20. Why Biofilms Might Be Behind Your Bloating

You treated the SIBO. You felt better. And then… the bloating came back.

Cue the internet: “It’s probably biofilm.”

But is it?

In this episode of Team Gut Girls, Dr. Christina Carew, Dr. Whitney Baxter, and Dr. Dominique Vanier dig into one of gut health’s buzziest—and most misunderstood—topics: biofilms. Biofilms are very real. They’re organized communities of microorganisms that build a protective matrix around themselves, communicate with one another, share resources, and may become harder for the immune system or antimicrobial treatments to reach.
Think less “random bad bacteria” and more tiny gated microbial community—with infrastructure, neighbours, and apparently a very aggressive HOA.

The bigger question is whether biofilms are actually responsible for your bloating, recurrent SIBO, IBS symptoms, or treatment resistance.

We unpack what the research tells us, what remains theoretical, and why “my SIBO came back” doesn’t automatically equal “I need a biofilm disruptor.” Motility problems, constipation, pelvic floor dysfunction, abdominal phrenic dyssynergia, endometriosis, celiac disease, disorders of gut-brain interaction, and even an incorrect diagnosis can all keep symptoms cycling.

We also get into the biofilm treatments you’ve probably seen online—including NAC, enzymes, EDTA, bismuth, lumbrokinase, nattokinase, and serrapeptase—and why something that disrupts biofilm in a Petri dish doesn’t automatically translate into better bloating or IBS symptoms in an actual human.

And we need to talk about “die-off.” Feeling awful after starting a supplement isn’t proof that treatment is working. Diarrhea, rashes, fatigue, GI irritation, medication interactions, excessive dosing, and allergic reactions deserve attention—not a badge of honour for suffering through your protocol.
Because when it comes to chronic gut symptoms, the better question may not be:

“What bacteria do I need to kill?”

It may be:

“What is happening in my gut ecosystem that allows this problem to keep coming back?”

What You’ll Learn

• What a gut biofilm actually is—and why biofilms aren’t an alternative-health invention
• How microbes form biofilms through attachment, maturation, communication, and dispersion
• What quorum sensing means and how bacteria communicate inside their microbial communities
• Why biofilms may make some microorganisms more persistent or difficult to eradicate
• The possible connection between biofilms, bloating, IBS, dysbiosis, and recurrent SIBO
• Why recurrent SIBO doesn’t automatically prove you have a problematic biofilm
• How gut motility and constipation can contribute to SIBO recurrence
• Why biofilms can contain multiple microorganisms rather than one single “bad bug”
• Whether all biofilms are actually harmful (spoiler: no)
• Why there currently isn’t a routine stool test that can reliably diagnose “biofilm-related bloating”
• What we know—and don’t know—about NAC, enzymes, EDTA, bismuth, lumbrokinase, nattokinase, and serrapeptase
• Why trying to “starve” biofilms by restricting minerals such as magnesium may backfire
• The problem with assuming every bad reaction is Herxheimer or die-off
• When persistent or treatment-resistant symptoms might make biofilms worth discussing with your healthcare provider

Biofilms may be one piece of the puzzle, especially when symptoms or infections repeatedly return despite appropriate treatment—but they’re rarely the whole puzzle.

Chapters

00:00 — Biofilms Buzzword Check
01:22 — SIBO Failure Myth
02:21 — NAC Case Study
04:52 — What Biofilms Are
07:32 — How Biofilms Form
10:19 — Why Biofilms Persist
11:50 — Biofilms and Bloating
13:47 — Recurrent SIBO Explained
15:48 — Polymicrobial Communities
16:49 — Are Biofilms Always Bad?
18:06 — Testing and Treatment Tools
20:38 — Enzymes and Minerals
23:26 — Die-Off Reality Check
27:18 — Practical Takeaways
30:36 — Final Summary

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Resources:

Ross, M. (2026, June 10). Biofilm gated communities. Treat Lyme. https://www.treatlyme.net/guide/lyme-disease-biofilms

The SIBO Doctor. (n.d.). Dr Paul Anderson. – https://www.thesibodoctor.com/tag/dr-paul-anderson

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20. Why Biofilms Might Be Behind Your Bloating

[00:00:00]

Biofilms Buzzword Check

Dr. Christina Carew, ND: So welcome back. Today we’re continuing our investigation into why people bloat, and this one is fascinating because we’re always talking about something that’s completely real, but also has become a kind of a buzzword in gu- in gut health, which is this word biofilms. and often it becomes this sort of elusive piece, you know, what is a biofilm?

Dr. Whitney Baxter, ND: The mysterious biofilm

Dr. Dominique Vanier, ND: yeah. The, well, the thing apparently, this biofilm is responsible for every treatment you’ve ever tried that is not working.

Dr. Christina Carew, ND: Exactly. But honestly, sometimes in my practice I would say that biofilms are a piece of the puzzle that, maybe we haven’t considered as much. And certainly, they might be linked to chronic infection or SIBO or candida or bloating, and there’s actually some really interesting [00:01:00] biology behind this idea and lots of research behind it.

And so, today we’re gonna sort of separate it into two areas. are biofilms real? Which absolutely they are, and we can talk a little bit more about that. And does your bloating mean that you have a problematic biofilm that needs to be treated? And that’s where things get a little bit more complicated.

SIBO Failure Myth

Dr. Dominique Vanier, ND: So let’s talk about what’s trending this week. and so if your SIBO treatment keeps failing, bacteria are probably hiding inside a biofilm. You wanna break down the biofilm, and then your treatment will finally work. True or false?

Dr. Whitney Baxter, ND: I’m gonna go with-

Dr. Christina Carew, ND: Don’t say false.

Dr. Whitney Baxter, ND: I was going to say oversimplified.

Dr. Dominique Vanier, ND: Correct. That’s the right answer.

Dr. Christina Carew, ND: Because microorganisms live inside the biofilms, and one of the interesting thing about biofilm organisms is that they can be difficult to eradicate. I always think about it, I talk to patients about it like a honey [00:02:00] hive or a beehive. So we know that there’s, the cone, right? If you’ve ever opened a beehive, and in- inside each layer there’s honey, but there’s, a layer in between a layer in between a layer.

And so that’s part of, like, how biofilms are established in biology is, they’re kind of these separators, in be- in between.

NAC Case Study

Dr. Christina Carew, ND: And, you know, the role that they play in IBS or SIBO or bloating is maybe a little bit harder to establish, but I actually have a, a really interesting, patient case. So we did a, a GI stool test with this patient.

It was, like, right before the pandemic. She was having lots of issues and problems, and we did some, support with this, things that had come up. There was, like, she had, she had all kinds of, sort of different infections and then had kind of shown up in, and she was doing a lot better, and then about two years into the pandemic she wanted to do a repeat test to see, like, where things, where were things at.

And so the [00:03:00] interesting thing about this patient is she was around 70 years old. her husband was quite ill, and so she was at home with him, and because of all the nature of not really understanding how does the disease spread, she had not left her house. She’d not left her house in two years. She had things delivered to her.

She would spray them out in the garage and bring them in her house. she’d not seen other people. We’d only done video calls between that time, so she, had really isolated herself. And the second stool test came back, and there was, like, all kinds of new stuff on it. And so there was, like, giardia on it that hadn’t been there before, and candida on there that hadn’t been there before, and I was like, “What the heck?”

And so I started talking to her about it, and in between, remember, it’s, COVID times, and so we were using a lot of NAC ’cause she was really concerned about her breathing and affecting her husband. And I think what had happened was in all that NAC, which is, you know, a biofilm opener, we [00:04:00] opened up this biofilm and all of this other stuff came out.

And so I was asking her about it. She’s like, “Oh, I used to be a lake swimming instructor, and I had gotten giardia many times- Whoa … in my 20s, and also had, also had repeated yeast infections in my 20s and 30s.”

Dr. Whitney Baxter, ND: Oh

Dr. Christina Carew, ND: my gosh. And so when we kind of, like- Cool … looked back, we, had really opened this biofilm, like 50 years worth of opening, which was crazy.

and so I think we’ll- Wow … never have that beauty of such an isolated case again. but it was really interesting because when we kind of like… First I was like, “Oh my gosh, this test must not be right at all.” And then when I started talking to her, she was like, “Oh, no, I used to get these infections all the time.”

and so that’s… I don’t know. It’s kind of cool.

What Biofilms Are

Dr. Christina Carew, ND: so Dominique, how do you explain biofilm, or what is biofilm, in your mind?

Dr. Dominique Vanier, ND: Yeah. Well, we want to [00:05:00] imagine, bacteria living in two different ways. So one bacterium is basically floating around by itself, but microorganisms can also attach to a surface, organize into communities, produce this protective, we’ll call it protective ext- extracellular matrix around themselves.

That’s a biofilm. And, the, the easiest example I will explain to patients is we have biofilms in our mouth, like in our teeth- Mm-hmm … like right around the teeth. Mm-hmm.

Dr. Whitney Baxter, ND: Y- yeah, when you wake up in the morning and there’s that film before we brush our teeth- Yeah … that’s what they’re doing, is they’re protecting themselves.

Dr. Dominique Vanier, ND: Exactly.

Dr. Whitney Baxter, ND: And so we, we think of it like a gated community-

Dr. Christina Carew, ND: Yeah, that’s a perfect way to describe it. I always talk about it like, Spider-Man’s web too, ’cause it’s like kind of that goopy, like things get caught in it, but you don’t always get to decide what gets caught in it.

Dr. Whitney Baxter, ND: Yeah.

Dr. Dominique Vanier, ND: yeah.

Dr. Whitney Baxter, ND: You’ve got, you’ve got these , all of these different organisms living in this film.

They’ve built this infrastructure, so this [00:06:00] matrix, and they’re communicating with each other. Nutrients are coming in, waste is getting out, so it’s their little microenvironment, and there is a gate around this whole thing.

Dr. Dominique Vanier, ND: Mm-hmm. Yeah, exactly. And we know that that matrix can contain sugars, proteins, like other substances.

Minerals can also become incorporated into the biofilm structure. So this isn’t just really a random pile of bacteria. It’s more… It’s really like it’s an organized microbial community. and the raw material describes organisms communicating chemically, accessing nutrients, and eliminating waste within these communities.

they live symbiotically together and they like, you know, a- if one has one thing that the other needs, they will trade. you know, and so we can also describe them as behaving almost like a super biotic colony.

Dr. Christina Carew, ND: Yeah. And the interesting thing is when we’re thinking about bloating, we’re talking about them being like bacterial or fungal or microbial driven, but we also see [00:07:00] like heavy metals get stuck in here.

Mm-hmm. Mycotoxins get stuck in here. And so, it’s like anything that your body has an exposure to can kind of get stuck in that, in that container. And so, an easy one for us to understand is like plaque on our teeth. So the reason we brush our teeth in the morning is ’cause this like little biofilm grows on our teeth.

Dr. Whitney Baxter, ND: Mm-hmm.

Dr. Christina Carew, ND: Yeah. And so, biofilm isn’t really like this alternative medicine invention. It’s been something microbes do forever. Maybe now we have a name for it.

How Biofilms Form

Dr. Whitney Baxter, ND: Okay, so let’s talk about how a microbiome forms. Dominique, do you wanna go through this with us?

Dr. Dominique Vanier, ND: Yeah, this is one of the pieces- Okay … I think is really interesting. so biofilm formation isn’t necessarily like this on-off switch. There’s a process. So, so first organisms, they have to attach. That’s step one. And then an attachment can become more established, and then the community starts developing and maturing, and then eventually these [00:08:00] organisms can also disperse from the biofilm.

And so they, we referenced the Anderson lecture in this. So this describes that progression at init, as initial attachment, irreversible attachment, maturation, and dispersion.

Dr. Christina Carew, ND: And just for anyone- The- … who’s listening, Dr. Anderson is, one of the leading naturopaths who really investigates biofilms and, like, how do we break them down and what to do about them, both in the context of complex chronic illness and cancer.

So he’s one of the docs- Mm … that has, really contributed a lot to this area.

Dr. Whitney Baxter, ND: Mm-hmm. so these little gated communities don’t appear overnight. They’re a little bit more complex than that, right?

Dr. Dominique Vanier, ND: Mm, yeah. That’s exactly right. Yeah, you wanna think of the first bacteria like pitching a tent, and then somebody builds a house, and then the roads go in- Mm-hmm

and then suddenly there’s a Starbucks.

Dr. Christina Carew, ND: And then everything skyrockets in terms of property value.

Dr. Whitney Baxter, ND: And these little [00:09:00] bacteria guys are bidding over $200,000 over asking.

Dr. Dominique Vanier, ND: Yeah. And now it’s much harder to remove the neighborhood than it otherwise would have been to remove the original tent. That’s how we wanna think of it.

Dr. Christina Carew, ND: And so the bacteria actually talk to each other. This is actually my favorite part, because they actually communicate.

Dr. Dominique Vanier, ND: Yeah. They do. yeah, and one of the concepts involved is called quorum sensing. And so microbes, they’re gonna release and detect chemical signals, and when enough organisms are present, that communication can change their collective behavior, including behaviors involved in biofilm formation and virulence.

So it’s, it’s pretty cool. They talk to each other. they are… It’s complex. Yeah.

Dr. Whitney Baxter, ND: Yeah. Yeah, they’re basically texting each other all night.

Dr. Christina Carew, ND: A bacterial group chat, like a strategy, what are we gonna do next?

Dr. Whitney Baxter, ND: Yeah. “Hi, is everybody here? Yeah. Good.”

Dr. Christina Carew, ND: Yeah. “What can I say?” “Build the wall. Here’s what we’re gonna do.”

Dr. Dominique Vanier, ND: And clearly [00:10:00] this is oversimplifying what actually happens, but that’s a pretty good way to visualize q- quorum sensing, this, this concept of quorum sensing. And that’s important because we’re starting to realize that microorganisms don’t necessarily behave the same way when they’re living together in a biofilm compared to when they’re isolated.

Why Biofilms Persist

Dr. Whitney Baxter, ND: Okay, so these biofilms happen in nature. Obviously, we’ve talked about that. They’re pretty complex. We’ve built our bacterial gated community. But why do we care?

Dr. Dominique Vanier, ND: We care because the matrix can protect the microorganisms living inside it. So you wanna think about species, the, the main thing that they do is to protect themselves, right?

For safety and for survival. And so it can physically limit penetration of certain mic- antimicrobial agents. and the organisms can change their metabolism. There can be changes in gene expression. Some bacteria can use something called efflux pumps, which essentially pump antimicrobial compounds back [00:11:00] out.

And then the immune system may have more difficulty accessing organisms inside these structures, and that’s what’s really key here is the immune system access.

Dr. Christina Carew, ND: So think about it, if you’ve ever had an infection, you took an antibiotic, you were better for a couple of days, and then you weren’t. so that’s, an example of, like, when a biofilm opens, everything sort of pours out of it.

And sometimes we get a reinfection, when we don’t expect it. And so same kinda idea. we’re removing the weeds from the garden, and they sit on top of the soil, and that’s one problem. But, but then we have those dandelions, right? Those deep, deep roots that are in there, and they just grow back again and grow back again.

Dr. Whitney Baxter, ND: Welcome back, weeds. What do we do next?

Biofilms and Bloating

Dr. Christina Carew, ND: So how does this all have to do with bloating, right? And this is what this, series is focused on, and could this actually be contributing to [00:12:00] bloating

Dr. Whitney Baxter, ND: Yeah. So potentially, but probably not in the way people picture it. So this biofilm, this, protective little matrix structure, isn’t just sitting there physically blowing out or pushing around and then out like a balloon.

And so think of it what we talked about through this bloating series. So there’s things moving through the guts. There’s food, there’s gas formation, there’s fermentation, so gas production, microbial composition. There’s inflammation going on. There’s how s- how much we feel that, or visceral sensitivity.

There can be constipation or slowing down of things moving through. So if there’s an altered microbial community persisting in the gut, this biofilm could theoretically be one factor helping that microbiome, that microbial ecosystem persist.

Dr. Christina Carew, ND: Mm. Mm-hmm.

Dr. Dominique Vanier, ND: Yeah. And then intestinal biofilms have actually been visualized and studied in people with GI disease, which is pretty cool.

So we can [00:13:00] see this thing, and there’s legitimate research interest in whether abnormal mucosal biofilms are associated with dysbiosis and conditions including IBS. But association is not the same thing as saying, we found the cause of your bloating, right? So even though we can see these things, we can’t say that there’s causation happening.

Dr. Christina Carew, ND: Yeah. And so because of this, the bloating could still be related to your constipation, or your SIBO, or your pelvic floor dysfunction, or your abdominal phrenic dyssynergia, or your endometriosis, your celiac disease, or your disorders of gut-brain interaction. The list is ongoing.

Dr. Whitney Baxter, ND: We have a very long season of bloating topics.

Recurrent SIBO Explained

Dr. Whitney Baxter, ND: Okay, so let’s talk about why these biofilms come up with recurrent SIBO. So you might have heard about this, you might have been giving treatment protocols, that start to disrupt this biofilm, and this is probably where [00:14:00] biofilms become most interesting for our listeners. Because we see people who say, say, “I treated SIBO, I got better, and then everything came back.”

Dr. Dominique Vanier, ND: Yeah, and recurrent or treatment-resistant infections are exactly where clinicians, have historically become interested in s- in biofilms. And like the– and interestingly, the stat with SIBO is that almost 50% of treated SIBO will come back. So that’s really high, and that’s one of the reasons why biofilms has been investigated so much in SIBO.

And both of these sources emphasize the pattern such that organisms persisting despite antimicrobial pressure or symptoms recurring after treatment. but here’s the caution. It’s that observation does not prove that biofilm is what’s happening in your gut. ‘

Dr. Christina Carew, ND: Cause there’s lots of reasons why SIBO can reoccur.

Remember the conveyor belt we talked about? Mm-hmm. Mm-hmm.

Dr. Whitney Baxter, ND: That migrating motor complex, the big flush that washes and pushes everything through your [00:15:00] gut.

Dr. Christina Carew, ND: And so if that’s not working very well, the bacteria will also accumulate. And if we’re, if we haven’t changed the conditions or we haven’t, repaired that mechanism, then the overgrowth, you know, could redevelop, and that’s not necessarily biofilm-related.

Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Same idea with constipation, right? So if somebody isn’t evacuating properly, we need to address that. It’s kind of like identifying what’s the downstream issue and what’s the upstream issue, right? So is the upstream the co- the, the issue itself, whereas downstream we’re having this, this SIBO or potentially biofilm

Dr. Christina Carew, ND: overgrowth.

Yeah. So the recurrence trigger is why does this keep happening? Biofilm should be on the consideration list, but it’s not the only automated sort of answer.

Dr. Dominique Vanier, ND: Mm-hmm.

Polymicrobial Communities

Dr. Dominique Vanier, ND: Yeah, let’s talk about biofilms and how they can contain more than one organism, ’cause we’ve just, we’ve just talked a little bit about that.

So we’ll build on it. So another interesting concept from this Anderson lecture is that biofilms can [00:16:00] be polymicrobial, and that means that we’re not necessarily talking about one species living alone. Different m- organisms can coexist in the same community.

Dr. Whitney Baxter, ND: Yeah. The, so this gated community, this ecosystem idea

Dr. Dominique Vanier, ND: Yeah, exactly.

So instead of here’s one bad bacteria, we need to kill it, we’re increasingly thinking, what’s happening in this microbial community? Who is there? What are they producing? How are they interacting? What environment are they living in?

Dr. Christina Carew, ND: Yeah. It’s a very different way of thinking about, gut health.

Instead of looking for the criminal or the bacteria or fungus, we’re, like, thinking about their neighborhood.

Dr. Whitney Baxter, ND: Yeah, a neighborhood with an HOA.

Dr. Dominique Vanier, ND: It’s a very expensive and aggressive HOA.

Are Biofilms Always Bad

Dr. Christina Carew, ND: So are all biofilms bad? If I have a biofilm, I need to get rid of them. Is that true?

Dr. Whitney Baxter, ND: No.

Dr. Dominique Vanier, ND: Mm-hmm. Yeah, biofilm [00:17:00] formation is, a normal microbial behavior.

And so the Andersen lecture actually makes this point very clear. Everybody has biofilms. The clinical question is when a particular biofilm becomes relevant.

Dr. Christina Carew, ND: Yeah, so that’s the important part because we don’t want everyone listening today thinking that I have this slime inside of me that I need to clean out.

Dr. Whitney Baxter, ND: And this is, really… Yeah, I, I see a lot of people who get these colonoscopies who have read about this and freak out ’cause it sounds disgusting, but please don’t clean your intestines ’cause you’ll come back and see us and say that everything got a lot worse.

Dr. Christina Carew, ND: Yeah. Your GI tract is an ecosystem, and sterility is not the goal, right?

We need to have good bacteria. We need many of these bacteria and fungi to break down our food, to create our good pro- probiotic support inside our gut. and so the question is really is this microbial community, is this biofilm contributing to some type of [00:18:00] dysfunction or repeat infection or inability to move forward?

Testing and Treatment Tools

Dr. Whitney Baxter, ND: So let’s talk about if we can test to see if, our biofilm is contributing to the issue or this, reinfection. Yeah. So this is where things can get tricky. There isn’t a standard everyday stool test that can reliably tell a bloated patient that, yes, this is the particular biofilm that is the cause of your symptoms.

there are research methods for studying biofilms, and they can be directly observed and sampled in certain settings, but again, this is in research. that’s very different from having a routine validated clinical biomarker for biofilm related bloating.

Dr. Christina Carew, ND: Yeah. And so it’s also not necessarily symptom-based, meaning, if I bloat after eating, I have biofilm, or if oregano makes you feel terrible, or if you’ve had SIBO multiple times.

but, but then we think about that story that I [00:19:00] shared about biofilm disruptors. So, you know, is there a biofilm disruptor that may have been entered into the picture that may have changed the outcome? and so when we think about biofilm online, we’re gonna think about all kinds of different things.

So you’re gonna see information about enzymes and NAC and herbs and, nutrients like EDTA or bismuth. So there’s like a wide range of supplements that have all kinds of different, support for clearing biofilm. We know there’s sort of like Biofilm 1, Biofilm 1.5, Biofilm 2. And so this isn’t something that you probably want to navigate on your own.

You want someone who has some experience in this because you can feel really ill if we kind of rip off, those layers of that protective coating, and suddenly your immune system’s exposed to all of these different things.

Dr. Dominique Vanier, ND: Yeah. [00:20:00] Exactly. So, like something breaking apart a biofilm in a Petri dish doesn’t automatically mean that that compound will improve IBS or bloating in a human, right?

We’re much more complicated than a Petri dish. And this Ross article actually makes the distinction itself. So it does discuss promising, how promising laboratory findings for several compounds, e- exist while acknowledging that some approaches that look, that looked impressive in vitro did not necessarily translate into this clinical benefit in his experience.

Dr. Whitney Baxter, ND: Sadly, we are not Petri dishes. We are humans. We are complex.

Dr. Christina Carew, ND: For sure.

Enzymes and Minerals

Dr. Christina Carew, ND: Um, so what about enzymes, Whit?

Dr. Whitney Baxter, ND: Enzymes do come up constantly in these biofilm protocols. Why is that?

Dr. Dominique Vanier, ND: Yeah, I think because the biofilm matrix contains different structural components, and so one proposed strategy is that using enzymes aimed at part, or it will be aimed at parts of that matrix.

And so you’ll see things like [00:21:00] proteolytic enzymes discussed because proteins contribute to biofilm structure. So it’s just one way to, you know, hammer, hammer away at it. but the sources also discuss enzymes such as lumbrokinase, nattokinase, and serrapepta- sep- serrapeptase in this context. A- a- but again, like what you just mentioned earlier, proposed mechanisms doesn’t necessarily mean that we’ve established that somebody with bloating actually needs to take these things.

Dr. Christina Carew, ND: You may also be taking these things for a completely different reason. They’re being used a lot in long COVID and cardiovascular support, and so you might be taking them for a completely different reason and end up getting bloated, which actually gives us some more information. we may also think about minerals.

So minerals are very much incorporated into that biofilm structure, and that we know that there are some chelating agents like EDTA, which has some ability to potentially break down that biofilm. but just because [00:22:00] something is in a biofilm or something is contained in a biofilm doesn’t necessarily mean it’s going to, open something up.

and so when we start thinking about minerals and, the Ross article, which we’ll attach to the, podcast, kind of talks just about like what do we know about biofilms to date. And so one of the things that they suggest is like sometimes when people find out there’s minerals in their biofilms, they then say, “Oh, I shouldn’t have those minerals,” right?

“I’m going to starve the biofilm, and that will make it all better.” Just like how people do certain diets to starve bacteria and think that that will make it better. And probably a similar kind of thing, does it really make it better? Not really. It just like kind of hangs around and waits.

Dr. Whitney Baxter, ND: So especially our constipated listeners, don’t stop taking that magnesium.

‘Cause we’re doing that for that m- migrating motor complex, that conveyor belt. Keep you moving.

Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Yeah. The, that Ross article specifically [00:23:00] argues against restricting calcium and magnesium simply just to starve a biofilm because human needs those minerals too. And I guess the concept is a little bit like, you know, our diet in general, right?

When we just cut it down and cut it down to starve candida, for example. Mm-hmm. These organisms are really smart. they will find a way.

Dr. Whitney Baxter, ND: Totally.

Dr. Christina Carew, ND: I’ll just, borrow it from our bone.

Dr. Dominique Vanier, ND: Yeah.

Dr. Christina Carew, ND: It’s still there.

Dr. Whitney Baxter, ND: Yeah. I’m sorry.

Die Off Reality Check

Dr. Whitney Baxter, ND: Okay, so let’s talk about a die-off reaction. So some of our listeners might have heard about this before.

We need to talk about this because it’s everywhere. someone takes a biofilm product, so opens up that biofilm, that ecosystem, and somebody tells them, “Great, that’s the die-off working,” once they start to feel terrible, so, achy, tired, maybe they get, a skin reaction. so let’s talk more about this.

Dr. Christina Carew, ND: Yeah, so that’s where people really need to be careful because, there’s sort of [00:24:00] this premise that maybe was passed through generations and wisdom, “Oh, if I have a die-off reaction, I must be getting better,” right? I will suffer through it. I actually had a patient last week that said, “When I took that thing, I had horrible diarrhea.”

I was like, “Oh my gosh, why did you keep taking it? Why didn’t you call me?” And she’s like, “I just thought it was part of the process.” Mm-hmm. I felt better on the other side.” And I was like, “That was not part of the process.” And, so I really specifically tell patients, if you feel worse, that’s, not the intention behind it, right?

And so same kind of idea when we’re talking about inflammatory or immune reactions that might be happening or chronic infections. part of the practitioner’s job is to not only, you know, maybe help you to open a biofilm, but then also to make sure that there’s something there to get rid of whatever is coming out.

Mm-hmm. and so you don’t necessarily need to feel worse to know that [00:25:00] you’ve successfully broken apart a biofilm. And we also have no idea how many layers there are, right? It’s… This is just, if… It’s a consideration if we’re doing a treatment that should be working, and the treatment’s not working, and we’ve ruled out all the other things that it could be.

Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. And you could also be experiencing a side effect, and I don’t think we have really any way of being able to tease those two apart. so for example, a medication interaction, GI irritation, you know, a dose that maybe is too high, especially for somebody who’s really sensitive, something completely unrelated, an, an allergy, right?

Who knows?

Dr. Christina Carew, ND: Yeah. So feeling horrible, like my patient last week, is not an indicator that things are going in the right direction. In her case, she got lucky, but it’s not always lucky. I actually had a patient who reacted to a, a medication called Nystatin. Nystatin’s super benign. It’s, not absorbed in the gut.

It’s a antifungal medication. [00:26:00] very, very, s- very good, like babies are given it in the hospitals, like very rare that people react to it, and she had this, like, crazy skin irritation and she was like, “Oh, this just must be, like, things I’m loosening up and letting out.” And, and we were… Like part- it was part of treating some, persistent fungus that she had, and I was like, “I don’t…

Like I don’t know.” I was like, “I think you should maybe-” Exactly … “just stop.” And so then she was like, “No, no.” She was very insistent, again, that she was like, you know, traveling through this experience and this was gonna be the best. And then, a week later, I was like, “You really should go to the hospital.

Like this seems un- like crazy.” And she actually was allergic to it. Oh. And she was getting like a skin burn reaction, so now in her profile and everyone related to her it says “Do not use Nystatin,” ’cause she found out that her dad was allergic to it. And that was the only reason she went to the hospital.

But it was like she was really re- reluctant to [00:27:00] stop because she thought she was getting better. Mm-hmm. So just keep that in mind. You’re not always getting better.

Dr. Dominique Vanier, ND: Mm-hmm.

Dr. Whitney Baxter, ND: Yeah. We don’t wanna take that risk and miss, ’cause al- allergies can be kind of vague like that. It could just be a skin reaction. But yeah, we don’t wanna assume.

Dr. Dominique Vanier, ND: Yeah.

Practical Takeaways

Dr. Whitney Baxter, ND: Um, so let’s go through some quick takeaways, about this episode, and when we should start to think about biofilms for our bloating or our gut health.

Dr. Christina Carew, ND: Yeah.

Dr. Whitney Baxter, ND: So if somebody comes into your office, Christina, and says, “I think I have biofilms,” where do you start?

Dr. Christina Carew, ND: Well, we wanna have some more information.

This is probably not the first thing that we’re ever gonna cross off our list. We’re gonna ask them way more about our bloating, all the things we ca- we talked about in the last episodes, diarrhea, pain, when you’re feeling it, is it related to bowel movements, are there foods that make things worse, are you taking medications, you know, have you had a food poisoning or abdominal surgery or treatments that, [00:28:00] you know, worked or didn’t work or improved for a little bit and then, didn’t?

So we wanna know all of that information. Biofilm’s not sort of step one.

Dr. Dominique Vanier, ND: Yeah, I, and I think that’s w- where the useful idea from these clinical biofilm frameworks come in, because bio- biofilm becomes more interesting when there’s a pattern or, like, of persistence or reoccurrence despite otherwise appropriate treatment. But even then, it- it’s still a hypothesis.

Dr. Whitney Baxter, ND: Yeah, it’s not a diagnosis that the biofilm is the issue.

Dr. Christina Carew, ND: So how are you gonna talk to your practitioner about this if you’re like, “Okay, well, maybe, maybe this is something that needs to be considered”? so if you have chronic bloating and you’re having, treatment resistance or treatment reoccurrence, these might be areas where the biofilm might become appropriate to ask.

And so, you might ask your clinician or your provider about, you know, “Are there any recommendations or explanations of why my symptoms keep [00:29:00] returning? Could, could biofilm be something relevant in my particular case? Is there any evidence that supports an additional treatment to what you’re recommending?”

And so there are some studies, especially around H. pylori, that talk about using other tools to help with, treatment resistance and, r- and making, the antibiotics work better. And so there are some studies that are coming out. And then also knowing, you know, what are the risks that I am, I am potentially having when I take a product, and how will I know when it’s working.

Dr. Whitney Baxter, ND: Yeah. I love that la- last one, and just really reiterating that we don’t know for sure, right? With these, this, Yeah … this, post-reaction, right? This die-off reaction. Because if the answer is you’ll feel worse first, and that means it’s working… Yeah.

Dr. Christina Carew, ND: Yeah, and it’s not- That’s a big one … necessarily the case.

sometimes if you have, if you have [00:30:00] resources, you could do repeat testing on something and see if something is worse, whether that is mycotoxins or SIBO or, GI disorders, if that’s important to you. but really a lot of our patients, at the end of the day, they just wanna feel better, and they don’t really care what gets them there.

It’s just, a consideration of all the things that we talked about. You know, why might something not be working?

Dr. Dominique Vanier, ND: Yeah, I think that that’s key. people just wanna feel better. They don’t a- they don’t always wanna know all the details, right, along the way. That’s, that’s our job.

Final Summary

Dr. Dominique Vanier, ND: Um, let’s talk about some big takeaways.

Number one, biofilms are real.

Dr. Whitney Baxter, ND: They’re organized microbial communities surrounded by a protective matrix

Dr. Dominique Vanier, ND: And microbes within them can communicate, super cool, behave differently, and become more tolerant of environmental threats.

Dr. Christina Carew, ND: And abnormal intestinal [00:31:00] biofilms are both a legitimate area of gastrointestinal research and potentially something that’s help- hap- not helping you, or preventing you from being helped.

Dr. Whitney Baxter, ND: But bloating does not equal biofilm.

Dr. Dominique Vanier, ND: Mm-hmm, same thing with recurrent SIBO. That does not the- prove that there is a biofilm. Actually, it could just be a wrong diagnosis. Yeah.

Dr. Christina Carew, ND: And treatment failure doesn’t mean you have to break open a biofilm, ’cause it could still be not the right i- the not the right issue, right?

And part of this concept that’s generally useful is how we think about, chronic gut problems. Instead of asking, what organisms do I need to kill, you know, what else is happening in that ecosystem that allows this problem to persist?

Dr. Whitney Baxter, ND: Yeah. I love that. And also the motility or the movement of our gut.

Dr. Dominique Vanier, ND: Mm-hmm, constipation.

Dr. Christina Carew, ND: Digestion.

Dr. Whitney Baxter, ND: That microbiome.

Dr. Dominique Vanier, ND: Mm-hmm, the gut environment is a big one.

Dr. Christina Carew, ND: The nervous [00:32:00] system. So, like, all these pieces matter, and biofilm may be a piece of the puzzle, but it’s definitely not the whole puzzle.

Dr. Whitney Baxter, ND: And we’re definitely not declaring war on every single bacteria-gated community in your intestine.

So do not do that intestine cleanse.

Dr. Dominique Vanier, ND: Yeah. Some of them are lovely neighborhoods that are hanging out in our guts, so.

Dr. Christina Carew, ND: Mm-hmm. Yeah, great schools.

Dr. Whitney Baxter, ND: Terrible parking.

Dr. Christina Carew, ND: And on that note, thank you for joining us, because better gut health does change everything.