154: Candida Rashes + SIFO w/ Dr. Christine Maren

[Music] Welcome to the Healthy Skin Show with Jennifer Fugo, where we're flipping everything you've been told about your chronic skin issues upside down and connecting you with alternative solutions your dermatologist never told you about. Welcome back to episode number one, fifty-four of the Healthy Skin Show. In today's episode, we're going to talk about Candida Rashes and something called CFO. Most people have heard about CFO. CFO is small and test in bacterial overgrowth, but fewer people have heard of CFO. CFO is small and test in fungal overgrowth, and that can be a major problem for some people, especially given that a lot of a struggle with dysbiosis who have these chronic skin conditions, and I want to point out something important. Fungal organisms can be, like Candida albacons, for example, is considered to be a commensal organism, so it should be in your gut's microbiome, but it happens to live more in your small intestine than it does in the large intestine. And so when it overgrows, that overgrowth tends to start in the small intestine, and if it gets really bad, it'll spread down into large intestine, and then continue to sometimes show up in other areas of the body. I always think of fungal organisms expressing themselves outwardly saying, "Hey, hello, I'm here!" And you're like, "What the heck? You try to do all of these topical things, but you notice that the fungal organisms continue to come back." And I will tell you, if you suspect that you have fungal rashes, do not fret, I've actually worked on a number of these types of cases in my clinical practice, and I've gotten some really, really stellar results that have dramatically improved not just my clients' overall confidence in health and being able to show their skin because the rashes are gone, but also just in a level of comfort and sanity, because the itchiness can be just absolutely maddening. And so my guest today, my friend and colleague, Dr. Christine Marin, is going to take us through this entire process of how do we understand and look at Candida rashes, as well as how CFO plays a role in all of that. For those of you unfamiliar with Dr. Marin, she's an osteopathic physician and the founder of a functional medicine practice in Colorado, Michigan, and Texas. She's also the co-founder of Hay Mommy, an online resource to help women navigate a healthy and happy Mommyhood. She was introduced to functional medicine after struggling with pregnancy, complications, and recurrent miscarriages. A functional medicine approach helped her address underlying health issues associated with gut infections, food sensitivities, hypothyroidism, hormone imbalance, and mold exposure. Now, a mother of three, she's devoted her professional life to helping other women optimize their health during pregnancy, thrive, postpartum, and get their life back. Dr. Marin is board certified in family medicine, and is an institute for functional medicine certified practitioner. Now that we've covered the introductions, let's dive into today's conversation. Thank you so much for joining us, Dr. Marin. I really appreciate you being here. Thanks, Jan. I'm so excited to be here. So today, I wanted to talk to you a bit about fungal organisms and how that can impact your skin. A lot of my listeners know that fungal organisms and bacterial communities can impact what's happening at the level of your skin if they live in the gut. So we know about that gut skin connection, but we haven't really talked a whole lot about something called CFO. So CFO is, I think in some respects, we could say it's kind of like a cousin or a sister to CFO, and we've talked a little bit about CFO, but why don't you share with everyone what is CFO and how are they different? Yeah, so CFO is smelling to send bacterial overgrowth. CFO is smelling to send fungal overgrowth. So you could have one or you could have both concurrently. The way that I differentiate in patients is really through testing to try to figure that out because the symptoms are quite similar. Bloating, gas, loose stools, or sometimes with CFO, especially methane predominant, there can be constipation. But I find with fungal overgrowth, it's often more loose stools and sometimes urgency. Okay. And so this is predominantly a gut issue, correct? Yes, first of all. So fungal overgrowth can be systemic in other ways, but yes, I would say, I guess it depends on the symptoms, right? It would. But a lot of times you can wait. Something in my gut can cause an issue at the level of my skin. I mean, with CFO, for example, is there a way to test for that? With CFO, we have breath tests, which there's some argument about how effective those breath tests are at even figuring that out. And there's different forms of CFO. But with CFO, do we have a way to even determine that you have it? Kind of. So there are some clinical studies. Dr. Rao has done where you basically get an aspirate from the small intestine and culture at least. I mean, that's obviously super invasive. It's really just used in research. It's not something that's used clinically, or especially relevant or necessarily helpful at this time. What I do in my clinical practice is organic acid testing, because we can get fungal metabolites and then sort of matching that to some of these symptoms. So if their symptoms are digestive in nature and they sound like CFO, I may or may not do a CFO breath test. If that comes back negative and they still have symptoms like CFO, that's when I really start to think about CFO or fungal overgrowth. So doing organic acid testing, if you can see evidence of a lot of fungal overgrowth, that tests for metabolites, from fungal metabolism, basically. And if those are very high and somebody has digestive symptoms like bloating, that's when I pretty much assume it's CFO, but yeah, a very direct test is hard to do. There's nothing perfect. No, no. And so it's interesting. You also kind of mentioned to me that there can be a connection between CFO and rosacea. And there's definitely, actually we've talked about it on the podcast with Dr. Weinstock about the connection between CBO and rosacea. But how, how have you, or I guess what connection have you found? Is it a clinical practice in your clinical practice that you find these connections? Is there any research that you know of? There's no research that I know of, Jen. All the research I can find is on CBO and rosacea. We know there's a strong correlation there. We know that when people get treated for CBO in those studies, that their rosacea gets better. But then the question is, what about the patients with CFO? And I clinically, I see a variety of different skin conditions with CFO or with fungal overgrowth, and it could be rosacea. I see a lot of keratosis polaris that chicken skin on the back of the arms. Acne. What's the other big one, eczema kind of conditions that clear up? So yeah, it's purely clinical. And I think we definitely need more research. I mean, the research is totally lacking around fungal overgrowth and CFO to begin with, right? And that is true. I think it becomes more difficult to figure out which way to go with a lot of these right now because our, well, to be fair, research is, it takes a long time to do. You have to have money to be able to do it. And so it's not always that simple. A lot of times you're in practice and you're just kind of like, okay, what do I do? I have these symptoms. I have this testing and you've got to kind of piece it together yourself in a true detective sense, you know? Which is really amazing that you also think about things from that perspective. It's not just like, I don't know. I don't know what's causing these issues. You're really looking deeper and saying, okay, let me make an educated guess based on all of the given information. So with fungal organisms, like for somebody listening to this and going, wait, all right. So you're saying I have fungal organisms living in my small intestine. Is that at all normal to have fungal organisms living in the small intestine? What about, like, how do we get here? How did you end up with CFO? Yeah. At least from what you can gather. So a healthy gut absolutely has fungal organisms in it. Somebody with a healthy gut has Candida growing in their gut. When it is overgrown or becomes invasive, that's when it becomes problematic. So, you know, I tell my patients, we just kind of have to do some investigative work and really, like, think about triggers and timelines and think back to when did this become a problem and what could have triggered it. So for somebody to have either bacteria or yeast in the small intestine, small intestine is relatively low in microbial organisms. You know, it's there mostly in the large intestine and intestine, but for various reasons, they can, you know, populate the small intestine, whether that's a motility issue or whatnot. But yeah, to have fungal overgrowth, you know, I really look with patients and look at triggers. So big triggers I see are a lot of Annabelle accused. For instance, I talked to somebody yesterday who had, like, tonsillitis, his entire teenage She had his tonsils taken out as well. it is 20s, you know, because he had an abotic exposure twice a year. I also think, you know, actually for him in particular, he had inhaled corticosteroids because he had asthma. And so that was maybe like the tipping point for him when he started those inhaled corticosteroids. They obviously have some benefits for some people, but that is a no risk is to get a soft agile candidysis or at least, you know, have an overgrowth of a Candida which, you know, for him was a measophagus. I also see patients with mold in their home. So if patients live in a home that has mold and other microbial overgrowth, that can be an issue too. Number one, it suppresses the immune system. And so that's when we see yeast overgrowth, but number two, you're breathing and eating and you're just in this, you know, you've got spores in your air on your food kind of everywhere all the time. So those are some big ones, steroids are another one that's a potential. I also look for oral issues. So people with dental health problems or maybe root canal, that's not super healthy or a crown that wasn't placed correctly or something like that. You can have Candida or yeast overgrowth in your mouth and then we're constantly swallowing that and you can see the effect that way. Now since most of my audience is very, I should say they're pretty tuned in to the whole steroid, well, steroid creams, a lot of people have done oral steroids, a lot of different things because that seems to be the standard of care for a lot of chronic skin rash issues. And you've mentioned that that could potentially create an imbalance so to speak in the microbiome. Do you have any thoughts on why that might be and is it so you're saying inhaled? So is that through and like a like a. Like flow, yeah, so people with asthma of a certain grade like I first still have a butrole, which is a rescue inhaler, but if they have persistent asthma and it's a daily kind of thing, then they go on an inhaled corticosteroid and that inhaled steroid is like a flow vent inhaler. So, you know, for people with persistent asthma symptoms, I think it's important to take that actually like I wouldn't recommend against taking it necessarily, but I think you have to understand that that can create some imbalances and hopefully get to the root cause of the asthma, so you can fix that, which might actually be a yeast issue, right? That might go back to your gut too. So yes, I mean, I think steroids like risk benefit all the time, right? So I'm advocating that people stay off of steroids when they really need them, but it can, it's like a lot of different things feel the bucket, you know? So it's like diet and lifestyle and then medication use and then antibiotics and like all these things add up and then you move into a moldy house and it's like the bucket is full. And I think that's a good point. You know, we're all unique and that's an important point that I always try to drive home here on the show. Like we can assume that one person's issue or one person's solution is equally your problem or your solution. We just don't know. And so the best thing to always do is to talk with your practitioner about these, but I like the fact that you're providing us with some insight as to like a possible problem or a possible trigger in your past. So so is that something? If someone's listening to this and they're like, Oh, wait, you know what? As a kid, I was constantly on an inhaler and I had a lot of allergy issues, a lot of asthma. That could be a potential red flag. Then what is what you're saying for yeast overgrowth? Yeah. Yeah. It's a risk factor. The other one I didn't mention are proton pump inhibitors. So many people have been on acid blocking medications for a long time and we do have research that looks at Candida overgrowth, specifically CFO with the use of proton pump inhibitors. Like that's one one place where we actually do have research. So we know you decrease acid in the stomach and you can increase your yeast counts. And so sometimes those are necessary medications, you know, for people who have bleeding ulcers and things like that. But you know, I try to really look at like what's the root cause of that? You know, what's the root cause of somebody's digestive issues of gourd or whatever so they can get off of those types of medications. And so if you feel like, wow, CFO might be something you should consider. What would you say aside from getting an organics panel of some sort, you know, there's a couple of different versions out there that are offered. But if you do find out you have CFO, like or CFO, I should say, what do you kind of feel are the best options? Like do you feel like medication is the best way forward? I mean, some people can't even get their doctors to get on board to get medication. Are botanicals or herbs a good choice? Do you feel like diet alone is effective? I personally haven't found diet alone to be very effective. What are your thoughts on all of this? Yeah. So with regards to diet, I agree with you. I don't think it can be solved with diet alone. And then people get into these super restrictive diets and it becomes hard, like stressful. And then you've got microbiomes even more narrow. And I'm not a fan of super restrictive diets. That said, there are definitely things to avoid if you have fungal overgrowth. You know, most of my patients react to things like gluten and dairy, so taking out some of the more reactive foods and really limiting sugar intake and then alcohol, and fermented beverages. So beer and champagne's like off the table. Those kinds of things are important. So diet obviously plays a role. But I think in terms of CFO, I think botanicals are big. I think that's very helpful, especially because there's a lot of overlap. You could have CFO, you could have CFO, you could have both. And so if you don't have a way to test that, you can take herbs that are pretty broad spectrum and relatively safe when not taken long-term. I mean, of course, people need to consult their practitioners, make sure there's not interactions with other things. They're not safe when pregnant and breastfeeding. But many times they could be used, safely in a lot of people. And like I mentioned, they're broad spectrums, so they'll have activity against bacteria and parasites. When we get into pharmaceuticals, I think that's when I really need some more evidence. Like I don't treat somebody with pharmaceuticals generally, pharmaceuticals into fungles. Unless I have something really demonstrating that it's fungal overgrowth. In which case, there are several to consider. One of them is nice statin, which is an oral medication that stays in the gut. It's relatively safe. And we use it in kids' event. And so there's not systemic absorption. It's not hard on the liver. But it only works in the gut. But that can be effective for some people. Another one is Diflucan, or fluconisol. Many people have heard of that because they may have been treated when they had a yeast infection, a vaginal yeast infection. And that would be like one or two pills that are usually prescribed. But that can be helpful for some people. There's a lot of Diflucan resistance. And so sometimes it's not helpful. But it can be very helpful for people. But it's hard on the liver. And it's not one that I use in everybody. I'm pretty judicious about that one. But just like antibiotics have different coverage for different types of bacteria. It's the same with antifungals. So there's different kinds of antifungals that have different coverage. So it's rachonisol. It's a different kind of azol. I mentioned Diflucan or fluconisol. It's rachonisol. It's called sphorinox. Not especially for those who've had overgrowth with asphragilis or exposure. So it can be very helpful. I think I personally use antifungals in part of my treatment. And they were a game changer for me. But I again think they should be really used judiciously by somebody obviously who knows how to safely prescribe them. And what's interesting is you've also mentioned, and I think it's an important point to make is it's not just candida albacons that we have to worry about here because there are other types of fungal organisms. What are some of the other fungal organisms that you see pop up in people? Because I'm not, do you agree with that? Like most people think it's just candida albacons, but it's not. Yeah, no candida. I say candida is like Kleenex to tissue. It's just like the neighbor for fungal organisms. So candida is sort of a umbrella term that I think it just implies fungal overgrowth when people say overgrowth of candida. But geotrychum and rototrulla are other types of species that will come up sometimes. But then again, I think also really looking environmentally. So I mentioned aspergillus. And that's something we find environmentally in moldy homes. And then of course, I mean, there's other things like staccatoid arteries and other ones that have specific metabolites you would find on more testing. But yeah, I mean, there's definitely, it's, that's why different herbs and different antifungals sometimes have to be employed because it's not just candida. And with that said, as far as like a long term plan, do you feel like most people when you understand what's happening and you, whatever your plan may be, whether it's a combination of pharmaceutical and antimicrobial or antifungal herbs or whatever, do you find that most people don't have to constantly be on like an anticantheta diet and the rest of their life. They're constantly being, I don't know, almost under like constant attack at war essentially. Because I find like there's a lot of people out there that feel like they have to be on an anticantheta diet for the rest of their life to control. And I'm like, my feeling is, well, maybe you didn't do something to actually deal with. But what's your experience? Do you feel like it's something you have to manage for the rest of your life if you, if you do really address it? I do think there is a degree of having to manage it and sort of live with it. And I, I say this from a very personal place. I, you know, Like I said, I'm not really big, like long-term or short-term diets are hard. They're really hard. And I don't know that they're really good for us, ultimately, right? So I think that, yeah, long-term, I mean, if somebody develops sort of symptoms that are very bad and gets leaky gut and they start to have an immune response to gluten, can they eventually go back and gluten? Probably not. Probably that one's going to be out. - Agreed. - But, fruit, I mean, I think eating whole fresh fruit is probably good for somebody who has candida and has a really high sugar diet 10 years later, I don't know. I mean, I don't think that's great for them. So I think it's important to adopt good habits and keep them life long. But I don't really support the life long, really strict anti-candida diet necessarily. I do think that people will have a tendency to go back toward, like, candida overgrowth and have to be somewhat vigilant about that and be very careful about their antibiotic keeps, right? Like, so somebody who has already had candida overgrowth and maybe has improved a lot and their gut has improved a lot and they're able to tolerate more foods and have better digestion. If they take an antibiotic, while it might be necessary, it's just you have to weigh the risks and benefits and try to do whatever you can to stay away from that. With my patients, I really try to, like, look up stream, like, why do you need antibiotics in the first place? Is it a sinus issue? Let's go there. Let's fix the sinus issue so that you don't need antibiotics again, so you don't end up with candida overgrowth again. - And it's more efficient, essentially, looking at things that way. And I was curious to, what if someone has, chronic nail fungal issues or athlete's foot or fungus elsewhere? Because I think they might be missing some red flags in their own life and I always like to give people my, well, let's see if we could check off these boxes and help us kind of narrow the ideas of what could be going wrong. Do you find that if you've had fungal issues elsewhere, that could be a clue? Maybe, yeah. I mean, yes, I ask patients all the time if they've had rashes and skin issues, fungal overgrowth or fungal infections on their nails, vaginally yeast infections. Itching ears too, carb craving, sugar cravings, all that stuff sort of gives me ideas of symptomatology. It can be so vague though. Also, sometimes people just have brain fog or they struggle with mood. Or maybe it's totally a digestive issue or maybe they have asthma. There's so many different kinds of things that could be, give us an idea for what's going on. But if it's that patient who's like, I was hospitalized and I got IV antibiotics and then I was on oral antibiotics for six months and then my health went down the drain and I got really bad digestion. That's about a lot of times where I'm thinking about fungal and stuff. The last thing about X, lots of protein-perioders. Gotcha. And is there anything or any particular type of probiotics or just supplement, sometimes like esplority can be helpful. But and everyone probably knows this already. Not if you're constipated. I don't find that to be helpful because a lot of times it makes it worse. But do you have any suggestions on any type of organisms that maybe people should check out if they know that they have fungal issues that might be helpful for that particular issue or that you found helpful with patients that have more of a CFO presentation? Yeah, I think you and I both are fans of Megas IV antibiotic. Yes. So I'm a fan. I use that I recommended a lot. I'd find there are some people who are very sensitive to it or don't do well with it. It's, I don't know. I'm going to just say one in a hundred. It might be more. I don't have exact statistics. But it's pretty rare. People generally do pretty well with it. So I like Megas IV a lot. I think also it's just about balance in the gut, right? So it's really about like how do you populate or go with a healthy bacteria to kind of help get this yeast in check? Because healthy bacteria is what keeps yeast in check. And so how do we get more of that? And sometimes it's eating more foods with resistant starch or even more probiotic foods like sourcrow. When you're talking about SIBO or bacterial overgrowth, most people say, you know, don't eat that kind of food. Don't eat sourcrow. Don't eat a lot of resistant starch because it can help the bacteria overgrow. But ultimately, if you find that that makes you feel better, then that might be maybe a clue that that's actually fungal in nature and that you're helping to rebalance things. I don't know for sure. But also the other big one I really like to use is mega IGG 2000 or SBI Protect. So a serum derived immune globulin to help support the immune system of the gut. So I use those a lot. I also focus a lot on just like liver gut support and gallbladder supports. Our gallbladder is just like under appreciated organ. We just take that thing out sometimes, you know? (laughing) - The little talk about that. Talk about why you feel like the gallbladder is underrated because bile does play an important role, but it can get hijacked when we have like SIBO, for example, can hijack bile and bile is important for fat absorption. So talk a little bit about why we should know more about our unsung hero, the gallbladder. - Yes, the gallbladder ejects bile. So you produce liver or you produce bile in your liver, stored in your gallbladder. When you eat your body signals the gallbladder to eject bile into your gut, upper gut. And that is not only something that's important for fat soluble vitamins, but it's acidic and it's anti-mincrobial. So it's a big deal. It also helps with detoxification. But the fact that it's acidic and antimicrobial I think is really important. So when it comes to sort of how do we prevent this from coming back, that's where I'm really looking at like the liver gallbladder axis. And then that goes hand in hand with your nervous system and your parasympathetics versus sympathetic dominance. And really like how do we get our body to be into a place where it's rest and digest and where our viscera or organs, like the gallbladder and liver are working as they should to eject bile or the pancreas with digestive enzymes, things like that. So I think those are important considerations or prevent. So for somebody who has already had their gallbladder removed and look, sometimes it is what it is. You know, you can't go, oh, that darn surgeon, he sold me on getting rid of my gallbladder, some people legit. - Sometimes he needed out. - Yeah, it just is what it is. So what do you recommend that someone do because I think people don't understand, they go, well, I constantly have bile in my system so I don't need any help or support. I think there's a misunderstanding about the importance of concentrating that bile and squirting it out at a very precise moment in the whole process of things, right? - Yeah, for sure. That's when I utilize oxfile supplements with meals. So anybody who's had a colicisectomy or had their gallbladder removed all recommend, you know, digestive enzymes often, but oxfile specifically. - And so would that also help acidify? Like, 'cause pH balance is important throughout the gut. So is it possible that that too could potentially help with some of this, the acidification, so to speak? - I think so. I think so, but I don't know for sure. - Yeah. We're all still in many respects, figuring this stuff out and whatnot, but I think I love the fact that you've highlighted, that I think this is the first time anyone is really pointed out the importance of the gallbladder on the healthy skin show and it really is truly important. And so just to kind of close, you know, start closing this up and making sure people understand this, if you are able to address this fungal overgrowth. And we could say CFO, which is in the small intestine, but you could also have this in the large intestine as well. You found this, like by addressing it, to be helpful in issues like rosacea, eczema, et cetera in your practice. - Yeah, yep, for sure. I think everything's connected, you know? And so I've see patients with fungal overgrowth who have all sorts of stuff. They have skin issues, sometimes psoriasis, sometimes eczema, whatever it may be. So skin issues, digestive issues, sometimes even like urinary symptoms. And yeah, I think that treating it helps things go in the right direction. It's like your body spins back into orbit and then we can rebalance things. - Yeah, that's perfect. Well, I really appreciate you coming on and talking about this. This was an exciting topic for me because I love to talk about that connection between what's going on at the level of the skin and how it's rooted a lot of times someplace else. We know there's a big connection with the gut, but I love that you've brought in these other pieces of the liver and the gall bladder and whatnot because it is in a sense all connected. And so everybody can find you over at dr. Christine Marin.com. You're also on Instagram and Facebook so they can check you out and follow you there. Any final words or gifts or anything that anyone can find from you to be able to get more support from you. 'Cause you've got a lot of, I love talking to you 'cause you always have a lot of wisdom about different things and you look at things in such a unique light. - Thanks, Dan. Well, I love your show. I've loved your show for years and years honestly. I have a free gift on my website that's for ways to be taught for home. So the question is like, how is this related to digestive health and actually has those types of ball bladder and has to do with these activation and the importance of avoiding missing. And it also has some really great nutrition tips that go one page down there for nutrition tips on haymommy.com. So that's a-c-y-m-a-m-i. And, There's basically like 10 types of principles to follow as the people who think about an intuition. - Perfect. Perfect. Well, everybody, you're gonna have to go check out Dr. Marin and I just appreciate you being here sharing this information and we'll have to have you come back sometime. - I won't kill. - All right, thanks so much. - Thank you. - Yeah. - I have to say, I truly enjoy talking about and digging into research on fungal organisms and CFO. I find it actually really interesting and kind of super nerdy. Hopefully you guys do too. I imagine you do. That's why you're here. You love nerding out with me and my guests every single time and I'm appreciative to Dr. Marin. Agreed to join us. You're super excited to be on the show. If you have any questions, comments, and you wanna check out any of the resources that we've talked about head on over to skinterrupp.com forward slash 154. And if you feel so inclined, which I know you do, that's why you guys are here. You're all about sharing everything that you learn, right? Because when we share, it means we care and we're helping to support other people in our community, get connected to the answers that they are desperately looking for. So if you know someone who is struggling with yeast infections, toenail infections, nail infections, jaw kitsch, athletes, but whatever. And they're also having a lot of GI issues. This would be a great episode to share with them, especially if they suspect the Candida or other fungal organisms are a problem. And before you head out for your day, if you haven't done so yet, head on over to your podcast platform of choice, right? And review the Healthy Skin Show and let someone who's looking for a new show, all about skin health and dealing with chronic skin rashes know what you think and why they should tune in. I would deeply appreciate you leaving your thoughts. Thank you so much for tuning in, and I look forward to seeing you in the next episode. [MUSIC PLAYING] Are you looking to work with an integrative or functional practitioner who specializes in helping people with chronic skin issues? My fully virtual clinic helps skin rash warriors just like yourself figure out your hidden root causes that make your skin so unpredictable, as well as drive the other awful symptoms throughout your body. Then we tailor an integrative approach to your unique case and create custom protocols to help you see and feel results, even if you're currently on medication to manage your skin. 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