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Discussion Starter · #1 ·
Hi,Perhaps this question has been posted a lot in the past, but I didn't find it so I had to ask.I'm planning to start the Vivonex Plus elemental diet next week, but I'm worried about Candida (actually any Yeast/Fungus) overgrowth.I've read that Vivonex starves the bacteria, but I'm afraid it may actually feed the yeats/fungus because of the high starch content. And in the absence of bacteria (they are bieng killed) may the yeats thrive and takeover?My breath test suggested SIBO but other tests suggested Candida as well, so that's why I'm concerned.Perhaps taking Fluconazole, Caprylic acid or the like while on the diet may help. I'm clueless. Dr. Pimentel has no official position on this matter, at least none that I know.Any suggestions, ideas?
Thanks everyone.
 

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What test did you have that suggested SIBO?What tests did you have that suggested candida?What kind of doctor has preformed the tests?
 

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My guess is it would starve the yeasts as well.They have to eat too, and I thought the whole rationale of this approach was you absorb everything before the food gets to where the bacteria or anything else that might be living in the GI live, even when they are in the small intestine and should only be in the large intestine.While a lot of alt. med make a lot of claims of Candida there isn't much data to support it is causing anyone's IBS (or any of the hundred or so other conditions it supposedly causes)K.
 

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Was it a lactolose breath test?Do you know the numbers?When was the last time you had a colonoscopy? Or stool and blood work?What did the doctor say about the blastospores?
 

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Some yeast is normal, that is why stool handling is very important when you run these tests.The yeasts grow really well out of the body where there is oxygen (why they usually don't grow that well inside is there isn't much so they grow slowly and the bacteria just keep them in check).Stool that sits at room temp for awhile can have elevated yeast that has nothing to do with what is going on inside the body. Yeast numbers also can go up a bit when you take antibiotics but usually go right back down after a few weeks when the bacterial population re-establishes itself.K.
 

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Discussion Starter · #7 ·
I see what you mean, intestinal yeast shall also starve if no food is coming. Perhaps I've just read too much (very usual for IBS guys like us
), but my major concern is Candida or yeast elsewhere or at least not directly fed by food chime, but instead by blood sugar concentrations. For example, yeasts in the mycelial form (aggressive) may feed upon blood vessels and not directly by undigested food or fiber. So, my concern again is what happens to those yeasts which may still be feeding by the absorbed Vivonex and may not be kept in check directly by those other bacteria that are being killed by lack of food. I think it is kind of the same question about Candida overgrowth while on antibiotics, though I in the Vivonex case no food is supposed to be present inside the intestines.Please let me know if I’m getting too philosophical
 

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Do you have an immune deficiency disease?Most of what is claimed to be how you get these whole body in everything yeast infections that cause every ill known to man really are only ever seen in people with AIDS or things like that.A lot of what I read takes stuff that really only happens to a very few really sick people then tries to say it is happening in all people with all symptoms, when realy in a standard issue mostly healthy person that stuff doesn't happen.K.
 

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I respectfully disagree. A compromised gut is prime target for candida overgrowth. Read Dr. William Crook's "The Yeast Syndrome" book (he's an M.D.). Candida overgrowth cannot reliably be tested for in a petri dish, but that doesn't preclude the chance that someone may have it. And for this thread, it certainly couldn't be a bad idea to add some anti-fungals to the program when one is living on a liquid diet that consists largely of a sugar (maltodextrin) such as Vivonex. Candida can live higher in the digestive system than can the troublesome bugs that SIBO sufferes may have, which appear to live lower down. The maltodextrin in the Vivonex can feed candida all the way down the throat, if one has enough of a starter colony of candida there, and if that person's system is compromised enough to not be able to fight off the candida.For a post on why a different sugar, other than maltodextrin, may have been a better idea for the Vivonex protocol, see the thread posted by Moises in Early November - I wrote about using honey intead of maltodextrin. Still feeds candida, but digests completely, higher up, to possibly avoid feeding the bugs that live lower in the person's system.
 

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We will have to agree to disagree on that.I go by a lot of what is in the peer-reviewed scientific literature rather than what people put in books.They tell two very different tales.With fructose it depends a lot. If you don't absorb it well, you will make things worse and a lot of people are fructose intolerant. They don't absorb it well when it is 1:1 with glucose and often not at all when it is solo. That is why High Fructose Corn Syrup is so bad for so many IBSers. It goes all the way to the colon intact.K.
 

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Discussion Starter · #11 ·
Thanks again for your reply ericI had 2 colonoscopies, one 2 years ago when my IBS started and the last one 5 months ago. So far no organic damage.Stool tests were done 3 weeks ago.And if I may, I little background about myself: My IBS started 2 years ago after taking antibiotics for 6 weeks because of a severe pneumonia. I also experienced chronic prostatitis for almost a year before the pneumonia. That’s why Candida for me is something to consider, at least I try not to underestimate it, since my Prostatitis was never explained.Back to your question, the breath test was lactulose indeed, and the Dr at that time explained to me the same things I read in Pimentel’s book, expect maybe that in my case he strongly recommended the Vivonex since my readings where slightly higher that the norm (the norm for positive SIBO readings, that is
).He was surpised about the blastospore readings, mostly because I explained to him my previous Prostatitis and Penumonia conditions, but he was not sure about the Vivonex and Yeast relationship.
 

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Discussion Starter · #12 ·
Kathleen, AIDS was one of the first tests performed by my regular GI, and along with my last colonoscopy another test was requested. So far I'm AIDS free (thank God). The thing about the inmune system is another reason why I'm concerned about Candida, some say Candida may lower your defences.But, as you said, there's a lot of contradictions between the books and the peer-reviewed scientific literature
That's why I find these forums very usefull to avoid getting mentally trapped into my own findings.
 

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The case for candida as a cause IBS has grown weaker and weaker over the last ten years.A lot less was known about IBS ten years ago then is known now.Even SIBO as a cause for IBS is speculation and theory and right now does not present a strong case. Really they are trying to figure out how many people with IBS have sibo? Most IBS researcher around the world have gotten different reults on SIBO and IBS then Cedars.As for candidaWhy is there candida in the bowel in the first place in humans?""Candida albicans, and other strains of Candida are yeast that normally inhabits our digestive system: the mouth, throat, intestines and genitourinary tract. Candida is a normal part of the bowel flora (the organisms that naturally live inside our intestines, and are not parasitic). It has many functions inside our digestive tract, one of them to recognize and destroy harmful bacteria. Without Candida albicans in our intestines we would be defenseless against many pathogen bacteria. Healthy person can have a millions of Candida albicans."alsoComment in: Postgrad Med J. 1993 Jan;69(807):80.The role of faecal Candida albicans in the pathogenesis of food-intolerant irritable bowel syndrome.Middleton SJ, Coley A, Hunter JO.Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK.Candida albicans was sought in stool samples from 38 patients with irritable bowel syndrome and 20 healthy controls. In only three patients with irritable bowel syndrome was C. albicans discovered and these patients had either recently received antibiotics or the stool sample had been delayed more than 24 hours in transit. C. albicans was isolated from none of the control stool samples. We conclude that C. albicans is not involved in the aetiology of the irritable bowel syndrome.PMID: 1437926Almost no major research on it being the cause was done after 92. IF you search pubmed there is almost nothing."About chronic candidiasisAn overgrowth in the gastrointestinal tract of the usually benign yeast (or fungus) Candida albicans has been suggested as the origin of a complex medical syndrome called chronic candidiasis, or yeast syndrome.1 2Purported symptoms of chronic candidiasis are fatigue, allergies, immune system malfunction, depression, chemical sensitivities, and digestive disturbances.3 4 Conventional medical authorities do acknowledge the existence of a chronic Candida infection that affects the whole body and is sometimes called “chronic disseminated candidiasis.“5 However, this universally accepted disease is both uncommon, and decidedly more narrow in scope, than the so-called Yeast Syndromeâ€"a condition believed by some to be quite common, particularly in people with a history of long-term antibiotic use. The term “chronic candidiasis” as used in this article refers to the as yet unproven Yeast Syndrome."Real Candidiasis which is a "Systemic Candidiasis are "systemic infections"http://www.emedicine.com/emerg/topic76.htmIBS is NOT an infectious disease.I have talked to quite a few lab people who do colonoscopies about this and they have never seen "yeast syndrome" but have seen "disseminated candidiasis" in aids patients and cancer patients where the immune system was highly compormised.IN IBS research researchers are using powerful electron microscopes and examing gut cells and still no "overgrowth" of candida.SIBO is also a functional disorder as well. What is causing malfunction in IBS and SIBO.SIBO, does not at this point explain a lot of IBS research already done.The strogest case for alternating d and c and d/c in IBS and pain or discomfort has to do with serotonin in the gi tract released from enterochromaffin (EC) cells.The research on the immune system in IBS also plays a role in IBS, especially mast cells. A ton of research has been done on mast cells and IBS and there are still working on that issue.About 30 percent or more of IBSers develop IBS after PI IBS. In those people they find an increase in enterochromaffin (EC) cells and mast cells. The mast cells are macroscopically inflammed.
 

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By the way the lactolose breath test can over predict SIBO.
 

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Nanobug, this area of IBS research is highly controversial.http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/443103162also"However, other studies have shown a much lower prevalence of SIBO in patients with IBS. In a recently reported retrospective study of patients who were referred for glucose hydrogen breath testing for SIBO, only 11% of 113 patients who met the Rome II criteria for IBS tested positive for SIBO, suggesting that IBS symptoms are often unrelated to SIBO.[4] On the basis of currently available data, the contributing role of SIBO in the pathophysiology of IBS remains controversial, and the large variation in the prevalence of SIBO in IBS (10% to 84%) indicates the problematic state of this research, particularly with regard to the accuracy of breath testing in detecting SIBO in patients with altered (particularly accelerated) gastrointestinal motility.Further epidemiologic studies and placebo-controlled clinical trials aiming at eradicating SIBO are necessary to clarify the true impact of SIBO on IBS symptoms. With regard to the latter, several small treatment trials have been reported and demonstrated improvement in IBS symptoms with antibiotic (eg, neomycin and rifaximin) therapy.[2,5] However, the results of a larger multicenter study with rifaximin are awaited with anticipation.From a clinical standpoint, until this issue is clarified, clinicians should consider SIBO in an IBS patient with typical symptoms (eg, bloating, distention, and diarrhea), as well as in patients with these symptoms who do not fulfill the diagnostic criteria for IBS."http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/947102852MedGenMed GastroenterologyIBS -- Review and What's NewAmy Foxx-Orenstein, DO, FACG, FACP Medscape General Medicine. 2006;8(3):20. ©2006 MedscapePosted 07/26/2006Small Intestinal Bacterial OvergrowthThe presence of a higher than usual population of bacteria in the small intestine (leading to bacterial fermentation of poorly digestible starches and subsequent gas production) has been proposed as a potential etiologic factor in IBS.[71] Pimentel and colleagues have shown that, when measured by the lactose hydrogen breath test (LHBT), small intestinal bacterial overgrowth (SIBO) has been detected in 78% to 84% of patients with IBS.[71,72] However, the accuracy of the LHBT in testing for the presence of SIBO has been questioned.[73] Sensitivity of the LHBT for SIBO has been shown to be as low as 16.7%, and specificity approximately 70%.[74] Additionally, this test may suboptimally assess treatment response.[75] The glucose breath test has been shown to be a more reliable tool,[76] with a 75% sensitivity for SIBO[77] vs 39% with LHBT for the "double-peak" method of SIBO detection.[74] In a recently conducted retrospective study involving review of patient charts for the presence of gastrointestinal-related symptoms (including IBS) in patients who were referred for glucose hydrogen breath tests for SIBO, of 113 patients who met Rome II criteria for IBS, 11% tested positive for SIBO.[78] Thus, results demonstrated that IBS symptoms are often unrelated to the presence of SIBO. Despite the controversy regarding the contribution of SIBO to the underlying pathophysiology of IBS and its symptoms, short-term placebo-controlled clinical studies with select antibiotics, including neomycin and rifaximin, have demonstrated symptom improvement in IBS patients.[61,72,79] Antibiotics may therefore have potential utility in select subgroups of IBS patients in whom SIBO contributes to symptoms. However, the chronic nature of IBS symptoms often leads to the need for long-term treatment. Given the fact that long-term use of antibiotics is generally undesirable, the place of antibiotics in IBS therapy remains to be established""Serotonin SignalingOf the putative mechanisms underlying the pathophysiology of IBS, the strongest evidence points to the role of serotonin in the GI tract. "http://www.medscape.com/viewarticle/532089_printIs there a relationship between IBS and small intestinal bacterial overgrowth?IBS and small intestinal bacterial overgrowth (SIBO)"Although the theory that SIBO causes IBS is tantalizing and there is much anecdotal information that supports it, the rigorous scientific studies that are necessary to prove or disprove the theory have just begun. Nevertheless, many physicians have already begun to treat patients with IBS for SIBO. In addition, a lack of rigorous scientific studies demonstrating benefit from antibiotics and probiotics has not stopped physicians from using them for treating patients. "http://www.medicinenet.com/irritable_bowel...drome/page6.htmThere is a lot more and I have a editorial you might want to read if you email me, I will send it to you on this subject.
 

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Eric,I went through the references you provided. Based on those, a case can be made that the lactulose breath test may not be a good proxy for SIBO. However, none of the abstracts that I read on Pubmed suggested anything contrary to what Pimentel is proposing. Maybe I am missing something. If I am, please, provide the PubMed Id's. As for the editorials, those are opinions and I have mine too! :)
 

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You asked if there were different results from different centers. If you do some research on it all you will see different opinions on the subject."However, other studies have shown a much lower prevalence of SIBO in patients with IBS. In a recently reported retrospective study of patients who were referred for glucose hydrogen breath testing for SIBO, only 11% of 113 patients who met the Rome II criteria for IBS tested positive for SIBO, suggesting that IBS symptoms are often unrelated to SIBO.[4] On the basis of currently available data, the contributing role of SIBO in the pathophysiology of IBS remains controversial, and the large variation in the prevalence of SIBO in IBS (10% to 84%) indicates the problematic state of this research, particularly with regard to the accuracy of breath testing in detecting SIBO in patients with altered (particularly accelerated) gastrointestinal motility.So differnnt centers have found different results from 10 to 80%. They also don't know the prevelence of SIBO in a non IBS population. Indeed in one IBS study controls had SIBO, but not IBS. The opinion is an expert opinion from a major researcher and chairman of the Rome Commitee to diagnose IBS. It is very much worth reading it regards to SIBO and IBS.For example this that Dr Drossman wrote for me a while back. However the other is an editorial balance to the information""Dear Shawn Eric,I do feel that the issue of bacterial overgrowth is an important considerations in IBS, and these authors have gone a long way to advance this area of investigation and raise awareness of bacterial overgrowth as a possible player in IBS. It kind of relates to other work being done in the area of post-infectious IBS and altered mucosal immunity in subsets of IBS. However, there is some disagreement within the community with regard to the prevalence in patients with IBS, these authors claiming up to 80% and others finding far less by standard methods. Another issue of concern is that explaining bacterial overgrowth as the cause of so many other aspects of the condition is going beyond the available scientific data. Their work should be considered more in the way of opinion/speculation, rather than accepted dogma within the medical community, and further confirmation is needed. You should keep in mind that all scientists will from time to time try to extend their data into understanding other aspects of a condition, but the checks and balances within medicine lead to common acceptance when there is confirmation from other groups and more conclusive evidence. That has not happenned as of yet but remains an area of interest in the field.Doug""I can also point out the last study did not show an improvement in global symptoms really, bloating got somewhat better. But not d or c or pain. It was also not by that high of a percentage.I believe the media is playing an important role in how this research and speculation is being presented.Also"Second, these findings suggest that SIBO can play a role in IBS symptoms and that development of effective therapies for SIBO would be beneficial for some patients. However, SIBO is not a disease; rather, it is a consequence of ineffective small-intestinal motility, and the underlying dysmotility will still exist after SIBO is eliminated. One would hypothesize that SIBO and IBS symptoms will reoccur in most patients who initially respond and that retreatment or chronic therapy for SIBO will be required. "http://gastroenterology.jwatch.org/cgi/con...ull/2006/1016/1At this time they are not the same conditions.There are also other treatments that IBSers respond too and that is important. There is also a large body of IBS research including post infectious IBS research which is very important.
 

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quote:You asked if there were different results from different centers. If you do some research on it all you will see different opinions on the subject.
Yes, I'm aware of different opinions. But it's not opinions I'm after, though.
quote:"However, other studies have shown a much lower prevalence of SIBO in patients with IBS.
I'm looking for these studies that purportedly show this much lower prevalence. Are you familiar with them? Could you provide references?
quote:In a recently reported retrospective study of patients who were referred for glucose hydrogen breath testing for SIBO, only 11% of 113 patients who met the Rome II criteria for IBS tested positive for SIBO, suggesting that IBS symptoms are often unrelated to SIBO.[4]
This reference [4], do you know what it is?
quote:Indeed in one IBS study controls had SIBO, but not IBS.
Could you provide the reference?
quote:I can also point out the last study did not show an improvement in global symptoms really, bloating got somewhat better. But not d or c or pain. It was also not by that high of a percentage.
Is this the one you are referring to?The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial.
quote:"However, SIBO is not a disease; rather, it is a consequence of ineffective small-intestinal motility, and the underlying dysmotility will still exist after SIBO is eliminated.
Agreed! And this is very much addressed in Pimentel's protocol with the use of erythromycin/Zelnorm, no?
 

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Discussion Starter · #20 ·
You guys lost me at some point.I agree that the SIBO theory is still controversial, as I myself have read a lot about that as well.So in the end, I'll appreciate an informed advice on whether Candida or other yeasts may pose a risk while on Vivonex?Or perhaps in the end none of us have a clue
.Thanks everybody.
 
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