Okay, so a number of you have reached out to ask me whether I’m going to talk about my next steps for SIFO treatment, which I wasn’t originally going to do as I have an expert in mind to invite onto the show, but as a number of you asked, I hope that sharing my story will be somewhat helpful for you! 

So, unlike with SIBO where I had quite a long-term plan in mind, this I am more so feeling out my journey because as I discussed in my previous update, I’m not 100% sure if the issue is gut dysbiosis or SIFO.

So, to recap, let’s start with what SIFO is. SIFO stands for small intestine fungal overgrowth and it’s when fungus like yeast (or other fungi) grow in the small intestine. We do have some normal, non-harmful levels of fungus and yeast in the large intestine, but they become a problem either when they overgrow or when they’re found I the small intestine. 

Unfortunately, the symptoms of SIFO are exactly the same as SIBO, so it can be very tricky to identify between the two. What makes it harder is that testing for SIFO is unreliable. Often the fungus hides in biofilms, which are protective mucosal-like layers, so they don’t show up on tests and even if they do, there’s no way, without a very invasive biopsy, to tell whether the fungus is in the large intestine or small intestine. What we do know is that the organic acids test tends to be the most reliable test, at least according to the practitioners I’ve trained with.

We also know the candida tends to be the culprit behind SIFO in many cases, and just to be clear, that’s the type of yeast which causes thrush, and we also know that about xxx of SIBO cases. 

Now there are some extra tell-tale signs of candida specifically, if that’s the fungus behind the problem, and those are… 

·       Allergies

·       Yeast overgrowth (vaginal, oral or on the skin)

·       Nasal congestion and excess mucus or phlegm 

·       Rashes

·       Joint pain

·       Brain fog and chronic fatigue

·       Headaches

The difficulty is that unless you have the obvious thrush, whether oral, vaginal or on your skin, this symptoms are also typical of histamine intolerance, which you know if you listen to my podcast, is very common with our community and is also very common with SIBO, and hydrogen sulphide SIBO specifically. 

As I had suspected hydrogen sulphide and for sure, have histamine intolerance, any possible SIFO really wasn’t obvious. Until more recently.

As you may know, about two months ago, I cleared my SIBO! But unfortunately, I still had the majority of the SIBO symptoms. I also had an unusual test result, which showed no hydrogen gas in my large intestine, which is where it should be. In a healthy negative result, you should see little hydrogen gas in the small intestine and then a rise in the large intestine, but I had a flat line. So, this indicates two possible issues – either hydrogen sulphide or a bacterial imbalance in my large intestine, essentially, the bacteria in my gut having been wiped out.

Because I’d done so many treatment rounds and most of them would target all three types of SIBO, I felt it unlikely it was still hydrogen sulphide remaining, and my colleagues agreed. Secondly, I had done a round of antibiotics, and I react quite badly to them, having lots of diarrhoea, fatigue, and headaches, and after I finished the course, I got shingles, which you only get when you’re very immune compromised. And 70% of the immune system is in and around the gut. If your healthy microbiome in the large intestine is wiped out, you can bet your immune system will be too.

So, for sure, I was certain that there was some gut dysbiosis happening. But I didn’t believe it was enough to cause all my symptoms. 

And a few clues made me suspect SIFO. 

Firstly, I was doing pretty well with symptom reduction until the third week of the elemental diet, which is full of simple sugars. Suddenly, I began to bloat up again. I also had a strong white film throughout the entire elemental diet, which indicated the sugars were feeding bacteria or yeast in my mouth, and secondly, I started having thrush symptoms during the elemental diet.

Then, from the elemental diet, I went onto the antibiotics, and I got thrush symptoms again!

Now Dr Siebecker warns that the elemental diet may cause yeast or fungal overgrowth in people who already have it, in contrast, Dr Ruscio uses the elemental diet for candida overgrowth, because he says the simple sugars are absorbed too quickly for the yeast to eat it. I think it’s probably the case that both doctors are right, but that it depends on the individual and that they see different types of patients. Either way, it seemed quite clear to me that I had some yeast overgrowth as a result. 

I went to my doctor at Vala, and they agreed that it looked like candida overgrowth in my mouth. 

Additionally, I’ve always had a white film on my tongue, honestly ever since I could remember. I used to ask dentists about it, but they would shrug it off, and tell me it was down to what I had eaten, but I was waking up with it before I had eaten a thing. Back then I just took what they said as gospel. Then a few years ago, my boyfriend and I went through a real sweet tooth phase, long before I had gotten on top of my endo and eating an anti-inflammatory diet, and we were eating a lot of sugar. At that point, I got full on oral thrush, which thankfully was cleared with 24 hours of taking the medication – or so I thought!

I’ve only ever had vaginal thrush a handful times, so again, initially, I really didn’t think candida was an issue for me! However, the fact that I then started getting the symptoms from two things which we know may cause yeast overgrowth – the elemental diet and antibiotics – made me think that maybe I have had SIFO all along, but the white film never got out of control, and it wasn’t really affecting my vagina too much.

Now having said this, according to Dr Jacobi, candida can also cause a burning bladder pain, and for sure, that’s what my pain feels like inside my bladder. Like I have a fire going on in there, and there’s also a few rusty knitting needles sticking through it too! 

So, alongside my colleagues who I trained with in SIBO and my doctor, I concluded I do likely have SIFO and gut dysbiosis. 

The problem is, if you have SIFO, its usually quite hard to clear SIBO or to stay in remission, and even though I still had all the symptoms of SIBO, I felt like I relapsed about 2 weeks into my all clear. The changes were subtle, but they were there. I was still having bloating and loose stools, that hadn’t changed. But what had improved is I could no longer feel fermentation happening in my gut, like active bubbles forming and moving around in my gut, which I used to get all the time – and that returned. The second issue was that my stools changed, and I won’t go into the detail, but it was reminiscent of when my SIBO used to be really bad. Then I started getting the burping back, which was a new symptom originally, that started I think in 2019, but it went during treatment, and came back around the same time as these other symptoms.

So, this occurred whilst I was in my prevention of relapse phase. So, when you clear your SIBO, you move into a three-to-six-month period where you put in place meal spacing, prokinetics (which are supplements or drugs which stimulate your migrating motor complex in the small intestine overnight, to clear out bacteria) and some kind of SIBO diet. There are also some additional extras you can do, which I was doing. I was pretty much doing everything perfectly, but I relapsed. 

So, I was two weeks in, whilst deciding what treatment to start for SIFO. And at that point, sometime after my relapse, is when we decided to go to Greece. 

Now originally, you’ll know my plan was to do a very specific reintroduction of foods, following the usual elimination diet reintroduction phase, where you try one new food basically a week. But now I had relapsed, and I was at a point where I never didn’t have symptoms. I bloated after every meal, despite being on the SIBO bi-phasic, so I couldn’t get any more restrictive. So, trying to tell what I was specifically going to react to was going to be incredibly difficult and frustrating. 

Also, we have been wanting to travel for years, but in addition to COVID, we hadn’t because of my SIBO. I didn’t want to be in a position where I had to eat outside of a SIBO diet and ended up relapsing. But now I had relapsed.

And part of what may cause relapse is chronic stress and an elevated nervous system. I won’t go into it now, but many of you know that I have felt very, very stressed and unsafe in our current home in Margate, but we’ve had continual circumstances that have prevented us from moving – one of them being that we didn’t want to just move to a new flat, we really wanted to move overseas and roam around for a while. Additionally, we had mould, which we’ve cleared as much as we can, but there’s likely a lot of hidden mould as the entire flat was flooded not long after we first moved in, and it was after that that I got very sick with histamine intolerance, which can flare up from mould triggering the immune system. But this is a stressor on the body and nervous system, and additionally, can cause relapse if your immune system is being compromised by something like mould.

On top of that, I’d worked really hard, for really, really long and it had been a tough few years. So, we made quite an overnight decision to go to Greece for six week. You know, our original vision was to pack up, leave the flat entirely and just travel Europe for six months, because that’s all we’re allowed to do thanks to Brexit, but because of the restrictions with COVID, etc. it was just all so limited and so fingers crossed, we can do that this year. But we both decided enough was enough and we wanted a break from the house and a change of scenery, of course it was something we just wanted to do in life, but in a large part for me, my health was my motivation and my therapist even called it an intervention, and that’s for sure what it felt like.

So, I made the decision to go to Greece, knowing full well I wouldn’t have total control about the reintroduction of food, but by this point I was pretty certain I had relapsed and giving that I still had the SIFO road ahead of me, a break away seemed not just like it wouldn’t do much more damage, but that it would be good for me.

So, my plan for SIBO and SIFO basically revolved around Greece because I would have to take all my treatment with me. And I established three goals, I mean I didn’t, I’m not that organised, but that’s this is what I focused on –

·       Keeping SIBO at bay and continuing the prevention of relapse to the best of my ability so it didn’t progress rapidly.

·       Beginning to take on SIFO, but gently, to avoid any die off reactions whilst away.

·       And to rebuild my microbiome and improve my gut lining, which I was already working on anyway.

So as a result, here’s what my current protocol looks like:

 

Diet

Before we went away, I began expanding with one to three new foods a week. Just some of the key ones that I thought I should try before we went, that I would likely rely on in restaurants, like lentils and some nuts.

Then, as we planned for Greece, my aim was to eat as expanded as possible, so basically the more lenient end of a SIBO diet, which looks more like the expanded version of the low FODMAP diet and the paleo diet. This is fine by the way; you won’t relapse if you expand. The point of the prevention of relapse phase is to expand to tolerance as rapidly as possible. Of course, I had no bloody idea what I was and wasn’t tolerating, so I just decided to follow the low FODMAP serving guidance to help me to stay within some kind of relatively low carb (that’s the basis of a SIBO diet) protocol. So, before we went, I basically started transitioning from the bi-phasic, which is very, very restrictive, to low FODMAP.

Because we are here for six weeks, I had the advantage of not eating out all the time. So, I my plan was, and what I have implemented whilst here, was to eat low FODMAP during the week at home, and then at the weekend, to eat as low FODMAP or paleo friendly as I could manage whilst out and about, but also allowing for treats and just basically enjoying and appreciating a different cuisine.

Now my doctor, who is a functional medicine doctor, sent me a candida diet. There are a few different versions, but essentially, it’s a low carb diet to a degree, that removes yeasts and sugars. I had a look through it and because in terms of servings, it’s generally less restrictive than the low FODMAP, I was essentially doing it, other than when I have some bread or ice cream over the weekend. But I didn’t really want to go down a rabbit hole with that, especially as I’m not sure how suitable the candida diet is for SIBO and equally, some practitioners debate whether the candida diet is even necessary. So that’s going to be a bridge that I cross when I get home. But for the most part, I am naturally doing it anyway.

So, we’ve been here for about two weeks now and I’ve settled into a routine of this kind of pattern. The first weekend we were in Athens for 48 hours and were travelling and didn’t really have time to seek out gluten free and dairy free, etc. We did stumble across a few places, thankfully, so that was great. But I ended up eating quite a bit of gluten, and by the third day I felt really nauseas and started getting an upset stomach. I also had dairy too, once, or twice, because it turns out that in Greece, it’s really hard to eat vegan and gluten free in general restaurants. The protein options are mainly meat, fish or dairy and often the fish was things that I just wouldn’t be able to stomach, like octopus, and as you know, I was hoping to transition back off of meat after having to eat on the bi-phasic, so I had some cheese every now and then, as being a health coach, blood sugar is important to me and so you do need protein with every meal. Also, my blood sugar is very suspectable to lows, so just having a plate of carbs would really mess me up and ruin the rest of the day, so I had to make choices about having enough fat and protein and that sometimes looked like a little dairy. Now I know I’m intolerant to dairy, which actually might be due to having SIBO, because it causes temporary lactose intolerance until you clear it, so I wasn’t eating huge amounts and I tried to choose cheeses that I know I tolerate better, and I avoided cow’s dairy and milk for the most part – except for a scoop of ice cream here or th