Practitioner Question of the Month – January 2017

Marie asks, “Would microbial herbs for SIBO also take care of SIFO?”

Dr. Ruscio’s Answer:

This is a good question. Technically, we don’t know because we have so little research on SIFO. However, this presents a chance to practice simple empiric medicine – meaning we can use symptomatic change to indirectly tell us if a treatment is addressing SIFO. If you see any of the following, you may want to then consider a course of herbals that are mainly anti-fungal:

• Little or no response to anti-bacterials
• Initial response to anti-bacterials that is then diminished or even regresses to worse than baseline after ending
• Other documentation of yeast/fungus/candida is present; stool culture, microscopy, antibodies
• The patient has a history of yeast infection or oral thrush
• The patient has been successfully treated with anti-fungal in the past
• The patient has a yeast, moldy odor

I typically use a broad spectrum herbal treatment that addresses both bacteria and fungus, so this would be addressing both SIBO and SIFO, or at least we think it would. However, if a patient is highly reactive/sensitive, I will start by using single ingredient anti-bacterials (usually two at a time). If any of the above were noted when using anti-bacterials only (or Rifaximin) then a course of anti-fungals herbs (or anti-fungal Rx) could be warranted. Sometimes very sensitive patients do better with Rx over herbals because there is less to react to in terms of volume to consume and number of compounds they contain.

So in short, yes it’s likely that herbal anti-microbials that are known to be anti-fungal will address SIFO. However, you have to use good clinical observation and monitoring to guide the process.

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