My Small Intestine Fungal Overgrowth Protocol

Okay, so a number of you have reached out to ask me whether I’m going to talk about my next steps for SIFO treatment, which I wasn’t originally going to do as I have an expert in mind to invite onto the show, but as a number of you asked, I hope that sharing my story will be somewhat helpful for you!  So, unlike with SIBO where I had quite a long-term plan in mind, this I am more so feeling out my journey because as I discussed in my previous update, I’m not 100% sure if the issue is gut dysbiosis or SIFO. So, to recap, let’s start with what SIFO is. SIFO stands for small intestine fungal overgrowth and it’s when fungus like yeast (or other fungi) grow in the small intestine. We do have some normal, non-harmful levels of fungus and yeast in the large intestine, but they become a problem either when they overgrow or when they’re found I the small intestine.  Unfortunately, the symptoms of SIFO are exactly the same as SIBO, so it can be very tricky to identify between the two. What makes it harder is that testing for SIFO is unreliable. Often the fungus hides in biofilms, which are protective mucosal-like layers, so they don’t show up on tests and even if they do, there’s no way, without a very invasive biopsy, to tell whether the fungus is in the large intestine or small intestine. What we do know is that the organic acids test tends to be the most reliable test, at least according to the practitioners I’ve trained with. We also know the candida tends to be the culprit behind SIFO in many cases, and just to be clear, that’s the type of yeast which causes thrush, and we also know that about xxx of SIBO cases.  Now there are some extra tell-tale signs of candida specifically, if that’s the fungus behind the problem, and those are…  ·       Allergies ·       Yeast overgrowth (vaginal, oral or on the skin) ·       Nasal congestion and excess mucus or phlegm  ·       Rashes ·       Joint pain ·       Brain fog and chronic fatigue ·       Headaches The difficulty is that unless you have the obvious thrush, whether oral, vaginal or on your skin, this symptoms are also typical of histamine intolerance, which you know if you listen to my podcast, is very common with our community and is also very common with SIBO, and hydrogen sulphide SIBO specifically.  As I had suspected hydrogen sulphide and for sure, have histamine intolerance, any possible SIFO really wasn’t obvious. Until more recently. As you may know, about two months ago, I cleared my SIBO! But unfortunately, I still had the majority of the SIBO symptoms. I also had an unusual test result, which showed no hydrogen gas in my large intestine, which is where it should be. In a healthy negative result, you should see little hydrogen gas in the small intestine and then a rise in the large intestine, but I had a flat line. So, this indicates two possible issues – either hydrogen sulphide or a bacterial imbalance in my large intestine, essentially, the bacteria in my gut having been wiped out. Because I’d done so many treatment rounds and most of them would target all three types of SIBO, I felt it unlikely it was still hydrogen sulphide remaining, and my colleagues agreed. Secondly, I had done a round of antibiotics, and I react quite badly to them, having lots of diarrhoea, fatigue, and headaches, and after I finished the course, I got shingles, which you only get when you’re very immune compromised. And 70% of the immune system is in and around the gut. If your healthy microbiome in the large intestine is wiped out, you can bet your immune system will be too. So, for sure, I was certain that there was some gut dysbiosis happening. But I didn’t believe it was enough to cause all my symptoms.  And a few clues made me suspect SIFO.  Firstly, I was doing pretty well with symptom reduction until the third week of the elemental diet, which is full of simple sugars. Suddenly, I began to bloat up again. I also had a strong white film throughout the entire elemental diet, which indicated the sugars were feeding bacteria or yeast in my mouth, and secondly, I started having thrush symptoms during the elemental diet. Then, from the elemental diet, I went onto the antibiotics, and I got thrush symptoms again! Now Dr Siebecker warns that the elemental diet may cause yeast or fungal overgrowth in people who already have it, in contrast, Dr Ruscio uses the elemental diet for candida overgrowth, because he says the simple sugars are absorbed too quickly for the yeast to eat it. I think it’s probably the case that both doctors are right, but that it depends on the individual and that they see different types of patients. Either way, it seemed quite clear to me that I had some yeast overgrowth as a result.  I went to my doctor at Vala, and they agreed that it looked like candida overgrowth in my mouth.  Additionally, I’ve always had a white film on my tongue, honestly ever since I could remember. I used to ask dentists about it, but they would shrug it off, and tell me it was down to what I had eaten, but I was waking up with it before I had eaten a thing. Back then I just took what they said as gospel. Then a few years ago, my boyfriend and I went through a real sweet tooth phase, long before I had gotten on top of my endo and eating an anti-inflammatory diet, and we were eating a lot of sugar. At that point, I got full on oral thrush, which thankfully was cleared with 24 hours of taking the medication – or so I thought! I’ve only ever had vaginal thrush a handful times, so again, initially, I really didn’t think candida was an issue for me! However, the fact that I then started getting the symptoms from two things which we know may cause yeast overgrowth – the elemental diet and antibiotics – made me think that maybe I have had SIFO all along, but the white film never got out of control, and it wasn’t really affecting my vagina too much. Now having said this, according to Dr Jacobi, candida can also cause a burning bladder pain, and for sure, that’s what my pain feels like inside my bladder. Like I have a fire going on in there, and there’s also a few rusty knitting needles sticking through it too!  So, alongside my colleagues who I trained with in SIBO and my doctor, I concluded I do likely have SIFO and gut dysbiosis.  The problem is, if you have SIFO, its usually quite hard to clear SIBO or to stay in remission, and even though I still had all the symptoms of SIBO, I felt like I relapsed about 2 weeks into my all clear. The changes were subtle, but they were there. I was still having bloating and loose stools, that hadn’t changed. But what had improved is I could no longer feel fermentation happening in my gut, like active bubbles forming and moving around in my gut, which I used to get all the time – and that returned. The second issue was that my stools changed, and I won’t go into the detail, but it was reminiscent of when my SIBO used to be really bad. Then I started getting the burping back, which was a new symptom originally, that started I think in 2019, but it went during treatment, and came back around the same time as these other symptoms. So, this occurred whilst I was in my prevention of relapse phase. So, when you clear your SIBO, you move into a three-to-six-month period where you put in place meal spacing, prokinetics (which are supplements or drugs which stimulate your migrating motor complex in the small intestine overnight, to clear out bacteria) and some kind of SIBO diet. There are also some additional extras you can do, which I was doing. I was pretty much doing everything perfectly, but I relapsed.  So, I was two weeks in, whilst deciding what treatment to start for SIFO. And at that point, sometime after my relapse, is when we decided to go to Greece.  Now originally, you’ll know my plan was to do a very specific reintroduction of foods, following the usual elimination diet reintroduction phase, where you try one new food basically a week. But now I had relapsed, and I was at a point where I never didn’t have symptoms. I bloated after every meal, despite being on the SIBO bi-phasic, so I couldn’t get any more restrictive. So, trying to tell what I was specifically going to react to was going to be incredibly difficult and frustrating.  Also, we have been wanting to travel for years, but in addition to COVID, we hadn’t because of my SIBO. I didn’t want to be in a position where I had to eat outside of a SIBO diet and ended up relapsing. But now I had relapsed. And part of what may cause relapse is chronic stress and an elevated nervous system. I won’t go into it now, but many of you know that I have felt very, very stressed and unsafe in our current home in Margate, but we’ve had continual circumstances that have prevented us from moving – one of them being that we didn’t want to just move to a new flat, we really wanted to move overseas and roam around for a while. Additionally, we had mould, which we’ve cleared as much as we can, but there’s likely a lot of hidden mould as the entire flat was flooded not long after we first moved in, and it was after that that I got very sick with histamine intolerance, which can flare up from mould triggering the immune system. But this is a stressor on the body and nervous system, and additionally, can cause relapse if your immune system is being compromised by something like mould. On top of that, I’d worked really hard, for really, really long and it had been a tough few years. So, we made quite an overnight decision to go to Greece for six week. You know, our original vision was to pack up, leave the flat entirely and just travel Europe for six months, because that’s all we’re allowed to do thanks to Brexit, but because of the restrictions with COVID, etc. it was just all so limited and so fingers crossed, we can do that this year. But we both decided enough was enough and we wanted a break from the house and a change of scenery, of course it was something we just wanted to do in life, but in a large part for me, my health was my motivation and my therapist even called it an intervention, and that’s for sure what it felt like. So, I made the decision to go to Greece, knowing full well I wouldn’t have total control about the reintroduction of food, but by this point I was pretty certain I had relapsed and giving that I still had the SIFO road ahead of me, a break away seemed not just like it wouldn’t do much more damage, but that it would be good for me. So, my plan for SIBO and SIFO basically revolved around Greece because I would have to take all my treatment with me. And I established three goals, I mean I didn’t, I’m not that organised, but that’s this is what I focused on – ·       Keeping SIBO at bay and continuing the prevention of relapse to the best of my ability so it didn’t progress rapidly. ·       Beginning to take on SIFO, but gently, to avoid any die off reactions whilst away. ·       And to rebuild my microbiome and improve my gut lining, which I was already working on anyway. So as a result, here’s what my current protocol looks like:   Diet Before we went away, I began expanding with one to three new foods a week. Just some of the key ones that I thought I should try before we went, that I would likely rely on in restaurants, like lentils and some nuts. Then, as we planned for Greece, my aim was to eat as expanded as possible, so basically the more lenient end of a SIBO diet, which looks more like the expanded version of the low FODMAP diet and the paleo diet. This is fine by the way; you won’t relapse if you expand. The point of the prevention of relapse phase is to expand to tolerance as rapidly as possible. Of course, I had no bloody idea what I was and wasn’t tolerating, so I just decided to follow the low FODMAP serving guidance to help me to stay within some kind of relatively low carb (that’s the basis of a SIBO diet) protocol. So, before we went, I basically started transitioning from the bi-phasic, which is very, very restrictive, to low FODMAP. Because we are here for six weeks, I had the advantage of not eating out all the time. So, I my plan was, and what I have implemented whilst here, was to eat low FODMAP during the week at home, and then at the weekend, to eat as low FODMAP or paleo friendly as I could manage whilst out and about, but also allowing for treats and just basically enjoying and appreciating a different cuisine. Now my doctor, who is a functional medicine doctor, sent me a candida diet. There are a few different versions, but essentially, it’s a low carb diet to a degree, that removes yeasts and sugars. I had a look through it and because in terms of servings, it’s generally less restrictive than the low FODMAP, I was essentially doing it, other than when I have some bread or ice cream over the weekend. But I didn’t really want to go down a rabbit hole with that, especially as I’m not sure how suitable the candida diet is for SIBO and equally, some practitioners debate whether the candida diet is even necessary. So that’s going to be a bridge that I cross when I get home. But for the most part, I am naturally doing it anyway. So, we’ve been here for about two weeks now and I’ve settled into a routine of this kind of pattern. The first weekend we were in Athens for 48 hours and were travelling and didn’t really have time to seek out gluten free and dairy free, etc. We did stumble across a few places, thankfully, so that was great. But I ended up eating quite a bit of gluten, and by the third day I felt really nauseas and started getting an upset stomach. I also had dairy too, once, or twice, because it turns out that in Greece, it’s really hard to eat vegan and gluten free in general restaurants. The protein options are mainly meat, fish or dairy and often the fish was things that I just wouldn’t be able to stomach, like octopus, and as you know, I was hoping to transition back off of meat after having to eat on the bi-phasic, so I had some cheese every now and then, as being a health coach, blood sugar is important to me and so you do need protein with every meal. Also, my blood sugar is very suspectable to lows, so just having a plate of carbs would really mess me up and ruin the rest of the day, so I had to make choices about having enough fat and protein and that sometimes looked like a little dairy. Now I know I’m intolerant to dairy, which actually might be due to having SIBO, because it causes temporary lactose intolerance until you clear it, so I wasn’t eating huge amounts and I tried to choose cheeses that I know I tolerate better, and I avoided cow’s dairy and milk for the most part – except for a scoop of ice cream here or there, but in Athens I could get vegan.  So, because I was nervous about eating foods out, that I hadn’t eaten for a long time, I took with me betaine HCL, which is stomach acid support; digestive enzymes; FODMATE, which is digestive enzymes specifically for FODMAP foods and charcoal capsules, which absorb gas if you have bloating and can also be helpful with diarrhea, and all of these have been really handy when out. I’ve still not had the happiest bowel movements, but I wasn’t having sudden severe reactions whilst out and needing to dash to the loo, which is what I used to get and what I was scared of. So that’s the diet side of things.   SIFO For SIFO, I didn’t want to go in too hard core now and then have lots of die off reactions whilst away, which would leave me feeling really unwell. So instead, I started subtle. I have a one-week course of an anti-fungal from my doctor, but I am also taking a high dose of saccharomyces boulardii, which is a healthy yeast probiotic that competes with candida for space in the gut and has been shown to be very effective. I am also taking another probiotic called lactobacillus acidophilus NCFM, which creates candida antibodies to kill it off.  I am also taking immunoglobulins, which are naturally a part of our immune system and line our gut, but I am very low on these. They bind to toxins and help expel them, and when they’re low, we’re more suspectable to infections, parasites, yeast, etc. So, I am taking them to help with both the SIBO and SIFO. Additionally, I am taking glutathione, which is an antioxidant that’s absolutely essential to liver function, and so this is supporting my liver to clear out all the toxins as the candida, fungus, etc. clears, helping me by lessening the die off.    SIBO For SIBO, I am keeping it at bay with the strongest prokinetic, called prucalopride. This is a pharmaceutical drug, but unfortunately, the natural prokinetics aren’t normally strong enough and this was certainly the case for me. I tried them all, and they just didn’t do the job. Whilst doing that, I am of course doing the diet 80% of the time, and then meal spacing as much as possible. So that’s 4 hours between meals and 12 hours overnight. Sometimes I can’t manage the 4 hours between meals because I’m hungry or I need to support my blood sugar, but at a minimum we’re required to do 12 hours over night. I think maybe three days I ended up doing less than that because of travelling, maybe 10 hours or something. And alongside that I am taking low dose allicin, which is an extract from garlic, and I use multiple times in my SIBO treatment with success, and allicin also kills off fungus. It’s reportedly not strong enough alone to kill fungus and yeast, but it can help and in combination with the probiotics, I think it’s a nice combo to keep the SIFO at bay at least, if not begin killing it off.  So, I am taking the allicin at a low dose to keep the SIBO at bay, and this is a common approach. Dr Siebecker doesn’t use it, but some other doctors do use it between treatment rounds instead of a prokinetic, and it does work. So, it may not be enough to kill the SIBO, in fact I know it’s not, but it just sort of keeps it from growing like crazy.  Then of course, the immunoglobulins help too.   Microbiome and gut lining repair So, I am taking high dose fish oil, about 2000mg, which helps to repair the gut lining.  I am taking 2000mg of quercetin, which again helps to repair the gut lining, and also lowers inflammation in the body and gut and is a natural antihistamine. I was taking l-glutamine before I left, which is the best leaky gut healer, but the tub was huge and was open, and is a white powder, so I thought I might get arrested for that one! Additionally, the saccharomyces boulardii also helps to repair the gut lining, and the lactobacillus acidophilus also contains two other strains which have been shown to repopulate the gut and increase levels of beneficial bacteria. Now normally, I wouldn’t take so many probiotics with SIBO, because taking too many can cause a flare up and even cause it to grow, but it’s about testing your tolerance. If you take a probiotic and you’re bloating or SIBO symptoms get worse, it’s probably not the best one for you because it’s feeding your SIBO. In contrast, certain single strains are better tolerated. I like to build people up to a few strains, and I was already on two, so with this combo I’m on four, and I tested them out before I left to make sure I wasn’t reacting. But essentially, I couldn’t find a single strain of lactobacillus acidophilus for the life of me, so this was the best I could find!  And the immunoglobulins help to rebuild the gut lining and support the microbiome too.  Additionally, in general, I have been supporting my gut by using the app. Nerva, which improves the gut-brain connection and using Arvigo massage at night to stimulate the migrating motor complex overnight. Both of these also help to lower stress, which damages the gut lining and microbiome, so addressing a stressed nervous system and an anxious gut is really important too – and I see Greece as part of that. I have to say, I haven’t been able to be consistent with the massage and the Nerva with all the travelling, but we’re a week into our new temporary home now and we’re here for another three weeks, so I can get back into my routine.  So that’s my current protocol. When I return to the UK, I am going to move into a high dose of oregano and another yeast antimicrobial, likely Candibactin AR, but continue with the probiotics, and I’ll of course retest for SIBO. If I am positive, I may do the elemental diet again, whilst taking anti-fungals, as that should kill it at the same time. I may then need to continue with the candida treatment for several months, as it can take some time to clear. But I think that will be judged on whether I am seeing any improvements, because if it’s not candida, then I don’t want to waste time treating the wrong issue. I’m hoping to do an organic acids test too, to see if any candida shows up. What I’ll do is take an anti-biofilm for two weeks ahead of the test, and that will hopefully break up the biofilm so it can be detected. It doesn’t always work, but we’ll see. But there are plenty of natural anti-fungals to rotate through and I have all the doses from my course with Dr Jacobi, so I’ll let you know which ones I’m doing as I go through the treatments. If it’s not candida, I may be still having symptoms because of possible Ehlers-Danlos syndrome, which I am being assessed for when I return, and I’ve been talking about that over on Instagram if you want to learn more about its connection to endo and SIBO. And it could also be that I am just rapidly relapsing and severely reacting because of an upregulated nervous system, in which case, there are two great courses for rewiring your brain if your body is very reactive, one is called DNRS and the other is the Gupta Programme, so I may consider those too. I see a lot of this with my clients, an upregulated nervous system from years of pain, inflammation, etc. It’s really too early to say which route I’m going to go down until I see what my SIBO results say, and I see how I respond to the candida treatment that I try when I get back. So that’s it. I hope that sharing my journey has given you some insight into your own, has maybe offered you some hope or some motivation to keep going. I know clearing these guys is tough, and I’m with you on that, but feeling well is possible.  Let's get social! Come say hello on Instagram or sign up to my newsletter. Sign up to my free Endo Belly Challenge here. To become a The Endo Belly Course Founding Member, email me at [email protected] with ‘Yes’ in the subject line. Sign up to the wait list for my course, Live and Thrive with Endo here. My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here. If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website. This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk   Show Notes Nerva DNRS Gupta Programme Arvigo massage practitioner