Dr. Sarah Myhill MB BS
Yeast (the fungus Candida albicans) is a normal resident of the gut, but when the internal ecosystem gets out of balance it causes trouble. And chances are, candidas troublemaking potential is much greater than you thought.
This term "candida" encompasses several processes, not all of which all candida sufferers have problems with. Different people get well at different levels. The idea is to tailor one's regimen so that the least input gets the best results.
Some people will get rid of their yeast/candida problems simply by doing a low sugar diet; others have to be much stricter with their diet and take drug or herbal antifungals, maybe desensitization, and maybe environment controls as well.
Yeast problems are a problem of Western lifestyles! They are triggered by: high carbohydrate diets, antibiotics (which kill the good gut bugs and allow yeast to flourish), the Pill or hormone replacement therapy / HRT (immunosuppressive), and more. It is often a combination of these factors.
Candida is also part of the fermenting gut [a factor in excess hydrogen sulfide production that Dr. De Meirleir & Dr. Myhill propose inhibits mitochondrial function and may underlie the fatigue in ME/CFS.] See Fermentation in the Gut and CFS.
The Underlying Problems
1. Yeast Overgrowth in the Gut
Gut flora contains 1% yeast, so some yeasts are normally present in the gut. Problems seem to arise either when they flourish in the wrong place (i.e., the upper gut - which should be sterilized by stomach acid) or there is a general overgrowth of them.
Wherever numbers build up one starts to ferment foods instead of digesting them. Fermentation causes symptoms of bloating and bubbling in the gut - sometimes this is very obvious.
If fermentation occurs within minutes of eating, it is occurring in the stomach.
2. Alcohol Production
Yeasts ferment sugars to alcohol, and this causes problems in its own right. The main one is that it tends to lower the blood sugar, thereby destabilizing blood sugar levels and making the sufferer crave sugars.
This is a very clever evolutionary ploy that yeasts have stumbled upon to make their host eat the very foods that the yeast wants! So sufferers often crave carbohydrates and sugars, but the more they eat, the worse they become.
3. Allergy to Yeast
If the levels of yeast build up in the gut, then they can switch the immune system on so that one gets allergy reactions against the yeast.
- This can cause low grade inflammation of the gut.
- Low grade inflammation will result in leaky gut.
- Leaky upper gut causes hypochlorhydria [lack of stomach acid] and all the problems that go with that.
4. Leaky Gut
An overgrowth of the yeast in the gut can cause leaky gut. What this means in practice is that large antigenically interesting [antibody stimulating] molecules get from the gut into the bloodstream where they should not be.
- This may elicit an immune response, which could switch on an allergy to that substance (food allergy),
- Or worse, an antibody could be formed which cross reacts with self and switches on autoimmunity.
5. Irritable or Allergic Bladder
Yeast cells are tiny compared to human cells and where there is leaky gut they can leak out into the bloodstream to cause allergy reactions. Eventually these yeast cells spill over into the kidneys and the urine and can be a major cause of Irritable Bladder Syndrome or Allergic Bladder.
6. More Systemic Problems
Yeast problems which become more systemic may result in yeast infections such as thrush (yeast overgrowth in the mouth), nail infections, tinea corporis (a skin infection that may form ring-like lesions, hence the name ringworm), Athlete's foot, and so on.
7. Cross Sensitivity to Environmental Molds & Yeasts
If one switches on yeast sensitivity in the gut, this can cause cross sensitivity to molds and yeasts in the environment.
This may explain why some people do not feel so well on damp days and feel very much better in hot, dry or cold, dry climates. They have become allergic to environmental molds.
Treatment Approaches - In Order of Importance
Getting Rid of Yeast in the Mouth
It is quite common for people with recurrent candida / yeast allergy problems to suffer oral thrush. Typically this presents with a white furry tongue and if the fur is scraped off, little red spots are seen underneath. Not everybody has this classic presentation!
Yeast thrives on sugars present in food, or indeed starches which are broken down by the enzyme amylase within the mouth.
After any food is consumed, the first step is to brush the teeth and tongue with a soft toothbrush to try to physically dislodge any yeast, then take a capsule of magnesium ascorbate 500mg (this is the neutral form of vitamin C - don't use the acidic form or it will dissolve the enamel of your teeth), and allow this to dissolve in the mouth and hold there for as long as possible. Swill it round the mouth, wash it through the teeth and swallow in dribs and drabs. This will help to kill any yeast in the mouth, and indeed, kill any dental plaque.
Another treatment which is as good is hydrogen peroxide mouthwash ... - again gargle with this and swill around the mouth after food.
This two-pronged approach usually sorts out all the thrush. However, it is prone to recur .
The Next Single Most Important Intervention is a Low GI (Glycemic Index) Diet
Yeasts are relatively primitive organisms and can only exist on sugar. So reducing sugar in the diet and carbohydrates (which are digested in the gut into sugars) will starve out the yeast. See Stone Age Diet [heavy on vegetables, seeds and nuts, meat, fish and eggs] and Hypoglycemia - the Full Story.
Correct Nutritional Imbalances
Studies done on patients with longstanding yeast problems almost invariably show nutritional deficiencies. Therefore sufferers should take my standard regime of Nutritional Supplements [including a multivitamin, a multimineral, vitamin C, vitamin B-12, vitamin D, fish oil (omega-3)].
Yeast Free Diet
Some people who have candida problems sensitize to yeast, and this also needs to be cut out from the diet.
Correct Hypochlorhydria Lack of Stomach Acid
Probiotics physically displace yeasts from the gut. One can only hope to get results from live, actively fermenting cultures taken in adequate doses. See Probiotics. (The gut flora is extremely stable and difficult to change. Therefore if one is going to take probiotics, they have to be taken long term.)
A diet rich in vegetables will be high in prebiotics, which is the food for probiotics. [Prebiotics tend to be plentiful in foods containing fiber that isnt digested by humans like berries, greens, and beans. And in breast milk, which helps bacteria picked up from the birth canal to flourish.]
If antibiotics are necessary for other reasons, make sure high doses of probiotics are taken. Some people also need antifungal cover such as fluconazole.
For those people who are mold sensitive, they need to reduce the population of mold and their antigens in the house as much as reasonably possible. Molds and yeasts can only survive when the humidity is above 40%, which for people living in a British climate is most of the time.
[In the UK,] Healthy House Ltd. does excellent air filtration devices for eliminating molds and I thoroughly recommend one of those. Some people also need dehumidifiers to dry out their house to prevent mold growing on walls or floors. Keep your house as dry and internally well ventilated as is reasonably possible.
If you feel better on a holiday in a hot dry climate, or a cold dry climate (e.g., mountain above 3,000 feet) then you are likely to be mold sensitive.
Enzyme Potentiated Desensitization (EPD)
Some people with yeast problems become so sensitive to them and have such difficulty avoiding them that desensitization is essential. I usually start off with Enzyme Potentiated Desensitization (EPD) because that is what I do and it is fairly straightforward. [Uses extremely small doses of allergens to desensitize. In the US, a version of EPD (Low Dose Allergens, or LDA) is used that adds a number of 'uniquely American' antigens such as sage.]
However, people who do not switch off their mold sensitivities with EPD/LDA may well benefit from neutralization [a widely used type of immunotherapy for food allergies]. This is often helpful because it can also diagnose the mold allergy as well as treat it.
- Mycopril. This is a fatty acid derived from coconut and comes in 250mg, 400mgs and 680mg capsules. Start with the 400mgs one daily and build up to one capsule three times daily. If tolerated go to 680mgs three times daily.
- Biocidin (75mgs) and Biocidin Forte (150mgs). This is a grapefruit seed extract, not absorbed systemically, anti-fungal (broad range), antibacterial (broad range including campylobacter jejuni and helicobacter pylori). Biocidin also kills the "good" bugs such as lactobacillus acidophilus and therefore probiotics (Bio-acidophilus or Replete) should be taken after a course.
- Eradicin Forte. Contains artemesia annua 300mgs, biocidin 75mgs, berberis 100mgs. Artemesia (a chinese herb) is recommended by the WHO for the treatment of chloroquine resistant malaria. It is effective against giardia, amoebiasis and blastocystis hominis. Berberis (used by the Chinese for 3,000 years) is active against many bacteria, fungi, protozoa, blastocystis, worms and viruses. This may have some systemic activity.
- Garlicin. 400mgs freeze dried, low odor garlic: use with above preparations to enhance their effect. Absorbed systemically.
- Oregano complex. (Used to be called candicidin.) A new preparation, broad spectrum, systemic effects. Contains oils of oregano, clove, artemesia, ginger, borage seed and lauric acid. NOT TO BE USED IN PREGNANCY. The usual dose is one capsule twice daily.
- Candistatin. Pau D'Arco, garlic, berberis, hydrastis canadensis, silymarin plus some enzymes.
- Fructo-oligosaccharides (FOS). This is a natural food which tastes sweet (like candy floss) but is not a sugar that yeasts can ferment. This is a soluble fiber, is not absorbed but passes into the large bowel, where the "good" bugs ferment it. FOS is mildly laxative, initially causes wind, feeds up the "good" bugs and thereby displaces the "bad" bugs. It can be used to sweeten foods for patients on an "anti-candida" diet.
I often prescribe a month of a systemic antifungal such as fluconazole, ketoconazole or Itraconazole (IMPORTANT - NONE OF THESE DRUGS CAN BE USED IN PREGNANCY) because these are very good at killing yeasts and also they are systemic - that is to say if there is a nidus [breeding place] of yeast infection outside the gut they should be able to eradicate it. The problem with these systemic antifungals is that they cannot be used for more than a month without checking liver function tests, so I often switch over to the gut-only antifungals such as nystatin - I use up to 8 million units a day.
A new useful antifungal is Lufenuron.
When one starts to kill off yeast, sometimes one can get what is called a Herxheimer reaction in which all one's yeast symptoms are initially flared.
This is thought to be due to an allergy reaction to the dying yeast cells. The problem is that it can be very difficult to distinguish Herxheimer reactions from adverse reactions to the drugs.
The latter is unusual, so if one does feel ill on starting these treatments I try to encourage people to keep going with them and hope that the "die off" will clear in a week. Again, die off reactions can be confused with symptoms of hypoglycemia because obviously people also need to change their diets.
Duration of Treatment
Practical experience suggests that treatment has to be long term.
The single most important therapeutic intervention is diet. Physicians are used to treating infections with short courses of antimicrobials but if the same principles are applied to positive fermenters, poor results should be expected.
Antifungals are usually given for not less than six months and often up to eighteen months, until a good diet has been established. However, often patients need an extra course if they have lapsed on the diet (everyone does - welcome to the human race!).
Individual people have to work out how well they have to stick to their regimens to control the problem!