Fungus Among Us: Diagnosing And Treating Yeast Problems - Transcript

Dr. George Papaicolaou: It's usually gut dysbiosis or imbalances of the bacteria to begin with. It's the fact that their nutrition's been really poor and they have multiple nutritional deficiencies. They live a really stressed out life. And that stress changes the gut microflora in such a way, it makes you more susceptible to Candida. Dr. Mark Hyman: Welcome to the Doctor's Farmacy. I'm Dr. Mark Hyman and that's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you've ever heard of yeast issues or Candida, or you think you might have some weird bloating after you eat, or something weird going on with you related to yeast or fungus, or maybe you have athlete's foot or vaginal itching or anal itching, this is the podcast for you. Because we're going to talk about what this is all about, what's true, what's not true, how to deal with it and why it's such a problem, with none other than my friend and colleague at the UltraWellness center, Dr. George Papanicolaou, who's a rockstar in his own right, and has been just such a great contribution to the center here and has the second most popular podcast of all my podcasts, which is pretty awesome. I love that. Dr. George Papaicolaou: I love that, too. Dr. Mark Hyman: You beat out everybody. Dr. Mark Hyman: And he's just a great guy. And I think we've been really digging into some great issues here on the house call version of the Doctor's Farmacy, which is a special episode dedicated to looking at some of the intractable conditions that people suffer from and they're not getting answers about with traditional medicine. So we're going to talk today about all things yeast and fungus. Dr. Mark Hyman: Welcome George. Dr. George Papaicolaou: Glad to be here, Mark. Dr. Mark Hyman: Okay. What is the deal with fungus and yeast? You know, we've been hearing for years about Candida and I got to go on the Candida diet and all this stuff. Is this true or what's the deal? Dr. George Papaicolaou: What's the deal? Candida is, first of all, it is a yeast, which is a type of mold. Okay? It just happens to be the most common yeast to cause infection in humans. Dr. Mark Hyman: Yeah. Like women get Candida infections of their vaginal tract, which is the most common thing, right? Dr. George Papaicolaou: Yeah. And we have other fungi that cause athlete's feet and other types of skin infections. Dr. Mark Hyman: It's like bacteria. There's lots of different fungi. There's not just like one thing like Candida. Dr. George Papaicolaou: Yeah. And Candida is a normal part of our gastrointestinal tract. And so it's not some foreigner. It lives naturally in our gastrointestinal tract. That's a really fundamental thing to know. And it's part of the balanced ecosystem. Dr. Mark Hyman: Yeah. Dr. George Papaicolaou: As we talk, we're going to talk eventually about like, well, when it overgrows, we got to kill it, right? Well, you need to rebalance it. You don't want to completely destroy it because it is a part of the ecosystem. So it's a normal part of our ecosystem and it can be problematic. And in conventional medicine, it's very well accepted and understood in immunocompromised patients. 90,000 Americans per year have what we call candidiasis or systemic Candida, meaning they have a blood infection because they're immunocompromised. Dr. Mark Hyman: If you have AIDS, or if you're on immunosuppressive drugs or you're on chemo drugs... Dr. George Papaicolaou: Exactly. Dr. Mark Hyman: Or you've taken steroids, or if you're diabetic, right? You tend to get more used issues. Dr. George Papaicolaou: Yes, you do. Dr. Mark Hyman: Your sugar is high because yeast love sugar. Dr. George Papaicolaou: So in those cases, it's very well accepted. Where it becomes a problem is when people begin to... particularly practitioners, begin to listen to somebody's symptoms. "I have a headache. I have brain fog. I have fatigue. I have thrush on my tongue. I have body aches. I have menstrual irregularity. I have an itchy anus. I have joint pain and I can't sleep. And my libido is low." Right? Dr. George Papaicolaou: Oh, it must be Candida, right? Dr. Mark Hyman: Right. Dr. George Papaicolaou: No, no. And so they... Dr. Mark Hyman: It might be, but it could be other things. Dr. George Papaicolaou: It might be. But now that person, "Oh well go spit into a cup and if you see strings than it's Candida", right? No, those are very non-specific symptoms. And that's not a very good test. But people who are desperate, who are really sick, and are looking for answers will gravitate and will do that. And sometimes it works, but we need to be really careful to know that they may be dealing with a totally different organism. Dr. Mark Hyman: Right. Dr. George Papaicolaou: It might be another yeast or another mold that needs to be treated a different way. And so that's one thing. It could be you have general dysbiosis. You may have something... Dr. Mark Hyman: That's imbalance in your gut flora. Dr. George Papaicolaou: Which is imbalance in the gut flora. You may have something called SIBO, which is, bacteria growing where it shouldn't. Dr. Mark Hyman: In the small intestine. Dr. George Papaicolaou: Up in the small intestine and that needs to be treated differently. So we need to be really careful when we talk about Candida and we just talk about yeast and mold as the cause of... Dr. Mark Hyman: Of everything, Dr. George Papaicolaou: Of everything. Dr. Mark Hyman: But it's the cause of many things. Dr. George Papaicolaou: Right. Dr. Mark Hyman: And some things... Dr. George Papaicolaou: And I think it's important to understand that because all doctors should understand the importance of certain maladies and we don't want to throw the baby out with the bath water. Candida does exist. It can make people sick, but you have to understand how, when and where, and have appropriate ways to evaluate and test. Dr. Mark Hyman: That's right. And in functional medicine, it's what we focus on is how do we get to the root cause or causes? And in some patients, it might indeed be Candida and in other patients it might be other fungus and other patients, the same symptoms might be caused by something entirely different. So let's talk about what are the common reasons we see fungal problems in our patients because they are really common. What are the common reasons we see this? Dr. George Papaicolaou: I'd say the biggest issue in our world today is our nutrition. We have a huge amount of sugar, high fructose corn syrup, processed carbohydrates. Dr. Mark Hyman: Starch, flour, right? Dr. George Papaicolaou: All of that, right? We have GMO, which alters the gut microbiome. All of these things cause an enormous shift. It shifts the bacterial balance, so now organisms that are commensal, meaning that they live in our gut. Dr. Mark Hyman: They're normally there, but they tend to bloom if you feed them what they like to eat, right? Dr. George Papaicolaou: Yeah. They bloom. And once you start feeding them and they bloom and you have e.coli as a normal part of your gut. But if you shift the ecology of your gut, you're going to get an enormous overgrowth of e-coli or a Clostridium or Klebsiella. And now all of you have probably heard that you've had an infection and I'm sure you've heard the e-coli. I'm sure you've heard Klebsiella or Clostridium, which causes C difficile, the diarrheal illness. Guess what? They all live in our gut. And when our diet is really poor, they bloom. Dr. Mark Hyman: And the thing about sugar and flour, which is 60% of our diet is essentially refined carbohydrates, right? That stuff is jet fuel for the yeast in your gut and for the fungus. So you're fertilizing all that stuff and you're starving the good guys, which feed on what? They feed on phytochemicals like colorful fruits and vegetables and fiber and all the good stuff. So you're starving the good guys, you're feeding the bad guys. And that's when you start to get this imbalance or overgrowth. Dr. George Papaicolaou: Yeah. Dr. Mark Hyman: There's actually a term for it now called SIFO, or small intestinal fungal overgrowth, right? Dr. George Papaicolaou: Yeah. Dr. Mark Hyman: But it can cause a lot of systemic symptoms. How would you know that people might be at risk for it? And how would you look for the symptoms that give you clue that they might have a fungal issue? Dr. George Papaicolaou: I look at Candida as a... it sort of comes along for the ride, right? And sometimes it's going to hijack the ship and become the main player. And sometimes it's going to be lurking there in the background and you're not going to realize it's creating a problem until you fix some other things. Or you can't fix those other things. I suspect that most all the time, I'm dealing with gut issues. The kind of gut issues that we see when people come in with longstanding constipation, longstanding eczema, longstanding yeast infections, recurrent vaginal yeast infections, recurrent UTIs, athlete's foot that's recurrent, as I said, allergies. I start to suspect there's inflammation going on. Dr. Mark Hyman: Maybe there's something going on. Dr. George Papaicolaou: And then we know there's inflammation. We know we're going to find something in the gut and Candida needs be on that list. Dr. Mark Hyman: Yeah. And I think... I go through, when I think about it, I go through, what are their risks, right? Have they been on antibiotics? That will cause fungal issues. Have they been on hormones? Like the birth control pill. Dr. George Papaicolaou: Oh, yeah. Dr. Mark Hyman: Have they taken steroid drugs, right? Have they eaten a diet that's tons of sugar? Dr. George Papaicolaou: Those are the four big players right there. Dr. Mark Hyman: Yeah, sugar and starch. Are they drinking a lot of wine and alcohol and beer? These are all things which promote the growth of the fungus. It's like feeding the bad guys and then if they're at risk for that. And then I go, "Wait a minute, what are their symptoms?" And you mentioned a lot of them, but they can be really common things that people just kind of think, "Oh, it's not a big deal. I got a fungal toe growth or I have an athlete's foot. Or I have vaginal itching and yeast issues. I've anal itching. I might have some eczema. I might have some psoriasis. I might have dandruff on my head." Dr. George Papaicolaou: I crave carbohydrates. Dr. Mark Hyman: I crave carbohydrates. Dr. George Papaicolaou: I can't lose weight. Dr. Mark Hyman: I can't lose weight. I'm constipated, like you said. They begin to sort of create this whole thing. And I remember I had this one patient, she was like a walking mushroom. She had dandruff and eczema and anal itching and vaginal itching. And she had athlete's foot. I mean, she pretty much had everything. And she has these tinea patches, which is another kind of skin... which is a well-known fungal infection called tinea versicolor, which is common. Dr. Mark Hyman: And so she had all these issues and she was also feeling like crap. And people can get other issues from it. They can get depression, they can get fatigue, they can get brain fog. They can get inflammation, they can get joint issues. They can get all these weird symptoms. So I'm always on the alert, and that's not to say that everybody who comes in has a fungal issue with these issues. But you have to make sure you don't overlook it. And that's really what we focus on in functional medicine. Dr. George Papaicolaou: Yeah. Yeah. And so when somebody comes in that sick and that's how we see them. They do come in that sick and they come in almost despairing sometimes because they've been fighting these symptoms for years and they're being treated with antihistamines, and they're being given topical steroids for their rash. And they're given PPI's for their heart... Dr. Mark Hyman: Acid blockers. Dr. George Papaicolaou: Acid blockers for their heartburn or their regurgitation. And they're taking some over-the-counter senna for their constipation. So they come in with these long list of pills to combat every symptom that was put in its own silo. And nobody stopped to put together the fact that maybe these belong together as one problem. Dr. Mark Hyman: Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Farmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love, and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements, to gadgets, to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to to sign up. That's, P-I-C-K-S. Dr. Mark Hyman: And sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode. Dr. Mark Hyman: So we see this a lot. And we treat it usually in the context of everything else. It's not only often just the yeast, but it's their overall gut flora and their imbalances. But you had a patient, Julia, who had all these issues. And she had a big yeast issue. Tell us about her and what you found and what you did and how you helped her. Dr. George Papaicolaou: Yeah. So, Julia, she represents the symptoms that I was just talking about. She came in with fatigue, brain fog, recurrent vaginal yeast infections, anxiety, carb craving, inability to lose weight. Let me make sure I got it all. Oh, she had migraines as well. She was also under an enormous amount of stress. And I think it's important, and we're going to talk about that, the role stress plays with Candida. But she had an enormous amount of stress, which I came to find out came from some childhood trauma that was significant. Her recent stress was a divorce that had just drawn out over four years. It was really difficult. There was a custody battle. And it was during this period of time that all these symptoms really worsened and she was not getting any relief from the multiple doctors she'd been seeing. Dr. George Papaicolaou: And so she arrived here. Her symptoms were really, at this point, anxiety and bloating and constipation. Secondarily, she was talking about, "I also have had this longstanding rash. It comes and it goes. And I get migraines." Of course, I do a gut microbiome test. And because of her symptoms, I was already thinking that, "This is definitely a gut issue, but yeast vaginitis, the recurrent rash, the bloating. I was definitely thinking she had dysbiosis or imbalance, but I did suspect that she might have Candida because of the carb craving and the bloating and the rectal itch. Dr. George Papaicolaou: It was there. So I did additional tests. I did Candida antibodies. Candida can be hard to find. Dr. Mark Hyman: Yeah. Dr. George Papaicolaou: And I really like to have something to hold onto when I make the diagnosis, something that is real. So here are the places I look. I did the Candida antibodies, the complete diagnostic stool test that I did is going to measure, is going to actually look for Candida using PCR testing. And then the other places I look... Dr. Mark Hyman: And these are tests you just don't get at your regular doctor. Dr. George Papaicolaou: You do not, no. Dr. Mark Hyman: It's what we do the UltraWellness Center. We look at things like antibodies to different foods, antibodies to yeast. We look at the stool test. Dr. George Papaicolaou: And then you can also look at what we talked about earlier was the organics acid test. The organics acid test can actually look for metabolites of gut bacteria in your urine. Dr. Mark Hyman: Or a fungus. Dr. George Papaicolaou: Or fungus. And one of those metabolites that Candida makes and makes alone is D-Arabinitol. And so I checked for D-Arabinitol and an Organics Acid Test, and that was enormously elevated. Dr. Mark Hyman: Off the chart, yeah. Dr. George Papaicolaou: Of the chart. And so that's all I needed to understand that she had Candida. Dr. Mark Hyman: What you're saying is basically there's tests that you can do where you can see if it's growing in the stool, whether there's the genetics of it in the stool, whether there's actually indicators in your blood from antibodies, but also you can look in your urine to see that these metabolites of fungus or even bacteria can be absorbed from your gut. And then they end up in your urine. So they're not human metabolites. If you see this thing in your urine, it's not coming from you. Dr. George Papaicolaou: Right. Dr. Mark Hyman: It's coming from that critter in your gut. Dr. George Papaicolaou: Yeah. Dr. Mark Hyman: And that can be an issue. So we use basically the history, which is really important. Dr. George Papaicolaou: Absolutely. Dr. Mark Hyman: All the symptoms we talked about where you have thrush, or you have a white coated tongue, or all these things. Dr. George Papaicolaou: I just have to emphasize one thing. Everybody gets a really, really, really deep history and a physical exam, right? Dr. Mark Hyman: Yeah. Dr. George Papaicolaou: And you know what? And it's out of that, that I cognate and I begin to put the pieces together. The narrative comes together and it can't come together unless you do those two things, right? Dr. Mark Hyman: Yeah, that's really the story and the tests confirm it. Dr. George Papaicolaou: And then the tests confirm where I was going and what I was thinking. And in this case, if the test didn't come back positive, then maybe she didn't have Candida. But I will say, the final thing is that on how do you make that final decision they have Candida... Dr. Mark Hyman: Or yeast. Dr. George Papaicolaou: Or yeast. Candida, fungus. Dr. Mark Hyman: Because [crosstalk 00:16:58] an umbrella term for fungus. Dr. George Papaicolaou: I agree. Dr. Mark Hyman: It's not just Candida. It can be many other... Dr. George Papaicolaou: It's the most common, but we can use the term yeast or fungus. I may say, "You know what? I know the test came back negative. I know how hard it is to find, but clinically, I think this person has fungus." I'm going to trap... Dr. Mark Hyman: Absolutely. And if someone is a walking mushroom, they have a white coating on their tongue and vaginal yeast infections and itching in their anus, and they have eczema and they have blepharitis, which is crusting around the eyes. They have itchy ear. I mean, there's a million symptoms that are from overgrowth of fungus or yeast. And even if their tests are normal, you still have to treat them. Dr. George Papaicolaou: Yeah. Dr. Mark Hyman: And what's amazing is these people really get better. Dr. George Papaicolaou: They do. Dr. Mark Hyman: It's like one of those miracle things in functional medicine. Dr. George Papaicolaou: When you get it right, it is. And that's why it's really important because it may be 10% of the people that come in have a fungal origin for their symptoms. And I will tell you, most of the time it's just not that. It's usually just not that. It's usually gut dysbiosis or imbalances of the bacteria to begin with. It's the fact that their nutrition has been really poor and they have multiple nutritional deficiencies. They live a really stressed out life and that stress changes the gut microflora in such a way, it makes you more susceptible to Candida. Dr. Mark Hyman: Absolutely. And I think, let's get into what we do for these patients, because we talked about the kinds of symptoms that people have, the kind of testing that we do that's a little bit different here at the UltraWellness Center. But this is not a hard problem to fix if you deal with the causes, right, and if you know what you're doing. Dr. George Papaicolaou: Yeah. Dr. Mark Hyman: So tell us, how do you approach these people through diet and the right supplements and maybe medications. What do you do? Dr. George Papaicolaou: Yeah. Those are the things that I look at. Again, I look at the general lifestyle and I start to think about what's going to work. And it's going to be all the lifestyle issues. So it's going to be nutrition. It's going to be sleep. It's going to be exercise. It's going to be stress reduction. Those are right at the top of the table. Dr. Mark Hyman: Those are key for anybody. Dr. George Papaicolaou: Key for anybody. So nutrition becomes a key place. When I think about Candida, I think about changing their diet. I think about treating it. Dr. Mark Hyman: What do you do to the diet? Dr. George Papaicolaou: The diet, we want to take out sugars, processed carbohydrates. We want to take out.... because those are the things that feed your Candida. So there's some specific diet... Dr. Mark Hyman: So stop feeding them. Dr. George Papaicolaou: Yeah, stop feeding them. Dr. Mark Hyman: Starve them. Dr. George Papaicolaou: So we're getting rid of all the processed foods, all the sugar, we're going to limit alcohol and reduce stress. Those are my top four things I do. Dr. Mark Hyman: Yeah. Dr. George Papaicolaou: Okay. Dr. Mark Hyman: You don't have to go on this super extreme anti-Candida diets that everybody talks about? Dr. George Papaicolaou: Well, they're dangerous. I mean, not that they're dangerous, but if you think about the anti-Candida diet, it restricts too many sugars. Right? And the same thing with the there's a diet called the GAPS diet. There's a diet called the SCD diet and the anti-Candida diet. One thing they have all in common is they're very restrictive of carbohydrates almost to a fault, to the point where you might go into ketoacidosis or ketosis. Dr. Mark Hyman: You wouldn't go into ketoacidosis unless you are diabetic. Dr. George Papaicolaou: Well, I'm sorry, I mean [crosstalk 00:20:04] ketosis. You may go into ketosis. Dr. Mark Hyman: Which is not necessarily a bad thing. Dr. George Papaicolaou: It's not. However, there are some studies that have shown that the antifungals that we use, both the pharmaceuticals and the herbs that we use, do not work as well in a fasted state. Dr. Mark Hyman: Interesting. Dr. George Papaicolaou: And also, neutrophils don't function as well. And neutrophils are very important in fighting the Candida and keep it from adhering to the intestinal wall. Dr. Mark Hyman: Those are your white blood cells, right? Dr. George Papaicolaou: So those diets, there's some research that points to them doing that, so that I'm a little cautious about wanting to use such strict reduction. Dr. Mark Hyman: Yeah. But just getting rid of the sugar and the starch and processed carbs and junk food. Dr. George Papaicolaou: That's what we do. What we do basically here is we... Dr. Mark Hyman: And you probably don't want to eat any blue cheese, right? Dr. George Papaicolaou: Right. So we do those things. We get rid of the processed carbohydrates. We get rid of the starchy carbohydrates. We get rid of the sugars. We limit the alcohol reduce the stress and we do something a little bit like a low FODMAP diet. We reduce those foods that are easily fermentable. It's like onions and asparagus and wheat would be examples of some of those foods you want to restrict. Now, that's a great place to start because good nutrition is good for everything. But, generally I find in my patients, that it's usually not enough. Candida is hard to treat and we need to then treat it. And, typically... Dr. Mark Hyman: You need a weed killer. Dr. George Papaicolaou: You need a weed killer. Yeah. You really do. Dr. Mark Hyman: And what do you use? Dr. George Papaicolaou: I'll typically start with herbals. There's caprylic acid, there's undecylenic acid. There is lauric acid. Dr. Mark Hyman: Which is in breast milk and coconut, right? Dr. George Papaicolaou: Yeah, breast milk and coconuts. And then two spices that are very potent, and I think you need to be careful when you use them, are oregano and thyme, and they can be very, very helpful. Dr. Mark Hyman: Yes. Oregano is a great [crosstalk 00:22:18]. Dr. George Papaicolaou: Berberine can also be effective and berberine also is an antibacterial, so it can be used to treat a bacterial overgrowth as well as a fungal overgrowth. I will generally start there. I'll also add in some biofilm busters, because these Candida, like other bacteria, they will congregate together, they will form a little town, they'll put up their umbrellas and be invisible to the immune system. Dr. Mark Hyman: What is a biofilm buster? What is biofilm? Dr. George Papaicolaou: Biofilm it's when they gather in a... it's like a big village of these Candida. They throw up their umbrellas. Dr. Mark Hyman: Like a protective tent over them. Dr. George Papaicolaou: A tent over them so they are invisible to your immune system and they're there to protect themselves against the antibacterial that you're going to use or the antifungal that you're going to use. Biofilms, when I have a patient that's not getting any better, I'm going to pull out the biofilm busters. And those are going to be things like serrapeptase, nattokinase, and there's one more that I use that's slipping my mind right now. Dr. Mark Hyman: That's okay. So we've got the antifungal herbs, we've got biofilm busters. And when you said you use medication and what do you use? Dr. George Papaicolaou: When that's not working, then we oftentimes do have to go to medication. So I'll use Diflucan, nystatin. Nystatin is sort of like the Xifaxan. If people have heard of SIBO, Xifaxan is an antibiotic that's not systemically absorbed. It just stays in the gut. Dr. Mark Hyman: You give a nystatin to babies? Dr. George Papaicolaou: Yeah. And pregnant women, babies can use nystatin. And so nystatin is a good choice if you're concerned about a patient's sensitivity to medications. Nystatin might be one of my starting points. The most effective treatment I use is Diflucan. Dr. Mark Hyman: Yeah. Diflucan is one of those drugs that we hear is bad and bad for your liver. Doctors freak out about it. They don't want to take it for more than a day, but the old fungal drugs were dangerous. We used to learn about this in medical school. There was a drug called amphoteracin. We called it amphoterrible because it had a lot of side effects. But these newer drugs don't, especially if you're not taking a lot of other medications or there's drug interactions. And I prescribe probably more Diflucan than any other drug I've ever prescribed in my entire medical career and knock wood, I've really had no problems with it. People do get die-off, where they can feel like the yeast gets killed and then they'll get an immune response to that. And they can feel kind of like flu-ey for a little bit. But that you can kind of cut out with getting charcoal afterwards, a few hours later. And I think that this is really a very effective treatment for people who really need it. Dr. George Papaicolaou: Oh, absolutely. Dr. Mark Hyman: And I think I wouldn't be afraid of using it. It's used for more than just a day. We use it for a few weeks or sometimes even a month. Dr. George Papaicolaou: Yeah. Candida is one of those controversial areas in conventional medicine, but in functional medicine, you're going to come across people who have fungal infection, who have yeast infection. And it's having an enormous impact on their life. And you've got to be really cognizant of that. You need to test for it and then you need to treat it appropriately. It is not that easy to get rid of. It can recur. And so we have to be really diligent in helping our patients, not just get rid of the Candida, but rebalance their nutrition, rebalance all of their lives because it's those things that led to the Candidal infection in the first place. Dr. Mark Hyman: That's right, right. Dr. George Papaicolaou: So that's a big part of what I do is when I'm treating that, they're happy to feel better. They're glad that we figured it out, but that change in diet needs to stay that way. Dr. Mark Hyman: Yeah. I mean, if you, if you go back to eating all the starch and sugar, you're going to just get a problem again. Dr. George Papaicolaou: Yeah. And so I think it's really important. It's an important topic. It was important enough for me to want to talk about it because I see it enough and see the impact it has and how wonderfully people can do. One of the places I see it most often, and I see some of the most dramatic turnarounds is in our autistic kids. Dr. Mark Hyman: Yeah. I was just thinking about that. Dr. George Papaicolaou: Autistic kids, one of the hallmarks of autism or part of their complex, is gastrointestinal issues, bloating, distension, diarrhea. That is one of the biggest things that an autistic kid will struggle with. And it goes ignored by their primary care and their pediatrician. Dr. Mark Hyman: Or their psychiatrist. I mean, 95% of these kids have gut issues, how is it not relevant? And how has the brain connected and not connected? Dr. George Papaicolaou: So we do the testing and we find that they have D-arabinitol off the charts. And so... Dr. Mark Hyman: Yeah. That's that urine marker for yeast [crosstalk 00:26:53]. Dr. George Papaicolaou: It's a urine marker for yeast. And sometimes they have nothing that shows yeast, but they're testing for... their complete diagnostic stool evaluation comes back. They have a huge imbalance in the gut bacteria. And so we're going to treat that. And those kids, if they're not getting better, when I'm trying to fix their gut, and I don't have positive testing for Candida, but I have all the others, I have other symptoms, I'll put that kid on Diflucan and I can't tell you how many kids have had amazing break breakthroughs on their Diflucan. Dr. Mark Hyman: It is. It's amazing when you hit it right and it's the right patient and the right condition, it can be one of those miracle treatments. Dr. George Papaicolaou: Yeah. Dr. Mark Hyman: I think this is an incredible conversation about a very common condition that's often ignored, or actually almost completely ignored by traditional doctors. It's one of those hot button issues that they freak out about and think you're a quack if you're talking about it. And I think there's been an overemphasis on Candida, but I think just in general, people who have these collection of symptoms by history who have the right tests... you hit it right. These people really get better. You cut out the starch and sugar, you use the herbal protocols. You sometimes use the medication in combination with an overall treatment of their health. And it's amazing how people get better. And that's what we do here at the UltraWellness Center. Dr. Mark Hyman: It's what you do, George, and what we've been doing for decades. And I think for people who struggle out there and are not getting any answers to their health issues, we're, we're here for you at the UltraWellness Center. And we see people from all over the world. We have all virtual consults now, if you want. You don't even have to come here. We can do great video consultations and telemedicine. Dr. George Papaicolaou: Which has been great. Everybody loves them. Dr. Mark Hyman: Yeah. People love them. And we can do all the diagnostics we need. We figured out how to do that. And just go to to learn more. And we'd love to see you if you're struggling and you can't figure out how to get better yourself, maybe just cut out the starch and sugar and take some probiotics. There's a lot of other things we didn't talk about, but this is really an important topic for people to understand that there are ways to get better from things that are [inaudible 00:28:51] for them that aren't getting answers through traditional care. So, hopefully, we'll see you at the Ultra Wellness Center. Thanks for joining us for this podcast, a special episode of House Call. Thank you George. Dr. George Papaicolaou: Thank you, Mark. It's always a pleasure. Dr. Mark Hyman: And if you love this podcast, please share it with your friends and family on social media. Tell us how you might think you have an issue with yeast. We'd love to hear and leave a comment and subscribe wherever you get your podcasts. And we'll see you next time on the Doctors Farmacy.