Chapter 51 Chronic Candidiasis
In the past 30 years overgrowth in the gastrointestinal (GI) tract of the usually benign yeast Candida albicans has become increasingly recognized as a complex medical syndrome known as chronic candidiasis, or the yeast syndrome.1,2 Specifically, the overgrowth of C. albicans is believed to cause a wide variety of symptoms in virtually every system of the body, with the GI, genitourinary, endocrine, nervous, and immune systems being most susceptible.3
Although chronic candidiasis has been clinically defined for a long time, it was not until Orion Truss published The Missing Diagnosis and William Crook published The Yeast Connection that the public and many physicians became aware of the magnitude of the problem.1,2
Normally, C. albicans lives harmoniously in the inner warm creases and crevices of the digestive tract (and vaginal tract in women). However, when this yeast overgrows, immune system mechanisms are depleted, or when the normal lining of the intestinal tract is damaged, the body can absorb yeast cells, particles of yeast cells, and various toxins.3 As a result, there may be significant disruption of body processes, resulting in the development of the “yeast syndrome.”
This syndrome is generally characterized by patients saying they “feel sick all over.” Fatigue, allergies, immune system malfunction, depression, chemical sensitivities, and digestive disturbances are just some of the symptoms patients with the yeast syndrome may experience.3
The typical patient with the yeast is female, as women are eight times more likely to experience the yeast syndrome compared with men due to the effects of estrogen, birth control pills, and the higher number of prescriptions for antibiotics (Box 51-1).4
Chronic candidiasis is a classic example of a “multifactorial” condition, as shown in Box 51-2. Therefore, the most effective treatment involves addressing and correcting the factors that predispose to C. albicans overgrowth. It involves much more than killing the yeast with antifungal agents, whether synthetic or natural.
Prolonged antibiotic use is believed to be the most important factor in the development of chronic candidiasis in most cases. Antibiotics, through suppressing normal intestinal bacteria that prevent yeast overgrowth and suppression of the immune system, strongly promote the overgrowth of Candida.
There is little argument that, when used appropriately, antibiotics save lives. However, there is also little argument that antibiotics are seriously overused. Although the appropriate use of antibiotics makes good medical sense, what does not make sense is reliance on them for such conditions as acne, recurrent bladder infections, chronic ear infections, chronic sinusitis, chronic bronchitis, and nonbacterial sore throats. Relying on antibiotics in the treatment of these conditions does not make sense, since either the antibiotics rarely provide benefit or these conditions are effectively treated with natural measures.
Eventually the “yeast syndrome” will likely be replaced by a more comprehensive term to include small intestinal bacterial overgrowth and the leaky gut syndrome. Both conditions are often associated with C. albicans overgrowth and may produce identical symptoms to the yeast syndrome. For further discussion of small intestinal bacterial overgrowth and leaky gut syndrome, see Chapters 10 and 20.
Although the Candida questionnaire can help, the best method for diagnosing chronic candidiasis is clinical evaluation by a physician knowledgeable about yeast-related illness. More than likely, the manner in which the doctor will diagnose the yeast syndrome will be based on clinical judgment from a detailed medical history and patient questionnaire. He or she may also employ laboratory techniques such as stool cultures for C. albicans and measurement of antibody levels to C. albicans or C. albicans antigens in the blood. Although these laboratory examinations are useful diagnostic aids, they should be used to confirm the diagnosis. In other words, the diagnosis is best made by evaluation of a patient’s history and clinical picture.
Rather than simply culture a stool sample for the presence of C. albicans, the comprehensive digestive stool analysis (CDSA) is more clinically useful (discussed in detail in Chapter 27). This battery of integrated diagnostic laboratory tests evaluates digestion, intestinal function, intestinal environment, and absorption by carefully examining the stool. It is a useful tool in determining the digestive disturbance that is likely to be the underlying factor responsible for C. albicans overgrowth. In addition, the CDSA may determine that the symptoms are not related to C. albicans overgrowth but rather to conditions such as small intestinal bacterial overgrowth and the leaky gut syndrome.
Another laboratory method to confirm the presence of C. albicans overgrowth is measuring the level of antibodies to Candida or the level of antigens in the blood.3,5 However, these tests are rarely necessary, as the results typically only confirm what the patient history, physical examination, and CDSA reveal. Hence, the test does not change the course of action. Nonetheless, some patients and physicians may desire confirmation that C. albicans is a responsible factor in the patient’s health equation. In this situation, blood studies can be helpful and can also be used as a way of monitoring therapy.
A comprehensive approach is more effective in treating chronic candidiasis than simply trying to kill the C. albicans with a drug or natural anti–C. albicans agent. Drugs like nystatin, ketoconazole, and Diflucan, as well as various natural anti–C. albicans agents, rarely produce significant long-term results because they fail to address the underlying factors that promote C. albicans overgrowth. The pharmaceutical approach is a bit like trying to weed a garden by simply cutting the weeds, instead of pulling them out by the roots. Nonetheless, in many cases it is useful to try to eradicate C. albicans from the system, preferably with the help of natural anti–C. albicans therapies such as timed-release caprylic acid preparations, enteric-coated volatile oil preparations, or fresh garlic preparations. A follow-up stool culture and C. albicans antigen determination will confirm if the C. albicans has been eliminated. If it has and symptoms are still apparent, it is likely that the symptoms patients are experiencing are unrelated to an overgrowth of C. albicans. Similar symptoms to those attributed to chronic candidiasis can be caused by small intestinal bacterial overgrowth. In this scenario, pancreatic enzymes and berberine-containing plants like goldenseal can be helpful.
In addition to using natural agents to eradicate C. albicans, it is important to address predisposing factors, recommend a C. albicans control diet, and support various body systems according to the individual patient’s need.
A number of dietary factors appear to promote the overgrowth of C. albicans. The most important factors are a high intake of sugar, milk, and other dairy products; foods containing a high content of yeast or mold; and food allergies.
Sugar is the chief nutrient of C. albicans. It is well accepted that restriction of sugar intake is an absolute necessity in the treatment of chronic candidiasis. Most patients do well by simply avoiding refined sugar and large amounts of honey, maple syrup, and fruit juice.1–4
Many experts generally recommend that individuals with chronic candidiasis avoid foods with a high content of yeast or mold, including alcoholic beverages, cheeses, dried fruits, and peanuts. Although many patients with chronic candidiasis may be able to tolerate these foods, we think it is still a good idea to eliminate them from the diet. At the least, they should be avoided until the situation is under control.1–4
Food allergies are another common finding in patients with the yeast syndrome.3 Enzyme-linked immunosorbent assay tests, which determine both immunoglobulin-E and immunoglobulin-G mediated food allergies, are often helpful in identifying food allergies.
An important step in treating chronic candidiasis in many cases is improving digestive secretions. Gastric hydrochloric acid, pancreatic enzymes, and bile all inhibit the overgrowth of C. albicans and prevent its penetration into the absorptive surfaces of the small intestine. Decreased secretion of any of these important digestive components can lead to overgrowth of C. albicans in the GI tract. Therefore, restoration of normal digestive secretions through the use of supplemental hydrochloric acid, pancreatic enzymes, and substances that promote bile flow is critical in the treatment of chronic candidiasis. The CDSA can provide valuable information in identifying which factor is most important.
People on antiulcer drugs like Tagamet (cimetidine) and Zantac (ranitidine) actually develop C. albicans overgrowth in the stomach.6 This occurrence highlights the importance of hydrochloric acid in the prevention of C. albicans overgrowth. Restoring proper levels of gastric acid by supplemental hydrochloric acid is often quite useful in chronic candidiasis.
Pancreatic enzymes can also be useful in the treatment of chronic candidiasis. As well as being necessary for protein digestion, the proteases serve several other important functions. The proteases are largely responsible for keeping the small intestine free from parasites (including bacteria, yeast, protozoa, and intestinal worms).7,8 A lack of proteases or other digestive secretions greatly increases an individual’s risk of having an intestinal infection, including chronic C. albicans infections of the GI tract.