A step-by-step framework for systematically working through symptom flare-ups - investigate what changed, screen for red flags, then move through the intervention hierarchy.
Assess
Is this new, or has it been going on for a while?
Is this a one-time flare or a consistent pattern?
Compared to your normal, how much worse is this?
When exactly did this start?
Assess
Did you start any new supplements?
Stop any supplements?
Increase any doses?
Introduce multiple supplements at once?
Potential interventions
Reduce the dose
Return to the last tolerated dose
Reintroduce one supplement at a time
Assess
Did you eat out recently?
Have you introduced any new foods?
Have you increased fiber recently?
Have you deviated from your usual routine?
Potential interventions
Return to baseline nutrition
Temporarily reduce fiber if appropriate
Identify potential food triggers
Assess
Has your morning routine changed?
Have you been skipping meals?
Have your pre-meal rituals changed?
Have you been traveling?
Have your stress levels or sleep quality changed?
Potential interventions
Reinstate supportive routines
Prioritize sleep and stress management
Re-establish meal consistency
Assess
What phase of your cycle are you in?
Is this pattern cyclical?
Does this happen around ovulation or menstruation?
Potential interventions
Normalize expected fluctuations
Increase support during vulnerable phases
Track symptom patterns across cycles
Refer out if experiencing
Severe abdominal pain
Fever
Persistent vomiting
Blood in stool
Inability to pass stool or gas
Rapid unexplained weight loss
Signs of dehydration
Chest pain
Difficulty swallowing or food getting stuck
If no red flags are present, proceed to symptom-specific interventions.
Always assess this first
Even if the client says: "I go every day."
Assess
Are you having daily bowel movements?
Are they complete evacuations?
Do you strain?
Do you ever skip days?
Do you feel fully emptied?
Are stools hard or difficult to pass?
Why?
Constipation can contribute to:
Bloating
Reflux
Histamine symptoms
Fatigue
Nausea
Loss of appetite
Dysbiosis relapse
Adrenal + Constipation Cocktail
12–16 oz warm water
½ teaspoon Celtic sea salt
1 teaspoon cream of tartar
Juice of ½ lemon (avoid with reflux)
Rationale: Supports hydration and provides potassium and minerals necessary for smooth muscle contractions.
Extra Virgin Olive Oil (EVOO)
Start with 1 teaspoon daily
Gradually work up to 1–2 tablespoons daily
Rationale: Stimulates bile release, improves motility, and may help lubricate stools.
Assess for:
Difficulty tolerating fats
Nausea after fatty meals
Floating or greasy stools
Gallbladder dysfunction or removal
Right upper quadrant discomfort
Consider:
Digestive bitters
Ox bile
TUDCA (when appropriate)
Castor oil packs
Adequate dietary fat intake
Ensure the client is:
Implementing morning practices from the Constipation Relief Protocol
Allowing adequate time for bowel movements
Responding promptly to the urge to go
Introduce one at a time.
Examples:
1 tsp–2 Tbsp soaked chia seeds
1 tsp–2 Tbsp ground flaxseed
â…“ cup raspberries
1–2 kiwifruit
1 cup cooked spinach
¼ cup cooked red lentils
Alkaline Green Smoothie
8 oz water
½ cucumber
2 stalks celery
½ avocado
1 cup spinach
1 cup kale
½ cup fresh parsley
Fresh mint
½ lemon
½ green apple
1 tsp chia seeds
1 Tbsp ground flaxseed
Drink slowly initially to assess tolerance.
Mag07
Use before bed
Capsules can be opened and mixed into water if needed
Glycerin suppositories
Use first thing in the morning as needed
Assess
Is this primarily heartburn?
Is it throat irritation, coughing, mucus, or hoarseness?
Did symptoms worsen after introducing supplements?
Is reflux occurring mostly at night?
Consider reducing or temporarily stopping:
Betaine HCl
Alcohol-based tinctures
Other supplements that appear to be worsening irritation
Encourage clients to:
Finish eating at least 4 hours before bed
Go for short walks after meals
Stop eating at approximately 80% full
Avoid lying down after meals
Avoid carbonated beverages and canned drinks
Practice diaphragmatic breathing regularly
Marshmallow Root Tea + Slippery Elm Powder + DGL Ultra
Use to help soothe irritated tissues and support the upper GI lining (DGL Ultra can be used before meals).
Sodium alginate products
Reflux Raft
UK Gaviscon Advance
Can be especially helpful when symptoms occur after meals or before bed.
AlkaLife pH Booster Drops
May provide additional symptom relief when irritation is predominantly affecting the throat.
Pepcid (famotidine)
May be used temporarily when symptoms are severe and additional support is needed to calm the system.
Coach Note
Pepcid should generally be viewed as a short-term symptom management tool rather than a long-term solution.
Assess
Are symptoms worse immediately after meals?
Have they stopped digestive supports?
Are they rushing meals?
Are they chewing thoroughly?
Potential interventions
Reinstate digestive supports
Improve meal hygiene
Slow down eating
Reinforce pre-meal rituals
Assess
Are symptoms consistently linked to specific foods?
Was fiber increased too quickly?
Could FODMAPs be contributing?
Is histamine playing a role?
Potential interventions
Return to tolerated foods
Reduce dietary extremes
Reintroduce foods systematically
Only investigate after addressing the previous pillars.
Assess
Does this resemble previous overgrowth symptoms?
Recent antibiotic use?
Recent illness?
Evidence suggesting dysbiosis relapse?
Potential interventions
Antimicrobial support when appropriate
Reseeding strategies when appropriate
Assess
"Have we actually moved the needle?"
If no, consider
Do not assume every flare-up represents a microbiome relapse.
Many symptom exacerbations improve significantly when coaches systematically evaluate:
What changed
Constipation
Reflux management
Digestive foundations
Food triggers
The microbiome