SIBO and Candida

Question 1

SIBO

Answer 1

An overgrowth of non-pathogenic bacteria in the small intestine. It is the most common cause of IBS (60-70%).

Question 2

SIBO: Hallmark symptoms

Answer 2

Bloating
Abdominal pain or discomfort
Constipation and / or diarrhoea
Flatulence.

Question 3

SIBO: Other symptoms

Answer 3

Nausea, GORD, excessive burping, prolonged feeling of fullness, malabsorption (e.g., anaemia symptoms), insomnia and brain fog.

Question 4

SIBO: Constipation or Diarrhoea

Answer 4

Hydrogen dominant gas production tends to cause diarrhoea;
Methane dominant gas production can cause severe constipation.

Question 5

Key clinical indicators of SIBO

Answer 5

• Worsening of GI symptoms from probiotics.
• Fibre worsens GI symptoms.
• Chronic GI symptoms following long term broad spectrum antibiotics / PPIs / opiates.
• Chronic low ferritin / iron with no other cause.
• Developing IBS following GI infection (post infectious IBS (PI IBS).
• When a coeliac patient reports insufficient improvement from strict gluten free diet.

Question 6

SIBO aetiology

Answer 6

• Hypochlorhydria
• Low SIgA
• Prolonged stress
• Scar tissue / adhesions from surgery
• Hypothyroidism (slows motility)
• Poor oral health (bacteria comes from the oral cavity).
• Ileocaecal valve dysfunction (related to a structural dysfunction, poor MMC functioning, etc.)
• Opioid pain medications (slows motility) and antibiotics.

Question 7

SIBO Trigger

Answer 7

1. Food poisoning
2. Bacterial toxin
3. Auto-immunity
4. Gut nerve cell damage
5. SIBO

Question 8

SIBO and food sensitivities

Answer 8

SIBO can damage the villi of the small intestine, reducing enzymes like lactase and diamine oxidase (DAO) that are produced in these finger like projections.
* A loss of lactase = possible lactose intolerance
* A loss of DAO = possible histamine intolerance .

Question 9

Dietary approach to SIBO

Answer 9

• Low FODMAP generally advisable to follow this for up to 6 weeks before gradually reintroducing FODMAPs.
• Specific carbohydrate diet (SCD) may be preferable to low FODMAPs, especially if there is intestinal inflammation.
• Sometimes symptoms will be more persistent / severe. It may be appropriate in some cases to combine dietary models (e.g., SCD and low FODMAP, or SCD and low histamine).

Question 10

Anti-microbials and SIBO:

Answer 10

• Use 1-3 of the following anti microbials (or a specialised formulated herbal formula) for 4-8 weeks depending on the case.
  ‒ Berberine
  ‒ Oregano oil
  ‒ Allicin (extract of garlic) mostly just for methane producing bacteria.
  ‒ Neem
  ‒ Also, uva ursi and cinnamon.

Question 11

Digestive support

Answer 11

Digestive bitters at the start of meals (e.g., greens such as dandelion, rocket, watercress herbs such as gentian, fennel, barberry bark).
– Betaine HCl, digestive enzymes, ACV.

Question 12

MMC support:

Answer 12

‒ 12-hour overnight fast (minimum) / intermittent fasting. Meal spacing (at least 4 hours) with no snacks
‒ Pro-kinetic agents before bed, e.g., ginger root, artichoke.
‒ Practise mindful eating; diaphragmatic breathing exercises.

Question 13

Other therapeutics for SIBO

Answer 13

• Repopulate the microflora (prebiotics and probiotics) and repair (see the 5R protocol).
• Visceral manipulation for the ileo caecal valve.
• Lion’s mane promotes regeneration of neurons if suspected autoimmune (also promotes regeneration of GI mucosa).

Question 14

Biofilms

Answer 14

A biofilm is an extracellular matrix that can protect bacteria and fungus from our immune system. If antimicrobial protocols / dietary changes are not working, consider biofilm production.

Question 15

Biofilm disruptors

Answer 15

NAC
Nano Silver
Serrapeptase

Question 16

Biofilm Natural Approach

Answer 16

Coconut Oil
ACV
Garlic
Curcumin

Question 17

Candidiasis:

Answer 17

• Candida albicans is the most common commensal yeast that asymptomatically inhabits mucosal surfaces.
• Candida is usually kept under control by native bacteria and the immune defences (especially by neutrophils, macrophages and T helper 1 cells.
• Infections are usually limited to the mouth or genitals (thrush) and skin, but infections can become systemic in severe immunocompromise.

Question 18

Candidasis: Signs and symptoms

Answer 18

Frequent UTIs , fatigue, digestive symptoms (e.g., bloating), sugar cravings, joint pain, depression, anxiety, brain fog, food sensitivities, skin and nail fungal infections, etc.

Question 19

Candidiasis pathophysiology:

Answer 19

• Disruption of the host bacterial environment or immune dysfunction
  can allow opportunistic candida to proliferate (terrain theory)
• C. albicans can then penetrate epithelial cells and switch morphology from commensal to pathogen.

Question 20

Candidiasis Risk Factors

Answer 20

Antibiotic use
High sugar intake
Low immunity ( low sIgA)
Dysbiosis
Chronic stress ((↑ cortisol)
Impaired liver function
↓digestive secretions
Exposure to toxins