Nirala Jacobi:

Welcome back to part two of The SIBO Doctor Podcast, and let's jump right back into it.

Nirala Jacobi:

Now, moving on, I want to get into the immunotherapy. But before we go there, can we talk a bit about this concept of a loss of immune tolerance and yeast hypersensitivity? Somewhere I was reading about your thoughts on that die off may not be problem with detoxification, but really more the yeast sensitivity that people have developed and that when you're killing it, you're exposing the immune system to more yeast substances and it's more of a reaction from the immune system, which I find really very astute and very interesting.

Ami Kapadia:

Yeah, so the book you mentioned, The Missing Diagnosis, that Dr. Truss wrote many years ago, so he was an allergist. That was my first tip-off that there was an allergic hypersensitivity component because he wrote about how he was treating patients with different dilutions of candida extract as a key part of their therapy and then Dr. Sidney Baker, who's one of the founding fathers of functional medicine, he also writes about in his books, I think one of them is Detoxification and Healing, the components of how he would treat this problem with diet, some antifungal therapy and sometimes this immunotherapy. So the way I talk about it with patients is that you can have an overgrowth of yeast that's easier to treat or you could have hypersensitivity that's developed; genetically, different people are predisposed to developing allergies and if that's part of your genetic makeup and your body gets an overgrowth of yeast, you can develop an allergy to the point that you're reacting an allergic hypersensitivity type of way to the normal yeast that lives on your mucus membranes.

Ami Kapadia:

The typical things we see with that is, I always tell patients we're going to treat the overgrowth first because there's definitely some people where we just have to treat an overgrowth and they don't have a hypersensitivity and then it's usually easier to treat those people. But if we keep treating them and it keeps coming back, particularly if it comes back within a couple days, we know that yeast doesn't grow that quickly so it's probably then this hypersensitivity that's developed where the body can no longer tolerate the normal amounts that live in our GI tract, the same as our body can no longer tolerate the pollen in the air or the mold or the dust; a normal allergic phenomenon. We know that there is data on patients who develop this allergic hypersensitivity. It in some ways compromises the immune system's ability to keep that organism in check. When we have allergy on our mucus membranes, there's more inflammation, there's inhibition of normal immune responses so it's more likely to have overgrowth of different organisms if you have allergic responses on your mucus membranes. Those are some of the things with the hypersensitivity immune tolerance issue.

Ami Kapadia:

We can talk more about how to address that. For some patients, if we just treat the problem long enough, their body gets used to more of a normal microbiome and mycobiome and it just self-resolves as we treat them. For other people, some of the things we use for patients with histamine intolerance and MCAS type issues, that can be helpful if we think it's more of an allergic hypersensitivity response. As part of treating the overgrowth, we can also use antihistamines, natural or pharmaceutical mast cell stabilizing medications, so those things can be helpful. And then there's ways to retrain the immune system more directly, and the couple ways that I offer to patients, one is a referral to an allergist who would actually test them for molds and pollens and all of those things and consider allergy shots as one way to retrain the immune system.

Ami Kapadia:

As far as what we directly, as integrative and naturopathic practitioners, can offer, there's this whole system of therapy that Dr. Ty Vincent came up with called low dose immunotherapy. His website, for anyone that wants to learn more, is Globalimmunotherapy.com, I believe. It's based on homeopathy for naturopathic doctors who are trained in that or other doctors that are trained in that. It works very different from homeopathy, but I think of it as a variation of. There's dilutions of the antigen that we're working on, whether that's environmental allergens, food allergens or yeast in this case, that have been diluted usually past Avogadro's number so it is a homeopathic in that range, and that's usually the range that helps people. It's a dose that's given every so often to help retrain the immune system, just a couple of drops under the tongue, as a way that he describes as reestablishing immune tolerance to that organism.

Nirala Jacobi:

I think that's going to be a really good resource for people to look that up. I wonder if, because I deal a lot with people with leaky gut and we know that candida can, in the hyphal stage can barrel into the mucosa and cause intestinal hyperpermeability. Obviously that is one of the foundations as to how the immune system would lose tolerance to that organism. I wonder if it's the similar mechanism as to why some people can't tolerate probiotics because when you have leaky gut and you're exposing your body to probiotics and you can actually launch an immune response to particular probiotics. I have lots of people who say, "Every time that I take any probiotics, there's a problem." And then using these types of immune therapies in conjunction with healing leaky gut, I assume, is going to be more successful. That's an interesting concept because I sometimes use desensitization drops, but to be honest, I haven't found them to be useful. So I'm really interested in looking into this particular program that you mentioned. But just to reiterate for people who may have missed it, because we're just moving at lightning speed here, Ami.

Nirala Jacobi:

We've got a lot to cover because we're experts in this. It's just really cool. My thought is also on... That's what I was going to say to people if you missed it, that they die off. If you have really severe die off, that may not be because you can't detoxify it. This is what was just mentioned, is that this may be more that you actually have an allergy to the dying or the endotoxins of yeasts that are being spilled. Because that's what I hear a lot. A lot of people are just pushing on with detoxification and it's not working. So that's a really good pointer there. Now, let's move on to this issue of biofilm because Candida is a fairly strong biofilm former. I just actually got this email from Dr. Rebar. He's been using Diatomaceous Earth. I wondered if you have any experience with that. I've just been experimenting with it and the jury's out, but it's well-tolerated by most and seems to be an inexpensive way to perhaps deal with candida, specifically with biofilm.

Ami Kapadia:

Right. Yeah, biofilms are interesting. I shied away from using them. Biofilm treatments, I'm using a lot more now. I would say I don't think it's necessarily an essential part of the initial program of addressing a yeast problem because there's patients that respond when we just treat them with herbals. But I think herbs are also so diverse. I know Stephen Buhner and a lot of his books on Lyme and co-infections talks about how a lot of herbs have biofilm properties. So it could be that we were treating it without even knowing it and that's why some people would get better without specifically addressing it. That being said, I think it's definitely worth considering in patients who have complex issues, especially if it's coming back a lot, it could be that the immune system isn't seeing their organisms. My caution with that was always that there's healthy biofilms as well and when we use too aggressive of protocols, we are disrupting the healthy and the not so helpful biofilms.

Ami Kapadia:

So I learned about a lot about biofilm treatment from some of Dr. Paul Anderson's lectures. I really like one of his products, the Biofilm Phase-2. I haven't used the one you mentioned, Nirala, but I've been using a lot more of the Biofilm Phase-2 and I have found it helpful. For some chronically ill patients, biofilm treatment can cause an exacerbation of symptoms because the immune system is finally seeing things that it previously couldn't see. So we just have to be ready for that. And so I let all of our patients know that if it happens, we back off, we add adrenal support, maybe add more antimicrobials and different things that Dr. Anderson talks about and usually that can get them through it. But it's also a good sign that we're getting to the organisms finally that we have been trying to treat for a while that the immune system just really couldn't get to. So I think it's helpful, although I'm not convinced it's always required, especially if you're using herbal protocols that might cover it in other ways.

Nirala Jacobi:

So speaking of herbal treatments or just yeast treatments, and you don't have to go into super great detail because I think you've got a course coming out and we will promote that course when the time comes, but in general, do you have a few favorites that you routinely use?

Ami Kapadia:

Yes. There's an old product from Thorne Research, SF722 that I find helpful. It's undecylenic acid so that one's really good. It's all about finding the right herbal product for whatever type of yeast strain that patient has. So I always explain that if we try something and it doesn't work, it doesn't mean that this isn't part of their problem. It might be that we didn't find the right agent. Just like with bacteria and antibiotics, not every bacteria is going to be susceptible to a particular antibiotic.

Ami Kapadia:

The other herbs, I use a lot of products from a called Supreme Nutrition that one of my mentors formulated. I'm not affiliated with them. But they're really high quality. No additive type products. They have a lot of the herbs that we use for SIBO and CIFO that overlap that have some form of Berberine or Neem or other things in them that I find very helpful as well. So those are a couple of their products that I routinely use. And the nice part is I consider their them broad spectrum antimicrobial herbs, especially the Supreme Nutrition products. So we're often covering for multiple organisms, not just yeast, as we're treating them.

Nirala Jacobi:

Nystatin, you use that as well and the standard antifungals. What's the length? Because I find that yeast treatment is typically a quite a prolonged process because I always tell people, "Look. Your digestive tract, if I were to take it out, it's got the surface area of more than a tennis court so you're not going to just get there in two weeks time to really fare it out, all these different nooks and crannies of yeast overgrowth." So usually, in my experience it's been more months rather than weeks.

Ami Kapadia:

Right. So I do at least a trial of one to three months to see how they did. And if they're not having any response, we'll often switch up the therapy. I do use nystatin. My advice is I don't love to use any pharmaceuticals long term but it is quite safe so I do use it if it's helping someone and if it's just going on and on, that's when I think about do we need to address biofilms? Is there a hypersensitivity response that this keeps coming back? Is there mold exposure? Systemic antifungals, I usually only do for a couple weeks because they have a lot of drug interactions and I just don't love the idea of using them longer term but I feel comfortable using nystatin in the months range. And then we could always switch it up to herbal therapies if they're open to that, just because it is for some people more ongoing treatment that we have to do for a while, while we work on all the other aspects of things.

Nirala Jacobi:

I think I used to use a lot more of that Thorne product you mentioned, but it's just the dose is just so crazy high. You got to take 15 pills. So that's a little bit of a turn off for some people.

Ami Kapadia:

Yes.

Nirala Jacobi:

But all right, excellent. Thank you so much for all of that insight. Just finishing up on this issue of, and I talk a lot about histamine intolerance on my podcast especially when it comes to candida because I find that goes hand in hand so often, what are your thoughts on that and how do you differentiate in your patients in terms of... MCAS is thrown around a lot right now, it's like everybody that has histamine intolerance is told they have MCAS. But how do you approach that?

Ami Kapadia:

Right. So we know from Dr. Theoharides's work, who's one of the teachers on this topic, that fungi do cause mast cells to deeply emulate. So it makes sense that if someone had an overgrowth, they would have a histamine issue as well. I don't do the lab testing for MCAS and histamine intolerance. It's just challenging to do, it requires a lot of special lab parameters. So I'm typically not telling someone they have MCAS unless they've come to me with that diagnosis. I more just use broad terms like histamine intolerance. I try to explain that the histamine excess is usually some combination of allergic phenomenon and dysbiosis. So I see a lot of people with protozoa that's causing excess histamine issues, a lot of skin issues like you said with overgrowth, other forms of dysbiosis.

Ami Kapadia:

And then some people are just prone to allergies. Again, genetically some of us just have more an allergic predisposition. So I think some way of treating the allergies, whether it's the low dose immunotherapy or antihistamine or allergy shots or whatever it is, can help decrease that overall load of the whole histamine reactivity. Dr. Galland, another one of the founders of functional medicine, he's talked about a theory where he said the Karolinska Institute did a study showing a link between excess mast cell degranulation, histamine issues in a certain percent of the population with EMF exposure. So that was one of his theories where that might be contributing to the current phenomenon of excess histamine problems. I do have some handouts on my website for EMF sensitivity, just basic things like turn the wifi off at night, put it on a timer, hard-wire your ethernet; things like that, that can be helpful as a piece of the puzzle as we treat all of the other GI symptoms that might be causing the hypersensitivity issues.

Nirala Jacobi:

Yeah. I've heard that theory before from Dr. Dietrich Klinghardt, I think, who postulated that maybe one of the reasons we're seeing such virulence in not just fungi but also a host of other organisms is because we are much more exposed to wifi and other frequencies. It's a really interesting concept that makes sense. If there's such a study that we could do, that would be wonderful. Thank you so much, Ami, for your time and for your amazing presence in this field and your insights. Now, where can people find out more about you and do you take on patients? I know you work with Dr. Gurvich, who I've interviewed many times and has done some courses for us. So it's great.

Ami Kapadia:

So my practice is in Portland, Oregon. The licensing laws for MDs at this time, I mostly see patients in Oregon and Washington where I'm licensed. So I cannot do virtual visits at this time but I've just recommended if patients are interested at some point, I think those laws are rapidly changing. So I have a newsletter sign up. I won't send you anything. I'll be in touch if at some point I can see patients out of my licensed dates. And then like we talked about, we'll be in touch with your audience once we have the course ready for them for a physician course on these two topics that we're updating at this time. My website is just Amikapadia.com, so it's just my name-dot-com. I have a resource tab that has lots of different handouts, basically just for patient education. It might be helpful for practitioners at as well for some of the topics that we went over.

Nirala Jacobi:

Fantastic. Thank you so much for your time and all the best in the new year.

Ami Kapadia:

Yes, you too, Nirala. Thank you for your time today. It was good talking to you.

Speaker 3:

Thank you for listening to the SUBI Doctor Podcast. We hope you find the information in this episode useful in the treatment of your SIBO patients. Thanks to our sponsors, SIBOtest.com, a breath testing service with easy online ordering. Thanks again for listening.