by Dr. Mark J. Pellegrino, MD
Excerpted from the book, Fibromyalgia: Up Close and Personal
Causes, Symptoms, Testing, Natural Treatments and Probiotic Strategies, Anti-Yeast/Weight Loss Diet, and Trigger Avoidance
What would you say if I told you we had millions of Dr. Jekyll's living in our bodies, each waiting for the opportune time to turn into Mr. Hyde?
We all have little round whitish organisms in our body known as Candida albicans that can lose their innocence and become rather vicious creatures that attack our bodies.
Candida albicans is fungus or yeast that normally thrives in the mouth, gastrointestinal tract, vagina, and skin. In healthy individuals this yeast is helpful in digestion and vitamin production, and it is harmless because it is kept in check by beneficial bacteria and other yeast such as Lactobacillus acidophilus that occupies the same space.
When the balance of intestinal bacteria and yeast is altered, or your immune system becomes compromised, the Candida can overgrow, transforming from a benign yeast into an aggressive fungus that releases numerous toxins and can cause many symptoms. When fungal growth exceeds the bodys ability to control it, the friendly Candida becomes unfriendly and cause a yeast infection.
Causes of Candida
Various causes of Candidiasis (Candida infection) include:
- Chronic illnesses or stress. For example, diabetic patients, hospitalized patients, and cancer patients all have low resistance to infection.
- Antibiotic use. This destroys normal bacteria and Lactobacillus acidophilus, but spares the Candida.
- Birth control pills. The estrogen favors Candida multiplication.
- Cortisone medicine
- Immunosuppressive drugs
- Pregnancy. Hormonal changes favor increased Candida growth.
- Diets high in sugar and carbohydrates. Candida loves glucose!
- Thyroid medicine. Increases Candida risk.
- Warm moist areas. Tight nylons, wet diapers, people who work as dish washers; all this can lead to Candida dermatitis.
- Alcohol. Another food for the Candida.
Those with Fibromyalgia often have multiple risk factors, particularly the altered immune system, the chronic stress, and the carbohydrate sensitivity. Throw in the woman... who is on birth control pills, thyroid medicine, and recently took a course of antibiotics for bronchitis, and you have a recipe for Candisaster!
When Candida albicans transforms into an invasive fungal state, it produces rhizoids which are long root-like structures. Rhizoids can penetrate the intestinal walls and leave microscopic holes that allow toxins, undigested food particles, bacteria and yeast to enter the blood stream. This invasion leads to many symptoms.
- Irritable bowel syndrome (IBS)
- Chronic heartburn
- Oral thrush (white spots on the mouth and tongue)
- Vaginal yeast infection
- Skin rashes
- Skin itching
- Vulvar pain and itching
- Rectal itching
- Food cravings (especially carbohydrates)
- Malnutition (poor nutrient absorption)
- Food allergies
- Bad breath
As you can see there is much overlap of Candidiasis symptoms with Fibromyalgia symptoms. These two conditions feed into each other where the Fibromyalgia makes one have more problems with the Candidiasis and the Candidiasis causes symptoms that can aggravate the Fibromyalgia.
If I suspect Candidiasis, I will treat it separately from the Fibromyalgia because this often leads to much improvement of Fibromyalgia symptoms as well as correcting the Candida Problem.
Testing for Candida
A simple home test for Candidiasis can be performed. Dr. Kelly Hannigan described a test you can take (Health Points 8 (2) 2003). Before you go to sleep at night set a clear glass of water next to your bed. When you wake up in the morning (before you clear your throat, swallow or speak), deposit your saliva into the glass of water. If within 30 minutes your saliva sinks to the bottom or there are strands of saliva running down into the water or the water turns cloudy, you probably have an abundance of yeast in your body.
Lab testing can be done for a definitive diagnosis of Candidiasis. Saliva, stool and blood samples can all be tested to look for specific immunoglobulin antibodies against Candida. These tests are not routinely covered by insurance companies so the patient has to pay for these tests, which are usually several hundred dollars.
Since intestinal Candidiasis is so common and easily identified with careful history of symptoms, and since treatments are low-risk and well-tolerated, I will usually treat Candidiasis based on the clinical exam (history and physical) and not always order a specific yeast test.
The strategies for treating Candidiasis are focused on rebalancing the intestinal bacteria and yeast. Candida that has overgrown needs to be killed and suppressed. The good yeast and bacterial needs to be replenished, and the gastrointestinal tract needs to be rebalanced. Here are some strategies used to rebalance the intestinal tract.
Antiyeast Products: Prescribed Medicines
Prescribed medicines to treat Candida include Nystatin (mycostatin) and Fluconazole (Diflucan). Nystatin is available in tablet and liquid form. The liquid form is used to treat oral thrush (swish and swallow). The tablet forms are used for intestinal Candidiasis and they are usually well tolerated, although some people have some nausea or diarrhea with them. Patients may need to be on this medicine for several months and some of them need to be on maintenance dose for long-term Candida management. Nystatin kills off Candida, but does not harm the Lactobacillus or bacteria.
Fluconazole is another antifungal medicine that is given to treat Candidiasis. Sometimes one tablet or two tablets only are used to treat a vaginal yeast infection. However, a vaginal yeast infection or recurring vaginal yeast infections in women are a sign of more widespread Candidiasis; the vaginal yeast infection is actually the tip of the iceberg. In treating intestinal or more widespread Candidiasis, Diflucan may need to be used for weeks instead of days.
Antiyeast Products: Natural Treatments
Natural antiyeast treatments include herbal products such as enteric coated oregano extract and olive leaf extract (Oleuropein).
Olive leaf extract has the ability to attack Candida and other potential harmful microorganisms while sparing the helpful ones. To treat Candida, two capsules every eight hours on an empty stomach are recommended. Olive leaf extract can be used in conjunction with the prescribed antibiotic, or can be used as a first line anti-Candida treatment.
Herxheimers reaction can occur when the Candida die off. [This reaction typically involves flu-like symptoms and results when infective agents are killed/toxins are released faster than the kidneys and liver can remove them via the natural detoxification process.] A sudden die-off of Candida can release a lot of toxins and the result may be aggravation of symptoms. Whereas this is not necessarily a bad thing, this type of reaction can cause significant discomfort, so we usually back off on the medicine to a lower dose to avoid a rapid die-off and to allow a slower and steadier die-off of Candida.
To minimize Herxheimers reaction when taking Nystatin I have patients start with one Nystatin tablet on the first day and then increase by one tablet a day until the desired dose of six tablets a day is being taken. A slow die-off of the Candida is preferred as it allows the gastrointestinal tract to better rebalance and not create sudden changes that a rapid die-off can cause. Plus a slower die-off allows the friendly yeast and bacteria to gradually fill the spaces and help rebuild the intestines.
Friendly Replenishers (Probiotics & Prebiotics)
Lactobacillus acidophilus and the good bacteria are called probiotics. These friendly yeast and bacteria help with digestion and vitamin production, and when Candida has died off, these friendly probiotics are necessary to help rebuild the gastrointestinal flora by filling the spaces where Candida used to be and restoring proper balance.
An acidophilus supplement is recommended to help replenish the flora. Fructooligosaccharides (FOS) are the food source for healthy bacteria. Any good nutrient (FOS) for the probiotics (acidophilus and other friendly bacteria) is called prebiotic. I like to use a prebiotic and probiotic blend that helps counteract Candida buildup and maintain healthy intestinal flora. Acidophilus supplements have done an excellent job of treating irritable bowel syndrome, which reinforces the theory that a lot of irritable bowel flare-up can be related to Candidiasis. I usually have patient continue the acidophilus on an ongoing basis, especially when fibromyalgia increases their risk of Candidiasis.
The Candida thrive on high sugar concentrations, so a basic diet strategy is cutting back the number of carbs. Fermented foods such as soy sauce, vinegar, pickles, cheese and yogurt have high sugar concentrations that feed yeast so these should be avoided. The Fibromyalgia Diet that I described in Chapter 17 is also a good antiyeast diet.
In addition to watching the carbohydrates, you should make sure to get enough fiber in your diet because that will help eliminate toxins and unwanted yeast in the bowel. Many people can learn to control Candida yeast overgrowth simply by modifying the diet. Often a combination of yeast antibiotic and friendly replenishers is also necessary along with dietary changes.
Avoid Aggravating Strategies
If possible, avoid drugs, chemicals and foods that can trigger the Candida and its symptoms. Since alcohol can aggravate Candida, it should be avoided or used in moderation. Obviously it is not practical to stop thyroid medicine, hormone medicines or other necessary prescribed medicines.
Likewise, if you develop a bacterial infection, you may require an antibiotic. If you must take an antibiotic for a bacterial infection, you might want to also take Nystatin or a natural yeast antibiotic to counteract the potential for Candida overgrowth while on the antibiotic. Any prescription medication that you have identified as a cause of Candidiasis should be reviewed with your doctor to see if it can be reduced or changed.
If you have Candidiasis, you can successfully transform the Candida back to Dr. Jekyll where he can live peacefully in the normal flora neighborhood...
Dr. Pellegrino has seen more than 20,000 FM patients in his practice at the Ohio Rehab Center, and has been a fibromyalgia patient himself since childhood.
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