DISCLAIMER: I am not a medical expert, but only an informed layman. This article is for informational purposes only, and is only based on online research. In this article there are no affiliate links. For real medical advice, please consult a health professional.
Some days ago, a friend told me about a health problem that might be underestimated by conventional medicine: Candida. Candida is a genus of yeasts. Some of them, like Candida Albicans, belong to our natural gut flora. If the gut flora is well balanced, then its presence doesn’t cause problems. However, there is a disease called Candidiasis, which is an infection caused by an overgrowth of Candida species, which can appear in different parts of the body.
Candidiasis
- Image made by Photostock and downloaded from freedigitalphotos.net
Now, the remarkable thing about Candidiasis is that there are different kinds of that infection, which might be called clinical Candidiasis and subclinical Candidiasis. Clinical forms of Candidiasis are acknowledged by all parts of medicine and describes two different forms. On one hand, there are localized candida infections, mostly somewhere in the mouth, gastrointestinal tract, or the genitalia. On the other hand, there’s also a systemic form of Candidiasis, which, according to standard medicine, only affects severely immonocompromised patients, like those suffering from AIDS or cancer.
Subclinical Candidiasis (often called “Candida overgrowth”) is a controversial condition, as large parts of the practitioners of conventional medicine deny its existence. It’s a condition that is mainly diagnosed in the alternative medicine community. There, it is claimed to be a common problem, which can cause many different chronic diseases. The list of symptoms and diseases, which Candida overgrowth is claimed to be connected with is pretty long (assembled from several different sites):
- Abdominal pain, acne, AD(H)D, alcohol intolerance, allergies, anal/penile/vaginal itching, anemia, anxiety
- Bad breath, foul taste in mouth, blisters in the mouth/tongue/throat, bloating, “brain-fog” – difficulty to focus or even think straight, brown colored mucus in the back of the throat
- Chills and night sweats, Crohn’s disease, chronic athlete’s foot, chronic dental problems, chronic fatigue, chronic sinus drainage – which antibiotics don’t help, cognitive dysfunction – poor memory, lack of concentration, constant craving for something sweet, constant fatigue, constipation, “crawling” skin
- Dark circles under the eyes, dandruff, depression, dermatitis, diarrhea, difficulty swallowing, disturbed sleep, dizziness and balance problems, dryness of the mouth and eyes
- Either white or “blood blisters”, eczema, extreme tightness in the shoulders and neck
- Fainting, feeling of being “hung over”, fibromyalgia, fungus on the finger or toe-nails
- Gluten and/or casein intolerance
- Hair loss, headaches including migraines, high cholesterol (hyperlipidemia), hyper-acidity/acid reflux, hypoglycemia
- Increasing allergies to foods (e.g. gluten or celiac problems), indigestion, infectious arthritis, infertility, inflammatory bowel diseases, irregular heartbeat, irritability, Irritable Bowel Syndrome (IBS), itching red eyes
- Jock and rectal itching, joint pain with arthritis-like symptoms
- Light-headedness, lupus, low body temperature, low-grade fever, low sex drive and/or numbness in the genital area
- Menstrual problems including PMS and endometriosis, mineral deficiencies, muscle aches, muscle twitching, muscle weakness
- nausea, numbness, tingling and/or burning sensations in the face or extremities
- Oral Thrush (a white film on tongue or in the mouth)
- Painful gas and abdominal bloating, panic attacks, paranoia, personality changes and mood swings (irrational rage or crying for no reason – fear of talking to people, any kind of confrontation, isolation), problems with concentration and short-term memory, projectile vomiting, psoriasis
- Rashes and dry, flaking skin, Recurring obsessive thoughts, recurrent throat/ear infections, recurrent vaginitis, Reiter’s syndrome, restless leg syndrome, rheumatoid arthritis, ringing in the ears (tinnitus)
- Scleroderma, sensitivities to noise/sound/foods/odors/chemicals/heat/cold, shortness of breath, Sjogren’s syndrome, skin discoloration and/or blotchiness, skin rashes on the body (eczema, atopic dermatitis), sore throat
- Un-refreshing sleep, Ulcerative Colitis, urinary infections (not helped by antibiotics)
- Vision problems, vitamin deficiencies
- Weakness, weight changes without changes in diet, white coated tongue
Ok, so this seems to be a condition which is made responsible for a huge number of health problems. How are those symptoms explained? A good and typical explanation is given on Ninazu:
When the protection of the useful microbes and that of the intestinal lining is impaired, proliferation of harmful organisms starts (dysbiosis). Candida transforms itself from a harmless yeast form to a pathogenic fungal form, a condition called candidiasis.
[...] Candida produces toxins (canditoxin and ethanol) that affect our brain and it releases metabolites that are also toxic and interfere with our biochemical processes. Overgrowth leads to the release of these molecules in large quantity.
[...] First, fungal metabolites and/or toxins interfere with the functioning of nutrient-uptake and their transfer into the bloodstream. Then the fungus grows long stringy structures (rhizoids) that can penetrate the upper cell layer of the intestinal wall.
[...] Over time, the rhizoids can penetrate the gut wall and make it inflamed and porous causing Leaky Gut Syndrome. [...] As the intestinal mucosa becomes permeable, macromolecules (partially digested dietary proteins), toxins and pathogens can enter the bloodstream and reach organs that they normally would not. Food intolerance and environmental sensitivities are adverse reactions to certain nutrients and environmental pollutants.
[...] Allergies develop when the agents (antigens) that entered the bloodstream set off a reaction by the immune system. Some of these molecules are similar to molecules of human tissue and when the immune system develops antibodies to attack the antigens it attacks healthy tissue as well and autoimmune disorders develop.
[...] In the next step the rhizoids break down the barrier between the intestine and the circulatory system in which case candida can enter the bloodstream and spread throughout the body (Systemic candida). Candida can invade virtually any organ or part of the body where the defenses (physical and immunological) are weakened.
But then, consider the following information from Medscape:
Invasive candidiasis has a mortality rate of 40-50%, with an estimated cost of $40,000 per episode.
Often, in alternative medicine the idea comes up, that otherwise “healthy” patients can develop a systemic candidiasis without being in lethal danger – they just feel totally terrible overall and develop many of the symptoms from the list above. Whereas in conventional medicine systemic candidiasis only affects immunodeficient patients, like those who suffer from AIDS or cancer (chemotherapy).
But is Candida Overgrowth real?
I haven’t found a lot of evidence for the assumption that candidiasis can become systemic in not immunodeficient patients, so that idea is highly questionable. It’s even not really necessary to explain the symptoms of candida overgrowth. In normal patients candida is more or less restricted to the gastrointestinal tract and the skin.
So, what’s true about the rest of the candida overgrowth theory? It’s really hard to tell, because research is pretty inconclusive. Let’s begin with the position of the sceptics:
(1) the concept of candidiasis hypersensitivity is speculative and unproven
(2) its basic elements would apply to almost all sick patients at some time because its supposed symptoms are essentially universal
(3) overuse of oral antifungal agents could lead to the development of resistant germs that could menace others
(4) adverse effects of oral antifungal agents are rare, but some inevitably will occur
(5) neither patients nor doctors can determine effectiveness (as opposed to coincidence) without controlled trials. Because allergic symptoms can be influenced by many factors, including emotions, experiments must be designed to separate the effects of the procedure being tested from the effects of other factors.
There’s also a study backing the claim that intestinal Candida overgrowth doesn’t really exist or cause any problems.
However, the case is more complicated, because other studies show different results:
- This study yields a result that contradicts the study above directly.
- Another study shows that “Candida” patients have increased Candida IgG serum levels, which indicates an elevated immune reaction to candida yeasts in “Candida” patients.
- Intestinal candida colonization often occurs in gastric ulcer and ulcerative colitis patients, and delays the healing process. Treatment with lactobacillus acidophilus turned out to be effective.
- A rather recent study shows some interesting mixed results:
Mucocutaneous Candida infections are due either to impaired host defenses or to altered gene expression in formerly commensal strains. The expression of virulence factors enables yeasts to form biofilms, destroy tissues, and escape the immunological attacks of the host. Yeast infections of the intestinal mucosa are of uncertain clinical significance, and their possible connection to irritable bowel syndrome, while plausible, remains unproved. Yeast colonization can trigger allergic reactions. Mucosal yeast infections are treated with topically active polyene antimycotic drugs. The adjuvant administration of probiotics is justified on the basis of positive results from controlled clinical trials.
- Candida yeasts can often be found in/on patients with skin diseases, like acne, psoriasis, and atopic dermatitis. Additionally, candida also correlates with diabetes mellitus, heart-insufficiency, hypertension, chronic tonsillitis, and urinary tract infection.
- Another study about candida, psoriasis, and atopic dermatitis shows interesting correlations.
- Patients with psoriasis have more Candida in their saliva and feces than a control group.
- Yet another recent study yields this result: “Prevalence of Candida on the tongue was significantly higher in psoriatic patients (32%) compared with atopic dermatitis (18%) (P = 0.024) and higher, although not significantly, than in normal controls (21%) (P = 0.08).”
- Anti-fungal therapy is effective against sebhorreic dermatitis and sebhorreic forms of psoriasis. Those patients had high quantities of Candida in their feces.
- More information and studies about Candida and psoriasis.
- Diallyldisulphide (DADS), a substance found in garlic, has anti-fungal effects, and can be used against candida yeasts. This is especially interesting as garlic has been accepted as a treatment for “Candida” in alternative medicine for a long time.
So, research is not perfectly conclusive, but there is a lot of evidence that Candida plays a role at least in some of the diseases, which are allegedly caused by intestinal Candida overgrowth. Some skin diseases seem to be a relatively strong indicator for problems with Candida.
As I suffer from a chronic, but relatively mild form of psoriasis, these results are pretty interesting. They indicate that my condition is possibly curable with an anti-fungal therapy. That’s a pretty novel information, as the typical claim is that psoriasis can’t be cured!
Widening the Picture
While I did more research, I found this medical online test. You have to answer hundreds of questions, and afterwards (after paying 25 US-$) you get an extensive result about which diseases you could have and how serious these issues are. My own results were partially quite interesting, but I won’t discuss them here in full detail.
Nevertheless, through the test I found out about Bacterial Dysbiosis, which is another gut health problem, but caused by harmful bacteria instead of harmful yeasts. There’s a great article that explains the different kinds of gut dysbioses, and also cites many studies. Anyway, the treatment regimes of all those diseases are pretty similar.
Diagnosis
One important difference between intestinal Candida overgrowth and bacterial dysbiosis, is that at least one form of the latter is a fully recognized disease: Small Intestinal Bacterial Overgrowth (SIBO). There are tests for SIBO, which are actually reliable. Wikipedia states:
The gold standard for detection of bacterial overgrowth is the aspiration of more than 100,000 bacteria per millilitre from the small bowel. The normal small bowel has less than 10,000 bacteria per millilitre.
Also, there are tests for intestinal Candida overgrowth, but none of them is really reliable either. This seems to be the main reason why that disease isn’t really accepted by conventional medicine, yet.
In that situation it might be a legitimate approach to try a treatment on spec, if there are enough symptoms that indicate intestinal Candida overgrowth. If the symptoms disappear, that might be considered as empirical diagnosis a posteriori. Of course, it’s not a really reliable diagnostic method, because the symptoms could be caused by a different problem, but disappear due to the placebo effect of the treatment. Anyway, improved health is improved health.
Beware of one test that can often be found on various sites about Candida: The spit test. On this site you can read:
What those websites don’t tell you that this so-called test was developed by a network marketing company Global Health Trax as a way to sell their ThreeLac probiotic supplements.
[...] The test has absolutely no bearing on Candida. People with Candida can pass it, and people who don’t have Candida overgrowth might fail it.
[...] What this test ‘measures’ is the thickness of your mucus. And that is affected by many more things than just Candida overgrowth.
Candida Treatment
There are a couple of pages which will give you a good idea about how a Candida treatment could look like:
In general, a Candida treatment consists of three components: Firstly, the yeast overgrowth needs to be reduced with anti-fungal drugs, like Nystatin, or natural products that have anti-fungal properties. Secondly, it is essential to stick to a Candida diet, which basically has the function of stopping the growth of the yeasts. Sugars and carbohydrates are the main foods of Candida, so it’s a good idea to cut out sugars and at least cut down on other carbohydrates. It’s also important not to eat any foods that you have developed allergies against. Finally, the balance of the gut flora needs to be restored with probiotics.
Anti-fungal therapy
There are some problems when it comes to anti-fungals.
- Candida yeasts can develop resistances against them, so it might be necessary to rotate the use of different anti-fungals.
- If the yeasts die too quickly, it can come to “die-off” reactions. In that case, the yeasts release their toxins very quickly, which can increase the usual symptoms.
- It’s not a good idea just to do anti-fungal treatment without any change in diet or the use of probiotics.
- Maybe Candida yeasts have some useful function for us, so a complete eradication might have adverse effects.
Therefore, the anti-fungal treatment is best seen as assistive treatment for the restoration of the gut flora with probiotics, which is actually the most important part.
Probiotics
If you have too many Candida yeasts it’s pretty likely that you don’t have enough good bacteria in your gut. So, these need to be added from the outside with probiotics. There’s a long list of helpful bacteria that can assist gut functioning, and compete with Candida yeasts for food and space.
The following list shows my subjective preferences for different probiotics. My main criteria were mainly scientific studies, endorsements, and empirical effectiveness, in the form of user reviews.
- VSL#3: Extremely potent probiotic. Effectiveness against some gastrointestinal diseases scientifically backed. Medical supervision strongly recommended.
- Syntol: New probiotic specifically designed to treat intestinal Candida overgrowth very effectively. Makes a seriously good impression.
- Theralac: High quality and high potency supplement with great reviews.
- Culturelle Probiotic (Lactobacillus GG): It’s a pretty good probiotic with lots of studies backing its effectiveness. Has relatively high potency.
- iFlora: High potency supplement with huge number of different helpful strains of bacteria.
- Garden of Life Primal Defense Ultra Ultimate Probiotics Formula: General broad spectrum probiotic. Has relatively low potency, but good reviews. Combined with Garden of Life Fungal Defense it’s a rather mild Candida treatment.
- Florastor: Quite safe and popular general purpose probiotic, but probably not especially good for treating Candida. Has relatively low potency. If you aren’t sure what kind of problem you have, using this product probably doesn’t hurt.
It’s also important to note that there are some questionable probiotics, like Threelac, which sometimes shows disconcerting and unexpected side-effects. Probiotics can have side-effects in general, but there are usually relatively mild. However, those side-effects can be very dangerous, and even lethal, to severely immunodeficient patients.
Even though some probiotics are really good, there is no guarantee that they work for all patients. Often it requires some experimentation to find the “right” probiotic. A stool analysis can help to find the bacteria strains that are deficient or missing in the digestive tract. That information can help with the choice of an effective probiotic.
Unfortunately, it usually takes months for probiotics to restore the balance in the gut. However, some beneficial effects are often noticed within days or weeks.
Edit (2011-04-24): I’ve found a long article about probiotics which offers a rather interesting (relatively critical) view on probiotics).
Leaky Gut Syndrome
After I found out about Candida overgrowth and SIBO, I also stumbled upon the medical condition called Leaky Gut Syndrome. Interestingly, the Leaky Gut Syndrome in itself is increasingly recognized as really existing medical condition. There’s a really good video that explains that condition: The intestinal lining gets damaged, so that harmful molecules can pass into the blood stream. Well researched information on the Leaky Gut Syndrome can be found in this Huffington Post article.
Leaky Gut Syndrome is quite an active topic of current research. Here are some interesting studies:
Causes of Leaky Gut Syndrome
As causes of Leaky Gut Syndrome the following are mentioned in this article or on the page about Leaky Gut Syndome on Diagnose-me.com:
- Alcohol
- Antibiotics
- Caffeine
- Candida overgrowth
- Enzyme deficiencies (e.g. celiac disease, lactase deficiency causing lactose intolerance)
- High refined carbohydrate diet (e.g. candy bars, cookies, cake, soft drinks, white bread)
- Mold and fungal mycotoxins in stored grains, fruit and refined carbohydrates
- NSAIDS (non-steroidal anti-inflammatory drugs) like ASA, aspirin, ibuprofen, indomethacin, etc.
- Parasites
- Prescription corticosteroids (e.g. prednisone, hydrocortisone, DepoMedrol, etc.)
- Prescription hormones like the birth control pill
- Some chemicals in fermented or processed foods
- Some special bacteria
- Steroids
- Stress
It’s actually the leaky gut, which causes most of the serious diseases associated with Candida overgrowth. The leakage of large molecules, or even bacteria and yeasts, out of the gut causes all kinds of allergies, as the immune system fights off the substances that don’t belong into the blood stream. This irritates and weakens the immune system. That way, auto-immune diseases can develop.
Intestinal Permeability Treatment
A successful Candida treatment also needs to address the problem of increased intestinal permeability. This article about intestinal permeability mentions some substances that can help the intestinal lining to heal itself:
This source also mention glutamine, omega 3 fatty acids and N-acetyl-D-glucosamine. Another site mentions some more helpful substances and claims that it might be better to heal the intestinal lining before using probiotics, because otherwise the latter could cause unwanted effects.
Heavy Metal and Candida
While this connection is highly speculative, Candida overgrowth could be a result of heavy metal (especially mercury) toxicity. This page draws parallels between mercury poisoning and Candida overgrowth. It also explains how to get rid of heavy metals. Also, the Yeast Infection Advisor mentions mercury poisoning and how to get rid of it. There’s also an interesting personal story, which addresses these issues.
The Environmental Illness Resource cites a lot of studies on the dangers of heavy metal toxicity, but doesn’t put it into connection with Candida. Anyway, even if Candida and heavy metal toxicity are independent issues, the latter exists and is a real health problem that needs to be addressed, if present.
Conclusion
While still not sufficiently researched, the Leaky Gut Syndrome most probably exists and poses a serious health threat. The condition called SIBO is an established disease and can be treated effectively. There is numerous evidence for the existence of intestinal Candida overgrowth, and its connection with the Leaky Gut Syndrome looks pretty plausible. Some evidence suggests that some probiotics are an effective remedy for those medical conditions. When considering the relatively high safety of probiotics, and their possible usefulness, it may be considered as quite rational to use them in the case of symptoms which indicate the presence of gut dysbiosis. Even if their use was just due to the placebo effect, they would still be a relatively good investment, as the placebo effect is surprisingly strong.
Because the topic of intestinal health hovers above the borderline between conventional and alternative medicine, a critical attitude regarding every statement – regardless of its origin – is highly advisable. The resource I deem most trustworthy is the Environmental Illness Resource, as it backs its claims with a satisfying number of scientific studies. While Wikipedia and large parts of the conventional medicine community might err on the side of being too “conservative”, the Yeast Infection Advisor might be too speculative, albeit it’s one of the best resources for the topic of gut health.
The ideas of subclinical systemic Candidiasis and the connection between heavy metal toxicity and Candida are highly speculative. Also, the effectiveness of natural remedies is only partially scientifically backed, if at all. As the spectrum of symptoms of intestinal Candida overgrowth is very broad, the danger of wrong positive diagnoses is high. On the other hand, there is no gold standard for diagnosing that condition, but many clinical tests can count as evidence for its presence.
In any case, the topic of gut health turns out to be very important, and more research is in high need.
My time with this blog had been turbulent, troublesome, interesting, and exciting. I started it as an unconventional method to deal with my depression and voice my thoughts about plenty of different topics. It always has been a pretty small blog, and I wasn’t eager to promote it to a larger audience. Now, that decision has taken me a lot of time, but I plan to discontinue writing on this blog.
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