Published data based on duodenal aspirated juice in patients with persistent unexplained GI symptoms has shown that 25% have exclusive small intestinal fungal overgrowth (SIFO), 30% have exclusive SIBO, and 45% have mixed SIBO and SIFO. Stool tests are not an accurate test for SIFO due to the fact that there is an abundance of fungus in a routine stool sample. Normally, there should be virtually no candida or fungus in the duodenum and small intestine. There is no blood test or breath test that will detect the presence of fungus in these organs. If endoscopy is not an option, and there is a high index of suspicion of SIFO, a reasonable approach is to give empirical antifungal treatment for 3 weeks. Fluconazole, rather than nystatin, is the drug of choice. Natural antifungal agents can also be used. Dietary modification can be helpful to prevent recurrence of SIFO as food is the primary source of fungal exposure to the GI tract, although there is a dearth of high-quality research on the influence of diet on fungal colonization in the duodenum and small intestine. Oral and genital sources of candida species should also be considered. Various factors promote C. albicans virulence and should be understood.
Published data based on duodenal aspirated juice in patients with persistent unexplained GI symptoms has shown that 25% have exclusive small intestinal fungal overgrowth (SIFO), 30% have exclusive SIBO, and 45% have mixed SIBO and SIFO. Stool tests are not an accurate test for SIFO due to the fact that there is an abundance of fungus in a routine stool sample. Normally, there should be virtually no candida or fungus in the duodenum and small intestine. There is no blood test or breath test that will detect the presence of fungus in these organs. If endoscopy is not an option, and there is a high index of suspicion of SIFO, a reasonable approach is to give empirical antifungal treatment for 3 weeks. Fluconazole, rather than nystatin, is the drug of choice. Natural antifungal agents can also be used. Dietary modification can be helpful to prevent recurrence of SIFO as food is the primary source of fungal exposure to the GI tract, although there is a dearth of high-quality research on the influence of diet on fungal colonization in the duodenum and small intestine. Oral and genital sources of candida species should also be considered. Various factors promote C. albicans virulence and should be understood.
CE Credits
CONO: Category A General – 1.0 credit
British Columbia: Category C General – 1.0 credit
AANP: General – 1.0 credit
OANP/OBNM: For Oregon attendees seeking OBNM approved CE credits, please note that this event has not been submitted for approval to the OBNM. CE certificate will be issued upon individual request.
Dr Michael Traub, ND, DHANP, FABNO
Dr Michael Traub obtained his undergraduate degree in biological sciences from the University of California, Irvine in 1976 where he conducted neurobiology research of learning and memory for Professor James L. McGaugh. He graduated from the National College of Naturopathic Medicine in 1981 and completed a residency there in Family Practice and Homeopathy. He became board certified in homeopathic medicine by the Homeopathic Academy of Naturopathic Physicians in 1989.
Dr Traub was recognized for his many years of service to the American Association of Naturopathic Physicians, including President from 2001-2003, when he was honored with the 2006 Physician of the Year Award. His father was a dermatologist, and this inspired Dr Traub to undertake extra study in this subject. He has taught dermatology at five of the seven accredited naturopathic medical schools in North America and is the author of “Essentials of Dermatologic Diagnosis and Integrative Therapeutics.” He is a recognized authority in the naturopathic profession on dermatology. He serves on the scientific advisory boards of several natural product companies, and has been actively engaged in clinical research for most of his career. Dr Traub has been medical director of Lokahi Health Center in Kailua Kona, Hawaii for the past 37 years. He is also board certified in naturopathic oncology by the American Board of Naturopathic Oncology.
