies are elevated. If so, this indicates that you have post-infectious IBS. If you're not sure whether to get the test, I generally recommend it when you have symptoms like persistent bloating, especially after meals, loose stools, urgency, or diarrhea that lingers after an infection, or alternating constipation and diarrhea, abdominal discomfort or cramping, food sensitivities, especially to high FODMAP foods like dairy and wheat, sore throat, acid reflux, warmth in your chest after eating, or a chronic cough, fatigue and brain fog, often linked to bacterial byproducts or nutrient malabsorption. And you have taken a round of Xifaxan or herbal antimicrobials, gotten better for a period of time, and then once again had symptoms. And you were not taking proton pump inhibitors at the time, like Prilosec or its generic omeprazole, or other products whose generic name names end in -prazole, like Protonix, Nexium, or Premacid. And if you've been listening for any length of time, you know that I have post-infectious IBS, so I can attest to the fact that this problem can last for decades, as mine started, I believe, with the food poisoning incident in Costa Rica in my mid-20s, and I'm in my mid-50s. I ate mayonnaise that hadn't been properly refrigerated for a couple days and had vomiting and diarrhea for about 24 hours. Ironically, my boyfriend at the time got the same food poisoning and didn't have any permanent issues afterwards. This is how it happens. While 9 in 10 people may have the same exposure, only 1 in 10 will develop an autoimmune reaction. I was also in Costa Rica the summer before and had a longer-term bacterial infection of some sort that I can't recall the name of, so it could have been that one too. No way to know at this point. So if you're wanting some clarity on why your IBS or SIBO won't go away, you can order the IBS Smart Test online for $249, and I just noticed there's currently a $100 off coupon you can use. I'll link to the test and the coupon code info in the show notes. And it looks like in addition to ordering it yourself in the US, you can also get it in Canada, Mexico, Panama, New Zealand, England, Spain, Poland, and Japan, although you may need to have a doctor order it for you in those other countries. One of these tests can help confirm a post-infectious IBS diagnosis, although not all practitioners are aware of or use them yet. And if you're working with me and want to order the Vibrant Candida IBS Profile, it's $270. Or it can be part of their 3 for $700 testing deal. I'll link to resources for that test as well in the show notes. And I know Vibrant will send tests internationally, but you have to be able to send the blood sample back in a reasonable amount of time, so there may be limitations. Now, if you've never had a confirmed SIBO diagnosis, you may wanna start with a SIBO breath test, which is specifically a lactulose or glucose hydrogen slash methane test, or a Triosmart test, another test developed by the Pimentel Lab, which also includes hydrogen sulfide gas in it, as well as hydrogen nitrogen and methane. Breath testing is the standard of care testing for gastroenterologists who are SIBO trained, but not many know about the Triosmart yet. Unfortunately, there are lots of ways breath testing can go wrong, and in my experience, that's usually with a false negative result. False positive results are not so much of an issue. If it's positive, you likely have it. First, you have to follow a very precise diet the day before of very limited foods like rice, potatoes, 1 egg, a little bit of butter, ghee, or olive oil, chicken breast or whitefish, salt and pepper. Then you fast overnight for 12 hours, take an initial reading. Then you have to drink a substrate mixed in water. If you can get lactulose, which is only available by prescription in the US, that's the best substrate option because it persists into the large intestine and you only need to take 10 grams of it in 250 to 300 milliliters of water. If you can't get lactulose, fructose is likely the next best option. Based on tests conducted by Jason Haralak, ND, PhD, an Australian gut health specialist and lecturer at the University of Tasmania. But then you have to take 25 grams of fructose in the same amount of water. Otherwise, you may be sent a sample of glucose to take for the tests, which is the least accurate option, and then you're supposed to take a whopping 75 grams in the same amount of water. But I discovered firsthand that this dosing might not be sent correctly. I got a test from Aero Diagnostics and they included glucose in their kit and said to take it based on weight, which left me taking only 22 grams of it. And then I got false negative result, which wasted my time, money, and effort. And then my gastroenterologist closed his practice anyway. Other ways the test can go wrong is if you don't do the breathing into the test vials properly. You're doing this every 15 or 20 minutes for up to 3 hours. If you have a test kit and bottles, you won't realize if your breathing was wrong until the lab gets your results back. I've seen countless TRIO Smart results that show multiple invalid responses right at the important times for testing for SIBO in the small intestine. That is up to the 90-minute mark, whereas EMO and hydrogen sulfide SIBO can be throughout the small and large intestines, so the entire time is relevant for them. Note that this has happened to me much more with the Triosmart than other SIBO breath tests because of the hydrogen sulfide addition, I believe. And finally, I just see people all the time who have all the history and symptoms to indicate either SIBO or hydrogen sulfide SIBO, also known as ESO, intestinal, intestinal sulfide overproduction, or EMO, intestinal methanogen overgrowth, formerly known as SIBO-C, for constipation, and they have a negative breath test result, and then we do a stool test and it shows the relevant bacteria or methanogens elevated. The other option in breath testing is the FoodMarble, which is an at-home breath testing device. It's a little more than $250 if you go through me, and you can only get the clinical one through a practitioner. I'm most likely to recommend this if you have constipation because it allows me to track your progress as you eliminate methanogens in your gut, which can take multiple courses of treatment. But I still prefer stool tests as they're generally more helpful overall if money is an issue and you can't order both. Now let's talk about treatment strategies. What can you do about post-infectious IBS? So based on 30 years of experience in dealing with this condition, I have my own methods. First of all, I found that periodically the bloating gets bad enough that you have to periodically kill some bacteria. If you see a doctor, they'll likely recommend Rifaximin for hydrogen-positive SIBO Rofeximin plus another antibiotic for E. coli and bismuth in the form of Pepto-Bismol for hydrogen sulfide SIBO. If you go the antibiotic route, I'd highly recommend taking 3 to 6 Saccharomyces boulardii probiotics a day and some form of butyrate while on antibiotics in order to protect your beneficial bacteria and prevent a Candida infection. But if you have post-infectious IBS, most doctors will give up on you and you'll give up on them before you've taken multiple rounds of a $2,000+ antibiotic for every recurrence. So you'll likely end up going the natural route eventually. Ideally, you prevent SIBO from coming back, but without good motility, it will eventually come back. So the question is, what is the least harmful way to do this? At this point, my recommendation would be to start by trying SBI powder or serum-derived bovine immunoglobulin powder, like the product I sell, to keep pathogens in check. A treatment dose is 5 to 10 grams a day. A maintenance dose is more like 2.5 grams a day. Studies have shown that it binds to pathogenic bacteria as well as to LPS or lipopolysaccharide. An inflammatory endotoxin on the bodies of gram-negative bacteria like E. coli, as well as to other pathogens put off by E. coli, including CDTB. It also binds to Candida, so it does double duty if you have some fungal overgrowth as well, and it's not harmful to beneficial bacteria. Another antimicrobial/prebiotic option that is definitely safe for beneficial bacteria is pomegranate husk powder, or if you're in Australia, MediHerb pomegranate husk pills, which hopefully will be available sometime soon in the US through Standard Process. Pomegranate husk has shown antimicrobial effects against both gram-positive and gram-negative bacteria, including Staphylococcus aureus, Staphylococcus epidermidis, Bacillus cereus, E. coli, Salmonella, Campylobacter, Listeria, Clostridium perfringens, and Pseudomonas putida, as well as antifungal activity against pathogens like Penicillium expansum and Aspergillus niger. As a powder, it's one of the most unpleasant tasting things you can imagine, and it doesn't even mix well into a beverage. So your best bet is if you can mix it into a smoothie or yogurt or kefir if you tolerate them. There's no standard dosing, but I believe Lucy Mehling recommends 1 teaspoon twice a day as a treatment dose. But I'd start with a half teaspoon twice a day and see how much you can get down. A maintenance dose would be less. For the MediHerb pills, apparently the 300mg pill is equivalent to 3 grams of the dried powder, and they recommend 1 pill 2 to 3 times a day. I've also experimented with using a small dose, half a teaspoon of MSM daily to kill off bacteria only for SIBO or EMO, not hydrogen sulfide SIBO though, because MSM is a sulfur molecule. There's also a protocol I've heard about doubling doses starting at 1/8 of a teaspoon of MSM and getting up to 32 grams a day that I've experimented with a little that definitely works in terms of bringing down bloating. I was waiting to take a stool test to determine whether this killed off my beneficial microbes, but I have since taken stronger antimicrobial microbials as that was all I had on hand while traveling, so my experiment was ruined. There's a little data out there in broiler chickens pointing towards MSM being good for beneficial species like Lactobacilli and harmful to E. coli, but no data about whether it persists into the large intestine and its effect on more fragile species like Bifidobacteria and butyrate producers in the colon. However, given it is a powder and dissolves rapidly, I felt it was safe enough for my purposes at a small daily dose, and I'm pretty sure that my dominant SIBO bacteria is E. coli. And it's cheap as dirt. If none of those options work for you, the least harmful option remaining is high-dose allicin for traditional SIBO or EMO, but again, not for hydrogen sulfide SIBO, as garlic is a no-go for people with this issue, for as short as possible time to bring down your bloating. Note that if you have hydrogen sulfide SIBO, there's a whole different protocol, so you should check out my podcast number 114 for more info on that. I also think it's good to bring in probiotics to keep beneficial bacteria coming through to use the nutrients pathogens would otherwise ferment. There's definitely controversy over whether probiotics, and in particular lactobacilli, are beneficial in SIBO, but I've found that using a relatively low dose of Seed Symbiotic for me with a meal, just one pill, not at night like they recommend, does not promote bloating for me. On the other hand, I have had issues with yogurt, which makes me bloat, although I do okay with a couple teaspoons of sauerkraut each morning with breakfast. And spore-based probiotics like MegaSporeBiotic, Enterogermina, or Proflora4R should be fine, as well as bifido-only probiotics like Seeking Health's probiotic Bifidobacterium, Master Supplements True Bifido Pro, or Therabiotic Bifido, as bifidos tend to thrive in the large intestine, not the small intestine. Some people can have overgrowth of lactobacilli in the small intestine once SIBO sets in, so if you sense a bad reaction to a probiotic or probiotic food, best to stay away from lactobacilli-based probiotics. And probiotics with Akkermansia or other anaerobic large intestine strains like F. prausnitzii or Roseburia should also be fine, depending on what other strains they're combined with. I discussed some of these options that are newly available in episode 141, so see those show notes for how to get hold of those strains. And of course, S. boulardii, which is a probiotic yeast, is also safe. And for people with histamine reactions common with Klebsiella, you should be careful to choose probiotics without any histamine-producing strains in them. Seeking Health's Probiota Histamine X and Vitanicus Florisymmetry are two I recommend in that case. Then the second important element in managing post-infectious IBS is using a prokinetic, or a medication or supplement that stimulates gut motility. This isn't motility in terms of constipation, but small intestine motility. They're often used after antimicrobial treatment for SIBO to prevent relapse. There are only two with a clinical study: low-dose erythromycin, which is an antibiotic, at a higher dose, and something called Tagacirod, which I've never heard anyone using in the SIBO community, likely because it was removed from the market in 2007 because of possible cardiovascular risk, but reapproved in 2019 for women under 65 without cardiovascular disease. Tegesrod extended recurrence from 2 to 15 weeks to 11 to 58 weeks, used at a dose of 2 to 6 milligrams once at bedtime for people with constipation in particular. And then low-dose erythromycin at 50 milligrams at night extended recurrence from 1 to 39 weeks. And I've heard current dosing up to 62.5 milligrams at night as well for the low-dose Erythromycin. These stats are a little wonky because it looks like they did some switching groups from one treatment group to the other. So there are two sets of extension times, but the long and short was Tagacerod was the best of the possible treatments for preventing recurrence, and low-dose erythromycin came after that, and then no treatment at all was terrible. I'll link to the study in the show notes. However, low-dose Motegrity, generic name pralipride, at 0.5 to 1 milligram at bedtime is what's most often used these days by prescription. I've also heard people mention low-dose naltrexone, 1.5 to 5 milligrams every night at bedtime, as a prokinetic because it's also successful in helping reduce autoimmunity. I decided to give it a try, and I've been on it for more than 6 months now, and I don't think it's made a difference for me, but it does make me very drowsy at night, which I like. Herbal prokinetics are based on either ginger or the herbal bitters formula Ibarogast, which is now easily found in the US in a new formulation, and I just discovered in both pill as well as the original liquid formula. Or other prokinetics, um, include those with orange peel or d-limonene, like MMC Restore. Iberogast is dosed at 30 to 60 drops before bed. I'm not sure about the new pill formula as a prokinetic, but they recommend 1 pill before or during meals on the package of 30. Some of the ginger-based prokinetics contain a formulation called ProDigest, which is a combo of ginger that's formulated not to produce that ginger burn effect, but helps with small intestinal motility. And artichoke extract like GI Motility Complex, which also has apple cider vinegar powder. And artichoke extract itself is known for helping with gastroparesis as it promotes stomach emptying. And Motility Activator is a similar formulation but without the apple cider vinegar powder. Some other ginger formulations also have 5-HTP, a precursor to serotonin, most of which is made in your gut and helps move the intestines. These may be more helpful for people with emo because 5-HTP can lead to loose stool. The one I like in that category is Pure Encapsulations ModulPro, mostly because it comes in a big bottle of 180 pills, which is helpful with the suggested dosing of 3 at a time. It also has B6 and acetyl-L-carnitine in it. Then there are a few more 5-HTP added formulations like ProKine, which has some additional B vitamins and lots of ingredients, so I rarely recommend that because of duplication with multivitamins and B complexes, and Sibo MMC, which has extra B6 and a couple more ingredients. And finally, there's Bio Revive Kinetic, which is sold in the UK and Europe and has some of the ingredients of the Ayurvedic prep Trefola, known for helping constipation, as well as ginger, bitter orange, and 5-HTP. It also has licorice root powder, so it would be contraindicated if you have high blood pressure. All those are linked in the show notes. While I do recommend prokinetics to my clients and generally take one of them myself at any given time, I've never been blown away by their ability to change the general course of my condition. Even while taking them, I've always needed to periodically or regularly kill off bacteria. But they may delay how long you can go without antimicrobials. So I do recommend that you use them if you have post-infectious IBS. Now, what's the best diet for post-infectious IBS? Well, I'm sure you've all heard of a low FODMAP diet in the context of SIBO or IBS. The biggest players in low FODMAPs are in fact wheat and dairy, and research has shown that just avoiding these two foods is about as effective as a full-on low FODMAP diet. And for me, dairy is the devil. Not only am I lactose intolerant, so eating dairy leads to hot lava exiting my entrails in the most painful fashion if I don't take lactase enzymes, but the lactose in dairy leads to the worst bloating I ever get. And this is speaking from the experience of just returning from 5 weeks in Italy and eating dairy almost daily and constantly looking and feeling 6 months pregnant. In my regular life, I eat it pretty rarely, and I recommend anyone with SIBO do the same and take lactase or a complete digestive enzyme with lactase in it if you do. I like a product called Lacto. For wheat, the issue is not in fact the gluten, but rather the fructans, which are also in onions and garlic, incidentally. And I've discovered over time that I personally do better with wheat than dairy by a long shot and can have a nice slice of sourdough bread with breakfast and have no bloating at all. So that's one you can try for yourself if you don't have gluten sensitivity or celiac. Going on a full low FODMAP diet may be a good idea the first time you go through antimicrobials or antibiotics for SIBO, but I wouldn't recommend living that way permanently because of the missing nutrients and fibers, in particular from beans and lentils, which support beneficial microbes. I have found that eating beans and lentils on an almost daily basis has alleviated my regular need for supplemental butyrate. I use my own Tributrin Max as needed now, and this has helped slow motility for me and firm up stool, and I much prefer doing that naturally to taking a pill for it. People with loose stool or diarrhea may do better with legumes than those with emo, of course, but I do recommend using some form of Tributrin or probuterate while on treatment-level antibiotics or antimicrobials for SIBO if you have loose stool or diarrhea, so as to protect the anaerobic bacteria in your colon. So to close, there are a few other things to know about. Instead of antimicrobials, you can always go on an elemental diet. M. biota is a new option on the scene and probably the most palatable elemental diet developed by Pimentel's group. This is a diet with no fermentable fiber whatsoever, so it basically starves out the bacteria or methanogens. Duration is 2 to 3 weeks with only this liquid formula to eat. You could also resort to a fecal transplant, but I imagine that like all the other options that change the bacteria, you'd still end up with an issue because of poor motility. So I have never I would never recommend that course of treatment for someone with only SIBO. But if you can access it and have tried everything else, definitely choose the krapfsuhl version rather than the enema version, as you want something that impacts your small intestine. If you have constipation-dominant post-infectious IBS, then I would also recommend trying Thanabiotic, a formulation from human stool of everything that's not alive, so all the postbiotic metabolites, that is. I tried it, and I would not recommend it for people with loose stool or diarrhea based on my experience. Experience. Finally, the one big hope that I'm holding out for a cure for SIBO is— hold the phone— fasting! In particular, the Prolon fasting mimicking diet, although you could just use water fasting. With Prolon, your body thinks you're fasting, but you get like 500 calories a day, and that way you're less likely to lose as much muscle mass. I've seen one report on Facebook of someone who used this diet to successfully bring down his vinculin antibodies, with pre- and post-testing to prove it. This makes sense because the research on this diet shows that it helps reverse autoimmunity. As someone who needs to eat 4 times a day to not have hunger pangs, this is something I've dreaded trying, but I'm finally going to take the plunge. This diet has been purchased and I booked an Airbnb in the middle of nowhere in Mexico for me and my husband in August where we can go and have no other food around us or within walking distance. So I'll definitely report back on how that goes for me. I plan to do it again after that as I anticipate it'll take several rounds, but I wanna see if first I can get through the first 5 days as the longest I've ever fasted before, with bone broth even was only— was not even 3 days. And I just wanted to emphasize why getting treatment for post-infectious IBS is so important. This isn't just about mild discomfort or less than ideal bowel movements. When left untreated, post-infectious IBS usually leads to an increase in systemic inflammation from the LPS from the gram-negative bacteria, which can lead to autoimmune diseases like Hashimoto's in my case, although I successfully reversed that, thankfully. Or much more serious ones, skin conditions and food avoidance, which can lead to nutrient deficiencies and more serious problems. The good news is that it's manageable and you can have an enjoyable life and even eat a variety of yummy foods while having post-infectious IBS. But the sooner you identify what's going on, the more likely you are to avoid long-term damage or complications. If you'd like help figuring out your next steps, I work with individual clients to get to the root of their digestive issues. You can set up a free 30-minute breakthrough session using the link in the show notes or visit High Desert Health Coaching dot com. And if you'd like to try the SBI powder or Tributrim Max I mentioned, or any of the other gut supportive supplements I mentioned in the podcast, you'll find links to those in the show notes as well. To support the podcast, you can order supplements through my FullScript dispensary, use my affiliate links to Amazon for anything, not just supplements, or iHerb, or become a supporter on Patreon. You can also connect with me on Instagram, Facebook, X, or in my Gut Healing Facebook group, all linked in the show notes. Thanks for joining me today. Here's wishing you all the perfect stool.