GI-MAP Uncovers a Case of Candida Mistaken for IBS
by Ilana Gurevich, ND, NSOM, FABNG
Unresolved Symptoms of IBS Leads Patient to Functional Medicine
Wendy is a 58-year-old female who presented to my clinic with a year-long history of chronic, life-affecting diarrhea. She was experiencing as many twenty urgent, watery, malodorous, and painful bowel movements per day. It was not uncommon for her to have bowel accidents due to the frequency and urgency of the diarrhea.
She originally sought help from a gastroenterologist who ruled out celiac disease, microscopic colitis, and inflammatory bowel disease (IBD). Unable to identify the cause, and based on Rome IV symptom criteria, the gastroenterologist diagnosed Wendy with irritable bowel syndrome (IBS) and sent her on her way. Frustrated and unwell, Brenda came to my office to see if functional medicine could help resolve her gastrointestinal (GI) complaints.
The GI-MAP Test Revealed a Prolific Infection of Candida
At our intake session, I did an extensive diet and lifestyle history with Wendy and discovered that she was consuming dairy three to four times a day. Occasionally, she felt worse after dairy consumption, but she felt bad all the time – so it never occurred to her that dairy could be an underlying cause of her symptoms.
I had Wendy do a month-long trial elimination of all dairy products, which significantly improved her symptoms. A week after removing dairy from her diet, she was having five to six episodes of slightly formed diarrhea per day. She also totally stopped having any bowel accidents.
However, after three months of dietary changes, her chronic diarrhea, while improved, had not resolved. I ordered the GI-MAP stool test to try and identify the underlying cause.
Wendy's GI-MAP showed a lot of robust diversity in her bacterial microbiome with every species present. Her opportunistic bacteria were low and showed only a slight overgrowth of Streptococcus spp. and Fusobacterium spp. which is indicative of weak digestion. Wendy's GI-MAP also revealed a significant overgrowth of Candida spp., Candida albicans, and Rodotorula spp.
Understanding Candida and How it Mimics IBS
Fungus, especially Candida is shown to be a healthy, commensal part of the microbiome in 70% of healthy adults.1 However, it is easy for a normal part of the microbiome to become overgrown and opportunistic. Fungal overgrowth often presents with abdominal pain, gas, bloating, flatulence, and diarrhea. This symptom picture often matches people who are diagnosed with irritable bowel syndrome (IBS), highlighting the importance of stool testing. The symptoms of IBS can be caused by Candida, H. pylori, and myriad other problems in the gut. Testing with GI-MAP can identify treatable underlying causes of your patient's symptoms.
There are many aspects of Western culture that pre-dispose individuals to fungal overgrowth in the intestine. This includes (but is not limited to) a western diet that is high in processed sugars and refined grains,2 antibiotic use,3 the use of proton pump inhibitors, as well as a diagnosis of diabetes.5
Fungal overgrowth in both the small and large intestine can be difficult to diagnose. In Wendy's case, the GI-MAP's quantitative PCR technology identified it and showed just how serious the infection was.
Results from GI-MAP Lead to Life-Changing Outcomes
The intestinal candidiasis picture matched Wendy's presentation accurately. To address the prolific yeast overgrowth in Wendy's gut, I started her on an anti-fungal protocol.
I prescribed Nystatin due to its high efficacy and preference for Candida spp.6 Nystatin is an anti-fungal medication that remains localized in the gastrointestinal tract. It binds to cell membrane sterols and increases permeability of the sterols.7 This drug has a very low side effect profile and is generally well tolerated by patients. I also started Wendy on an herbal anti-fungal protocol including garlic,8 oregano oil,9 and cinnamon.10
Wendy tolerated the treatment quite well and within three weeks, her bowel movement frequency greatly declined. She reported having only one to two formed bowel movements daily with no urgency.
Wendy stayed on the treatment protocol for three months and tapered off without issue. Since then, Wendy's digestion has been much healthier. Most importantly, she no longer deals with chronic gastrointestinal symptoms that impact her quality of life. She still needs to avoid dairy but can tolerate most other foods without any significant worsening of her digestion. Outcomes like Wendy's illustrate just how impactful a GI-MAP test can be for patients.
Author: Ilana Gurevich, ND, NSOM, FABNG
Dr. Gurevich is a naturopathic medical physician and an acupuncturist who uses individualized natural therapies to address the underlying cause of disease. She encourages her patients to take an active role in their own health care. Dr. Gurevich relies on a variety of natural modalities including Chinese and Western herbal medicine, acupuncture, nutritional supplements, homeopathy, hydrotherapy, and dietary education.
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