Symptoms like chronic yeast infections, brain fog and sugar cravings can indicate dysbiosis or an imbalance in the gut microbiome. About 20 years ago candida albicans began receiving a lot of attention. For awhile there it was the cause of a long list of ailments according to some.  We’ve learned a lot since then and continue to learn more all the time.  Endoscopies are not perfect but can show fungal overgrowth occurring in the small intestine. (SIFO).   In out-patient settings, we test the gut using stool and breath tests primarily although a urine organic acids test can also be helpful as I’ll explain.

Candida albicans is one strain of bacteria residing in the colon.  It is part of a healthy colon when in balance, however it does get out of balance. This can happen when there is a dybiosis of insufficiency meaning a lack of other good bacteria. Often it occurs after antibiotics especially if several rounds were used.

Keep in mind that high stress, poor diet and reactions to foods also trigger an imbalance in gut flora. Similarly a parasitic infection like giardia can trigger the onset of Celiac disease and non-celiac gluten sensitivity. This is why people go traveling and say their gut was never the same afterwards.

So what causes SIFO?

If you are on a very limited diet to manage symptoms that appear to be fungal overgrowth but your labs come out looking good we have to consider SIFO. There isn’t a breath test available for SIFO and it won’t show on stool tests. Certain antibodies can be used to detect it but this is not yet widely used. An organic acids test has markers that are more telling. This is what I end up using because it has a variety of other markers that are helpful for assessing the patient’s health status in general. Knowing what triggered the symptoms is important so reinfection can be avoided. There is a strong correlation between long-term use of proton pump inhibitors and SIFO.   Low stomach acid means more pathogens make it into the small intestine.

Treatment can include both pharmaceuticals and botanicals.   As far as botanicals go I use monolaurin, a concentrate of coconut oil, oregon grape root, other berberines, caprylic acid or allicin and biofilm disruptors like NAC or Interfase Plus. Gastroenterologist Dr. Satish Rao suggests cycling antibiotics and following with antifungals. This is because onset of fungal infection occurs after the good bacteria is killed off whether its in the small intestine or the colon.

What about diet?

A lower carb diet rich in nutrients is a good starting place. There is some indication in the research that ketones can feed the overgrowth so use caution with this approach. Often people will know what triggers symptoms and these need to be avoided. Following treatment a period of rebuilding is key to ensure that the colon is functioning optimally. A prokinectic like 5-HTP or bitters encourage the migrating motor complex to prevent reinfection in the small intestine. If the ileocecal valve between the two bowels is inflamed we want to address this. Bacteria collect around these valves and take up residence where they shouldn’t. So inflammation and any immune issues also need to be addressed.

Keep in mind that candida albicans is different than candidiasis, which is a serious condition occurring in immune compromised people. Candidiasis requires immediate medical intervention.