Candida

Candida – that is, infection with Candida albicans, the thrush germ – is now big business. Probably no condition in the natural health arena is attracting more interest at present. Many magazines and newspapers feature articles on it, yet doctors’ journals virtually ignore it. It recently gained notoriety in the UK when a pop star’s wife was said to suffer from it and the public watched her getting sicker and sicker until it was obvious that the treatment was more deadly than the disease.

What are the real facts? So much ignorance and misinformation abounds that you may be wondering if there is anything really known about the topic. I will attempt to summarize just what we do know about Candida and also put an end to some of the nonsense and falsehoods, spread principally by unqualified medical practitioners. Many of these enthusiastic amateurs have set themselves up as ‘Candida experts’ and are making belligerent claims they cannot justify and treating individuals with techniques that are sometimes worthless or – at worst – downright dangerous.

FALSE CLAIMS
Some of the confusion about Candida comes from the fact that a number of widely circulated ‘anti-candida diets' do have beneficial effects, at least at first. What isn’t understood is that the mechanism at work is often that of  eliminating a food allergy and not eradication the Candida at all. I saw one diet in Sweden which asked patients to exclude dairy produce as part of an anti-Candida regime; a naturopath here in Britain says ‘no grains’. There is absolutely no rationale for these omissions in the fight against Candida but these methods ensure that a great many people who are dairy or wheat allergic will ‘miraculously’ get better. This creates the false impression that the patients had indeed had Candida.

     Another incorrect datum that has gained much currency is that once you have got Candida you are stuck with it. One hears of people who are supposed to have had it for years. Again, the amateur meddlers’ fundamental lack of knowledge is to blame. Because they are not able to prescribe proper anti-fungal drugs – and indeed, to protect their own shaky position as ‘experts’ some even say that it is undesirable to take an anti-fungals – they are not able to effect proper eradication. This means that many sufferers are denied the full treatment that they need, treatment that would enable them to overcome their condition.

WHO GETS CANDIDA ?
A number of factors are known to predispose infection with Candida. Anything that compromises the immune system is likely to have this effect (AIDS patients often die of severe systemic Candida; they are simply unable to fight it off). ME cases seem to get it very consistently. Any long-term debilitating illness may be accompanied by what we call ‘opportunistic infections’ (those that get under way while the patient’s resistance is low).

     Steroids (including the birth control pill, which is often overlooked as a steroidal) sometimes lead to Candidiasis. However, there is little doubt that the single most widespread cause of Candidiasis is the administration of broadspectrum anti-biotics. Incidental to their main, beneficial effect, these antibiotics kill off resident bacteria in the gut. This ‘gut flora’ is needed for optimum health and proper gut performance. When the bacteria are killed off other pathogens are free to move in, and Candida is one of the most common of these. Countless patients have become chronically ill after frequent or prolonged use of antibiotics and can pinpoint the onset of their troubles to such a course of treatment.

     Finally, some Candida patients have none of the above predisposing causes yet they seem to have the condition. Perhaps our modern, manufactured ‘junk’ diets are partly to blame.

TOXICITY
Candida is able to ferment and release alcohols from sugars in food (see intestinal fermentation). To many people these alcohols are quite allergenic. There have been several celebrated cases in which individuals who were guilty of driving under the influence of alcohol were able to show they had not been drinking but that they did have significant infections with Candida and so escaped the laws. Remember Candida is a yeast, related to moulds, and these organisms themselves are also often quite toxic and may be highly allergenic in their own right.

     But the real problem is that Candida also appears able to generate food and chemical sensitivities. Increase in food intolerance has been blamed on damage to the gut wall. Like many yeasts and fungi, Candida has a vegetative from, which grows out small threads or hyphae into the surrounding cells. It has been hypothesized that these hyphae may provide channels through which the products of digestion escape prematurely into the bloodstream. This means that food substances have not been broken down fully and are thus still biochemically ‘wheat’, ‘pork’ etc.

     If this were so we would certainly expect trouble form allergies, so the supposition fits with the observed facts. But please remember, it is only another theory. It sounds good but may be totally wrong. Clinical ecologists call it the leaky gut syndrome’.

     I believe personally that Candida doesn’t really cause allergies but that Candida and allergies share a common origin: a poor or ‘flat’ immune system.

THE MOULDY PATIENT
I use the concept of Candida in talking to patients since most people have heard of it and believe that is what they have got. However, I prefer the label I used in my Allergy Handbook (Thorsons, 1988), the so-called ‘mouldy patient’. It is a term that stays in the mind, broadens out the debate and gives better insight into what we are dealing with. Whatever the nature of this illness, its manifestation is of a disease caused by encountering and being sensitized by biological products from yeasts, fungi and moulds.

Patients are made worse by anything that can be fermented, such as starch and sugars; they react to foodstuffs containing yeast or mould (bread, wine, mushrooms; etc.); they are often ill in mouldy or musty surroundings (old buildings, woodlands or animal byres); some are even sensitive to damp weather, when moulds are sporing freely; often there are accompanying infections of the fungus type including athlete’s foot or other skin infections such as Tinea and Epidermophyton; finally, the patient may have been diagnosed as having candida, either in the mouth, gut or vagina.

DIAGNOSIS
We are plagued by the lack of a suitable diagnostic test to show whether or not a patient has Candida. Some practitioners use applied kinesiology techniques but this is hardly acceptable to the medical community. Until the time comes that we have a proper test we must rely heavily on taking a careful patient history, seeking to elicit symptoms typical of those outlined above.

     Fatigue is an almost constant accompaniment of Candidiasis and mould problems; depression and disturbance of mood are also particularly prominent, However, lists of symptoms are not reliable guides to candida infection or any other mould problem. Most such lists give symptoms that are typical of food allergy, ME and many other states. These simply reflect a body under stress and not some specific condition.

However, there are four symptoms that I have found very helpful in pin-pointing Candida: a craving for sweet foods, a poor tolerance of alcohol, chemical sensitivity and bloating. This is the ‘awesome four-some’! All four means a certainty, any three will do. Craving for sugary foods is often outstanding among Candida victims.

One thing is certain, there is virtually no correlation between Candida in a stool sample and the existence of the ‘yeast syndrome’. Indeed, Candida albicans is rarely identified in specimens, despite it known very wide occurrence.

Researchers are trying to establish a valid gut fermentation test. The idea is to take a resting blood alcohol level and then repeat the test some hours after a sugar feed. If alcohol appears in the blood this would suggest that fermentation going on. But it doesn’t tell us what is doing the fermenting.

A likely improvement is to look for a wider range of fermentation products. At the moment Biolab (London) are testing for short-chain fatty acids such as acetate, proprionate, succinate and butyrate, and for other alcohols such as iso-propanol, butanol and 2,3-butylene glycol. The advantage of this newer test is that it doesn’t need ‘before’ and ‘after’ samples, so it is easier to do.

At the end of the day, we rely mainly on what is called a therapeutic trial. That is, we give the patient the appropriate treatment and, if it works, we infer he or she must have had the disease.

TREATMENT
A successful anti-mould programme must include efficacious restoration of bowel flora. That means removing the offenders and replacing them with ‘friendly’ bacteria. Several steps are necessary: killing off the moulds, avoiding sugars, minimizing further contact with mould and yeast, especially in the diet and, lastly, recolonization with suitable flora.

     The most important step is medication with suitable anti-fungals. These must be prescribed by a competent physician. Nystatin is the most popular. Even among allergics it is well tolerated, The usual doses are in the range of 1,000,000 units = quarter of a teaspoon).

     Remember: Nystatin can act as a chelating agent (that is, it binds to metals and blocks them) and so should not be taken with nutritional supplements (it would remove zinc, magnesium etc.).

     Alternatives include ketoconazole (Nizoral) tables and fluconazole (Diflucan) capsules. The latter is expensive but easy to take. A ‘one-shot’ form exists, for those likely to develop reactions to medication. Except for Nystatin, lengthy treatments should not be undertaken, as side-effects are potentially serious.

Capricin, a trade brand of caprylic acid, has been frequently advocated as an antifungal. Other substances include garlic and Taheebo tea (Pau D’Arco).

Much is disseminated about the ‘burn off’ reaction patients sometime get when first starting anti-fungal treatment. This is similar to the Herxeimer reaction that syphilis patients used to get when starting a course of penicillin; it was caused by a flood of circulating dead spirochetes (syphilis germs). Burn-off (a sudden exacerbation of symptoms) does exist but is much exaggerated and rarely amounts to anything serious. Discontinuance allows it to settle and, nine times out of ten, when the patient resumes the treatment there is no further trouble.

Medication needs to be supplemented by avoidance of added sugars in the diet. Extreme denials are not called for. Some writers foolishly recommend avoidance of fruit and similar natural foods. This may lead to dangerous inadequacies in nutrition and is bad advice because it isn’t necessary. Anyone with ‘Candida’ made ill by eating fruit has a fruit allergy, almost certainly. Those who feel unwell after eating sugars may really have a degree of carbohydrate intolerance due to deficient enzymes (see inborn errors of metabolism).

Similarly, with avoidance of yeast or mouldy foods – fanaticism is not necessary and may be counter-productive. Patients willing to experiment a little will find suitable tolerances to a number of items in this category. The full list of ferments is very extensive and your physician will probably give you more detailed information. The table below summarizes all the main yeast and fermentation products.

 Fermentation and yeast products

GUT FLORA
Finally, it makes sense to try and recolonize the bowel with friendly bacteria. Most well known among these friendly bacteria is Lactobacillus acidophilus, the yoghourt-making germ. Many supplements of ‘acidophilus’ are currently being marketed. Some contain very few live bacteria and are of poor value if not completely fraudulent.

     In fact Bifidobacteria is much more prevalent in the gut, comprising some 90 per cent of natural bowel flora. Top brand probiotics, as these flora supplements are known, now include primarily Bifidobacteria. Look for those that provide human-strain acidophilus; logically these are more likely to establish themselves in the human colon.