Functional Nutrition for Candida

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What is candida albicans?

Candida albicans is a variety of yeast that naturally grows in the gastrointestinal tract, reproductive tract, mouth, and skin of humans.

It normally grows at low levels, in symbiosis with the rest of the microbiome, but it can occasionally grow out of hand and require treatment.

In some cases, candida can spread systemically and become fatal (1). It is believed that many systemic infections originate from gastrogenitourinary overgrowths, so prevention is key (23).

What are the symptoms of candida overgrowth?

Symptoms of candida overgrowth can include:

  • Chronic fatigue (4)
  • Depressed mood (5)
  • Food and/or chemical sensitivities (5)
  • GI issues – gas, bloating, constipation or diarrhea (5)
  • Poor immunity (5)
  • Rectal itching (5)
  • Trouble concentrating (5)

What factors are associated with a greater risk of candida overgrowth?

The following factors have been associated with candida overgrowth:

  • Antibiotic use (6)
  • Being female (5)
  • Catheter use (7)
  • Celiac disease (8)
  • Chronic antacid or PPI use (5)
  • Corticosteroid use (6)
  • Damage to the lining of the intestinal tract or mucous membranes (9)
  • Denture use (10)
  • Diets high in simple carbohydrates (111213)
  • Diseases that suppress the immune system, like HIV/AIDS, leukemia, etc (7)
  • Drugs that suppress the immune system (like radiation or cytotoxic therapy) (7)
  • Gut dysbiosis (14)
  • High estrogen levels / hormone replacement therapy (7)
  • Hypothyroidism (5)
  • IBD (15)
  • Inflammation (15)
  • Inhaler use (16)
  • Intercourse with an infected partner (5)
  • Iron overload (17)
  • Low immunity (18)
  • Newborns with very low birth weight (19)
  • Nutrient deficiencies (selenium, zinc, vitamin C, vitamin E) (20)
  • Older age (>70) (9)
  • Oral birth control pills (7)
  • Overconsumption of alcohol (6)
  • Poor digestion (low stomach acid, low pancreatic enzymes, low bile) (5)
  • Stress (5)
  • Type II diabetes (7)

What testing can be done to evaluate candida levels in the gut?

Is the “spit test” for candida valid?

The spit test is widely discussed on the internet as an at-home way to check for candida overgrowth.

The claim is that if you spit into a glass of water first thing in the morning, and the spit is “stringy” in appearance, then you may have candida overgrowth.

There is no scientific evidence to validate this claim.

There ARE ways to actually test your saliva for candida overgrowth, but they are done in a lab, not at home.

An oral rinse sample (containing your saliva) can be cultured for the presence of candida (21).

Flow rates of saliva can also be examined (the higher the candida count, the less the saliva flows) (2223).

How is a fungal overgrowth treated?

The following may be recommended for treating candida overgrowth:

1. Prescription antifungals

  • Fluconazole (Diflucan)
  • Itraconazole
  • Nystatin (caution: may cause liver damage in some people)

2. Herbal antifungals

  • Biocidin – A broad spectrum antimicrobial and antifungal formula to correct dysbiosis. Recommended to take for 2-3 months for the elimination of candida overgrowth, plus a maintenance dose for several months afterward. (See usage chart for more details.)
  • Berberine (24) – Caution, may have a blood sugar lowering effect.
  • Yeast Formula by Integrative Therapeutics – Blend of herbs (oregano, thyme, peppermint, goldenseal) to keep a healthy yeast balance.
  • GI Microb-X by Designs for Health – Contains herbs like wormwood, caprylic acid, berberine etc. to rebalance gut flora.

3. Biofilm disrupters

What are the dietary interventions for candida?

An “anti-candida diet” is often used in conjunction with antifungal medication and probiotics to help eradicate a candida overgrowth and keep it from coming back.

Anti-candida diets are temporary, usually for a few months, in order to rebuild GI health and restrengthen the immune system.

They are typically low in carbohydrates/sugars and do not include yeast-containing foods.

However, it is important to note that human research on this topic is lacking…

One small pilot study in humans found that an anti-candida diet + nystatin was no more effective at eradicating candida overgrowth than nystatin alone, but it was roughly twice as effective at keeping candida at bay over the subsequent 3 months (25).

More human research is definitely needed.

Some of the general recommendations for an anti-candida diet include:

1. Reduce simple carbohydrate intake

Research has linked high-carbohydrate intake to increased abundance of candida in the gut (26).

However, carbohydrate intake has NOT been linked to increased risk of pathogenic overgrowth in humans (there is likely a multitude of factors involved, including reduced immunity or dysbiosis that allows the opportunistic infection the chance to grow, not just diet alone).

The low-carb recommendations stem from the idea that if you are currently suffering from fungal overgrowth, it would probably be wise to reduce your intake of foods that can fuel the fungi.

Examples of simple carbohydrates that are commonly limited or avoided on an anti-candida diet include added sugars, refined sugars, table sugar, maple syrup, fruit juice, and honey (5).

Some, but not all, practitioners also recommend temporarily limiting sugar fruit intake to no more than 2 servings per day.

However, there is currently no evidence to suggest that reducing carbohydrate intake is an effective primary intervention for eliminating candida overgrowth.

2. Avoid alcohol

Alcohol intake has been associated with increased risk of candida overgrowth, so it is typically recommended to abstain from drinking while healing from an overgrowth.

3. Avoid yeast-containing foods and mycotoxins

People following an anti-candida diet also typically avoid foods that contain yeast, however, there is no research to back up this claim.

If the body is already overwhelmed by yeast, it may theoretically be helpful to avoid foods that contain high levels of mycotoxins as well.

Foods that are typically avoided include nuts, cereal grains, dried spices, wine, grape juice, dried fruit, coffee, bread, fermented foods, vinegar, kombucha, and beer.

4. Avoid dairy products (except those with probiotics) 

Since dairy products contain the milk sugar lactose and some dairy products, like cheese, may contain fungi, they are typically avoided on an anti-candida diet. Plain yogurt with probiotics is generally allowed.

However, there has not been any research to show whether these recommendations are effective.

5. Avoid any foods you are allergic or sensitive to

Since candida overgrowth is a highly inflammatory condition and battling it is tough on the immune system, it is generally advised to avoid any foods that you are allergic or sensitive to while on an anti-candida diet.

The goal is to not consume anything that would distract your immune system from battling the candida and to reduce any food-related inflammation that might worsen symptoms.

While the basis behind this recommendation is plausible, there is no research to support it.

6. Use coconut oil

Coconut oil contains caprylic acid, which may help combat candida overgrowth (26).

No human research has been conducted, but one study in mice found that diets rich in coconut oil (18% by weight) significantly reduced candida overgrowth compared to diets rich in beef tallow or soybean oil (27).

7. Address nutrient deficiencies

Deficiencies in nutrients that affect immune function can hinder the ability of the body to fight off candida.

Checking for deficiencies in nutrients like selenium, vitamin C, vitamin E, and zinc (and correcting with supplements) may help (20).

8. Probiotics

Promoting a good balance of gut bacteria is essential for preventing the overgrowth of candida or other pathogens.

A variety of studies have shown that consumption of probiotics via food or supplements can help prevent the candida overgrowth in the mouth, GI tract, and vagina of humans.

Effective adult daily doses have ranged from 3.1 ounces of probiotic-rich yogurt for 15 days, 50 grams of probiotic-rich cheese for 4 months, (2829).

For infants, 5 to 6 billion CFUs per day of S. boulardii or L. rhamnosus while in the NICU have been effective for preventing candida overgrowth (30).

Some proposed mechanisms include competition for nutrients or binding sites on the mucosa, probiotic biofilms protecting the lining of the GI tract, and the production of surfactants and acids that inhibit the growth of fungi (31).

Are there any lifestyle interventions for candida?

It is important to address all possible factors that predisposed the person to candida overgrowth in order to prevent it from returning.

It is typically not enough to just treat with antifungals. The root contributing factors should be addressed too.

Many times poor immunity is at the root of recurring candida infections. Factors that should be addressed include:

1. Stress Management

Chronic stress can impair the immune system, so efforts should be made to reduce stress (32).

Someone can choose whatever stress management technique they enjoy. Suggestions include yoga, meditation, music, art, nature, gardening, or other calming activities.

2. Avoid smoking

Smoking reduces antioxidant status and impairs immunity, so it should be avoided while the body is fighting off candida overgrowth (33).

3. Good sleep hygiene

High-quality sleep is great for the immune system, so good sleep hygiene is recommended (34).

Maintain a regular sleep schedule, even on weekends, avoid caffeine in the evenings, and avoid using screens before bed (computer, phone, tv, etc).

4. Address the root causes!

Are there any additional risk factors that may be disposing someone to a candida overgrowth? Medications, alcohol intake, gut health, poor immunity, etc.? It is important to address the issue from all angles.

Is candida overgrowth related to the onset of celiac disease?

There is evidence that an amino acid sequence (Hwp1) on the cell wall of Candida is very similar to the alpha & gamma gliadin protein T-cell epitopes (35).

Some researchers hypothesize that this could predispose the immune system to form antibodies against gluten.

They also state that tissue transglutaminase and endomysium can attach to the candida, and possibly trigger an autoimmune response against tissue transglutaminase and endomysium.

But… is it the chicken or the egg?

Did the candida infection develop first & trigger the celiac disease?

Or did celiac disease damage the small intestine, which then altered T-cell response in the gut and the rest of the body, which then increased the likelihood of developing a candida overgrowth or having candida misidentified by the immune system as pathogenic?

Regardless, there does seem to be an association between celiac disease and candida overgrowth in the GI tract (10).

Does testing reactive to candida on a food sensitivity test (like MRT) mean you have an active infection?

No, it just means that your immune system has flagged candida as a threat, and may kick off an immune response if it is exposed to it in high amounts again.

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