The Hidden Epidemic... Is Yeast Overgrowth Destroying Your Health?

Did you know your gut microbes could be dramatically affecting your health?

Hey guys! ...this is not just for women.  Men, too, commonly suffer from intestinal yeast overgrowth or fungal dysbiosis!

Every day we see new research on the effects of unhealthy gut organisms on the brain, the thyroid gland, the nervous system, the immune system, and the heart and vascular system.  In functional medicine, this is one reason we focus so intently on helping our patients heal their gut and thrive.  Without a healthy bacterial population in the colon, it’s nearly impossible to experience the optimal health we all desire.

Many people are unknowingly fighting a battle against a single-cell fungus in the gut.  Its name is Candida Albicans, although in recent years there has been an increase in non-albicans species of yeast.  Candida is a normal organism that is part of our skin flora, intestinal microbes, and for women, vaginal flora.  Men, this doesn't mean you can't harbor yeast as well!   This seemingly benign player can become hostile if the environment is right.  High intake of refined carbohydrates and sugar, frequent antibiotic or prednisone use, hormones and birth control pills and other medications give the yeast an advantage over the normal protective bugs, like lactobacillus, so that it flourishes.  It has the ability to take over and becomes invasive leading to a host of unwanted symptoms.  Sadly, many conventional physicians do not recognize that the gut can be a reservoir of these fungal organisms.   If you have ever experienced vaginal yeast infections, rectal irritation, white coating on your tongue called thrush, or any fungal skin or nail infections, like onychomycosis, you may also have a large number of these buggers living in your gastrointestinal tract.

I crave sweets and carbs all the time…

One of the most important things that I notice with patients who have fungal dysbiosis is the feeling of being tired and “run down” all the time with intense cravings for sugar or carbohydrates. Many patients don’t believe me when I tell them that if their gut is healthy, they will get to the point of having no food cravings at all!  It’s really true!  And if you are still experiencing intense, uncontrollable cravings, binge eating, or other issues in a love-hate relationship with sugar and refined carbohydrates, you can bet there is a problem with your gut microbes!

Take this quiz to find out if YOU have a problem!

These are common symptoms that may occur with yeast overgrowth in the gut.  Keep in mind, these are not specific to yeast alone, but if you experience them on a regular basis you are likely to have a real problem with fungal dysbiosis, or yeast overgrowth.

 Give yourself 1 point for every one of these symptoms you experience regularly:

• Weight gain
• Difficulty losing weight
• Premenstrual symptoms
• Fatigue
• Muscle pain/fibromyalgia
• Poor focus/concentration
• Brain fog
• Irritable
• Depression
• Anxiety
• Headaches or migraines
• Cravings for sugar or carbohydrates
• Drowsy after meals
• Constipation
• Diarrhea
• Gas and bloating
• Rectal itching
• Vaginal discomfort or burning
• Low libido
• Joint pain
• Crying spells
• Dizziness or light-headedness
• Sinus pressure/congestion
• Trouble sleeping
• Halitosis (bad breath)
• Body odor
• Frequent sore throat
• Coughing/wheezing/shortness of breath

Scoring

• > 8 – You may have intestinal dysbiosis
• > 14 – It is likely you have an issue with intestinal dysbiosis, which could include yeast overgrowth
• > 20 – It is almost certain that you have fungal dysbiosis or yeast overgrowth

Fungal Dysbiosis and Leaky Gut Syndrome

If yeast becomes dominant in the gut, it may take over and overwhelm the good bacteria.  This is called Fungal Dysbiosis.  The situation becomes dire when yeast or abnormal gut microbes proliferate and dysbiosis occurs.  The problems start when yeast changes from a benign one cell organism to the more invasive hyphe form.  These forms can secrete enzymes, like proteases and phosopholipases that break down cell membranes and contribute to intestinal permeability or “leaky gut”.  As the gut becomes more permeable, toxic metabolites, such as acetaldehyde, leak into the blood stream and cause symptoms such as brain fog, fatigue, or depression.  Did you know that this chemical yeast produces can make you feel hungover?  Alcohol, when metabolized by the liver, also produces acetaldehyde which causes that "hangover" feeling.  The yeast bugs also drive cravings for the very foods that allow them to survive –sugar, refined carbohydrates and sometimes fermented foods or alcohol.  I’m always amazed by the number of people who were struggle with alcohol craving or addiction that have yeast overgrowth in their gut.  In addition to the toxic materials that leak into the blood stream, partially digested food may also leak through the lining of the gut and create food sensitivities.  Many people with chronic yeast overgrowth will experience sensitivities to common foods, like gluten, dairy, sugar, corn, and soy and may even experience improvement in symptoms when they go on an elimination diet.  Yeast also produces more than one-hundred other toxins that may leak into the blood stream and affect thyroid and hormone function, brain function and even neurotransmitter production.

Fungal Dysbiosis and the Connection with Autoimmune Diseases

This invasion and consequent problem of a leaky gut may also trigger the immune system to become confused in a process called “molecular mimicry” when the bacteria or yeast in the gut or cross over where they don’t belong into the blood stream and trigger creation of antibodies by the immune system.  These antibodies may cross-react to joint tissue, skin, thyroid, or even brain and create autoimmune diseases.  It is very common to see some of the following autoimmune conditions occur in someone with fungal dysbiosis:

• Psoriasis
• Rheumatoid arthritis
• Hashimoto’s thyroiditis
• Crohn’s disease
• Ulcerative Colitis
• Celiac Disease
• Meniere’s disease
• Raynaud’s disease
• Lupus

 So What Causese Fungal Dysbiois?

Here are some of the most common factors that upset the balance of gut microbes and contribute to yeast overgrowth or fungal dysbiosis

• Chronic stress, which impacts your immune system, also contributes to yeast overgrowth
• Diabetes (due to abnormal blood sugar)
• Pregnancy (due to change in hormone levels)
• Eating too much sugar and too many grains. Sugar is the main fuel for yeast.
• Taking antibiotics, which kill both your good and bad bacteria.
• Exposure to environmental toxins, which can lower your immune system’s ability to keep yeast in check.  Mercury is especially problematic with yeast overgrowth
• Taking other medications, such as birth control pills and steroids, which are both known to increase yeast

How Does My Doctor Diagnose Fungal Dysbiosis?

Well, the first step is finding a functional medicine trained physician or naturopath who understands the importance of having a healthy gut microbiome.  There are many physicians who understand vaginal yeast infections or the more severe systemic candidiasis, where candida enters the blood stream and can be life threatening but ignore the possibility that you could have too many yeast bugs living in your gut.  Even when we are looking for a problem it can often be hard to detect.  I commonly use a combination of clinical history and symptoms and the following lab tests:

1. Serum Candida antibiodies (IgG, IgM, IgA)
2. Organic Acids in urine, such as Arabinose
3. Comprehensive Digestive Stool analysis for candida culture and sensitivity

By combining a patient’s symptoms with the testing above, it becomes relatively easy to determine if a patient has fungal dysbiosis or not.  Other red flags are someone with  inflammatory bowel disorder or other bacterial dysbiosis, such as SIBO (small intestinal bacterial overgrowth) as the two can co-exsist.

So Tell Me How to Get Rid of it!

1. DIET

The most important starting point is diet.  In fact, I frequently tell patients that no amount of anti-fungal drugs or herbal medications can overcome a high sugar, high carbohydrate diet.  In order to eradicate the yeast, one must do the following:

1. Eat a diversified, whole foods (in as natural and fresh a state as possible) diet, emphasizing non-starchy vegetables, proteins, like fish, organic chicken, turkey, lamb, wild game and organic grass-fed beef.  Healthy oils, like coconut, grape seed and olive are also essential. Include pastured ghee or butter as well for a rich source of Vitamin K and other fat-soluble vitamins
2. Chose organic, free-range meat and be sure they do not contain added growth hormones or antibiotics.  I advise all patients to avoid cow’s dairy due to lactose content, which is a sugar that yeast likes.
3. Avoid all foods that feed the yeast!  That would include all forms of sugar (honey, molasses, maple syrup, agave, xylitol, and artificial sweeteners, like aspartame, splenda)
4. Avoid all dried fruits and fruit juices.  Stevia may be used to sweeten teas and beverages.
5. You may need to eliminate fruit in the beginning or at least stick to no more than one serving of low-glycemic fruit per day – best bets are berries, green apples, or citrus.
6. Eliminate any allergenic foods – these commonly include gluten, dairy, egg, soy, corn, and cane sugar
7. You should also eliminate the following: alcohol; vinegar (and anything containing vinegar, like salad dressing and sauces); all bread (which contains yeast); high starchy vegetables, like carrots, potatoes and beets; peanuts and corn (due to high mold content); mushrooms (fungus); and aged or moldy foods, like blue cheese.
8. Drink plenty of purified water daily.  If you are feeling dizzy, add some electrolytes (ElectroMix or Elyte Sport) to your morning water.
9. Get some form of daily exercise (walking, hiking, yoga, bicycling). Pick an activity you enjoy and try to get in 30-40min every day.
10. Make time for rest and relaxation.  Epson salt baths can be especially helpful for the yeast die-off symptoms.  Use 2-3 cups of salt in warm bath and soak 20min.

2. AVOID ANTIBIOTICS

3. DECREASE STRESSORS

4. IDENTIFY AND ELIMINATE FOOD ALLERGIES

5. TAKE A PROBIOTIC!  (my favorite is Klaire Labs Detox Support, which you can order here)

6. TREAT ANY DIGESTIVE IMBALANCES (like insufficient pancreatic enzyme production or low stomach acid)

7. MEDICATIONS

• Fluconazole
• Itraconazole
• Nystatin
• Compounded Oral amphotericin B

8. HERBAL REMEDIES

• Caprylic Acid
• Undecylenic acid
• Berberine
• Garlic (Allicin)
• Oil of Oregano
• Olive Leaf Extract
• Pau D-Arco
• Grape Seed Extract

9. OTHER ESSENTIAL NUTRIENTS

• Vitamin D
• Vitamin A
• Biotin
• Essential Fatty acids
• Probiotics
• Pantethine
• l-Glutamine
• Coenzyme Q10
• Magnesium

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6 Signs that SIBO might be the root cause of your IBS

Photo courtesy of www.freedigitalphotos.net

Studies show that over 50% of patients diagnosed with IBS actually have an underlying imbalance called SIBO, or small intestinal bacterial overgrowth. The majority of our gut bacteria should be in the colon. When the bacteria migrate backwards into the small bowel or when there is low stomach acid or poor pancreatic enzyme production, bacteria in the small bowel can overgrow and cause symptoms, such as diarrhea, gas, or bloating.

Six signs you might have SIBO

1. You notice that fiber worsens your constipation
2. You notice an improvement in IBS symptoms when taking antibiotics
3. You feel more gas and bloating when you take probiotics that contain prebiotics
4. You are celiac or gluten intolerant and do not have 100% resolution of symptoms on a gluten-free diet
5. You develop chronic symptoms of gas, bloating, constipation or diarrhea after taking pain medications, like opiates.
6. Your blood work shows chronically low iron or ferratin with no known cause

Top 6 Symptoms of SIBO

1. Abdominal bloating and distention
2. Constipation 
3. Diarrhea
4. Abdominal pain or discomfort
5.  Acid reflux or heartburn
6. Excessive gas or belching

How do I know this isn’t just leaky gut?

While SIBO usually manifests with local GI symptoms, a leaky gut will manifest with systemic complaints that affect the immune system. Keep in mind that is is not uncommon to have both SIBO and leaky gut simultaneously. And very often if you have SIBO for a long period of time, you will develop a leaky gut.

Here are some systemic signs of a leaky gut:

• Multiple food sensitivities
• Skin rashes, acne or rosacea
• Respiratory symptoms, like asthma
• Allergic symptoms or increase in seasonal allergies
• Fatigue
• Brain fog or poor concentration, especially after meals
• Any autoimmune disease
• Joint pain or arthritis
• Headaches or migraines

Remember SIBO can cause leaky gut syndrome but not everyone with SIBO has leaky gut. About half of the patients diagnosed with SIBO will also have leaky gut. Most of the time if SIBO is treated, leaky gut will heal itself!

10 conditions that may predispose you to have SIBO

1. Hypochlorhydria (low stomach acid)
2. Pancreatic insufficiency
3. Decreased motility in small intestine
4. Bowel obstruction
5. Diverticula 
6. Surgical bowel resection or bariatric surgery 
7. Food poisoning (Post infectious IBS)
8. Nerve damage that affects the GI tract
9. Drugs, like opiates 
10. Any disease that slows motility (diabetes, hypothyroid)

Other disorders that may be associated with SIBO

• Rheumatoid arthritis
• Ankylosing spondylitis
• Scleroderma
• Hashimoto’s thyroiditis
• Rosacea
• Restless leg syndrome
• Pancreatic insufficiency
• Liver disease
• Diabetes
• Crohn’s disease
• Celiac disease
• Fibromyalgia
• Kidney failure
• Liver disease
• Diverticulosis

How to Diagnose SIBO

Ask your doctor to order the Lactulose Breath Test (preferred over glucose as it will test the entire small bowel vs. just duodenum). You may also need to check a comprehensive stool analysis and urinary organic acids, which may point in the direction of other dysbiosis but are not directly assessing small bowel bacterial overgrowth

How do we treat SIBO?

1. Diet options

• Paleo diet or autoimmune paleo diet
• Low FODMAP diet
• Specific Carbohydrate Diet
• GAPS Diet
• Avoid all alcohol
• Use caution with probiotics/prebiotics
• Use caution with fermented foods as they can increase histamine
• Homemade Elemental Diet by Dr. Siebecker

2. Antibiotics

• Xifaxan

3. Dr. Jill’s favorite antimicrobial herbs

• Allimed
• Oil of oregano
• Thorne Berberine 500
• Biocidin 

Treating SIBO successfully is not always easy and may involve major dietary changes and medication or herbal treatment for an extended period of time. However, getting the balance of your gut microbes healthy will likely prove to be the most important step in regaining your health and vitality! I know it was in my case… if you haven't read My Story, read more here.

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FODMAPs?! The Diet That May Eliminate Your IBS Symptoms!

Are you looking for relief from your IBS symptoms?

Symptoms of Irritable Bowel Syndrome include abdominal bloating and distension, excess wind (flatulence), abdominal pain, nausea, changes in bowel habits (diarrhea, constipation, or a combination of both), and other gastrointestinal symptoms.

What are the FODMAPs?

FODMAPs are found in the foods we eat. FODMAPs is an acronym for:

• Fermentable
• Oligosaccharides (eg. Fructans and Galactans)
• Disaccharides (eg. Lactose)Monosaccharides (eg. excess Fructose)
• Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)

This is a collection of molecules found in food, that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue along their journey along the digestive tract, arriving at the large intestine, where they act as a food source to the bacteria that live there normally. The bacteria then digest/ferment these foods and can cause symptoms of Irritable Bowel Syndrome.

Where are FODMAPs found?

• Excess Fructose: Honey, Apples, Mango, Pear, Watermelon, High Fructose Corn Syrup, Corn Syrup Solids
• Fructans: Artichokes (Globe), Artichokes(Jerusalem), Asparagus, Beetroot, Chicory, Dandelion leaves, Garlic (in large amounts), Leek, Onion (brown, white, Spanish, onion powder), Raddicio lettuce, Spring Onion (white part), Wheat (in large amounts), Rye (in large amounts), Inulin, Fructo-oligosaccharides.
• Lactose: Milk, icecream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, margarine, soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone).
• Galacto-Oligosaccharides (GOS): Legume beans (eg. baked beans, kidney beans, bortolotti beans), Lentils, Chickpeas
• Polyols: Apples, Apricots, Avocado, Cherries, Longon, Lychee, Nectarines, Pears , Plums, Prunes, Mushrooms, Sorbitol (420), mannitol (421), xylitol (967), maltitol (965) and Isomalt (953).

The most common FODMAP is fructose!

What is fructose?

Fructose is a monosaccharide, or single sugar. It is found in three main forms in the diet as:

• fructose in fruits, honey and some root vegetables
• part of the disaccharide, or double sugar, sucrose. Sucrose is made up of glucose and fructose.
• Sucrose is also known as table sugar.
• fructans in some vegetables and wheat. Fructans are short chains of fructose. They are also called inulins and fructo-oligosaccharides.

Fructose is the sweetest of all naturally occurring carbohydrates. For this reason it is often added as a sweetening ingredient in prepared foods. Since it is sweeter than table sugar, smaller amounts of fructose are needed to get the same sweetness.


How do I go on the FODMAPs diet?

During your elimination trial, it is recommended that you eliminate all FODMAPs either significantly or entirely. Most patients will begin to feel significantly better within a few hours and a few days, but will take up to two weeks to feel fully healthy. A minority of patients have reported that it took up to three months to fully recover. After recovery, you can begin to gradually reintroduce foods using the steps outlined at the end of this article.

Many IBS sufferers with generally mild symptoms will find that a general reduction of fructose intake alone significantly relieves them of their symptoms. Other individuals will find that they must significantly reduce their intake of all FODMAPs to experience relief. You may find over time that eating certain FODMAPs does not bother you.

Finally, it should be noted that fructose – the ubiquitous simple sugar – is often allowed in “safe foods” if the food also contains a glucose-to-fructose ratio greater than one. This is because research shows that ingesting glucose at the same time as fructose (and in the same quantities as fructose) eases fructose absorption.

Is it dangerous to limit fructose intake?

In short: no. While carbohydrates are an essential source of energy, refined sugars are anything but and current research shows that fructose may be best ingested in strict moderation.

Further, some sources report that a modern diet contains upwards of ten times the amount of sugar humans ingested for much of evolution. This may help to explain why fructose malabsorption is found in up to 40% of inhabitants of western countries. You will still be ingesting a significant level of glucose and other carbohydrates. Overall, limiting your fructose intake will likely be beneficial to your health. But when in doubt, listen to your body (and, of course, doctor). It is also not inherently dangerous to limit other FODMAPs, but missing out on whole food groups could easily lead to a diet missing in nutrients and lacking in vitamins.

Which foods contain FODMAPs?

The best way to determine the fructose content of a given food is to use publicly available USDA data.

To save you some time, and to bring your attention to foods which contain non-fructose FODMAPs, the list below names some foods that you will definitely want to avoid at least initially. .

Fruits

Most fruits which are excluded are excluded due to excessive fructose content, or greater than a 1:1 Fructose:Glucose ratio. Also, some contain Polyols.

• Apples
• Apricots
• Cherries
• Mango
• Pears
• Nectarines
• Peaches
• Pears
• Plums and prunes
• Watermelon
• High concentration of fructose from canned fruit, dried fruit or fruit juice

Grains

• Rye
• Wheat

Lactose-Containing Foods

• Custard
• Ice cream
• Margarine
• Milk (cow, goat, sheep)
• Evaporated milk
• Condensed milk
• Milk powder
• Soft cheese, including cottage cheese and ricotta
• Yogurt
• Greek yogurt

Legumes

• Many legumes contain Galacto-Oligosaccharides (GOS).
• Baked beans
• Chickpeas
• Lentils
• Kidney beans

Sweeteners

• Sweeteners which end in -ol are excluded because they are fermentable polyols.
• Fructose
• High fructose corn syrup
• It should be noted that HFCS actually only contains marginally more fructose than glucose as compared to refined sucrose. It is included in this list only because it was found on another list (better safe than sorry), and because it still has a F:G ratio greater than 1. The accuracy of this entry will be checked soon for validity.
• Corn syrup solids
• See above
• Palm sugar
• Honey
• Agave nectar
• Isomalt
• Maltitol
• Mannitol
• Sorbitol
• Xylitol

Vegetables

• Vegetables may be on this list for containing fructans.
• Artichokes
• Asparagus
• Avocado
• Beets
• Broccoli
• Brussel sprouts
• Cabbage
• Cauliflower
• Garlic
• Garlic is possibly okay to consume, but should not be ingested in large quantities.
• Fennel
• Leeks
• Mushrooms
• Okra
• Onions
• Onions have recently been reported to be especially troublesome. It is best to completely avoid them.
• Peas
• Radiccio lettuce
• Scallions (white parts)
• Shallots
• Sugar snap peas
• Snow peas

So, what’s safe to eat?
It’s best to obtain your calories principally from a source that is indisputably fodmap-friendly (such as rice or meat). In moderation, however, the following foods are safe to eat on a low-FODMAP diet.

Fruits

• Banana
• Blueberry
• Grapefruit
• Grapes
• Honeydew melon
• Kiwi
• Lemon
• Lime
• Mandarine oranges
• Orange
• Raspberry
• Strawberry

Sweeteners

• Artificial sweeteners that do not end in -ol
• Glucose
• Maple syrup
• Sugar (sucrose)

Lactose Alternatives 

• Butter
• Hard cheeses
• Brie (exceptional cheese)
• Camembert (exceptional cheese)
• Lactose-free products, such as lactose-free ice cream and yogurt
• Gelato
• Rice milk
• Sorbet

Vegetables

• Bok choy
• Carrots
• Celery
• Corn
• Eggplant
• Green beans
• Lettuce
• Parsnip
• Scallions (green parts only)
• Tomato
• Reintroducing foods/Moving beyond the elimination phase

Once you are symptom-free, you may attempt to reintroduce foods in order to determine exactly what was causing your symptoms. There are really no established guidelines on how to best do this – it varies from individual to individual. Key concepts, however, follow:

1. Write it down! Be scientific. Keep a food diary. Your future self will thank you.
2. Only reintroduce one food at a time.
3. Wait ~72 hours for symptoms to reappear before moving on to the next food