A challenge of clinical practice is seeing patients coming with a firm idea of what they think is going on with their symptoms. “Hey doc, I have SIBO, I know it, let’s fix it”. “Or I tracked my foods, and it I am 100% sure I have dairy intolerance and I want a food allergy panel to prove it”. They have researched their symptoms thoroughly and they believe they know what’s going on. I love an informed patient. Someone that may have done a little research into what they think may be going on with their body. Because yes, you know your body best.
Today let’s start with the basics of giving you an insight into the most common conditions I treat in clinical practice that can present like your not so average abdominal discomfort.
Candida overgrowth aka fungal/yeast overgrowth
There are many types of yeast. When discussing candida overgrowth, we often talk about candida albicans. Know this, we all have yeast on our skin, urinary tract and yes, in our gut. The likelihood that this fungus one day becoming a problem really depends on the state of your body and your immune system.
Symptoms to look for:
- Fatigue, brain fog, white tongue coating, skin rashes, sugar cravings, recurring sinus like infections and allergies, digestive issues like gas, bloating, cramps, nausea, or constipation.
Testing:
Blood test: looking for IgG, IgA, IgM antibodies.
Stool test: looking for candida species in the colon and lower intestine.
Urine testing: the organic acid test gives us an insight on more than just your gut health.
SIBO aka Small Intestinal Bacteria Overgrowth
One of the most challenging condition to treat is SIBO. The protocol is tedious, patients will get well but the chance for relapse is high.
Symptoms to look for:
- Abdominal bloating (gas), belching, flatulence, abdominal pain, cramps, constipation, diarrhea or both. Patients would say to me “no matter what I eat or don’t eat or drink, I’m bloated, and my stomach feels hard and in pain.”
Testing:
There is no perfect test. A SIBO breath test is administered in the comfort of your home over the course of 3-hrs where patients drink a sugar-based solution of lactulose or glucose, and you are required to blow into a plastic bag that will eventually measure the production of hydrogen or methane gas by the bacteria in the small intestine. The report comes back with either hydrogen, methane or both gases rising and doctors correlate it with patients’ symptoms. Hydrogen SIBO has been associated with more diarrhea and methane SIBO with more constipation. With that said, it is not uncommon in my practice to see both levels rising on the report.
Food sensitivities
Unlike the common allergies that we know cause hives and anaphylaxis reactions, food intolerances are sneakier. Reactions to the foods can happen as soon as the food is consumed or a few days after the food is eaten. This makes food intolerances challenging to decipher and diagnose.
Symptoms to look for:
- Fatigue, acne, skin rashes, headaches, painful cycles, acid reflux, nausea, vomiting, constipation or diarrhea, abdominal pain and even joint pain can be due to the offensive foods consumed.
Testing:
You can start with something as simple as a food sensitivity test. Please know that removing the “offending foods” on your list is not enough to truly “heal” from these sensitivities. You must work with a licensed professional to have a gut healing protocol made just for you. More specifically it is wise to have a practitioner who can order a test that looks at a “leaky gut” aka increased intestinal permeability marker like Zonulin which is an even better indicator of increased intestinal permeability.
When I work with patients on their gut ailments, I want them to understand that more than one condition mentioned above could be going on. It is my job to determine which tests will be best to start with. All three conditions have different testing methods and with that all of them have different treatment protocols. My motto is: don’t guess, test and no probiotics won’t fix everything.
Sources:
Inflammation and gastrointestinal Candida colonization
Chronic intestinal candidiasis as a possible etiological factor in the chronic fatigue syndrome
Arabinitol ratio in urine for early diagnosis of Candidiasis infection
A Small Intestinal Bacterial Overgrowth: A Comprehensive Review
