Candida Overgrowth Syndrome

What is Candida Overgrowth Syndrome?

Key Symptoms

What Causes Candida Overgrowth Syndrome?

Conventional Treatments

Medications

Tests and Procedures

Treatment and Prevention

How Supplements Can Help

Self-Care Remedies

Alternative Therapies

When to Call a Doctor 

The body plays host to a multitude of microorganisms, and a proper balance among them is a key to good health. While bacteria are the most common, we also carry another microorganism, a yeast called Candida albicans (popularly known as Candida).

Normally present in small amounts along the gastrointestinal tract (in the intestines and the mouth), in the vagina, and on the skin, Candida overgrowth syndrome is generally kept in check by the immune system and by the body's "good" bacteria. Problems arise, however, when Candida start to grow out of control and excessively populate one or more locations in the body.

Vaginal candidiasis. The most common form of Candida overgrowth is vaginal candidiasis (a yeast infection), which frequently appears after taking antibiotics. These drugs kill "bad" bacteria but also destroy "good" strains that typically keep Candida in check. Candida itself is unaffected by antibiotics and, in the absence of its natural bacterial counterbalance, proceeds to reproduce wildly. Intense vaginal itching and a white discharge are signs of a vaginal yeast infection.

Oral candidiasis. Candida overgrowth in the mouth, also called oral thrush, can occur in people using steroid inhalers for asthma (steroids encourage Candida proliferation), and in breast-fed infants whose mothers are taking antibiotics. Oral thrush also develops in people with severely depleted immune systems--those undergoing cancer chemotherapy or immunosuppressive therapy after an organ transplant, or people with AIDS.

Candida overgrowth syndrome (COS). Vaginal candidiasis, oral thrush, and Candida overgrowths on the skin such as diaper rash are common medical conditions, which all physicians agree should be treated. A third type of Candida proliferation within the intestines, however, is a controversial disorder, accepted by some physicians and rejected by others as a "fad" diagnosis. It is known variously as Candida overgrowth syndrome (COS), chronic candidiasis, or just simply "a yeast problem."

Often it is nutritionally oriented doctors who believe that COS does indeed exist and treat it as they would any medical condition. They contend that Candida overgrowth is a specific disorder, which can be responsible for months or even years of chronic ill health. And they assert that even though Candida remains confined to the digestive tract and vagina, the overgrowth has far-reaching effects throughout the body.

They also emphasize that COS is totally different from the potentially fatal Candida fungal infection of the bloodstream that spreads the organism rapidly throughout the entire body. This life-threatening situation is usually seen only in people with severely compromised immune systems, and it requires specialized hospital care.

In contrast, symptoms of COS are said to develop from several sources. Overgrowth in the intestines can cause excessive gas, bloating, and bowel movement changes; in women, overgrowth in the vagina can bring on recurrent yeast infections. In addition, the body absorbs particles from Candida organisms after they die along with chemical substances produced by the live Candida itself. The effect of these compounds is felt systemwide, producing such unpleasant chronic symptoms as fatigue, muscle aches, and brain "fog." Because these substances produce symptoms, they are frequently referred to as Candida toxins.

In some cases, while still alive, the proliferating Candida yeast burrows deeply into the delicate lining of the gastrointestinal tract, damaging it and creating a syndrome called intestinal hyperpermeability or "leaky gut." When this occurs, a person can develop new sensitivities and intolerances to once harmless foods, such as dairy, eggs, corn, and wheat (gluten).

# Bloating, gas, diarrhea, constipation, new sensitivities to commonly eaten foods

# Fatigue, headache, depression, irritability, disorientation, dizziness, inability to concentrate

# Sugar cravings, sensitivities to chemicals and perfumes, alcohol intolerance, increased susceptibility to the side effects of medications

# Muscle and joint aches, sinusitis and recurrent colds, recurrent skin rashes

# In women, premenstrual syndrome (PMS), decreased libido, recurrent vaginal yeast infection, vulva itching and pain

# In men, prostate and bladder infections

According to nutritionally oriented physicians who treat COS, the overuse of broad-spectrum antibiotics is by far the most frequent cause of the ailment. People who have been on antibiotic drugs for long periods of time--to treat acne or recurrent sinus infections, for example--are at particularly high risk for developing the disorder. Because antibiotics so effectively wipe out bacteria (both the beneficial strains and the harmful ones), they dramatically disrupt the body's delicate balance of microorganisms. Candida yeast then takes over.

In addition, medications other than antibiotics can also increase the body's susceptibility to Candida overgrowth. These drugs include birth control pills and oral corticosteroids (such as prednisone), which are commonly prescribed to control inflammatory and autoimmune conditions such as lupus.

Other factors that can increase a person's susceptibility to COS include stress, a weakened immune system (due to any cause), a high-sugar diet, hormonal changes from pregnancy, and diabetes.

Doctors routinely treat clinical manifestations of Candida albicans overgrowth in the vagina, mouth, and skin. Vaginal yeast infections are so common that self-treatment using over-the-counter preparations is encouraged by most doctors. Likewise, pediatricians and other physicians regularly treat oral thrush and diaper rash.

Candida overgrowth syndrome (COS) is another issue altogether. During the decades since its original description in the early 1980s, COS has merited few articles in conventional medical journals, and it is not mentioned in medical textbooks. Few studies have been conducted, and most conventional doctors are very skeptical about the existence of the condition at all.

And indeed, COS's elusive set of signs and symptoms can make this problem hard to identify unless the patient and/or physician suspect its presence and believe that Candida is a real, diagnosable condition. Confusing matters further is the fact that COS often closely resembles other hard-to-diagnose disorders, such as fibromyalgia, chronic fatigue syndrome, food sensitivities, irritable bowel syndrome, and depression.

Over-diagnosis. Unfortunately, misinformation about Candida overgrowth syndrome abounds. Most of the popular books on COS incorrectly imply that the Candida proliferation can be widespread, occurring within virtually every organ. This is simply not the case. Although chemicals produced by the Candidabacteria are dispersed by the bloodstream, in COS the Candida organism itself is not.

Many people who believe they are suffering from Candida overgrowth, in fact, may not have it at all. (This can be a risk of reading a book about a disease and making a self-diagnosis.) Such individuals often spend hundreds of dollars on supplements that in the end turn out to be useless because the individuals never had COS in the first place. Others may confine themselves to extremely restrictive diets, or worry unnecessarily about a condition they do not have.

Under-diagnosis. Antibiotics are often prescribed and taken for the wrong conditions (for cold and flu viruses, for instance), or for inappropriately long periods. This sets the stage for Candida proliferation. Because most conventional doctors are skeptical that COS exists at all, it is possible that many chronically ill but undiagnosed individuals actually have this easily treatable condition. In these cases, many nutritionally oriented doctors believe that the diagnosis of COS is probably being overlooked by doctors every day.

Natural therapies available for COS (see below) can be useful for mild cases and are a good first step. The most effective COS treatments, however, are prescription antifungal medications, such as nystatin (Mycostatin, Nilstat, Nystex), itraconazole (Sporanox), and fluconazole (Diflucan). There’s some evidence that nystatin has lost some of its effectiveness in recent years, but the other two are both safe and effective.

Most nutritionally oriented physicians who treat COS do not place absolute reliance on any test, preferring instead to evaluate the whole patient. They will begin immediate treatment if the clinical suspicion of Candida is great enough. This includes a history of antibiotic overuse plus recurrent vaginal yeast infections (in women) and symptoms suggestive of COS.

The tests that nutritionally oriented doctors order include cultures of both vaginal secretions and stool, along with a blood test to measure antibodies and antibody complexes to the Candida. The blood test measures levels of three separate antibodies (IgM, IgG, IgA) that the immune system creates if Candida is present, as well as levels of Candida antigen, created when a particle of a Candida breakdown product enters the bloodstream and triggers an antibody response.

According to some doctors, repeating these tests at the end of treatment is a good way to determine if it has been successful. If it has, levels of a number of these measurements will show a decline.

There are various steps you can take to treat COS and also to prevent recurrences.

Treatment: Most cases of COS are mild and can be fully cleared up with a combination of supplements and lifestyle changes (see Self-Care Remedies below as well). Because the Candida organism burrows deeply into the intestinal wall, it may take several months to fully treat COS. Recommendations include the following:

# Begin with natural remedies. Many nutritionally oriented physicians recommend starting with anti-Candida supplements and adding prescription antifungal medications only if needed. There are good reasons for this.

First, many cases of COS are mild enough to be cleared up by natural remedies. And, while safe, prescription drugs can be extremely expensive if not covered by a health insurance plan.

In addition, if the Candida count in the intestine is especially high, a powerful prescription drug will cause a massive die-off effect (called a Herxheimer reaction). This creates uncomfortable flulike symptoms because so many toxins are released simultaneously from large numbers of dying Candida organisms. With gentler natural remedies, the Candida is killed more gradually, lessening or preventing this reaction.

# Revamp your diet. Some changes in your eating habits are necessary to eliminate a Candida overgrowth. Increase your intake of protein and high-fiber vegetables, and consume moderate amounts of whole grains and high-carbohydrate vegetables, such as potatoes, beets, and artichokes.

Try to limit or eliminate sugar from your daily fare because Candida thrives on sugar. Fruit, though allowable, is also limited during the treatment phase because of its sugar content.

Some practitioners recommend an even more restrictive diet. Pediatrician William G. Crook, M.D., who first popularized COS in his 1983 book The Yeast Connection, also eliminates baker's and brewer's yeast, all packaged and processed foods, cheeses, melons, mushrooms, and a number of other foods. Most nutritionally oriented physicians now consider this diet unnecessary, primarily because of the development of better anti-Candida supplements and medications.

# Avoid unnecessary antibiotic use. This is the number one reason people develop COS. Although appropriately used antibiotics can be lifesaving, it's important not to request or take antibiotics for every little cold, flu, or mild sinus infection. Many of these routine ailments are caused by viruses (not bacteria) which antibiotics can't affect, and these infections just go away by themselves.

If you have a medical condition that requires long-term antibiotics, ask your doctor if a narrow-spectrum antibiotic (one that's specific to your infection) can replace a broad-spectrum drug (one that kills all bacteria, good and bad).

If you need to use antibiotics, also take probiotics (Lactobacillus acidophilus, Lactobacillus bifidus, saccharomyces boulardii) for at least two to three weeks after your antibiotic treatment is completed. They will help restore your natural bacterial balance.

Important note: When you do get a prescription for an antibiotic, always finish the bottle. If you fail to do so, the offending bacteria may become more resilient and cause problems later on.

# Avoid unnecessary steroid use. If you have a medical condition requiring steroids, work with your doctor to reduce your dose to the lowest amount that is effective for your condition. If you use a steroid inhaler, rinse your mouth after each use.

# Get checked for diabetes, especially if you are middle-aged, obese, or have a positive family history for the condition. People with diabetes are especially susceptible to Candida infections.

Use the supplements listed below until all symptoms of Candida overgrowth have disappeared. Supplement treatment should be continued until diagnostic blood and stool tests show a clearing of the Candida.

Just a reminder: If you have a serious medical condition, it's always a good idea to talk to your doctor before beginning a program of supplements.

Supplements to treat COS include those that kill the yeast, those that strengthen the immune system, and those that restore "good" bacteria in the intestines (known as probiotics). In addition, naturopathic physicians often add supplements to promote liver detoxification and supplements to enhance digestive function.

Goldenseal and other berberine-containing herbs such as Oregon grape and barberry have been studied for their ability to counteract Candida albicans. Combinations of these herbs are widely used by naturopathic physicians for chronic Candida infections. There's some evidence that goldenseal is effective for COS-related diarrhea.

Garlic (Allium sativum) both enhances immunity and reduces Candida counts in the body. In test-tube studies, garlic has been found to inhibit the growth of C. albicans. It's also effective against a variety of infectious organisms that damage and invade tissues.

Oregano oil and other essential oils (such as rosemary or thyme) represent a new generation of anti-Candida preparations. Recent laboratory studies have actually shown that oregano oil is many times more potent than caprylic acid (see below), although more research into this oil is needed.

Caprylic acid is a fatty acid with antifungal actions. It's made by the body in small amounts, and can also be extracted from plant fats, such as coconut and palm oils. While there isn't any recent research on caprylic acid, older studies found that when taken orally it can lessen the Candida yeast's ability to grow and replicate.

Echinacea (Echinacea angustifolia) boosts the immune system and helps the body battle yeast infections. This herb works best when taken in alternating cycles with other immune-enhancing herbs, such as astragalus or goldenseal.

Lactobacillus acidophilus and L. bifidus both help maintain a healthy balance of "friendly" bacteria in the gastrointestinal tract and vagina. They also produce substances that combat hostile microorganisms. Research shows that L. acidophilus may help prevent or slow the growth of vaginal yeast infections, replacing the natural acidophilus that antibiotics destroy.

Saccharomyces boulardii (SB) is gaining recognition for its power to normalize intestinal bacteria. Like L. acidophilus, this friendly yeast produces lactic acid, which acidifies the intestinal contents and reduces the Candida population. It also increases levels of IgA, an antibody produced by the intestine that is helpful in combating Candida overgrowth.

Lipotropic supplements and silymarin are often recommended by naturopathic physicians, who believe that Candida-related toxins suppress the liver's normal ability to remove toxins. This suppression accounts for the multiple chemical sensitivities and allergies associated with COS. Lipotropic combinations (including choline, betaine, methionine) and silymarin (milk thistle) will enhance liver function and protect the liver from toxic substances.

Digestive enzymes may also be suggested by naturopathic physicians, who believe low enzyme levels can lead to Candida overgrowth syndrome. A comprehensive stool analysis will check for Candida and also determine how efficiently your digestive process is functioning. If there's evidence of inadequate stomach acid or pancreatic enzymes, supplemental enzymes may be prescribed.

# Begin an exercise program. Regular exercise will help improve your overall well-being and enhance your immune system.

# Reduce stress. Learn how to do yoga, tai chi, or meditation, and practice them consistently.

# Wear cotton or silk underwear. This is particularly important if you are susceptible to recurrent vaginal yeast infections. Nylon or other polyester fabrics can trap moisture, creating an environment friendly to fungal growth.

# Avoid commercial feminine products. Some douches, feminine sprays, and perfumed tampons can make COS worse. For some women, chemicals in such products can inflame delicate vaginal membranes, causing them to be more susceptible to yeast infections.

# Eat yogurt. Check the label to be sure it contains active or live cultures of acidophilus; research shows a cup of yogurt a day can reduce the number of vaginal yeast infections a woman gets.

# Increase dietary fiber. Eating enough fiber promotes a daily bowel movement. This will help eliminate the organisms and the toxins that the Candida yeast produces.

Most cases of Candida overgrowth can be adequately treated without the use of alternative therapies. However, the following therapies are definitely worth consideration for persistent, chronic cases of COS.

Traditional Chinese medicine. The combination of acupuncture and professionally selected Chinese herbal formulations may be able to simultaneously clear up a Candida infection and strengthen the immune system.

Homeopathy. A classically trained homeopath may be able to select and combine remedies capable of treating a Candida overgrowth problem.

Colon therapy. Some, but certainly not all, practitioners believe that COS treatment should begin with a colon cleanse, mainly to reduce the total population of Candida albicans in the large intestine. The colon cleanse should be done professionally by a colon therapist. See our WholeHealthMD library entry on colon therapy for more information.

When to Call a Doctor

# If you experience the symptoms of Candida overgrowth syndrome for three months and your self-treatment therapies are not helping. (Call your doctor sooner if the condition keeps you from carrying out your day-to-day activities.)

# If you have a vaginal discharge that has a strong, unpleasant odor, or is tinged with blood.

# If you have a vaginal yeast infection that returns within two months.

Disclaimer: All material provided in the WholeHealthMD website is provided for educational purposes only. Consult your physician regarding the applicability of any information provided in the WholeHealthMD website to your symptoms or medical condition.