Six Commonly Missed Diagnoses: Candida (Yeast)

Posted 06/18/2012

Back in 1993, several weeks before the opening of what would be known as  WholeHealth Chicago, I was summoned to the office of the chief of medicine at the hospital where I was a staff member. The chief had heard rumors I was opening a center that would combine conventional and alternative practitioners and he wanted to take the opportunity to express his disapproval. A generally unpleasant man and very full of himself, he looked as if he wanted to grab my tie (had I been wearing one) as he snarled, “Are you going to be one of those candida quacks?”

I had absolutely no idea what he was talking about, but I made a mental note to ramp up my education on candida. Apparently this was a big issue for people who had holistic medical centers.

Candida, full name Candida albicans, is a microorganism that lives in our gastrointestinal tracts. The candida population is held in check by the multiple billions of bacteria that share space with it. When the population of bacteria plummets, most commonly after a broad-spectrum antibiotic is taken for an extended period, overgrowth of candida can occur, usually manifesting in women as a vaginal yeast infection.

These vaginal infections are well recognized by conventional doctors, and definitely not what was getting my chief’s knickers in a twist.

In the early 1970s, two physicians working separately, William Crook and C.O. Truss, proposed a syndrome they’d observed primarily in women who had taken antibiotics for weeks or months, usually for acne. The main symptoms were digestive (gas, bloating, diarrhea) with recurring vaginal yeast infections. In time, Dr Crook added numerous other symptoms to his list, including fatigue, brain fog, sinus congestion, skin rashes, and the development of food sensitivities. Because he was unable to get his research into mainstream medical journals, Dr Crook self-published The Yeast Connection. And knowing he’d receive little acceptance from his medical colleagues, he included a questionnaire to help readers with self-diagnosis and self-treatment, using diet changes and nutritional supplements.

But because the information went to the general public before being broadly accepted by physicians, readers (mainly women) who diagnosed themselves with “yeast overgrowth” encountered a wall of unexpected hostility, irritation, and disbelief from their physicians. They’d arrive, The Yeast Connection in hand, questionnaire carefully completed, and face a look of withering contempt from their doctors. “Yeast,” by the way is a misnomer—your bread doesn’t rise because it has candida. For more on that, click here.

It didn’t help the situation that articles denying the existence of candida overgrowth actually did appear in medical journals in response to this rising public interest. And it really (really!) did not help the situation that Dr Crook, aware of the resistance, marketed his book mainly to alternative practitioners (chiropractors, naturopaths, nutritionists). While this tactic made Dr Crook a millionaire, it resulted in two unfortunate consequences.

First, the separation between the “yes-candida-exists” camp and “no-it-doesn’t” camp grew wider because candida was adding fuel to the longstanding hostility between conventional and alternative practitioners. This, I soon realized, accounted for the hostility of my chief toward my nascent holistic center. Second, and of equal concern, candida overgrowth became vastly overdiagnosed by alternative practitioners because they “owned it.”

“Your arm hurts? Must be candida!” “Tired? It’s your candida!” Or even “My intuition tells me your body is filled with candida” (a very Stephen King image, eh?). At the same time, candida was vastly underdiagnosed by conventional doctors who should have known better. (“I know you’ve been taking antibiotics for a year and have daily vaginal infections, but there’s no such thing as yeast overgrowth.)

Now, almost 40 years later, this bickering continues. Patients, mainly women, continue to hear “I think you have candida” from alternative practitioners of every stripe, including well-meaning health food store clerks, and then face a barely repressed sneer from their physicians and a “No, you don’t. There’s no such thing.”

Not surprisingly, the truth lies somewhere in between. Isn’t that just like life?

If you’ve taken a prolonged course of a broad-spectrum antibiotic (which triggers an ecological catastrophe against the helpful bacteria in your intestines) and you’ve developed protracted digestive symptoms and especially if you now have recurring vaginal yeast infections, then indeed you may have candida overgrowth syndrome.

Other risk factors for developing candida overgrowth can include (but definitely not necessarily) taking birth control pills or oral corticosteroid drugs (such as prednisone) or being diabetic (having high blood sugar). Contrary to popular belief, a high-sugar diet doesn’t predispose you to candida. If this were the case, the entirety of western civilization, devouring as it does 120 pounds of sugar per person annually, would be suffering from candida.

Candida rates a “frequently missed diagnosis” in this series simply because it’s so thoroughly and deliberately ignored by conventional physicians. Symptoms reported by their patients are not taken seriously and many doctors are reluctant to order the relatively simple tests that prove or disprove the diagnosis (or even hostile to the suggestion). The three diagnostic tests are: a stool sample sent to a microbiology lab for microscopic examination and culture of candida, a blood test for the presence of antibodies to candida, and, if needed, a vaginal discharge microscopic examination and culture.

Once a candida diagnosis is confirmed, treatment is fairly straightforward. Prescription anti-candida medications (fluconazole, nystatin) are safe and effective. For those averse to prescription meds, several natural remedies (grapefruit seed extract, caprylic acid, garlic) are effective as well. You’ll also need a good probiotic to replenish the bacteria in your intestines.

A healthful diet is always a good idea, but the extremely restrictive eating plan originally proposed by Dr Crook is really not necessary. Even he backed off its almost painful austerity in his later years. Although virtually all patients report feeling vastly better on an anti-candida diet, this doesn’t mean they necessarily have candida, but rather that anyone would feel better after eliminating junk and processed foods, simple carbs, and sugar.

My associate Casey Kelley, MD has been especially interested in candida overgrowth syndrome and, working with our nutritionists Marla Feingold, Seanna Tully, and Marcy Kirshenbaum has developed an extremely effective program that will establish once and for all whether or not a patient has candida and help those who do finally get rid of it.

I think of them as the queens of candida.

Be well,

David Edelberg, MD

PS: Some of you might be pleased to know that candida was the subject of a musical. Written by the same team who gave Broadway “Urinetown,” the musical “Yeast Nation” enjoyed short runs in both New York and Chicago despite only so-so reviews. The CD does not exist.