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154: Candida Rashes + SIFO w/ Dr. Christine Maren

Many of us are familiar with SIBO (small intestine bacterial overgrowth). But have you heard of its cousin, SIFO (small intestine fungal overgrowth)? My guest today will explain in detail what it is, and how it may be related to skin rash issues.

Or, listen on your favorite app: iTunes (Apple Podcasts) | Spotify | Stitcher | TuneIn | Subscribe on Android

My guest today is Dr. Christine Maren, an osteopathic physician and the founder of a functional medicine practice in Colorado, Michigan and Texas.

She is also the co-founder of Hey Mami, an online resource to help women navigate a healthy and happy mamihood.

Dr. Maren was introduced to functional medicine after struggling with pregnancy complications and recurrent miscarriages. A functional medicine approach helped her address underlying health issues associated with gut infections, food sensitivities, hypothyroidism, hormone imbalance, and mold exposure.

Now a mother of 3, she’s devoted her professional life to helping other women optimize their health during pregnancy, thrive postpartum, and get their life back.

Dr. Maren is board-certified in Family Medicine and is an Institute for Functional Medicine Certified Practitioner (IFMCP).

Join us as we talk about SIBO, SIFO, and skin rashes.

Has your skin rash been triggered by fungal overgrowth? Let me know in the comments!

In this episode:

  • What is SIBO (small intestine bacterial overgrowth)?
  • What is SIFO (small intestine fungal overgrowth)?
  • Are they gut issues?
  • Can you test for SIFO?
  • Is there a connection between SIBO, SIFO, and rosacea?
  • Causes of SIFO
  • Treatment options that you should consider

Quotes

“SIBO is small intestine bacterial overgrowth. SIFO is small intestine fungal overgrowth. So you could have one, or you could have both concurrently.” [2:37] 

“I see patients with fungal overgrowth who have all sorts of stuff. They have skin issues, sometimes psoriasis, sometimes eczema, whatever it might be. So skin issues, digestive issues, sometimes even urinary symptoms and yeah, I think that treating it helps things go in the right direction. It's like your body spins back into orbit once we can rebalance things.” [26:18]

Links

Find Dr. Maren online here and here

Download Dr. Maren's FREE ebook, 12 Ways to Detox Your Home

Healthy Skin Show ep. 019: SIBO-Rosacea Connection w/ Dr. Leonard Weinstock

Follow Dr. Maren on Instagram here and here | Facebook here and here

154: Candida Rashes + SIFO w/ Dr. Christine Maren FULL TRANSCRIPT

Jennifer: Thank you so much for joining us, Dr. Maren. I really appreciate you being here.

Dr. Maren: Thanks, Jen. I'm so excited to be here.

Jennifer: So today I wanted to talk to you a bit about fungal organisms and how that can impact your skin. And a lot of my listeners know that fungal organisms and bacterial communities can impact what's happening at the level of your skin if they live in the gut. So we know about that gut skin connection, but we haven't really talked a whole lot about something called SIFO. So SIFO is, I think, in some respects we could say it's kind of like a cousin or a sister to SIBO and we've talked a little bit about SIBO, but why don't you share with everyone what is SIBO, what is SIFO and how are they different?

Dr. Maren: Yeah. So SIBO is small intestine bacterial overgrowth. SIFO is small intestine fungal overgrowth. So you could have one, or you could have both concurrently. The way that I differentiate in patients is really through testing to try to figure that out because the symptoms are quite similar, bloating, gas, loose stools, or sometimes with SIBO especially methane predominant, there can be constipation, but I find with fungal overgrowth, it's often more loose stools and sometimes urgency.

Jennifer: Okay. And so this is predominantly a gut issue, correct?

Dr. Maren: Yes. For sure. I mean, fungal overgrowth can be systemic and other ways, but yes. I would say, I guess it depends on the symptoms, right?

Jennifer: It would, but a lot of times people go, wait, something in my gut can cause an issue at the level of my skin. I mean, with SIFO for example, is there a way to test for that? Because SIBO, we have breath tests, which there's some argument about how effective those breath tests are at even figuring that out and there's different forms of SIBO, but with SIFO, do we have a way to even determine that you have it?

Dr. Maren: Kind of. So there are some clinical studies Dr. Rau has done where you basically get an aspirate from the small intestine and culture it for yeast. I mean, that's obviously super invasive. It's really just used in research. It's not something that's used clinically or especially relevant or necessarily helpful at this time. What I do in my clinical practice is organic acid testing because we can get fungal metabolites and then sort of matching that to some of these symptoms. So if their symptoms are digestive in nature and they sound like SIBO, I may or may not do a SIBO breath test. If that comes back negative and they still have symptoms like SIBO, that's when I really start to think about SIFO or fungal overgrowth. So doing organic acid testing, if you can see evidence of a lot of fungal overgrowth that tests for metabolites from fungal metabolism, basically, and if those are very high and somebody has digestive symptoms like bloating, that's when I pretty much assume it's SIFO, but yeah, very direct test is hard to do. There's nothing perfect.

Jennifer: No, no. And so it's interesting. You also kind of mentioned to me that there could be a connection between SIFO and rosacea and there's definitely, actually, we've talked about it on the podcast with Dr. Weinstock about the connection between SIBO and rosacea, but how have you, or I guess what connection have you found? Is it in your clinical practice that you find these connections? Is there any research that you know of?

Dr. Maren: There's no research that I know of, Jen. All the research I can find is on SIBO and rosacea. And we know there's a strong correlation there. We know that when people get treated for SIBO in those studies that their rosacea gets better. But then the question is what about the patients with SIFO? And I clinically, I see a variety of different skin conditions with SIFO or with fungal overgrowth and it could be rosacea. I see a lot of keratosis pilaris, that chicken skin on the back of the arms, acne, and what's the other big one, eczema kind of conditions that clear up. So yeah, it's purely clinical and I think we definitely need more research. I mean, the research is totally lacking around fungal overgrowth and SIFO to begin with, right?

Jennifer: And that is true. I think it becomes more difficult to figure out which way to go with a lot of these right now, because our, well, to be fair, research is it takes a long time to do. You have to have money to be able to do it. And so it's not always that simple, a lot of times you're in practice and you're just kind of like, “Okay, what do I do? I have these symptoms, I have this testing,” and you've got to kind of piece it together yourself in a true detective sense, which is really amazing that you also think about things from that perspective. It's not just like, I don't know. I don't know what's causing these issues. You're really looking deeper and saying, “Okay, let me make an educated guess based on all of the given information.”

Jennifer: So with fungal organisms, like for somebody listening to this and going, “Wait, all right. So you're saying I have fungal organisms living in my small intestine. Is that at all normal to have fungal organisms living in the small intestine?” How did we get here? How did you end up with SIFO, at least from what you can gather?

Dr. Maren: So a healthy gut absolutely has fungal organisms in it. Somebody with a healthy gut has candida growing in their gut. When it is overgrown or becomes invasive, that's when it becomes problematic. So, I tell my patients, we just kind of have to do some investigative work and really think about triggers and timelines and think back to when did this become a problem and what could have triggered it.

Dr. Maren: So for somebody to have either bacteria or yeast in the small intestine, small intestine is relatively low in microbial organisms. They're mostly in the large intestine, but for various reasons, they can populate the small intestine, whether that's a motility issue or whatnot, but yeah, to have fungal overgrowth, I really look with patients and look at triggers.

Dr. Maren: So big triggers I see are a lot of antibiotic use. For instance, I talked to somebody yesterday who had tonsillitis his entire teenage years. He had his tonsils taken out of his twenties, because he had antibiotic exposure twice a year. I also think, actually for him in particular, he had inhaled corticosteroids because he had asthma and so that was maybe the tipping point for him when he started those inhaled corticosteroids. They obviously have some benefits for some people, but that is a known risk is to get esophageal candidiasis or at least have an overgrowth of candida, which for him was in the esophagus.

Dr. Maren: I also see patients with mold in their home. So if patients live in a home that has mold and other microbial overgrowth, that can be an issue too. Number one, it suppresses the immune system and so that's when we see yeast overgrowth, but number two, you're breathing and eating and you're just in this, you know, you've got spores in your air, on your food, kind of everywhere all the time. So those are some big ones.

Dr. Maren: Steroids are another one that's a potential. I also look for oral issues. So people with dental health problems, or maybe a root canal that's not super healthy or a crown that wasn't placed correctly or something like that. You can have candida or yeast overgrowth in your mouth and then we're constantly swallowing that. You can see the upper gut that way.

Jennifer: Now, since most of my audiences, very, I should say, they're pretty tuned in to the whole steroid, well steroid creams. A lot of people have done oral steroids, a lot of different things, because that seems to be the standard of care for a lot of chronic skin rash issues. And you've mentioned that that could potentially create an imbalance so to speak in the microbiome. Do you have any thoughts on why that might be and is it so you're saying inhaled, so is that through …?

Dr. Maren: Like Flovent. Yeah. So people with asthma of a certain grade, at first they'll have albuterol, which is a rescue inhaler, but if they have persistent asthma and it's a daily kind of thing, then they go on an inhaled corticosteroid and that inhaled steroid is like a Flovent inhaler. So, for people with persistent asthma symptoms, I think it's important to take that actually. I wouldn't recommend against taking it necessarily, but I think you have to understand that that can create some imbalances and hopefully get to the root cause of the asthma, so you can fix that, which might actually be a yeast issue, right? That might go back to your gut too.

Dr. Maren: So yes. I mean, I think steroids, risk benefit all the time, right? So I'm not advocating that people stay off of steroids when they really need them, but it can, it's like a lot of different things fill the bucket. So it's diet and lifestyle and then medication use and then antibiotics and all these things add up and then you move into a moldy house and it's like, the bucket is full.

Jennifer: And I think that's a good point. We're all unique and that's an important point that I always try to drive home here on the show. We can't assume that one person's issue or one person's solution is equally your problem or your solution. We just don't know. And so the best thing to always do is to talk with your practitioner about these. But I like the fact that you're providing us with some insight as to a possible problem or a possible trigger in your past. So, is that something, if someone's listening to this and they're like, “Oh wait, you know what? As a kid, I was constantly on an inhaler and I had a lot of allergy issues, a lot of asthma,” that could be a potential red flag then is what you're saying for yeast overgrowth.

Dr. Maren: Yeah. Yeah. It's a risk factor. The other one I didn't mention are proton pump inhibitors. So many people have been on acid blocking medications for a long time and we do have research that looks at candida overgrowth, specifically SIFO with use of proton pump inhibitors. That's one place where we actually do have research. So we know, you decrease acid in the stomach and you can increase your yeast counts. And so sometimes those are necessary medications for people who have bleeding ulcers and things like that. But, I try to really look at what's the root cause of that? What's the root cause of somebody's digestive issues or GERD or whatever, so they can get off of those types of medications longterm.

Jennifer: And so if you feel like, wow, SIFO might be something that you should consider. What would you say aside from getting an organics panel of some sort, there's a couple of different versions out there that are offered, but if you do find out you have SIBO or SIFO, I should say, what do you kind of feel are the best options? Do you feel like medication is the best way forward? I mean, some people can't even get their doctors to get on board to get medication. Are botanicals or herbs a good choice? Do you feel like diet alone is effective? I personally haven't found diet alone to be very effective. What are your thoughts on all of this?

Dr. Maren: Yeah. So with regards to diet, I agree with you. I don't think it can be solved with diet alone and then people get into these super restrictive diets and it becomes hard, stressful and then your gut microbiome is even more narrow and I'm not a fan of super restrictive diets. That said, there are definitely things to avoid if you have fungal overgrowth. Most of my patients react to things like gluten and dairy, so taking out some of the more reactive foods and really limiting sugar intake and then alcohol and fermented beverages, so beer and champagnes off the table. Those kinds of things are important. So diet obviously plays a role.

Dr. Maren: But I think in terms of SIFO, I think botanicals are big. I think that's very helpful, especially because there's a lot of overlap. You could have SIFO, you could have SIBO, you could have both. And so if you don't have a way to test that, you can take herbs that are pretty broad spectrum and relatively safe when not taken long term. I mean, of course people need to consult their practitioners, make sure there's not interactions with other things. They're not safe when pregnant and breastfeeding, but many times they could be used safely in a lot of people. And like I mentioned, they're broad spectrum, so they'll have activity against bacteria and parasites.

Dr. Maren: When we get into pharmaceuticals, I think that's when I really need some more evidence. I don't treat somebody with pharmaceuticals generally, pharmaceutical antifungals, unless I have something really demonstrating that it's fungal overgrowth. In which case, there are several to consider. One of them is Nystatin, which is an oral medication that stays in the gut. It's relatively safe. I mean, we use it in kids even and so there's not systemic absorption. It's not hard on the liver, but it only works in the gut, but that can be effective for some people.

Dr. Maren: Another one is Diflucan or Fluconazole. Many people have heard of that because they may have been treated when they had a yeast infection, a vaginal yeast infection. And that would be like one or two pills that are usually prescribed, but that can be helpful for some people. There's a lot of Diflucan resistance and so sometimes it's not helpful, but it can be very helpful for people, but it's hard on the liver and it's not one that I use in everybody. I mean, I'm pretty judicious about that one, but just like antibiotics have different coverage for different types of bacteria, it's the same with antifungals. So there's different kinds of antifungals that have different coverage.

Dr. Maren: So Itraconazole is a different kind of azole. I mentioned Diflucan or Fluconazole. Itraconazole is called Sporanox. That also it's a pretty big gun, but some people need that, especially for those who have had overgrowth with Aspirgillus or exposure. So it can be very helpful. I think I personally used antifungals in part of my treatment and they were a game changer for me, but I again think they should be really used judiciously by somebody obviously who knows how to safely prescribe them.

Jennifer: And what's interesting is you've also mentioned, and I think it's an important point to make is it's not just candida albicans that we have to worry about here, because there are other types of fungal organisms. What are some of the other fungal organisms that you see pop up in people? Do you agree with that? Most people think is just candida albicans, but it's not.

Dr. Maren: Yeah, no. I say candida is like Kleenex to tissue. It's just like the name brand for fungal organisms, you know? So candida is sort of this umbrella term that I think it just implies fungal overgrowth when people say overgrowth of candida, but Geotrichum and Rhodoturula are other types of species that'll come up sometimes. But then again, I think also really looking environmentally, so I mentioned Aspirgillus and that's something we find environmentally in moldy homes. And then of course, I mean, there's other things like Stachybotrys and other ones that have specific metabolites you would find on mold testing. But yeah, I mean, that's why different herbs and different antifungals sometimes have to be employed because it's not just candida.

Jennifer: And with that said, as far as a longterm plan, do you feel like most people, when you understand what's happening and you, whatever your plan may be, whether it's a combination of pharmaceutical and anti-microbial or antifungal herbs or whatever, do you find that most people don't have to constantly be on an anti-candida diet and the rest of their life they're constantly being, I don't know, almost under constant attack at war essentially. Because I find there's a lot of people out there that feel like they have to be on an anti-candida diet for the rest of their life to control. And I'm like, my feeling is, well, maybe you didn't do something to actually deal with it, but what's your experience? Do you feel like it's something you have to manage for the rest of your life if you do really address it?

Dr. Maren: I do think there is a degree of having to manage it and sort of live with it. And I say this from a very personal place. Like I said, I'm not really big, like longterm restrictive diets are hard. They're really hard. And I don't know that they're really good for us ultimately, right? So I think that, yeah, longterm, I mean, if somebody develops sort of symptoms that are very bad and gets leaky gut and they start to have an immune response to gluten, can they eventually go back on gluten? Probably not. Probably that one's going to be out. But fruit. I mean, I think eating whole fresh fruit is probably good. For somebody who has candida and has a really high sugar diet 10 years later, I don't know. I mean, I don't think that's great for them. So I think it's important to adopt good habits and keep them lifelong, but I don't really support the lifelong really strict anti-candida diet necessarily.

Dr. Maren: I do think that people will have a tendency to go back toward candida overgrowth and have to be somewhat vigilant about that and be very careful about their antibiotic use, right? So somebody who has already had candida overgrowth and maybe has improved a lot and their gut has improved a lot and are able to tolerate more foods and have better digestion, if they take an antibiotic, while it might be necessary, it's just you have to weigh the risks and benefits and try to do whatever you can to stay away from that. With my patients, I really try to look upstream, like why do you need antibiotics in the first place? Is it a sinus issue? Let's go there. Let's fix the sinus issue so that you don't need antibiotics again, so you don't end up with candida overgrowth again.

Jennifer: And so it's more efficient essentially looking at things that way. And I was curious too, what if someone has chronic nail fungal issues or athlete's foot or fungus elsewhere? Because I think they might be missing some red flags in their own life and I always like to give people, I'm like, wow, let's see if we can check off these boxes and help us kind of narrow the ideas of what could be going wrong. Do you find that if you've had fungal issues elsewhere, that could be a clue?

Dr. Maren: Maybe. Yeah. I mean, yes. I ask patients all the time if they've had rashes and skin issues, fungal overgrowth or fungal infections on their nails, vaginal yeast infections, itching, itchy ears too, carb cravings, sugar cravings, all that stuff sort of gives me ideas of symptomatology. It can be so vague though. Also, sometimes people just have brain fog or they struggle with mood or I mean, maybe it's totally a digestive issue or maybe they have asthma. There's so many different kinds of things that could give us an idea for what's going on. But if it's that patient, who's like, “I was hospitalized and I got IV antibiotics and then I was on oral antibiotics for six months. And then my health went down the drain and I got really bad digestion.” That's when a lot of times where I'm thinking about fungal kind of stuff. Lots of antibiotics, lots of a proton pump inhibitors.

Jennifer: Got you. And is there any thing or any particular type of probiotics or just supplement? Sometimes [inaudible 00:21:14] can be helpful, but, and everyone probably knows this already, not if you're constipated. I don't find that to be helpful, because a lot of times it makes it worse. But do you have any suggestions on any type of organisms that maybe people should check out if they know that they have fungal issues that might be helpful for that particular issue or that you found helpful with patients that have more of a SIFO presentation?

Dr. Maren: Yeah, I think you and I both are fans of MegaSporeBiotic. So, I'm a fan. I use it. I recommend it a lot. I find there are some people who are very sensitive to it or don't do well with it. I don't know. I'm going to just say one in a hundred. It might be more, I don't have exact statistics, but it's pretty rare. People generally do pretty well with it. So I like MegaSpore a lot. I think also it's just about balance in the gut, right? So it's really about how do we populate our gut with a healthy bacteria to kind of help get this yeast in check because healthy bacteria is what keeps yeast in check. And so how do we get more of that?

Dr. Maren: And sometimes it's eating more foods with resistant starch or even more probiotic foods like sauerkraut. When you're talking about SIBO or bacterial overgrowth, most people say, don't eat that kind of food. Don't eat sauerkraut, don't eat a lot of resistant starch because it can help the bacteria overgrow. But ultimately if you find that that makes you feel better, then that might be maybe a clue that that's actually fungal in nature and that you're helping to rebalance things. I don't know for sure, but also the other big one I really like to use is Mega IgG 2000 or SBI Protect. So a serum derived immune globulin to help support the immune system of the gut. So I use those a lot. I also focus a lot on just liver gut support and gallbladder support. Our gallbladder is this under appreciated organ. We just take that thing out sometimes.

Jennifer: Talk about that. Talk about why you feel like the gallbladder is underrated because bile does play an important role, but it can get hijacked when we have SIBO, for example, can hijack bile and bile is important for fat absorption. So talk a little bit about why we should know more about are our unsung hero, the gallbladder.

Dr. Maren: Yes. The gallbladder ejects bile. So you produce liver or you produce bile in your liver stored in your gallbladder. When you eat, your body signals the gallbladder to eject bile into your gut, upper gut. And that is not only something that's important for fat soluble vitamins, but it's acidic and it's antimicrobial. So it's a big deal. It also helps with detoxification, but the fact that it's acidic and antimicrobial I think is really important. So when it comes to sort of, how do we prevent this from coming back, that's where I'm really looking at the liver gallbladder access. And then that goes hand in hand with your nervous system and your parasympathetics versus sympathetic dominance. And really how do we get our body to be into a place where it's rest and digest and where our viscera or organs like the gallbladder and liver are working as they should to eject bile or the pancreas with digestive enzymes, things like that. So I think those are important considerations for prevention.

Jennifer: So for somebody who has already had their gallbladder removed and look, sometimes it is what it is, you can't go, “Oh, that darn surgeon. He sold me on getting rid of my gallbladder.” Some people legit.

Dr. Maren: Sometimes you need it out. For sure.

Jennifer: Yeah. It just is what it is. So what do you recommend that someone do, because I think people don't understand. They go, “Well, I constantly have bile in my system, so I don't need any help or support.” I think there's a misunderstanding about the importance of concentrating that bile and squirting it out at a very precise moment in the whole process of things, right?

Dr. Maren: Yeah, for sure. That's when I utilize ox bile supplements with meals, so anybody who's had a cholecystectomy or had their gallbladder removed, I'll recommend digestive enzymes often, but ox bile specifically.

Jennifer: And so would that also help acidify, because pH balance is important throughout the gut, so is it possible that too could potentially help with some of this, the acidification so to speak?

Dr. Maren: I think so. I think so, but I don't know for sure.

Jennifer: Yeah. We're all still in many respects figuring this stuff out and whatnot, but I think I love the fact that you've highlighted and I think this is the first time anyone has really pointed out the importance of the gallbladder on The Healthy Skin Show and it really is truly important. And so just to kind of start closing this up and making sure people understand this, if you are able to address this fungal overgrowth and we could say SIFO, which is in the small intestine, but you could also have this in the large intestine as well. You found this by addressing it to be helpful in issues like rosacea, eczema, et cetera in your practice.

Dr. Maren: Yeah. Yeah. For sure. I think everything's connected, you know? And so I see patients with fungal overgrowth who have all sorts of stuff. They have skin issues, sometimes psoriasis, sometimes eczema, whatever it might be. So skin issues, digestive issues, sometimes even urinary symptoms and yeah, I think that treating it helps things go in the right direction. It's like your body spins back into orbit once we can rebalance things.

Jennifer: Yeah. That's perfect. Well, I really appreciate you coming on and talking about this. This was exciting topic for me, because I love to talk about that connection between what's going on at the level of the skin and how it's rooted a lot of times someplace else. We know there's a big connection with the gut, but I love that you've brought in these other pieces of the liver and the gallbladder and whatnot because it is in a sense all connected. And so everybody can find you over at DrChristineMaren.com. You're also on Instagram and Facebook, so they can check you out and follow you there. Any final words or gifts or anything that anyone can find from you to be able to get more support from you, because I love talking to you because you always have a lot of wisdom about different things and you look at things in such a unique light.

Dr. Maren: Thanks, Jen. Well, I love your show. I've loved your show for years and years, honestly. Yeah. I have a free gift on my website. That's 12 ways to detox your home. So the question is like, well, how is this related to digestive health? And I actually have, it goes back to your gallbladder. It has to do with detoxification and the importance of avoiding those things. And I also have some really great nutrition tips, like a one page download for nutrition tips on HeyMami.com. So that's H-E-Y-M-A-M-I and there's basically 10 top sort of principles to follow for people looking for better nutrition.

Jennifer: Perfect. Perfect. Well, everybody you're going to have to go check out Dr. Maren and I just appreciate you being here, sharing this information and we'll have to have you come back sometime.

Dr. Maren: I'd love to.

Jennifer: All right, thanks so much.

Dr. Maren: Thank you.

“SIBO is small intestine bacterial overgrowth. SIFO is small intestine fungal overgrowth. So you could have one, or you could have both concurrently.” [2:37] 


Jennifer Fugo, MS, CNS

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.


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