It’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.
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.
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.
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?
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 nystatin, fluconazole, 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.
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!
About the Author
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.