Because I’ve been talking a lot about the exceptionally common and epidemic condition, small intestinal bacterial overgrowth, SIBO, I feel that it’s important to discuss its closely-related cousin: small intestinal fungal overgrowth, SIFO, i.e., unrestrained small intestinal proliferation of Candida fungal species, especially Candida albicans. In addition to SIFO, there may also be fungal overgrowth in the colon, large intestinal fungal overgrowth, LIFO. For simplicity, let’s call all of it “fungal overgrowth.”
Most people harbor Candida species in their intestinal tracts, as well as skin, hair, sinuses, airways, vaginas, even internal organs to a limited degree. It lives in those places quietly without causing health problems until something—a course of antibiotics, steroids, intestinal inflammation, change in the composition of bowel flora, over-reliance on dietary grains and sugars, excessive alcohol, stomach acid-suppressing drugs—permits Candida to proliferate. Any situation in which the intestinal lining becomes inflamed, e.g., dysbiosis, SIBO, Crohn’s disease, ulcerative colitis, probably irritable bowel syndrome, creates an environment favorable for Candidal proliferation. What is not clear is whether Candidal overgrowth can occur independent of any other health issue, i.e., develop independently. I suspect that it does not and that changes in the intestinal environment are required before Candida are allowed to proliferate. These are also many of the same reasons that allow SIBO to develop.
Candida is an opportunistic organism: Given a chance, it will proliferate, form a biofilm (mucous) to protect itself, and can be responsible for some of the toughest infections to eradicate since the biofilm makes the organism less susceptible to anti-fungal agents. This explains, for instance, why Candida infections of indwelling catheters or artificial heart valves or prosthetic hips are almost impossible to eradicate with anti-fungal drugs. (For this reason, the device almost always has to be physically removed.)
Let’s put aside such serious Candidal infections treated in hospitals and instead focus on more common, but less severe, forms of fungal overgrowth. This is mostly commonly experienced as increased numbers of Candida albicans in the colon (semi-arbitrarily defined as >100,000 CFUs/ml since about 50% of healthy people have up to 10,000 CFUs/ml in stool) and the small bowel (>1000 CFUs/ml? by duodenal aspirate). This can occur concurrently with Candidal infections of skin, mouth/throat, and vagina.
SIBO and SIFO/LIFO can occur together. In one study, about a third of participants with SIBO also had SIFO (defined as >1000 fungal CFUs per ml identified in duodenal aspirate, i.e., a sample of upper gastrointestinal material). Fungal overgrowth is also associated with many of the same symptoms and health consequences as SIBO such as:
- Skin rashes, especially atopic dermatitis and eczema, unresponsive to other efforts
- Allergies—of the skin, airway, sinuses, etc., at least some of which are due to the presence of fungal proteins
- Triggering or worsening of autoimmune diseases
- Irritable bowel syndrome-like symptoms of abdominal discomfort, bloating, and diarrhea
- Fatigue, mood swings
Fungal overgrowth is not associated, however, with intolerance to prebiotic fibers (as occurs in SIBO) but can be associated with intolerance to sugars. Interestingly, emerging experimental evidence has associated Candida with dementia, reversed with Candida eradication. It is also suspected to allow increased intestinal permeability like SIBO, a process that can be responsible for body-wide inflammation and autoimmune phenomena, though it remains an unproven association.
If you have taken efforts to reverse SIBO and have had only a partial response, then it’s time to consider fungal overgrowth. You can submit a stool sample to quantify Candida or other fungal species through lab services such as Genova’s GI Effects Comprehensive Profile or the GI Map.
In addition to the powerful start in reducing Candida provided by the Undoctored Wild, Naked, Unwashed program, fungal species can also be further suppressed by a number of herbal and probiotic preparations, such as coconut oil, the allicin of garlic or (aqueous) garlic extracts, ashwaghanda, turmeric, berberine, and ginger, all natural and benign efforts. But such agents have not been shown to be effective beyond Candida-suppression in the mouth or a Petri dish. In other words, while these strategies work in artificial settings, they have not been shown to work in suppressing Candida in, say, the ileum or colon many feet down the gastrointestinal tract. Coconut oil, for instance, is digested and absorbed long before it reaches the colon. There are, of course, anti-fungal prescription drugs that we know work to suppress Candida. In addition to conventional anti-fungal drugs, natural agents that are probably helpful include:
Oil of oregano—The essential oil of oregano has proven to have substantial efficacy in reducing Candida populations.
Saccharomyces boulardii—The fungal species S. boulardii can be taken as a probiotic supplement and appears to suppress Candida via competition.
Bacterial probiotics—While the precise composition of the ideal probiotic to suppress Candida has not been established, several different preparations have been shown to reduce Candida, an effect that requires up to one year to develop. Strains of Lactobacillus plantarum may be especially effective.
Of the herbal antibiotic regimens we use in the Undoctored program to manage SIBO, the Candibactin AR/Candibactin BR is the preferred combination, as the AR provides the active anti-fungal component of oil of oregano while the BR provides berberine, both of which have anti-fungal properties. Reversal of fungal overgrowth can also require many weeks, even months, of effort.
One of the most common mistakes in reducing (as you really cannot and perhaps should not fully eradicate) Candida is to not address the situation that allowed it to proliferate in the first place. The most common oversight is to not address SIBO that requires its own set of specific efforts. Exactly how to identify Candidal overgrowth and manage it will be discussed in detail in our Undoctored Inner Circle conversations. Please join the conversation if you’d like to pursue the question and management of Candida further.