Here’s a question that currently has no firm answer, but raises some important uncertainties in our management of the intestinal microbiome:
Antibiotics effective against the microorganisms of SIBO, small intestinal bacterial overgrowth, yield various bacterial breakdown products such as peptidoglycans as bacteria die en masse. This has been shown to provoke proliferation of fungi, in addition to promoting fungal transition to a more virulent (disease-causing) hyphal (elongated and invasive) form, rather than the more benign spherical yeast form. The more virulent hyphal form is also a vigorous producer of a biofilm, i.e., a protective layer that makes it less susceptible to the human immune system or anti fungal agents. All this suggests that our efforts to reduce the bacteria of SIBO—E. coli, streptococcal species, enterococcal species, Campylobacter, others—may allow proliferation of fungi such as Candida albicans, C. glabrata, and C. krusei. We also know that SIBO and small intestinal fungal overgrowth, SIFO, often co-exist with some estimates as high as 50-64% or more of people with unexplained abdominal symptoms (excessive gas, bloating, discomfort, diarrhea) having both.
The question is therefore: Should we ALWAYS add anti-fungal agents to our antibiotic regimens for SIBO to prevent this fungal overgrowth or to reduce fungal populations that co-exist with SIBO? If you take FC Cidal and Dysbiocide, for example, should you add several agents with anti-fungal effects such as curcumin, oil of oregano, and oil of cinnamon? Or should we choose antibiotic regimens that include anti-fungal components, such as the oil of oregano and berberine of the Candibactin AR/BR regimen? (These are regimens we’ve been using for SIBO and SIFO in our Undoctored Inner Circle.)
This is speculation, as these questions have not yet been fully explored in humans. Downside: Our SIBO management, while effective for bacterial species, may tilt the scales in favor of allowing fungal overgrowth. Upside: The methods we have been using to suppress fungal overgrowth are fairly benign, unlike conventional anti fungal agents such as nystatin or amphotericin B. I’m inclined to believe that all SIBO treatment should also involve SIFO-suppressing efforts. Or, at the very least, be alert to either incomplete responses to efforts to eradicate SIBO and/or appearance of symptoms after SIBO treatment, watching for appearance of telltale signs of fungal proliferation.