True health begins in the gut. In a healthy microbiome — the trillions of microorganisms living in your digestive tract — the gut bacteria is balanced, regulating countless physiological processes and affecting almost every aspect of your health, including immune function, brain function and fat storage.

This balance of bacteria is delicate, so it’s easy (and common) for the digestive system to go haywire, creating digestive distress and subsequently wreaking havoc on your overall health. There are two common (and frequently undiagnosed) issues at the root of this: SIBO (small intestinal bacterial overgrowth) and SIFO (small intestinal fungal overgrowth).

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What Is SIBO?

The majority of your gut bacteria is meant to be in your large intestine and colon, breaking down food, synthesizing and metabolizing key nutrients and eliminating waste. Sometimes the bacteria normally found in the large intestine and colon grow beyond healthy levels, spilling over and colonizing in the small intestine. This overgrowth causes SIBO.

There are three types of SIBO:

• Hydrogen
• Methane
• Hydrogen sulfide

Each type has slightly different symptoms and, in turn, different treatment methods. The best way to diagnose SIBO is through a breath test. A healthy small intestine is sterile, so if bacteria are fermenting in your small intestine, breath tests will detect this abnormal growth.

What Is SIFO?

SIFO is essentially like SIBO, however, it’s characterized by a fungal overgrowth rather than bacterial. Often patients who test negative for SIBO may actually have SIFO. While there is currently no reliable test for SIFO, working with a functional medicine provider can help you rule out other gut disorders and pinpoint whether you may be suffering from SIFO. In order to diagnose SIFO, your provider will collect a thorough patient history and evaluate your symptoms along with other markers of dysbiosis (another term for imbalanced flora) in the gut.

Symptoms of SIBO and SIFO

• Hydrogen SIBO: Severe bloating, diarrhea (common), malnutrition (possible)
• Methane SIBO: Chronic constipation, bloating, diarrhea (sometimes)
• Hydrogen sulfide SIBO: Diarrhea or constipation, foul smelling gas
• SIFO: Belching, bloating, indigestion, nausea, diarrhea and gas

That being said, not all cases of SIBO or SIFO look the same. Other symptoms of SIBO and SIFO can include anxiety, depression, migraines and more.

What Causes SIBO and SIFO?

Though this list covers the main causes of SIBO and SIFO, it's not exhaustive — a provider will be able to elaborate on the root causes of individual cases of SIBO or SIFO.

How to Treat SIBO and SIFO

Specific strains of probiotics and herbal antimicrobials or antifungals can be very effective in eliminating bacterial or fungal overgrowth. There are also herbal therapies to help promote better digestive motility which is very important in the treatment of both SIBO and SIFO.

Pharmaceuticals may be necessary depending on the severity and resistance to treatment. Antifungal drugs (such as fluconazole or nystatin), antibiotics (such as rifaximin) and/or prokinetics (meds for acid reflux) may be considered, however, this study found that herbal antimicrobials were as effective as antibiotics for treating SIBO.

If you are experiencing symptoms of SIBO or SIFO, book an appointment with your provider to get tested and who can help create an individualized treatment plan depending on symptoms and severity.