New research to be published in the April issue of the Journal of Human Nutrition and Dietetics relating to dietary intervention in Chronic Fatigue Syndrome had me very frustrated this week. The research was supposedly an attempt to determine if an anti-Candida diet is beneficial in those with Chronic Fatigue Syndrome.

The researchers note that Candida has been linked to CFS in many books and anecdotal reports but little scientific evidence exists for such a link. I couldn't agree more, good quality research that really gets to the bottom of this issue is required, unfortunately the research in question here does nothing to further scientific knowledge and to my mind is of very little value.

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The researchers randomly assigned 52 CFS patients to either an anti-Candida diet or a general 'healthy eating' diet. The patients were required to adhere to the diets for 24 weeks and had to complete questionnaires before and after this period in which they rated their level of fatigue and overall quality of life. The researchers found that the anti-Candida diet was no more effective than the healthy eating diet and was harder to adhere to. They conclude that it is best to recommend general healthy eating to CFS patients.

There are many difficiencies in this research. The only measures of success were the patients own perceptions of benefit. To base medical research solely on subjective views makes it very unscientific. Do the researchers believe that if cancer patients undergoing chemotherapy were to rate their level of fatigue and quality of life over a 24 week period that they would indicate the treatment was doing them good? I don't think so, they would feel terrible. If these scores were to be compared with cancer patients eating a healthy diet for 24 weeks it would seem that the diet might be more effective as patients would no doubt feel better. In this case however there would be a host of other data from scans and blood tests indicating that chemotherapy was likely the most effective treatment. As with this example, it is possible that an anti-Candida diet may actually make patients feel worse before they feel better (Herxheimer reaction as excess Candida dies off). It may be that the diet did reduce the level of Candida growth in the patients but that this wasn't evident as less fatigue and improved quality of life after only 24 weeks. This research doesn't account for this and tells us nothing about what is going on in patients' bodies.

What we need is REAL research looking at the link between Candida and CFS. An overgrowth of Candida would undoubtedly leave a number of markers in the body that could provide evidence of its existence. Integrative medical doctors use a range of lab tests to identify these and determine if a patient has a Candida/yeast problem. Levels of Candida can be measured in stool samples to give a direct measurement of numbers present in the gut. Candida produces ethanol and acetaldehyde, toxic products of fermentation, which can be measured in the blood after a meal, particularly a high carbohydrate meal. Other markers of yeast metabolism can me identified in the urine. Finally, the blood can be tested for antibodies against Candida which indicate that the immune system has detected an infection and is trying to fight it off. In addition it is possible to test how permeable the intestinal wall is which can indicate the presence of malabsorption or 'leaky gut syndrome'. If there is an overgrowth of Candida in the intestines it is only logical that there will be damage to the intestinal lining both through the presence of the organism itself and exposure to its waste products which are known to produce a leaky gut.

What is needed is research involving a large number of CFS patients (certainly in the hundreds) which uses a combination of these tests along with symptoms to determine if Candida could be a problem for a large number of patients. There has been no such research to date so the issue has remained completely unresolved and a potential target for treatment is dismissed by doctors except for a select few with a special interest in CFS and gut issues.

Any research in this area has been small scale and has only hinted at a link. For example, just recently the case of a 13 year old girl with CFS was published in Neuro Endocrinology Letters. The girl was found to have a 'leaky gut' and after appropriate treatment her CFS symptoms completely resolved. This kind of research is not taken seriously and no attempts have been made to initiate large scale studies to investigate further. You would think when a report like this appears that researchers would want to investigate further but it doesn't happen. Perhaps this is because funding for research into CFS is woefully inadequate to begin with and the more mainstream ideas get funding first.

Another point of contention is that many in the medical profession don't regard any of the tests mentioned above as being reliable. It may be the case that they are not 100% accurate but what test is? I find it strange that these tests appear to be dismissed out of hand if someone mentions Candida being involved in CFS and other unexplained illnesses. If you search the published research in a database such as PubMed it quickly becomes apparent that many of these tests are routinely used in medical research! Just recently a study found that the ELISA IgG test, which is often used to diagnose a Candida problems by integrative medicine doctors and other practitioners, is an accurate indicator of systemic Candida in the immunocompromised. The study found it has comparable accuracy to conventional testing methods. If the ELISA antibody test is reliable in this situation surely it may be of value in less acute Candida infections such as those proposed to play a role in CFS. The lactulose/mannitol test which is used to detect leaky gut syndrome is also commonly used by researchers looking at gut function and how it relates to other diseases. For example leaky gut has been found to be present in liver disease and arthritis.

Even if some of these tests can't prove a connection between Candida and CFS by themselves; surely if a study tested hundreds of CFS patients using ALL of the tests I've mentioned and a pattern emerged suggesting a link, this would make people sit up and take notice. Perhaps more accurate diagnostic techniques could then be developed.

I find it very difficult to understand why the majority of the medical profession find it so hard to believe that CFS patients could be susceptible to an overgrowth of Candida and other yeast in the gastrointestinal tract. It is well recognised that immune function in CFS patients is impaired. It is also a fact that a large part of the immune system is concentrated in the gut since it is a major gateway (along with the lungs) by which pathogens could gain entry to the body. If immune function in CFS is impaired then surely immune function in the gut is impaired giving potential pathogens like Candida the chance to get out of hand. More Candida means more toxic waste products which can interfere with the persons health further. This seems like an entirely plausible chain of events to me but apparently is not to the medical profession.

I sincerely hope that this important issue will stop being ignored and will be properly investigated sooner rather than later.