At least once a week, a patient comes in, saying, “You’re the fourth [or seventh or tenth] doctor I’ve seen. I feel simply terrible but am always told that my tests are normal, and there’s nothing wrong with me. Recently I read about yeast overgrowth, and the symptoms seem to fit my case exactly. The doctors, however, all tell me there’s no such illness.”
And there you have it: Truly miserable patients suffering from exhaustion, abdominal bloating, fuzzy thinking, muscle weakness, joint pains, congested sinuses, loss of interest in sex, a craving for sweets, and recurring vaginal infections. And when they tell me how as teenagers they’d taken a year’s worth of antibiotics for acne, I know their self-diagnosis is absolutely correct. They are indeed poster children for the Candida Overgrowth Syndrome.
What is Candida Overgrowth Syndrome?
The body plays host to a multitude of microorganisms, and a proper balance among them is one of the keys to good health. While bacteria are by far the most common, the body also supports a very small population of another microorganism, a type of yeast called Candida albicans (popularly known as candida).
Normally present in small amounts along the gastrointestinal tract (in the intestines and the mouth), in the vagina, and on the skin, candida is generally kept in check by the immune system and by the body’s “good” bacteria. Problems arise, however, when candida grows out of control and excessively populates one or more locations in the body.
Vaginal candidiasis. The most common form of candida overgrowth is vaginal candidiasis (a yeast infection), which frequently occurs after taking an extended course of antibiotics. Because antibiotics can kill many kinds of bacteria, often the “good” strains that typically keep candida within bounds can be destroyed along with the “bad.” Candida, however, is unaffected by antibiotics and, in the absence of its natural bacterial counterbalance, proceeds to reproduce wildly. Intense vaginal itching and other discomforts, along with a white discharge, are characteristic signs of a vaginal yeast infection.
Oral candidiasis. Candida overgrowth in the mouth, also called oral thrush, can occur in people using steroid inhalers for asthma (steroids encourage candida proliferation), and in breast-fed infants whose mothers are taking antibiotics. Oral thrush also develops in people whose immune systems are severely depleted–for example, those who are undergoing cancer chemotherapy or immunosuppressive therapy after an organ transplant, or people with AIDS.
Candida overgrowth syndrome (COS). Vaginal candidiasis, oral thrush, as well as candida overgrowths on the skin such as diaper rash, are common medical conditions, and, when they occur, all physicians agree they should be treated. A third type of candida proliferation within the intestines, however, is a controversial disorder, accepted by some physicians and rejected by others as a “fad” diagnosis. It is known variously as candida overgrowth syndrome (COS), chronic candidiasis, or just simply “a yeast problem.”
Often it is nutritionally oriented doctors who believe that COS does indeed exist and treat it as they would any medical condition. They contend that candida overgrowth is a specific disorder, which can be responsible for months or even years of chronic ill health. And they assert that even though candida remains confined to the digestive tract and vagina, the overgrowth has far-reaching effects throughout the body.
They also emphasize that COS is totally different from the potentially fatal candida fungal infection of the bloodstream that spreads the organism rapidly throughout the entire body. This life-threatening situation is usually seen only in people with severely compromised immune systems, and it requires specialized hospital care.
In contrast, symptoms of COS are said to develop from several sources. Overgrowth in the intestines can cause excessive gas, bloating, and bowel movement changes; in women, overgrowth in the vagina can bring on recurrent yeast infections. In addition, the body absorbs particles from candida organisms after they die along with chemical substances produced by the live candida itself. The effect of these compounds is felt systemwide, producing such unpleasant chronic symptoms as fatigue, muscle aches, and brain “fog.” Because these substances produce symptoms, they are frequently referred to as candida toxins.
In some cases, while still alive, the proliferating candida yeast burrows deeply into the delicate lining of the gastrointestinal tract, damaging it and creating a syndrome called intestinal hyperpermeability or “leaky gut.” When this occurs, a person can develop new sensitivities and intolerances to once harmless foods, such as dairy, eggs, corn, and wheat (gluten).
· Bloating, gas, diarrhea, constipation, new sensitivities to commonly eaten foods
· Fatigue, headache, depression, irritability, disorientation, dizziness, inability to concentrate
· Sugar cravings, sensitivities to chemicals and perfumes, alcohol intolerance, increased susceptibility to the side effects of medications
· Muscle and joint aches, sinusitis and recurrent colds, recurrent skin rashes
· (In women), premenstrual syndrome (PMS), decreased libido, recurrent vaginal yeast infection, vulvar itching and pain
· (In men), prostate and bladder infections
What Causes Candida Overgrowth Syndrome (COS)?
According to nutritionally oriented physicians who treat COS, the overuse of broad-spectrum antibiotics is by far the most frequent cause of the ailment. People who have been on antibiotic drugs for long periods of time–to treat acne and recurrent sinus infections, for example–are at particularly high risk for developing the disorder. Because antibiotics so effectively wipe out bacteria (both the beneficial strains and the harmful ones), they dramatically disrupt the body’s delicate balance of microorganisms. Candida then takes over.
In addition, medications other than antibiotics can also increase the body’s susceptibility to candida overgrowth. These drugs include birth control pills and oral corticosteroids (such as prednisone), which are commonly prescribed to control inflammatory and autoimmune conditions such as lupus.
Other factors that can increase a person’s susceptibility to COS include stress, a weakened immune system (due to any cause), a high-sugar diet, hormonal changes from pregnancy, and diabetes.
Doctors routinely treat clinical manifestations of Candida albicans overgrowth in the vagina, mouth, and skin. Vaginal yeast infections are so common that self-treatment using over-the-counter preparations is encouraged by most doctors. Likewise, pediatricians and other physicians regularly treat oral thrush and diaper rash.
Candida overgrowth syndrome (COS) is another issue altogether. During the decades since its original description in the early 1980s, COS has merited few articles in conventional medical journals, and it is not mentioned in medical textbooks. Few studies have been conducted, and most conventional doctors are very skeptical about the existence of the condition at all.
And indeed, COS’s elusive set of signs and symptoms can make this problem hard to identify unless the patient and/or physician suspect its presence and believe that candida is a real, diagnosable condition. Confusing matters further is the fact that COS often closely resembles other hard-to-diagnose disorders, such as fibromyalgia, chronic fatigue syndrome, food sensitivities, irritable bowel syndrome, and depression.
Over- and Under-Diagnosis. Unfortunately, misinformation about candida overgrowth syndrome abounds. Most of the popular books on COS incorrectly imply that the candida proliferation can be widespread, occuring within virtually every organ. This is simply not the case. Although chemicals produced by the candida are dispersed by the bloodstream, in COS the candida organism itself is not.
Many people who believe they are suffering from candida overgrowth, in fact, may not have it at all. (This can be a risk of reading a book about a disease and making a self-diagnosis.) Such individuals often spend hundreds of dollars on supplements, which in the end are useless because they never had COS in the first place. Others may confine themselves to extremely restrictive diets, or worry unnecessarily about a condition they do not have.
On the other hand, antibiotics are often prescribed and taken for the wrong conditions (for cold and flu viruses, for instance), or for inappropriately long periods. This sets the stage for candida proliferation. Because most conventional doctors are skeptical that COS exists at all, it is possible that many chronically ill but undiagnosed individuals actually have this easily treatable condition. In these cases, many nutritionally oriented doctors believe that the diagnosis of COS is probably being overlooked by doctors every day.
Natural therapies available for COS (see below) can be useful for mild cases and are a good first step. The most effective COS treatments, however, are prescription antifungal medications, such as nystatin (Mycostatin, Nilstat, Nystex), itraconazole (Sporanox), and fluconazole (Diflucan). There’s some evidence that nystatin has lost some of its effectiveness in recent years, but the other two are both safe and effective.
Tests and Procedures
Most nutritionally oriented physicians who treat COS do not place absolute reliance on any test, preferring instead to evaluate the whole patient. They will begin immediate treatment if the clinical suspicion of candida is great enough. This includes a history of antibiotic overuse plus recurrent vaginal yeast infections (in women) and symptoms suggestive of COS.
The tests that nutritionally oriented doctors order include cultures of both vaginal secretions and stool, along with a blood test to measure antibodies and antibody complexes to the candida. The blood test measures levels of three separate antibodies (IgM, IgG, IgA) that the immune system creates if candida is present, as well as levels of candida antigen, created when a particle of a candida breakdown product enters the bloodstream and triggers an antibody response.
According to some doctors, repeating these tests at the end of treatment is a good way to determine if it has been successful. If it has, levels of a number of these measurements will show a decline.
Treatment and Prevention
Treatment: Most cases of COS are mild and can be fully cleared up with a combination of supplements and lifestyle changes (see Self-Care suggestions below as well). Because the Candida organism burrows deeply into the intestinal wall, it may take several months to fully treat COS. Recommendations include the following:
• Begin with natural remedies. Many nutritionally oriented physicians recommend starting with anti-candida supplements and adding prescription antifungal medications only if needed. There are good reasons for this.
First, many cases of COS are mild enough to be cleared up by natural remedies. And, while safe, prescription drugs can be extremely expensive if not covered by a health insurance plan.
In addition, if the candida count in the intestine is especially high, a powerful prescription drug will cause a massive die-off effect (called a Herxheimer reaction). This creates uncomfortable flulike symptoms because of the release of toxins from large numbers of candida killed simultaneously. With gentler natural remedies, the candida is killed more gradually, lessening or preventing this reaction.
• Revamp your diet. Some changes in your eating habits are necessary to eliminate a candida overgrowth. Start by increasing your intake of protein and high-fiber vegetables, and by consuming moderate amounts of whole grains and high-carbohydrate vegetables, such as potatoes, beets, and artichokes.
At the same time, try to limit or eliminate sugar from your daily fare because candida thrives on sugar. Fruit, though allowable, is also limited during the treatment phase because of its sugar content.
Some practitioners recommend an even more restrictive diet. Pediatrician William G. Crook, M.D., who first popularized COS in his 1983 book The Yeast Connection, also eliminates baker’s and brewer’s yeast, all packaged and processed foods, cheeses, melons, mushrooms, and a number of other foods. Most nutritionally oriented physicians now consider this diet unnecessary, primarily because of the development of better anti-candida supplements and medications.
Prevention: To reduce your risk of developing COS, take measures to:
• Avoid unnecessary antibiotic use. This is by far the most common reason people develop COS. While everyone agrees that appropriately used antibiotics are lifesaving, it’s important not to request or take antibiotics for every little cold, flu, or mild sinus infection. Many of these ailments are caused by viruses (not bacteria) which antibiotics can’t affect, and usually they just go away by themselves.
If you have a medical condition that requires long-term antibiotics, ask your doctor if a narrow spectrum antibiotic (one that’s specific to your infection) can replace a broad spectrum drug (one that kills all bacteria, good and bad).
If you need to use antibiotics, also take probiotics (Lactobacillus acidophilus, Lactobacillus bifidus, saccharomyces boulardii) for at least two to three weeks after your antibiotic treatment is completed. They will help restore your natural bacterial balance.
Important note: When you do get a prescription for an antibiotic, always finish the bottle. By not doing so, the offending bacteria can become more resilient and cause problems later on.
• Avoid unnecessary steroid use. If you have a medical condition requiring steroids, work with your doctor to reduce your dose to the lowest amount that is effective for your condition. If you use a steroid inhaler, rinse your mouth after each use. Even the nasal steroid sprays can cause candida problems. Since it’s difficult to rinse your nasal passages, try to use nasal steroid sprays only when absolutely necessary.
• Get checked for diabetes, especially if you are middle-aged, obese, or have a positive family history for the condition. People with diabetes are especially susceptible to candida infections.
Most of the supplements listed below are useful until all candida symptoms have disappeared. Supplement treatment should be continued until diagnostic blood and stool tests show clearing of the candida.
Just a reminder: If you have a serious medical condition, it’s always a good idea to talk to your doctor before beginning a program of supplements.
Some nutritionally oriented practitioners may recommend that before you begin the supplements, you do a colon-cleansing regimen to reduce your total candida population. It’s unclear, however, just how effective such a treatment is. A healthful, high-fiber diet that promotes regular elimination may be sufficient. (See the Alternative Therapies section below for more information on colon cleansing.)
Supplements to treat COS include those that kill the yeast, those that strengthen the immune system, and those that restore “good” bacteria in the intestines (known as probiotics). In addition, naturopathic physicians often add supplements to promote liver detoxification and supplements to enhance digestive function.
Echinacea (Echinacea angustifolia) boosts the immune system and helps the body battle yeast infections. This herb works best when taken in alternating cycles with other immune-enhancing herbs, such as astragalus or goldenseal.
Garlic (Allium sativum) both enhances immunity and reduces Candida counts in the body. In test-tube studies, garlic has been found to inhibit the growth of C. albicans. It’s also effective against a variety of infectious organisms that damage and invade tissues.
Goldenseal and other berberine-containing herbs such as Oregon grape and barberry have been studied for their ability to counteract Candida albicans. Combinations of these herbs are widely used by naturopathic physicians for chronic candida infections. There’s some evidence that goldenseal is effective for COS-related diarrhea.
Caprylic acid is a fatty acid with antifungal actions. It’s made by the body in small amounts, and can also be extracted from plant fats, such as coconut and palm oils. While there isn’t any recent research on caprylic acid, older studies found that when taken orally it can lessen the candida yeast’s ability to grow and replicate.
Oil of oregano and other volatile oils represent the “new generation” of anti-candida preparations. Recent laboratory studies have actually shown that oil of oregano is many times more potent than caprylic acid, although more research into this oil is needed.
Lactobacillus acidophilus and L. bifidus both help maintain a healthy balance of “friendly” bacteria in the gastrointestinal tract and vagina. They also produce substances that combat hostile microorganisms. Research shows that L. acidophilus may help prevent or slow the growth of vaginal yeast infections, replacing the natural acidophilus that antibiotics destroy.
Saccharomyces boulardii (SB) is gaining recognition for its power to normalize intestinal bacteria. Like L. acidophilus, this friendly yeast produces lactic acid, which acidifies the intestinal content and reduces the candida population. It also increases levels of IgA, an antibody produced by the intestine that is helpful in combating candida overgrowth.
Lipotropic supplements and silymarin are often recommended by naturopathic physicians, who believe that candida-related toxins suppress the liver’s normal ability to detoxify. This suppression accounts for the multiple chemical sensitivities and allergies associated with COS. Lipotropic combinations (including choline, betaine, methionine) and silymarin (milk thistle) both enhance liver function and protect the liver from toxic substances.
Digestive enzymes may also be suggested by naturopathic physicians, who believe low enzyme levels can lead to candida overgrowth. A comprehensive stool analysis will check for candida and also determine how efficiently your digestive process is functioning. If there’s evidence of inadequate stomach acid or pancreatic enzymes, supplemental enzymes may be prescribed.
• Begin an exercise program. Regular exercise will help improve your overall well-being and enhance your immune system.
• Reduce stress. Learn how to do yoga, t’ai chi, or meditation, and practice them consistently.
• Wear cotton or silk underwear. This is particularly important if you are susceptible to recurrent vaginal yeast infections. Nylon or other polyester fabrics can trap moisture, creating an environment friendly to fungal growth.
• Avoid commercial feminine products. Some douches, feminine sprays, and perfumed tampons can make COS worse by irritating the delicate vaginal membranes.
• Eat yogurt. Check the label to be sure it contains active or live cultures of acidophilus; research shows a cup of yogurt a day can reduce the number of vaginal yeast infections a woman has.
• Increase dietary fiber. Eating enough fiber promotes a daily bowel movement. This will help eliminate the organisms and the toxins that the Candida yeast produces.
Most cases of candida overgrowth can be adequately treated without the use of alternative modalities. However, the following therapies are definitely worth consideration for persistent chronic cases of COS.
Traditional Chinese Medicine. The combination of acupuncture and professionally selected Chinese herbal formulations may be able to simultaneously clear up a candida infection and strengthen the immune system.
Homeopathy. A classically trained homeopath may be able to select and combine remedies capable of treating a candida overgrowth problem.
Colon Therapy. Some, but certainly not all, practitioners believe that COS treatment should begin with a colon cleanse, mainly to reduce the total population of Candida albicans in the large intestine. The colon cleanse may be done professionally by a colon therapist or can be undertaken at home. A typical self-care procedure would be to drink at least two quarts of water or herbal tea during the day, and, twice a day, drink a mixture of psyllium husks, lactobacillus acidophilus powder, liquid bentonite clay, and water. See our WholeHealthChicago library entry on Colon Therapy for more information.
When to Call a Doctor
· If you experience the symptoms of candida overgrowth syndrome for three months and your self-treatment therapies are not helping. (Call your doctor sooner if the condition keeps you from carrying out your day-to-day activities.)
· If you have a vaginal discharge that has a strong, unpleasant odor, or is tinged with blood.
· If you have a vaginal yeast infection that returns within two months.
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David Edelberg, MD