Candida, SIBO or H. pylori (helicobacter pylori) may occur alone, but they frequently exist in conjunction with one another or one leads to the other at some point. Since many of their symptoms overlap and testing for each of them is not very reliable and complete eradication is very difficult in each condition, it can sometimes be hard to differentiate between the three of them or get an accurate diagnosis.
Since dysbiosis makes one vulnerable to any microbe, Candida may open the door for SIBO or H. Pylori, or vice versa in any direction. Sometimes it can be hard to know which one came first, however, one thing is for certain — they can all perpetuate one another. Each of them can cause inflammation and degradation of the gut lining and compromise the immune system, which then creates an environment that encourages proliferation of either one.
As we learned in our previous discussion on this topic, overgrowth of bacteria in the small intestine may cause elevated levels of ammonia that increase the gut pH, weaken the immune system, impair function of the ileocecal valve and create leaky gut, and create sympathetic nervous system dominance, all of which would create an ideal environment for Candida to thrive. Hydrogen, which is produced by bacteria, can be used as a source of energy by H. pylori, so SIBO provides a never ending source of fuel for H. pylori. Additionally, Candida can attach itself to bacteria, which provides it with protection from antifungals.
However, Candida can create opiates, deplete acetylcholine and serotonin, increase histamine and intestinal permeability, impair thyroid function, immunity and the ileocecal valve and can cause sympathetic dominance, all of which could encourage small intestinal bacterial overgrowth. H. pylori can also hide inside of Candida yeast cells.
If H. pylori colonizes the small intestine, it will contribute to inflammation and leaky gut that can encourage both SIBO and Candida. If it colonizes the stomach, it will reduce our hydrochloric acid levels, which fosters the overgrowth of other bacteria and Candida.
Intestinal parasites may also perpetuate SIBO or Candida, as it has been found that bacteria can attach to parasites and parasites may harbor yeast inside themselves.
Therefore, if SIBO or H. pylori are present and not addressed when one has Candida, then they may not make much progress in eradicating yeast overgrowth and vice versa. So, it is important that one knows which microbe they are dealing with and address each of them accordingly.
Although it seems counterproductive due to their impact on Candida, a pharmaceutical based antibiotic may be needed to address bacteria before the use of an antifungal. However, if one uses some of the herbal antibiotics (oregano oil, cat’s claw, berberine, cinnamon, turmeric) many of them are effective against bacteria and Candida, so both issues could be addressed simultaneously.
The symptoms of these conditions are so similar that SIBO is often mistaken for Candida or H. pylori. So, here are a few characteristics about SIBO that I have witnessed in the people I work with, as well as myself, that set it apart from Candida or H. pylori.
SIBO is more painful and the symptoms (particularly the upper GI and center of the abdomen) can be much more severe.
The psychological symptoms of small intestinal bacterial overgrowth are much broader and disruptive.
The diet needs to be lower in carbs and more restrictive with fruit and nuts with bacterial overgrowth and bacteria is much less forgiving than Candida when you stray even a little bit from those restrictions and the complications can be more harsh.
The overall health of the individual with SIBO tends to be more compromised.
Gastrointestinal symptoms from small intestinal bacterial overgrowth are more surrounded around the center of the stomach in the belly button area.
SIBO is noisy (lots of gurgling, moaning and squirting in mid section) – Candida isn’t.
Acid reflux, GERD, heart burn, indigestion, and belching, tend to be more related to SIBO or H. pylori rather than Candida.
You may indeed have excess gas when carbs are eaten with Candida, but the gas that is produced with SIBO is much more excessive and its smell is wicked. It may smell like ammonia or sulfur.
Stool from someone with bacterial overgrowth smells much more foul than stool from someone with Candida only.
As someone who has dealt personally with Candida for decades and SIBO for only a few years, I can share with you that Candida is a walk in the park compared to SIBO.
H. pylori and SIBO can be hard to distinguish as well, as they both can produce upper GI symptoms like acid reflux, burning sensation in the abdomen, heart burn and belching. However, H. pylori symptoms (burning sensations of tissue, indigestion, belching) are typically experienced higher up in the abdomen. On the other hand, symptoms from bacteria in the small intestine can radiate out and up.
SIBO and H. pylori both produce a great deal more belching than Candida. SIBO belching originates from lower in the stomach down near the belly button, while H. pylori belching originates higher up. If you pay close attention when belching, you can feel where it originates from.
If you get really in tune with your body, you can also identify where your gas is originating from. When you expel gas, if you can feel it in your upper abdomen, then that is likely SIBO. If you feel it in your lower abdomen, that is likely bacteria or yeast in the colon.
Symptoms that develop as soon as food hits your stomach are more likely to be due to H. pylori, because that is the only microbe that can survive in this acidic environment. However, Candida and bacteria do reside in the mouth and esophagus and they become active as soon as food enters the mouth.
If gas begins in about 30 minutes of eating, that indicates that fermentation (due to Candida or bacteria) is taking place in the small intestine, because it typically takes about five or six hours after eating for food to make it to the colon. However, H. pylori may also inhabit the first section of the small intestine, (duodenum), so belching and pain that begins in 30 minutes could also be H. pylori.
You can get a general idea of where your bacteria or Candida are colonized by when your symptoms appear. Earlier on in the digestive process indicates they are higher up in the small intestine, later on in the process indicates they are further down in the small intestine and after five or six hours indicates they are in the colon. However, transit time does vary from person to person, so this may not be exact if one has slower or increased transit time.
Candida responds very well to a low-carb diet; many symptoms will resolve with changes in diet alone. SIBO requires significantly more restriction on the carbs and fiber including fruit and nuts to get relief. If bacterial overgrowth is severe, it may not improve much with diet alone or one may have to eliminate nuts and fruit completely to achieve significant relief. However, not following the diet makes SIBO symptoms unbearable. Additionally, some bacteria will feed on protein and fat when carbs are absent, so even these foods can become problematic to some degree.
H. pylori symptoms will also persist to some degree in the face of low-carb. So, if you are following the Paleo for Candida diet faithfully as I suggest, but still have a lot of upper and middle of the stomach GI symptoms and/or psychological symptoms (depression, anxiety, unexplained fear or paranoia, OCD, brain fog) are persistent, then your focus needs to be more on bacteria and Helicobacter pylori. One should always explore the possibility of parasites as well.
Let me share my personal experience with you to demonstrate how confusing it can be and how SIBO can develop so gradually that you don’t realize it is happening until afterwards when you can look back and see how it unfolds.
I’ve been managing Candida in my own life for more than 25 years pretty successfully. Then around the age of 50 I developed new GI problems that didn’t respond very well to my usual regime. The new symptoms were located more in the upper GI and in the small intestine area, where I had never really had symptoms before and they were much more severe. The low-carb, Paleo diet I had been following for years wasn’t working very well to alleviate these symptoms. I had to go even lower carb, down to 25 to 30 grams per day, but I could go to around 60 or 70 grams three times a week. This helped a lot for a while, but gradually things got worse and worse, despite the very low carb diet and removal of FODMAPS. Weird brain symptoms I had never experienced began to develop intermittently as well like intense brain fog, a choppy thought process, and songs or phrases would get stuck in my head and high levels of fear. I knew this wasn’t Candida, because candida had never been this painful, produced gas that smelled this way or this type of brain symptoms.
Initially these symptoms were attributed to H. pylori and parasites. Parasite treatment helped some, but not everything, and I could keep H. pylori to a minimum, but was not able to eradicate it completely. I came to realize that I had developed a SIBO problem when I was forced to took an antibiotic for a persistent respiratory infection and inadvertently cleared up my gastrointestinal and brain symptoms and made me feel better than I had in a long time. This didn’t use to be the case, in the past, antibiotics would cause a flare in my Candida symptoms and I would feel worse. I then did research and discovered this is an indication that SIBO is present.
At first I thought I felt better because it cleared up my H. pylori, but several months later I experimented with resistant starch and all those gastrointestinal symptoms and brain dysfunction returned with a vengeance and it was way worse than it had ever been. I was like, “what the heck is going on here?” At this point, the abdominal pain, gas, distention, etc., were excruciating and I couldn’t touch fruit or nuts at all without severe brain symptoms and unbearable gastrointestinal pain. Even protein and fat became problematic, as the bacteria began to eat that as well.
So more research led me to discover that a negative reaction to resistant starch is an indication of small intestinal bacterial overgrowth because they will feed on this substance like any other starch, at which point I came to realize that this fed SIBO and the hydrogen from the SIBO fed the H. pylori. Therefore, I came to understand that my focus now needed to be more on SIBO, but without ignoring Candida or H. pylori, of course. After starting herbal antibiotics, then my symptoms started to dissipate again, which confirmed that the major problem was bacterial. However, the herbals were not powerful enough for me and I was forced to take an antibiotic. I learned the hard way that supplementing with resistant starch can be downright dangerous when small intestinal bacterial overgrowth is present, so please do read my post on this issue to educate yourself.
I hope all of this helps you know what signs to look for and hopefully identify your microbes more quickly.
Fortunately, most of the steps that one will take to improve Candida overgrowth, will also be required and beneficial for H. pylori and SIBO. However, if they are present, this will not be enough. Therefore, the healing plan must address each of these aspects simultaneously or the one that is the most dominant problem may need to be dealt with first. You can learn more about how to address bacteria here and here and how to address Candida here. A post on H. pylori will be coming in the near future. Alternatively, if you need a more personal touch, you can schedule a phone consultation to discuss things in more detail.