Candida is one of those controversial topics in medicine. On the one hand, you have got the conventional medicine perspective, which holds that candida only causes problems in severely immunocompromised people like patients with HIV/AIDS. On the other hand, you have got some practitioners in the alternative medicine world that blame candida for everything and claim you can diagnose it accurately by merely spitting into a glass.
In this article, we will discuss the overdiagnosis of candida for non-specific symptoms, small intestinal fungal overgrowth and testing treating for fungal overgrowth.
Meet Frank from Barrhaven
This article was inspired by an email sent to me through my blog website at DominickHussey.ca.
"Hi, Dominick. I am a 40-year-old male living in Barrhaven Ottawa suffering from what I suppose to be as a candida. I’ve been feeling symptoms for at least a year and a half now, but I have noticed some signs which could be related to candida. My symptoms include jock itch, severe fatigue, poor concentration, and severe sweets craving.
My diet is usually healthy, but I have been doing a lot of travelling with work and so have been reliant on fast food and restaurants. I have also been snacking on candy bars.
I think my diet is contributing to the way I am feeling now. In the last few weeks, my symptoms have been overbearing where some days I can barely walk or even function.
Other symptoms I forgot to mention, include constipation and gas.
I have been to see my family doctor for a fungal infection, and she gave me antibiotics.
I took the antibiotics and vomited, so I stopped taking them.
So I do not know what to do, and I wondered if you could help me. I appreciate it. Kind regards Frank."
What is Candida?
As I explained above Frank's question is somewhat controversial and complicated. Despite that let us start with the basics.
Candida is a species of yeast that is the most common cause of fungal infections worldwide.
The best-known sub-species of Candida is Candida albicans. Candida Albicans is a typical inhabitant of the gut. Problems arise when it becomes overgrown and can lead to systemic infections of the bloodstream and major organs, which we refer to as Candidiasis.
Candidiasis is common in immunocompromised patients. Candidiasis is well established and accepted in conventional medicine. However, the idea that that candida can cause a problem in people, such as Frank, without severe immune dysregulation like HIV and AIDS is controversial.
Overdiagnosis of Candida
The conventional medical establishment’s perspective is that, like Frank, we all have candida in the digestive tract and it only becomes a problem in people with severe immune dysfunction.
On the other hand, a subset of the alternative practitioners blame candida for everything and suggests that you do not need anything more than a list of symptoms to diagnose candida infection.
Back in the 1990's, candida was a label given to any collection of signs and symptoms that had no proper medical diagnosis.
Twenty years later although this trend is less, we still have articles on popular websites that continue to promote the idea of candida. These sites have headlines like,
“Five warning you may have a candida problem.”
The article may begin with the question,
“Do you ever encounter any of these health issues?
Fatigue, sweet cravings, bad breath, a white coated tongue, brain fog, joint pain, low libido, chronic sinus issues, gas, bloating, frequent colds, or urinary tract infections.”
Following this question may be the statement,
“If so, these are some of the signs that you might have candida.”
The issue with this, of course, is that it is not scientific.
The above list of symptoms is very nonspecific, which means we cannot attribute it to only one problem.
If Frank was reading the above article, he might well conclude that he has a candida infection. He could try and treat it as such.
The same issue may apply to the health practitioner that wrote that article.
If Frank went to see them as a client, they might well diagnose him with candida, purely on his presenting symptoms.
Without testing, he may miss a diagnosis of SIBO, a parasite infection, or more seriously, something like inflammatory bowel disease that would require a radically different treatment approach than a supposed candida overgrowth.
In Functional Medicine, we frequently say, “test don't guess,” and the logic for that is that obtaining the correct diagnosis is the starting place for an effective treatment.
That said I disagree with the conventional medicine standpoint that candida is only a problem in immunocompromised individuals.
As I earlier stated, Candida is an everyday part of our gut flora. The gut flora is an ecosystem, and like all ecosystems, it can get out of balance. Many aspects of the modern lifestyle such as poor diet, excessive antibiotic use, cesarean section births can reduce levels of beneficial bacteria in our gut. That, in turn, creates a more hospitable environment in which Candida can proliferate.
Small Intestinal Fungal Overgrowth
Several recent studies highlight that candida can be a problem even in people, like Frank, without HIV or AIDS.
One of those studies was a review paper on small intestinal fungal overgrowth or SIFO.
SIFO is like SIBO, but instead of overgrowth of bacteria in the small intestine, it’s an overgrowth of candida.
The review paper looked at two studies that found that patients with remarkably similar incidents (25 and 26 percent) of unexplained digestive symptoms had SIFO.
That is very significant.
That means we may be misdiagnosing a quarter of patients with gut problems when the problem is yeast overgrowth in the small intestine.
Another study found that yeast that we commonly see in the GI tract worsened the symptoms of inflammatory bowel disease in mice.
A third study found that intestinal fungi or yeast can worsen alcoholic liver disease.
Although these are preliminary findings, these studies do indicate that even regular intestinal yeast can become problematic in certain situations.
Testing For Candida Overgrowth
Because conventional medicine has denied the existence of candida for so long, testing is hugely inadequate compared to other conditions like SIBO.
We can use stool testing from speciality labs like Diagnostic Solutions to look for candida overgrowth in a stool.
We can also use organic acid testing to look at markers such as d-arabinitol which can indicate candida overgrowth.
Interestingly, some hospitals use D-arabinitol as a marker for invasive candidiasis.
In some cases, testing antibodies against candida in the blood can be helpful.
The problem here is that those antibodies do not tell you whether there is a current or past problem.
The stool testing and the urine testing can be helpful, but they also have issues as well.
So there is no perfect test that we have for diagnosing fungal overgrowth.
The situation is even worse with SIFO.
We have lactulose breath testing available for testing for SIBO, but there are currently no tests for SIFO outside of a research setting.
In the case of Frank, I would suggest using a stool test to rule out parasites, candida and IBD plus a breath test to look for SIBO.
Treating Candida Overgrowth
Treating candida is usually a 3 step process that includes diet, supplements and often type of emotional intervention.
Diet
The diets that I find to be most effective in practice are the low-carb Paleo or a ketogenic diet.
Studies are suggesting that yeast can thrive on ketones, but empirically I question that because in practice I see people responding very well to these lower carb diets when they have a candida overgrowth problem.
Supplements
Supplements can be divided into three main types including antifungals, biofilm disruptors and probiotics.
Antifungals
There are many antifungals including:
- Undecylenic acid
- Lauric acid
- Caprylic acid
- Uva ursi
- Cat’s claw
- Pau d’arco
- Oils like thyme and oregano
- Oregon grape
- Chinese skullcap
- Berberine
The above are all time-tested medicines that are antifungals. Some are also antibacterial and antiparasitic so that they can be useful in situations like that.
These supplements do not have the same kind of negative impact on the gut flora as prescription antibiotics or antifungals, and have far, far fewer side effects and risks.
That said, they still can be quite potent and may deplete the gut flora especially when used over the long term, so it is best to work with a practitioner if possible and if not be judicious with your use of them.
Biofilm disruptors
Biofilm disruptors help to break down the protective layer we find around bacteria, candida and parasites. Some biofilm disruptors you might want to consider include:
- N-acetylcysteine
- Nattokinase
- Biofilm Defense
Probiotics and Prebiotics
A popular myth about probiotics is that they help to repopulate your gut flora. Current research shows this not to be true. Probiotics act like antimicrobials in the fact they secrete chemicals that can kill bacteria and candida. Probiotics that are useful in the treatment of candida include:
- Soil-based organisms like ProFlora 4R
- Transient commensals like MegaSporeBiotic
- Beneficial yeast Saccharomyces boulardii
Candida is a big subject, so this article is merely an overview of the considerations. Not everyone, including Frank, has access to the kind of testing that can help diagnose candida. So a conservative approach might be to try the low-carb Paleo diet, and choose undecylenic acid or lauric acid, a biofilm disruptor, and see if that helps. It’s always beneficial to do it under the guidance of an experienced and trusted healthcare practitioner, but I recognise that is not possible all the time.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment.