The Fungus Among Us: Why Fungal Overgrowth & SIFO Are A Hidden Health Epidemic (& What You Can Do About It).

On this episode of the Ben Greenfield.

Fitness Podcast, My name is Dr. Ganoum. I am the scientist who named the microbiome in 2010. The microbiome is an ecosystem of trillions of organisms. My interest in the study of fungi came about in the 70s when I noticed people use antibiotics. Both these communities, bacteria and fungi, live in our body. Good bacteria is only half of the story because in our body, we have both good bacteria and good fungus together. We also have to study fungi because when you disrupt this balance, you are causing other problems. So in probiotic, you need to introduce good bacteria and good fungi because what they do is they will address the digestive plaque, which is made of bad bacteria and bad fungi. And biome is the only probiotic that can keep it imbalance.

All right, if any of you all are interested in fungus, this is an episode for you. If you think you might have sibo or even small intestine fungal overgrowth candida issues, my guest on today's show is a fungus ninja. All right, well, as you know, the gut is a topic that I talk about a lot on this show. Part of it might be because if I personally have one weak link, I guess, in my body, it, I think, is my gut, stemming from years and years of, you know, bodybuilding and ironman triathlons and all the strange things I consumed and also the strange critters and parasites and, you know, possibly even fungi. As is the topic of today's show that I've been exposed to over the years has certainly made me pretty interested in the gut. And one thing that I see coming up over and over again these days is this idea of sibo, small intestine bacterial overgrowth, and all these companies popping up to test the microbiome or to control the growth of something like intestine bacteria in the case of sibo. But what isn't talked about a lot of the time is not the microbiome, but the mycological, the mycobiome. And that's the fungus that lives inside your body. And as a matter of fact, there's something called sifo, small intestinal fungal overgrowth that in many cases can mirror some of the things that you guys might see with sibo, but the approach to it is completely different. Now there's this brand new book that I finished last month about the mycobiome. It's called Total Gut Balance. The author is the guy who actually coined the term mycobio and has done a ton of research on fostering healthy fungi and knocking out issues like Candida etc. His name is Dr. Mahmoud Ganum, and he's actually professor at the center for medical Mycology at Case Western Reserve University. And he's pretty much spent his entire career studying fungi and microbial biofilms. So if you guys are interested in intestinal health and also in things that could be contributing to elements like bloating, gas, brain fog, bathroom issues, and, you know, even immune system issues, this is going to be a really, really interesting discussion for you. And so the book was fantastic, and I'm just stoked to be able to interview Dr. Ghanoum today. So, Dr. Ghanoum, welcome to the show, man.

Thank you very much for having me. It's a great pleasure to be with you.

Yeah, yeah. And you know, that's a pretty big claim you make, I think, early in the book about the fact that I think you said youyou actually coined the term mycobiome. So I want to hear a bit about that, like if you really coined that term and if so, how that came to be.

Yes, certainly I did coin the term. And really, when you think about it, mycology is the study of fungi. Since everybody talks about bacteria, so basically in the gut we call it bacterium. So to me it made sense to call it mycobiome, to refer to the fungal community in our gut as well as on our skin and different parts of our body. So for years I realized that really in our body we have not only bacteria, but also we have fungus, we have viruses, and so on so forth. So around 2008 and just before that, I used to go to all these meeting and everybody talking about the microbiome, really basically saying about bacteria. So to me, as somebody who first did his doctorate in how if we take a person, let's say a lady, that takes tetracycline, the antibiotic, tetracycline, you really are killing the bacteria. And guess what happens? She will develop thrush. So to me, it made sense that we should look at both bacteria and fungi, because if you disturb one of them, in this case, we are killing the bacteria, good and bad one. In our gut, we have overgrowth of Candida. And that's why I started writing articles around that time saying we really need to look at both bacteria and fungi. I first wrote an article in the Microbiome, which is an American society for microbiology, you know, newsletter. But of course nobody listened to it. So I did research and I showed in healthy people, we found hundred and one different fungal species in our mouth. So you can imagine that really encouraged Me to come out with the term microbiome. And that's how it started.

Now, when it comes to the bacteria versus the fungi, can you get into what exactly the reason is that we would have fungus, as you say in the book fungus among us, rather than just bacteria. Like what exactly are fungal species doing in the gut? Why would the human species actually benefit from having fungus inside us?

Really, this is a very good question. Because a lot of people, when they think about fungus, they think that it causes problems. But in fact, science now is starting to show that we also need fungi in our gut. Because the good fungi, even Candida, when it is present at low doses, what it does, it helps our body in a number of ways. Number one, it helps you in breaking down food, food fermentation, you have a complex carb, for example, it can be broken down by Candida, which helps beneficial bacteria to use the byproduct and grow. Also, studies are showing that Candida at that level, or fungi at the low level, colonizer we should call them, they train our immune system. So as long as they are at low level, they really work with the bacteria to help our body.

Okay, so even Candida would be something that would be beneficial on small levels.

Oh, yes. Oh, definitely. That's why when we do our test through Biome Healthcare, we look at both bacteria and fungi and we see Fungi in nearly 50% of people. But they are present at low, let's say 1% with respect to 1% of the total fungal load in our gut is Candida. That's no problem. When you start having problem, when it goes up to 10% or more, then we have a lot of that organism. So having Candida at low dose is not harmful at all.

And what's that test that you're running to test for fungus people?

We do the gut report where we take fecal samples, stool samples, and we extract the DNA from the stools. And we look at both bacteria and fungi using 16S, which is next generation sequencing, 16S RNA, and also ITS, which is the primer or the probe that can detect the fungus. So we are able to look at both bacteria and fungi in that sample. And then we look at what is the, we compare it to normal, what you may call normal. And in this case you see whether you are, have, whether a person has imbalance or not. If there is imbalance, then we have nutritionists that can guide you how to eat better and also how to really have a better lifestyle.

Now, would that be a different test than a lot of people are doing? The viome or the longevity to do their full genes in the biome or what do they call it? I guess they just call it a microbiome analysis. Or would it be different than, than something like a three day stool panel from, you know, a lot of people will run like a Genova diagnostic stool panel. Is what you're doing any different than that? When it comes to fungal identification, what.

We do is that we, when we do they look usually at bacteria only. We look at both bacteria and fungi. And also with our background in the field of mycology, we are able to see what is the biological significance of these organisms.

Okay, all right.

Which is not done by the other group.

What's the website that people could go to if they wanted to get a fungus test? Or is that something they need to order through their doctor?

Yeah, no, I think you can do it. Go to the website biomehealth.com biohmhealth.com you will see the how to do the test.

Okay, all right, got it. So when you're, when you're doing this identification, I would imagine you're coming up with a wide range of fungal species. What would be an example of good fungal species that you'd see and what would be examples of bad? Or is it simply the level of all of them that would determine whether they're good or they're bad?

This is very good question. I think it's for Candida, the pathogen. I think the level is good and bad. But if you have Saccharomyces, for example, Saccharomyces cerevisia, it's the yeast that we use, used to make bread, brew beer and this sort of thing, this is a good organism, Saccharomyces cerevisiae. And if you have another organism which is called Picchia P I C H I A, or some people call it Pichia, which is a good yeast as well. In fact, we did a study in HIV infected patients and published in 2014 where we found people who have pickia in their mouth did not have Candida. And remember HIV infected patients, they used to develop oral flush. So anyway, the presence of this good yeast, Picia was able to control the bad one, which is Candida, which overgrowth and have thrush in the mouth. Okay, so this is a couple of examples of good guys.

Okay, so in addition to Candida, what would be examples of a few of the ones that you would be pretty concerned to see in the gut?

I like to see in addition to Candida, I mean there are different species of Candida like for example, if I see Candida albicans, Candida glabrata or Candida tropicalis, I am concerned. But in addition, if I the other things which we look at, like for example Aspergillus, okay, Aspergillus is another fungi, but it is a mold, it's not a yeast. Anyway, this we as long as the level is low because we can have it through eating some food. Okay. Or Penicillium, for example, we eat a lot of us cheese with you know how with the fungus in them. So these are transient and they will be washed out. So to me, I look when we have the test, as you say, we come out with large number of organism, we focus on few of them. Do you have Candida? If yes, what level and what species it is like Glabrata tropicalis. And this one, do you have Picia? Because I like to have Picia. I also like to have Saccharomyces. So I would like. If you don't have them and then I like you to take like for example, probiotic, which is again, for the sake of transparency, we in the same biomehealth.com we have a probiotic that have good bacteria and good yeast, which is Saccharomyces boulardis. So we like you to have that. Also you can have it by eating food, for example, yogurt. Okay. Or kimchi, other fermented food would be good as well.

No, just to interrupt real quick, what I understand from the book is that as you kind of alluded to earlier, certain bacterial species can help to control the level of certain food fungal species as well. So do you kind of cross reference, do you look at. Okay, well, this person may have high levels of Candida or moderate levels of Candida, but because their Bifidobacteria levels or their Lactobacillus levels are elevated or in really good count, the Candida must be kept under control.

Absolutely. You raise really a very important point because the diet, we want to restrict or limit the growth of Candida, but we want to encourage the growth of Bifidobacterium of Lactobacillus, because these are the good guys. And if you have. That's why when we look at bacteria and fungal profile, one of the organisms or some of the organism we look into is Bifidobacterium or Lactobacillus as bacteria, because we would like to have more of that. So you are absolutely right.

Okay, got it. Now, when it comes to what happens when the fungus actually gets out of control, I'm sure A lot of people, perhaps they haven't tested, but they're curious what it feels like to actually have a fungal overgrowth. What exactly are some of the most common signs and symptoms somebody would experience if they have a fungal overgrowth?

I think one of the things is like diarrhea, for example, there have studies have been shown that people with a lot of Candida overgrowth do have diarrhea. And some studies in the children showed that as well. You may have allergy, for example. Some studies have shown that allergy could be also contributed to Candida. You have some pain, you know, GI pain, for example. These are the most prominent, really symptoms of having too much Candida.

And what is exactly that Candida is doing in the GI tract, like from a cellular standpoint that would cause that to occur? What exactly is the fungus doing?

What happens if Candida overgrow? We showed in our paper or published paper on Crohn's disease patients, for example, this is a good way to really look at how it can hurt us. Candida comes and cooperate with E. Coli, as well as another bacteria, Serratia marcescens, which are pathogens, both of them, as you know, they work with Candida. They make what we call a biofilm. Okay, this biofilm, the best example of it is the plaque in our teeth. Every morning we brush our teeth because we have all these organisms form a biofilm. In our gut, we have similar situation. So what happens when they form this biofilm? These bad organisms get protected because biofilm, a hallmark of it is it is resistant to antimicrobials as well as its resistance to the immune system. Our cellular immune cell phagocytes, for example. Okay. So they come together, they start to work together, and then they change. In particular, Candida change its form. Usually it's a yeast, it's like baker's yeast, you know, oval shape. When it becomes in our gut, inside this biofilm, it starts to form thread like, or filament, what we call filament. And these filaments can start causing damage to our gut lining. And that's why you have damage and then you have inflammatory response. And of course, that where we have problem with having Candida in our gut.

Yeah. In the book, you talk about how it makes like these enzymes that break down the cell membrane lipids. And then I think there's another enzyme actually weakens the host cells to make those little filaments able to attach to the gut wall even more. And then you also talk about this concept that I've heard thrown around before. But I would love for you to explain a little bit more detail, the ability to form these protective plaques, these biofilms.

Yes. So, you know, it's very interesting. For years I was funded by the National Institute of Health to study biofilms, but it was not related to the gut. What happens when a person goes to a hospital? You know, we put all these catheters in them so that we can give them nutrition, we can give them drugs. You know, when you are in hospital, this is a good way to access the bloodstream and give you, as you say, for example, TBN for kids, you know, nutritional food for kids through the catheter. But what happens if candida or bacteria, both of them can do biofilms, stick to the catheter. They become again, they form biofilm, which, let me just give you, like visualization. It's like having jello. Inside this jello you have raisins, for example, OR M&MS. The M&MS. Are the organism and the yellow which covers it, called a matrix, which means it's carbohydrates secreted by this organism. They form a shield around these organisms, the raisins, okay? So it's very difficult to get rid of them. So that's where I started studying biofilm. And we were able to develop a lock solution, in other words, a solution which you can put it in the catheter which will be able to prevent and treat these biofilms on the catheters so that you don't have to pull it out. And that was maybe 12 years. I was funded from the National Institute of Health to study that. But recently, in 2016, the first paper when we published in Crohn's Disease patients, I start looking at biofilms in the gut, okay? And it turns out that in our gut, these organisms, they are not free floating. In other words, they are not in suspension. They come and they stick to our gut lining. Once they stick to our gut lining, they start secreting these, we call it matrix. It's basically complex polysaccharides, okay, and forms around it as if you have a tent. And they are living inside the tent, okay? And of course, they are protected, as I mentioned, from drugs as well as our host immune cells. And that's where the damage is.

And thesethese things, these biofilms, from what I understand, they canand I'll ask you later on about how one would get rid of fungus. But whether it's a fungal overgrowth or a bacterial overgrowth, from what I understand, it's the biofilms that make it such a hard condition to get rid of because they're so resistant to being broken down, to being dissolved.

Absolutely. That's where the problem I tell you. We did a number of studies, you know, because I was working for many years in this area and we showed that very few antibacterial, if you have bacterial biofilm, or antifungal, if you have fungal biofilm, that works. You know, we were lucky. We did a study. I Forgot now maybe 2004, 2005, it's been a long time where we screen all the antifungal agents to see which ones are good to get rid of this biofilm. And we identified couple of them, which was great because usually you think like Diflucan, everybody knows about Diflucan. Or Fluconazole, if you use Diflucan. It does not work against biofilms. But what we found that there is a new class of antifungal at that time, it's called Echinocandins. They are fantastic against biofilms. And that's now really what people use to treat these infections.

What did you call it again?

Echinocandins. One of them, There are a number of them. One of them called Caspo fungin, another one called mega fungi, and the third is Anedula fungi. They are from the same class. What they do these, they can break the cell wall. They really inhibit the synthesis of the fungal cell wall. And when the fungi does not have a cell wall, it becomes weak and easy to kill.

And are these pharmaceuticals or over the counters or supplements or how exactly does one get them?

These are pharmaceuticals because remember when we were developing that, we were targeting people in hospitals.

Okay, got it. And who manufactures those?

Different companies like Astellas, for example, Astellas Pharmaceutical, Pfizer and Merck. And now what's exciting is we have at least three different investigational antifungals. They're going, I help doing clinical trials for them. We did like in vitro, in vivo, and now we are doing clinical trials which really also show promise. So I am very happy that we have some really tools to try to get rid of the biofilm in hospitalized patients, you know, cancer patients, immunocompromised patients and this sort of thing.

Are there any probiotic strains that would have an impact on biofilms?

In April of 2019, we published this paper where we had the probiotic, which has Lactobacillus bifidobacterium as well as the yeast Saccharomyces boulardii. And we showed that it is able to break the digestive plaque or the biofilms in our gut. And this is published in a journal called mBio M B I O.

Okay, so. So there might be a way to actually go after the biofilm with probiotics. But would you, would you think that the best way to do it would be like one of these pharmaceutical formulations that you talk about in the book, like the Caspl fungin or the andalafungan or the mica fungin combined with something like a probiotic?

I think this is a good idea. The problem with these antifungals, which we have are mainly iv. You have to give them by injection, you know, and they don't absorb. They are not very effective when you take them orally. So there are some drugs which come in the way where they are effective orally, but all what is in the market at the moment, it's by injection. So they are not. To me, if I want to get a biofilm, I think your idea is really good idea. But at the moment what I would do, I will use probiotic. Also. I'll use certain food ingredients such as apple cider vinegar, garlic, coconut oil have been shown to show good activity against biofilms.

Okay, I want to ask you a little bit more about the dietary component because I know you kind of have a whole microbiome based diet as well. But before we do, let's back up a second. How would somebody actually get a fungal infection? Like, is this typically something that comes from food exposure from some type of parasite exposure, lifestyle environment? Like, what are the common reasons someone actually gets a fungal infection in the first place?

Very good question. When you are in hospital, first of all, remember a lot of these immunocompromised patients, they have a lot of antibiotics. So you are killing all the bacteria which we talked about that are useful, like Lactobacillus, bifidobacterium and this sort of thing. And also Candida can grow. So one of the ways for Candida to cause serious infection is it will go through the GI tract, the gastrointestinal tract, and invade in the blood. That's one way. Another way. Remember we talked about the catheters? We did a study many years ago where we found that Candida could be in the hands of the healthcare workers, like nurses, for example, or doctors for that matter. Okay. We found 40% of healthcare workers can have Candida in their hand. So when they are manipulating the catheter, when you are in hospital and the nurse come to Take care of your catheter. If she does not have gloves, if she did not wash, that is not good news because 40% of these people have this fungus. It could go through the catheter and cause an infection. So these are some of the routes for fungal infection. Also if you have surgery, like abdominal surgery, for example, in your tummy, you know that also could be another way where you are doing the surgery. So you give an excess of the organisms in your gut that can spill into the blood and cause an infection. So there are a number of factors and number of ways for this organism to cause infection.

And then once you are exposed, what type of things? Obviously sugar is a biggie. And I know most people know that sugar would feed fungus, which is why often, oftentimes things like kombucha and beer and wine and processed sugars especially are something that can really help to control Candida. But are there other things that once somebody has been exposed, would actually make that candida or that fungus infection even worse? Like any type of drugs, supplements, things along those lines?

Sure. I mean we talk about antibiotic, of course, also another drugs like corticosteroids, steroids, for example, for anti inflammatory. Again, when I was a young man many years ago, there was a paper where you have a rabbit which treated with steroids and guess what? It became susceptible to Candida infection. In fact, you will laugh at this. My PhD thesis was on the effect of steroids on Candida. So that's one thing. Now of course, there are other medications as well over the counter. Some of them, like, you know, this for pump inhibitors, for gerd, you know, acid reflux pumps. These are not very, very, very good sometimes, for example contraceptives, they can also predispose you. So there are a number of risk factors, some of them which you can control, others you can't. Okay, and these are a couple of the things which I mentioned.

Okay. Now when it comes to this idea of sibo, small intestine bacterial overgrowth, a lot of people think they have SIBO or have been diagnosed with sibo. And from what I understand, this idea of having a fungal overgrowth, which I think you call sifo, small intestinal fungal overgrowth, it can kind of be similar to sibo. So can you compare and contrast SIFO and sibo and whether the approach to one would be different than the approach to the other when it comes to actually getting rid of the issue, or also I'd be interested in whether the two can coexist at the same time?

Sure. So as you define Them SIBO is small intestinal bacterial overgrowth and SIBO is the same small intestinal fungal overgrowth. When you look at the published work, you find that they have similar symptoms. Okay. For example, bloating, indigestion, nausea, abdominal pain, gas and belching sometimes. Okay. Also another study compared the two since they have similar ones and what they found out is that nausea is more prevalent and severe in SIFO people, while abdominal pain and gas are more common on sibo. So there is some differentiation between them. Now what they found again, whether they coexist together or not, that they found all individual with C4, they grow Candida while subject with SIBO they have more aerobic bacteria, bacteria that lives in the air. Basically that's like Enterococcus, streptococcus and the few that had anaerobic flora, which means those that don't like to have oxygen, like Bacteroides for example. Okay. Now they found about 19% could have both as well. So you can have SIFO alone, SIBO alone, and some of the people may have both together.

Okay, got it. And how common is that to see someone with both SIBO and sifo? Is that something the biome test that you run can diagnose or is it two different tests?

I think with C4, I think it's two different tests. What the biome test can tell you is if you have an increase in candida. So definitely if you have an increase in Candida, we know it has sifo. If we also look at, I mean this is a good question. We really, when we look at the bacterial component of the analysis of the microbiome, we also look at E. Coli C. Diff, for example. And if they are high, then you know, they are a problem. So we could detect it. But usually we don't call it a test to know whether you have SIFO or sibo. However, the data contains that information and we will tell people about it. You have too much of this pathogen, you have too little of that and this sort of thing.

Okay, got it. Now one thing also in terms of contributing to a fungal overgrowth could potentially of course be not just the consumption of a lot of like fermented beverages for example, or sugars that could feed the fungus, but then also certain diets as a whole you seem to actually think may have an impact possibly deleteriously on a pre existing state of fungal overgrowth. Like one you talk about is the Mediterranean diet. That shocked me when you said that once study hadn't showed an increased prevalence and abundance of Candida. In people who ate a Mediterranean diet. And then, of course, there are other popular diets like the Paleo diet or a vegetarian diet. Are there certain diets that you would say would actually be conducive to a fungal overgrowth that people might think are actually healthy diets?

You know, it's really very, very good question. And also to me, first of all, I am from the Mediterranean region, so I love Mediterranean food, and I think it's very, very healthy. However, there are certain components. Like, you know, the Mediterranean diet has huge amount of grains, also complex carbs, a lot of dependence on pasta, which could encourage the growth of Candida. But that's why in the book we mention you can follow the Mediterranean diet, provided you avoid, for example, taking too much alcohol. Because, you know, when you are in Ital or in Spain, you sit down and you enjoy yourself, and people, or France for that matter, you enjoy a lot of wine and this sort of thing. And these definitely have effect on our microbiome, which could encourage the growth of Candida as well.

Now, just to interrupt you real quick, is that something specific about the alcohol or is it the sugars that are in these alcoholic beverages? Beverages.

I think it's the sugar. And the sugar as well, as I said, the tendency to have too much car.

Okay, all right. So arguably the same could be said for fruit juices as could be said for alcohol. It's not the ethanol. It's the actual sugar delivery mechanism.

Yes. You know, the alcohol. You are absolutely right with respect to alcohol. Studies have shown that if you drink too much, you are going to have problem with your gut microbiome.

Yeah, well, yeah, I would suspect to be an indirect effect. Like somebody could say, well, okay, well, I'm just gonna drink vodka if I have a Candida infection because it's low in sugar. But then you're looking at potentially the impact that vodka might have on the bacteria, because we know that ethanol can produce some toxicity to the bacteria, which would then indirectly allow something like a fungal infection to get out of control.

I agree with you absolutely. I mean, to me, when I talked about the Mediterranean diet more to encourage Candida, it's really the carb aspect, which is too much of that. So to me, if you take a little bit of carb at different times of the day, it's fine as long as you don't have this huge pasta ball and this sort of thing. And that's not a good way to go.

What about something like a Paleo diet?

I mean, the Paleo diet again, what the Interest in that is really what about what they have? They have some good stuff, as you know, but there is a lot of grains, for example, they don't like, if I remember correctly. This is what I think I will not recommend, you know.

Okay. Yeah, well, I think, I believe, if I recall what you said in the book, was that it might have too little prebiotic content because of the lack of whole grains and legumes. And the only thing I would think when it comes to perhaps that not providing enough fuel for the bacteria, the gut, would be the idea that we do know that short chain fatty acids and ketones, particularly beta hydroxybutyrate to a certain extent, can actually simulate a lot of what fiber does in terms of being able to facilitate natural bacterial count. And so perhaps if one were consuming short chain fatty acids or using butyrates or even, you know, in a relative state of ketosis much of the time, they might be able to get away with something like a paleo diet, even if it was low in prebiotic content.

I really agree with you. That's why we say our diet, total gut balance diet or the microbiome diet is really customizable. And you can change it, you can stick to your diet, provided you can add exactly like what you said, if you have the short chain fatty acid debutate and whatever this could substitute for that. So you can modify it to address the sort of the drawback of that particular kind.

Now, does the impact of something like a non digestible starch versus a digestible starch have any effect? Like, if I'm looking at something like fiber or resistant starch, would that actually feed a fungal infection in a different way than a digestible starch, like, you know, processed sugar or pasta or something like that? Like, is there going to be a difference in terms of the fungal impact?

Yes, definitely. In the simple sugar, as you mentioned before, and the refined sugars, definitely that is a negative impact. However, the resistant starch or indigestible carbs are quite good because what happens, we don't break them down in our intestine, they go down to the large intestine where they are broken down by vegetation, the beneficial bacteria. And by being broken down by beneficial bacteria, we are producing the short chain fatty acids and other good metabolites which can help us. So definitely, I will err into the resistant starch or indigestible carb much more than the simple one or refined sugars because of the fact that on the one hand, and these last ones, refined sugar and simple sugar are gonna increase Candida, whereas the others are gonna feed the good guys which keep Candida under control.

Right, right. And just to clarify for folks listening in, the indigestible starches would be things that you might get from vegetables or to a certain extent whole grains or legumes or fruits, which you'd wanna be careful with due to the sugar content. But then you've also got your resistant starch foods like sweet potatoes or plant plantains or squash. And if you were going to have, let's say you're an athlete, you're concerned about fungal infection, you still need carbs to support performance, you definitely want to go over that stuff versus like a isolated fructose maltodextrin or some kind of processed sugar source which is gonna feed the fungus much more readily than a resistant starch or something like a higher fiber food.

Absolutely. I think you said it so beautifully and clearly. You, because of your exercise and bodybuilding maybe experience before, you know, this is absolutely the way to go.

Now walk me through this whole microbiome diet. I want to hear how this diet came to be like eating to actually control the fungus, whether any research has been done on it. And then let's get into the details of what a typical day of eating would look like on this microbiome type of diet to create control fungus.

Yeah. So really how it came about is when we looked at what issues do we have in our gut, okay. Especially with, to do with our westernized diet. Western diet, okay, the western diet, we are eating a lot of red meat, we are eating a lot of sugars and everything is oversized. And this sort of thing, the sugar of of course it's gonna feed the Candida. As we have established now you have the red meat and high fat food. What you are encouraging, you are encouraging bacteria that is pro inflammatory. In other words, it loves to break down bile loving, bile loving organisms which cause inflammatory symptoms. Now we wanted to do, okay, what can we do to try to limit the growth or starve the growth of the bad guys. And this includes the Candida as well as the pro inflammatory bacteria. So with the Candida, I looked into the literature and the experience we have and we found that as you said, we talked a lot about it, about sugars. We found that people who are low in vitamins A, B and C tend to have gi Candida issues. And also the type of protein you select, we need good protein from plants, you know, or fish, for example. So that's the first thing. Then we wanted to encourage the good beneficial bacteria and with that, that's where we come out with fibers. We come out with resistant starch. Okay. Now we also wanted to make sure we are able to disrupt the biofilms because the biofilms or digestive plaque is causing an issue to our gut lining as well as inflammation. And we wanted to add finally, like cruciferous vegetables, for example, because they have good antioxidants and anti inflammatory. So this is with respect to the microbiome, also because of our experience that you may be eating the best food, yet at the same time you might have imbalance in your microbiome, in your gut. We said there should be certain lifestyles that we should follow. Number one, you need to exercise, you need to have less stress, Go out, enjoy yourself, go for hikes, walks. If you are so stressed out, take a few minutes during the day and relax. I never did yoga before and now I do yoga and I find it so relaxing because all the time I'm thinking about how I can do these moves and how I can do breathe and whatever. And by the end of the one and a half hour, I definitely feel much, much better.

Although, as you note in the book, during extreme exercise, blood can get diverted away from the GI system to the heart or to the lungs or to the muscles. And that's why a lot of these, these more extreme sports or hard and heavy exercise can actually lead to a state of intestinal ischemia where the intestines get starved of blood or a state of leaky gut due to increased intestinal permeability during exercise. So I think this is why anyone who's on kind of a path to heal their gut, get rid of sibo, get rid of sifo, et cetera, should do more of the aerobic sunshine, walking, the yoga, the swimming, some of the light restorative exercise, or things that aren't going to divert as much blood away from the GI tract because it gets so much harder to heal your gut when you're doing a lot of that kind of like metcon, high intense training or the long bouts of endurance.

I really agree with you, absolutely. So like to me, I wake up in the morning during the week, like five o', clock, I do my exercise half an hour in an elliptical machine. I found that like running is not great because, you know, at my age, it's not great for my knees or my ankle. So I do this elliptical for the last few years. I love it, you know, and then before I do that, a little bit of stretching, some yoga moves, it's half an hour, it's not huge. And at the weekend I don't do it because I do a lot of taking my dog for a walk. I love to go out in nature. We are very lucky. We have beautiful, you know, nature reserves here. So go out, take your dog for a walk, and this all together is gonna help you really feel much, much better.

Yeah, yeah. And I want to ask you a few specifics about the diet too. Like, for example, there's no full fat dairy. You have a specific section on the microbiome diet where you say no full fat dairy. What's the link between dairy and fungus?

I mean, really, it's not necessarily related directly to the fungus because you have the saturated fat. And as you know, saturated fat are not very good for our heart and cardiovascular issues.

Well, not necessarily. I mean, it would depend on, you know, your genetic status, like if you have the FTO gene. And also, you know what those saturated fats are, you know, how much of your, your total fat intake those are comprised of. And certainly some people do have pretty, pretty robust ability to be able to handle higher amounts of saturated fat. So I personally don't think there's a direct link, depending on the person, between high saturated fat intake and cardiovascular disease, for example.

I mean, from my point of view is I would like to keep the good stuff. I don't want to say don't take yogurt or don't take dairy products because I think dairy products have other advantages, you know, from the minerals, for example, the vitamins, the proteins, you know, casein. So you really, you should have some of it. But why not limit some of the stuff, which, as you appropriately said, could not be helpful for others while others can handle it. So it's a way of in the median or in the middle. I'm always a moderate person of guy and that's why I think this will be much better for a general use.

Okay, got it. Now, what about certain herbs or spices? Are there any that are particularly good at killing fungi? Like, you know, for example, I know you mentioned coconut oil earlier, and I think it's wonderful to just start off the day with some coconut oil pulling to help with the bacterial profile in the mouth. And it can also, of course, have an antifungal effect, from what I understand, in the gut. But other than coconut oil, are there other kind of key staples of an antifungal diet that you think have a real impact on candida or other fungus?

I think turmeric, for example, is very good. I tend to have an egg in the Morning and then add a little bit of that. Garlic is fantastic. I published many years ago again three papers about the effect of garlic on Candida. It's fantastic, I tell you. So these two I would go with anytime.

And then you also said, I think earlier you said apple cider vinegar.

Yes, apple cider vinegar have been shown to have very good activity against the biofilms, which of course include ability of candidate to form biofilm.

Okay, got it. And then you talked about these antifungal medications. But in addition, in addition to that, would there be other supplements that you think would pair really well with something like this microbiome diet?

Yes. One is the using a probiotic that have Saccharomyces boulardii. And I mentioned the biome product has that because studies have been shown and we, in our hand, we published this paper which I mentioned before, we showed that having Saccharomyces boulardii, as well as Lactobacillus acidophilus, rhamnosus and Bifidobacterium previi have very good activity against Candida by itself, as well as when it forms a biofilm with others. One other thing which I think is very good is some enzymes like amylase, for example, which is also part of the probiotic of biome, where studies have been shown to show it has anti biofilm activity.

And in amylase. You mean like you would get in a digestive enzyme complex?

Yes, yes. Yeah. That's why like also it made sense to add it because it's quite safe because we have it. And now other supplements are the vitamins. As I mentioned before, people who are deficient in vitamins A, B and C really should take them to keep Candida at bay.

Now, another thing regarding the actual kind of the supplementation piece is when it comes to these enzymes like amylase you mentioned, don't a lot of doctors use enzymes like interphase or serrapeptase or things like that to help to break down the biofilm as well?

I think, I think that, for example, peptide, peptide days, it's gonna break down the protein portion with the biofilm. It's more a car type of thing because the matrix, which I mentioned is complex, complex polysaccharides. So we need something that in addition to. And in addition to breaking some proteins, it will be good to have also something that can break the polysaccharide.

Okay, got it. So what would be a sample breakfast? I want to hear a few sample meals, sample breakfast, sample lunch, and a sample dinner on this Diet.

Okay. I can tell you what I do. I mean what I do in the morning is I like to have a steel cut oatmeal. I love it. I add to it sometimes bananas sometimes because especially on the unripened side, I add for example some berries. Berries are great, you know, and so that's during the week because I'm in a holly. That's what I do. Sometimes I add just one spoon of honey even though it has sugar, but it's not too much. That's allowable during the week. Weekend. Sorry. I like to have an egg. I like to have an egg. I like to have tomatoes as well. Some turmeric as I mentioned in them. And of course I love olives. Olives, you know, where I come from we had a lot of olives tree and my mom used to have a cup on the table where we have olives. You eat it like you are eating peanuts. So I love that. That's. Yeah, so that's in the, in the morning at lunchtime, I tend to go after one of two ways. Either I go after soup, particularly lentil soup. I love lentil soup. It has a lot of benefit. Also to that I add a little bit of, of spring onions. I add lemon, I love lemon, you know, squeezed lemon on it. That's great. A little piece is sometimes of protein, like a little bit of chicken and this sort of thing. So that's one thing. Or if I am in the mood, I'll take salad. I love cucumber. Like my salad usually it has cucumber, it has spring onion, it has garlic, it has lettuce. And of course I love to have some like salmon as a protein. I love that. Now sometimes between breakfast and lunch, depending on how I'm feeling, if I feel a little bit hungry about 10 o' clock because I wake up early. So I take some nuts. Pistachio, I love pistachio. And actually studies, yeah, those are, those.

Are fantastic for the biome, aren't they?

Isn't it? It's really great. And the studies have shown that now in the evening my wife, she really takes care of me. She has, you know, like for example, now this autumn or full vegetables are really, really nice. So we had like asparagus, we have cauliflower, we have brussels sprouts. So that are our vegetable baked. And we have sometimes chicken, roasted chicken. We love fish as well. So variety in what different vegetables to have but. And the variety of different, what you call proteins. We focus mainly on chicken, on turkey is good, especially in certain times. Of the year, you know, if it's available, as well as fish.

Yeah, it sounds like very much a Mediterranean diet without a lot of added sugar, sweeteners, I would guess not a lot of alcohol based on what you've said before. Not a lot of refined grains. And it sounds kind of low on the oils and fats and even the full fat dairy products like we talked about a little bit earlier. But do you track your blood sugar at all, or do you think that there are any. Any issues in terms of, like, you know, oats and berries and kind of like weaving the carbs in throughout the day? Do you ever use a continuous blood glucose monitor or a blood glucose monitor to track your blood glucose?

I really don't, but when I go to my, you know, primary physicians, I. Look, I never had an issue. I mean, as far as these, especially oils and whatever. I love olive oil again, for the same reason that when I was grown up, that's what we had. I think it's very healthy. I think, as you said rightly, it's like Mediterranean diet, but it is customized to make sure we reduce the fungus, encourage the others. So I don't want people to misunderstand that pungent diet is bad. Not at all. It's great diet. We take all the beneficial component of that and we avoid the ones which science have shown that they are. Really could be detrimental.

Right, right. And then I guess the other thing is, you know, a lot of these compounds, you know, like the onions and brussels sprouts and things like that, if people did have a concurrent sibo issue, I know that in many cases, the high amount of fiber fodmaps, like the fermentable compounds, the oligosaccharides, things like that, can contribute to gas and bloating. If someone had sibo, so could someone, if they had sibo and sifo at the same time, kind of do something similar to what you were doing, but then reduce some of those, those fodmap foods or, you know, the high amount of raw veggies, things like that?

Yes, I really agree with you. I really agree with you. That's why, again, we, I, I stress the fact this is customizable diet. All of us, even in the diet itself description, we say, look, you need to ease into this diet. We all sometimes eat in certain way, and suddenly we would like to change our diet drastically, try to do it slowly again, moderation, build into it, and then you will be able to have a nice transition from something which, let's say, have so much sugar into one more manageable. And then you will feel much, much better. You know, the other thing which was interesting is we did a clinical study where we had people, we took their fecal samples before they started the diet, the microbiome diet, which we have, and let them go for four weeks on the diet. And we took another sample in the middle fecal sample. Also we gave them a questionnaire to try to, sorry, a sort of list of their weight, how did they feel with respect to their constipation, how all these questions we added. And you know, lo and behold, at the end of the trial, we looked at the microbiome and it really shifted into better profile of bacteria and fungus that was more beneficial one, which really pleased me tremendously. Also we looked at the symptoms that they had. One lady had sibo, and the first week did not do much to her second week and same, but she started a little bit to feel different by week three, end of week three, by week four, she felt, she said, I have never felt as good as this. So this really, as a scientist, it makes me happy, you know, because sometimes you do something, you don't know whether it's gonna work or not. So lo and behold, this lady was a very happy camper. Other people where they had, for example, craving for sugars, they lost these cravings, but better sleep, some of the participants reported. So all in all, it was very pleasing. And now I'm doing even a larger trial because I like, you know, I like to have more and more data, as you can imagine, because of my background.

Yeah, yeah. Well, it sounds like data is the place to start, like getting this, this bio. By the way it's spelled B I O H M, this biome health test for fungus. And then from there, if you have it, then you could go into looking into whether getting on a pharmaceutical regimen for breaking down the biofilms and some of these antifungals you talked about combined with this microbiome diet. And I'm curious, obviously you're just one guy. I don't imagine that you can handle the, you know, every person on the planet who has sifo. But is there a. Is there a way to find a doctor who's actually well versed in something like sifo? Do you have a practitioner network or anything like that?

Yes, sure. We have at University Hospitals of Cleveland. You know, I am a professor at Case Western Reserve University and also member of the University Hospitals of Cleveland. We have a great gastrointestinal, intestinal and hemorrhage hepatology institute. We have really good people who can help, especially when it comes to the actual clinical symptoms and whatever, which I really don't do. What I can do is we can partner where I have my it's called integrated microbiome core where we analyze the data and then the physician and these institutions can help.

Okay. Yeah, got it. Well, what I'll do is I'll link to your profile on the show notes, which are going to be@BenGreenfieldFitness.com TotalGutBalance that's BenGreenfieldFitness.com TotalgutBalance and if you guys go there, I'll include links to all the things that Dr. Ghanoum and I talked about today and then also some of the other resources for finding out if you have sifo, some of the tests in his website as well as his book Total Gut Balance, which is just really fantastic and I thought very educational on this whole concept of fungus, which I think, you know, as I mentioned in the introduction, I think sometimes getstens to get underemphasized compared to bacterial issues, but it's pretty important. And I'm always shocked when I'm looking over, you know, like the gut results of some of the clients that I've had tested. How many people have really high levels of things like Candida and they are symptomatic at the same time, but it's more than just swallowing some coconut oil. There's a pretty systematic dietary approach and often a supplement and a medication approach that you need to take into consideration. So this book's a really good way to navigate all of that. So Dr. Ganoum, thank you so much for coming on the show and sharing a lot this stuff with us, man.

I really appreciate it was great pleasure.

Awesome. Well, folks, I am Ben Greenfield along with the author of Total gut balance, Dr. Mahmoud Ghanoum signing out from BenGreenfieldFitness.com Again, all the shownotes are@BenGreenfieldFitness.com Total gut balance. Have an amazing week. Well, thanks for listening. Listening to today's show, you can grab all the show notes, the resources, pretty much everything that I mentioned over@BenGreenfieldFitness.com along with plenty of other goodies from me, including the highly helpful Ben Recommends page, which is a list of pretty much everything that I've ever recommended for hormones, sleep digestion, fat loss, performance, and plenty more. Please also note that all the links, all the promo codes that I mentioned during this and every episode help to make this podcast happen and to generate income that enables me to keep bringing you this content every single week. So when you listen in, be sure to use the links in the show notes, use the promo codes that I generate, because that helps to float this thing and keep it coming to you each and every week.