Everything You Need to Know about SIFO (Small Intestinal Fungal Overgrowth)

Could SIFO be causing your unexplained IBS symptoms?

Could a fungal infection in the small intestines be the cause of your gastrointestinal symptoms and leaky gut?

Recent research at Augustana University found that an overgrowth of fungus in the gastrointestinal tract might be the root cause for more than 25% of IBS patients!  

When it comes to gut infections, small intestinal fungal overgrowth or SIFO is the new kid on the block. SIFO was introduced to the medical community in a research paper published in 2015 (1). As with any new discovery, there are skeptics. And, of course, more research is needed.

Personally, I think SIFO may prove to be a very important finding when it comes to unexplained gastrointestinal symptoms. I’m glad to see this topic emerging and I am following the research closely.

Most of my readers are familiar with small intestinal bacterial overgrowth or SIBO by now. Our understanding of how to treat SIBO has really evolved in the last few years and it’s helping a lot of patients. But I also see a subset of patients in my clinic who have all of the symptoms of SIBO (gas, bloating, belching, abdominal pain, diarrhea or maybe even constipation) and yet their digestive tests are normal.

I’ve always suspected that something else was wrong in these cases; something that has nothing to do with bacteria.

The symptoms of SIFO and the symptoms of SIBO are identical.

Both conditions involve the symptoms that we associate with IBS or irritable bowel syndrome. But the culprit is completely different: Fungus.

A Fungus Among Us

Fungal infections are known to occur outside the gastrointestinal tract and can cause conditions like athlete’s foot, ringworm, vaginal yeast infections, thrush and more.

When it comes to the gastrointestinal tract, fungal strains (like bacterial strains) are a normal part of the gut ecosystem and not usually a cause for concern. Bacteria and fungi mostly colonize the large intestine; the small intestine is only lightly colonized as it provides a much less hospitable environment. Problems start to occur when heavier colonization takes place in the small intestine and leads to overgrowth.

What happens when there’s an overgrowth in the small intestine?

  • If it’s an overgrowth of bacteria, you have SIBO
  • If it’s an overgrowth of fungus, you have SIFO

Those who were negative for SIBO often had SIFO

In a multi-year study of 124 patients with otherwise unexplained gastrointestinal symptoms, more than 25% of the patients were diagnosed with SIFO through endoscopic testing (1).

Symptoms of SIFO

Belching, bloating, indigestion, nausea, diarrhea, and gas are the digestive issues that are most often found with SIFO.

Unfortunately, these are very common symptoms and this makes diagnosing SIFO via symptoms difficult. It’s common for SIFO patients to see multiple practitioners, endure repeated GI tests and still have no diagnosis.

Treatment for fungal infection does bring dramatic improvement in gastrointestinal symptoms for these patients. Patients also report improvements in:

  • Joint pain and discomfort
  • Fatigue and energy levels
  • Headache

What Causes SIFO?

There are a number of factors that can increase your risk for SIFO:

  • Excessive use of proton pump inhibitors
  • Excessive use of antibiotics
  • Taking immunosuppressant drugs
  • Diabetes
  • Ehlers-Danlos syndrome
  • Motility disorders
  • Colectomy (2)

Lack of stomach acid also plays an important role in SIBO and SIFO. Stomach acid production is crucial for gut health. One of the important functions of stomach acid is killing bacteria and fungi before they enter the small intestine. Some people don’t produce enough stomach acid and this increases their risk for SIBO and SIFO.

Some conditions increase the likelihood you have low stomach acid, including:

  • Autoimmune conditions
  • Anemia
  • Being over sixty-five
  • Chronic use of painkillers or antacids

I want to make a special note about proton pump inhibitors (PPIs).

If you use proton pump inhibitors over long periods of time, you significantly increase the risk of bacterial and fungal infections in your gut (3), (4), (5).

PPIs are designed to lower stomach acid. They play an important role in the treatment of some GI disorders. For example, short-term use of proton pump inhibitors is a very effective treatment for stomach ulcers. But I believe these drugs are overprescribed. Please use proton pump inhibitors with caution.

Testing for SIFO

There are a number of ways to test for bad bugs the gastrointestinal tract. We can do a stool test to identify an overgrowth of pathogenic bacteria like H. pylori, Campylobacter and Salmonella or protozoa like Blastocystis hominis and Giardia. We can use a breath test to identify a SIBO infection. None of these tests are perfect, but they do provide good diagnostic options.

When it comes to SIFO, there are no readily available diagnostic tests.

In the research lab, SIFO tests are done by extracting fluids from the digestive tract with an endoscope. This is a highly invasive procedure and it’s not practical for clinical practice. While there may be some exciting new diagnostic tests on the horizon, for now we must diagnose SIFO based on clinical evidence and empiric treatment.

Clinical Evidence

If a patient has significant digestive issues that correspond with symptoms of SIFO and if testing for other GI infections is negative, we can suspect SIFO.

Empiric Treatment

If SIFO is suspected, the best approach is to go ahead and try an antifungal treatment to see if it works. This is called empiric treatment. If the patient’s digestive issues start to clear up, we can confirm, the diagnosis of SIFO.

Prescription antifungals and natural treatments for SIFO are quite safe. This makes empiric treatment a good choice for SIFO.

Treating SIFO

Antifungal Drugs for SIFO

Standard treatment for SIFO is 3 weeks of antifungal drugs. Fluconazole is the top choice drug because it is very sensitive to candida and its cousins. Alternative antifungal drugs are itraconazole or posaconazole.

Nystatin may not be as effective for SIFO because it appears to get broken down by stomach acid and may not reach the small intestine at an effective dose.

Natural Treatments for SIFO

In my experience probiotics and herbal antimicrobials like oregano, artemisinin and berberine, can be as effective as antifungal medications. While these natural treatments have not yet been directly studied in the treatment of SIFO, probiotics have shown impressive ability to combat intestinal fungus:

Probiotics are as effective as antifungal drugs:

  • In a study of 181 infants, the probiotic S. boulardii was as effective as Nystatin (an antifungal medication) in reducing fungal infection. The infants taking probiotics had fewer side effects than the infants taking Nystatin (6).
  • They also experienced an increased food tolerance.

Another benefit of herbal antimicrobials is they confer both antibacterial and antifungal action. This is important because research shows that half of patients infected with SIFO also have SIBO (1).

  • One clinical trial found herbal antimicrobials were as effective as antibiotics for treating SIBO and reducing abdominal pain (7).
  • A meta-analysis of 18 clinical trials concludes that probiotics can correct SIBO (8).
  • Another exciting study found that probiotics work better for digestive issues if you also have SIBO, as compared to those who have digestive issues without SIBO (9).

What’s the Best Dietary Approach for SIFO?

We don’t have any research to directly answer this question. However, I would not advise blindly following a low carb diet because “carbs feed fungus”. Your gut is not that simple.  Use whatever diet you feel best on. For some, this will be a lower carb diet.  For others this could be low FODMAP or meditearanian diet. An elemental diet is also an option.

The best diet for the host (you) is likely the best diet for the microbiota (the world of bacteria and fungus in your gut). See here for more help finding the best diet for your gut.

Repeating Treatments for SIFO

Some patients have challenging conditions that cause SIFO (and SIBO) to recur. These patients may have an underlying dysmotility (e.g. scleroderma, Ehlers-Danlos syndrome, gastroparesis) or may have had a colectomy.

In these cases, a cyclical approach to treatment may be necessary to keep digestive issues in check and ensure a better quality of life. I prefer using herbal antimicrobials over prescription meds in these cases.

Preventing SIFO

A healthy, balanced diet and high-quality probiotic supplements are usually advisable for good gut health. In addition, it makes sense to address the root causes of SIFO, where possible. This may include:

  • Taking a digestive acid supplement to increase stomach acid production
  • Reducing use of acid-lowering medications (antacids, proton pump inhibitors)
  • Reducing use of antibiotics and immunosuppressant drugs

If you have a condition that causes dysmotility, seek the help of a competent doctor to provide long-term support. Not all doctors recognize the existence of SIFO or even SIBO.

In Summary

If you’ve been struggling with unexplained digestive symptoms, it’s worth investigating to see if SIFO may be the reason.  Thankfully, natural SIFO remedies can be trialed safely without requiring testing.  Make sure to OK this with your doctor first.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

140 thoughts on “Everything You Need to Know about SIFO (Small Intestinal Fungal Overgrowth)

    1. Hi Brad,
      It’s hard to say because we rarely are able to quantify SIFO via lab testing – so we are not sure if a treatment has reduced SIFO. Most clinicians use symptomatic improvements to gauge this. Dr. Rao uses Fluconazole, I use and suspect many herbals are also effective based upon my clinical observations.

      1. Would Grapeseed Extract and Pau D’Arco be detrimental to the healthy bacteria? Also, the article did not address the need to dismantle the BIOFILM which the fungi use as a protective shell to hide in and regenerate when conditions permit.

    1. Hi Brad,
      It’s hard to say because we rarely are able to quantify SIFO via lab testing – so we are not sure if a treatment has reduced SIFO. Most clinicians use symptomatic improvements to gauge this. Dr. Rao uses Fluconazole, I use and suspect many herbals are also effective based upon my clinical observations.

  1. Hi Michael,

    In terms of testing, even less invasive than blood antibody testing is saliva antibody testing. This can be done at home by anyone and does not require a trip to a clinic for a blood draw.

    Do you have any experience with saliva testing? If you don’t use it, could I ask why?

    Kind regards,,
    Ross

        1. Thanks Ross. Interesting test, it doesn’t appear to be available in the US though. There is the potential for urine organic acids but I am not committing to this until I have a chance to perform a literature review. Hope this helps and stay tuned for review.

  2. Hi Michael,

    In terms of testing, even less invasive than blood antibody testing is saliva antibody testing. This can be done at home by anyone and does not require a trip to a clinic for a blood draw.

    Do you have any experience with saliva testing? If you don’t use it, could I ask why?

    Kind regards,,
    Ross

        1. Thanks Ross. Interesting test, it doesn’t appear to be available in the US though. There is the potential for urine organic acids but I am not committing to this until I have a chance to perform a literature review. Hope this helps and stay tuned for review.

    1. Hi Kelli,
      It may be helpful to start with a lower carb paleo diet (very similar to a candida diet) and then perform the reintroduction to see where you feel best. One of the main variables for yeast/fungus is carb intake but there is more to finding your ideal diet than just carbs. My book will lay out a good plan for this. Ultimately the best diet for you is the one you feel best on and not what a given conditions diet rules recommend. Hope this helps!

    1. Hi Kelli,
      It may be helpful to start with a lower carb paleo diet (very similar to a candida diet) and then perform the reintroduction to see where you feel best. One of the main variables for yeast/fungus is carb intake but there is more to finding your ideal diet than just carbs. My book will lay out a good plan for this. Ultimately the best diet for you is the one you feel best on and not what a given conditions diet rules recommend. Hope this helps!

  3. Hello
    I tested positive for Sibo and took many antimicrobial herbs then took antibiotic Rifaximin and neomycin all to no avail Now taking Diflucan in case of Sifo
    Would you recommend taking Alliimed and/or berberine for Sibo while taking antibiotic for Sifo
    I don’t want Sibo to get worse
    I will be talking another sibo test soon

    Thank you

  4. Hello
    I tested positive for Sibo and took many antimicrobial herbs then took antibiotic Rifaximin and neomycin all to no avail Now taking Diflucan in case of Sifo
    Would you recommend taking Alliimed and/or berberine for Sibo while taking antibiotic for Sifo
    I don’t want Sibo to get worse
    I will be talking another sibo test soon

    Thank you

  5. Hi Dr, Rao, if you had to prescribe Itraconazole for a patient to combat SIFO, what would be the strength you would prescribe, how many times per day, and for how long?

  6. Hi Dr, Rao, if you had to prescribe Itraconazole for a patient to combat SIFO, what would be the strength you would prescribe, how many times per day, and for how long?

  7. Dr. Ruscio

    I have tested positive for SIBO(via saliva test) and scant fungal overgrowth(via a stool test). It would be best Tovah treat both, yes? It would be difficult to know what is causing the issues.
    I do have issues with motility. I know it’s important to treat the underlying infections, but is poor motility the route of the problem here? And correcting that needs to be addressed?

    Thank you!

  8. Hi!
    I found that herbal antibiotics, candida enzymes, low FODMAP diet and enemas keep things at bay, but when consuming prebiotic foods (like in a green superfood powder) aggravate my digestive system. What am I missing? Digestive enzymes/HCL/DAO? oh, and staying away from histamine foods too.
    Any suggestions? What prokinetics would you suggest besides ginger? I found that laxative teas relieve discomfort almost within an hour, which makes me suspect SIBO/SIFO but clearly not something I consider as a solution. Also, since daily enemas, there has been no need for such tea.
    Thank you!

  9. Is it possible to have both SIBO and SIFO? I was diagnosed with SIBO through a breath test two years ago but still have bad GI symptoms even on the Low Fodmap diet and viberzi.

  10. Is it possible to have both SIBO and SIFO? I was diagnosed with SIBO through a breath test two years ago but still have bad GI symptoms even on the Low Fodmap diet and viberzi.

  11. Hi Dr. Ruscio,

    While I understand why taking probiotics might be problematic for individuals dealing with SIBO and/or SIFO, does this change when a patient’s stool test indicates no growth at all of beneficial bacteria, for example bifidobacterium? If a lack of beneficial bacteria is causing other major symptoms in the individual, but they also have SIBO/SIFO, should they just treat the SIBO/SIFO and ignore the missing bifido? It seems like these types of patients can’t do anything in either direction. What’s worse, the risk of symptoms from not managing the dysbiosis out of fear of aggravating SIBO/SIFO or the risk of causing further SIBO from attempting to address the dysbiosis? Thanks.

    1. Hi Sam,
      Stool testing does not predict what probiotics are needed, don’t make this mistake. For SIBO you can use both probiotics and antimicrobials.
      Hope this helps.

  12. Hi Dr Ruscio, does an elemental diet help and starve fungal as in Sifo or does it only work with starving bacteria in sibo?

    1. Good question Jay. Some people experience temporary oral thrush while on ED, which clears quickly when coming off. In terms of intestinal fungus, I think it could go either way depending on the person. This is where the home made lower carb version of the ED may be helpful, for those who are carb sensitive.

  13. I had bad constipation vs diarrhea. Yet am convinced that I have/had SIFO. Can constipation be a symptom of SIFO, too? Recently tho, after a week long dose of Diflucan for another fungal issue (a skin fungal rash called Tinea Versicolor) and for toenail fungus, my health has greatly improved!

  14. Is alcohol intolerance a possible symptom / byproduct of SIFO? I cannot tolerate alcohol anymore (nausea and diarrhea starting hours after I’ve had just 1/2 of a drink and hangover symptoms the entire next day). I was diagnosed with methane SIBO but my tolerance did not return after I cleared the SIBO..

    1. Hey Ani – I have these same symptoms with alcohol. Terrible stomach issues, heart racing and feel hungover after the teeniest amount. Have you found any reasons for this or treatment?

      1. Hi Shannon – no, have not found any reasons or treatment unfortunately. The only thing I found after extensive searching online was that a handful of people reporting sudden alcohol intolerance online ended up testing positive for SIBO. I did test positive for SIBO myself, but after clearing it, I still did not regain my tolerance. It did make me *slightly* better — instead of a few sips making me feel terrible almost right away, I can now drink 1/2 a drink. I will still feel terrible, but it’s hours later instead of right away. Perhaps my gut never healed enough? It’s frustrating…

        1. I also have intense intolerance and SIBO for years and likely SIFO since I’ve had relief of smell sensitivities post-antifungal treatment. Cannot rid the symptoms. Is there a pod cast that goes over this alcohol intolerance question?

    2. Hey, I have noticed that too. I’ve never been a big drinker, and even before I had severe stomach issues, I had trouble with red wine upsetting my stomach and causing reflux (I have been told it’s the sulfites?) but I was for the most part, able to tolerate most anything else (I am not big on beer, but I have tried to sip one since this started and even 1/2 a bottle bothers me). I can mostly tolerate clear liquors, and white wines, but I can only tolerate maybe 1-3 drinks. Even at that, it usually gives me reflux and on occasion a bad flare with horrible burps (smells like sulfur, was told by an acquaintance this is sour stomach), and my emergency meds do little. If the burping gets bad enough it will make me nauseous and occasionally vomit. However I rarely feel the brunt of the effects when I’m still consuming the alcohol or later that day/night. It’s the next day and possibly a few days after that my stomach really gets going.

      Also before developing the stomach problems, I very rarely got a hang over, and at least that part hasn’t changed. Although a couple of years ago I had one and I hadn’t really had a lot to drink, but the hangover was the worst of my entire life, and I don’t really understand why. I only had two drinks of sparkling white wine, a glass 0f tea with dinner, and I had been drinking water most of the day, and continued to do so while drinking and afterward.

      I have found one of the easiest things for my stomach (it’s almost ironic really) has been clear tequila. unlike the brown/gold it doesn’t upset my stomach, and as long as I’m not consuming a huge margarita, it doesn’t give me reflux.

      However I mainly started turning to it because whatever is wrong with my stomach (I have been diagnosed IBS-D, but I was urged by a friend to find a new doctor, as my current GI is more incompetent than I realized. But it’s a strong possibility I have Crohn’s instead), also came hand-in-hand with severe weight gain (I know, that’s usually the opposite of what IBD patients experience. Idk why I just know when I flare I gain, and when I’m not flaring, I’m starting to actually lose weight again. For a long time I was gaining but couldn’t lose to save my life.

      And I was reading about things that help with weight/diet, and also blood sugar (I’m not diabetic but I’m at risk and my blood sugar seems to be unstable) and I found out tequila (clear only I think, but I’m not sure) has a low glycemic index so it doesn’t cause a blood sugar spike.

      I would say check into possibly healing your gut more before drinking again, but if you absolutely want to have something to drink, you might try my method and see if that helps you. Another thing I have noticed is I seem to be intolerant to lots of added sugar, so if you do choose this method, be careful with sweet wines (although a local winery by me makes honey wine, and it is so, so good), and with liquors, be careful with oversweetened mixers.

      For example, I was making a slimmed down version of a margarita by using scant amounts of honey or agave, fresh lime juice, and a splash of fresh orange and lemon juice, and water to taste. I tried doing a frozen version, but it’s hard to get the ice ratio right. if you are going to do this I would suggest omitting water from the drink, or preparing the mixer ahead of time and freezing it to make frozen margaritas. However, for a no-fuss easy to mix drink, I prefer to make it on the rocks. I’m big on the salted rim too, and I think it helps to balance out the bitterness of the barely sweet mixer.

  15. Hi Dr. Ruscio,
    I have SIBO-C and both my naturopath and I suspect I also have SIFO. To treat both simultaneously, do you suggest “feeding” the bacteria with high FODMAP foods during treatment? Also, do you think the strain(s) of yeast determines choice of herbs, or does it not matter? Thanks, and thanks for all your work!

    1. Hi Tove,
      I don’t think you need to, but you could as long as it doesn’t flare symptoms. You could try to antimicrobials step 1a, 1b and 2a and 2b in our store.

  16. My teenager has been treated for SIBO with antibiotics and herbals multiple times over the past two years but cannot seem to get rid of the SIBO completely (although the hydrogen levels reduced and methane went all the way down). Strangely, she would feel better in the beginning of treatment, go through die off, feel better, then at the end of treatment just start feeling yucky and become constipated again. I am now convinced she has SIFO as well and we are working with another doctor and are currently waiting on Blood, stool and acids test results. What are some SIFO specific herbs that you find effective. We did two rounds of Candibactin AR/BR and one month of Berberine, Neem, Allimax, along with motilpro and megasporbiotic. The megasporbiotic did amazing things for her skin. Any thoughts you have would be helpful. We tried to get in to see you but the wait is just too long. Thanks.

  17. I like to test for SIFO but both my PCP and GI doctor said they don’t know anything about SIFO testing. Please advise me where I can take SIFO test to treat my on going issues with my gut.
    Thanks,
    A.S.

  18. I like to test for SIFO but both my PCP and GI doctor said they don’t know anything about SIFO testing. Please advise me where I can take SIFO test to treat my on going issues with my gut.
    Thanks,
    A.S.

  19. I was diagnosed with celiac disease 4 years ago. I don’t have symptoms relating to that since I am very careful about what I eat but I have been having other symptoms for a while now. I have borderline high cholesterol for 2 years which I’ve never had before accompanied by diarrhea after eating a lot of different foods and it seems to be growing in scope. A lot of the foods I can’t tolerate are oils and fats like peanut butter but also some gf Panko, garlic and onions, tomato sauce, spinach, carrots and others. It seems like my body can’t break it down. The fodmap diet isn’t beneficial for me since some things work and others don’t. Is it possible I have SIBO and/or SIFO? My GI doc said I probably have IBS but I do eat a diet high in carbs and sugar. I’m concerned about my cholesterol and need to get this in check since I’d like to start a family soon but I can’t figure out why my body can’t process it. I’d really appreciate any advice.

    1. Hi Becky,
      I would strongly recommend going through the protocol in Healthy Gut, Healthy You. Yes, you may have SIBO, SIFO and/or IBS – the protocol works well for all. Make sure to keep you doctor in the loop also.

  20. I was diagnosed with celiac disease 4 years ago. I don’t have symptoms relating to that since I am very careful about what I eat but I have been having other symptoms for a while now. I have borderline high cholesterol for 2 years which I’ve never had before accompanied by diarrhea after eating a lot of different foods and it seems to be growing in scope. A lot of the foods I can’t tolerate are oils and fats like peanut butter but also some gf Panko, garlic and onions, tomato sauce, spinach, carrots and others. It seems like my body can’t break it down. The fodmap diet isn’t beneficial for me since some things work and others don’t. Is it possible I have SIBO and/or SIFO? My GI doc said I probably have IBS but I do eat a diet high in carbs and sugar. I’m concerned about my cholesterol and need to get this in check since I’d like to start a family soon but I can’t figure out why my body can’t process it. I’d really appreciate any advice.

    1. Hi Becky,
      I would strongly recommend going through the protocol in Healthy Gut, Healthy You. Yes, you may have SIBO, SIFO and/or IBS – the protocol works well for all. Make sure to keep you doctor in the loop also.

  21. Dear Dr Ruscio,
    I’ve been scripted Fluconazole for ongoing vulval dermatitis. Co-incidentally I am on a low FODMAP diet due to intestinal issues (for last 4 weeks). Will the medication counter-act the positive effects of the diet. Is it okay to follow both treatments at the same time.
    Many thanks
    Sue

  22. Dear Dr Ruscio,
    I’ve been scripted Fluconazole for ongoing vulval dermatitis. Co-incidentally I am on a low FODMAP diet due to intestinal issues (for last 4 weeks). Will the medication counter-act the positive effects of the diet. Is it okay to follow both treatments at the same time.
    Many thanks
    Sue

  23. Hi Dr. Ruscio,
    How do you feel about Microbial Organic Acid Testing for fungal overgrowth? (I like The Great Plains Lab better than Genova for this test) I have had 5 Genova Stool tests over the past 25 years and they all have been negative for fungus. However, I have had 4 MOAT tests over the same time period that have all been positive for fungal metabolites. I have read that these conflicting test results indicate an overgrowth in the upper GI tract, SIFO possibly? I have responded in the to fungal medications in the past, but symptoms eventually return. Now when I try treatment, both herbal or pharmacological I get an unbearable die off reaction. Your thoughts?

  24. Hi Dr. Ruscio,
    How do you feel about Microbial Organic Acid Testing for fungal overgrowth? (I like The Great Plains Lab better than Genova for this test) I have had 5 Genova Stool tests over the past 25 years and they all have been negative for fungus. However, I have had 4 MOAT tests over the same time period that have all been positive for fungal metabolites. I have read that these conflicting test results indicate an overgrowth in the upper GI tract, SIFO possibly? I have responded in the to fungal medications in the past, but symptoms eventually return. Now when I try treatment, both herbal or pharmacological I get an unbearable die off reaction. Your thoughts?

  25. Hi Dr. Ruscio,
    My husband and I discovered a large variety and quantity of mold in our A/C unit three years ago! Even after remediation and purchasing a vacation home, we have suffered tremendous health issues! We have spent thousands in MD’s and holistic health care!
    About two years ago, I was showering with a new facial wash! For extra cleanliness I used it under my armpits and buttocks area! To my horror, I discovered these little white, rice looking things! I have had three bowel movements tests! The first just came back with no parasites and no ecoli! Last week, a new test revealed no good bacteria, no parasites, but an extreme overgrowth of what appears to be yeast but not candida ablicans! I wish I could have been tested for aspergilles or mycotoxins, but there may not be such a test! My health practitioner has me on many supplements, but my stomach was so painful, I had to go to the gastro! Again, a BM test showed negative and no parasites! Ugh! She wants me to take Xifaxan for two weeks! I have heard antibiotics can only make mold worse! However, being a flight attendant, I just want to get well! Help!

  26. Hi Dr. Ruscio,
    My husband and I discovered a large variety and quantity of mold in our A/C unit three years ago! Even after remediation and purchasing a vacation home, we have suffered tremendous health issues! We have spent thousands in MD’s and holistic health care!
    About two years ago, I was showering with a new facial wash! For extra cleanliness I used it under my armpits and buttocks area! To my horror, I discovered these little white, rice looking things! I have had three bowel movements tests! The first just came back with no parasites and no ecoli! Last week, a new test revealed no good bacteria, no parasites, but an extreme overgrowth of what appears to be yeast but not candida ablicans! I wish I could have been tested for aspergilles or mycotoxins, but there may not be such a test! My health practitioner has me on many supplements, but my stomach was so painful, I had to go to the gastro! Again, a BM test showed negative and no parasites! Ugh! She wants me to take Xifaxan for two weeks! I have heard antibiotics can only make mold worse! However, being a flight attendant, I just want to get well! Help!

  27. Hi Dr Ruscio,
    I recently received my results from The American Gut study that I participated in. Apparently I have 14 rare taxa and 2 of those are my most enriched microbes. My genus Serinicoccus was listed as 76x fold and from what I can tell, this is a fungus. Does this mean I have fungal dysbiosis and if so, where would I begin to try and treat this?

  28. Hi Dr Ruscio,
    I recently received my results from The American Gut study that I participated in. Apparently I have 14 rare taxa and 2 of those are my most enriched microbes. My genus Serinicoccus was listed as 76x fold and from what I can tell, this is a fungus. Does this mean I have fungal dysbiosis and if so, where would I begin to try and treat this?

  29. Hi Dr. Ruscio,
    I was recently diagnosed with a mild case of SIBO. After a round of herbal supplements and rifaxamin, my symptoms feel ten times worse. They are now debilitating. Could this be a clue that I have SIFO?

    1. Hi Kelli,

      It’s tough to say for sure without more information, but antimicrobial herbs are often helpful with fungal overgrowths as well, so I would have expected that to help some if it were SIFO. Definitely worth bringing up with your doctor though. Good luck!

  30. Hi Dr. Ruscio,
    I was recently diagnosed with a mild case of SIBO. After a round of herbal supplements and rifaxamin, my symptoms feel ten times worse. They are now debilitating. Could this be a clue that I have SIFO?

    1. Hi Kelli,

      It’s tough to say for sure without more information, but antimicrobial herbs are often helpful with fungal overgrowths as well, so I would have expected that to help some if it were SIFO. Definitely worth bringing up with your doctor though. Good luck!

  31. Hi Dr Ruscio,

    I strongly suspect that I have SIFO since my GI troubles went away when taking a number of antimicrobial herbs. At the same time, various skin rashes (presumably fungal) also disappeared.

    After that, I found out I had severe anaemia, but realised with successive blood tests that my haemoglobin levels were rising quite quickly.

    However, at some point the haemoglobin stopped increasing, and at the same time my skin rashes returned, and a little later the GI troubles too.

    This leads me to wonder: Could SIFO cause anaemia, for example, by inhibiting absorption of iron?

  32. Hi Dr Ruscio,

    I strongly suspect that I have SIFO since my GI troubles went away when taking a number of antimicrobial herbs. At the same time, various skin rashes (presumably fungal) also disappeared.

    After that, I found out I had severe anaemia, but realised with successive blood tests that my haemoglobin levels were rising quite quickly.

    However, at some point the haemoglobin stopped increasing, and at the same time my skin rashes returned, and a little later the GI troubles too.

    This leads me to wonder: Could SIFO cause anaemia, for example, by inhibiting absorption of iron?

  33. Since 2000 at age 28 had anal itch, groin area reoccurring yeast infections, non-normal stools, neverending athlete’s foot OTC haven’t helped at all, gas and bloating incredible, joint and muscle aches for no reason almost like full body arthritis, ache upper left abdomen constant but not bad, sometimes when going to bathroom pain from anus to stomach like someone is shoving a knife up in me and screaming from the pain. I’ve done blood tests and supposedly no infections are found. Last 2 yrs bright red blood on stools. I am at such a loss I myself have believed Candida from bad diet that has overgrowthed. Ive taken antibiotics and during treatment blood on stools has lessesned and came back after treatment was completed. Symptoms seem to kinda go away but not really. I finally was prescribed 3 days 100mg Fluconazole and day 1 thru 4 vomited 3 or 4 times a day weak and tired. After that aches and pain in muscles went away bleeding lessened and I was overall better for about a week or 2. Now all symptoms are back again and I am miserable because I saw happiness for only such a short time and I am again miserable from pain and heartburn oh and 5 yrs ago I lost 30 lbs for no reason I wasn’t trying to lose weight. I feel like my body is trying to kill me. No STDs I’m so confused. Should I see an infectious disease specialist cause can’t find answers. Help please.

    1. Hi Angelo,
      1. Consider going on a zero carb, mostly meat diet. It should help with skin fungal infections. If there are no blood glucose spikes after dietary carbs, the skin usually improves a lot. Blood glucose levels in peripheral tissues may be much higher than what is measured systemically and in the finger capillary blood. High blood glucose = flares of skin fungal infections.

      2. In people with bacterial overgrowth and some other issues, zero carb diets seem to be effective. In people with fungal overgrowth, zero carb, mostly meat diets may be less effective. But a reduction of symptoms is quite likely.

      3. If you do a zero carb diet and it works, make sure to eat enough. More than 2 lbs, and at times, as much as 3 lbs of meat. Start with smaller quantities and increase slowly over weeks.
      Eat diverse types of protein. There is a lot of confusing information out there, but muscle-meat only diet is deficient in folate, calcium and in other nutrients. Meat and muscle meat are, on the other hand, often better digested than other sources of protein.

      I hope this helps.

      The New Neander’s Physiological Literacy

    2. Hi Angelo,

      I’m so sorry you’ve been dealing with this for so long. We can’t give personalized medical advice on this forum, but it could potentially be helpful to see a functional medicine doctor. If you’d like to apply to become a patient of Dr Ruscio’s (he sees people virtually if you don’t live in CA), you can do so here: https://www.drruscio.com/gethelp

      His book may also be of interest to you, as it walks through a DIY protocol that’s the same one he uses in his clinic to help patients overcome stubborn issues (including yeast). You can find that here: https://www.drruscio.com/getgutbook

      Good luck!

  34. Since 2000 at age 28 had anal itch, groin area reoccurring yeast infections, non-normal stools, neverending athlete’s foot OTC haven’t helped at all, gas and bloating incredible, joint and muscle aches for no reason almost like full body arthritis, ache upper left abdomen constant but not bad, sometimes when going to bathroom pain from anus to stomach like someone is shoving a knife up in me and screaming from the pain. I’ve done blood tests and supposedly no infections are found. Last 2 yrs bright red blood on stools. I am at such a loss I myself have believed Candida from bad diet that has overgrowthed. Ive taken antibiotics and during treatment blood on stools has lessesned and came back after treatment was completed. Symptoms seem to kinda go away but not really. I finally was prescribed 3 days 100mg Fluconazole and day 1 thru 4 vomited 3 or 4 times a day weak and tired. After that aches and pain in muscles went away bleeding lessened and I was overall better for about a week or 2. Now all symptoms are back again and I am miserable because I saw happiness for only such a short time and I am again miserable from pain and heartburn oh and 5 yrs ago I lost 30 lbs for no reason I wasn’t trying to lose weight. I feel like my body is trying to kill me. No STDs I’m so confused. Should I see an infectious disease specialist cause can’t find answers. Help please.

    1. Hi Angelo,

      I’m so sorry you’ve been dealing with this for so long. We can’t give personalized medical advice on this forum, but it could potentially be helpful to see a functional medicine doctor. If you’d like to apply to become a patient of Dr Ruscio’s (he sees people virtually if you don’t live in CA), you can do so here: https://www.drruscio.com/gethelp

      His book may also be of interest to you, as it walks through a DIY protocol that’s the same one he uses in his clinic to help patients overcome stubborn issues (including yeast). You can find that here: https://www.drruscio.com/getgutbook

      Good luck!

    2. Hi Angelo,
      1. Consider going on a zero carb, mostly meat diet. It should help with skin fungal infections. If there are no blood glucose spikes after dietary carbs, the skin usually improves a lot. Blood glucose levels in peripheral tissues may be much higher than what is measured systemically and in the finger capillary blood. High blood glucose = flares of skin fungal infections.

      2. In people with bacterial overgrowth and some other issues, zero carb diets seem to be effective. In people with fungal overgrowth, zero carb, mostly meat diets may be less effective. But a reduction of symptoms is quite likely.

      3. If you do a zero carb diet and it works, make sure to eat enough. More than 2 lbs, and at times, as much as 3 lbs of meat. Start with smaller quantities and increase slowly over weeks.
      Eat diverse types of protein. There is a lot of confusing information out there, but muscle-meat only diet is deficient in folate, calcium and in other nutrients. Meat and muscle meat are, on the other hand, often better digested than other sources of protein.

      I hope this helps.

      The New Neander’s Physiological Literacy

  35. Hi!
    I have Hashimoto’s and my doctor believes it’s due to my gut. In the past, like 2 years ago, I had a stool test done and the results came back with low good bacteria and Candida. I did a cleanse and was on a probiotic. I noticed my symptoms got better (BM’s were formed and not loose and less IBS issues.)
    Recently, I had a rectal swab and was diagnosed with E. Historica parasite. I took a round of two pharmaceutical drugs to kill it. However, I still have some digestive issues. Do you think there could also be a SIBO or SIFO infection in a case like mine? Or maybe my gut is still trying to heal from the parasite damage?
    I still experience some loose stool, but nothing like before. I also have white coating on my tongue and rigging on the sides of my tongue.
    I know you can not diagnose anything, but your opinion would be greatly appreciated!
    I hope to hear back from you!

    1. Hi Noel,

      As you mentioned, we can’t diagnose or give medical advice on this forum, but it could be worth giving the protocol in Dr Ruscio’s book a try. It is designed to help with a variety of gut issues from SIBO, SIFO, IBS, parasites, etc – with no expensive testing required. You can find it here: https://www.drruscio.com/getgutbook

      Hope this helps!

  36. Hi!
    I have Hashimoto’s and my doctor believes it’s due to my gut. In the past, like 2 years ago, I had a stool test done and the results came back with low good bacteria and Candida. I did a cleanse and was on a probiotic. I noticed my symptoms got better (BM’s were formed and not loose and less IBS issues.)
    Recently, I had a rectal swab and was diagnosed with E. Historica parasite. I took a round of two pharmaceutical drugs to kill it. However, I still have some digestive issues. Do you think there could also be a SIBO or SIFO infection in a case like mine? Or maybe my gut is still trying to heal from the parasite damage?
    I still experience some loose stool, but nothing like before. I also have white coating on my tongue and rigging on the sides of my tongue.
    I know you can not diagnose anything, but your opinion would be greatly appreciated!
    I hope to hear back from you!

    1. Hi Noel,

      As you mentioned, we can’t diagnose or give medical advice on this forum, but it could be worth giving the protocol in Dr Ruscio’s book a try. It is designed to help with a variety of gut issues from SIBO, SIFO, IBS, parasites, etc – with no expensive testing required. You can find it here: https://www.drruscio.com/getgutbook

      Hope this helps!

  37. Hi dr ruscio and dr drew
    This page has been so helpful and informative.i would be really grateful if you could give me any insight on my IBS treatment mentioned below.

    I have been taking rifaximin 550 for IBS for about 2 months, my concern is how do I get off this antibiotic. The doctor keeps increasing the period of treatment every month. I’m waiting patiently but isnt it risky to keep taking antibiotics for so long . I also keep getting a larger prescription for 5-6 extra medicines (normaxin, actapro, digestal) in every followup even when my symptoms have almost gone away. Is this a standard protocol for IBS treatment?

    Thanks a lot
    Keep up the good work.

    1. Hi Siddharth,

      Every doctor treats their patients in a different way and I’m unable to comment on your doctor’s protocol. If you look through the IBS content on this site (type “IBS” into the search bar), you’ll get a general idea of how Dr Ruscio approaches it. You may also want to pick up a copy of Dr Ruscio’s book, “Healthy Gut, Healthy You” as he walks through a DIY natural protocol to heal the gut and fix stubborn issues (including IBS) that’s the same as what he uses in the clinic. You can find it here: https://www.drruscio.com/getgutbook
      Good luck!

  38. Hi dr ruscio and dr drew
    This page has been so helpful and informative.i would be really grateful if you could give me any insight on my IBS treatment mentioned below.

    I have been taking rifaximin 550 for IBS for about 2 months, my concern is how do I get off this antibiotic. The doctor keeps increasing the period of treatment every month. I’m waiting patiently but isnt it risky to keep taking antibiotics for so long . I also keep getting a larger prescription for 5-6 extra medicines (normaxin, actapro, digestal) in every followup even when my symptoms have almost gone away. Is this a standard protocol for IBS treatment?

    Thanks a lot
    Keep up the good work.

    1. Hi Siddharth,

      Every doctor treats their patients in a different way and I’m unable to comment on your doctor’s protocol. If you look through the IBS content on this site (type “IBS” into the search bar), you’ll get a general idea of how Dr Ruscio approaches it. You may also want to pick up a copy of Dr Ruscio’s book, “Healthy Gut, Healthy You” as he walks through a DIY natural protocol to heal the gut and fix stubborn issues (including IBS) that’s the same as what he uses in the clinic. You can find it here: https://www.drruscio.com/getgutbook
      Good luck!

  39. I wonder what are the typical breath tests, stool tests, and other tests in people who have both fungal infections on their skin and gastrointestinal symptoms. Similar to what is described in the comment by Angelo T from February 19, 2019 (see a quote below in my comment). Angelo T has a more serious condition, it seems. But in the cases of just skin fungal infection and digestive issues, the typical test results would be interesting to know. For instance, what kind of gas shows up on breath test? Is it methane or hydrogen? If Candida “does not ferment as bacteria”, as we read in the article, where the bloating and gas come from in patients with fungal overgrowth?

    Dr. Ruscio does an impressive work in many domains and he is one of the most solid health practitioners in terms of common sense and logical thinking. Big thanks to Dr. Ruscio.

    Angelo T says
    February 19, 2019 at 8:26 AM

    Since 2000 at age 28 had anal itch, groin area reoccurring yeast infections, non-normal stools, neverending athlete’s foot OTC haven’t helped at all, gas and bloating incredible, joint and muscle aches for no reason almost like full body arthritis, ache upper left abdomen constant but not bad

  40. I wonder what are the typical breath tests, stool tests, and other tests in people who have both fungal infections on their skin and gastrointestinal symptoms. Similar to what is described in the comment by Angelo T from February 19, 2019 (see a quote below in my comment). Angelo T has a more serious condition, it seems. But in the cases of just skin fungal infection and digestive issues, the typical test results would be interesting to know. For instance, what kind of gas shows up on breath test? Is it methane or hydrogen? If Candida “does not ferment as bacteria”, as we read in the article, where the bloating and gas come from in patients with fungal overgrowth?

    Dr. Ruscio does an impressive work in many domains and he is one of the most solid health practitioners in terms of common sense and logical thinking. Big thanks to Dr. Ruscio.

    Angelo T says
    February 19, 2019 at 8:26 AM

    Since 2000 at age 28 had anal itch, groin area reoccurring yeast infections, non-normal stools, neverending athlete’s foot OTC haven’t helped at all, gas and bloating incredible, joint and muscle aches for no reason almost like full body arthritis, ache upper left abdomen constant but not bad

  41. Hi there, I have ibs with constipation. Besides the usual ibs symptoms I also smell like poop. However my provider doesn’t believe me. I was diagnosed with sibo in the past, went on antibiotics and it cleared up. I’ve done two tests since and they both were negative for hydrogen and methane.

    Have you ever worked on a case where others have confirmed fecal body odor that worsens when I don’t have a bowel movement? Can it be SIFO?

    1. Hi Ashley,

      I’m sorry to hear you’re going through this. We can’t make diagnoses on this site, but it’s possible that’s a sign of systematic constipation – which it sounds like you’ve been dealing with for a while. If you’re still having IBS symptoms, you may want to check out Dr Ruscio’s book “Healthy Gut, Healthy You”, where he lays out a DIY plan to overcome stubborn gut issues. You can find it here: https://www.drruscio.com/getgutbook Hope it helps!

  42. Hi there, I have ibs with constipation. Besides the usual ibs symptoms I also smell like poop. However my provider doesn’t believe me. I was diagnosed with sibo in the past, went on antibiotics and it cleared up. I’ve done two tests since and they both were negative for hydrogen and methane.

    Have you ever worked on a case where others have confirmed fecal body odor that worsens when I don’t have a bowel movement? Can it be SIFO?

    1. Hi Ashley,

      I’m sorry to hear you’re going through this. We can’t make diagnoses on this site, but it’s possible that’s a sign of systematic constipation – which it sounds like you’ve been dealing with for a while. If you’re still having IBS symptoms, you may want to check out Dr Ruscio’s book “Healthy Gut, Healthy You”, where he lays out a DIY plan to overcome stubborn gut issues. You can find it here: https://www.drruscio.com/getgutbook Hope it helps!

    1. Hi there,

      So sorry you’re not feeling well. Everyone is unique and will have different reactions to different diets and interventions. Low carb doesn’t work for everyone and has been known to occasionally cause digestive distress in certain people. It’s not the right diet for everyone. You could try adding in more carbs and see if that helps. Good luck!

    1. Hi there,

      So sorry you’re not feeling well. Everyone is unique and will have different reactions to different diets and interventions. Low carb doesn’t work for everyone and has been known to occasionally cause digestive distress in certain people. It’s not the right diet for everyone. You could try adding in more carbs and see if that helps. Good luck!

  43. Hi!
    I found that herbal antibiotics, candida enzymes, low FODMAP diet and enemas keep things at bay, but when consuming prebiotic foods (like in a green superfood powder) aggravate my digestive system. What am I missing? Digestive enzymes/HCL/DAO? oh, and staying away from histamine foods too.
    Any suggestions? What prokinetics would you suggest besides ginger? I found that laxative teas relieve discomfort almost within an hour, which makes me suspect SIBO/SIFO but clearly not something I consider as a solution. Also, since daily enemas, there has been no need for such tea.
    Thank you!

  44. Is alcohol intolerance a possible symptom / byproduct of SIFO? I cannot tolerate alcohol anymore (nausea and diarrhea starting hours after I’ve had just 1/2 of a drink and hangover symptoms the entire next day). I was diagnosed with methane SIBO but my tolerance did not return after I cleared the SIBO..

    1. Hey Ani – I have these same symptoms with alcohol. Terrible stomach issues, heart racing and feel hungover after the teeniest amount. Have you found any reasons for this or treatment?

      1. Hi Shannon – no, have not found any reasons or treatment unfortunately. The only thing I found after extensive searching online was that a handful of people reporting sudden alcohol intolerance online ended up testing positive for SIBO. I did test positive for SIBO myself, but after clearing it, I still did not regain my tolerance. It did make me *slightly* better — instead of a few sips making me feel terrible almost right away, I can now drink 1/2 a drink. I will still feel terrible, but it’s hours later instead of right away. Perhaps my gut never healed enough? It’s frustrating…

        1. I also have intense intolerance and SIBO for years and likely SIFO since I’ve had relief of smell sensitivities post-antifungal treatment. Cannot rid the symptoms. Is there a pod cast that goes over this alcohol intolerance question?

    2. Hey, I have noticed that too. I’ve never been a big drinker, and even before I had severe stomach issues, I had trouble with red wine upsetting my stomach and causing reflux (I have been told it’s the sulfites?) but I was for the most part, able to tolerate most anything else (I am not big on beer, but I have tried to sip one since this started and even 1/2 a bottle bothers me). I can mostly tolerate clear liquors, and white wines, but I can only tolerate maybe 1-3 drinks. Even at that, it usually gives me reflux and on occasion a bad flare with horrible burps (smells like sulfur, was told by an acquaintance this is sour stomach), and my emergency meds do little. If the burping gets bad enough it will make me nauseous and occasionally vomit. However I rarely feel the brunt of the effects when I’m still consuming the alcohol or later that day/night. It’s the next day and possibly a few days after that my stomach really gets going.

      Also before developing the stomach problems, I very rarely got a hang over, and at least that part hasn’t changed. Although a couple of years ago I had one and I hadn’t really had a lot to drink, but the hangover was the worst of my entire life, and I don’t really understand why. I only had two drinks of sparkling white wine, a glass 0f tea with dinner, and I had been drinking water most of the day, and continued to do so while drinking and afterward.

      I have found one of the easiest things for my stomach (it’s almost ironic really) has been clear tequila. unlike the brown/gold it doesn’t upset my stomach, and as long as I’m not consuming a huge margarita, it doesn’t give me reflux.

      However I mainly started turning to it because whatever is wrong with my stomach (I have been diagnosed IBS-D, but I was urged by a friend to find a new doctor, as my current GI is more incompetent than I realized. But it’s a strong possibility I have Crohn’s instead), also came hand-in-hand with severe weight gain (I know, that’s usually the opposite of what IBD patients experience. Idk why I just know when I flare I gain, and when I’m not flaring, I’m starting to actually lose weight again. For a long time I was gaining but couldn’t lose to save my life.

      And I was reading about things that help with weight/diet, and also blood sugar (I’m not diabetic but I’m at risk and my blood sugar seems to be unstable) and I found out tequila (clear only I think, but I’m not sure) has a low glycemic index so it doesn’t cause a blood sugar spike.

      I would say check into possibly healing your gut more before drinking again, but if you absolutely want to have something to drink, you might try my method and see if that helps you. Another thing I have noticed is I seem to be intolerant to lots of added sugar, so if you do choose this method, be careful with sweet wines (although a local winery by me makes honey wine, and it is so, so good), and with liquors, be careful with oversweetened mixers.

      For example, I was making a slimmed down version of a margarita by using scant amounts of honey or agave, fresh lime juice, and a splash of fresh orange and lemon juice, and water to taste. I tried doing a frozen version, but it’s hard to get the ice ratio right. if you are going to do this I would suggest omitting water from the drink, or preparing the mixer ahead of time and freezing it to make frozen margaritas. However, for a no-fuss easy to mix drink, I prefer to make it on the rocks. I’m big on the salted rim too, and I think it helps to balance out the bitterness of the barely sweet mixer.

      1. Still herbal antimicrobials need to be combined with a low foodmap diet? From what i ve read in various articles ant microbials alone are not sufficient enough

      2. Would Grapeseed Extract and Pau D’Arco be detrimental to the healthy bacteria? Also, the article did not address the need to dismantle the BIOFILM which the fungi use as a protective shell to hide in and regenerate when conditions permit.

  45. Dr. Ruscio

    I have tested positive for SIBO(via saliva test) and scant fungal overgrowth(via a stool test). It would be best Tovah treat both, yes? It would be difficult to know what is causing the issues.
    I do have issues with motility. I know it’s important to treat the underlying infections, but is poor motility the route of the problem here? And correcting that needs to be addressed?

    Thank you!

  46. I had bad constipation vs diarrhea. Yet am convinced that I have/had SIFO. Can constipation be a symptom of SIFO, too? Recently tho, after a week long dose of Diflucan for another fungal issue (a skin fungal rash called Tinea Versicolor) and for toenail fungus, my health has greatly improved!

  47. My teenager has been treated for SIBO with antibiotics and herbals multiple times over the past two years but cannot seem to get rid of the SIBO completely (although the hydrogen levels reduced and methane went all the way down). Strangely, she would feel better in the beginning of treatment, go through die off, feel better, then at the end of treatment just start feeling yucky and become constipated again. I am now convinced she has SIFO as well and we are working with another doctor and are currently waiting on Blood, stool and acids test results. What are some SIFO specific herbs that you find effective. We did two rounds of Candibactin AR/BR and one month of Berberine, Neem, Allimax, along with motilpro and megasporbiotic. The megasporbiotic did amazing things for her skin. Any thoughts you have would be helpful. We tried to get in to see you but the wait is just too long. Thanks.

  48. Hi Dr Ruscio, does an elemental diet help and starve fungal as in Sifo or does it only work with starving bacteria in sibo?

    1. Good question Jay. Some people experience temporary oral thrush while on ED, which clears quickly when coming off. In terms of intestinal fungus, I think it could go either way depending on the person. This is where the home made lower carb version of the ED may be helpful, for those who are carb sensitive.

  49. Hi Dr. Ruscio,
    I have SIBO-C and both my naturopath and I suspect I also have SIFO. To treat both simultaneously, do you suggest “feeding” the bacteria with high FODMAP foods during treatment? Also, do you think the strain(s) of yeast determines choice of herbs, or does it not matter? Thanks, and thanks for all your work!

  50. Hi Dr. Ruscio,

    While I understand why taking probiotics might be problematic for individuals dealing with SIBO and/or SIFO, does this change when a patient’s stool test indicates no growth at all of beneficial bacteria, for example bifidobacterium? If a lack of beneficial bacteria is causing other major symptoms in the individual, but they also have SIBO/SIFO, should they just treat the SIBO/SIFO and ignore the missing bifido? It seems like these types of patients can’t do anything in either direction. What’s worse, the risk of symptoms from not managing the dysbiosis out of fear of aggravating SIBO/SIFO or the risk of causing further SIBO from attempting to address the dysbiosis? Thanks.

Leave a Reply

Your email address will not be published. Required fields are marked *