Some people put up with it for a lifetime – but here’s a lifeline

 This patient phoned me, describing herself as having a white tongue, with difficulty eating and breathing.  I asked her to send a photo of her tongue, and it looked as if it was coated with cottage cheese!  I asked her to see her local GP to review her condition and probably prescribe nystatin or fluconazole.

She duly went to see her doctor, who was not concerned about her condition and was about to send her away without treatment.  However, she insisted on having the prescription that I had mentioned on the phone.

Her doctor suddenly became agitated and nervously asked if he had not prescribed nystatin drops.  As the patient answered no, the doctor reluctantly gave her a prescription for them, with an awkward look, as if she had asked for too much.

I understand exactly why my colleague had reacted in this manner.  We simply have not been given enough training to diagnose and treat Candida infections.

Candida is a fungal infection.  We have enough information about every bacterial infection, because we have enough tests to make an accurate diagnosis and enough antibiotics to treat those infections.  This is not the case when it comes to fungal infections: we do not have enough tests, and just a couple of decades ago, there was only one safe anti-fungal agent at our disposal (nystatin).

In this article, I will discuss this yeast-based infection, how serious it is, its causes, and what you can do to prevent and treat this condition.

When I was a medical student in Africa in the 70s, I attended a small party, and one of my neighbours asked for advice to treat athlete’s foot.  I happily advised him to take a course of antibiotics, namely tetracycline.  Fortunately, this was overheard by a senior pharmacist across the room.

I was surprised when he took me aside at the end of the party and said, “Don’t do that again.”  I asked why.  “Prescribing antibiotics for a fungal infection,” he said, “is not helpful because it is going to make the condition worse.”  That was my first training in infection.  The pharmacist’s voice has stayed with me for more than 40 years, and, believe me, I didn’t do it again!

I have met many people who are under the impression that fungal infection is not serious.  This is because toenail fungus or athlete’s foot is not taken seriously.  People buy an over-the-counter application, and when these don’t work, they live with their fungus for the rest of their lives.

Even worse, some people view fungal infection as a sign of poverty or poor personal hygiene.  For example, people often keep away from someone with taenia versicular, a common fungal skin condition, on the assumption that it is contagious.

Candida lives in small amounts in the mouth, intestine, skin or vagina, as part of the normal body flora.  It helps with functions such as the digestion of food.  Candida is normally kept in check by the healthy bacteria flora and immune system.  These are the safety mechanisms that keep our microbiome in harmony.

Chaos reigns when the immune system is not strong enough

Problems occur when we lose our healthy microbiome, or the harmful agents become too strong and take over.  Chaos reigns when the immune system is not strong enough to support normal physiology.  Candida gets out of control, dividing rapidly resulting in overgrowth, known medically as candidiasis.  It turns from a useful commensal to harmful pathogenic organisms.

I remember early in the 80s, at the beginning of the AIDS era, patients with signs of Candida overgrowth caused great concern, because early cases of HIV exclusively presented with Candida overgrowth – signs of the untreatable acquired immune deficiency (AIDS), at that time.

Now when I see patients with Candida overgrowth, I will very carefully exclude diabetes and pre-diabetes.  I have learnt during my long clinical practice that Candida overgrowth can happen at a very early stage, even before blood sugar rise (insulin resistance.)  At these stages of diabetes, blood sugar stays within the normal range but insulin levels soar.

I have also seen hundreds of babies with oral thrush, due to sugary processed milk formula and mothers with vaginal thrush from high levels of oestrogen during pregnancy.  These simple cases can benefit from the application of probiotics (friendly bacteria) in yoghurt in the mouth or the vagina.

Candida overgrowth is the logical outcome of heavy consumption of sugar and processed carbohydrates.  Candida thrives on that preferred diet to grow and flourish.  Doing the opposite, on the other hand, will starve the Candida to death.

Candida can also overgrow and become a problem if you are not giving the healthy beneficial bacteria enough fibre.  Eating real food – fruit, vegetables, nuts and seeds – provides the fibre that feeds the friendly bacteria.

Not a simple case of oral thrush

Let’s go back to the patient who triggered this blog by sending the photo of her tongue.  I wanted to assess the severity of her condition and to find the cause of her oral thrush.

This 51-year-old lady attended my clinic one week after being put on nystatin drops (with little relief there), seeking to relieve her uncomfortable symptoms, and to receive an explanation of her condition, in the hope that it was not serious.

She gave me an interesting history: she had gone to her dentist with periodontal disease and recurrent gum abscess.  She received a six-month course of antibiotics, alongside the usual dental procedures.  She experienced worsening symptoms of blocked nose, sinus problem, sore throat and excessive mucus formation.

She started to have difficulty eating, as food stuck to her throat, and she had to wash it down with warm water.  She also suffered with bloating after each meal.  She also had stomach cramps, loose motions, and frequent and urgent urination, having to visit the toilet every 30 minutes.

Interestingly, she had recently been diagnosed with an under-active thyroid and prescribed a 100mcg daily dose of thyroxine.

I hope you agree that this was not a simple case of oral thrush.  This was extensive candidiasis involving three body systems: there was the upper respiratory tract, extending down into the gullet, a condition known as oesophageal candidiasis.  Her symptom of bloating was suggestive of a small intestinal fungal overgrowth (SIFO.)  Candida ferments food in the upper gut resulting in the generation of gas and bloating.  This must have progressed to damaging the integrity of the gut lining resulting in a leaky gut syndrome.  Through bowel leakage, the damage had extended to cause the under-active thyroid gland.  The yeast infection reached the urinary system, resulting in cystitis and frequency of urine.

Nystatin drops are not enough to sort out this extensive Candida overgrowth.

In 8 weeks, her weight and BMI plummeted: the 38-year-old in despair

Another lady, this time a 38 -year-old, presented with excessive weight gain, difficulty losing weight and multiple medical issues, with a family history of metabolic disease.  She was born by C-section, bottle-fed as a baby.  She had had repeated courses of antibiotics for recurrent urinary infections.

She presented with non-specific symptoms, namely fatigue, sluggishness, lethargy and restlessness.  She was always tired with low energy levels in the early morning, waking up after 2 or 3 alarms; very sleepy during the day, she has extreme exhaustion by Friday evening.

She felt her brain was not working properly, with significant decline in memory (names), speech fluency (word finding), concentration and focus.  She craved sugar and carbohydrates; she had water retention, anxiety, fear and irritability.

She had visited various hospital departments with high oestrogen states, manifested as early puberty, PMS, endometriosis and polycystic ovary syndrome, fibrocystic breast diseases and hot flushes.  She also had severe joint pain and stiffness, particularly in the morning.

There was peripheral neuropathy (neurology) presenting with symmetrical pins and needles from the tips of fingers to elbows, which often woke her up at night, but further investigation with an MRI scan and nerve conduction studies reported back as normal.

There were symptoms of frequent and urgent urination.  There was hair loss, dry skin and constipation.  She felt bloated an hour after eating.  She had a blocked nose, with sneezing attacks and excessive mucus formation.

The test results showed oestrogen dominance, and a low level of methylation, which means she had been struggling to produce a small molecule known as methyl (CH3) necessary to complete essential body activities.  She had been struggling to detoxify toxins because the main detox gene in the liver was missing.

She had insulin resistance, a thyroid function within the normal range, apart from rT3 upper normal range.  This indicated that stress was having a negative impact on the thyroid gland.  Her vitamin D of 90 was inadequate, and a genetic test confirmed gluten sensitivity.

Her treatment included an elimination diet (sugar, gluten, milk and dairy products), a real food diet of 8 to 10 portions of low-sugar fruits and vegetables, three decent real food meals per day (with no restriction on meal size), intermittent fasting for 16 hours (3 meals within the 8-hour eating window), and walking 10,000 steps per day.

In two months, her weight plummeted from 97 to 79kg, and her BMI from 33.6 to 27.0.  Her symptoms score went from 167 to 109.

You are predisposed to Candida overgrowth if you have

  • Antibiotic treatments, diabetes, low stomach acid, anti-acid pills
  • Poor diet, high in sugar and process carbohydrates, and low in fibre
  • Oestrogen state, contraceptive pills and hormone replacement therapy (HRT)
  • Immune suppressing therapies, such as steroids and cytotoxic drugs, AIDS
  • High stress, which can suppress the immune system, and invite yeast overgrowth

Candida overgrowth can result in

  • Chronic fatigue syndrome (CFS)
  • Recurrent respiratory symptoms
  • Recurrent urinary infection
  • Reduced libido and sexual dysfunction
  • Premenstrual symptoms (PMS)
  • Headache, migraine and depression
  • Allergies, such as eczema and psoriasis
  • Irritable bowel single (IBS)
  • Toenail fungus, athlete’s foot, rectal and genital itch

Tests to investigate Candida overgrowth

  • A complete blood count will show a low white cell count, relatively high neutrophil and low lymphocyte count – the test is not a specific but highly suggestive
  • A throat, nasal or vaginal swab can grow Candida
  • A comprehensive digestive stool test can show high inflammation markers (calprotectin), and the specific yeast
  • Secretory IgA protects the gut mucus membrane – a low level indicates that your immune system is suppressed, a state consistent with Candida overgrowth
  • Urine organic acid test (OAT) can indicate upper small intestine Candida overgrowth on high Arabinose, Citramalic or Tartaric acid
  • Check Candida IgG, IgM, IgA antibodies: high levels of these antibodies indicate recent or past yeast overgrowth

Tips to avoid yeast infection

  • Avoid antibiotics, steroids and contraceptive pills
  • Have a low-sugar, low refined carbohydrate and high fibre diet
  • Avoid food high in yeast, such as cereals, grains and coffee
  • Take probiotics to top up beneficial bacteria and antacid to kill the bad ones
  • Reduce your stress levels

Treatments

  • Starve Candida by cutting out sugar and processed carbohydrates – so, eliminate sugar, flour and starch, grains, alcohol and dairy
  • Be aware that Candida can consume cellular iron and zinc reserves that may need to be replenished
  • Practise intermittent fasting or water fasting is another way to starve and kill Candida
  • Take probiotics and fermented food to populate beneficial bacteria to keep them in charge
  • Use natural anti-fungal agents – oregano oil, berberine, garlic and tannin – all have antibacterial, antifungal and antiviral activity
  • Take caprylic acid as a natural agent, extracted from coconut oil, which is anti-viral, anti-fungal that damages the yeast cell wall
  • In terms of drugs, Fluconazole and Nystatin are the most common anti-fungal, pharmaceutical agents, but they have side-effects

Finally, please be aware that killing yeast can result in the release of toxins and other biproducts, making you feel worse before you feel better.  During this period, you need support with a good diet, as well as binders to pull out toxins such as charcoal, pectin and soluble fibres in guar gum, milk thistle or psyllium husk.

And now, my friends, I would love to hear your stories – your experiences of success and failure – in relation to Candida.  Your journey may well help or encourage someone else suffering along the same lines.