Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
6 Sep

A Primal Primer: Candida

calbicansIt’s been awhile since I’ve done one of these, but I think it’s about time for a Primal Primer. Today we’ll be discussing candida, a genus (more than a species, less than a family) of yeast with many members, at least one of which is currently residing on or in your body: candida albicans. Candida albicans and friends are everywhere, and they’re usually a normal, healthy part of the human microbiome, but it can get a little out of hand. As I’ve mentioned before, the human gut hosts a tumultuous mix of microbial species vying for position and supremacy and trying to further their own ends. If all’s well, a balance is maintained, and the various species keep each other in check while promoting good health for the human host. But things can get out of whack. The balance can be upset. Certain species can gain ground on the others, perhaps by utilizing a new source of sustenance or taking advantage after a round of antibiotics, to our detriment. Candida is a particularly robust microbe who can thrive on a variety of fuel sources to apparently make itself a real nuisance in these situations. Let’s take a closer look, shall we?

When most people talk about “candida,” they’re talking about candida overgrowth, or candidiasis, of which there are several types:

  • Candidal vulvovaginitis – Also known as vaginal thrush or yeast infection, this is a fairly common manifestation of candidiasis that causes pain during sex and urination, itching, redness, swelling, and/or vaginal discharge.
  • Candidal keratitis – Candidal infection of the eye.
  • Esophageal candidiasis – Candidal infection of the esophagus
  • Intestinal candidiasis – Overgrowth in the small intestine. This is the “candida” people are usually talking about.
  • Candidemia – This often fatal condition involves the presence of large numbers of candida yeast in the blood and typically arises only in severely immunocompromised patients.

Conventional medicine has yet to formally recognize candidiasis as an issue prevalent enough to seriously study. On one hand, I understand their hesitancy, as candida has become a catch-all explanation for dozens of symptoms online, some of which may or may not be interrelated. On the other hand, gut dysbiosis is a real condition with huge – if as yet to be completely understood – ramifications to our health. We have some idea of what is going on in our guts and how it all impacts our health (especially with regards to obesity and immunity), but the field is still in its infancy. Eventually, thanks to programs like the Human Food Project, we’ll have a stronger understanding. For now, we work with what we have. I seriously doubt claims like “99% of all people have candida overgrowth,” but I have an open mind, and if people are feeling awful and getting no relief from their doctors’ attempts to help, it makes sense to expand your search. Right?

One researcher even went so far as to orally inoculate himself with candida (he ate a very large dose of it) to find out of it was capable of colonizing his gut and entering his blood (PDF). Two hours after inoculation, he experienced chills and a headache. At hours 3 and 6, candida was cultured from his blood, and at hours 2.75 and 3.25, from his urine. The researcher was otherwise healthy, hadn’t used antibiotics in ten years, and had no preexisting yeast infections. This is but one example, but it suggests that candida in sufficient amounts can make it to the gut and through the intestinal wall, even in healthy people.

Diagnosis

Since the existence of intestinal candidiasis isn’t universally accepted among medical professionals, it makes diagnosis difficult to obtain. “Endoscopic brushings” (sounds pleasant, doesn’t it?) have been used in the past, as have stool cultures. You might read about the “candida spit test,” which involves depositing fresh saliva into a glass of water upon waking and observing its trajectory and behavior, but this doesn’t appear to be accurate. Further complicating matters is that dozens of candida species exist, even though most of the already limited research has focused on candida albicans. Still further, research suggests (PDF) that chronic candida overgrowth is almost impossible to fully diagnose with lab tests that measure immune response, since it often downregulates the immune system, thereby creating an “immunologic tolerance.”  Thus, symptoms may be the best we have, especially if we can’t get our doctor to run a stool test.

Symptoms

Unfortunately, going by symptoms can also be confusing, because candida overgrowth appears to have dozens of them, like headaches, fatigue, chills, feeling drunk or hung over, a lack of libido, weight gain, weight loss, food intolerances, bloating, joint pain, diarrhea, hair loss, gas, cravings, and depression. Just go to Google and search for “candida and [enter malady or symptom of your choice].” It’ll autofill before you can even finish typing and hitting enter will bring up tons of articles telling you that “yes, you are indeed experiencing symptoms of candida.” See the problem? Any negative feeling or symptom could be evidence of candida.

This doesn’t negate the reality of candida overgrowth nor its symptoms, but it does make figuring out whether you have it extremely difficult. It also makes an incorrect diagnosis fairly likely, since many of those symptoms can also have other causes.

Risk Factors

While absolute causes of candidiasis are tough to pin down, looking at some of the common risk factors for the condition can give us a hint. What are they?

Antibiotic usage

You know the drill here. We’ve discussed how antibiotic usage (especially flagrant, excessive usage) can have a “collateral damage” effect on “innocent” gut microbes in addition to the target microbes. We’ve also discussed how the delicate balance of gut flora can be disrupted, thereby opening up space for existing species to flourish and overpopulate. Antibiotics represent a potent disruptive force in the gut, and antibiotic usage has been linked to both candidal vulvovaginitis (yeast infections) and systemic candidiasis. Patients with antibiotic-associated diarrhea are often found to have greater levels of candida in their stool. One girl even developed an overgrowth of intestinal candida immediately following antibiotic treatment.

Diabetes

Diabetes is consistently linked to candida overgrowth, women who have diabetes are more likely to have recurrent vaginal yeast infections, and patients with elevated blood sugar (as is often seen in diabetes) are more susceptible to candida overgrowth, probably due to the yeast’s taste for glucose.

Immune dysfunction or suppression

Patients with poor immune systems, like those with HIV/AIDS or undergoing chemotherapy, are at a greater risk of candida overgrowth.

Treatment

First and foremost, if you indeed have a serious candida overgrowth, it’s a complicated issue that may require a professional’s attention and the use of anti-fungals, like nystatinfluconazole, or anidulafungin. Unfortunately, as with bacteria and antibiotics, candida often develops resistance to anti-fungals (PDF), which may explain why treatment can be so frustrating and seemingly ineffective. Seek help if you’re really suffering.

That said, I’m no expert on candida, and I have neither the desire nor the ability to coach you through an overgrowth. However, the following “treatments” are generally pretty safe to try, and, even if you don’t have candida overgrowth, may result in health benefits. If you just suspect you have an overgrowth of candida and have no formal diagnosis, giving these ideas a try can’t hurt.

Avoid sugar and limit fruit.

Candida likes sugar (who doesn’t like sweets?) because it represents a quick food source. It’s also a fairly reliable source of energy, since most people are more than happy to pump themselves full of refined sugar. Fruits should be less problematic, but stick to lower sugar fruits and keep a close watch on how it affects your symptoms.

Avoid very low carb.

Paul Jaminet, who suffered from candida overgrowth, argues that since candida (being eukaryotes) have mitochondria that can feed on both ketones and carbs (as opposed to prokaryote bacteria without mitochondria), going very low carb or ketogenic will only provide more fuel for the overgrowth. Furthermore, since ketones are water-soluble and pass easily through cellular membranes, ketones will actually be a more accessible food source for candida. Don’t go high-carb, since any extra glucose will just be food for the yeast, but don’t go ketogenic, either. Stick to around 100-150 grams of carbs while still limiting sugar. Although other sources do recommend going as low-carb as possible, my money’s on Paul.

Consider a saccharomyces boulardii supplement.

S. boulardii has proven effective against candidal overgrowth, reducing both the resultant inflammation and the colonization of the gut. It appears that the capric acid released by s. boulardii deserves praise here, seeing as how it prevents growth, adhesion to the host, and formation of resistant candida biofilms. Coconut oil, another source of capric acid, has also been shown to inhibit candida in an in vitro study, but it will also promote the generation of ketone bodies, which may serve as fuel for the candida. Your call; they’re available online.

Use more spices and herbs.

Since plants often have to deal with pathogenic fungi, many spices and herbs have developed anti-fungal capabilities. Cumin spice exerts antimicrobial activity against candida. Oregano is a famous anti-fungal herb, and garlic has proved efficacious against candida biofilms in in vitro studies (and may even work synergistically with anti-fungal drugs against drug-resistant candida species). When you start getting into essential oils of the various plants, however, use caution, as these are highly concentrated and may be more powerful than you or your body are prepared to handle. Personally, unless you’re under the observation of a skilled medical professional, I’d stick to the whole plants and herbs. You might try drinking some strong black tea, too.

Ibogaine?

Even ibogaine, the psychoactive plant compound that William S. Burroughs went looking for to cure his heroin addiction, exhibits some effectiveness against candida. I’m not suggesting you rush out and find yourself an ibogaine tour to Gabon, but it’s still pretty interesting.

Die-off?

Formally known as the Herxheimer reaction, negative health effects – like headaches, fever, chills, and pain – resulting from microbial die-off are a real occurrence. When antimicrobials are administered to take care of certain infections, including syphilis, borreliosis (from Lyme disease), leptospirosis, Q fever, cat scratch fever, brucellosis, typhoid fever, and trichinosis, certain inflammatory cytokines are upregulated. It has been argued that endotoxins released from dying microbes are the cause of die-off symptoms, but studies call that into question.

Note that the existence of candida die-off has yet to be shown. Given that die-off exists for other microbial infections, however, I think it’s fairly plausible. What I find questionable is when every negative symptom under the sun is proclaimed to be die-off. Feverish chills? Okay, I’ll buy it. A slight headache and a weird headspace? Sure, that’s reasonable. Violent convulsions punctuated by frothy spurts of blood-flecked vomit? Eh, I think that might be something other than “candida die-off.” You might want to get that checked out.

It’s difficult to say anything absolutely conclusive about candida overgrowth. There’s no standard, easily-accessible test for it. There are so many signs and symptoms that they almost become useless for diagnosis. There are many species of candida, many species of other yeasts, and some candida can even be helpful in the right doses! However, even though it’s hard to get a doctor to test for it (if he or she even knows how) and it’s hard to know if you even have it, it looks like candida overgrowth is a real condition. Whether its prevalence is under- or overstated, though, we simply don’t know.

What do you know about candida? Have you had it? Do you think you do currently? If you’ve ever been treated for it, how’d you know it was actually candida? This is a hot topic in the health world, rife with misinformation on both sides of the debate, so let us know what you know in the comment section!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I was diagnosed with irritable bowel syndrome by my GP, and when I went to a gastroenterologist, he wrote me a prescription for anti-nausea pills. Then I saw my nutritionist. Using muscle testing, she diagnosed Candida overgrowth and put me on a no-carb, no-sugar, no-dairy diet. Bingo. I stayed on the diet a month and thought I was fine, so I went back to my regular diet. Three weeks later the awful symptoms returned (nausea after eating, gas, anxiety, depression). I returned to the diet, but the die-off period was hell, and getting better took longer. I have begun, after a few months, to introduce fruit and high-glycemic vegetables, and I have remained well. Added a little dairy and sugar too and still stay well. Conclusion: possible gluten intolerance? Could this be what I had all along? Thanks for the article and thanks for acknowledging that western medical people often think Candidiasis is not to be taken seriously. This made it hard to get well.

    Susan BIngham wrote on October 9th, 2013
  2. I echo James’ concerns. Regardless of whether symptoms can be attributed to Candida or not, my biggest concern is seeing a diagnosis of Candida abused as a way to sell natural remedies. The fact that there are no reliable testing protocols makes this so much more likely.

    As an aside, I was surprised not to see a mention of Lactoferrin. We have been using this to improve my daughter’s iron and appears to have no side effects and also appears to have a host of other benefits, including tackling Candida and improving the immune system. Anyone trying it have any comment?

    Bois wrote on December 9th, 2013
  3. I didn’t know fruits were bad for you with candida until my DR told me. This is the program he recommended, and it got rid of my y infection in 2 days.

    Lady Soma Advance Candida Supplement
    with Distilled watter (with added minerals)
    organic beans
    garlic
    onions
    ginger
    avacado
    olive oil

    Now that I have my diet straight, I take the lady soma candida supplement, and going to the gym every day I am yeast free!

    brooklynD wrote on March 4th, 2014
  4. Candida is very real. I suffered from debilitating stomach aches everyday for months with no explanation. I was checked for autoimmune disorders, cancers, gallstones, and more. No answers. I was then diagnosed with intestinal candidiasis after a stool test. With a semi-low carb diet and medicine, almost all of my symptoms have subsided except for the now very rare crippling stomach ache, or itchy stomach from eating too many carbs, especially fruit sugar.

    Nicole wrote on March 6th, 2014
  5. I am suffering from Candida since 2 years and inspite of lot of treatments not able to get rid of it.

    I am very worried.. Its recurrent but not severe everytime. Rarely once or twice a year i get severe and unbearable white discharge.

    Can it be ended ever?? Is it very dangerous..

    I m not yet married and still virgin.Can it affect my sex life after marriage??

    Doctor is asking for HIV and Sugar test…Please suggest!!!

    SOMEONE wrote on March 27th, 2014
  6. I had felt before as if I could die! Multiple symptoms including brain fog, foul smelling urine, abdominal pain, bowel problems, insomnia, bad breath, fatigue, joint pain, hunger pain followed by pain after eating, ETC! After reading that untreated Candida is life-threatening, I am especially pleased to be on the road to recovery. Very thankful my gyno recommended the Lady Soma Candida Cleanse! And a nice by-product of taking the Lady Soma Candida Cleanse capsules is losing 6 pounds of stubborn belly fat and getting back to my high school weight at age 53!!

    Kyoung11 wrote on April 27th, 2014
  7. This article leaves me with a few questions. Paul Jaminets’ argument over ketosis and candida throws me off a bit. recently I’ve gotten myself into ketosis as a way to rid a candida overgrowth, I’ve been suspicious that I have been struggling on and off with one for a few years.
    I have done a few diets and cleanses for candida and each time Have gotten myself feeling great, Strong and energetic. My downfall, however, is I enjoy alcohol and after about a year-year and a half I find myself back to the retched gut problems I have had before.

    For the last few years, other than the alcohol, I’ve lived mostly primal with a few cheats here and there but not very often.
    Recently I started having the problems in my gut again and this time I cut out the alcohol and even went as far as getting myself eating during the time frame of 12:00, because that my work lunch, and 7:00 and with very little carbs for about 4 days now. I’ve also gotten more serious about doing weight lifting to tone, this over the last two weeks. I’ve lost 4 pounds and feel stronger, healthier and more energetic already, Except I am also experiencing the die-off symptoms. They are exactly as I have had them when doing the cleanses. Light-headed, spacey, mild headache, and for me, trouble breathing from COPD, which I suspect the toxic die-offs trigger. I’ve had no symptoms or problems with COPD since going primal except for when doing these candida treatments.
    Paul argues that ketosis or low carb will actually feed candida but I still seem to be having the die-offs and at a high rate, I’m thinking. am I misunderstanding what ketosis is or how to get there? I was thinking I was in ketosis, know I am burning fat instead of glucose and can tell a difference in how I feel and am not getting famished from skipping meals in the slightest.
    Something else that has puzzled me is I had my appendix remove when I was very young and wonder If this is when I started having troubles with my gut. I read that the appendix helps kick start your systems gut flora after something comes through and washes it out such as antibiotics or a stomach bug. I’ve had trouble with constipation all through my childhood and wonder if this and other gut problems began after the removal of my appendix.
    I’ve had very painful stomach spasms I’ve gotten from eating pineapple. It has sent me to the hospital in search of answers before I found out what was causing it.
    I stopped eating the pineapple. however, sometime after a candida cleanse I accidentally found out I could eat it again and began doing so until one day When I got the spasms all over again. I suspect having another candida overgrowth being the reason. So, my theory is having candida and introducing a strong antibacterial good such as pineapple set off an ugly reaction. Do you think that is possible?

    Rachael warth wrote on May 6th, 2014
  8. The argument against fighting candida with a ketogenic diet would only apply to the rare instances of systemic (i.e. bloodborne) candidiasis. The intestines run primarily off fatty acids (which supplied from without) and when fats/proteins are consumed they won’t yield ketones in the intestinal tract. Keto seems like a perfect solution to intestinal candidiasis.

    dj wrote on May 15th, 2014
  9. @Rachael warth…
    Pineapple is fibrous and acidic, both can irritate the intestines. Pineapple is high in salicylate which can also irritate the intestines if you are sensitive. Pineapple contains amines and is also a histamine liberator if you have issues with biogenic amines or histamine intolerance. Histamine can affect smooth muscle contractions in the intestines leading to contraction (spasm/diarrhea), relaxation (constipation) or both.

    dj wrote on May 15th, 2014
  10. For those of you that want more science. Here is scientific evidence of Candida involved in Multiple Sclerosis…

    https://www.dropbox.com/s/zdn6jdz5xjx43zp/Evidencia_Candida_MS.pdf

    zjac020 wrote on July 5th, 2014

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