Small intestinal fungal overgrowth (SIFO) or small intestinal bacterial overgrowth (SIBO) is characterized by the existence of excessive quantities of fungi or bacteria in the small intestine, which is linked to gastrointestinal (GI) symptoms. Fungal infection, i.e., candidiasis, is notorious for causing symptoms in the gastrointestinal tract, especially in patients with underlying conditions such as diabetes mellitus, cancer, and those prescribed antibiotics or steroids. However, it has been only recently recognized that these overgrowths may be emerging evidence of their possible pathological role in individuals with otherwise unexplained gastrointestinal symptoms (1). The management of fungal and bacterial overgrowth and, in particular, candidiasis depends on several factors such as the severity of disease, history of intolerance to antifungal and antibacterial therapy, involvement of organs, underlying immune status, and clinical stability of the patient, past exposure to azole and antibiotic therapy and also type of Candida and bacterial strains that are resistant to azole antifungals and antibiotics, especially fluconazole or presence of non-albicans Candida strains (2, 3).

Candida and other bacterial species begin to overproduce, leading to various health problems such as digestive issues. The health of the digestive system is heavily dependent on a healthy balance between the “good” and the “bad” bacteria which reside in your gut. The “good” bacteria that typically live in your gut are essential for the digestive process as they assist in processing certain sugars, fibres, and starches. When the bacteria inside your gut become imbalanced, you can experience digestive issues like diarrhea, constipation, gas, nausea, cramps, and bloating. Recent studies indicate that an overgrowth of Candida is associated with several gastrointestinal tract diseases, including ulcerative colitis and Crohn’s disease (4).

Seven Lessons Learned

While an unhealthy gut can result from underlying disease or genetics, certain lessons have been learned by patients who suffered from intestinal infections. As a result, you can opt for those things others know that can help you keep your intestines healthy. These include:

Taking antibiotics when it’s only necessary. Antibiotics kill whatever is making you sick, but they can also reduce the levels of good bacteria within your gut. This allows harmful disease-causing bacteria and fungi, most probably Candida, to propagate. Nevertheless, it’s essential to take antibiotics at times, so it is important to make sure that you take them in those situations. 

Taking antibiotics, especially broad-spectrum antibiotics, can lead to bacterial and fungal growth. This is because antibiotics can kill some good bacteria that help keep yeast from growing out of control by competing for space and food. When you stop taking antibiotics, your immune system will go back to normal. But while you’re taking the medication, you might see Candida in your stool. 

Eating a healthy diet. A healthy diet that includes whole grains and foods with lots of fibre, such as beans and apples, will help keep your gut healthy. Increasing the diversity of bacteria in your gut is another way to ensure your intestinal environment stays healthy. You can do this by eating a wide variety of healthy foods. Carbohydrates, refined sugars, and high-lactose dairy products can encourage Candida and other “bad” microorganisms to grow (5). Eating too many of these foods may promote infection if you have a suppressed immune system. On the contrary, some foods have been shown to encourage the growth of “good” bacteria to develop and inhibit the growth of Candida. The foods mentioned below have been demonstrated to help in fighting Candida infections; hence consuming them can prevent recurring infections:

• Kombucha: Kombucha tea is rich in acetic acid and polyphenols, both of which have been proven to kill Candida in test-tube studies (6).
• Garlic: Garlic consists of an antifungal substance which is called allicin. This antifungal substance has shown action against yeasts and bacteria in test-tube and animal studies (7, 8). 
• Pomegranate: A test-tube study indicated that the plant compounds in pomegranate are beneficial against Candida yeasts (6).
• Coconut oil: Coconut oil contains high amounts of lauric acid, which has been proven to fight bacterial and yeast infections in numerous test-tube studies (9, 10).
• Xylitol: In one test-tube study, xylitol helped fight Candida, decreasing its ability to stick to a surface and cause infection. (11)
• Curcumin: Test-tube studies indicate that curcumin may kill Candida yeasts or reduce their growth. (12-15)
• Fermented foods. Fermented foods, for example, kimchi, sauerkraut and yogurt, are foods that yeasts or bacteria have amended. Therefore, they consist of many bacteria that help keep your gut in a healthy state.
  
  

Taking probiotics. Probiotics are defined as supplements made up of living microorganisms, particularly bacteria. There is mixed evidence for them, but certain researchers propose that consuming probiotics can aid the bacteria in your gut to stay balanced. Hence, talking to your doctor about adding a probiotic to your daily routine would help you avoid the recurring infections caused by bacteria and fungi in your small intestine. In addition, probiotics like Lactobacillus may reduce Candida growth and protect against infections (16).

Eating prebiotic food. Prebiotic foods promote the development of good bacteria in your gut. Foods with lots of complex carbs or fibre are your best sources of prebiotics. These include fruits, vegetables, and whole grains.

Keeping blood sugar levels in check: If your diabetes isn’t well-controlled, your blood sugar levels can spike to unreasonably high levels. This increase in sugar can cause yeast and bacteria to overgrow, particularly in the gut area. Your body may develop a yeast or bacterial infection in response. Maintaining your blood sugar levels may help reduce your risk of infection (17).

Quitting smoking: Cigarette smoke is a representative source of toxic chemical exposures to humans. The adverse consequences of cigarette smoking are mediated by its effect on neuronal and immune-inflammatory systems. Cigarette smoking also is a major risk factor for intestinal disorders, such as Crohn’s disease and peptic ulcer. The effects of cigarette smoking on intestinal disorders include changes in intestinal irrigation and microbiome, increases in mucosa permeability, and impaired mucosal immune responses (18).

Avoiding heavy alcohol consumption. Drinking too much weakens the immune system, making the body vulnerable to infectious diseases, such as pneumonia and tuberculosis. Alcohol causes changes in red blood cells, white blood cells, and platelets (19). A drop in the white blood cell count can occur due to alcoholism. It has been found in a study that alcohol negatively impacts clinical outcomes of patients with IBD, specifically increased intestinal infections, antibiotic injections, abdomen CT scans, and large intestine biopsies (20).

Everyone goes through challenges during their lives, and one of the best ways to surmount these difficulties is to seek out the experience of others, which is why there is so much importance in sharing your journey and educating yourself on others’ unique experiences/challenges. By doing so, you create a foundation with building blocks regarding your illness and provide an open dialogue for others to know that they are not alone and that there is an entire support system behind them to help them through their healing journey while also helping people practically, as they seek relief and healing steps in their recovery. 

About the author:

 Dan Jackowiak, Nc, HHP, Founder of  Yeast Infection Advisor. Dan is a Holistic Healthcare Practitioner and Nutritional Consultant that personally suffered from yeast and bad bacterial overgrowth of the gut for most of his life. The information on his website is a combination of his own nutrition and holistic training, life experiences, collaboration with fellow experts on his team, and over 18 years of studying medical research on candida yeasts infections of all types, which has allowed him to take his life and health back help others overcome yeast-related health problems and digestive problems of all kinds.

References

1.             Erdogan A, Rao SS. Small intestinal fungal overgrowth. Curr Gastroenterol Rep. 2015;17(4):16.

2.             Ruhnke M. Epidemiology of Candida albicans infections and role of non-Candidaalbicans yeasts. Current drug targets. 2006;7(4):495-504.

3.             Rex JH, Rinaldi M, Pfaller M. Resistance of Candida species to fluconazole. Antimicrobial agents and chemotherapy. 1995;39(1):1-8.

4.             Kumamoto CA. Inflammation and gastrointestinal Candida colonization. Curr Opin Microbiol. 2011;14(4):386-91.

5.             Martins N, Ferreira IC, Barros L, Silva S, Henriques M. Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment. Mycopathologia. 2014;177(5-6):223-40.

6.             Pai MB, Prashant GM, Murlikrishna KS, Shivakumar KM, Chandu GN. Antifungal efficacy of Punica granatum, Acacia nilotica, Cuminum cyminum and Foeniculum vulgare on Candida albicans: an in vitro study. Indian J Dent Res. 2010;21(3):334-6.

7.             Khodavandi A, Alizadeh F, Harmal NS, Sidik SM, Othman F, Sekawi Z, et al. Comparison between efficacy of allicin and fluconazole against Candida albicans in vitro and in a systemic candidiasis mouse model. FEMS Microbiol Lett. 2011;315(2):87-93.

8.             Ghannoum MA. Inhibition of Candida adhesion to buccal epithelial cells by an aqueous extract of Allium sativum (garlic). J Appl Bacteriol. 1990;68(2):163-9.

9.             Shino B, Peedikayil FC, Jaiprakash SR, Ahmed Bijapur G, Kottayi S, Jose D. Comparison of Antimicrobial Activity of Chlorhexidine, Coconut Oil, Probiotics, and Ketoconazole on Candida albicans Isolated in Children with Early Childhood Caries: An In Vitro Study. Scientifica (Cairo). 2016;2016:7061587.

10.          Ogbolu DO, Oni AA, Daini OA, Oloko AP. In vitro antimicrobial properties of coconut oil on Candida species in Ibadan, Nigeria. J Med Food. 2007;10(2):384-7.

11.          Pizzo G, Giuliana G, Milici ME, Giangreco R. Effect of dietary carbohydrates on the in vitro epithelial adhesion of Candida albicans, Candida tropicalis, and Candida krusei. New Microbiol. 2000;23(1):63-71.

12.          Kumar A, Dhamgaye S, Maurya IK, Singh A, Sharma M, Prasad R. Curcumin targets cell wall integrity via calcineurin-mediated signaling in Candida albicans. Antimicrob Agents Chemother. 2014;58(1):167-75.

13.          Khan N, Shreaz S, Bhatia R, Ahmad SI, Muralidhar S, Manzoor N, et al. Anticandidal activity of curcumin and methyl cinnamaldehyde. Fitoterapia. 2012;83(3):434-40.

14.          Sharma M, Manoharlal R, Puri N, Prasad R. Antifungal curcumin induces reactive oxygen species and triggers an early apoptosis but prevents hyphae development by targeting the global repressor TUP1 in Candida albicans. Biosci Rep. 2010;30(6):391-404.

15.          Neelofar K, Shreaz S, Rimple B, Muralidhar S, Nikhat M, Khan LA. Curcumin as a promising anticandidal of clinical interest. Can J Microbiol. 2011;57(3):204-10.

16.          Mailänder-Sánchez D, Wagener J, Schaller M. Potential role of probiotic bacteria in the treatment and prevention of localised candidosis. Mycoses. 2012;55(1):17-26.

17.          Thaiss CA, Levy M, Grosheva I, Zheng D, Soffer E, Blacher E, et al. Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection. Science. 2018;359(6382):1376-83.

18.          Gui X, Yang Z, Li MD. Effect of Cigarette Smoke on Gut Microbiota: State of Knowledge. Frontiers in Physiology. 2021;12(816).

19.          Yang A-M, Inamine T, Hochrath K, Chen P, Wang L, Llorente C, et al. Intestinal fungi contribute to development of alcoholic liver disease. The Journal of clinical investigation. 2017;127(7):2829-41.

20.          Cannon AR, Kuprys PV, Cobb AN, Ding X, Kothari AN, Kuo PC, et al. Alcohol enhances symptoms and propensity for infection in inflammatory bowel disease patients and a murine model of DSS-induced colitis. J Leukoc Biol. 2018;104(3):543-55.

Links:

1. Small intestinal fungal overgrowth – PubMed (nih.gov)
2. Epidemiology of Candida albicans Infections and Role of Non-Candi…: Ingenta Connect
3. Resistance of Candida species to fluconazole (asm.org)
4. Inflammation and gastrointestinal Candida colonization (nih.gov)
5. Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment – PubMed (nih.gov)
6. ANTIBACTERIAL AND ANTIFUNGAL ACTIVITIES OF BLACK AND GREEN KOMBUCHA TEAS – BATTIKH – 2013 – Journal of Food Biochemistry – Wiley Online Library
7. Comparison between efficacy of allicin and fluconazole against Candida albicans in vitro and in a systemic candidiasis mouse model – PubMed (nih.gov)
8. Inhibition of Candida adhesion to buccal epithelial cells by an aqueous extract of Allium sativum (garlic) – PubMed (nih.gov)
9. Antifungal efficacy of Punica granatum, Acacia nilotica, Cuminum cyminum and Foeniculum vulgare on Candida albicans: an in vitro study – PubMed (nih.gov)
10. Comparison of Antimicrobial Activity of Chlorhexidine, Coconut Oil, Probiotics, and Ketoconazole on Candida albicans Isolated in Children with Early Childhood Caries: An In Vitro Study – PubMed (nih.gov)
11. Effect of dietary carbohydrates on the in vitro epithelial adhesion of Candida albicans, Candida tropicalis, and Candida krusei – PubMed (nih.gov)
12. Curcumin targets cell wall integrity via calcineurin-mediated signaling in Candida albicans – PubMed (nih.gov)
13. Anticandidal activity of curcumin and methyl cinnamaldehyde – PubMed (nih.gov)
14. Antifungal curcumin induces reactive oxygen species and triggers an early apoptosis but prevents hyphae development by targeting the global repressor TUP1 in Candida albicans – PubMed (nih.gov)
15. Curcumin as a promising anticandidal of clinical interest – PubMed (nih.gov)
16. Potential role of probiotic bacteria in the treatment and prevention of localised candidosis – PubMed (nih.gov)
17. Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection – PubMed (nih.gov)
18. Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection – PubMed (nih.gov)
19. Fungi in the gut linked to alcoholic liver disease | National Institutes of Health (NIH)
20. Alcohol enhances symptoms and propensity for infection in inflammatory bowel disease patients and a murine model of DSS-induced colitis – PubMed (nih.gov)