A noted allergy specialist questions many of the most common assumptions about candida overgrowth.
As a well known clinical ecologist once remarked, "If all you've got is a hammer, everything starts looking like a nail." He was referring to candida albicans infection and the tendency of many doctors and alternative practitioners to diagnose anyone suffering a collection of unexplained symptoms as another victim ofthe "yeast syndrome". Some doctors with extensive experience in treating candida are beginning to doubt some of the most popular theories about candida. Candida albicans may only one of several bugs wreaking havoc in the gut; so called candida sufferers may have several, quite distinct problems; the classic anti candida diet may be needlessly harsh. Keith Mumby, author of The Allergy Handbook who has treated countless cases of candida, questions a number of supposed symptoms of and treatment for the yeast syndrome now accepted as gospel.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. Dr Orian Truss of Birmingham, Alabama, first brought the candida hypothesis to us in 1978. He is a psychiatrist with a special interest in clinical ecology ,and his seminal papers in the Journal of Orthomolecular Psychiatry (Vol 7, No1, 1978 and Vol 9, No 4, 1980) revealed an extensive and fascinating area of personal investigation. His work was taken up enthusiastically by Dr William Crook, an allergist in Alabama, who has done more than any individual to popularize the candida hypothesis, or what has now become known as the "yeast connection", taken from the title of his book (Professional Books, Jackson, Tennessee, 1983).
Since that time, Truss's theory seems to have gripped public imagination. Clinical ecologists have been keen to extol the enormous benefits of tackling it vigorously. Unquestionably, there are gains, through following an anti candida programme, taking anti fungal drugs and excluding sugar and yeast.
Yet Truss's idea is no more than a theory. It has been 12 years now since Truss's innovative papers, and that is ample time to carry out detailed studies which would make his claims valid. Yet they are singularly lacking. A catalogue of startling recoveries does not constitute scientific study. The fact is, we may be getting the right results for the wrong reasons. There is some evidence that the "yeast syndrome" may be several syndromes, or the fallout from a generally weakened body with several unrelated problems. Candida albicans may not be the only pathogen, but one of several.
Some of the confusion about Candida comes from the fact that a number of widely circulated "anti candida diets" do have a beneficial effect, at least at first. But what isn't understood is that the "cure" is often simply that of eliminating a food allergy and not eradicating Candida at all. One diet in Sweden excludes dairy produce as part of an anti Candida routine; a naturopath here in Britain cuts out all grains. There is absolutely no rationale for these dietary restrictions in the fight against candida. All they ensure is that a great many of those who are dairy or wheat allergic will become miraculously better. This creates the false impression that they suffered from candida.
If the real origin of the recovery isn't understood it can be confusing and even counter productive. It may lead to a patient being stuck on a difficult and inadequate diet almost indefinitely since the patient may feel ill each time he or she tries to come off it without knowing why.
Who gets Candida?
There is little doubt that the single most widespread cause of candidiasis is the indiscriminate administration of broad spectrum antibiotics. Incidental to their main beneficial effect, these kill off resident bacteria in the gut. This "flora" is needed for optimum health and proper gut performance. When they are gone, other pathogens can move in and candida albicans is one of the commonest of these. But a number of factors are known to predispose infection with candida.
Cancer patients, especially those who have had chemotherapy or irradiation of the tumour, will probably get it. Any long term debilitating illness may be accompanied by "opportunistic infections", such as ME and AIDS.
Steroid therapy is known to predispose to Candidiasis. Asthma patients and arthritics who have taken these drugs are especially prone. Most people don't realize that the birth control pill is a kind of steroid (even doctors often seem to overlook this point), perhaps one reason that the syndrome is more common in women.
Some candida patients fit into none of the neat categories above yet definitely seem to suffer from the problem. Perhaps our modern manufactured junk diets are to blame.
[Or maybe the candida generation is the first that wasn't breastfed and the first to be subjected to mass vaccination, practices that have left a generation with weakened immunity. editor]
Candida is able to ferment and release alcohols from sugars in food. To many people these are quite allergenic. There have been several celebrated cases in which individuals who were accused of driving under the influence of alcohol were able to show they had not been drinking but were victims of severe candida infections .
It is worth remembering that candida is a yeast, related to moulds. These organisms are often quite toxic and may be highly allergenic in their own right. But the trouble is far worse than this. Candida also appears able to generate food and chemical sensitivities. It is difficult to work out why this should happen, other than the fact that the yeast increases the toxic load the body is coping with. Nevertheless, the association has cropped up so consistently in my clinic that bad chemical allergics almost automatically get an anti mould programme.
Increase in food intolerance has been blamed on damage to the gut wall. Like many yeasts and fungi, candida has a vegetative form, which grows out small threads of 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 blood stream. This means that food substances have not been broken down fully and are thus still biochemically "wheat", "pork" etc. This is referred to as the "leaky gut" syndrome.
If this were so, we would certainly expect trouble from allergies, so the supposition fits with the observed facts. But please remember, it is only another theory. It sounds good but we may be totally wrong. I personally believe that candida doesn't really "cause" allergies, but that the source of the problem is a generally weakened immune system, which then leads to both candida overgrowth and allergies.
The mouldy patient
Although I refer to this syndrome as "candidiasis" in order to be understood, I prefer to refer to my patients who suffer from the syndrome as "mouldy". Whatever the nature of this illness, those suffering from it are definitely sensitized by biological products from yeasts, fungi and moulds.
Patients are made worse by anything which 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.
Remember that moulds and their relatives are individually quite toxic; it would be quite surprising if we were not made ill by contact with them. Many cases of so called candidiasis may not be so much an allergy as a poisoning.
We are plagued by the lack of a suitable diagnostic test to show whether or not a patient has candida. Some alternative practitioners use applied kinesiology techniques, but these tests have not gained acceptance by the allopathic medical community. Until we do come up with a scientifically sanctioned test, practitioners of conventional medicine must exclusively rely on clinical history.
The lists of symptoms often published as a weathervane of a person's "candida quotient" are not reliable guides to candida infection or that of any other mould. These simply reflect a body under stress, rather than any single specific condition. The symptoms usually listed could be typical of food allergy, ME or a host of other ailments.
In my experience fatigue is an almost constant accompaniment of candidiasis and mould problems, as is depression or mood swings. However, four symptoms almost always are present in the "yeast syndrome": craving for sweet foods, a poor tolerance of alcohol, chemical sensitivity and bloating. Three or four are a sure sign of candida particularly a craving for sugary foods.
Researchers in the UK are trying to establish a valid gut fermentation test. The idea is to take a resting blood alcohol level and then repeat it some hours after a sugar feed. If alcohol appears in the blood, this suggests fermentation is going on. But it doesn't tell us what is doing the fermenting.
One way we might pinpoint the cause of the yeast syndrome is to look for a wider range of fermentation products. At the moment Biolab in London is testing for short chain fatty acids and other alcohols (see box, p 3). The advantage of this newer test is that it doesn't need "before" and "after" samples, so it is easier to do. It is too early to say if these tests will have any meaningful use in terms of 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, to my mind, is medication with suitable anti fungals. Polyene antibiotics have revolutionized this field. They are effective against yeasts and filamentous fungi. Nystatin is the most popular. It is highly toxic but because it isn't absorbed when taken orally, it is well tolerated. The usual doses are in the range of 1,000,000 units four times a day (1,000,000 units = quarter of a teaspoon). Capricin, that is, caprylic acid, often advocated as an anti fungal has been, in my experience, disappointing.
Although 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 just isn't necessary. Anyone with "candida" made ill by eating fruit has a fruit allergy, almost certainly. In my experience, an occasional modest indulgence in something sweet causes no difficulty, except in unusual cases.
Thus, therapy for the majority need not be tied to the excessive requirements of the unusual few. An easy going, sensible attitude is psychologically important, especially for children. After all, we are talking about body toxic load, not some deadly poison! Those who claim they are made ill by any quantity of any sugar, if they are correct, are probably really suffering from a defective carbohydrate metabolism.
Similarly, with avoidance of yeast or mouldy foods fanaticism is not necessary and may be counter productive. Gut Flora
Finally, it makes sense to try and recolonize the bowel with friendly bacteria. Most well known among these is lactobacillus acidophilus, the yoghourt making germ. Many supplements of "acidophilus" are currently being marketed. Some contain very few live bacteria and are poor value, if not 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 which provide human strain acidophilus; logically these are more likely to establish themselves in the human colon and elsewhere.
Finally, the question that most patients want to ask: is it possible to eradicate this problem permanently? The answer is yes. Another assumption which 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.
But so long as you use the proper anti fungals and follow it with a sensible anti sugar diet, there is no reason to think you won't get better after several monhts.
However, there is nothing to stop it coming back. For this reason it would be prudent, even when successfully treated, for you to remain cautious of mould foods or excess sugar in the diet.
Times when a recurrence is especially likely are during or after stressful episodes, such as allergy relapses or intercurrent infections. Even a viral infection may temporarily suppress the immune system and cause candida.to return.
Ironically,antibiotics occasionally solve the problem presumably when the culprit is not candida but some form of fermenting bacteria.