Small Intestinal Fungal Overgrowth with Dr. Ami Kapadia: Rational Wellness Podcast 268

Dr. Ami Kapadia discusses Small Intestinal Fungal Overgrowth with Dr. Ben Weitz.

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Podcast Highlights

1:58  Small Intestinal Fungal Overgrowth (SIFO).  Some of the most common symptoms of SIFO include some of the common IBS symptoms, including gas and bloating, nausea, constipation or diarrhea, though more commonly constipation, skin rashes, allergies, and brain fog.

2:58  Risk Factors for SIFO.  Some of the risk factors include decreased intestinal motility, the use of antibiotics or acid suppressing medications (such as omeprazole or Prilosec), opiate use, and certain GI surgeries. Some patients have a hypersensitivity reaction to yeast that live in the GI tract and on our mucous membranes.  Decreased intestinal motility refers to the lack of the cleansing waves that happen when you don’t eat for at least 3 hours and that function to clear out excess bacteria and fungi from the intestines.  The lack of these cleansing waves can occur because of stress or not spacing our meals out and just snacking all day.

6:50  Antibiotic use can lead to fungal (candida) overgrowth because when you reduce the population of the good intestinal bacteria, candida can overgrow and fill up some of that space.  Dr. Kapadia recommends that when someone takes an antibiotic, we should have them take saccharomyces boulardii or other potentially botanical antifungal options to help keep that yeast population down so it doesn’t overgrow.

8:11  Testing for SIFO.  Dr. Kapadia usually starts with ordering candida antibodies and a candida immune complex from a routine lab like Quest or Labcorp.  An organic acid test can look for fungal metabolites in urine. including arabinose.  Stool testing often does not tell us that much about what is in the small intestine.  The other issue is that we don’t have a normal concentration of yeast as a standard to define what’s normal and what is above normal on a stool test.

11:25  Nutritional Deficiencies.  There are certain nutritional deficiencies that tend to occur with SIFO, including iron, zinc, copper, B12, and vitamin D, so Dr. Kapadia will often check for ferritin levels, as well as zinc, copper, B12, and vitamin D, which is important for the immune system to regain balance.



Dr. Ami Kapdia is trained in family medicine as an MD and she has also pursued training through the Institute of Functional Medicine and the American Academy of Environmental Medicine and she is certified by the American Boards of Integrative and Holistic Medicine. She now works in Portland, Oregon at the Kwan Yin Healing Arts Center and her website is AmiKapadia.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.


Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me. Let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Thank you for joining me again. Our topic for today is small intestinal fungal overgrowth with Dr. Ami Kapadia. Many of us who listen to the Rational Wellness Podcast are familiar with small intestinal bacterial over growth or SIBO, which is the most common cause of irritable bowel syndrome. We have had a number of episodes with Dr. Mark Pimentel, Dr. Allison Siebecker, Dr. Steven Sandberg-Lewis, and other experts on the podcast speaking about SIBO.  Today we’re going to speak about fungal overgrowth. So this also exists as well as bacterial overgrowth, even though this topic has been less studied and there’s also no breath test to test for it as there is for SIBO. Dr. Ami Kapadia, did I pronounce that properly?

Dr. Kapadia:                        You’re close, you’re close. Kapadia.

Dr. Weitz:                            Kapadia. Ami Kapadia, she’s trained in family medicine as an MD, and she’s also pursued training through the Institute of Functional Medicine, the Academy of Environmental Medicine, and she’s certified by the American Board of Integrated and Holistic Medicine. Her practice is in Portland, Oregon at the Kwan Yin Healing Arts Center. Ami, thank you so much for joining us today.

Dr. Kapadia:                        Yeah, thank you for having me.

Dr. Weitz:                            Great. So why don’t we jump right into SIFO. If you had a patient, what are some of the symptoms that might alert you to the possibility that your patient might be suffering with small intestinal fungal overgrowth?

Dr. Kapadia:                        Yeah, so the symptoms are really similar to SIBO and you can’t really tell clinically which is which, but it’s some of the common symptoms we see like IBS, bloating and gas, nausea. It can really be constipation or diarrhea, but we tend to see constipation more clinically. A lot of my patients who end up having something with fungal overgrowth often have skin rashes. Sometimes they have mast cell histamine related issues, allergies. So there can be sort of like intestinal related imbalances, but then also extra intestinal symptoms. Brain fog is also pretty common. So those are some of the things we look for.

Dr. Weitz:                            Okay. So it looks like you listed some of the risk factors, like decreased intestinal motility are similar to some of the risk factors for SIBO.

Dr. Kapadia:                        Right. So, some of the risk factors are the same. There’s some that are a bit different that we can talk about. Definitely if there’s motility issues where someone’s prone to overgrowth in general, they can end up with issues with bacterial or fungal overgrowth. If they’ve been on a lot of antibiotics or acid suppressing medications that can also lead to potential overgrowth. Opiate use and certain GI surgeries.  Then the one that’s quite different is sort of, I wouldn’t say it’s been fully defined or elucidated, but a lot of us who work with patients over the last several decades have suspected a sort of allergic or hypersensitivity reaction to yeast that live in the GI tract and on our mucus membranes. That would be a different risk factor that we can talk about that we tend to find more in people who are prone to allergies.

Dr. Weitz:                            Let’s go into a couple of those a little more. So one of them, say, is decreased intestinal motility. So the concept behind how that leads to SIBO, at least Dr. Pimentel’s explanation, it may have evolved over time, was that you don’t get the cleansing waves that help clear out bacteria. I guess those are the same cleansing waves that would clear out fungal overgrowth?

Dr. Kapadia:                        Right. With the migrating motor complex. So, if that’s affected for any number of reasons, which a common one is stress or not spacing our meals out and just snacking all day, those little things can still affect motility. Then of course there’s other neurologic conditions and other reasons people might develop motility disorders, but it’s the same idea as with SIBO.

Dr. Weitz:                            Now, in terms of, Dr. Pimentel also talks about this autoimmune issue. Is there something similar for fungus?

Dr. Kapadia:                        That’s a good question. I have not read anything about an autoimmune condition per se. There’s been some research that there might be a role of genetics in some people who are prone to more fungal issues, but I haven’t seen anything per se, like with Dr. Pimento’s IBS smart test, that type of thing, which would help give us a cause from food poisoning or something.

Dr. Weitz:                            Right. So fungal overgrowth, is basically we’re talking about for the most part candida, right?

Dr. Kapadia:                        Yeah. We’re mostly talking about candida, when we’re talking about yeast overgrowth in the GI tract. Occasionally there can be others.

Dr. Weitz:                            By the way, yeast, fungus, are basically synonyms. Right?

Dr. Kapadia:                        Right. So you have over overarching fungi and then under that would be molds and yeasts as the separate categories. The main yeast we’re talking about would be candida. Occasionally for people who do stool testing and other things that may or may not be helpful in determining this diagnosis, we’ll see other forms of yeast, but that’s the main one is we’re talking about candida.

Dr. Weitz:                            Right. Candida occurs naturally in a gastrointestinal tract. In this case, we’re just talking about an overgrowth of candida.

Dr. Kapadia:                        Right. So it’s a commensal organism on the mucus membranes and the GI tract. The problem occurs when there’s an overgrowth again, often with antibiotic use and for other things. But there’s this sort of interplay with people who potentially genetically, some people can be on antibiotics and not have any problems and other people, one course of antibiotics, and they tend to develop a whole host of problems. So, but yes, it’s normally a commensal organism.

Dr. Weitz:                            Now, maybe you could explain how antibiotics would lead to fungal over growth.

Dr. Kapadia:                        Right. So when we take an antibiotic, it’s going to reduce our population of the good bacteria that live in our GI tract and those good bacteria actually secrete certain products that can help keep yeast in check. So when we reduce our population of the good intestinal bacteria, yeast can overgrow and fill up some of that space.  Since the antibiotic doesn’t work on yeast at all, we can end up with this imbalanced picture. Which is why sometimes at this point, if we’re going to have someone who has to take an antibiotic, we’ll have them take something like saccharomyces boulardii or other potentially botanical antifungal options to help keep that yeast population down so it doesn’t overgrow.

Dr. Weitz:                            Right. So, people take antibiotics because they have either a bacterial infection with a pathogenic bacteria or an overgrowth of bacteria, but yet most of these antibiotics also damage the healthy bacteria in the microbiome.

Dr. Kapadia:                        Right. With Dr. Pimentel I’m sure spoke about with Rifaximin we don’t really worry about fungal overgrowth, but with most other antibiotics, it can be a potential problem. Especially the broad spectrum, tetracycline and those types of antibiotics.

Dr. Weitz:                            Right. So since there’s no breath test for SIFO, how do we test for it?

Dr. Kapadia:                        So there’s different things you can do. There’s some questionnaires that Dr. Crook from his books many years ago had come up with various questionnaires. I use those occasionally, but more so I definitely do some lab testing with patients. The way I explain it is that there’s no perfect test for this. Gastroenterologists can do a duodenal aspirate during an endoscopy procedure, but that’s invasive and not many of them do it. So the standard testing I start with, with most patients is what’s called candida antibodies and a candida immune complex.

Those are routine labs that you can get through Quest or Labcorp with the doctor. So that’s where I generally start. If any of those are positive, particularly the immune complex or the IgG antibody, those have some research that potentially could correlate with an intestinal overgrowth. The other antibodies, I still pay attention to them, but I just let patients know this isn’t like a yes, no. It’s more like it’s giving me clues that your body might not be having a balanced relationship with yeast in the GI tract and in other areas.

Dr. Weitz:                            Okay. Is there other testing?

Dr. Kapadia:                        Yes. There’s other testing as well. So there’s something called an organic acid test that can look at different fungal metabolites. The metabolite that’s most been written up about with fungal overgrowth is arabinose. So that I’ll sometimes do, if we just don’t have a clear picture and we’re trying to get a sense of if someone might have this as part of what’s going on. Then there’s different interpretations of stool testing that the challenge with stool testing is that it’s mostly looking at the large intestine and we don’t know where the overgrowth potentially is in that patient, but it’s not really going to give us a representation of small intestinal overgrowth.  The other issue is that we don’t have a normal concentration of yeast as a standard that we could go by to define what’s normal and what’s above normal because almost everyone does have yeast in the GI tract. So there’s a couple challenges. That being said clinically, if we see it on a stool test, some labs that I’ve talked to have said, they do seem to correlate it more with patients who have an issue with overgrowth, even though I can’t prove that based on a normal range.

Dr. Weitz:                            Now, there are different forms of candida, different strains. Does that matter? Is there a particular type that’s more problematic?

Dr. Kapadia:                        The candida albicans is the more common strain.  In different parts of the world there can be more resistant strains.  In the US, for example, for women that come in, if we’re doing vaginal testing, sometimes it can be harder to treat some of those other strains like candida tropicalis, and glabarata, and those types of strains. So as far as if it makes a difference, it could potentially be more challenging to eradicate if it’s not the albicans, but fortunately that’s not super common.  If it is one of those, there’s still things that can work. Particularly if we’re using botanicals, there’s many that could still work. In pharmaceuticals as well they’ve done some studies on women with recurrent vaginal fungal issues, on which protocols to use if someone has a different strain.

Dr. Weitz:                            Now, I understand that there’s certain nutritional deficiencies that tend to occur with small intestinal fungal overgrowth.

Dr. Kapadia:                        Yes. So the nutrients that I always check for, if there’s this form of dysbiosis or other forms as well at times, ferritin, iron stores can be low and you want to be replete that. It’s kind of like a Goldilocks principle with iron. We don’t want too much or too little, but that can be important for the immune system. Zinc deficiency, I find pretty commonly. Then sometimes B vitamins can be low.   So as far as testing, I commonly will check a zinc and a copper, a ferritin, and a B12. I often will supplement with a B complex just to cover our bases because those are all important, and vitamin D. Those are all important for the immune system to help regain that balance that we’re trying to get to.

Dr. Weitz:                            Now, because you have excess fungus lining the intestinal walls, just the same as if you have excess bacteria and because the small intestine is where many of the nutrients are absorbed, that’s one of the reasons why you’re more likely to have nutritional deficiencies.

Dr. Kapadia:                        Right. Then you could develop elevated intestinal permeability and food allergies and all of these things that can affect nutrient absorption in what you mentioned in these other ways as well.

Dr. Weitz:                            So for the patients with SIBO, we often use a low FODMAP diet, low amounts of fermentable fiber. What about for SIFO? What kind of diet do you find most effective?

Dr. Kapadia:                        So for a diet, there’s a couple things I look at. One is sort of, I do what we call a five day yeast mold elimination challenge, just to determine if the patient has become sensitive or allergic to molds and yeast and foods. So we remove things like yeast, vinegar, dried fruit, alcohol, and sugar, fermented vegetables. There’s a whole list that we give people. We’ll remove those for five days, challenge them back and try to get a sense of if their bodies develop a cross-reactivity.  Those foods are also high in histamine. So it’s sometimes tricky to determine what they might be reacting to. If they’re reacting, then we’ll keep those out for a few weeks while we try to treat the overgrowth. So that’s a piece of the puzzle. I’ve had some patients where their IBS symptoms go away completely when they take those foods out. Then we try to correct things enough so that they can eat them again.

Dr. Weitz:                            So what are some of those foods?

Dr. Kapadia:                        Yeah, so yeast, vinegar, dried fruit, alcohol, and anything fermented really would be in that category, like kombucha, fermented vegetables, those types of things.

Dr. Weitz:                            Okay.

Dr. Kapadia:                        We’ll remove those. I try to be really clear. Those can be very healthy foods. We’re just trying to make sure there’s not a cross reactivity. Then we try to get those back into the diet. They’re not feeding the yeast per se. So that would be part of it. Then the other part is, I try to make sure we’re getting a sense of what someone’s food sensitivities are. So we can talk about this, but some people have a cross reactivity to gluten for many reasons, but with a candida overgrowth, there can be a cross reactivity of the proteins.  So I’ll do significant testing to figure that out. So we’ll try to troubleshoot what that person’s sensitivities are, whether it’s gluten and dairy, or both, as well as that yeast, mold related piece. I don’t typically use low FODMAP per se with this, just because it’s so restrictive, unless someone has come in on that already and they’re comfortable and want to do it for a period of time. We try to find other ways so they don’t have to stay on that.

Dr. Weitz:                            You use an anti-candida diet, like low sugar, starchy carbs?

Dr. Kapadia:                        Yeah. Well, I remove sugars except for fruit. I don’t limit starches as long as we’re being reasonable because I don’t want to restrict things too much. So unless they’re telling me that every time they eat any starch, they’re having a lot of symptoms, we try to leave in the starches they tolerate as long as they’re healthy. We do remove added sugars because they suppress the immune system. So no maple syrup, honey, refined sugars, all of that we remove until we get further along.

Dr. Weitz:                            Have you ever felt the need to use a keto type diet for fungal patients?

Dr. Kapadia:                        I’ve had some patients come in on that. I haven’t put people on that specifically for this, but I definitely have a handful that say that, that helps keep their symptoms in check.

Dr. Weitz:                            Right. What are the most effective treatments?

Dr. Kapadia:                        So, I always try to start with foundational things, which we all do. If we skip those, then nothing ends up working, but try to make sure as best we can. Sleep, general nutrition, exercise, and some sort of stress reduction. Then we build on that. We check those nutrients to make sure we’re repleting those. Then as far as building on the diet, once we’ve got that in place, antifungals. I use a lot of botanicals for that. So Thorne sf722 is an old one that we’ve been using for a long time. That works well.

I’ll use neem, berberine, some of the things we use for SIBO can also work well. Coptis. There’s a product called MYCOREGEN from Beyond Balance that works well, and olive leaf, those would be some of the main ones that I’ve tried. I don’t use a lot of pharmaceuticals, but sometimes I’ll use nystatin for one to three months just to see if we get a response from that because it’s more narrow spectrum, it’s only working on yeast. Whereas these botanicals, it could be working on all sorts of different things. So those are the main treatment approaches I use for supplements and medications.

Dr. Weitz:                            Now I was surprised to hear that you’ll use nystatin for one to three months because typically the most common treatment is for one to two weeks.

Dr. Kapadia:                        Yeah. Botanicals I’ll do for a three to four week trial and then I’ll check in with someone. If they’re doing better, if they’ve had long standing issues, we may decide to just do a couple months of treatment if they’re tolerating it well. If they’ve made no progress, we’ll switch to something else.

I would say some of my mentors that I learned from they would be able to resolve this issue sooner, but I think there’s so many different factors. A lot of our patients might be living in a water damaged building or have other chronic exposures that’s going to make it hard for their immune system to recover. So typically it’s at least one to three months and sometimes it can be a lot longer depending on how many other factors they have.

Dr. Weitz:                            Yeah. Exposure to mold often crosses over with fungal overgrowth. Doesn’t it?

Dr. Kapadia:                        Right.

Dr. Weitz:                            That’s another whole layer.

Dr. Kapadia:                        Yes. It’s another layer. It’s challenging to work with, but yes.

Dr. Weitz:                            So as part of your treatment protocol, do you address biofilms?

Dr. Kapadia:                        I’ve been doing that more and more. So in the past, what we try to keep in mind is that we’re not trying to eradicate every last organism of the candida. It’s part of our normal flora. So we’re just trying to reestablish the balance. So I don’t use it right off the bat. If we’re having someone that’s having recurrent symptoms every time we stop treatment or we’re just really not getting anywhere and we think this is part of their problem, that’s typically when I’ll use biofilm treatment for again, one to three months or so, just to see if that helps prevent recurrence of symptoms. That’s been helpful at times. Other times, the biofilm treatment doesn’t seem to have an effect. Other times it just doesn’t seem to be necessary as part of this.

Dr. Weitz:                            What’s your most effective biofilm treatment?

Dr. Kapadia:                        I like Dr. Anderson’s Biofilm Phase-2. So I use that a lot. I do use the prescription version that Dr. Anderson formulated sometimes as well. I’ll usually start with the Biofilm Phase-2 product.

Dr. Weitz:                            Okay. That includes bismuth. That’s one of the key nutrients, right?

Dr. Kapadia:                        It is. It’s bismuth, I think cumin, black cumin seed, and alpha lipoic acid all together.

Dr. Weitz:                            Yeah. Yeah. We’ve used that quite a bit too.

Dr. Kapadia:                        Yes.

Dr. Weitz:                            What about agents to restore motility?

Dr. Kapadia:                        So I think one thing that’s quite common is if we’re in fight or flight all day long and stress is the main contributor, I try to talk to patients about that, but it’s just not very easy to change. So I sometimes will recommend that some sort of limbic system retraining or the Nerva app, just to have them do something on a day to day basis that helps with the parasympathetic component because I think that’s…

Dr. Weitz:                            What is the Nerva app?

Dr. Kapadia:                        Yeah. The Nerva app, they’ve done quite a bit of research. It’s an app that’s based on hypnotherapy developed by, I believe a psychologist, a doctorate psychologist who found that it was just as effective as a low FODMAP diet for IBS. So it’s sort of like a subscription app, I believe that patients can sign up for. A few of my patients have done it with improvement in their symptoms. So that’s one option.  Then I often recommend limbic system retraining, which is a whole other category of working on rebalancing, like the primitive area of our brain that gets stuck in fight or flight. That’s the DNRS program or the Gupta program are the main ones I use for that.

Dr. Weitz:                            Right.

Dr. Kapadia:                        So if we think it’s mostly a stress component, like it is for a lot of people, we’ll try those. I haven’t had a ton of success from the botanical options for motility, but sometimes we’ll try MotilPro or Prokine or some of those. Then sometimes we’ll use Motegrity which is the prescription that’s used with SIBO to prevent relapse. We’ll try that same one and see if we can prevent things that way. There’s not a ton of research on using motility agents, or there’s no research on using motility agents in SIFO, but it would make sense that, that would be something to help prevent relapse.

Dr. Weitz:                            Right. Now, what about the use of probiotics at the same time?

Dr. Kapadia:                        I don’t use probiotics at the same time. Sometimes I’ll use those after. I would say I’ve had… Excuse me, I have to take a sip of water here.

Dr. Weitz:                            I know some people recommend saccharomyces boulardii specifically as a treatment.

Dr. Kapadia:                        Yeah. I found, I think because a lot of my patients have allergies, if I’m suspecting they have this yeast, mold allergy, I don’t often use saccharomyces boulardii. I use it sometimes if they tolerate it, but not during the antimicrobial treatment. Maybe after. Then sometimes I’ll use a spore forming probiotic, and sometimes I’ll use lactobacillus plantarum afterwards. That’s had good research for IBS. So it’s not for everyone. It’s been 50, 50 as far as patients that improve or get worse or don’t improve with probiotics. So we do a bit of a trial and error process after we treat the overgrowth.

Dr. Weitz:                            Right. Yeah. I’m always concerned that if we’re going to get some of the cars out of the parking spaces, we don’t want to leave those spaces empty.

Dr. Kapadia:                        That’s true. It’s like this balance because I think Dr. Pimentel talks about if someone’s prone to overgrowth and we keep giving them probiotics, are they going to then get overgrowth of those bacteria? I can’t say clinically I’ve seen that as much, but I do wonder about particularly people with motility issues, if we’re going to get more overgrowth of something else in that way. So if we can get fermented foods back in or if they tolerate probiotics, I think it’s a good thing to try. Especially the spore forming ones that wouldn’t overgrow anyway.

Dr. Weitz:                            Right. So some patients get a die-off reaction when treating for the overgrowth?

Dr. Kapadia:                        Right. So the die-off reaction is thought to be potentially one clue that they might have an allergy to yeast and the breakdown products of that. So we can use that as a clue. Then to get them through that period we use different tools like decreasing the dose of the antifungal we’re giving, making sure they’re having a bowel movement every day, drinking lots of water, increasing fiber. Sometimes we’ll use charcoal at a different time of the day, or Alka-Seltzer Gold as well can be helpful just to help get them through that initial week or two so that they’re not so uncomfortable.

Dr. Weitz:                            I saw that Alka-Seltzer Gold.

Dr. Kapadia:                        Yeah. That’s an old environmental medicine trick that one of my mentors told me about they had been using since the ’70s, I think with environmental medicine patients to help with all sorts of reactions. Yeah.

Dr. Weitz:                            Okay. When do you also see parasites as a cofactor? Do you see parasites?

Dr. Kapadia:                        Yeah, very frequently. So the way I like to talk about it with patients is that there’s often this sort of multiple layers of the dysbiosis. So bacteria, yeast, and protozoa are very common. So the protozoa, I feel like we have a pretty good shot at eradicating. So if we are going to do testing for that, or if they’ve had testing, we’ll try to treat that first because I feel we have a pretty good chance of eradicating that. So that would be giardia, cryptosporidium, [inaudible 00:24:32]. Those are common ones we see.  Then the bacterial and fungal overgrowth tend to take more time. So that’s one of the reasons I like to use botanicals for that because we can address them somewhat at the same time or at least sequentially. So protozoa I’ll treat first if we have the data. If they can’t do an out of pocket test for whatever reason, then we’ll start with treating the fungal overgrowth and then circle back around to that if they’re not getting better.

Dr. Weitz:                            So what are your favorite treatments for protozoans?

Dr. Kapadia:                        For protozoa, I usually use pharmaceuticals if they’re open to that, just because I found that typically will work a bit more effectively and sooner than doing several months of herbals, especially if we’re going to be using botanicals for the other pieces. So I tend to use Alinia or nitazoxanide and tinidazole, are two of the more common medications that we’ll use. They’re pretty well tolerated. We’ll warn people of potential side effects, but I haven’t seen a lot of side effects with those.

Dr. Weitz:                            Okay. Let’s see. Histamine tolerance. Does that play a role as well?

Dr. Kapadia:                        Yeah. There’s been interesting animal studies that have shown if they induced an overgrowth of yeast or fungus, those animal studies show that it can predispose to developing environmental allergies as well as increase mass cell activity in the GI tract. So this could be one piece of the puzzle for people who feel like they’re reacting to a lot of histamine in foods, or are having a lot of allergic or pseudo allergic type reactions all the time. This can be a piece of that. If we treat the fungal overgrowth, the histamine excess mast activity, it might take one piece of that down a notch.

Dr. Weitz:                            Right. I’m thinking about, I’ve talked to Dr. Rahbar who said that a lot of times when he is treating a patient with SIBO, especially the methane SIBO, he may see fungal overgrowth coexisting with that. Do you see SIFO coexisting with SIBO? Is it more common in methane or you find [inaudible 00:26:42]?

Dr. Kapadia:                        Yeah, it’s a good question. A lot of the patients I see have already had SIBO testing and treatment. I have seen that they definitely can co-occur and I’ve heard that from Dr. Rahbar as well. So I think he probably has more comparisons at the same time of what he’s looking at, but I definitely have seen people with very high methanes who also have a fungal overgrowth. It might be part of this synergistic piece with biofilms and such with these bugs talking to each other where they keep each other going. So it definitely, I think is part of the puzzle and it’s not uncommon to see people with all three of those imbalances at once.

Dr. Weitz:                            Okay, great. I think those are the questions that I had available. You rattled through a lot of information.

Dr. Kapadia:                        I did. So maybe people can listen to it more on a slower speed. I tend to talk too fast.

Dr. Weitz:                            I typically listen to podcasts at one and a half speed.

Dr. Kapadia:                        I know.

Dr. Weitz:                            Maybe we’ll want to listen to this one on half speed.

Dr. Kapadia:                        Yeah, I can talk slower. I just need someone to remind me when we start, if I’m going to talk [inaudible 00:27:48].

Dr. Weitz:                            Great. So any final thoughts for our listeners, viewers?

Dr. Kapadia:                        I would just say that this piece with the candida hypersensitivity or potential allergy, I think is an important piece. So if someone’s not getting… They keep getting treated and they aren’t getting better it would be helpful to talk to their doctor about that. Some allergists recognize it and some don’t, but most integrative type practitioners, whether they’re environmental medicine doctors or functional medicine doctors or naturopathic doctors may be aware of that. There are treatments for that.  Just like we desensitize people to environmental allergens, there are ways through sublingual immunotherapy to work on that. There’s a doctor in New York doctor, Dr. Dean Mitchell, who has some really nice online videos that I’ve referred patients to learn a bit more about that.

Dr. Weitz:                            Yeah. You have some courses that are available?

Dr. Kapadia:                        I do. I have a couple courses. One is a patient course for patients to try to learn as much as they can to help their integrative or naturopathic doctor, because there’s a lot of different pieces like we talked about. So it can help if the practitioner and the patient are keeping track of all of them. It goes through what we talked about, but in more detail, and it does include this piece about a potential hypersensitivity and how to explore that.

Then there’s a practitioner course where I go into a compilation of 20 years of data that I collected on this as much as I could find, as far as a practitioner’s general guide to approaching fungal overgrowth, as well as a direct approach to mold illness, because I found a lot of the information can be overwhelming on that. Most of my mentors had been treating mold since the late ’70s. I continue to use their approaches, which is a more straightforward way to work with mold, which can be sometimes related to fungal overgrowth. So we go into that in a lot more detail as well for practitioners.

Dr. Weitz:                            Just one more thing. When you were talking about the sensitivity to mold, I notice in your PowerPoint as part of your presentation that you shared with me, talking about how when you look at a food sensitivity panel, you can see that there’s hints that they may be sensitive to candida.

Dr. Kapadia:                        Yeah. So I don’t use it, again, to diagnose, but it’s another clue. So if someone’s had an IgG food test that includes bakers and brewers yeast, sometimes that will show up as another clue that their body has developed this cross reactivity to yeast and mold in food. Then we can see if that clears once we treat them, or if that persists, sometimes the allergies need to be treated on their own as a separate step of this.

Dr. Weitz:                            That’s great. So what’s your website so folks can get a hold of you and find out about your courses?

Dr. Kapadia:                        Yeah. My website is just my name dot com, so amikapadia.com. A-M-I K-A-P-A-D-I-A dot com. There’s a resource tab that just has sort of all sorts of information for patients. Then there’s a courses tab as well.

Dr. Weitz:                            Awesome. Thank you, Ami.

Dr. Kapadia:                        Yeah. Thanks, Ben.

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple podcasts and give us a five star ratings and review, that way more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. I wanted to let everybody know that I do now have a few openings for new nutritional consultations for patients at my Santa Monica Weitz Sports Chiropractic and Nutrition clinic. So if you’re interested, please call my office (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive nutritional consultation with Dr. Ben Weitz. Thank you and see you next week.


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