Elson M. Haas M.D.
(Excerpted from Staying Healthy with Nutrition)
The "yeast" problem with Candida albicans is one of the new medical concerns of the 1980s that will continue into the next century. It has been described by many prominent physicians, including C. Orian Truss in The Missing Diagnosis, William Crook in The Yeast Connection, and Keith Sehnert in The Candidiasis Syndrome. It is a very common problem, one of the most frequent I see, and is to me a medical adventure, because I learn a great deal while working with people with this problem. Often the therapy for yeast, or candidiasis as it is commonly known, will positively and dramatically change lives. The somewhat complex, multilevel treatment program has been effective in a high percentage of the people I have treated, and I have worked with hundreds with this problem to date.
Factors Common to Patients with Yeast Syndrome
Frequent or long-term use of antibiotics, such as tetracycline for acne
Frequent use of broad-spectrum antibiotics for recurrent infections, such as in the ears, bladder, vagina, or throat
Birth control pill use in women
Recurrent vaginal yeast infections in women or prostate problems in men
Regular use of cortisone-type drugs
Cravings for sweets, breads, or alcohol
Sensitivity to molds, dampness, and smells
Mental symptoms such as depression, mood swings, or confusion
Chronic fatigue, indigestion, or food reactions
Recurrent skin fungus infections, such as ringworm, athlete’s foot, "jock itch," or nail problems
The yeast syndrome is a controversial topic. Most traditional doctors do not want to hear about this condition and call it a "fad" disease, but those who will explore the possibility and look for it in their patients will be hard-pressed not to accept this problem as "real." One of the reasons, I believe, for medicine not really accepting the "yeast syndrome" is because the problem arises predominantly as a side effect from the use of commonly prescribed drugs—antibiotics, birth control pills, and corticosteroids.
The problem originates when a common yeast, Candida albicans, begins to overgrow in the intestinal or genito-urinary tract. It may be contracted initially through sexual contact. When other normal body microflora are killed off by antibiotics, the yeasts will then proliferate and coexist with the useful germs. Mild mucocutaneous infections (of the skin, vagina, throat, or bladder, for example) may develop in the yeast phase of this dimorphic organism. This common yeast is usually noninvasive (that is, it remains localized) except in the severely debilitated patient. However, with long-term infestation or with the weakened immune state that can result from a reduction of normal colon bacteria, the yeast can shift into its fungal form, wherein it develops rhizoids, or roots, that can be implanted in the intestinal wall or other mucosal linings. This allows absorption into the body of by-products (toxins) of fermentation and other antigenic material generated by the fungus. The body will then make antibodies to the Candida albicans organisms. This can lead to an immunological or hypersensitivity reaction that is manifested as the polysystemic disease for which this syndrome is now known.
The yeast problem thus occurs at two levels—the localized infections, of which skin rashes and vaginitis are the most common (intestinal overgrowth is also common), and the secondary and more serious systemic reactions. This problem can then produce such symptoms as recurrent skin fungus infections, examples being ringworm, athlete’s foot, "jock itch," or nail problems; headaches; fatigue; cystitis or prostatitis; mental symptoms such as mood swings, poor memory or concentration, depression, or confusion; premenstrual symptoms; recurrent herpes infection; joint pains; cravings for sweets, bread, or alcohol; indigestion or food reactions; and sensitivity to molds, dampness, environmental pollution, cigarettes, and various smells.
This yeast syndrome is much more common in women than in men and seems to affect the hormonal balance, initially causing mild premenstrual symptoms of irritability, depression, fatigue, and swelling, and leading to actually abnormal and/or painful menstrual periods. I would estimate that a significant number of women with PMS have a problem with Candida albicans, and probably more than half the women with candidiasis have some uncomfortable premenstrual symptoms.
Diagnosing polysystemic candidiasis may involve several tests. Most doctors who work with this problem use a questionnaire such as the one provided by Dr. Crook in his book, The Yeast Connection. The scores indicate the likelihood of a yeast problem, and while not exact, this is a pretty accurate tool. Many doctors suggest a trial treatment program merely on the basis of an interview, exam, and questionnaire score, as the response to therapy is often a good indication of the presence of the problem. However, I like to have more objective monitors, so I perform two main tests, both reasonably inexpensive. One is a culture of a stool specimen to quantify the amount of Candida albicans (or other yeast) organisms present. This can then be repeated to measure the effectiveness of the program. Also, a sensitivity test that finds what substances will actually kill the yeast (in the lab, at least) can be done after the organism is isolated. The other test measures the blood levels of three antibodies (IgA, IgM, IgG) to the Candida albicansorganism, performed by Immunodiagnostic Lab in San Leandro, California. If these antibodies are elevated, this suggests that some systemic reaction is occurring in the body (the stool reveals only an intestinal overgrowth), which may be correlated with more widespread symptoms. This test also gives us the opportunity to monitor the body’s status over time to measure treatment response. Reducing yeast organisms in the body and replacing friendly bacteria will usually reduce elevated antibody levels.
Other tests may be helpful in determining coexisting medical problems. A study of the stool for ova and parasites may show these to be more commonly present in yeast carriers than in the average population, as often the same predisposing factors, poor digestion and low stomach acid, are present. Treatment may also be needed to eliminate these parasites. Creating proper colon ecology is a crucial factor in health, disease resistance, and many important body functions. When normal colon bacteria are present in sufficient quantities (which they may not be when other invaders are taking their place), they will actually produce many vitamins using the nutrient fuel provided them. Vitamin K and most of the B complex vitamins—niacin, B12, pantothenic acid, B6, biotin, and folic acid—are among these. Intestinal bacteria also aid final digestion of food, such as proteins and milk. With low colon bacteria counts, poor digestion, and an unhealthy intestinal lining, more food allergies may develop. A blood test measuring specific antibodies to many commonly allergenic foods may be indicated in some people with candidiasis, especially when there is a real problem with food intolerance. Frequently found reactions, indicated by greatly elevated IgG antibody levels, include reactions to both baker’s and brewer’s yeasts, wheat, milk, cheeses, mushrooms, and eggs. Many others are possible, but those are the ones I have found to be most common and most strong.
Three-Faceted Approach to Treatment of the Yeast Syndrome
Do not feed the yeasts foods upon which they thrive.
Reduce yeast growth through natural and pharmaceutical agents.
Reestablish normal intestinal ecology.
The overall approach to treating the yeast problem is threefold. The first facet is to refrain from feeding those "yeastie beasties" what they like to eat so they can thrive and divide. They live on mostly simple sugars and yeast and fermented foods. These include fruits, fruit juices, and dried fruits, sugary foods, refined flour products, alcoholic beverages, cheese, vinegar, breads, and other yeasted fermented food products, such as soy sauce. All these foods are avoided on the yeast diet.
What to eat? There are many recommended foods—fish, poultry, meat, lots of vegetables, some whole grains, nuts, seeds, and occasional eggs. (The antiyeast diet is more difficult for vegetarians, but definitely possible.) Some yogurt, especially acidophilus culture, is all right if milk is tolerated. Oils are obtained from some butter and more cold-pressed vegetable oils, such as olive, flaxseed, sesame, and sunflower. Legumes are often limited because they add to intestinal gas.
Basic meals include proteins and vegetables or, occasionally, starch and vegetables. For the first few weeks, the carbohydrates, including pastas and especially breads, are limited, with only some whole grain cereals being used. This lowers fiber intake, but usually other aspects of the treatment help colon function. The Ideal Diet discussed in Part Three, with certain modifications, will make a good Candida diet. The rotation is a good way to reduce food reactions. Initially, the diet includes no fruit, or only one piece a day, and none of the sweeter fruits, such as grapes, bananas, and melons. The starches are limited to one portion a day, and the meals are oriented toward proteins and vegetables.
This is a special therapeutic diet, and not necessarily a lifelong one, though many people like the way they feel on it. Intestinal symptoms decrease, energy improves, and itchy or irritated skin may start to heal with a decrease in sugar and yeasty foods. Also, some weight can be shed easily on this diet. This may be a problem for the already trim person, and lighter people need to emphasize regular eating to prevent weight loss.
After a few weeks, we can test ourselves with fruit, bread, other grain products, or cheese—of course, one food at a time, and only one daily—to see how we handle them. If they seem to cause no problems, we can then bring these foods into our diet on a rotating basis. Eventually, adding more whole grains and fiber will provide what I believe is a healthier diet. Different degrees of strictness with the diet may be necessary, depending on the severity of the problem. A more stringent diet might exclude all fruits; whole grains, particularly the glutinous ones—wheat, barley, and oats; herb teas and spices, which may contain molds; and many nuts, which can also carry molds.
Anti-Yeast Diet Plan
|Vegetables||Sugar - all forms|
|Beans & Pulses||Baked Goods|
|Whole Grains||Pickled Vegetables|
|Nuts & Seeds||Cheese|
|Fruit**||Refined Flours & Breads|
*Vegetarians will need to use more whole grains, beans, and nuts and seeds but this higher carbohydrate diet does not really curb yeast as well. Furthermore, vegetarians seem to be more prone to yeast overgrowth because their diet is more alkaline and sweet, which supports the yeast.
**Limited to two pieces daily.
The second facet of the treatment is to diminish the amount of yeast present. This is what Western medicine is so good at accomplishing. Nystatin powder is the most commonly used pharmaceutical for initial treatment of intestinal yeast. Nystatin itself is made from a culture of certain bacteria and it will actually kill yeast. It is not readily absorbed through the intestinal mucosa, so basically it just handles the gastrointestinal yeast. Since it is most often given as pure powder dissolved in water, it will also kill some of the yeast in the oral cavity when it is gargled. A solution can be used to wash the sinuses as well by dissolving nystatin in saline solution and using a dropper or inhaling the solution. For men with candidiasis and recurrent prostatitis or genital or skin symptoms of yeast, or for women with recurrent cystitis or other systemic symptoms, I may prescribe a stronger antifungal agent called ketoconizole, brand name Nizoral. This is effective for most yeast problems, but it can be irritating to the liver, so its use must be watched closely. For people who do not respond well to Nystatin or other natural remedies, Nizoral may be indicated. The usual dosage is one 200 mg. tablet daily for three to six weeks if it is well tolerated. A new Nizoral-related drug, fluconazole, or Diflucan, is now available and, though expensive, may be a slight improvement over Nizoral. Other "azole" drugs are available from many European countries and Canada. These include clotrimazole, miconazole, tinadazole, and econazole. They have similar systemic antifungal action (most are also mild amoebicides), are less expensive, and are also less toxic on the liver.
During yeast treatment, symptoms may arise secondary to killing the yeast. This occurs most with Nystatin, at times with the natural therapies, and only occasionally with the systemic medicines. The symptoms might include headache, fatigue, a mild flulike syndrome, or an exacerbation of already existing symptoms. It may be helpful during "die-off" periods to clear the colon every two or three days with a water enema or have a colonic irrigation every week or two for several treatments. Adding some Nystatin to the water to introduce it directly into the colon may help clear some more yeast.
Natural remedies that help to reduce yeast by killing it or by interfering with its growth include caprylic acid, fresh garlic and garlic extract, and the herb, pau d’arco, or taheebo. Caprylic acid is a natural fatty acid extracted from coconut oil. It interferes with the growing and duplicating process of the Candida albicans does not actually kill yeast, but it is effective in reducing intestinal yeast levels. It must be used for a fairly long period. I often prescribe the caprylates to follow a two to three month course of Nystatin and use a caprylic acid product such as Caprystatin or Capricin for a few months also. The length of treatment for yeast depends on the degree of the problem, the response to the treatment, and the results of tests.
Garlic has been shown to kill some yeast in sensitivity tests in the lab. It can be added to the treatment regimen and often helps. Two capsules several times daily is the usual dosage, though good garlic may have a blood-pressure-lowering effect at that amount, which may detrimentally affect some people. Goldenseal root also has some antifungal properties. Pau d’arco, a Brazilian tree bark, has become a very popular herb in the treatment of yeast, allergies, and other immune problems. It can be taken in capsules, or tea made from the bark can be drunk several times daily. It seems to tonify or strengthen the gastrointestinal tract and may help reduce yeast.
The third facet of the yeast treatment involves restoring the colon to its natural state, mainly by reimplanting lactobacillus bacteriae. Acidophilus primary products used. There are a couple of other bacteria that are also helpful in the gut and used in some formulae. Lactobacillus bifidus, a cousin to provide some colon support in the adult. Streptococcus faecium, a friendly form of strep bacteria, also adds a helpful function by replacing the once-present yeast.
A formula that contains all three of these bacteria is produced and marketed by Klaire Laboratories in Southern California. This high-quality, milk-free product called Vital-Plex can be taken as a supplement during the yeast treatment. Another product that has been well researched is DDS-1, produced by UAS Laboratories. It is available in powder, capsules, and tablets. Studies at the University of Nebraska and Michigan State University have shown acidophilus DDS-1 to have many positive effects, as described by Keith Sehnert, M.D., in "The Candidiasis Syndrome, Old Problem, New Mystery." This acidophilus in the colon can produce acidophilin, which has an antibiotic effect on a number of potentially pathogenic colon bacteria. It also has been shown to inhibit growth of Candida albicans yeast. This product, as do most effective acidophilus cultures, helps restore bacteria that produce many B vitamins, including B2, B3, B6, B12, folic acid, biotin, and pantothenic acid. DDS-1 has also been shown to produce enzymes that help in digestion of proteins and milk sugar (lactose), and through its effect on fat metabolism, it has a mild cholesterol-lowering potential. Other research has revealed that DDS-1 and other lactobacilli may have antiviral effects with some viruses (herpes is one example) and anticancer effects, especially in the colon. I have seen lactobacillus treatment reduce the severity and recurrence of cold sores, genital herpes outbreaks, and canker sores, which may be a result of its correcting chemical or acid-base imbalance. By replacing putrefying bacteria in the mouth, throat, and upper intestinal tract, it has been seen to resolve bad breath as well as many symptoms of gastrointestinal upset, helping people’s guts "feel more settled."
DDS-1 Lactobacillus acidophilus is discussed at such length here because it has been studied more extensively than others. However, there are other lactobacillus products that likely have similar effects, and these are being researched as well. Potency of the product is likely important. Many cultures now contain billions of live bacteria per dosage, rather than the few million that were once common. This should make them more effective, since the higher counts will allow a greater number of bacteria to actually reach the colon. Replacing the diminishing yeast with these physiologically active bacteria will help restore the colon’s normal functions. Yeasts in the colon use up nutrients, rather than making additional ones, and they ferment foods, often leading to gas, bloating, abdominal discomfort, and flatulence. Reimplanting the colon with friendly bacteria helps to reduce many of the intestinal and digestive symptoms of candidiasis.
There are a number of other supplements that can help in treating the yeast syndrome. Supplemental hydrochloric acid with meals followed by digestive enzymes after eating can often help us to better break down and utilize our protein, fats, and food in general to make available the amino acids, essential fatty acids, and mineral micronutrients we need for healing. And they help to relieve digestive symptoms and make it easier for us to obtain the energy from the food. Healing the intestinal wall is an important part of clearing the candidiasis symptoms and reducing food reactions. Flaxseed or evening primrose oil and certain herbs can help with this.
For nutrient supplementation, a general multiple is used as a base, with some additional antioxidants to help handle certain toxic by-products, avoid immune suppression, and improve immune function. Organic germanium may be used to aid in this immune support and to improve the gut mucosa. Vitamin A, beta-carotene, and vitamin C are useful in the regulation of the yeast and support of the immune function. Extra magnesium is also a part of the program. Less zinc is suggested than in other programs, at least initially, as it possibly stimulates the Candida growth. Extra B vitamins, including biotin, provide support by replacing some of those lost because of the diminished colon bacteria that produce them. Coenzyme Q10 has been shown to have positive effects in yeast treatment as well.
Some of the nutrient oils may be used in the treatment of the yeast problem. In addition to garlic oil and the caprylic acid formulas, essential fatty acids (EFA), fish oil (EPA), and evening primrose oil (EPO) may be helpful, along with vitamin E. A product I have used that incorporates all of these oils is Samolinic, made and distributed by the Key Company. I might suggest a product such as this or separate portions of some of these oils if there seem to be many inflammatory or allergic symptoms.
The type of herbal treatment suggested for the yeast condition depends mostly on the other, coexisting problems. If there are premenstrual symptoms, diuretic herbs or female tonifying herbs may help (see the Premenstrual Syndrome program later in this chapter). With intestinal symptoms or upset, soothing digestive herbs may be helpful. Peppermint or chamomile teas are beneficial; capsules containing slippery elm bark and comfrey root powder can help heal the intestinal lining. Goldenseal root powder in short courses (one or two weeks) strengthens the mucous membranes, but it also stimulates liver detoxification, which can cause an increase in symptoms. Pau d’arco is a tonic herb that is often used in yeast treatment. Thyme oil has also been claimed to reduce yeast growth, but I have no experience with that.
Evaluating and treating the yeast syndrome is a real challenge for both doctors and patients. It takes patience and can often require a very long therapy as the body uses its very sensitive biofeedback process to let us know what is working. Often, Nystatin or other antifungal products must be taken for years, but usually will produce, within a few months, a marked change in the symptoms and a reduction in colon yeast colonization and blood antibodies to the yeast. Many people experience a profound and positive change in their health with proper diagnosis and treatment of this condition. However, we must also be careful not to overtreat and turn this medical concern into nothing more than the latest "fad" of the 1980s, as the medical profession would like. Yeast awareness is here to stay, and doctors and patients must be even more careful in their use of antibiotics, birth control pills, and the immunesuppressive corticosteroids.
Yeast Syndrome Nutrient Program
Vitamin A 10,000 IUs Magnesium 400–800 mg.
Beta-carotene 15,000 IUs Manganese 5–10 mg.
Vitamin D 400 IUs Molybdenum 500 mcg.
Vitamin E 800 IUs Selenium 300 mcg.
Vitamin K 300 mcg. Zinc 15 mg.
Thiamine (B1) 50 mg.
Riboflavin (B2) 25–50 mg. Lactobacilli and other 4–10 billion
Niacinamide (B3) 100 mg. helpful microorganisms organisms
Pantothenic acid (B5) 500 mg. Caprylic acid 300–600 mg.
Pyridoxine (B6) 50 mg. Organic germanium 100 mg.
Pyridoxal-5-phosphate 50 mg. Coenzyme Q10 20–40 mg.
Cobalamin (B12) 50 mcg. Essential fatty acids* 4 capsules
Folic acid 800 mcg. Gamma-linolenic acid*
such as evening
primrose oil 4 capsules
Biotin 1,000 mcg. Hydrochloric acid
(with meals) 1–2 tablets
Vitamin C 3,000 mg. Digestive enzymes
(after meals) 2–3 tablets
Bioflavonoids 250 mg.
Calcium 600–1,000 mg. Goldenseal 2–3 capsules
Chromium 500 mcg. root powder (2–3 weeks)
Copper 2 mg. Pau d’arco 2–4 capsules
or 2 cups tea
Iodine 150–225 mcg.
Iron 10–18 mg. Garlic oil or garlic extract 4–6 capsules
Echinacea freeze dried 2–4 capsules
*Flaxseed oil, 2–4 teaspoons daily, can replace these two products.