Candida and fungi—just like bacteria—are a normal part of our gut’s ecosystem. And yet, for many of the same reasons a person might develop SIBO, if your digestive tract isn’t functioning properly, those organisms can overgrow and cause a host of problems. In today’s episode, we get into the issue of how to parse out whether you’re GI symptoms are being caused by a yeast or fungal overgrowth (SIFO), bacterial overgrowth (SIBO), or as is often the case BOTH.
Joining me is Dr. Ami Kapadia, an integrative medicine practitioner at Kwan Yin Healing Arts Center, where she combines western and functional medicine diagnostics with traditional and complementary therapies to help patients reach their goals.
In our conversation, we discuss the difference between local chronic yeast infections and when your body has an immune response to ordinary fungi inhabiting the digestive tract. We also talk about the best methods of treatment, how your diet should be adjusted to combat a yeast overgrowth, and how this dovetails with the low FODMAP approach for SIBO.
A quick taste of what we’ll cover:
- The relationship between women’s hormones, chronic yeast infections, and candida overgrowth in the gut
- The process of investigating SIBO versus SIFO and the challenges in testing for fungi
- How environmental mold factors into fungal tolerance and your immune system
- Differences in treatment of SIBO and SIFO
- How to do a diet test to see if you’re sensitive to yeast or mold in foods
- The role that diet plays in overcoming a yeast overgrowth and what many in the wellness world get wrong
- How yeast sensitivities dovetail with histamine sensitivities
- And so much more…
Resources, mentions and notes:
- Dr. Kapadia’s website
- Dr. Kapadia’s yeast elimination diet protocol
- Dr. Kapadia’s environmental mold guide
- Episode 13 with Dr. Aviva Romm on the vaginal microbiome
- Episode 15 on Histamine Intolerance
- Herbal Anti-Fungals: CandiBactin-AR, BR; Thorne SF722 Formula or Undecyn Acid
- Join the SIBO Made Simple Facebook Community Page
- Subscribe to receive a free low FODMAP cookbook
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This episode is brought to you by SIBO Made Simple – THE BOOK! Part patient guide and part cookbook (complete with over 90 low FODMAP recipes), this is your trusty road map to become your own intestinal detective, gut problem solver, and critter-free kitchen crusader. Those who pre-order their copy will be able to do my Gut Heal Bootcamp for FREE. You will also get access to one free online cooking class. To find out more details about the pre-order bonuses and to submit your receipt, click here.
HOW TO TREAT SMALL INTESTINE FUNGAL OVERGROWTH
PHOEBE: Today we are talking about fungi, fungi as you say?
DR.K: Sure. You all have known a person with that right pronunciation.
PHOEBE: Okay, good. Let’s start with the basics for those at home who are wondering about it because I’ve gotten a ton of questions over the first two seasons of doing this podcast about this piece of the puzzle for those with gut issues. We hear a lot about Candida I feel like in the wellness space. I don’t know if I’d call it catch-all term, but I feel like I’m just curious what just the bare bones difference is between people who talk about Candida versus talk about yeast versus talk about fungi.
DR.K: Sure. Fungi in general is an overarching category and within that is Candida as a yeast species. There’s also environmental molds that are also fungi, but are different than yeast. You can think of it as those two categories. Generally, when we’re talking about internal issues in our microbiome, we’re talking about yeast species that are like Candida for the most part although there’s a few others, but that’s the majority on type of yeast that we talk about. It does have different species of it, but that’s the majority of what we’re talking about internally. When we talk about external mold exposures that’s in the environment, whether it be indoor in a water-damaged building or outdoor molds that people can be allergic to, those are in the mold category which is still in the overarching category of fungi, but is definitely different than the Candida yeast that we worry about internally when it gets out of balance.
PHOEBE: Thank you for clarifying that so much. There’s obviously yeast and fungi that exist in our system similar to bacteria that in most cases have a harmonious existence. What happens when things start to go awry?
DR.K: Good question. Phoebe, we talk about this normal microbial ecology that we ideally can maintain. The issue arises when these normal microbes like Candida that live on most of our mucous membranes in harmony with our body, when they’re disrupted. When the immune system is disrupted from anything, it can be from antibiotics, from acid blocking medications, a stress response can do it especially prolonged stress over time has known effects on the microbiome, other medications, certain surgeries, all of those can affect our normal microbial balance and lead to an excessive colonization or overgrowth of Candida as well as the possible development of even an allergic or hypersensitivity response to those Candida organisms that are there. You can either have an excess number of these organisms that develop or you can develop an abnormal immune response where you’re reacting to the normal amounts or you can have both, if that makes sense.
PHOEBE: Totally. Then what is the difference between one of those two types and a local infection like a yeast infection or I don’t know, I guess a toenail infection?
DR.K: Yeah. Good question. I don’t typically think of people who get an occasional vaginal yeast infection when they’re on an antibiotic or have toenail onychomycosis which is a fungal issue with the nails. They don’t necessarily have this internal balance issue when it’s just an isolated area that’s getting an occasional problem. Those types of infections are readily diagnosed with regular diagnostic measures. Vaginal yeast infections are relatively easy to diagnose these days just from an exam as well as with PCR or wet mounts that we can do in the clinic. Same with onychomycosis of the nails, relatively easy to diagnose. These other issues we’re talking about with this internal disruption are not as easy to diagnose and part of that is that we don’t have a good non-invasive test to see if someone has a small intestinal fungal overgrowth. The main way to diagnose it is through – if you go to get an endoscopy with a GI doctor, they can take an aspirate of the fluid from the small intestine and analyze that for the concentration of yeast species, but obviously, that’s an invasive test.
The difference lies in ease of diagnosis and with treatment. Again, a woman who gets an occasional yeast infection like once a year when she was on an antibiotic generally responds pretty well to our normal antifungal agents. Whereas someone who’s developed this disruption of the normal mycological flora just like with SIBO can fall into this category of relatively easy to treat with a round or two of prescription or a natural antifungal burst recurrent issues where we found with SIBO, two-thirds of patients are falling into this category of recurrent issues. With SIFO as well, if the risk factors aren’t taken care of or there’s unmodifiable issues that can’t be changed that are leading to the overgrowth, it can continue in this cycle until we get to the bottom of things.
PHOEBE: Okay. I want to get more into how you can parse through the differences between SIFO and SIBO, but first, we talked about a little bit in – I’m forgetting the episode number, but it’s the one with Dr. Aviva Romm. We talked a lot about women’s issues and also fertility and infertility, and the relationship between the vaginal microbiome and your gut microbiome. I’m just curious, I mean, if someone is getting constant yeast infections not just right after an antibiotic, but I do have some friends and family members who get chronic yeast infections, does that have any bearing on these other two categories of yeast issues? Is there ever a correlation between someone who might have SIFO and is seeing those chronic issues in the vaginal microbiome as well?
DR.K: Good question. There is old research in some books written by Dr. William Crook back in the ‘80s. They were some of the initial books written on this whole Candida connection. He did write about how women who are getting recurrent yeast infections had this excess gastrointestinal reservoir of yeast. There’s other studies that show there’s no correlation between the gastrointestinal reservoir and recurrent vaginal yeast infections. I believe that there’s likely – it’s likely somewhere in between where for some women there’s likely this issue where there’s an overgrowth in other areas that’s affecting their immune system and they have common risk factors that are affecting this propensity to have overgrowth in the GI tract and in the vaginal area. One of those risk factors can be this actual allergy to Candida and of a hypersensitivity or allergy reaction almost like a food sensitivity or food allergy where if you do have an allergic response to Candida, since we all have it in our intestinal tract, and the majority of women have it in their vaginal tract.
If you’re reacting to even the normal amounts that are there, you can have ongoing symptoms that seem like an infection when it’s actually just a hypersensitivity – not just but it’s an actual hypersensitivity or allergic reaction. What happens is, when you have that type of reaction going on it actually disrupts part of your normal body’s immune system that keep those organisms in check. It has a self-propagating issue when there’s an allergy or hypersensitivity where you keep becoming more likely to get recurrent infections and symptoms until the allergic or hypersensitivity component is addressed.
PHOEBE: Interesting. Is that usually systemic or just happening?
DR.K: Yeah. People manifest with symptoms with yeast overgrowth in different areas. I think of it as there’s hypersensitivity kind of like other things. What I see with patients with food sensitivity, where it can really manifest in any organ system. They can have an allergic response to something that’s affecting multiple mucous membrane areas in the body. I’ve had some women where they just had recurrent vaginal symptoms and otherwise, they feel pretty good. I’ve had other women where they have concomitant GI and vaginal symptoms, and they just don’t feel well in general. Part of that could be because these yeast organisms can produce byproducts that are similar to mold toxins and they’d have to be cleared from the system. If you do have this overgrowth or hypersensitivity in certain body areas, it can have systemic effects. It can have local effects, or it can have both.
PHOEBE: I know we’ve talked about this on past episodes often since SIBO affects so many more women than men, but I don’t know the data on yeast issues in general either at the immune variety or SIFO, but why – I mean, assuming that they do affect more women than men, why is that?
DR.K: I think there’s probably a few different reasons. There just seem to be somewhat of a hormonal connection. We know that some women when they get recurrent yeast infections it tends to happen right before their cycle or in the second half of their cycle when there’s certain hormones that are surging and other ones lowering. I’ve had women where they’ll get them recurrently before their menstrual cycle. One way to mitigate that is to use something [00:11:20]around ovulation when the estrogen receptors are more active in the vaginal tract. You can actually use something like boric acid for a couple of days around ovulation to help prevent and disrupt that ongoing cycle. For some women who have recurrent issues, let’s say with vaginal yeast infection, we initially treat them for 10 to 14 days or however long it takes.
I do sometimes use boric acid in that case, and then if that works, we can use that as a preventative around ovulation to help mitigate that on the stimulation of yeast overgrowth due to the hormonal effect during that second half of the cycle. Just taking it between using boric acid locally, days 12 to 14 can help prevent that recurrence around the time of the menstrual cycle. There is that hormonal connection. There’s other reasons women we know are more likely to have autoimmune issues and we know that at least in some women can have this yeast overgrowth tends to [00:12:18]some autoimmune type reactions whether it’s linked to celiac disease potentially that we can talk about or a link to allergies. We know women in general tend to have more autoimmune type issues. I don’t have exact data on other reasons it’s more common in women, but we do clinically see that.
PHOEBE: Yeah. I feel like just over the next decade we’re going to be learning hopefully a lot more on the subject. Real quick for people who weren’t aware, what is the autoimmune correlation between yeast issues? I know you mentioned celiac or I just made that.
DR.K: Yeah, good question. [00:12:56]. Just to review some of the studies that have been done, there’s a protein in the Candida cell wall called hyphal wall protein 1 that’s similar to the gliadin protein in gluten and gliadin-containing grains. There’s this potential cross reactivity where it’s theorized that Candida colonization and overgrowth may be a trigger for some people to develop non-celiac gluten sensitivity or celiac disease because of this concept of molecular mimicry where a body confuses one protein for another. If it develops antibodies to this protein in the Candida cell wall, it may also then start producing antibodies to gluten and gliadin proteins. This has not been definitively proven, but there’s studies showing that there’s this potential molecular mimicry. There’s also studies showing an increased propensity to develop allergies, environmental and food sensitivities after a Candida colonization in animal models. We know that there’s often allergic components in autoimmune illness. There’s intestinal permeability that’s alleviated and there’s studies showing that Candida colonization can increase intestinal permeability as well.
PHOEBE: Back to parsing out the difference between SIBO and SIFO or one of the immune-related issues, if I’m getting this correctly, and from what I read previously, the symptoms are really similar and the root causes can be quite similar. Are there any root causes or symptoms that you look for to differentiate between the two?
DR.K: That’s a really good question. Unfortunately, the symptoms are quite similar to SIBO and it’s not possible to tease it up clinically just by asking someone questions. Dr. [00:14:47]has some great publications showing that the symptoms are quite similar and so we can’t use those to differentiate one from the other. That being said, part of what we do in integrative and functional medicine and in naturopathic medicine, we often use herbal antimicrobials in treating some of this overgrowth. The good part of this is that you can often pick some products that would address both the SIBO and the SIFO in a patient without necessarily having to have a definitive diagnosis of one or the other initially. Of course, we do have testing for SIBO. One of the things we look for is let’s say someone has a positive SIBO test, you treat them and their test results normalize, but their symptoms don’t. Then you know that there’s likely something else causing those ongoing persistent bloating, gas, constipation, diarrhea, whatever it is.
That’s an instance where you might think well, maybe fungal overgrowth is a part of this picture as well and maybe want to do some more targeted antifungal treatment to see if we get a response there. There’s not any questions you could ask someone specifically outside of – there’s nothing that’s been proven in research to show clinically that it’s validated to differentiate these two. The few that I would think of when I do have patients that get recurrent let’s say vaginal yeast infections, dandruff, lots of skin rashes, of course you can have these along with SIBO, but it gives me some clues that their body might be having issues with yeast and molds as well.
PHOEBE:I don’t know. I feel like Candida’s been more of a buzz work in the last several years than even SIBO. Presumably since there is no real test, are people being told by some doctors that they have Candida? What is the reason why someone might get told that and they’ve never even heard of SIBO or aren’t even told to get the tests as a process of elimination?
DR.K: Okay. Good question. In regular medicine, I’m not sure that there’s a current belief in SIFO at this point and I think part of that is that we don’t have a really good non-invasive diagnostic test like we do with SIBO. I find a lot more GI doctors in our area are currently on board with SIBO as far as a valid diagnosis that can require and benefit from treatment. SIFO, it had this surge I feel like in the early ‘80s where a lot of publications were written about it. It wasn’t really believed to be a real diagnosis by most doctors. I still think it probably isn’t thought to be a real diagnosis unless you’re seeing a natural medicine or functional medicine doctor. That being said, with Dr. Rawls’s publications over the last few years, we actually have good research now showing that patient’s symptoms can be related to fungal overgrowth and going over some of the risk factors and treatment options for it.
If you’re a patient that’s seeing your regular doctor, it’s very unlikely they’re going to mention this at all. If you’re seeing your natural medicine or functional medicine provider and you have general [00:17:43]symptoms, most of my colleagues are still going after SIBO initially for the most part. That makes sense because we have a test for it, but I think part of what we’re trying to bring awareness to is that there is this concurrent issue that could be going on at the same time. Patients can read more about this and talk to their integrative functional medicine, naturopathic doctor about it who will likely be very open to treating that as well as part of their SIBO if they have that concurrently. It may be more patient-driven at this point asking questions about it.
PHOEBE: Interesting. Are there any nutrient deficiencies that you look for as – or maybe there are no no-brainers for diagnosing SIFO?
DR.K: There are some that we know about. There’s some old but still really helpful research from a paper written by Dr. Leo Galland in the ‘80s on nutrient deficiencies in these patients that had this yeast issue. Some of the more common ones that he found are things that I do commonly test most of my new patients for. Iron is like a Goldilocks phenomenon. Iron you don’t want too much or too little. Both can stimulate yeast overgrowth and can have negative effects for other reasons. I check a ferritin level on a lot of my patients and I shoot for 30 to 50. I don’t go for super high. There’s some research showing women feel better when we can get her ferritin about 50 energy wise, but I’m just cautious that they also have a lot of gut symptoms that if you over replete the iron, it can stimulate yeast growth as well. Iron is one that we look at. Zinc is something I test in almost all of my patients. It’s hard to get enough from food and it’s really important for multiple reasons including immune system as well as making hydrochloric acid, as well as detoxification. B6, B12, magnesium, vitamin A are the main ones that I’ve read about as far as an effect on the particular yeast issue that you want to replete if they’re low and try to get back to a good level.
PHOEBE: I know you mentioned before that there were certain herbs that you can use to cover both of your bases. Which are the herbs that are better for SIFO?
DR.K: Okay, good question. I use a lot of what I call – when I explain it to patients, I call them broad spectrum antimicrobial herbs. The way I like to explain it is that with regular pharmaceutical medicine, if someone has a bacterial infection like strep throat, we give them an antibiotic. If someone has a vaginal yeast infection, we give them an antifungal. In our integrative medicine world, one of the benefits of using herbs is that they often have broad spectrum properties meaning you don’t need a separate thing for each organism that you think is out of whack. I use a lot of products from a company called Supreme Nutrition Products, and I’m not affiliated with them, but one of my mentors developed that line. It’s really clean. They tested in every way possible. They also energetically test each batch that they get.
They have various names for their products but the main ones that I use are various forms of [00:20:45], berberine particularly Coptis is the one that they use in their product, Golden Thread. Noni, Vidanga. These are all herbs that have a long history of use in Chinese or Ayurvedic medicine often. Those are just a few of the big ones I use. There’s one specific for yeast called SF722 or undecylenic acid made by Thorne Research that I also like a lot. There’s also been studies done by Dr. Mullin, a gastroenterologist from the East Coast who published on herbals for SIBO. A lot of the herbals that he published on – I don’t remember the names off the top of my head but they have properties for both yeast and bacteria. I believe he uses various Metagenics products that he list [00:21:27]and I think those are on Dr. Siebecker’s website as far as the specific products that were in his study showing the effectiveness of herbals for SIBO. That also covers SIFO.
PHOEBE: The CandiBactin-AR, BR I think is what they are.
DR.K: I think there’s another one as well and he used a combination in his trial.
PHOEBE: Awesome. Moving on to diet which I feel like is something I get asked about a lot obviously in relation to SIBO, but also for the yeast, fungus element. Is there anything – I know people talk a lot about sugar and simple starches. Is there any reason or precedence in someone’s diet that would preclude them more towards the overgrowth of SIFO than SIBO considering that they might have a similar root cause?
DR.K: Starches tend to feed both yeast and the SIBO issue. Refined sugars like plain sugar, glucose, things like that tend to be more of a problem for patients with SIFO than with SIBO. It’s not just the complex starches in SIFO. It’s also refined sweeteners. Actually, I don’t try to do extreme diets with patients that are unsustainable. I allow a reasonable amount of starch. I do have them avoid refined sweetening. We try to limit sugar as much as possible, and when I say that I mean honey, maple syrup, sugar, all of those. Things like Stevia, Xylitol, I find that the person tolerates them. Fresh fruit is fine, but I do recommend people avoid the refined sweetening. I don’t remove completely whole grains or anything like that if the person tolerates them. We just individualize it that way, but the big ones that we try to remove for most patients would be gluten, refined sweetening, and then figuring out their other main food sensitivities.
The other thing that I have patients do routinely is what we call a yeast/mold elimination challenge for five days. The reason for that is that you have – if you have a yeast overgrowth or hypersensitivity, you may have developed a cross-reactivity to yeast and molds in food. There’s a relatively simple way to figure out if you fall in that category. These foods don’t necessarily feed the yeast, but again you may have an allergic reaction to them if you’re reacting to yeast and molds in that way. I have on my website actually a link to this that I can tell you, Phoebe how to link to it. Basically, you remove yeast, dried fruit, alcohol, sugar, vinegar, and all fermented foods for about five days, and then you have them back in, see how you feel. I’ve had pretty dramatic results with some people just doing this five-day elimination challenge. Once they add them back, they get all sorts of symptoms. That’s the one additional piece of the puzzle that I have patients do that we don’t routinely do in patients with SIBO.
PHOEBE: I know that that list is really similar to the histamine no-no food list. Is there any correlation there? Is it possible that some of the benefits to taking those things out might be on a histamine level as well?
DR.K: Definitely. There’s research showing that Candida colonization can increase mast cell activity in the GI tract, and so that’s going to increases your histamine levels. I do think there’s likely some cross-reactivity. To tease that out, I have people do – distilled vinegar is high in histamine but definitely high in yeast or molds. If someone is reacting to that from the vinegar, I think a bit more that they definitely have a histamine issue as well. Then we have to tease out, do they also have this yeast/mold sensitivity that we need to treat or is it really just a histamine issue. Lemon and citrus also are high in histamine, but don’t have yeast or molds. Those couple of foods are things that I use to tease out if it’s one or the other or both.
PHOEBE: Interesting. Do you have people reintroduce those two things upfront to differentiate?
DR.K: That’s a good question. I actually just have them eat a bunch of the foods they removed first just to see if they have a problem in general with that category, and then we’ll try to tease it out later usually. First, I want to know, while we’re treating them for this potential overgrowth, do we need to avoid this category of foods? Because if they are reacting to them in either of those ways, it’s going to make it harder for their immune system to focus on eliminating the overgrowth while we’re doing that.
PHOEBE: Got it. Are there any other food groups that can cross-react? I know you mentioned gluten before. I’ve heard about soy and corn being no-nos for mold problems?
DR.K: Again, it’s always a [00:26:06]between making the program doable versus removing everything that we think might be causing an issue. I do think some grains are contaminated with mold and mycotoxins, but the more whole the grain is – let’s say you’re eating white rice. That’s going to be much less likely to have mold than if you’re eating a flour product that’s been ground up and has a large surface area and has been sitting on the shelf for a while. If you’re sticking to being actual whole grain, people tend to tolerate white jasmine rice as you probably know, Phoebe, somewhat better than other grains. We’ll often start with that, but things like quinoa, buckwheat, et cetera, if they’re tolerating it in the whole form, I don’t see a major reason to avoid those. We try to tease that out on an individual level.
Corn and soy are common food sensitivities in general. Whenever we’re not sure about one of these foods, I have them do this five-day elimination challenge with that food by itself, so we can tease that out. There are certain forms of corn that don’t have mold. There’s this particular method. I don’t know if I’m going to pronounce it right called the mix [00:27:09]method of preparing corn. In Portland, we’re lucky we have this local three-sister company that makes corn tortillas and corn products with this method. It’s an old method that I believe was done basically to prevent the formation of mold and mold toxins in the corn.
PHOEBE: It’s like the lime that’s added, something like that?
DR.K: There might be other companies that do that as well, but I find that if you’re getting organic corn and you try that. Particularly, if you can find a brand that’s made with this method. Some people do find that even if they can’t do run-of-the-mill corn tacos from the local taco place down the street, then we don’t really know what kind of corn they’re using.
PHOEBE: Amazing. Besides the five-day test to see if any of these foods are a problem for you. Is there anything to be said of using diet as a treatment for SIFO? I feel like there are a lot of Candida diets floating around the web that are super strict that take out basically all carbs. I was surprised to see carrots fell under the no-no list. I’m just curious how actually relevant that is and useful?
DR.K: I like this quote from Sidney Baker, one of the [00:28:24]functional medicine doctors who have written some great books on this. He said something to the effect of, we don’t want to put someone in unhealthy diet in an attempt to help them become healthy. I keep that in mind. It doesn’t make sense to me to remove things like carrots and things like that just on a naturalistic perspective of trying to keep someone in a relatively healthy diet. I’ve never used those extreme diets. One of my mentors, Dr. Lebowitz who’s been doing this since the early ‘80s never found those to be necessary if we can address enough of the other factors. You can’t really starve out yeast. That’s one thing to keep in mind. There’s been studies that show, if you remove all starches, they can start to feed on other food groups.
I don’t find it helpful or enjoyable in any way to change someone’s diet to become that restricted where we’re eliminating complete food groups like starches and things like that. I try to keep it – of course, there’s people who do better on higher protein, higher fat diets, but particularly I’m not going to remove things like carrots or those types of minimally starchy vegetables. We then try to modulate it to the person’s response, but I don’t think it’s enough to put someone on a restrictive diet to treat yeast. It’s not going to get rid of the overgrowth. Keeping them on a healthy diet that’s individualized to them that’s devoid of their main food sensitivities, which we could talk a little bit more about how to sort that through and if lab testing is helpful, keeping it reasonable so that they can still enjoy their diet by keeping out refined sweetening. It’s going to help their immune system respond to whatever treatment program we’re going to put them on to decrease that overgrowth.
PHOEBE: The sugar is the one non-negotiable, starchy things, refined carbs, a little bit more wiggle room.
DR.K: Starchy carbs like carrots and things like that I’m not super worried about. White jasmine rice in reasonable quantities. If the person’s not having symptoms right after eating it or doesn’t notice a problem, I don’t have a problem with people keeping those in their diets because we know it can be helpful for other things like resistant starch and feeding the large intestine and all of that. I know you know about, Phoebe and your audience probably knows about too. We don’t want to overly restrict, but we want to remove the things that are going to potentially supress the immune system in our goal of getting some rebalance in the microbiome.
PHOEBE: Got it. Is there a difference, I guess, between what you would do diet-wise for someone who’s having that immune response versus just SIFO, just the overgrowth? Is the test meant to really identify the immune element?
DR.K: You got it. That five-day yeast challenge, mold elimination that I do with people is to identify if they’re currently reacting to those foods. If they are having this yeast hypersensitivity issue which we talked about may end up being histamine, may end up being more of a yeast sensitivity allergy. Regardless of what it is; we take those foods out while we’re treating them. I don’t say it’s 50/50 for people. Once we treat the overgrowth, that half of them can come back and have no issues. I have half of the people who still are reacting to various forms and vinegar and things. Not because they’re feeding the yeast, but because they have yeast antigens in them. It’s an allergic type of an issue that we can treat with other modalities but we want to identify that. Again, so we can keep those out of the diet until we achieve a level of balance and then we can treat that immune hyperreactivity to the yeast.
PHOEBE: How do you treat that?
DR.K: Good question. There’s some people that have allergies to molds and Candida and yeast that can be tested for and treated by a regular allergist. A referral to a local allergist and you ask them, can you test me for molds? Sometimes you have to ask for the test for Candida. They usually have the antigen and can test you, but sometimes you have to ask specifically for that. There are studies showing that that can be helpful to treat as part of someone’s allergic issue. Those are treated with allergy shots by allergists. Some of them also use sublingual immunotherapy. The other modality is called low-dose allergen immunotherapy or LDI which is more on the integrative alternative medicine world.
Patients can look up Dr. Ty Vincent. His website is global immunotherapy. He’s got a ton of great YouTube videos explaining this modality that he’s developed Those are treated with allergies videos explaining this modality that he developed over the last decade. It stems from a therapy that was developed initially in England about 50, 60 years ago, but he’s modified it to use it in this context specifically treating people with this type of a hypersensitivity issue as it relates to our current discussion. I think that’s a really good resource for people to look up. He treats people worldwide, so anyone can schedule a consult with him.
PHOEBE: Very cool. Back to the mold as an environmental issue thing. How common is it for that to be a factor that triggers the immune intolerance to yeast and mold?
DR.K: Just some general context, probably about 50% of buildings have had water damage. What that means is whether it’s been remediated or not, about half of our buildings have had some issue with water damaging the materials in the home or the office where if they haven’t been dealt with, it could elicit an immune system response in patients who are susceptible. There are studies that show if you have Candida colonization, you can become more prone to develop an environmental mold allergy. I don’t know a specific research showing it the other way around, but I suspect that it’s likely that if you have environmental mold exposure, it just make sense to me that your body is going to have trouble dealing with Candida internally since they’re in that same overall category of organisms. I think it goes both ways. I only have found research showing – it goes the one-way. Let’s say you’re on antibiotics. This is an animal model. You’re on antibiotics. You develop a Candida colonization in the bile.They then challenge the animals with environmental molds and found out that those who had a Candida colonization developed mold allergy much more likely than an animal that didn’t have a Candida colonization.
PHOEBE: Interesting. Is there any relationship between environmental mold and SIBO?
DR.K: I suspect that there is. There’s not research-specifically in this area, but what we do know is that environmental mold has a couple of effects that may increase risk for SIBO. One of them is that it affects the quality of the bile because there’s more toxins involved that affect the quality of the bile and we know that you need intact bile to basically digest your food properly and keep bacterial overgrowth from collecting in the proximal part of the small intestine. We also know that environmental molds can suppress the immune system and of course we need an intact immune system to keep overgrowth down in the GI tract. The third say we know always that environmental mold can affect the nervous system. Because it affects the nervous system, it can affect motility which is better we know is a risk factor for SIBO and SIFO if you have any motility disorder. There’s theoretical risks of it affecting SIBO, but I have not found specific research looking at it and proving it.
PHOEBE: Interesting. Is there anything besides removing the environmental triggers that you can do for someone who is facing that environmental mold issue?
DR.K: Mold is this very frustrating issue because the biggest issue is the way that we construct buildings in the country, and of course none of us have control over that. They go up as quickly as possible to turn a profit and they don’t necessarily keep our health in mind as far as even the new building standards that are for energy efficiency and things like that, it’s for the outdoor environment, but it’s not taken into account how these materials and making homes tighter is affecting our health. There’s a whole group of – they’re called building biologists. It’s a great group where they do look at how we built homes and how that affects humans. How that’s supposed to just – the health of the environment.
The most important thing I can tell people is I can suspecting you have a mold issue or if you’ve had recalcitrant symptoms for a long time, you’re seeing really good providers and you’re getting stuck, this is just one of the issues that comes up over and over and over again. I recommend doing your best to find a trustworthy environmental consultant in your area. I really like this group of Building Biologist. You can Google that and find someone in your area that’s doing that. You can also of course just start calling around to environmental mold consultants and try to find someone who you feel is ethical and has your best interest in mind. There are certain guidelines that they would need to follow and things like that, but the most important thing is to have someone that knows what they’re doing or start on your own. I have some handouts on my website, Phoebe, that I can give you some links to where you can do your own visual inspection of your home.
There’s some very common things that come up over and over again as far as what’s creating a problem in someone’s home. If you own your home, the best thing to do is to get to know it better so that you can mitigate this overtime. In the meantime, while you’re in that process, there is a great website by an ENT doctor. It’s called sinusitiswellness.com. He’s got tons of articles and tons of products that he’s tested that can decrease the mold exposure before you’re able to do any structural changes that may need to be done just to decrease your exposure. That itself can help with your immune system functioning in the meantime while you’re working on those more long-term issues. I hope that made sense overall. It’s a big topic and I think it’s really important to address especially if you’re getting stuck with your health.
PHOEBE: Yes. We’re going to hopefully do a whole episode of just this at some point this season. Back to just the other things that you can do. Would you recommend doing a low mold/yeast-free histamine-friendly diet in addition just to help your body cope if you know that this is an issue?
DR.K: No. I think it is pretty much 50/50 of my patients who notice a beneficial response versus those who don’t. I think it’s good to do an individualized trial on yourself. I know the histamine diets that have been published are quite variable. Again, we’re aiming for this balance of not driving our patients crazy or driving themselves crazy, but also covering enough variables so that we’re hopefully going to achieve the results we want. I definitely think it’s worthwhile to familiarize yourself with some of the histamine list. I listed some of those on my website too. The most reputable ones I could find just so you know. For instance, I’ve had patients where they were like, oh, I’ve been drinking lemon water every day. That was on that list you sent me and since I stopped doing that, my heartburn went away just from that one intervention because you think of lemon water as something healthy otherwise, but it is high in histamine.
I think it’s good to familiarize yourself with those lists. Do a trial and see if I removed those higher histamine foods for my diet for a couple of weeks. Do I feel any better? Then see if you can play around and figure out the ones that are really the big ones for you because it’s unlikely to be all of it. There’s probably a couple that are really triggering symptoms for you. For the most part, what we found is that once we’re able to correct enough of these things we’re talking about, that histamine sensitivity goes down greatly or resolves just depending on the person’s genetics whether we can get rid of it completely or we almost always can get it to go down significantly once we address the other factors.
PHOEBE: Yeah, I was going to ask how long most people stay on that type of diet and whether or not you recommend a low FODMAP approach in addition while you’re hedging your bets with the broad-spectrum herbs?
DR.K: Yeah. That’s a good question. With the histamine diets, what I’ve noticed is that most of my patients will figure that on their own when they can start cheating on that. It usually has to do with they just are starting to feel better in general. Maybe we’ve addressed an environmental issue. Maybe they’ve been working on their sympathetic nervous system response by working on some meditation program, yoga, et cetera to down regulate the fight or flight response which also stimulates histamine. We’ve addressed enough things where they’re generally feeling better then we start to add things back. Ultimately, my goal with all of our patients is not to have them to rely on any – outside of basic nutrients and nutrition, ideally, I don’t want them to have to rely on tons of supplements long-term. [00:40:50]. I don’t want them to have to rely on an overly restrictive diet but we do use it as a tool in the midst of trying to treat these other factors for some symptom relief.
That’s how I approach the histamine issue. As far as low FODMAP, again, if someone feels like that’s the only way that we’ve been working on other things, and that’s the only way that they can keep their symptoms at bay temporarily, I think it’s okay. I’m not a huge fan of course of using it for very long because we know that over time it’s going to starve our large intestine microbiome. I don’t often recommend low FODMAP diets. Part of that might be because the patients I’ve seen usually have tried that on their own first and they either didn’t do anything or was so restrictive that they couldn’t maintain their nutrition for other reasons. I’m not opposed to it as a mitigating factor again, but I don’t find that I need to use that as often as I do the yeast histamine-related variation in their diet.
The other thing I’d like to point out is that there was a study comparing a low FODMAP diet to yoga as far as mitigation of IBS symptoms. I believe that there were similar responses to both. That’s an intervention again working on the nervous system, where we don’t have to keep going after dietary restriction over and over. I’m particularly empathetic to patients because I have been on all of those diets myself before I figure out enough things. I remember how difficult it is to maintain a social life or even enjoy your food when we restrict things too much. I’m always doing my best to figure out how can we maintain the balance without overdoing it?
PHOEBE: Yeah. What did the yoga do?
DR.K: The yoga relieved IBS symptoms to the same extent as the FODMAP diet.
PHOEBE: That’s amazing.
DR.K: Yes, though I’m not [00:42:32]by that study.
PHOEBE: Totally. One last random question before I let you go. You mentioned of course that the SIBO testing is an easier avenue. I know a lot of people are now talking about the blood ttest to check for a post infectious IBS. Do you find that’s at all useful in your practice in general? Then also for maybe identifying one of the potential root causes for CFO?
DR.K: Yeah. I think it’s a good time. It’s only for diarrhea predominant IBS. That’ eliminates half of the patients we would see as far as the utility of it, but for those patients that have diarrhea predominant IBS, it’s helpful in that it identifies this autoimmune reaction that might have developed as part of the ongoing trigger for their past symptoms. It can give us that idea of the potential need for motility agents more long-term for someone. I do think it’s a useful test to use for someone who’s got recurrent SIBO or SIFO if it’s diarrhea predominant just to get that added information that this is someone where we might need to use motility agents more long-term because we’ve identified that as part of their ongoing propagation of symptoms.
PHOEBE: Even though the nerve cells regenerate after this acute autoimmunity happening after a pathogen gets it there even though they are known to repair I find that people need long-term health if that’s one of the root causes.
DR.K: Not necessarily. This would be more for someone who we’re getting stuck, but they’re just having resistant symptoms that are ongoing and we’re looking for one more piece of the puzzle. I don’t think that someone is going to need it definitely just because they have that because like you said, Phoebe, that problem could potentially take care of itself over time, but if we’re looking for another piece of the puzzle, like why can’t this patient get off of motility agents for the past year or two. We can’t really find any other triggers for their symptoms. It’s just another piece of the puzzle. I don’t do a ton of extra lab testing. That’s a test I ordered if someone asks for it or I bring it up and they really – some people just really like to have as much laboratory data as they can. I don’t find many labs that are predictive of someone’s outcomes that are more important than what we figure out clinically. If we would completely – I don’t think someone’s going to need motility agents indefinitely just because they have that. It’s an interesting piece of the puzzle. We want to try to identify what started triggering this in the first place. Maybe they need more of that help with that motility component.
PHOEBE: Very interesting. We are reaching the end of our interview. Is there anything that I didn’t cover with regards to diet or just the way that yeast or mold interacts with the body that you want to tell our listeners who are struggling with these issues plus SIBO or both.
DR.K: I want to say Phoebe, I think you covered most of the main areas. I would just say in general that I feel like we have more information about how to treat chronic, complex, digestive orders and systemic disorders than we have. In my career thus far, that’s really encouraging that even though we don’t have lab test per se for some of these issues, I feel like the information we’ve gathered and the spreading of the information amongst – even if it’s starting mostly with naturopathic and functional medicine doctors, we just know a lot more about how to address these things than we used to even five years ago.
I would just say to stay encouraged. It can be your frustrating journey to go through some of this and always trying to figure out what can I eat, what can I not eat? What [00:46:10]do I have now? It can go on and on. Just trying to stay positive about it and continue to seek care from someone you trust and you can find in your community because we’re having so much more information these days that eventually you’ll get to an answer. It’s just how many things do I have [00:46:26]? That’s just what I’d want to leave you with, but I think you covered most of the main things as far as what I’d want to share with your audience.
PHOEBE: Amazing. This has been so informative. I’ll make sure to link to all of the resources on your site, and thank you for creating them and sharing them with our listeners. I really appreciate your time today.
DR.K: Thanks Phoebe. It was nice chatting with you and we’ll be in touch.
Disclaimer: The information in this podcast does not provide medical advice, professional diagnosis, opinion, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.