Disease, Illness and Condition Library
Chronic Candidiasis
benign yeast (or fungus) Candida albicans is now becoming recognized as a complex medical syndrome. Specifically, the overgrowth of candida is thought to cause a wide variety of symptoms in practically every system of the body, with the gastrointestinal, genitourinary, endocrine, nervous, and immune systems being the most vulnerable Even though 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 conscious of the scale of the problem. Normally, Candida albicans lives harmoniously in the inner warm creases and crevices of the digestive tract and in the vaginal tract in women. However, when this yeast overgrows, or when immune system mechanisms are depleted, or when the normal lining of the intestinal tract is damaged, the body can absorb yeast cells, and various toxins. As a result there may be significant disruption of body processes resulting in the development of the yeast syndrome. This syndrome is 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. The classic patient with the yeast syndrome is female; women are eight times more likely to experience the yeast syndrome than men, due to the effects of estrogen, birth control pills, and the higher number of prescriptions for antibiotics. Causes Chronic candidiasis is a typical example of a “multifactorial” condition. Therefore, the most effective treatment involves addressing and correcting the factors that predispose an individual to candida overgrowth; there is much more to it than killing the yeast with antifungal agents, whether synthetic or natural. Predisposing Factors to Candida Overgrowth: * Altered bowel flora * Decreased digestive secretions * Dietary factors * Drugs (particularly antibiotics) * Impaired liver function * Impaired immunity * Nutrient deficiency * Prolonged antibiotic use * Underlying disease states Prolonged antibiotic use is thought to be the most important factor in the advance of chronic candidiasis. Antibiotics suppress the immune system and the normal intestinal bacteria that prevent yeast overgrowth, strongly promoting the proliferation of candida. There is little argument that, when used appropriately, antibiotics save lives. However, there is very little argument that antibiotics are dangerously overused. While the appropriate use of antibiotics makes good medical sense, using them for such conditions as acne, recurrent bladder infections, chronic ear infections, chronic sinusitis, chronic bronchitis, and nonbacterial sore throats does not. The antibiotics rarely provide benefit, and these conditions can be successfully treated with natural measures. The widespread use and abuse of antibiotics is becoming increasingly alarming, not only because of the chronic candidiasis epidemic, but also due to the development of “superbugs” that are resistant to the current batch of antibiotics often prescribed. According to the World Health Organization, we are coming dangerously close to arriving at a “postantibiotic era” in which many infectious diseases will once again become almost impossible to treat. Improper use of antibiotics significantly increases the risk of developing complications, such as overgrowth of Candida albicans and other organisms, as well as the risk of developing a bacterial infection that is resistant to antibiotics. In addition, it may be several decades before it is truly known what role the worldwide use of antibiotics plays in many health conditions. For example, antibiotic exposure is now being linked to Crohn’s disease. Syndromes Related to Yeast Syndrome Eventually, “yeast syndrome” will probably be replaced by a more comprehensive term that includes small intestine bacterial overgrowth and leaky gut syndrome. Both of these conditions are often associated with Candida albicans overgrowth and may produce symptoms identical to those of the yeast syndrome. Diagnosis One of the most valuable screening methods for determining the possibility of yeast related illness is a comprehensive questionnaire. Although the candida questionnaire can help, ultimately the best method for diagnosing chronic candidiasis is clinical evaluation by a physician knowledgeable about yeast related illness. The manner in which the doctor will diagnose the yeast syndrome will more than likely be based on a clinical judgment from a detailed medical history and patient questionnaire. The doctor may also employ laboratory techniques, such as stool cultures for candida, and measurement of antibody levels to candida, and measurement of antibody levels to candida or candida antigens in the blood. However, while these laboratory exams 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 history and clinical picture. Conventional Medical Treatment for Candidiasis Candida that occurs only on the skin or in the mouth or vagina can be treated with antifungal drugs that are applied directly to the affected area (for example, clotrimazole and nystatin). A doctor may prescribe the antifungal drug fluconazole to be taken by mouth. Candidiasis that has spread throughout the body is a severe, progressive, and potentially fatal infection that is usually treated with intravenous amphotericin B, although fluconazole is effective for some people. Caspofungin and voriconazole, drugs that are still being studied, may prove useful as well. Therapeutic Considerations In treating chronic candidiasis, a wide-ranging approach is more effective than simply trying to kill the candida with a drug or a natural anticandida agent. Drugs such as nystatin, ketoconazol, and diflucan, as well as various natural anticandida agents, rarely produce significant long term results because they fail to address the primary factors that promote candida overgrowth. It is similar to trying to remove an ant-bed by removing a few ants from the top of the mound rather than taking action to eliminate the whole colony. Nonetheless, in many cases it is useful to try to eradicate Candida albicans from the system, preferably with the aid of natural anticandida therapies such as timed release caprylic acid preparations, enteric coated volatile oil preparations, or fresh garlic preparations. A follow up stool culture and candida antigen determination will confirm whether the candida has been eliminated. If it has been eliminated and symptoms are still apparent, it is likely that the symptoms are not related to an overgrowth of Candia albicans. Similar symptoms to those attributed to chronic candidiasis can be caused by small intestine bacterial overgrowth. In this scenario, pancreatic enzymes and berberine containing plants such as goldenseal can prove helpful. In addition to using natural agents to stamp out Candia albicans, it is important to address predisposing factors, following a candida control diet, and support various body systems according to individual needs. Diet A number of dietary factors appear to encourage the overgrowth of candida. The most important factors are high intakes of sugar, milk and other dairy products, foods with a high content of yeast or mold, and food allergens. Sugar: Sugar is the main nutrient for Candida albicans. It is well established that restriction of sugar intake is an absolute necessity in the treatment of chronic candidiasis. Most people do well by simply avoiding refined sugar and large amounts of honey, maple syrup, and fruit juice. Milk and Dairy Products: There are several reasons to limit or eliminate the intake of mild in chronic candidiasis: * Milk’s high lactose content promotes the overgrowth of candida * Milk is one of the most common food allergens * Milk may contain trace levels of antibiotics, which can further disrupt the gastrointestinal bacterial flora and promote candida overgrowth. Mold and Yeast Containing Foods: It is commonly recommended by many experts that individuals with chronic candidiasis avoid foods with a high content of yeast or mold, including alcoholic beverages, cheeses, dried fruits, and peanuts. Even though many patients with chronic candidiasis may be able to tolerate these foods, it is still a good idea to eliminate them from the diet. At the very least, they should be avoided until the situation is under control. Food Allergens: Food allergies are another frequent finding in patients with yeast syndrome. ELISA tests, which determine both IgE and IgG mediated food allergies, are often helpful in identifying food allergies. Increasing Digestive Secretions In many cases, an important step in treating chronic candidiasis is improving digestive secretions. Gastric hydrochloric acid, pancreatic enzymes, and bile all inhibit the overgrowth of candida 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 Candia albicans in the gastrointestinal tract. Therefore, restoration of normal digestive secretions through the use of supplemental hydrochloric acid, pancreatic enzymes, and substances that promote bile flow is important in the treatment of chronic candidiasis. Patients on anti ulcer drugs such as Tagamet (cimetidine) and Zantac (ranitidine) actually develop candida overgrowth in the stomach. This occurrence highlights the importance of hydrochloric acid in the prevention of candida 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 (enzymes that break down protein) serve several other significant functions. The proteases are largely responsible for keeping the small intestine free from parasites (including bacteria, yeast, protozoa, and intestinal worms). A lack of proteases or other digestive secretions significantly increases an individual’s risk of having an intestinal infection, including chronic candida infections of the gastrointestinal tract. Enhancing Immunity Recurrent or chronic infections are characterized by a depressed immune system. A repetitive cycle makes it hard to overcome chronic candiasis: a compromised immune system leads to infection, and infection leads to damage to the immune system, further weakening resistance. The importance of a healthy immune function to protect against candida overgrowth is well known by any physician who has seen a patient suffering from AIDS or taking drugs that suppress the immune system. In either case, severe overgrowth of Candida albicans is a characteristic feature. The occurrence of candida overgrowth in these conditions provides considerable evidence that attaining better immune system function is necessary for the patient with chronic candidiasis. Additionally, patients with chronic candiasis often suffer from other chronic infections, presumably due to a depressed immune system. Usually this depression of immune function is related to decreased thymus function, which manifests as depressed cell mediated immunity. Although expensive laboratory tests can document this depression, it is better to rely on the history of repeated viral infections (including the common cold), outbreaks of cold sores or genital herpes, and prostatic (men) or vaginal (women) infections. Causes of Depressed Immune Function in Candidiasis The patient with chronic candidiasis is characteristically stuck in a vicious cycle. In regard to the immune system, a triggering event such as antibiotic use or nutrient deficiency can lead to immune suppression, allowing Candida albicans to overgrow and become more firmly entrenched in the lining of the gastrointestinal tract. Once the organism attaches itself to the intestinal cells, it competes with the cell and ultimately the entire body for nutrition, often robbing the body of vital nutrients. In addition, Candida albicans secretes a large number of toxins and antigens (compounds that he body recognizes as foreign and develops antibodies to). Candida albicans is referred to as a polyantigenic organism because over seventy nine distinct antigens have been identifies. As a result of this tremendous number of antigens and overgrowth of Candida albicans seriously taxes the immune system. The immune system is directing many of its resources to fighting Candida albicans. Therapeutic Goals Restoring proper immune function is one of the key goals in the natural treatment of chronic candidiasis. There isn’t any single magic bullet that can instantly restore immune function in patients with chronic candidiasis. Instead, a comprehensive approach involving lifestyle, stress management, exercise, diet, nutritional supplementation, glandular therapy, and plant based medicines is the most effective plan for eliminating Candida albicans. Possibly the most effective intervention in reestablishing a healthy immune system is employing measures designed to improve thymus function. Promoting optimal thymus gland activity involves: * Prevention of thymic involution or shrinkage by ensuring adequate dietary intake of antioxidant nutrients such as carotenes, vitamin C, vitamin E, zinc, and selenium * Use of nutrients that are required in the manufacture of action of thymic hormones * Use of products that contain concentrates of calf thymus tissue A good high quality multiple vitamin and mineral formula and extra vitamin C and vitamin E are the most important recommendations. When thymus function is very depressed, orally administered calf thymus extracts can be quite useful in restoring and enhancing immune function. The effectiveness of thymus extract is reflective of broad spectrum immune system enhancement, presumably the result of improved thymus gland activity. The dosage will vary from one manufacturer to another, as there are no quality control procedures or standards enforced in the glandular industry. It is left up to the individual company to adopt quality control and good manufacturing procedures. From a practical view, products concentrated and standardized for polypeptide are preferable to crude preparations. Based on current clinical research, the daily dose should be equivalent to 120mg of pure polypeptides with molecular weights less than 10,000, or roughly 750mg of the crude polypeptide fraction. No side effects or adverse effects have been reported with the use of thymus preparations. Promoting Detoxification Candida patients usually exhibit multiple chemical sensitivities and allergies, an indicator that detoxification reactions are stressed. Therefore, the liver function of the candida patient needs to be supported. In fact, improving the health of the liver and promoting detoxification may be one of the most critical factors in the successful treatment of candidiasis. Damage to the liver is often an underlying factor in chronic candidiasis as well as chronic fatigue. When the liver is even slightly damaged by a toxic chemical, immune function is severely compromised. The immune system suppressing effect of liver damage has been continually demonstrated in experimental animal studies and human studies. For example, when the liver of a rat is damaged by a toxic chemical, immune function is severely hindered. Liver injury is also linked to candida overgrowth, as evident in studies of mice demonstrating that when the liver is even slightly damaged, candida runs rampant through the body. A rational approach to aiding the body’s detoxification involves: * A diet based on fresh fruits and vegetables, whole grains, legumes, nuts, and seeds * A healthy lifestyle, including regular exercise and avoidance of alcohol * A high potency multiple vitamin and mineral supplement * Lipotropic formulas and silymarin to protect the liver and enhance liver function * A three day fast at the change of each season If any of the following factors are present, enhancing detoxification is a major therapeutic goal. Lipotropic Factors: The nutrients choline, betaine, and methionine are often beneficial in enhancing liver function and detoxification reactions. These nutrients are referred to as lipotropic agents – compounds that promote the flow of fat and bile to and from the liver. In essence, they produce a decongesting effect on the liver and promote improved liver function and fat metabolism. Formulas containing lipotropic agents are very useful in enhancing detoxification reactions and other liver functions. Lipotropic formulas have been used by nutrition oriented physicians for a wide variety of conditions, including a number of liver disorders (hepatitis, cirrhosis, and chemical induced liver disease). The dosage should provide 1,000 mg of choline and 1,000 mg of either methionine and/or cysteine daily. Lipotropic formulas appear to increase the levels of two important liver substances: SAM (S-adenosylmethionine), the major liptropic compound in the liver, and glutathione, one of the major detoxifying compounds in the liver. Silymarin: There is a extensive list of plants that wield beneficial effects on liver function. However, the most impressive research has been done on a special extract of milk thistle (Silybum marianum) known as silymarin. Silymarin refers to a group of flavonoid (plant pigments with impressive antioxidant effects) compounds. These compounds protect the liver from damage and improve its detoxification processes. Silymarin has shown notable results in improving liver function and detoxification processes in double blind studies. The standard dosage for silymarin is 70 to 210 mg three times daily. Promoting Elimination In addition to directly supporting liver function, proper detoxification involves promoting proper elimination. A diet that focuses on high fiber plant foods should be adequate to encourage proper elimination by supplying an ample amount of dietary fiber. If additional support is needed, fiber formulas can be taken. These formulas are composed of natural plant fibers derived from psyllium seed, kelp, agar, pectin, and plant gums such as karaya and guar. Alternately, these formulas may contain purified semi synthetic polysaccharides such as methyl cellulose and carboxymethyl cellulose sodium. Psyllium containing laxatives are the most popular and usually the most effective. Fiber formulas are the laxatives that approximate most closely the natural mechanism that promotes a bowel movement. In the treatment of candidiasis, 3 to 5 grams of soluble fiber are recommended at bedtime, especially if anti-east therapies are employed, to ensure that dead yeast cell are excreted and not absorbed.
Intestinal flora plays a major role in a person’s health and nutritional status. The intestinal flora affects immune system function, cholesterol metabolism, carcinogenesis, and aging. Due to the importance of Lactobacillus acidophilus and Bactobacillus bifidum to human health, supplements containing these organisms can be used to promote overall good health. There are several specific uses for probiotics, however. The four primary areas of use related to chronic candidiasis are: * Promotion of proper intestinal environment * Postantibiotic therapy * Vaginal yeast infections * Urinary tract infections The dosage of commercial probiotic supplements is based upon the number of live organisms it contains. The ingestion of one to ten billion viable L. acidophilus or B. bifidum cells daily is a sufficient dosage for most people. Amounts exceeding this may induce mild gastrointestinal disturbances, while smaller amounts may not be able to colonize the gastrointestinal tract. Natural Anti-yeast Compounds There are a number of natural anti-yeast formulas with proven activity against Candida albicans. Rather than relying on these agents as a primary therapy, however, it is still imperative to address the factors that predispose a person to chronic candidiasis, especially a lack of either hydrochloric acid or pancreatic enzymes. The four natural agents recommended to treat Candida albicans are: * Caprylic acid * Berberine containing plants * Garlic * Enteric coated volatile oil preparations Most patients (but not all) can realize benefits from the natural agents described here rather than the drug approach. Use of any effective antiyeast therapy alone will probably result in the Herxheimer (“die off”) due to rapid killing of the organism and subsequent absorption of large quantities of east toxins, cell particles, and antigens. The Herxheimer reaction refers to a worsening of symptoms as a result of this die off. This reaction can be minimized by Following the dietary recommendations for a minimum of two weeks before taking an antiyeast agent * Supporting the liver by following the recommendations given previously * Starting any of the above described antiyeast medications in low doses and gradually increasing dosage over one month to achieve full therapeutic dosage Caprylic Acid: Caprylic acid, a naturally occurring fatty acid, has been reported to be an valuable antifungal compound in the treatment of candidiasis. Since caprylic acid is readily absorbed in the intestines, it is necessary to take timed release or enteric coated caprylic acid formulas to allow for gradual release throughout the entire intestinal tract. The standard dosage for these delayed release preparations is 1,000 to 2,000 mg with meals. Berberine Containing Plants: Berberine containing plants include goldenseal (Hydrastis canadensis), barberry (Berberis aquifolium), and goldthread (Coptis chinensis). Berberine, and alkaloid, has been extensively studies in both experimental and clinical settings for its antibiotic activity. Berberine exhibits a wide-ranging spectrum of antibiotic activity, including activity against bacteria, protozoa, and fungi, particularly Candida albicans. Berberine’s action in inhibiting both Candida and disease causing bacteria prevents the overgrowth of yeast that is a common side effect of antibiotic use. Diarrhea is a common symptom in patients with chronic candidiasis. Berberine has shown extraordinary antidiarrheal activity in even the most sever cases. Positive clinical results have been shown with berberine in relieving diarrhea in cases of cholera, amebiasis, giardiasis, and other causes of acute gastrointestinal infection and may also relieve the diarrhea seen in patients with chronic candidiasis. Berberine and berberine containing plants are generally nontoxic at the recommended dosages; however, berberine containing plants are not suggested for use during pregnancy, and higher dosages may interfere with B vitamin metabolism. Garlic: Garlic has demonstrated significant antifungal activity. In fact, its inhibition of Candida albicans in both animal and test tube studies has shown it to be more potent than nystatin, gentian violet, and six other reputed antifungal agents. The active component is allicin the pungent and odorous principle of garlic. The modern clinical use of garlic involves commercial preparations designed to offer the benefits of garlic without the odor. These preparations are made in such a way that the allicin is not formed until the enteric coated tablet is delivered to the small and large intestine. Treatment of chronic candidiasis requires a daily dose of at least 10 mg of allicin or a total allicin potential of 4,000 mcg. This amount is equal to approximately one clove (4 grams) of fresh garlic. Going beyond this dosage with these preparations usually results in the odor of garlic being noticeable. Enteric Coated Volatile Oils: The most recent new wave of natural anticandida formulas are enteric coated volatile oil preparations. Volatile oils from oregano, thyme, peppermint, and rosemary are all effective antifungal agents. A recent study compared the anticandida effect or oregano oil to that of caprylic acid. The results indicated that oregano oil is over 100 times more potent than caprylic acid against candida. Since the volatile oils are rapidly absorbed and associated with inducing heartburn, enteric coating is recommended to ensure delivery to the small and large intestine. An effective dosage for an enteric coated volatile oil preparation is 0.2 to 0.4 ml twice daily between meals. Source: Encyclopedia of Natural Medicine Merck Manual of Medical Information
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