I have a female patient with the main presentation of bad lower abdominal pain and wind for 15 years. As well as cold hands and feet and PMS. She had a poor diet and drank alcohol regularly, which is what we worked on first. I since ran a Doctor’s Data stool panel, and the main finding was many in microscopic yeast, although no dysbiotic flora in the yeast culture. Also many yeast in all three parasitology and microscopy samples. She also had no growth for E. coli, no growth for Enterococcus, and 2+ for Lactobacillus. I didn’t run a SIBO test because the treatment would have been essentially the same as it is for yeast. She has been on the basic antifungal protocol plus charcoal and A-FNG for two months now with no change at all. Naturally, she is disappointed and wary of spending more money. In this situation, would you suggest trying pharmaceuticals for fungal overgrowth, and if so, what options would you advise she discuss with her doctor? Otherwise, what would the next steps be? Cyrex testing, perhaps, but she didn’t get any changes when doing a strict reset.

Chris Kresser: So, to me this sounds like a case where there is possibly something else going on that is contributing to the ongoing dysbiosis. In this kind of situation, this is when we start to look for other things such as mold or heavy metal toxicity. You might run the Quicksilver blood metals panel or the Quicksilver Tri-Test to look for mercury, lead, arsenic, or other heavy metals. You might do a workup for chronic inflammatory response syndrome because when they don’t have any improvement at all with antifungals, if they don’t have any improvement at all with diet, that’s unusual, and that suggests there may be something else going on. It’s possible that pharmaceutical antifungals such as nystatin, which is kind of the antifungal version of rifaximin in that it’s not systemically absorbed and is kind of like a topical antifungal in the gut, that is fairly potent and may be worth a try, especially given that she still has the yeast, but, you know, in functional medicine, we’re always trying to get to the root of the problem. Eight times out of ten in this situation, we find something else that is causing the gut to become a hospitable environment for pathogenic organisms, like I mentioned, so I would continue to look a little bit deeper and see if you can identify any of those other factors.