Candidiasis, also known as candida, affects millions of Americans, many of whom unknowingly suffer from this condition of yeast overgrowth. Along with food allergy, with which it is often interrelated, candidiasis is one of the most commonly overlooked or misdiagnosed chronic disease conditions in America, and is responsible for a host of symptoms, including gastrointestinal disorders, chronic fatigue, depression, allergies, and low immune function. It is precisely because of this wide range of symptoms that candidiasis so often goes undetected.
In many respects, candidiasis is a disease that began in the last century, since many of its causes are directly due to modern day factors such as antibiotics, birth control pills, environmental pollutants, and today's typical devitalized American diet. Normally, Candida albicans, the yeast that is most responsible for causing candidiasis, is a naturally-occurring yeast that inhabits the human gastrointestinal and genitourinary tracts, the mouth, and the vagina. So far, research has determined that the yeast's only function is to help the body absorb B vitamins. In healthy individuals, candida is kept in balance by the essential bacteria that also inhabit the gastrointestinal and genital tract, especially lactobacillus and bifidus. Sometimes referred to as acidophilus bacteria, these friendly strains of bacteria help manufacture enzymes and vitamins, lower cholesterol levels, and fight undesirable bacteria, targeting candida as their food. So long as adequate amounts of these healthy bacteria are present in the intestines a homeostatic relationship is maintained, and candida poses no problem. Unfortunately, this balance is delicate and can be easily disrupted.
Causes And Risk Factors
The most frequent cause of candidiasis is recurrent or extended use of antibiotics, which kill not only the harmful bacteria implicated in the condition for which the antibiotic is prescribed, but also the good bacteria needed to keep candida in check. Broad-spectrum antibiotics are particularly suspect, because the broader their scope, the greater the likelihood that they will kill the body's reserves of lactobacilli and bifidus. Vaginal yeast infections, a form of candidiasis, often occurs soon after women use antibiotics, for example. The majority of patients who have taken three of more courses of antibiotics (10 to 14 days per course) within a six month period, tend to also suffer from some degree of candidiasis. Since most antibiotics are administered orally, the friendly bacteria in the intestines are particularly susceptible to these medications. Antibiotics are also commonly found in commercially grown meats and poultry, making these foods potential sources for yeast overgrowth.
Hormones, especially progesterone, and birth control pills can also cause or contribute to candidiasis, explaining why the condition is more prevalent in women than in men. (Incidence of candidiasis is also less common among children and women who have entered menopause.) Progesterone, which is contained in most birth control pills, is also produced at high levels by the body prior to menstruation, and has been shown to stimulate candida growth, and cause severe symptoms of PMS when excess candida is present in the body. Pregnancy also increases the likelihood of canididiasis among women, since progesterone levels remain at continuously high levels during this time. Cortisone medications, such as prednisone and prednisolone, which suppress immune function, can also stimulate yeast overgrowth, as can chemotherapy and radiation treatments among cancer patients. Other forms of medication that have been linked to candidiasis include aspirin; nonsteroidal antiinflammatories (NSAIDs) such as Feldene, Motrin, Advil and Nuprin; and ulcer medications such as Tagamet and Zantac. Aspirin and NSAIDs can cause ulcerations or inflammation in the lining of the gut, thus allowing candida to gain a stronger and deeper foothold. Ulcer medications reduce acidity and increase pH levels in the stomach, creating an ideal environment for yeast to proliferate.
Environmental toxins and chemicals, including pesticides, herbicides, solvents, paints, formaldehyde, petrochemicals, and heavy metals also weaken the immune system, thereby increasing the likelihood of candidiasis. These environmental and chemical agents are particularly prevalent in urban areas. Poor diet is usually a major contributor to candida, especially one that is high in sugar. Other risk factors for candidiasis include alcohol, food and environmental allergies, chronic viral infection, parasites (especially giardia and amoeba), stress, physical and emotional trauma, adrenal dysfunction, hypothyroidism, and deficiencies in hydrochloric acid, pancreatic enzymes, and bile. Once the scale has been tipped and yeast overgrowth begins, it quickly becomes exacerbated so long as sugar continues to be part of the diet. Candida thrive on sugar, which also weakens the immune system, diminishing the ability of white blood cells to attack and destroy unwanted organisms.
Like other chronic disease conditions, candidiasis usually occurs as a result of a number of factors being present at the same time. Among my patients, the primary causes are recurrent use of broad-spectrum antibiotics, a poor diet that is high in sugar content, and significant emotional stress.
Symptoms of Candidiasis
It is precisely because the symptoms of candidiasis are many and varied that its diagnosis is frequently overlooked. This wide variety of symptoms is largely due to the way in which yeast overgrowth occurs. Initially, candida invades the tissues of the gastrointestinal (GI) tract by metamorphosing into a plantlike form and sending roots into the walls of the small intestines. Eventually these roots can bore holes in the intestinal wall, causing a condition known as "leaky gut syndrome" that enables candida, bacteria, food, and other material to enter the bloodstream. From there candida are then carried throughout the body to inhabit those areas most favorable for their continued growth. These areas include the rectum, anus, vagina, the genitourinary tract, and the moist mucous membranes of the lungs and sinuses. Once these tissues are colonized symptoms such as inflammation, sinus pain, muscle aches, joint pain, vaginal and anal itching, and burning following urination can result. Whether these symptoms are due directly to candida or from the toxins they release as they migrate through the body has yet to be verified.
Usually the initial symptoms of candidiasis occur in the GI tract and are caused by widespread inflammation in the small bowel. These include symptoms of bloating, diarrhea, constipation, gas, cramping, rectal itching, and a feeling of fullness. If prolonged (usually for more than a year), leaky gut syndrome can follow, triggering multiple food allergies and sensitivities.
In severe cases of candidiasis, the toxins released by candida can cause tissue damage in other organs throughout the body and inhibit the function of suppressor T-cells, thus weakening the immune system. These white blood cells modulate antibody production. When weakened by candida, they produce an excess of antibodies which, in combination with poorly digested proteins caused by leaky gut syndrome, account for the multiple adult-onset allergies experienced by many people suffering systemic, or whole-body, candidiasis. When this occurs, even normally tolerated exposure to common chemicals can cause severe allergic reactions. An immune system weakened by candidiasis can also produce antibodies to the body's own tissues, resulting in severe PMS, hypothyroidism, fatigue, irritability, depression, headache, and cravings for sweets. Feelings of spaciness or mental fog is another common symptom of candidiasis, as are poor memory and concentration, and mood swings. What follows are the symptoms that are most common.
Brain and neurological: fatigue and lethargy, mood swings, depression, irritability, diminished ability to concentrate, impaired memory, headaches, insomnia, feelings of spaciness or "fuzzy headedness."
Urogenital: vaginal itch or burning, recurrent prostatitis, recurrent urethritis or cystitis, burning on urination.
Skin: acne, scaly skin, generalized itching, hives.
Ear: recurrent ear infections, ear pain, diminished hearing.
Musculoskeletal: joint pain, muscle pain/ache.
GI tract: constipation, diarrhea, cramping, bloating and distention, mucousy stools, indigestion.
Respiratory: chronic stuffy or runny nose, itchy throat, recurrent sinusitis and other infections, postnasal drip.
Female conditions: severe PMS (including feelings of depression and anxiety), irregular periods, painful periods, decreased libido, endometriosis-like symptoms.
Senses: blurred vision, watery eyes, salty or metallic taste.
Other: intolerance to heat and cold, overweight. Additional warning signs include rapid heartbeat, cold extremities, and sensitivities to foods (especially dairy products and foods containing dietary yeasts and molds), chemicals, and inhalants.
The first step in treating candidiasis lies in making a proper diagnosis to ensure that it is, in fact, at the root of the patient's health problems. Unfortunately modern medicine has yet to devise a truly reliable lab test to confirm the disease's existence. Among the current tests that are available are cultures (primarily of the stool, but also vaginal, nasal, throat, and skin), candida antigen titer test (a blood test to determine the presence of yeast antigens or toxins), and candida antibodies and immune complexes (which measure the level of antibodies immune system cells have manufactured to fight candida). All of these tests are fallible, however, in some cases failing to detect candida, and in others giving a false positive reading. The last test is also expensive.
In contrast, many holistic physicians that I've spoken with report that the most reliable way to diagnose candidiasis is by reviewing the patient's symptoms and compiling a thorough medical history. The following questionnaire, adapted from The Yeast Connection by Dr. William Crook, one of the first physicians to call attention to the problem of candidiasis is an essential part of the process.
Do you now suffer or have you in the past suffered from: fatigue; lethargy; a feeling of being "drained" or "wiped out;" memory problems; depression; itching; numbness, burning, or tingling sensations anywhere on your body; muscle ache, weakness, or paralysis; painful or swelling joints; abdominal pain; constipation; diarrhea; bloating; persistent vaginal itch or burning; prostatitis; impotence; low libido or loss of sexual desire; endometriosis; menstrual cramps or other menstrual irregularities; PMS; blurred vision and/or "floaters;" drowsiness; irritability; lack of coordination; mood swings; difficulty concentrating; headache; dizziness or balance problems; rashes; heartburn or indigestion; mucus in stools; hemorrhoids; dry mouth; bad breath; nasal congestion, nasal discharge, nasal itching, or postnasal drip; sore throat; persistent cough; pain or tightness in your chest; wheezing or shortness of breath; frequent urination; burning or tearing eyes; recurrent ear infections or fluid in the ears.
The more yes answers to the above questions, the greater is the likelihood that you suffer from candidiasis, but even a few of the above symptoms can be a sign that the condition is present. If you suspect you may be suffering from candidiasis, I recommend seeing a holistic physician, since many conventional doctors today still fail to test for the condition or rely on the fallible medical tests mentioned above.
The successful treatment of candidiasis incorporates several of the basic principles of holistic medicine, which emphasizes self-care, proper diet, and the wise use of both conventional and complementary therapies. Since usually a variety of factors are responsible for candidiasis, each of them need to be addressed directly. Because candidiasis results from these conditions occurring over a prolonged period of time, patients must realize that there is no quick-fix cure. In order to be effective, both time and personal commitment to dietary and lifestyle changes are required. Treatment also depends on the degree of yeast overgrowth and how badly it has compromised immune function. When yeast overgrowth is confined only to the gastrointestinal (GI) tract or vagina, the treatment tends to be shorter and less involved. In systemic cases, however, where yeast toxins have spread throughout the body, treatment protocols can last as long as six months to a year. And in severe cases of leaky gut syndrome, successful treatment (requiring the healing of the bowel lining) takes at least a year or more.
Many holistic physicians prescribe a four-stage approach in treating systemic candidiasis and find that best results are obtained when my patients begin with parts I and II before progressing to III and IV. The four stages consist of I) killing the yeast overgrowth, II) eliminating the fuel for the growth of candida through a yeast-free diet, III) restoring normal friendly bacteria in the bowel, and IV) strengthening the immune system.
Stage I: The most effective way of killing candida is through the judicious use of prescription antifungal drugs, such as Nizoral, Diflucan, and Sporonox. All of these drugs are expensive, and can also cause side effects (Nizoral in particular can cause liver toxicity), but nothing else usually works as well in eliminating yeast overgrowth. Typically, physicians prescribe 200 mg per day of one of the above drugs for at least one month, and often suggest Nizoral every other day for a second month. (To safeguard against liver toxicity, have your doctor perform a blood test for liver enzymes prior to taking Nizoral, and take milk-thistle extract for its liver-protecting properties.) Nystatin is another popular prescription drug used in the treatment of candidiasis. It's very effective in killing candida in the bowel, but seems to be ineffective when candida is systemic.
During the first two to three weeks of treatment, a common side effect to watch for is the "Herxheimer reaction," which occurs due to the rapid yeast die-off caused by these drugs. As they die, they release additional toxins into the bloodstream that can trigger headaches, fatigue, nausea, loose stools, flulike aches and pains, and other symptoms. To minimize these effects, drink plenty of pure, filtered water and supplement with vitamin C. Sometimes these symptoms can be so severe that you might feel worse than you did before starting this program, but if you stick with it, eventually you will begin to feel much better.
For patients who are unable to obtain these drugs or who cannot take them due to their potential side effects, a number of other options are available, although none of them work as quickly or effectively, in my experience. Among these are the homeopathic remedies Aqua Flora, Candida-Away (available in health food stores) and Myocan Combo (available only through health care practitioners). All of these remedies can also be used with Nystatin with good results. Other products are also available at most health food stores to combat candida, including Yeast Fighters, Candida Cleanse, Cand-Ex, Caprystatin Yeast Defense, and Cantrol. Caprylic acid, garlic, pau d'arco, and other herbs that either act directly on candida or indirectly by strengthening the immune system can be helpful, as well.
Bowel cleansing during this stage of your program is also important. If you suffer from candidiasis, chances are you also have mucus and impacted food residue built up as a thick coat along the walls of your large intestine. This encrusted matter diminishes colon function, contributes to disease by preventing the absorption of vital nutrients, and creates an ideal enviroment for yeast to thrive. You can clean your colon by following a yeast-free diet, drinking plenty of water, getting regular exercise, taking caprylic acid, and drinking 8 to 10 ounces of water or diluted juice mixed with one heaping teaspoon of psyllium and two tablespoons of liquid bentonite twice a day. Both psyllium and bentonite eliminate colon toxicity. You may experience some bloating if you try this combination. If so, reduce the above dosages in half but still take it twice a day.
Stage II: In addition to killing off candida, eliminating their fuel through diet and strengthening immune function is also essential. Dietary considerations comprise the second part of candidiasis treatment and should be adopted at the same time that you begin stage I. Although there is no single anticandida diet that perfectly meets everyone's unique biochemical needs, the following principles can be of help to most people: Eat primarily protein and fresh vegetables, with a limited amount of complex carbohydrates and foods rich in healthy fats, along with small amount of fresh fruit. Avoid sugar and all concentrated sweets. For best results, rotate all acceptable foods, eating particular foods no more than once every three to four days. Usually three to six months is the minimum time frame required for maintaining the diet, although it can become less restrictive the longer you follow it. The more involved you become in shopping, planning your meals, and cooking, the easier and more rewarding you will find the diet to be.
Acceptable foods include raw or lightly steamed, fresh, organic vegetables, especially those high in water content and low in starch. These include all green and leafy vegetables, such as lettuce, spinach, cabbage, kale, sprouts, greens, and parsley; and low-starch vegetables such as celery, zucchini, squash, green beans, broccoli, cauliflower, bell peppers, asparagus, tomato, onion, cucumber, garlic, radish, and Brussels sprouts. Carrot, beet, turnip, eggplant, artichoke, avocado, and peas can also be eaten, although they contain moderately higher levels of starch. Proteins can be eaten freely, especially free-range, organic meats, and deep-water ocean fish. (Pork should be avoided, however.) Organic seeds and nuts are also permissible. Complex carbohydrates can also be used, but try to limit them to no more than one serving a day. These include potatoes, sweet potatoes, yams, legumes, and whole grains, either sprouted or cooked. For best results, wait until you are in the third week of your program before introducing legumes and also be sure to rule out any food allergies you might have.
Flaxseed oil (1 to 2 tablespoons daily) used on grains or vegetables, or as a salad dressing, should also be consumed (do not heat or cook with it). Other acceptable oils are cold pressed olive, linseed, walnut, safflower, sunflower, and soy. Certain fruits are also permitted, although you should limit yourself to one serving per day until you are sure they are not aggravating your symptoms. For the first 21 days, start with melons and berries. Then add grapefruit, apple, pear, peach, orange, nectarine, apricot, cherry, and pineapple. Fruits juices in general are best avoided unless they are freshly squeezed.
Foods to avoid include all foods containing sugar (cakes, cookies, donuts, ice cream, soft drinks, etc.); sucrose, fructose, maltose, lactose, glucose, dextrose, corn sweetener, corn syrup, sorbitol, and manitol; honey; molasses; maple syrup; date sugar; barley malt; rice syrup; NutraSweet; and saccharine. Also avoid table salt, which contains 50 percent sugar. (Use sea salt instead.) Milk and dairy products (including cheese) should also be avoided, although butter is acceptable in limited amounts. (Unsweetened almond or soy milk can be used in place of milk.) Also eliminate all bread and yeast-raised baked products, such as whole grain cereals, pastas, tortillas, muffins, and crackers. Other foods to avoid include mushrooms, rye and wheat, alcoholic beverages, caffeine, white or refined flour products, packaged and processed foods, olives, pickles, sauerkraut, vinegar, mustard, ketchup, margarine, and refined and hydrogenated oils.
Improvement should begin to occur within one month of following the above dietary guidelines and the steps outlined in stage I.
Stage III: After you have followed stages I and II for about six weeks, you will be ready to begin stage III, which involves restoring normal friendly bacteria in the bowel through the use of lactobacillus acidophilius and bifidus supplements commonly available at most health food stores. Good bacteria cannot fully grow back until yeast overgrowth in the bowel has been greatly diminished. Although there are many brands of these products to choose from, the majority of them are of little worth, as they contain only a small amount of these living organisms. Even most freeze-dried types are deficient in adequate amounts. To ensure potency buy refrigerated brands with an expiration date between one and ten months from the date of your purchase. Also buy only liquid cultures or powdered forms containing whey (dairy) or nondairy varieties, as only these forms provide an ample food supply to sustain the fragile lactobacilli. Take two servings per day, morning and evening.
Stage IV: The final stage in treating candidiasis involves strengthening the immune system. One of the easiest ways to do this, along with proper diet, is through the use of the following nutritional and herbal supplements.
Vitamins: vitamin C, beta carotene, vitamin E, selenium, zinc picolinate, magnesium citrate or aspartate, chromium picolinate, vitamin B complex, and biotin.
Herbs: Garlic, echinacea, and grapeseed extract.
Other supplements include flaxseed oil or other essential fatty acids (Omega 3, evening primrose, or black currant oils), amino acid supplements, and hydrochloric acid (HCl) (one capsule with pepsin with every meal) to restore digestive function. In addition to the above, be sure to drink adequate amounts of water throughout the day, exercise regularly, and get eight hours of sleep per night. Also take care to reduce or eliminate sources of emotional stress.
If, after following this program for six weeks or more, you still are experiencing little or no improvement, most likely there are other contributing factors to your problem which still need to be addressed. These can include food allergy and leaky gut syndrome, intestinal parasites (especially giardia), pancreatic enzyme deficiency, hypothyroidism, adrenal exhaustion, chronic viral infection, chronic fatigue syndrome, chemical hypersensitivity, and heavy metal poisoning, among other possible causes. Candidiasis can also be sexually transmitted from your spouse or partner. In all cases of prolonged candidiasis, professional care is required to address all of the causes, and to implement an appropriate treatment strategy.
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