Chris Kresser: It’s a good question. I mean, mold exposure comes to mind certainly as one possibility there if the patient is exposed to mold or has heavy metal load. That can make it difficult to address conditions like SIBO, dysbiosis, or fungal overgrowth in our experience. Perhaps a lack of beneficial bacteria so that even the antimicrobials keep things in check, but when you remove the antimicrobials, then the beneficial bacteria aren’t there to step in and continue with the job. Those are the most likely scenarios.
Fungi is notoriously difficult to treat. This has been kind of well-known in the functional and integrated medicine worlds for a long time, which is why there are things like the antifungal hit parade. If you Google, let’s see, I don’t know if it’s there—if there’s anything on the web about it. But some clinicians actually rotate between antifungal medications like nystatin, Diflucan, herbals like A-FNG, undecylenic acid, some of the stuff in Yeastonil or GI Synergy, InterFase, lauricidin. They create a protocol that rotates among these different products because that can kind of keep, make it more effective, reduce the chances of resistance developing, and sometimes patients need to be on those for longer periods of time.
However, I’m a little wary of that approach because just my desire to support and protect the overall microbiome, and taking any kind of anti anything, antifungal, antiviral, antibiotics for a significant length of time makes me a little bit nervous, so I would investigate some of these other possibilities probably before doing a really extended antifungal protocol.