March 22, 2018 by Amy Hollenkamp
When I first began my healing journey, I suspected that I had candida. I took a deep dive into the candida diet world and came out with an “all carbohydrates are the enemy” mentality. But when I went to my first functional medicine practitioner, he told me my symptoms were much more likely a result of bacteria and not yeast.
After my SIBO diagnosis, I put candida on the back burner. Because if I had SIBO, I couldn’t possibly have candida, right?? Life had already served me a big shit sandwich with SIBO….I couldn’t even fathom having both!
But, as it turns out, when it rains it really can pour! A little later on in my SIBO journey, I did confirm that I had a systemic yeast problem after my first round of antibiotic with SIBO.
Contrary to what I wanted to believe (that having SIBO and candida was just too much for one person to deal with), Candida and SIBO often go hand and hand.
SIBO and candida together….What are the odds?
There is not tons of studies looking at SIFO (small intestine fungal overgrowth). But, there is one study that can shed some light on the prevalence of the dreaded SIBO-candida combination.
This study examined the prevalence of bacterial and fungal overgrowths in patients with unexplained GI symptoms. They conducted an endoscopy on each patient where they collected a distal duodenal aspirate and culture to diagnose the overgrowths (which is the gold standard).
Of the 124 study participants, 77 (62%) had a fungal and/or bacterial overgrowth. Of the 77 with overgrowths, 34% had both SIBO and SIFO, 40% had SIBO alone and 26% had SIFO alone.
The researchers concluded that the “findings reveal that SIFO, either alone or together with SIBO, may be one more important and unrecognized piece of the puzzle that could explain chronic refractory gastrointestinal symptoms.”
The researchers are right! SIFO is often a missing “piece of the puzzle” in the SIBO world.
There are 4 big take aways from this study:
1. 43% of patients who tested positive for SIBO had SIFO too! Ruling out SIFO with proper testing is important in developing the most effective treatment plan.
2. If you have SIBO and candida, antibiotics treatment for SIBO could exacerbate yeast issues. I’ve experienced this first hand with thrush and a weird fungal nail infection following antibiotic treatment for SIBO. #yeastprobs
3. Bloating and other SIBO-esque symptoms may be a result of SIFO rather than SIBO. I know many with severe bloated bellies and other SIBO symptoms who are treating solely based on symptoms. Without proper testing you may think you have SIBO, when you really have SIFO. And the real kicker is that the antibiotic treatment for SIBO will exacerbate yeast overgrowth.
4. This study only looked at fungus in the small intestine and did not test for fungus in the large intestine or elsewhere in the body. Since most people with SIBO have large intestine bacterial imbalances, I think the odds of candida issues in the large intestines increases.
Symptoms of candida overgrowth
Here is where things get confusing! In the SIBO world, there is a tendency to mistakenly blame every symptom under the sun on SIBO. The blame game is even worse in the online Candida forums!
Candida symptoms are often non-descriptive and not exclusive to candida, so they should not be used as the sole diagnostic tool. Chronic fatigue, brain fog, depression and digestive symptoms could all be signs of a yeast overgrowth as well many other conditions like Hashimotos, parasites, heavy metal toxicity, HPA axis dysfunction, SIBO and large intestinal dysbiosis (just to name a few).
Candida symptoms should be viewed as clues, not as diagnostic criteria.
I think that there are a couple clear signs and symptoms that are a little more specific to candida these include:
- Vaginal Yeast Infections
- Fungal nail and skin infections
- Thrush on tongue
Other more non-specific symptoms include:
- Chronic fatigue
- Brain fog and difficulty concentration (especially after eating meals high in carbohydrates)
- Cravings and hunger for sugar and carbohydrates
- Mood swings and irritability
- Rashes and other skin issues
- Bloating, diarrhea, constipation and GI pain
I do think that there is an over diagnosis of candida, because many people use these non-specific symptoms to self-diagnose. For instance, I see many individuals solely use their cravings for carbs and brain fog to self-diagnose a candida overgrowth. But, craving carbs and brain fog are also key symptoms of blood sugar instability, which could be a result of hormonal disturbances and not candida.
That’s why testing is necessary to the proper diagnosis of fungal issues.
Testing for candida overgrowth
If you think you have candida, it is important to test and not guess! Like SIBO, signs and symptoms are almost always not definitive enough to accurately diagnose candida. Testing is vital to select the right treatment!
With candida testing, it is best to do multiple testing methods for two main reasons. First, certain tests are more sensitive than others. Second, depending on the location of the overgrowth, some tests may produce a false negative. For instance, there were two instances where I tested negative for yeast in my stool test and positive for yeast bi-products in my urine organic acids test.
Stool testing is the most popular testing method for candida among functional practitioners. Stool testing looks for candida specifically in the intestines (primarily in the colon). I believe that my stool tests were negative for candida, because my overgrowth was not in the colon, but rather in my small intestine or nasal cavity. Of the stool tests available, I prefer the GI Map stool test, because I have heard from a number of trusted practitioners that it is more sensitive to picking up on candida compared to other stool testing.
Urine organic acids testing is also another tool to diagnose yeast overgrowth. This testing measures the yeast metabolites in the stool. If you have high metabolite levels in your urine, then you probably have a yeast overgrowth somewhere in your body. One of the draw backs of this test is that you can’t determine the location of the yeast based off this test. But, it can fill in the gaps of the stool test and let you know how yeasty your whole body is not just your colon.
Blood testing for candida antibodies can also indicate an overgrowth of yeast. High levels in anti-bodies indicate that the body is fighting candida. But, as Dr. Amy Myers points out in this article, low antibodies don’t necessarily mean that you don’t have candida. If your immune system is compromised, then you may not be able to produce antibodies to kill candida.
I would not rely on the blood testing to diagnose, but if you get a positive stool or urine test than the blood test can provide additional insight into how well your immune system is attacking the overgrowth. A complete blood cell count can also clue you into how the immune system is functioning. Dr. Myers points out that many candida patients often have low white blood cell counts due to candida’s ability to weaken the immune system.
Tips for treating the candida/SIBO combo
1. Make the candida easier to kill!
Probably the biggest mistake that people make when they treat candida is not recognizing candida’s ability to evade anti-fungal attack. There are two main ways that candida escapes antifungal treatment.
First, candida can morph from its yeast from into its hyphal form rendering it pathogenic. The hyphal form allows the candida to burrow deep into tissues causing inflammation, tissue damage and disease. In the hyphal form, candida can start infecting many organs making it much more difficult for the immune system to contain.
Second, the hyphal morphology plays a pivotal role in the production of mature biofilms that protect the yeast from antifungal onslaught. Biofilm is this collection of micro-organisms that are encapsulated in a protective polysaccharide matrix that the organisms produce making them much harder to kill. Biofilms act as a shield for microorganisms.
To efficiently attack candida, you must break down biofilms and revert the candida from its hyphal form back into its yeast form. There are a number of compounds that can do just this!
Monolaurin is a combination of glycerol and lauric acid that also reduces candida biofilms and also enhances the immune response to candida. I have had a lot of success using Lauricidin as an antifungal agent.
Gymnemic acids extracted from the plant Gymnema sylvestre have been shown to revert the hyphal candida back into its yeast form. I used gymnema sylvestre supplements in the past and it helped with both blood sugar control and my candida. I don’t really have a preferred brand, but it should be easy to find on amazon or at a health food store.
Enzymes can also play a powerful rule in busting through the polysaccharide matrix that protects the bacteria in the biofilm. Interphase Plus or Kirkman Biofilm defense are both good products. Be careful with Interphase Plus if you are dealing with heavy metal issues since it has EDTA, which can start chelating the heavy metals. There is also just a plain Interphase supplement that doesn’t have the EDTA, which may be best for individuals suffering from heavy metal toxicity.
2. Picking a good antimicrobial that may help both candida and SIBO
When it comes to treating both SIBO and candida, choosing the right antimicrobial can kill two birds with one stone. I really like GI Microbe-X from Designs for Health.
Caprylic acid is another strong antimicrobial that could be used to treat fungus. You could pair this with Rifaximin and prescription antibiotics too.
I wouldn’t stay on any antimicrobial long term (more than a month) without the supervision of a healthcare practitioner since long term use could lead to wiping out too many gut bacteria. We need bacteria and even yeast in our GI tract to stay healthy. Also, try to steer clear from the kill mentality that it is easy to fall into.
For the most effective treatment, I would combine antimicrobial treatment with one or more of the biofilm busters and hyphal inhibitors we discussed above.
3. Probiotics can help restore balance in both the small and large intestines
For both SIBO and candida, a healthy and diverse microbiome is vital to a successful recovery. The right probiotic can both fight the overgrowth head on and create an environment for the good bacteria to flourish.
I have talked about MegaSpore Biotic in detail before, so I don’t want to beat a dead horse, but it is the best probiotic I have tried. MegaSpore Biotic was a powerful tool in my personal recovery and I definitely think it can help combat fungal/bacterial overgrowths and re-balance the large intestines.
4. Prebiotics to increase the growth of good bacteria and repair large intestine imbalances
Prebiotics are a controversial topic in the SIBO world, but I believe they can be helpful for both SIBO and candida issues. Prebiotics are probably even more powerful than probiotics at promoting growth of good bacteria. Good bacteria can fight and crowd out yeast in the GI tract.
As I described in my prebiotic post, prebiotics promote the growth of Bifidobacteria that are essential for the smooth operation of our MMC. When the MMC is running efficiently, food will not be left sitting in the small intestine for yeast or bacteria to digest.
If you plan on adding in more prebiotics, it is important to start low and slow. Increasing too quickly can cause a flair up of symptoms. There are two ways you can go about increasing the prebiotics in your diet.
First, you can increase the amount of prebiotics you are eating in your diet! Eating a wide variety of plant foods will ensure that you are getting both the right amount and variety of fiber to facilitate a healthy and diverse bacterial population in your colon. Foods high in polyphenols like berries, chocolate and tea also a have a prebiotic effect on your gut.
While it is important to have some prebiotics in your diet, it is also important that you try to avoid foods that you don’t tolerate well. Don’t force the prebiotics if your gut is not ready.
Second, you can take a prebiotic supplement. Again, starting low and slow is important here! I really like powders with GOS (such as Bimuno and Galactomune).
5. Don’t restrict carbs too much.
Most candida protocols preach that the best way to eliminate it is to have virtually zero carbs in your diet. This strategy will most likely be ineffective. Extremely low carb diets can cause stress hormones to rise and thyroid hormones to plummet.
With your stress hormones high, your immune response won’t be primed to combat the candida effectively. In addition, cortisol will prevent proper blood flow, nutrients and enzyme production in the GI tract leading to poor digestion and gut function.
In addition, your thyroid hormones are crucial GI motility. Hypothyroidism will cause delayed motility leaving you susceptible for both bacterial and fungal overgrowths in your small intestines.
When it comes to carbs, you may want to limit them a tad when you have candida, but I wouldn’t go too far. Each person is going to require a different amount of carbs based on activity level, health status and hormonal status
6. You may need some detox support at the beginning to deal with excess toxin release
When you start your kill protocol, the yeast will bust apart releasing mycotoxins and acetaldehyde in large amounts in your body! This toxin release can make you feel worse before you feel better. A similar reaction can happen with SIBO and it is often refereed to as a “die off” effect.
Activated charcoal and certain clays can bind to toxins so they can be efficiently excreted from the body. If you can’t excrete the toxins effectively, fungal cell walls can be reabsorbed into the colon and recirculate in the body preventing you from getting rid of them. I really like the supplement GI Detox.
Molybdenum can also help with the die-off reactions to candida. It converts the harmful neurotoxin, acetaldehyde, into acetic acid, which is easily excreted from the body.
7. Work with a knowledgeable practitioner
When you have both SIBO and candida, it is wise to find a practitioner that knows what their doing and can be devoted to your own personal case. Trying to tackle the candida and SIBO combination by yourself is ill advised!
SIBO often comes with a side of candida. Treating both requires a little more finesse, but can be done!