Anti-candida therapy: back to the future?

Posted on Tue, 23 Sep 14

Dietary, nutritional and anti-fungal treatments for chronic candida infection have been employed clinically for over 40 years, and throughout this time have been a controversial practice, new research into the pathogenic role of candida, however, may warrant a resurrection of the yeast connection.

Chronic candida infection - also known as candidiasis, candida hypersensitivity syndrome, or candida related complex (CRC) – was first reported in 1978 when C. Orian Truss, MD described over a decades experience in treating a wide range of otherwise unexplained symptoms with anti-fungal medication (1). This work was then expanded by William G. Crook, MD who communicated with Dr. Truss after noticing improvement in a mutual patient, and then later popularized the treatment of CRC with a low-sugar diet and anti-fungal therapy in 1983 with the publication of his book; The Yeast Connection (2).

The CRC has since been a condition that has attracted considerable criticism by convectional academic medicine (3,4), yet many clinicians employing anti-candida dietary approaches and treatments including nutritional and herbal medicine have continued to report important clinical results (5-7). A problem with CRC is that much of the literature supporting its existence and response to therapy is now relatively old, and often overlooked or discredited as a consequence. However, new research may change that and call for a timely renaissance of anti-candida therapy.

Fungal invasion 

One of the most compelling areas for a pathogenic role of Candida that has emerged in just the last few years is related to inflammatory bowel disease and gastrointestinal inflammation. Although Candida species are considered a dominant fungal commensal in the human gut, healthy individuals tend to harbor very low levels of Candida in their colon (8). But in people with inflammatory bowel disease, there may be an overgrowth of Candida that is bi-directionally related to inflammation in the gut mucosa.

Because Candida levels in feces are different from those the living along the gut mucosa, investigating the presence of Candida is difficult. But a very recent study comparing surgically obtained ileal mucosal specimens from people with Crohn’s disease to healthy subjects produced some remarkable insights (9). Laser scanning microscopy clearly showed a rich and diverse elevation of fungus, in particular Candida species, in the inflamed mucosa. Further, the mucosal fungal community was associated with the local expression of inflammatory mediators (TNF-α, IFN-γ, or IL-10), and positively correlated with serum C-reactive protein and clinical disease activity.

In addition to Crohn’s disease, relatively high levels Candida colonization have been found in people with ulcerative colitis and gastric ulcers, and in these cases the level of Candida has been linked to disease severity and treatment response, and, in ulcerative colitis treatment with anti-fungal medication has been shown to reduce disease activity and improve the structure of the gut mucosa (10). Collectively, it appears that Candida plays an important role in the maintenance of gastrointestinal inflammation and associated disease; further, localized inflammation due to Candida overgrowth in the gastrointestinal system can cause systemic inflammation and may also be linked to extra-intestinal autoimmune and allergic inflammatory disease (11).

Mind-altering microbes

Although it may still sound like science fiction, it is a relatively well-established scientific fact that your gut bacteria can influence your mood and behavior through a variety of neural, endocrine and immune pathways and may be linked to a wide range of complex nervous system disorders (12). This new understanding is, in a sense, a case of back-to-the-future, because the early pioneers of the CRC hypothesis were often treating unexplainable symptoms otherwise described as multiple sclerosis, schizophrenia, chronic fatigue, cognitive and memory impairment, depression and migraine headaches (13).

Recently Rucklidge published a fascinating report describing recovery of attention-deficit/hyperactivity disorder (ADHD) and depressive symptoms with an anti-candida protocol. Rucklidge has been pioneering research into the treatment of psychiatric illness with micronutrients (14), then while doing the clinical work she observed that Candida infection appeared to reduce response to nutritional therapy and subsequently published a case review and commentary on this issue (15).

Kate (an alias) was being treated for significant ADHD and moderate depression with nutritional therapy and was responding very well to long-term treatment until she began reporting that she was feeling increasingly unwell, experiencing a chronic sore throat, a constant runny nose, cramps, itchy toes, anus, and vagina, rashes on her legs and groin area; and an overall flu-like feeling. All her psychiatric symptoms had returned, and she was moody, anhedonic, chronically irritable and was having cravings for sugary and starchy foods. Kate sought advice from her GP and was diagnosed with a vaginal yeast infection and prescribed an antifungal cream, but it did not change her symptoms.

Subsequently Kate was advised to follow an anti-candida protocol of olive leaf extract (four capsules providing a total of 2000 mg daily) and a multi-strain probiotic (two capsules daily in the evening) along with dietary changes. After 1.5-weeks she reported improved mood and energy levels, elimination of her runny nose, cessation of the chronic itching of both her anus and vagina, and disappearance of her rash. After 2-months, her psychiatric symptoms had improved to a level equivalent to before the Candida infection. Thus, anti-candida therapy appeared to be well tolerated, and very effective.

Anti-Candida therapy

The identification of candida in a clinical setting is mostly based on clinical observation, as available diagnostic tests may lack accuracy (7). Typical symptoms, along with a history of vaginal yeast infections or oral thrush, antibiotic prescriptions and glucocorticoid use may indicate need for treatment. A 7-item “fungal related disease questionnaire” (FRDQ-7) is sometimes used to identify patients who might benefit anti-fungal treatment and dietary changes (below) (16).

Fungus Related Disease Questionnaire-7 (FRDQ-7)

Score: 0 = none, 1 = occasional or mild, 2 = frequent or moderately severe, 3 = severe or disabling

1.   Have you, at any time in your life, taken broad spectrum antibiotics?                

2.   Have you taken tetracycline or other broad spectrum antibiotics for
      one month or longer?                                                                                  

3.   Are your symptoms worse on damp, muggy days or in mouldy places?               

4.   Do you crave sugar?                                                                                    

5.   Do you have a feeling of being "drained?”                                               

6.   WOMEN:  Are you bothered with vaginal burning, itching or discharge?    

      MEN:  Do you have burning, itching or discharge from the penis?            

7.   Are you bothered by burning, itching or tearing of your eyes?                  

Result: 0-3 = FRD unlikely, Score  4-9 =  FRD probable, Score 10-21 =  FRD almost certain.

Anti-candida treatment is personalized by a nutritional therapist familiar with CRC, but typically involves identification and elimination of food sensitivities, restriction of refined sugars, nutritional supplementation that supports the immune system, natural or pharmaceutical anti-fungal treatments and/ or probiotics (7). While more research is needed, a long legacy of clinical experience along with the relative safety, and additional benefits, of improving peoples diets, nutritional status, and gut bacteria is an immediately practical approach to suspected CRC and deserves a modern revival.

This article first featured in CAM Magazine, August 2014.

References:

1. Truss CO. Tissue injury induced by Candida albicans, mental and neurological manifestations. J Orthomol Psychiatry 1978;7:17–37.
2. Crook WG. The Yeast Connection. Jackson, TN: Professional Books; 1983.
3. Dismukes WE, Wade JS, Lee JY, Dockery BK, Hain JD. A randomized, double-blind  trial of nystatin therapy for the candidiasis hypersensitivity syndrome. N Engl J Med. 1990 Dec 20;323(25):1717-23.
4. Lacour M, Zunder T, Huber R, Sander A, Daschner F, Frank U. The pathogenetic significance of intestinal Candida colonization--a systematic review from an interdisciplinary and environmental medical point of view. Int J Hyg Environ Health. 2002 May;205(4):257-68.
5. Crook WG. A controlled trial of nystatin for the candidiasis hypersensitivity syndrome.  N Engl J Med. 1991 May 30;324(22):1592-4.
6. Crandall M. The pathogenetic significance of intestinal Candida colonization.  Int J Hyg Environ Health. 2004 Jan;207(1):79-81.
7. Gaby, AR. Candidiasis. In, Nutritional Medicine. Fritz Pelberg Publishing. Concord, NH. 2011.
8. Scanlan PD, Marchesi JR. Micro-eukaryotic diversity of the human distal gut microbiota: qualitative assessment using culture-dependent and -independent analysis of faeces. ISME J. 2008;2(12):1183–1193.
9. Li Q, Wang C, Tang C, He Q, Li N, Li J. Dysbiosis of Gut Fungal Microbiota is  Associated With Mucosal Inflammation in Crohn's Disease. J Clin Gastroenterol. 2014 Jul;48(6):513-23.
10. Kumamoto CA. Inflammation and gastrointestinal Candida colonization. Curr Opin Microbiol. 2011 Aug;14(4):386-91.
11. Sonoyama K, Miki A, Sugita R, Goto H, Nakata M, Yamaguchi N. Gut colonization  by Candida albicans aggravates inflammation in the gut and extra-gut tissues in mice. Med Mycol. 2011 Apr;49(3):237-47.
12. Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nat Rev Neurosci. 2012 Oct;13(10):701-12.
13. Truss CO. The Role of Candida Albicans in Human Illness. J Orthomol Psychiatry 1981;10 (4): 228-238.
14. Rucklidge JJ, Kaplan BJ. Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: a systematic review. Expert Rev Neurother. 2013 Jan;13(1):49-73.
15. Rucklidge JJ. Could yeast infections impair recovery from mental illness? A case study using micronutrients and olive leaf extract for the treatment of ADHD  and depression. Adv Mind Body Med. 2013 Summer;27(3):14-8.
16. Santelmann H, Laerum E, Roennevig J, Fagertun HE. Effectiveness of nystatin in polysymptomatic patients. A randomized, double-blind trial with nystatin versus placebo in general practice. Fam Pract. 2001 Jun;18(3):258-65.