Have you heard of SIBO, aka small intestinal bacterial overgrowth? It is a digestive health condition that affects many of us, and it is often mistakenly diagnosed as “IBS” or irritable bowel syndrome.

We normally have different kinds of bacteria in the small intestine (the long squiggly bunch in the middle) and in the large intestine (the big loop on the outside). The different bacterial communities are kind of analogous to a pond and the sky — we find fish in the pond and birds in the sky but we don’t usually find fish in the sky!

​In SIBO, the bacteria from the large intestine get into the small intestine where they just don’t belong. This can happen for a variety of reasons that I’ll get to shortly. These bacteria can then create havoc, producing gases in response to what we eat, which can cause bloating, abdominal pain, diarrhea, constipation, heartburn, nausea, and all kinds of other unpleasant digestive symptoms. SIBO is also a leading cause leaky gut (also known as intestinal permeability) which can present with a variety of symptoms around the body such as:

• Food sensitivities
• Joint pain
• Fatigue
• Headaches
• Skin symptoms like eczema or rashes
• Respiratory symptoms like asthma
• Mood symptoms like depression
• Brain symptoms like in autism
• Iron deficiency anemia
• Vitamin B12 deficiency
• Fatty stools

​There is a test for SIBO that involves collecting breath samples over several hours after drinking a sugary solution called lactulose. The testing is about $200. If the test is positive, then we obviously treat! The test results will tell us which kind of bacteria are present! The testing is important as it determines the severity of the infection and which treatment would be most effective.

Testing requires the individual to follow a limited 24-hour prep diet the day before testing, which includes:

• Baked or broiled meat or fish (raw fish is allowed)
• Plain, steamed white rice
• Eggs
• Clear meat broth (no bouillon, bone/cartilage or vegetable broth)
• Fats and oils (coconut/olive/vegetable oil, butter, lard)
• Salt and pepper
• Weak black coffee/tea (no sweeteners or cream)

Nothing outside of this list is permitted during the 24-hour prep diet, because anything else could feed the bacteria and we want to calm any bacteria down a bit before the big test day!

The night before the test collection, the individual must fast for 12 hours, which isn’t usually too difficult because mostly the individual is asleep! In the morning, the person is ready to start the test collection, which involves drinking the lactulose solution and providing breath samples every 20 minutes over 3 hours. Test results usually arrive about 7-10 business days after the lab has received the samples.

​There are many approaches to treating SIBO out there, from the low FODMAP diet to the elemental diet, Cedar Sinai diet, prescription medications, herbal therapies, and more. The way I treat SIBO is a multi-phase approach:

• Prepare the body for treatment (takes about 2 weeks)
• Remove the bacteria from the places we don’t want it (takes 2-4 weeks)
• Repair any inflammation that the infection caused (takes about a month)
• Restore healthy micro biome
• Prevent relapse by addressing the root cause of the infection

​Some of the potential underlying factors that can cause SIBO in the first place include:

• Stress, chronic anxiety, and trauma that lead to delayed peristalsis (aka gut motility)
• Low thyroid function (hypothyroidism)
• Low stomach acid or frequent use of proton pump inhibitors (heartburn medications)
• An episode of acute gastroenteritis (ie. stomach flu)
• A history of voluntarily withholding stools
• Scar tissue in the abdomen from surgeries or injuries
• Ileocecal valve dysfunction
• Diet can certainly contribute but is rarely the cause all by itself

It is important that we determine the root cause of the issue and treat it to prevent SIBO symptoms from returning again and again.

In summary, I really love testing and treating for SIBO. It’s really pretty easy, and most people see a complete resolution of their digestive symptoms, which is so, so satisfying. Most people who eventually come in and get tested for SIBO have usually been struggling with digestive symptoms for many years - sometimes up to 20 or 30 years. You can imagine how wonderful it is when these individuals feel well in their digestive system after all that suffering.

To learn more about SIBO or to discuss digestive health, please contact me or schedule an appointment. 

Let's talk about symptoms. 

Vaginal yeast infections are common and usually present with vaginal itching, burning, redness, and often thick or white discharge (often referred to as “cottage cheese” discharge). However, an absence of any of these symptoms doesn’t mean there isn’t a yeast infection present. Sometimes it’s just itching, for example. The way to know for sure is to get a vaginal swab for yeast through your doctor, and this can quickly confirm whether your vaginal symptoms are related to yeast. However, most people who have had a vaginal yeast infection can recognize when the symptoms come back and don’t need a test every time.

How are they treated?

Treatment of vaginal yeast infections usually includes vaginal anti-fungal creams or oral medications, conventionally speaking. But there are a host of other treatment considerations that can be incredibly useful, which I’ll get into in a moment.

What happens if a vaginal yeast infection keeps coming back?

When vaginal yeast infections are frequent, say once per year, once per month, all the time, etc, it is useful to ask my favourite question: WHY? Vaginal yeast infections are usually caused by an overgrowth of a particular yeast called Candida albicans, which is part of our natural microbiome but which can cause a lot of issues if it’s allowed to get out of control! Some of the reasons why Candida grows out of control are:

• Taking antibiotics
• Eating too much sugar and carbohydrates
• Blood sugar irregularities like in diabetes
• Frequent use of steroids

Yeast is usually kept in check by the healthy bacteria in our digestive tract and vagina. When we eliminate the healthy bacteria (by taking antibiotics, which kill both the bad bacteria and the good bacteria), yeast can flourish! If we add to this a high-sugar diet (even too much fruit), we can make matters worse! Steroid use and high blood sugar caused by diabetes can also lead to yeast growing out of control.

We might need to go deeper.
​
Often, and especially if vaginal yeast infections keep occurring, our best bet is to turn our attention to what’s happening in the digestive system. It is not uncommon for sufferers of vaginal yeast infections to also have symptoms of irritable bowel syndrome (IBS) like chronic bloating, gas, and loose or explosive stools. In fact, many yeast infection sufferers have been diagnosed with IBS and have accepted these symptoms as a normal fact of life. I’ve said it before and I’ll say it again — digestive symptoms like those we see in IBS are never “normal” and are always a sign that something is out of balance. People who have an overgrowth of intestinal yeast may also experience:

• Acne
• Brain fog
• Fatigue
• Symptoms with menstruation like menstrual pain or PMS
• Joint pain
• Mood issues like anxiety, depression, and irritability
• Other “fungal” issues like toenail fungus, jock itch, or oral thrush
• Poor immune function like frequent colds and flus or colds that last too long

How is it tested? 

Intestinal yeast overgrowth has traditionally been diagnosed by evaluating for yeast in the stool. These days, most conventional labs don’t offer this, but there are still many specialty labs that offer stool testing for yeast.

Ok, get to the good stuff. How do I treat this? 

By treating yeast where it starts (ie. through the diet, in the blood sugar, or in the gut), we can help the microbiome get back to a healthy normal state and prevent yeast overgrowth in the vagina for good.

The treatments I use when treating frequent vaginal yeast infections are:

• Antifungal herbs or medications for the digestive tract
• Antifungal herbs or medications for the vagina
• Therapeutic diet that starves yeast and prevents it from coming back
• Probiotics that re-establish a healthy microbiome and prevent yeast from coming back
• Cessation of medications that are causing yeast in the first place (steroids, antibiotics)
• Correction of blood sugar dysregulation, if applicable (like in uncontrolled diabetes)
• Supporting adequate stomach acid and digestive enzymes
• Therapies that help bust up biofilm, when needed

​
Treating yeast at the source usually results in:

• Resolution of vaginal yeast infections
• Normalization of digestive function (no more bloating, no more excessive gas, normal poops!)
• Improved energy
• Improved skin
• Improvements in menstrual symptoms
• Reduction in pain
• Improved immune function
• Better focus and clearer mind

​                ...and so much more!

There you have it! If you experience frequent vaginal yeast infections, please know that this is not an issue you just have to accept. Tests and treatment are available, and I love treating yeast and helping people reclaim their health.