For decades now I’ve been saying that good health starts with the gut. Treat it right and it will return the favor with a well-functioning body, mind and ultimately, a long and healthy life, aka ‘lifespan.’ Assuming that’s what you’re after and looking to keep all your systems humming, you may also know that at times, life can throw the occasional curveball, and interfere with even the best intentions. You fall off the wellness wagon (however briefly) and before you know it, your belly is misbehaving. A lot.

So what’s causing the belly trouble? There are any number of possible culprits, but one of the biggies that’s often overlooked is SIFO, or small intestinal fungal overgrowth, which, left unattended can make you unwell for quite a long time. So, instead of letting SIFO get the better of you, now’s the time get it on your radar if your gut starts to give you a hard time. Here’s the lowdown on SIFO – and what to do about it:

What’s SIFO all about?

Though the term SIFO may not ring a lot of bells, many of my readers have heard about SIBO, or Small Intestinal Bacterial Overgrowth. If you have common IBS-style gut issues – bloating, excess gas, diarrhea, constipation – and you know that SIBO is one likely cause, then you owe it to yourself to learn something about SIFO, Small Intestine Fungal Overgrowth. It’s quite possible that SIFO could be the bad actor causing, or at least, contributing to, your problems.

How does SIFO start?

The human gut is home to trillions of micro-organisms, most importantly bacteria, that play a key role in digesting otherwise indigestible dietary fiber and keeping our gut immune system on track. The problem is, most of the bacteria live in the colon, or large intestine. The small intestine has a more limited population of these critters. If and when the intestinal ecosystem gets out of whack and their numbers increase, this excess bacteria can cause a lot of gut unhappiness.

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That’s SIBO. Change the “B” to an “F” and you’ve got SIFO, Small Intestine Fungal Overgrowth. The concept is similar. Fungal microorganisms like Candida that usually don’t cause problems in the colon can become a nuisance, or worse, when they take up residence, in too great numbers, in the small intestine. The symptoms are pretty much the same as SIBO’s.

Why haven’t I heard of it before?

Though most patients have never heard the term, conventional medicine has been aware of SIFO for some years. But it was thought only to be a problem for the immune-compromised, that is, people who were on immune-system suppression drugs to treat auto-immune disorders or cancer. Not so. More recent research tells us that the rest of us can be vulnerable too. Fully one-quarter of the people who were studied, people with unexplained gut issues, didn’t have SIBO. They had SIFO.

How is SIFO diagnosed?

With SIBO, in-office breath and stool tests can offer some good diagnostic clues but the results aren’t always easy to interpret. With SIFO, it’s even tricker, although, almost always there is a history of multiple courses of antibiotics in the past. However, with SIFO, the good news is that what’s going on at the surface of the body, or just underneath it, can be an excellent indication as to what’s going on in your gut. If you’ve a fungal rash on the skin (typically, skin-meets-skin areas like under the armpits or the breasts) or recurrent vaginal yeast infections or thrush on the tongue (look for a white coating), that’s a good indication that the fungi are out of control in the small intestine as well.

How to treat SIFO?

Even better news is that the most reliable treatment for SIFO is the same dietary upgrade that works for SIBO, and for that matter, your over-all health. A diet that supports the happiest and best-balanced gut microbiome translates to a small intestine that is less hospitable for fungi and bacteria alike.

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1. Lose the Sugar, Decrease the Carbs:  You’ve heard this dietary advice from me before, and it’s doubly true for SIFO. Reduce your carb intake, especially carbs in their most concentrated form, sugar and grains. You think you’re drawn to the sweet taste of sugar. Those noxious fungi like it even more. So, out with the table sugar, the honey, the maple syrup, the agave, and all the other foods that pack a sugar punch. Non-starchy vegetables (think leafy greens, the cruciferous veggies, asparagus, etc.) are the preferred prebiotic food to keep your gut microbiome healthy and resistant to fungal invasion. Probiotics, whether fermented foods or a probiotic supplement, can be a problem in the initial phases, so avoid them.
2. Don’t Stint on the (Stomach) Acid: The acidic gastric juices secreted inside the GI tract act as a natural check on fungal overgrowth. So, when we reach our senior years, our bodies secrete less and we’re more at risk for SIFO. With an integrative health-care provider, you may want to explore options like taking a hydrochloric acid supplement such Betaine HCL or digestive enzymes to increase digestive efficiency. And, no matter what your age, if you’re regularly taking a heartburn or GERD remedy that tamps down your body’s natural production of stomach acid, you’re putting yourself at risk for SIFO. The PPI (proton pump inhibitor) drugs are the worst offenders.
3. Get Your Gut Moving: The recent research on SIFO points sends up two warning flags, about low stomach acid and slow gut motility. A slow gut means your GI system is taking longer than usual to send bodily wastes packing, in other words, less frequent bathroom breaks. And the longer these wastes stay in the gut, the better the fungi like it. The antidote: space out your meals by three hours or more so your system has time to digest one meal before another one comes down the pike. Don’t eat within three hours of going to bed and cut out the snacking at all hours. A body benefits from having an empty stomach for some part of the day, in order to trigger the internal muscular wave that clears food out of the system.
4. Get the Rest of You Moving: Nothing stimulates elimination like moving the rest of the body. You’d don’t have to be a triathlete. A simple 10-15 minute walk after a meal can do wonders. And any kind of movement or exercise is a great way to tamp down stress which itself can throw the gut off balance and bring on those IBS-like symptoms. And don’t forget to say hydrated – drink plenty of water to ease the passage of food through the system.
5. Ditch common fungi-friendly drugs:  Frequent use of antibiotics and pain-killers like the NSAIDs, regular use of hormone replacement drugs like birth control pills, and yes, good old alcohol all increase the risk you could run afoul of gut fungi and kick off the overgrowth you really want to avoid.
6. Herbal antifungals: For patients with suspected SIFO, I’ll usually start with herbal anti-fungals like olive leaf extract, grapefruit seed, oregano oil, artemisinin and berberine – all can help rebalance the scales. And don’t forget adding plenty of tasty herbs and spices to your food. They too have anti-fungal properties – fresh garlic, ginger, rosemary, oregano, cloves and cinnamon – so take (tasty) advantage.

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In severe SIFO cases, mainstream medicine’s heavy artillery is often warranted – a course of anti-fungal pharmaceuticals. I usually start with Nystatin, which is pretty benign, but sometimes a course of Diflucan is needed. Think of that as the absolute last resort, instead of the first line of attack, and follow all of the steps above. Chances are, they will provide that relief and good belly balance that you’re after – no anesthesia required.