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Antifungal Treatment
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2016-03-21 16:52:39 UTC
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Antifungal Treatment

Last Updated on Monday, 16 November 2015 21:41

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Anti-Fungal Substance NamesA small intestinal candida/yeast overgrowth is a common finding amongst environmental illness patients according to lab tests such as the organic acid urinary analysis and gut fermentation profiles, as well as patient repsonses to Dr. William Crook's yeast questionnaire. As a result, anti-fungal therapy is usually a major part of an overall functional/integrative medicine based treatment plan for these illnesses. This is usually made up of three distinct parts, an anti-fungal diet, anti-fungal medications and/or natural products and finally, probiotic supplementation. Most people seem to get the best benefit when treatment involves all three parts, implemented properly at the same time, as they work together to restore the normal balance of organisms in the small intestine. If anti-fungal agents were taken without concurrent probiotic supplementation for example, with the amount of yeast reduced and no supply of beneficial bacteria to replace it, the opportunity is there for pathogenic bacteria to become dominant.


The Anti-Fungal Diet

First outlined by Dr. William Crook in his book 'The Yeast Connection', the anti-fungal diet has been an integral part of treating intestinal yeast overgrowth ever since. The aim of the diet is to reduce intake of sugar and refined carbohydrates as well as moldy foods and yeast products. The reason for reducing sugar and refined carbohydrate intake is that yeast feed on sugar and ferment it producing alcohol in the form of ethanol (drinking alcohol) and an even more toxic chemical called acetaldehyde. By reducing the amount of sugar in your diet you are also reducing the amount available to the yeast in your intestines. This may help to keep their growth in check and will also reduce the amount of toxic waste products they create as a result of fermentation. Elimination of moldy foods and yeast products is suggested because as a result of an intestinal yeast overgrowth the likelihood of developing an immune reactions to these things is greatly increased. This is as a result of yeast overgrowth leading to leaky gut syndrome and the possibility of "translocation" of the organisms from the intestine into the blood stream and other body tissues where they may cause immune reactions, mainly of the IgG mediated delayed reaction type. As a result, the immune system may cross react with molds and yeasts from your diet.

A typical anti-fungal diet has the following restrictions:


Foods that must be avoided
Sugar & sugar containing foods:

Table sugar (Sucrose) and all other simple, fast releasing sugars such as fructose, lactose, maltose, glucose, mannitol and sorbitol. All honey and sugar syrup type products such as maple syrup and molasses.
Packaged and processed foods:

This includes canned, bottled, boxed and otherwise processed and pre-packaged foods as they more often than not contain sugar of one type or another.
Examples:

Canned - Baked beans, soups, ready-made sauces

Bottled - Soft drinks, fruit juices, condiments/sauces

Boxed/Packaged - Ready-made meals, breakfast cereals, chocolate/candy, ice cream, frozen foods.

Mold and yeast containing foods:

Cheeses: moldy cheeses like stilton are the worst, buttermilk, sour cream and sour milk products.

Alcoholic drinks: beer, wine, cider, whiskey, brandy, gin and rum.

Condiments: vinegar and vinegar containing foods like mayonnaise, pickles, soy sauce, mustard and relishes.

Malt products: cereals, candy and malted milk drinks.

Edible fungi: including all types of mushrooms and truffles.

Processed and smoked meats: sausages, hot dogs, corned beef, pastrami, smoked fish, ham, bacon.

Fruit juices: All packaged fruit juices may potentially contain molds. Fresh fruit juices are allowed in moderation due to their sugar content.

Dried fruits: raisins, apricots, prunes, figs, dates etc.


Foods to be eaten in moderation
Grains: Wheat, rice, corn, barley, millet, oats.

High carbohydrate vegetables: sweet corn, potatoes, beans and peas, sweet potatoes, squashes, turnips, parsnips.









Anti-fungal drugs and natural products

For mild cases the diet along with healthier lifestyle choices in general may be enough to resolve the problem, however in moderate to severe problems an anti-fungal drug or a natural product with anti-fungal activity will need to be taken as well. The question of whether to use a drug or a natural product is one for you and your doctor to decide upon. From personal reports and the limited scientific evidence that is available, a lot of the natural products do seem to be as effective as many of the anti-fungal drugs. The exception maybe the systemic drugs which are usually reserved for cases that won't respond to either drugs that only act in the intestine, such as Nystatin, or the natural anti-fungal's. Most doctors treating yeast overgrowth suggest that patients will need to take the majority of anti-fungal's for at least 3 months and some will have to stay on them indefinitely. Of course most will be somewhere in between these extremes. Below we'll take a look at the most common anti-fungal's. and the advantages and disadvantages of each. It should be noted here that with any anti-fungal treatment there is a chance of experiencing what is known as the Herxheimer or "die-off" reaction. This is said to occur as a result of the yeast being killed too rapidly which overwhelms the body with yeast cells and their toxins. Any number of nasty symptoms can arise as a result, most frequently a flu-like feeling or worsening of symptoms already present. The solution to this may be to take a lower dose of anti-fungal for a while or take extra fibre or a product like bentonite clay to help carry the toxins out of the body before they are absorbed.


Medications

Nystatin
Nystatin was one of the first anti-fungal drugs developed and probably the most commonly used to treat intestinal yeast overgrowth. It is extremely safe due to the fact that hardly any of the drug is absorbed from the intestinal tract. As a result the only side-effects that may occur are mainly restricted to the digestive system and are usually mild. In addition, in rare cases patients may develop a rash as a result of an allergic reaction. Nystatin is available in a number of different forms including, tablets, powder and liquid oral suspension. You can therefore choose the form that suits you best. The liquid and powder forms are probably superior to tablets because they don't need to be digested before they start to work and hence will kill yeast further up the digestive tract. The only drawback to this is the extremely foul taste! The usual dosage of nystatin ranges from 1 tablet or 1/8 of a teaspoon of powder 4 times a day to 8 tablets or 1 teaspoon 4 times a day. Another advantage of this drug is that it is very cheap compared to all of the others. As a result of it being cheap, safe and relatively effective, nystatin is likely to be the first choice treatment for many people and their doctors. The only drawback is that due to its widespread use for decades certain yeast species are becoming resistant to it.
Amphotericin B
This drug is similar to nystatin as it is chemically related. As with nystatin it is not absorbed from the intestine in any significant amount so again is very safe. You may hear stories of amphotericin being very toxic or poisonous but don't worry, this is most likely referring to IV use of the drug in hospitalized patients suffering a fungal infection of the blood or severe infection of body tissues. This doesn't apply to its use in the digestive tract. Amphotericin B may be effective in cases where nystatin has failed so it is something to consider if that is the case with you. The drawback of this drug is the cost, it is significantly more expensive that nystatin and therefore is rarely used as a first line treatment unless a sensitivity test has indicated it to be the most effective in a particular patient.
Diflucan (fluconazole)
Diflucan belongs to a group of drugs called the 'azoles' and unlike the previous two drugs, Diflucan is absorbed by the intestines and is referred to as a systemic anti-fungal drug. Diflucan is a more modern drug than nystatin and amphotericin, it was first used in Europe during the 1980's and licensed in the US in 1990. A lot of doctors and patients have found Diflucan (and other azoles) to be effective where nystatin and amphotericin have failed. It has been found to be very safe considering its systemic action with few side-effects reported by patients. The dosage range is typically from 100 to 600mg a day with period of treatments ranging from a few weeks to many months or in rare cases, indefinitely. Treatment with Diflucan is certainly not cheap, current prices are typically $150-$200 for 30 100mg tablets. With some patients needing up to 600mg or more a day the price will put it out of reach for many if insurance won't pay for it. These prices were from a major online pharmacy, if you shop around you will likely find significantly cheaper sources.
Sporanox (itraconazole)
Sporanox is one of the newest azole drugs being licensed in the US in 1993. It would seem to be similar in safety and effectiveness as Diflucan but may be a more successful treatment for certain species of candida and other fungal infections as Diflucan may be more effective for other species. Unless you have a stool sample tested and a particular species of candida/yeast can be detected and tested for sensitivity to different drugs, it is a matter of trial and error with regards to which will work best for you. Dosages are typically 100 to 400mg a day and prices are comparable to Diflucan, possibly being slightly more.
Nizoral (ketoconazole)
This drug was the first of the azole drugs to be developed but its use is limited due to the possibility of serious liver damage. As a result, patients must undergo regular liver enzyme tests during treatment to monitor the effects. In cases that have failed to respond to any other anti-fungal agent its use may be justified but otherwise it is probably best avoided.
Lamisil (Terbinafine HCL)
This is the newest anti-fungal drug in routine use. It is a systemic drug but is unrelated to the other systemic 'azole' drugs. As a result it is an effective treatment as yeast have not yet had chance to develop resistance to it. Lamisil has become more and more widely used since its introduction a few years ago and is set to become the systemic drug of choice, replacing Diflucan. As with most of the systemic drugs there have been instances of adverse effects on the liver and as with Sporanox, Lamisil has recently been linked with congestive heart failure. Lamisil is marginally more expensive than Diflucan and Sporanox with 30 250mg tablets costing between $200 and $250.

Natural Anti-fungal's

Saturated Fatty Acids
Undecylenic and caprylic acids are common medium chain saturated fatty acids used to treat yeast infections. Both are found naturally in the human body in small amounts. Common commercial sources of caprylic acid are palm and coconut oils, whereas undecylenic acid is extracted from castor bean oil. Caprylic acid products are far more common than those of undecylenic acid but don't assume this means it is better, undecylenic acid has far more research data avilable on it and was the treatment of choice for fungal skin infections for a long time before newer drugs arrived1,2. Both have been shown to be comparable to a number of common anti-fungal drugs. In fact undecylenic acid was the main agent used to treat fungal infections prior to the development of newer drugs and is still prescribed today for some infections. A typical dosage for caprylic acid would be up to 3600mg per day in divided doses with meals. Undecylenic acid is commonly taken in dosages of up to 1000mg per day, again in divided doses. A major advantage of using natural products over drugs is the cost. A months supply of either of these fatty acids will cost only about $20-30 for a quality product.
Berberine
Berberine is an alkaloid found in a herb called barberry (Berberis vulgaris) and related plants as well as in goldenseal, oregon grape root and Chinese goldthread. This herb has long been used in chinese and ayurvedic medicine. Berberine has significant anti-fungal activity and is also effective against some kinds of bacteria. As with all previously covered anti-fungal's, berberine is reported to spare beneficial organisms such as lactobacilli species. An added benefit for some people is its anti-diarrheal action. Research has shown that berberine can effectively prevent candida species from producing an enzyme called lipase which they use to help them colonize3. Berberine has also been widely shown to have a powerful directly anti-fungal action4,5 Cost of treatment with berberine is roughly equivalent to that of the fatty acids.
Oregano
Most people will be familiar with oregano as the strong smelling herb commonly used as a seasoning in Italian food. This is usually Oregano marjoram rather than Oregano vulgare that we're interested in here. Oregano vulgare contains a variety of substances that make it an effective anti-fungal. In a study assessing its action against Candida albicans, carvacrol, a major phenolic constituent of the oil, was found to inhibit candida to a greater extent than caprylic acid. It is also highly effective against many bacteria with studies published in the most prestigious medical journals showing it is as effective as many antibiotic drugs. Usually supplied in oil form, oregano treatment will cost around $25 per month. It is very potent so only a few drops in a glass of water are needed at a time. Higher dosages would be likely to cause irritation of the mucous membranes.
Garlic
Garlic (Allium sativum) contains a large number of sulphur containing compounds that exhibit potent anti-fungal properties. Among the most studied are allicin, alliin, alliinase and S-allylcysteine. Some studies have found garlic to be at least as effective as nystatin at killing Candida albicans. A point that should not be overlooked is that because of the many different compounds with anti-fungal properties in garlic, yeast and fungi are unlikely to become resistant to it. Garlic also has many other beneficial properties particularly for the cardiovascular system. It has been shown to lower levels of LDL cholesterol and act as an anti-coagulant, lowering blood pressure as a result. Like barberry, garlic has a long history of medicinal use, reportedly dating back as far as 3000 years. For treating intestinal yeast infections garlic is available in a number of different forms including, odorless capsules, liquid extract and tablets. However, a study at the National Institutes of Health found that fresh garlic was significantly more potent against Candida albicans. It also found that the fresh garlic could be a suitable alternative to drugs for serious systemic infections in patients with severe immune suppression. Therefore adding garlic to food (raw) or crushing and swallowing raw cloves if you can tolerate it, is a cheap and powerful anti-fungal treatment.
Colloidal Silver
A colloid is defined as very small particles of one substance suspended (not dissolved) in another. Colloidal silver is a suspension of silver particles in water. Silver is a well known anti-microbial, it is commonly used in items such as water filters to kill any microbe that may be in the water, including bacteria, fungi, worms and protozoa. Colloidal silver is said to be effective against up to 650 pathogens including, of most interest to us here, yeast and fungi species including Candida. It works by denaturing the enzyme involved with supplying the organism with oxygen. Chances of resistance to this process are by all accounts, very low. It was used widely to treat infection before the development of antibiotic drugs. It is now classified as a pre-1938 drug by the FDA which means that it is available without prescription. The number of companies offering colloidal silver as an alternative to antibiotic medications is increasing daily. The renewed interest can be explained by the increase in chronic infections and the fact that many microbes are becoming resistant to the commonly used drug treatments. The dosage of colloidal silver needed to treat yeast overgrowth will vary between products because they may have slightly different concentrations. Prices are similar to the other natural products discussed at about $30 for an 8oz bottle.
Cellulase
This is a relatively new treatment approach for intestinal yeast infections. The cell wall of common intestinal yeast such as Candida species have been found to be made mainly from cellulose. Cellulase is the enzyme that breaks down cellulose and hence, when significant concentrations come into contact with yeast cells the cell wall is irreparably damaged and the organism dies. It's claimed that using this mode of action, the yeast do not release a flood of toxins when they die as occurs with most other anti-fungal agents so that the sufferer does not experience the usual die-off symptoms to any significant degree. The yeast should be unable to develop resistance to cellulase products as they lack the ability to modify their cell wall. As cellulase products have only been around for a few years reports of their effectiveness in practice is limited but they offer a promising alternative to more established treatments. Prices again, are in a similar range to all the natural anti-fungal's.
Plant Tannins
Tannins are natural substances found in a number of plants such as Black Walnut and a vast array of plants used in traditional eastern medicine. Tannins are what give red wines such as merlots and cabernets their sharp, biting taste. They are also found in the bark of trees that are particularly resistant to fungus such as the redwood tree. They have been demonstarted to have a powerful anti-fungal and astringent action in a multitude of clinical studies6,7,8. Tannins are one of a number of natural substances tested against pathogens found in stool samples by functional medicine labs. More information can be found on these tests here. Tannins are available in a number of froms to treat intestinal yeast overgrowth. As previously mentioned they are the active anti-fungal ingredient in many traditional eastern herbal preperations. Black walnut has a very high tannin content and is commonly used to treat infections with Candida sp, parasites and worms. It is widely available from health stores and nutritional supplement suppliers. Tannins are also available in an isolated and concentrated form. Treatment with plant tannins is comparable in cost to most natural anti-fungal agents, being in the region of $15-$30 per month.

Probiotics

It is essential that as the yeast overgrowth is being treated probiotic bacteria are consumed to take the place of the yeast colonies. To learn more about probiotics click here
References


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Candida and Gut Dysbiosis

Last Updated on Tuesday, 20 October 2015 21:38
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Candida albicans under microscopeThe Intestinal Zoo

It is currently estimated that more than 1200 species of bacteria, yeast and other organisms numbering 100 trillion in total inhabit the human gastrointestinal tract and make up the "gut flora". In an average adult the bacteria weigh about 2kg (4-5 pounds) and the number of individual organisms outnumbers the total number of cells in the human body by a factor of 100 to 1.

Luckily for us a large number of these organisms don't cause disease, as it would be easy to assume, in fact, they help protect us from disease. The gut flora perform many functions that contribute to the health of the human host; "friendly bacteria" mostly have names beginning with 'Lactobacillus' or 'Bifidobacteria' which denotes the genus they belong to. You may have noticed food products like yogurt that contain these bacteria. It is becoming more common for them to be added, just as vitamins and minerals are frequently added to breakfast cereals, for example.

Major useful functions of friendly bacteria:

Producing short chain fatty acids which supply a valuable proportion of human energy requirements.
Producing a number of valuable nutrients notably B vitamins and vitamin K
Participating in the metabolism of drugs, hormones and carcinogens
Protecting the host from infection by pathogenic bacteria (through competing for space and production of anti-bacterial substances amongst other methods.)
Maintaining a healthy intestinal pH
Enhancing immune function
The friendly bacteria aren't the only type of microorganism present in the human gastrointestinal tract however. There are also a number of organisms that don't provide the human host with any benefits or do so only when their numbers are kept low by competing friendly bacteria. Such microorganisms include coliform bacteria (E.coli etc), yeasts/fungus and bacteroides.



What can go wrong?

Illness can occur when the amount of friendly bacteria is reduced and the other organisms are able to increase their numbers and become the majority. There are a number of factors that can disrupt the balance of organisms in the intestines and lead to overgrowth of the less desirable species.

The most important factors are:

Antibiotic use
Use of the birth control pill
Use of other hormones, especially immunosuppressants like steroids
Diet
Alcohol
Stress
Probably the most important factor is the use of broad spectrum antibiotics. These medications don't discriminate between friendly and pathogenic bacteria. This means that every time you take one of these drugs for an infection you're are wiping out large numbers of the friendly bacteria in your intestines that give protection from other, potentially harmful, intestinal residents. This fact has long been known by researchers and is taught to microbiology students.

The amount of research in this area involving human subjects, regarding Candida in particular, is limited due to a lack of agreement on accurate testing methods and the fact that it is a relatively new area of study. Testing for small intestinal bacterial overgrowth (SIBO) however, is now becoming established using breath hydrogen testing. There has also been a lot of animal research showing that both antibiotics and steroids commonly cause substantial increases in Candida and pathogenic bacterial colonization, due to destruction of friendly bacteria and suppression of immune defenses (1, 2, 3, 4).

One result of antibiotic use which is undisputed is antibiotic induced diarrhea which is thought to be caused mainly by Clostridium difficile infection, the incidence of which is on the increase (5). Recorded cases reported in March 2005 put the number of cases annually at 3 million in the United States (6). C.difficile infection is difficult to treat and severe cases can even lead to death. Treatment in the conventional medical setting involves more antibiotics, targeted at C.difficile in particular.

Until recently antibiotic drugs were seen as a magic bullet without side effects. As we can now see however, there ARE side effects that can be significant and the effects of the disturbance they cause to gut flora and overall health are only starting to be uncovered.









Candida/Yeast

Candida is a type of yeast that is one of the most common residents of the human mucous membranes such as the gut, urinary tract and vagina. In the small intestine (not the large intestine, or colon, as is often suggested) Candida and Lactobacilli are the predominant residents. The most common type of Candida is 'Candida Albicans' but other species are also widely found. Candida is a "dimorphic" organism which means that it can exist either as a round yeast cell or as a fungus (mycelial form) with spindly outgrowths called hyphae that can penetrate the body tissue of the host. In healthy individuals candida is kept in check by friendly bacteria and a healthy immune response and remains in the yeast form.

If the friendly bacteria are disrupted by any of the factors previously discussed, Candida can increase it's numbers drastically and become a more dominant member of the "intestinal zoo". When this happens it spells trouble for the human host. As Candida is a yeast, it produces alcohol (ethanol) and acetaldehyde (this is the chemical responsible for the main symptoms of a hangover) as the major products of its metabolism. In healthy individuals alcohol can be detected in the blood from exactly this source but it is at a level that doesn't cause any problems as the bodies detoxification systems can cope with it. If however you have an overgrowth of intestinal Candida, the levels of alcohol entering the bloodstream are going to be greatly increased. In a study conducted by doctors at Biolab in London, UK, a number of chronically unwell patients were tested for blood ethanol levels an hour after ingesting a sugar solution. The study found the patients consistently had high blood levels of ethanol which the researchers concluded came from small intestinal yeast overgrowth (7). To make this situation worse, when Candida has a foothold it is free to transform into the fungal form and its branching hyphae can penetrate the intestinal wall (1). This makes the intestine more permeable (Leaky Gut Syndrome) so more of the toxic alcohol and acetaldehyde are absorbed into the body. Also with a highly permeable intestine, the Candida themselves may actually be able to slip through and gain access to the rest of the body causing chronic immune reactions like allergies and autoimmune diseases.

Recent research has directly shown that antibiotics and the resulting increased Candida colonization of the intestinal tract leads to an increase in airborne allergies (4). One study showed that mice given antibiotics had increased intestinal Candida colonization, which has been shown many times before, but also showed a concurrent increase in allergic responses to an airborne mold spore called Aspergillus fumigatus. This research is very important as it shows that alteration of gut flora with antibiotics can affect immune response and lead to an increased incidence of allergies.

Other research has linked intestinal Candida to Celiac disease (8). Celiac disease is an autoimmune disease in which a T-cell mediated immune response results in damage to the tissue of the small intestine. This reaction is triggered by the ingestion of gluten, a protein found in grains, predominantly wheat, barley and rye. What the research shows is that a protein found in the cell wall of Candida is very similar to gluten. As a result, the immune system can confuse gluten found in grains for the cell wall of Candida and mount a response against the gluten. The immune cell bound gluten then damages the small intestinal wall as in Celiac disease.



Signs and Symptoms of Intestinal Candida Overgrowth

Everyone knows that drinking too much alcohol makes you feel less than great, imagine if your body is absorbing a level of alcohol a lot higher than normal, constantly, over a period of years. This is clearly going to lead to a less than optimal state of health. Nutrients will be depleted, valuable liver enzymes will become depleted, resulting in oxidative stress, due to being constantly overworked trying to detoxify the yeast products and the yeast products themselves will also cause direct damage to multiple body systems.

As you can probably imagine, as the whole body is effectively "poisoned" by an overgrowth of Candida, the number of symptoms it can produce are vast and affect every bodily system.

Here's a short list of common symptoms:

Fatigue
Weakness
Muscle & joint aches
Headaches
Feeling of being "hung over"
Gastrointestinal disturbances - diarrhea, constipation, nausea, bloating after eating
Psychological disturbances - depression, anxiety, irritability, mood swings
Cognitive dysfunction - poor memory, lack of concentration
Recurrent vaginitis
Menstrual Disturbances and Infertility
Allergies
Skin irritations/rashes/acne
Recurrent throat/ear infections
Hypoglycemia


Candida in Environmental Illnesses

The symptoms above may seem very similar to those presented by CFS sufferers and sufferers of the other illnesses covered on this website. Indeed, clinical studies have hinted at the involvement of Candida in CFS (9) and other published material has hypothesized a causal link (10). It is increasingly common for doctors specializing in CFS/Fibromyalgia to treat their patients for yeast overgrowth as part of their treatment.

Research conducted in Norway and published in January 2005 suggests Candida may be a cause of irritable bowel syndrome (IBS)(11). The authors state that:

"...there is increasing evidence for yeasts being able to cause IBS-symptoms in sensitized patients via Candida products, antigens and cross-antigens."

They go on to say however that more research needs to be conducted before antifungal therapy can be recommended as a first line treatment for IBS.

Candida has also been put forward by a number of sources as being involved in the etiology of autistic disorders. One leading proponent of this is Dr. William Shaw of The Great Plains Laboratory in the US. Dr. Shaw discovered elevated levels of certain organic acids in the blood and urine of autistic twin boys when he was working for the CDC.

Learn more about Candida and autism spectrum disorders



Testing for Candida/Yeast Overgrowth

Yeast overgrowth can be detected by stool sample, testing Candida antibody levels or either a urine or blood sample testing for levels of yeast products such as alcohol and organic acids. The first line of investigation used by many doctors to determine if a patient has a yeast problem is an extensive questionnaire, originally employed by Dr. William G. Crook.

Click here to view the Candida/yeast Questionnaire

Most doctors still refuse to admit that candida can cause illness due to intestinal overgrowth but this is changing as the research suggesting otherwise continues to grow. Even a major medical institution like the CDC now mentions it on their website; this statement is from a CFS related page:

"Candida albicans: A common saprophyte* of the digestive tract and female urogenital tract. It does not ordinarily cause disease, but may do so following a disruption of bacterial flora of the body, or in patients with depressed immune systems."

*"An organism, especially a fungus or bacterium, that grows on and derives its nourishment from dead or decaying organic matter."

Most official medical institutions issue statements such as:

"Although the increase in Candida colonization associated with the use of antibiotics, particularly broad-spectrum ones, is well established, there is no proof that this results in the production of Candida toxins...the hypothesis of 'chronic candidiasis' must be considered speculative and unproven.”

They would appear to be simply covering their backs in the absence of what they would call "definitive" proof. The suggestion that they accept substantial yeast overgrowth but not the production of toxins seems ridiculous. The major products of normal yeast metabolism (ethanol and acetaldehyde) are well known toxins that cause serious damage to living tissue. With this in mind, an increase in yeast colonization will undoubtedly lead to an increase in production of toxins and at some point, disease as a result.

The main factor that is hampering efforts to determine the role of intestinal yeast in disease is the lack of agreement over a definitive diagnostic test for intestinal yeast overgrowth. Stool samples are often unreliable as positive results do not always correlate with symptoms and the reverse can be true with negative results found in a clearly symptomatic patient who has many other factors pointing at yeast overgrowth.

This situation has hampered research efforts and understanding for a long time now. A solution may be on the horizon however as recent research has strongly suggested that D-arabinitol may be a candidate for this definitive marker of intestinal yeast overgrowth (12, 13). D-arabinitol is a 'sugar alcohol' produced by yeast when they feed on a sugar called arabinose. If there is a yeast overgrowth in the intestines this substance will be absorbed and be detectable in the blood and urine.

Until a definitive diagnostic test is developed, it is wise to look at evidence from different sources. Stool, antibody and organic acid tests along with the yeast questionnaire will give a good idea of whether you have a yeast overgrowth or not, especially when used together.

You can learn more about these tests on our lab tests page.

To learn about the treatment options for Candida overgrowth visit our anti-fungal treatment page



Bacterial Dysbiosis

Bacterial dysbiosis results from the same situation as Candida overgrowth, namely disruption of normal intestinal flora by the the various factors mentioned previously. When the normal balance of organisms in the intestines is disturbed, potentially pathogenic bacteria are able to thrive. Common bacterial infections found on CDSA tests include klebsiella and proteus species as well as various strains of e.coli. It should be noted that doctors who routinely use diagnostic tests such as CDSA's and organic acid testing often find evidence that Candida and bacterial overgrowth are both present in the same patient.

According to Dr. Leo. Galland, a New York physician specializing in gut dysbiosis, there are 4 distinct types that can occur, these being:

Putrefaction
Fermentation
Deficiency
Sensitization


Putrefaction

Putrefaction dysbiosis results from diets high in fat and animal flesh and low in insoluble fiber which increases transit time and allows ingested material to putrify in the colon. This results in an increased concentration of Bacteroides species and a decreased concentration of Bifidobacteria species (friendly bacteria) in the stool. The change in composition of the gut flora leads to an increase in bacterial enzymes which amongst other things can increase cancer causing substances, play a role in inflammatory bowel disease (IBD), cause diarrhea and interfere with the body's hormones (14, 15, 16, 17). As there is a decrease in friendly bacteria, the production of short chain fatty acids and other beneficial nutrients is decreased. There is also an increase in ammonia which can have negative effects on numerous bodily functions, especially liver/detoxification pathways and brain functions. Research has implicated this type of dysbiosis in contributing to colon cancer and breast cancer.



Fermentation/Small Intestinal Bacterial Overgrowth (SIBO)

This type of dysbiosis is commonly referred to as Small Intestinal Bacterial Overgrowth or SIBO. This is due to the fact that it involves overgrowth of bacteria in the small intestine rather than the colon. The result is the same type of problem as with yeast overgrowth (also predominantly in the small intestine) whereby the sufferer develops an intolerance to carbohydrate. Any carbohydrate ingested is fermented by the bacteria and results in production of toxic waste products such as organic acids (acetic acid, lactic acid etc) and hydrogen sulphide (H2S), all of which are potentially toxic in increased amounts and can lead to acidosis. The bacteria also compete with the patient for nutrients, potentially leading to malnutrition, and may also damage the cells of the intestine (18). A study at Biolab Medical Unit in London, UK, found that patients with increased gut fermentation also had increased intestinal permeability, also known as leaky gut syndrome (19). These findings have also been replicated elsewhere (20).

Typical symptoms of SIBO include:

Diarrhea
Anemia
Weight Loss
Malnutrition
Flatulence
Abdominal Pain
It is likely, due to the increased production of organic acids and other metabolites that end up in the circulating blood, that SIBO can cause a much wider range of systemic complaints, as suspected with Candida overgrowth, but these are obviously much more difficult to document.

Unlike Candida overgrowth however, a reliable test is available to diagnose SIBO. The test is known as the breath hydrogen test and measures the amount of hydrogen on a patient's breath a specified amount of time after they have ingested a sugar solution. An elevated level of hydrogen indicates an overgrowth of bacteria in the small intestine. The breath hydrogen test is now in common use and has been used in multiple published studies (21, 22, 23).



Deficiency

Use of antibiotics or a diet low in soluble fiber may create an absolute deficiency of normal gut flora, including Bifidobacteria, Lactobacillus and E. Coli. As a result of deficiency the human host will be deprived of the nutrients usually supplied by the gut flora and deficiencies may result. There will also be weakening of the immune system and hence a reduced resistance to infection. Deficiency has been linked to Irritable Bowel Syndrome (IBS) and food intolerance. Deficiency and putrefaction dysbiosis often occur simultaneously.



Sensitization

Sensitization dysbiosis refers to a condition where there is an increased immune response to the normal gut flora. This situation may be associated with the development of inflammatory bowel disease, spondyloarthropathies, other connective tissue disease and skin disorders like psoriasis or acne. One study at King's College, London, UK, found that IBD patients produced a higher than normal number of IgG antibodies in their intestines and that these antibodies were directed against the intestinal bacteria (24). The immune system may be overreacting to the bacteria themselves, or substances produced by them. Intestinal bacteria may play a part in autoimmune diseases as the immune system first reacts to bacterial antigens and then cross reacts with the body's own cells with a similar protein structures. Sensitization and fermentation types of dysbiosis may go hand in hand, just as deficiency and putrefaction do.



Bacterial Dysbiosis in Environmental Illness

The most extensively studied connection is between SIBO and allergic illnesses such as asthma and eczema, particularly in children. There is an increasing awareness of the importance of the gut flora to the health of the immune system and to the body as a whole, this is reflected in the vast amount of research published in this area in recent years. The general consensus is that the gut flora interact directly with the immune system and that disturbances in the gut flora leads to an increased incidence of allergic diseases (25, 26, 27). In fact the gut flora is the major factor involved with the development of the immune system after birth. Abnormal gut flora has been repeatedly found in babies and young children with allergic diseases and the administration of healthy Lactobacilli bacteria have been shown to prevent development of these same diseases (27).

By far the most common type of bacterial dysbiosis associated with environmental illnesses is excessive fermentation type or small intestinal bacterial overgrowth (SIBO).

There have been multiple studies implicating SIBO in irritable bowel syndrome, chronic fatigue syndrome and fibromyalgia (28, 29, 30, 31).

One study published in the Journal of the American Medical Association (JAMA), one of the world's most prestigious journals, concludes that SIBO likely plays a major role in the disease process of IBS (31). The study says:

"The possibility that small intestinal bacterial overgrowth (SIBO) may explain bloating in IBS is supported by greater total hydrogen excretion after lactulose ingestion, a correlation between the pattern of bowel movement and the type of excreted gas, a prevalence of abnormal lactulose breath test in 84% of IBS patients, and a 75% improvement of IBS symptoms after eradication of SIBO"

In conclusion the study authors state that the gastrointestinal and immune effects of SIBO provide a possible explanation for the multiple gastrointestinal and non-gastrointestinal symptoms of IBS.

SIBO has also frequently been seen in chronic fatigue syndrome patients. One review of published literature states that amongst other things, CFS patients " have marked alterations in microbial flora, including lowered levels of bifidobacteria and small intestinal bacterial overgrowth" (28).

Interestingly, a study published in 2004 found that SIBO is more common in fibromyalgia patients than in IBS patients (30). This result was based on the amount of hydrogen detected with hydrogen breath testing after a lactulose solution was ingested. An important aspect of this study that should be noted is that the severity of SIBO detected in fibromyalgia correlated with the amount of tender point pain the patient was suffering, so there is clear evidence of a connection there. Pain levels were assessed with patient questionnaires.

Finally, the link between intestinal health and mental health is starting to be investigated. Research is showing that nutritional influences on depression are currently underestimated and that depressive patients have altered gastrointestinal function, increased oxidative stress, altered immune function and deficiencies of various nutrients, omega-3 fatty acids in particular (32). SIBO is suggested as a reason for the decreased nutrient status and stress is known to have a negative impact on gut flora, reducing numbers of the beneficial Lactobacilli and Bifidobacteria species. Further research is needed to look directly for SIBO in depressive patients.

It is likely, as knowledge of the roll of gut flora in health expands, that dysbiosis will be found to be involved in many more illnesses, but until then we have a lot to think about with what has already been discovered.

To learn about treatment options for bacterial dysbiosis visit our anti-bacterial treatment page

References


http://www.ei-resource.org/illness-information/environmental-illnesses/candida-and-gut-dysbiosis/?print=1&tmpl=component
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Antifungal Treatment
Last Updated on Monday, 16 November 2015 21:41
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Anti-Fungal Substance NamesA small intestinal candida/yeast overgrowth is a common finding amongst environmental illness patients according to lab tests such as the organic acid urinary analysis and gut fermentation profiles, as well as patient repsonses to Dr. William Crook's yeast questionnaire. As a result, anti-fungal therapy is usually a major part of an overall functional/integrative medicine based treatment plan for these illnesses. This is usually made up of three distinct parts, an anti-fungal diet, anti-fungal medications and/or natural products and finally, probiotic supplementation. Most people seem to get the best benefit when treatment involves all three parts, implemented properly at the same time, as they work together to restore the normal balance of organisms in the small intestine. If anti-fungal agents were taken without concurrent probiotic supplementation for example, with the amount of yeast reduced and no supply of beneficial bacteria to replace it, the opportunity is there for pathogenic bacteria to become dominant.
The Anti-Fungal Diet
First outlined by Dr. William Crook in his book 'The Yeast Connection', the anti-fungal diet has been an integral part of treating intestinal yeast overgrowth ever since. The aim of the diet is to reduce intake of sugar and refined carbohydrates as well as moldy foods and yeast products. The reason for reducing sugar and refined carbohydrate intake is that yeast feed on sugar and ferment it producing alcohol in the form of ethanol (drinking alcohol) and an even more toxic chemical called acetaldehyde. By reducing the amount of sugar in your diet you are also reducing the amount available to the yeast in your intestines. This may help to keep their growth in check and will also reduce the amount of toxic waste products they create as a result of fermentation. Elimination of moldy foods and yeast products is suggested because as a result of an intestinal yeast overgrowth the likelihood of developing an immune reactions to these things is greatly increased. This is as a result of yeast overgrowth leading to leaky gut syndrome and the possibility of "translocation" of the organisms from the intestine into the blood stream and other body tissues where they may cause immune reactions, mainly of the IgG mediated delayed reaction type. As a result, the immune system may cross react with molds and yeasts from your diet.
Foods that must be avoided
Table sugar (Sucrose) and all other simple, fast releasing sugars such as fructose, lactose, maltose, glucose, mannitol and sorbitol. All honey and sugar syrup type products such as maple syrup and molasses.
This includes canned, bottled, boxed and otherwise processed and pre-packaged foods as they more often than not contain sugar of one type or another.
Canned - Baked beans, soups, ready-made sauces
Bottled - Soft drinks, fruit juices, condiments/sauces
Boxed/Packaged - Ready-made meals, breakfast cereals, chocolate/candy, ice cream, frozen foods.
Cheeses: moldy cheeses like stilton are the worst, buttermilk, sour cream and sour milk products.
Alcoholic drinks: beer, wine, cider, whiskey, brandy, gin and rum.
Condiments: vinegar and vinegar containing foods like mayonnaise, pickles, soy sauce, mustard and relishes.
Malt products: cereals, candy and malted milk drinks.
Edible fungi: including all types of mushrooms and truffles.
Processed and smoked meats: sausages, hot dogs, corned beef, pastrami, smoked fish, ham, bacon.
Fruit juices: All packaged fruit juices may potentially contain molds. Fresh fruit juices are allowed in moderation due to their sugar content.
Dried fruits: raisins, apricots, prunes, figs, dates etc.
Foods to be eaten in moderation
Grains: Wheat, rice, corn, barley, millet, oats.
High carbohydrate vegetables: sweet corn, potatoes, beans and peas, sweet potatoes, squashes, turnips, parsnips.
Anti-fungal drugs and natural products
For mild cases the diet along with healthier lifestyle choices in general may be enough to resolve the problem, however in moderate to severe problems an anti-fungal drug or a natural product with anti-fungal activity will need to be taken as well. The question of whether to use a drug or a natural product is one for you and your doctor to decide upon. From personal reports and the limited scientific evidence that is available, a lot of the natural products do seem to be as effective as many of the anti-fungal drugs. The exception maybe the systemic drugs which are usually reserved for cases that won't respond to either drugs that only act in the intestine, such as Nystatin, or the natural anti-fungal's. Most doctors treating yeast overgrowth suggest that patients will need to take the majority of anti-fungal's for at least 3 months and some will have to stay on them indefinitely. Of course most will be somewhere in between these extremes. Below we'll take a look at the most common anti-fungal's. and the advantages and disadvantages of each. It should be noted here that with any anti-fungal treatment there is a chance of experiencing what is known as the Herxheimer or "die-off" reaction. This is said to occur as a result of the yeast being killed too rapidly which overwhelms the body with yeast cells and their toxins. Any number of nasty symptoms can arise as a result, most frequently a flu-like feeling or worsening of symptoms already present. The solution to this may be to take a lower dose of anti-fungal for a while or take extra fibre or a product like bentonite clay to help carry the toxins out of the body before they are absorbed.
Medications
Nystatin
Nystatin was one of the first anti-fungal drugs developed and probably the most commonly used to treat intestinal yeast overgrowth. It is extremely safe due to the fact that hardly any of the drug is absorbed from the intestinal tract. As a result the only side-effects that may occur are mainly restricted to the digestive system and are usually mild. In addition, in rare cases patients may develop a rash as a result of an allergic reaction. Nystatin is available in a number of different forms including, tablets, powder and liquid oral suspension. You can therefore choose the form that suits you best. The liquid and powder forms are probably superior to tablets because they don't need to be digested before they start to work and hence will kill yeast further up the digestive tract. The only drawback to this is the extremely foul taste! The usual dosage of nystatin ranges from 1 tablet or 1/8 of a teaspoon of powder 4 times a day to 8 tablets or 1 teaspoon 4 times a day. Another advantage of this drug is that it is very cheap compared to all of the others. As a result of it being cheap, safe and relatively effective, nystatin is likely to be the first choice treatment for many people and their doctors. The only drawback is that due to its widespread use for decades certain yeast species are becoming resistant to it.
Amphotericin B
This drug is similar to nystatin as it is chemically related. As with nystatin it is not absorbed from the intestine in any significant amount so again is very safe. You may hear stories of amphotericin being very toxic or poisonous but don't worry, this is most likely referring to IV use of the drug in hospitalized patients suffering a fungal infection of the blood or severe infection of body tissues. This doesn't apply to its use in the digestive tract. Amphotericin B may be effective in cases where nystatin has failed so it is something to consider if that is the case with you. The drawback of this drug is the cost, it is significantly more expensive that nystatin and therefore is rarely used as a first line treatment unless a sensitivity test has indicated it to be the most effective in a particular patient.
Diflucan (fluconazole)
Diflucan belongs to a group of drugs called the 'azoles' and unlike the previous two drugs, Diflucan is absorbed by the intestines and is referred to as a systemic anti-fungal drug. Diflucan is a more modern drug than nystatin and amphotericin, it was first used in Europe during the 1980's and licensed in the US in 1990. A lot of doctors and patients have found Diflucan (and other azoles) to be effective where nystatin and amphotericin have failed. It has been found to be very safe considering its systemic action with few side-effects reported by patients. The dosage range is typically from 100 to 600mg a day with period of treatments ranging from a few weeks to many months or in rare cases, indefinitely. Treatment with Diflucan is certainly not cheap, current prices are typically $150-$200 for 30 100mg tablets. With some patients needing up to 600mg or more a day the price will put it out of reach for many if insurance won't pay for it. These prices were from a major online pharmacy, if you shop around you will likely find significantly cheaper sources.
Sporanox (itraconazole)
Sporanox is one of the newest azole drugs being licensed in the US in 1993. It would seem to be similar in safety and effectiveness as Diflucan but may be a more successful treatment for certain species of candida and other fungal infections as Diflucan may be more effective for other species. Unless you have a stool sample tested and a particular species of candida/yeast can be detected and tested for sensitivity to different drugs, it is a matter of trial and error with regards to which will work best for you. Dosages are typically 100 to 400mg a day and prices are comparable to Diflucan, possibly being slightly more.
Nizoral (ketoconazole)
This drug was the first of the azole drugs to be developed but its use is limited due to the possibility of serious liver damage. As a result, patients must undergo regular liver enzyme tests during treatment to monitor the effects. In cases that have failed to respond to any other anti-fungal agent its use may be justified but otherwise it is probably best avoided.
Lamisil (Terbinafine HCL)
This is the newest anti-fungal drug in routine use. It is a systemic drug but is unrelated to the other systemic 'azole' drugs. As a result it is an effective treatment as yeast have not yet had chance to develop resistance to it. Lamisil has become more and more widely used since its introduction a few years ago and is set to become the systemic drug of choice, replacing Diflucan. As with most of the systemic drugs there have been instances of adverse effects on the liver and as with Sporanox, Lamisil has recently been linked with congestive heart failure. Lamisil is marginally more expensive than Diflucan and Sporanox with 30 250mg tablets costing between $200 and $250.
Natural Anti-fungal's
Saturated Fatty Acids
Undecylenic and caprylic acids are common medium chain saturated fatty acids used to treat yeast infections. Both are found naturally in the human body in small amounts. Common commercial sources of caprylic acid are palm and coconut oils, whereas undecylenic acid is extracted from castor bean oil. Caprylic acid products are far more common than those of undecylenic acid but don't assume this means it is better, undecylenic acid has far more research data avilable on it and was the treatment of choice for fungal skin infections for a long time before newer drugs arrived1,2. Both have been shown to be comparable to a number of common anti-fungal drugs. In fact undecylenic acid was the main agent used to treat fungal infections prior to the development of newer drugs and is still prescribed today for some infections. A typical dosage for caprylic acid would be up to 3600mg per day in divided doses with meals. Undecylenic acid is commonly taken in dosages of up to 1000mg per day, again in divided doses. A major advantage of using natural products over drugs is the cost. A months supply of either of these fatty acids will cost only about $20-30 for a quality product.
Berberine
Berberine is an alkaloid found in a herb called barberry (Berberis vulgaris) and related plants as well as in goldenseal, oregon grape root and Chinese goldthread. This herb has long been used in chinese and ayurvedic medicine. Berberine has significant anti-fungal activity and is also effective against some kinds of bacteria. As with all previously covered anti-fungal's, berberine is reported to spare beneficial organisms such as lactobacilli species. An added benefit for some people is its anti-diarrheal action. Research has shown that berberine can effectively prevent candida species from producing an enzyme called lipase which they use to help them colonize3. Berberine has also been widely shown to have a powerful directly anti-fungal action4,5 Cost of treatment with berberine is roughly equivalent to that of the fatty acids.
Oregano
Most people will be familiar with oregano as the strong smelling herb commonly used as a seasoning in Italian food. This is usually Oregano marjoram rather than Oregano vulgare that we're interested in here. Oregano vulgare contains a variety of substances that make it an effective anti-fungal. In a study assessing its action against Candida albicans, carvacrol, a major phenolic constituent of the oil, was found to inhibit candida to a greater extent than caprylic acid. It is also highly effective against many bacteria with studies published in the most prestigious medical journals showing it is as effective as many antibiotic drugs. Usually supplied in oil form, oregano treatment will cost around $25 per month. It is very potent so only a few drops in a glass of water are needed at a time. Higher dosages would be likely to cause irritation of the mucous membranes.
Garlic
Garlic (Allium sativum) contains a large number of sulphur containing compounds that exhibit potent anti-fungal properties. Among the most studied are allicin, alliin, alliinase and S-allylcysteine. Some studies have found garlic to be at least as effective as nystatin at killing Candida albicans. A point that should not be overlooked is that because of the many different compounds with anti-fungal properties in garlic, yeast and fungi are unlikely to become resistant to it. Garlic also has many other beneficial properties particularly for the cardiovascular system. It has been shown to lower levels of LDL cholesterol and act as an anti-coagulant, lowering blood pressure as a result. Like barberry, garlic has a long history of medicinal use, reportedly dating back as far as 3000 years. For treating intestinal yeast infections garlic is available in a number of different forms including, odorless capsules, liquid extract and tablets. However, a study at the National Institutes of Health found that fresh garlic was significantly more potent against Candida albicans. It also found that the fresh garlic could be a suitable alternative to drugs for serious systemic infections in patients with severe immune suppression. Therefore adding garlic to food (raw) or crushing and swallowing raw cloves if you can tolerate it, is a cheap and powerful anti-fungal treatment.
Colloidal Silver
A colloid is defined as very small particles of one substance suspended (not dissolved) in another. Colloidal silver is a suspension of silver particles in water. Silver is a well known anti-microbial, it is commonly used in items such as water filters to kill any microbe that may be in the water, including bacteria, fungi, worms and protozoa. Colloidal silver is said to be effective against up to 650 pathogens including, of most interest to us here, yeast and fungi species including Candida. It works by denaturing the enzyme involved with supplying the organism with oxygen. Chances of resistance to this process are by all accounts, very low. It was used widely to treat infection before the development of antibiotic drugs. It is now classified as a pre-1938 drug by the FDA which means that it is available without prescription. The number of companies offering colloidal silver as an alternative to antibiotic medications is increasing daily. The renewed interest can be explained by the increase in chronic infections and the fact that many microbes are becoming resistant to the commonly used drug treatments. The dosage of colloidal silver needed to treat yeast overgrowth will vary between products because they may have slightly different concentrations. Prices are similar to the other natural products discussed at about $30 for an 8oz bottle.
Cellulase
This is a relatively new treatment approach for intestinal yeast infections. The cell wall of common intestinal yeast such as Candida species have been found to be made mainly from cellulose. Cellulase is the enzyme that breaks down cellulose and hence, when significant concentrations come into contact with yeast cells the cell wall is irreparably damaged and the organism dies. It's claimed that using this mode of action, the yeast do not release a flood of toxins when they die as occurs with most other anti-fungal agents so that the sufferer does not experience the usual die-off symptoms to any significant degree. The yeast should be unable to develop resistance to cellulase products as they lack the ability to modify their cell wall. As cellulase products have only been around for a few years reports of their effectiveness in practice is limited but they offer a promising alternative to more established treatments. Prices again, are in a similar range to all the natural anti-fungal's.
Plant Tannins
Tannins are natural substances found in a number of plants such as Black Walnut and a vast array of plants used in traditional eastern medicine. Tannins are what give red wines such as merlots and cabernets their sharp, biting taste. They are also found in the bark of trees that are particularly resistant to fungus such as the redwood tree. They have been demonstarted to have a powerful anti-fungal and astringent action in a multitude of clinical studies6,7,8. Tannins are one of a number of natural substances tested against pathogens found in stool samples by functional medicine labs. More information can be found on these tests here. Tannins are available in a number of froms to treat intestinal yeast overgrowth. As previously mentioned they are the active anti-fungal ingredient in many traditional eastern herbal preperations. Black walnut has a very high tannin content and is commonly used to treat infections with Candida sp, parasites and worms. It is widely available from health stores and nutritional supplement suppliers. Tannins are also available in an isolated and concentrated form. Treatment with plant tannins is comparable in cost to most natural anti-fungal agents, being in the region of $15-$30 per month.
Probiotics
It is essential that as the yeast overgrowth is being treated probiotic bacteria are consumed to take the place of the yeast colonies. To learn more about probiotics click here
References
Candida & Gut Dysbiosis Forums
Useful Books - In association with Amazon
Complete Candida Yeast Guidebook: Everything You Need to Know About Prevention, Treatment & Diet
Complete Candida Yeast Guidebook: Everything You Need to Know About Prevention, Treatment & Diet
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