Yeast problems and candida
This term "Candida" encompasses several processes, not all of which all candida sufferers have problems with. Different people get well at different levels. The idea is to tailor one's regime so that the least input gets the best results. Some people will get rid of their yeast/candida problems simply by doing a low sugar diet, others have to be much stricter with their diet and take drug or herbal antifungals, maybe desensitisation and maybe environment controls as well.
Yeast problems are a problem of Western lifestyles! They are triggered by high carbohydrate diets, antibiotics (which kill the good gut bugs and allow yeast to flourish) and the Pill or HRT (immunosuppressive). It is often a combination of these factors. Candida is also part of the fermenting gut so also see Fermentation in the gut and CFS.
The Underlying Problems
- Yeast overgrowth in the gut - gut flora contains 1% yeast so some yeasts are normally present in the gut. Problems seem to arise either when they flourish in the wrong place (ie the upper gut - which should be sterilised by stomach acid) or there is a general overgrowth of them. Wherever numbers build up one starts to ferment foods instead of digesting them. Fermentation causes symptoms of bloating and bubbling in the gut - sometimes this is very obvious. If fermentation occurs within minutes of eating, it is occurring in the stomach.
- Alcohol production - yeasts ferment sugars to alcohol and this causes problems in its own right. The main one is that it tends to lower the blood sugar, thereby destabilising blood sugar levels and making the sufferer crave sugars. This is a very clever evolutionary ploy that yeasts have stumbled upon to make their host eat the very foods that the yeast wants! So sufferers often crave carbohydrates and sugars, but the more they eat, the worse they become.
- Allergy to yeast - if the levels of yeast build up in the gut then they can switch the immune system on so that one gets allergy reactions against the yeast. This can cause low grade inflammation of the gut. Low grade inflammation will result in leaky gut. Leaky upper gut causes Hypochlorhydria and all the problems that go with that.
- Leaky gut - an overgrowth of the yeast in the gut can cause leaky gut. What this means in practise is that large antigenically interesting molecules get from the gut into the bloodstream where they should not be. This may elicit an immune response, which could switch on an allergy to that substance (food allergy), or worse an antibody could be formed which cross reacts with self and switches on autoimmunity.
- Yeast cells are tiny compared to human cells and where there is leaky gut they can leak out into the bloodstream to cause allergy reactions. Eventually these yeast cells spill over into the kidneys and the urine and can be a major cause of Irritable Bladder Syndrome or Allergic Bladder or allergic perineum (vulval irritation).
- Yeast problems which become more systemic may result in yeast infections such as thrush, nail infections, tinea corporis, Athlete's foot and so on.
- If one switches on yeast sensitivity in the gut, this can cause cross sensitivity to moulds and yeasts in the environment. This may explain why some people do not feel so well on damp days and feel very much better in hot, dry or cold, dry climates. They have become allergic to environmental moulds.
Treatment Approaches - in order of importance
- Getting rid of yeast in the mouth. It is quite common for people with recurrent candida / yeast allergy problems to suffer oral thrush. Typically this presents with a white furry tongue and if the fur is scraped off, little red spots are seen underneath. Not everybody has this classic presentation! Yeast thrives on sugars present in food, or indeed starches which are broken down by the enzyme amylase within the mouth. After any food is consumed, the first step is to brush the teeth and tongue with a soft toothbrush to try to physically dislodge any yeast. Many toothpastes contain sorbitol which may enourage yeast overgrowth. Neem is very helpful - it makes microbes less sticky so they cannot adhere to the mouth and throat - neem mouthwash works well. Swill it round the mouth, wash it through the teeth and swallow in dribs and drabs. This will help to kill any yeast in the mouth, and indeed, kill any dental plaque. Another treatment which is as good is hydrogen peroxide mouthwash 3 vol strength - available from Boots - again gargle with this and swill round the mouth after food. This two-pronged approach usually sorts out all the thrush. However it is prone to recur and you may have to continue with this on a regular basis.
- The next single most important intervention is a low GI diet. Yeasts are relatively primitive organisms and can only exist on sugar. So reducing sugar in the diet and carbohydrates (which are digested in the gut into sugars) will starve out the yeast. See [Ketogenic diet - the practical details] and Hypoglycaemia. Please see also My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- Correct nutritional imbalances. Studies done on patients with longstanding yeast problems almost invariably show nutritional deficiencies. Therefore sufferers should take my standard regime of Nutritional Supplements.
- Yeast Free Diet - some people who have candida problems sensitise to yeast and this also needs to be cut out from the diet.
- Correct Hypochlorhydria
- Probiotics - probiotics physically displace yeasts from the gut. One can only hope to get results from live, actively fermenting cultures taken in adequate doses. See Probiotics - A diet rich in vegetables will be high in prebiotics which is the food for probiotics.
- Antibiotics - if necessary for other reasons, makes sure high doses of probiotics are taken. Some people also need antifungal cover such as fluconazole.
- Environmental Controls - For those people who are mould sensitive, they need to reduce the population of mould and their antigens in the house as much as reasonably possible. Moulds and yeasts can only survive when the humidity is above 40%, which for people living in a British climate is most of the time. Healthy House (0845 4505950) - HEALTHY HOUSE do excellent air filtration devices for eliminating moulds and I thoroughly recommend one of those. Some people also need dehumidifiers to dry out their house to prevent mould growing on walls or floors. Keep your house as dry and internally well ventilated as is reasonably possible. If you feel better on a holiday in a hot dry climate, or a cold dry climate (eg mountain above 3,000 feet) then you are likely to be mould sensitive.
- Enzyme Potentiated Desensitisation (EPD) - Some people with yeast problems become so sensitive to them and have such difficulty avoiding them that desensitisation is essential. I usually start off with Enzyme Potentiated Desensitisation (EPD) because that is what I do and it is fairly straightforward. However, people who do not switch off their mould sensitivities with EPD may well benefit from neutralisation - this is often helpful because it can also diagnose the mould allergy as well as treat it.
- Mycopril. This is a fatty acid derived from coconut and comes in 250mg, 400mgs and 680mg capsules. Start with the 400mgs one daily and build up to one capsule three times daily. If tolerated go to 680mgs three times daily. Taking raw coconut oil is as effective, possibly better.
- Biocidin (75mgs) and Biocidin Forte (150mgs). This is a grapefruit seed extract, not absorbed systemically, anti-fungal (broad range), antibacterial (broad range including campylobacter jejuni and helicobacter pylori). Biocidin also kills the "good" bugs such as lactobacillus acidophilus and therefore pro-biotics (Bio-acidophilus or Replete) should be taken after a course.
- Eradicidin Forte: contains garlic (900mgs), oregano(150mgs), cinnamon(100mgs) and clove(150mgs) in a time release tablet form.
- Garlicin: 400mgs freeze dried, low odour garlic: use with above preparations to enhance their effect. Absorbed systemically.
- Oregano complex: (used to be called candicidin) a new preparation, broad spectrum, systemic effects. Contains oils of oregano, clove, artemesia, ginger, borage seed and lauric acid. NOT TO BE USED IN PREGNANCY. The usual dose is one capsule twice daily.
- Candistatin: Pau D'Arco, garlic, berberis, hydrastis canadensis, silymarin plus some enzymes.
- Horopita - some of my patients have been helpded by this.
- Fructo-oligosaccharides (FOS): this is a natural food which tastes sweet (like candy floss) but is not a sugar that yeasts can ferment. This is a soluble fibre, is not absorbed but passes into the large bowel, where the "good" bugs ferment it. FOS is mildly laxative, initially causes wind, feeds up the "good" bugs and thereby displaces the "bad" bugs. It can be used to sweeten foods for patients on an "anti-candida" diet.
I often prescribe a month of a systemic antifungal such as fluconazole, ketoconazole or Itraconazole (IMPORTANT - NONE OF THESE DRUGS CAN BE USED IN PREGNANCY) because these are very good at killing yeasts and also they are systemic - that is to say if there is a nidus of yeast infection outside the gut they should be able to eradicate it. The problem with these systemic antifungals is that they cannot be used for more than a month without checking liver function tests, so I often switch over to the gut only antifungals such as nystatin - I use up to 8 million units a day.
A new useful antifungal is Lufenuron.
When one starts to kill off yeast sometimes one can get what is called a Herxheimer reaction in which all one's yeast symptoms are initially flared. This is thought to be due to an allergy reaction to the dying yeast cells. The problem is that it can be very difficult to distinguish Herxheimer reactions from adverse reactions to the drugs. The latter is unusual, so if one does feel ill on starting these treatments I try to encourage people to keep going with them and hope that the "die off" will clear in a week. Again die off reactions can be confused with symptoms of hypoglycaemia because obviously people also need to change their diets.
Duration of Treatment
Practical experience suggests that treatment has to be long term. The single most important therapeutic intervention is diet. Physicians are used to treating infections with short courses of antimicrobials but if the same principles are applied to positive fermenters, poor results should be expected. Antifungals are usually given for not less than six months and often up to eighteen months, until a good diet has been established. However, often patients need an extra course if they have lapsed on the diet (everyone does - welcome to the human race!). Individual people have to work out how well they have to stick to their regimes to control the problem!
- Fermentation in the gut and CFS
- Irritable Bladder Syndrome or Allergic Bladder
- Nutritional Supplements
- Enzyme Potentiated Desensitisation (EPD)
- Ketogenic diet - the practical details
- My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
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