Everything You Need To Know About Candida Overgrowth (Part 3)
In Part 1 of this series, I covered what Candida is (and isn’t) and how it could be present in your body. In Part 2, I covered the symptoms and root causes. Today, we’re going to talk testing for and treatment of Candida.
So, you’ve read Parts 1 and 2 of this series. You understand what Candida overgrowth is, and (I hope!) you even understand HOW it can cause so many systemic symptoms.
And if you’ve made it here to Part 3, you probably suspect that chronic Candida overgrowth is something you could be dealing with.
Today, I want to share how I work with patients in my clinic who present with Candida symptoms. I hope this is helpful to you - and please don’t forget that I’m here for you! My passion in life is supporting women through health challenges like Candida overgrowth so they can overcome them and get on with the stuff that really matters in life!
If you want to learn more, book a free 15 minute consult with my team by clicking here.
Testing For Candida Overgrowth
“Don’t guess, test” is one of my mantras for life.
There are some instances where guessing is perfectly fine - but when it comes to something as vital as your health, why mess around??
Testing is more accurate and affordable than ever before. It ensures we know exactly what we’re dealing with - and aren’t wasting time, money, and energy on the wrong treatments.
With a condition as diverse as Candida overgrowth, testing is especially important. The same symptoms could be caused by hormone imbalances, gut dysbiosis, HPA axis issue, SIBO and more… so bottom line: don’t guess, test!
In my clinic I use a few different tests (depending on the patient).
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- Stool Tests - not all stool tests can pick up Candida, but advanced ones like the GI-Maps and Genova GI-Effects can. I like to order a comprehensive stool test on all my patients because it can reveal a ton about your overall health - not just candida!
- Organic Acids Panel - This test (I like the Organix test from Genova) looks for D-arabinitol, a specific marker for invasive candidiasis. Some other organic acids panels look for arabinose as a marker instead, but I don’t like those, as they can easily give false positives based on what you’re eating. Organic acids tests are another of my favorite tests because of the breadth of information they can provide (and they’re totally non-invasive!)
- Blood testing - antibodies in your blood can show past or current level of candida overgrowth… but can’t tell you which. (I rarely use blood testing).
- Culture sample - you can take scrapings from the vaginal mucosa, vulva, oral cavity, etc and culture it to identify candida. (Again, I don’t usually use this testing myself).
And this is important - be sure you test BEFORE you complete any treatment for candida. If you’ve recently treated candida, your test will probably come back negative - but that doesn’t mean you don’t have any remaining yeast - especially if it is invasive.
Before You Go Any Further...
When you have Candida overgrowth, your white blood cells produce antibodies to fight the candida called IgE immunoglobulins, which also cause allergic reactions.
More IgE is made every time you have another yeast infection flare. When the IgE reacts against the Candida, it causes the release of histamine. Histamine makes your blood vessels dilate and can cause swelling, redness, itching, and burning (in super fun places like the vagina, sinus, and gut).
When you treat the candida, killing it causes the yeast to release antigens, causing an increase in IgE… which means more histamine symptoms (itching, burning, redness).
Basically - all of this was to say: you’re very likely to experience die-off symptoms when you treat candida!
The bummer is that this WHOLE process weakens your immunity. The increased levels of histamine suppress your white blood cell mediated immunity and inhibit the production of T cells.
This means that supporting your immune system during Candida treatment is absolutely necessary! You must protect and support immunity ON TOP of changing your diet, using antifungals, and doing leaky gut repair.
Don’t forget your immune system in this process!
How I Treat Candida Overgrowth
Step #1: Clean Up Your Microbiome
Before you treat Candida, you need to clean up other gut infections. A stool test can identify which bacteria overgrowths or parasites you’re dealing with. If you don’t get a handle on this first, your Candida treatment won’t be effective!
Probiotics and prebiotics can also help. Lactobacilli bacteria can inhibit the growth of candida albicans (I like the Femecology formula by Vitanica). Both oral supplementation and vaginal use can help.
Step #2: Adapt Your Diet
Most people don’t need to go on a super-restrictive, very low-sugar diet - but most people do need to make SOME changes.
A yeast-free, carbohydrate restricted diet alone won’t cure candida overgrowth. In a study of those with chronic candida, diet and anti-fungals was shown to be the most effective treatment (compared to diet and antibiotics, or diet alone). In fact, antibiotics and diet combined had the WORST outcomes!
For my patients, I recommend:
- 80 grams or less of carbohydrates daily (avoiding refined and processed carbs entirely)
- Avoid dairy (except ghee, butter, and some cheeses)
- Avoid yeast in foods (like kombucha, alcohol, and apple cider vinegar)
- Avoid all refined sugar
- Avoid alcohol
Step #3: Antifungals
To get rid of Candida overgrowth, you must use an antifungal that can kill the yeast overgrowth.
In certain cases, I have seen clients gain greater success by combining natural antifungals with prescription antifungals like Nystatin or Difllucan, for limited periods through the extended herbal treatment period. Nystatin is not absorbed outside of the gut (it is local, not systemic), so it’s a good choice. Most systemic antifungals (like Diflucan) can cause elevations in liver enzymes. If you’re using a systemic antifungal, you need to have liver testing before starting and every 2 weeks of treatment.
But there’s also plenty of evidence that Candida is becoming resistant to antifungal drugs - just like bacteria are becoming resistant to antibiotics. Yikes!
That’s why, I always use a well rounded botanical protocol alongside prescription antifungals to help prevent resistance.
The 2 keys to remember when using natural products like garlic, caprylic acid, undecylenic acid, lauric acid from coconut, lactoferrin, propolis, specific enzymes, and essential oils like oregano and cinnamon:
- Treat long enough! 7-10 days of treatment is not enough. It might clear some symptoms - but you need at least 8 weeks of treatment (sometimes more) to truly clear Candida overgrowth.
- Use the right dosage! If you take natural products in the wrong amounts, you won’t only not get better - but you risk damaging your microbiome. Don’t mistakenly believe they are safe at any dose because they are natural--I’m looking at you, oregano! I highly recommend working with a professional (like me) to get the right doses.
Step #4: Hyphae Interrupters
Remember the “roots” Candida can grow called hyphae? A good Candida protocol should also include something to help hyphae release from the gut wall.
In my practice, I like to use undecylenic acid. It’s a fatty acid obtained from castor bean, and it helps disembed hyphae from the intestinal wall.
Treating Tough Cases
Truthfully, I think every case of Candida is a “tough case.” Most of my patients need the specialized support I can provide after working with Candida overgrowth for years to get better.
For those with repeat vaginal Candida, monthly mid-cycle treatment can help (alongside systemic treatment). We use vaginal treatments for 3 days, and often for 3 more days prior to the start of your period, for 3-9 months to help stop the yeast cycle.
And for those with a history of Candida, we take preventative measures if they have to use antibiotics, corticosteroids, PPIs, or are following an elemental diet (as a treatment for SIBO). Preventative antifungals can help keep Candida at bay!
Need Help With Candida?
We’ve covered a LOT in these 3 articles (make sure you read parts 1 and 2 as well!) and I know you might be feeling overwhelmed.
Are you uncertain if Candida overgrowth could be an issue for you? Not sure what the next step should be? I get it!
My job as a clinician is to take all this complicated stuff and make it easy for you to get better. No more confusion, just results.
I’d love to work with you. Don’t be shy - book a free 15-minute consult with my team. It’s a no-obligation way to see if we can help you. I hope to chat with you soon!
Everything You Need To Know About Candida Overgrowth (Part 2)
In Part 1 of this series, I covered what Candida is (and isn’t) and how it could be present in your body. In Part 2, we’re going to cover the symptoms and root causes. Be sure to look for Part 3 (all about how I treat Candida in my practice!).
Sugar cravings, brain fog, joint pain, fatigue… these are just some of the nonspecific symptoms often attributed to chronic Candida overgrowth.
But the problem is these same, ambiguous symptoms can be caused by multiple conditions! So how do you know if a Candida diagnosis is really something you should pursue?
Today, I’m going to dig into the symptoms that send up red flags for Candida in my practice - and I promise, it’s a lot more than “exhausted mom craves dark chocolate before bed!”
I’m also going to talk about the risk factors and root causes that make a Candida overgrowth more likely.
Here, There, Everywhere: Candida Symptoms
The most striking characteristic of Candida is its complexity. While no two people with chronic Candida may have the *exact same* symptoms, they will all have a variety of seemingly unrelated symptoms - ranging from “annoying” to “life-altering.”
Here are just some of the places you might have Candida-related symptoms:
- Central nervous system,
- Gastrointestinal tract (digestive)
- Genitourinary tract
- Endocrine glands
- Skin
- Muscles and joints
- Respiratory system
How could one condition cause so many different symptoms?
How Candida Can Mess With Your Whole Body
This gets kind of complicated, so I’m going to try and make it as simple as possible to understand.
Candida can produce acetaldehyde and ethanol (AKA the same compound we drink in alcohol!) when the yeast in the gut ferment sugar and carbs. In fact, Candida can produce so much ethanol, it can cause your blood alcohol level to rise and make you drunk. (This phenomenon is called Auto-Brewery Syndrome).
Then, when the ethanol or acetaldehyde is oxidized, it requires that Nicotinamide adenine dinucleotide (NAD) be changed from its oxidized form (NAD+) to its reduced form (NADH). It’s basically like drinking a 6-pack daily - but without the fun part!
(You may have heard about NAD as an anti-aging supplement. NAD is a really important cofactor and levels reduce over time, as we age. Some promising research suggests that raising NAD levels can reverse mitochondrial damage - aka the effects of aging!)
OK, here’s what all this means: chronic Candida causes the production of a bunch of alcohol inside your body. To get rid of the alcohol, NAD+ is converted to NADH. Over time, this leads to lower levels of NAD+ in the body - and that can lead to a cascade of symptoms.
Low NAD+ levels are linked to chronic illnesses like diabetes, heart disease, Alzheimer’s vision loss, and premature aging. Higher levels of NADH can lead to less mitochondrial energy production, lower levels of serotonin, and problems metabolizing proteins, fats, and carbs.
But that’s not all...
Acetaldehyde produced by Candida can also impact the membranes inside your body. Membranes are the outer layers of cells and act as “gatekeepers” of your cells - keeping bad stuff out, letting good stuff in, and transmitting messages.
When this happens to the cells in your gut, you develop “leaky gut” - aka increased intestinal permeability. Leaky gut causes by Candida can further complicate the symptoms caused by Candida.
If You Have Candida, You Might Also Have…
Here are some of the most common symptoms of Candida I see in my clinic:
- Sugar cravings - yes, this one is “overplayed” but real! Candida will send signals along the gut-brain axis to make you crave more sugar.
- Allergies - Candida releases chemical mediators like histamine, leukotrienes, and prostaglandins that all lower your body’s white blood cells’ effectiveness. You might have rhinitis, chronic hives (urticaria), or asthma. Candida can also cause chronic stuffiness.
- Inflammatory Bowel Disease - individuals with high Candida burdens appear to be more prone to intestinal inflammatory diseases.
- Carpal Tunnel Syndrome - this occurs as an effect of acetaldehyde.
- Formaldehyde Sensitivity - formaldehyde is processed through the same detox pathways as acetaldehyde, and with that system overburdened, you may have trouble detoxing formaldehyde.
- Histamine sensitivity and intolerance - again, histamines are processed through same detox pathways as acetaldehyde. This can lead to food intolerances, rashes, and hives.
- Central Nervous System Symptoms - especially common is trouble with short-term memory, a result of acetaldehyde lowering the availability of acetylcholine (an important neurotransmitter)
- Rashes - dermatitis, psoriasis, eczema, hives, jock itch, diaper rash are all common symptoms. Especially on nails, in skin folds, and in the area of the groin or genitals.
Root Causes & Risk Factors for Candida
There’s no way I could cover every potential symptom of Candida, but if you read anything on the above list that was a little too familiar, keep on reading.
Now it’s time to talk about the most common risk factors and underlying causes for Candida overgrowth.
This is a BIG list, but I’m taking the time to write them all out because most people have multiple predisposing factors - and for each one you have, the likelihood of Candida becoming a problem for you increases.
Risk factors are cumulative. That means, the more times you take antibiotics (for example), the more the ratio between opportunistic yeast and good bacteria shifts. Eventually, Candida levels will rise above a threshold and symptoms develop.
#1: Antibiotics or Steroid Use
The number one cause of Candida overgrowth is prolonged use of antibiotics (especially broad spectrum). The worst offenders are penicillin, clindamycin, vancomycin, metronidazole, Cipro, keflex, zithromax, augmentin, bactrim and erythromycin.
These drugs kill both aerobic bacteria and anaerobic bacteria. Anaerobes help prevent yeast colonization by inhibiting the ability of Candida to adhere to the gut wall. They can also lead to decreased digestive secretions and altered pH.
Corticosteroids work by suppressing the immune system, so it’s understandable why can predispose to yeast!
#2: Hormone Changes
Any change in hormone levels put you an increased risk for Candida overgrowth:
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- Oral contraceptive use has been shown to increase Candida in the oral microbiome , which leads to the gut (in fact, studies show that just brushing teeth 3 x daily reduced levels of Candida in the stool!)
- Estrogen replacement therapy (for any reason)
- Pregnancy not only causes increased levels of estrogen - but also causes natural immunosuppression and increased cortisol levels to keep the mother’s immune system from attacking the fetus. This creates an ideal environment for Candida to take hold!
#3: Diet
Candida thrives on a diet rich in glucose - the simple sugar found in foods like bread, pasta, and refined sugar. Dietary glucose is necessary to start the process of candida invading tissues.
But please know: this doesn’t mean the answer to Candida is simply a zero-sugar diet! More on this in Part 3!
Diabetes and high blood sugar also put you at increased risk for Candida overgrowth.
Finally, alcoholism - or even just frequent alcohol use - increases risk of Candida. Beer, wine, and other fermented alcohols promote Candida colonization, and all alcohol inflames the gut lining, making you more prone to inflammation, dysbiosis, and leaky gut.
In those already genetically prone to alcoholism, research has suggested that Candida overgrowth (and the Auto-Brewery syndrome it can cause) can even lead to a Candida-perpetuated form of alcoholism. (Other research has also established the connection between intestinal fungal overgrowth and alcoholic liver disease.)
#4: Nutrient Deficiency
Nutrient deficiency goes hand-in-hand with some of the other risk factors listed here. Low stomach acid (which can be caused by antibiotic use, stress, antacids, or PPI drugs) can cause incomplete digestion of the food you eat.
Poor diet (like too much sugar or refined carbs, and not enough fruits and veggies) can lead to nutrient deficiency, too.
Iron, zinc, and biotin deficiency are all risk factors. Both too much and too little iron (anemia) can predispose you to Candida. Iron stimulates yeast overgrowth, but low iron can interfere with the white blood cell’s ability to function and fight infection.
#5: Environmental Factors
Pesticides like glyphosate have been shown to disrupt the microbiome, reducing beneficial bacteria that help to protect you from Candida overgrowth.
High levels of stress dysregulate the HPA Axis, and can cause abnormally low or high cortisol levels. We know stress is associated with an increased risk of vaginal Candida - and I suspect if we studied it, we’d find it also tracks with gut Candida.
#6: Gut Health
If you already have altered bowel flora - aka dysbiosis - you’re at increased risk for Candida.
Overgrowths of H. pylori and Streptococcus facilitate Candida overgrowth.
This is why it’s so important to treat those other bacterial overgrowths and gut dysbiosis alongside Candida. If you’re trying to clear Candida without addressing overall gut health, it’s like chasing your own tail! (More to come on this topic in Part 3).
#7: Impaired Immunity or Underlying Disease States
If you have Candida, overgrowth, it’s a major sign your immunity is decreased. Likewise, if you have known decreased immunity, you’re at increased risk of Candida.
Conditions like thyroid dysfunction and diabetes can also predispose you to Candida overgrowth.
Start Counting…
Most people have multiple risk factors and symptoms for Candida overgrowth. If you count up all your symptoms and potential risk factors, what number do you come up with?
If you have more than one or two, be sure you read Part 3 of this series, where we’re going to discuss how you can find out if you actually have Candida overgrowth - and if you do, what to do about it!
I’ll share the tests and protocols I use with patients in my own practice - so don’t miss Part 3!
Everything You Need To Know About Candida Overgrowth (Part 1)
Depending on who you ask, Candida overgrowth is either entirely made up or the root of all disease.
Some experts claim as much as 90% of people have chronic candida overgrowth and it causes a gamut of health issues from weight gain to cancer. Others say it’s only an issue in acute cases like oral thrush or vaginal yeast infections (which can be easily treated and eradicated).
So what’s the truth?
As with most things, the truth is somewhere in the middle. Chronic candida is a research-backed condition, but that doesn’t mean everything you’ve heard about it is true.
As a functional medicine practitioner, I’m interested equally in what the research has shown and what my patients are experiencing. In this series, I’m going to share everything I know—both from research and anecdotal experience—about candida overgrowth with you.
This will be a multi-part blog post. Today, we’re going to focus on what Candida is (and isn’t) and how it presents.
Part 1: What The Heck Is Candida?
First of all, you need to know that 99% percent of the time, when you hear “Candida,” it refers to Candida albicans.
Other species do exist (C. glabrata, C. krusei, C. tropicalis and C. parapsilosis for example) but C. albicans is the most common. For the rest of this post, know that I’m talking about C. albicans when I say “Candida.”
OK—moving on.
Candida is normally a commensal fungus that lives in your oral, gastrointestinal, and genital tracts and is part of the “world of microorganisms” that live inside your body and make up the microbiome.
“Commensal” means that Candida gets nutrients from you without causing any harm. Your body recognizes the Candida as a “friendly” fungus and doesn’t mount an immune response against it.
As a commensal fungus, Candida is very common: approximately 80% of healthy people have commensal Candida living in their mouths, guts, and vaginas. In fact, it’s completely normal for Candida colonization of the vagina to increase in puberty as hormonal shifts make the vagina even more hospitable to fungal growth.
The main point is: Candida isn’t all bad! For most people, it’s just part of a healthy microbiome.
But that can change when Candida shifts from “commensal” to “pathogenic.”
Here’s What Happens When Candida Breaks Bad
Under specific conditions, Candida can shift from it’s normal commensal state to a pathogenic state, overgrow, and cause symptoms.
This happens in two ways:
#1 Candida Changes Form
Under certain circumstances (like a change in temperature or acidity) Candida can go through a process called “morphogenesis” and change form from one your body recognizes as friendly to one it sees as an enemy. The result is an immune response from your body toward the new form of candida. This is also when candida can grow “roots” - aka hyphae - and start burrowing into intracellular space.
#2 Your Body Starts Reacting To Candida
The Candida doesn’t always have to change form for a response to happen. In vulvovaginal candidiasis (vaginal yeast infection), the Candida that’s normally present in the vagina doesn’t necessarily change form (although that can also happen) - but the tissue of the vagina creates an immune response against the Candida.
This means that the symptoms are caused both by Candida changing form AND your body changing how it reacts to the Candida.
Acute vs. Chronic Candida Overgrowth
Acute Candida overgrowth is called candidiasis. This is the typical vaginal yeast infection or oral thrush, but can also cause infections in the esophagus and intestines.
The acute form results in an overgrowth of yeast on mucosal surfaces (like your mouth and vagina), but that’s not all. During active infection, Candida can grow hyphae, which are like roots that can burrow into intracellular spaces. With hyphae, Candida can invade deeper tissues and grow inside the epithelial cells. There, they release products of fermentation and enzymes that kill the tissue cells. The result are the white patches that characterize candidiasis (the white is actually dead cells, not clumps of Candida colonies!).
Acute candidiasis is often treated with a short course of antifungal drugs or herbals. But if the treatment is incomplete, the yeast in the epithelial cells won’t be totally eradicated… leading to chronic Candida overgrowth symptoms.
In the chronic form, the Candida is inside the epithelial cells, instead of just on the surface of the cells. The yeast is “dormant” but still releasing antigens that trigger inflammation, and can result in red and inflamed tissues.
The low-grade inflammation caused by chronic Candida can cause pain, tenderness, burning, and more. This is especially common with vaginal yeast infections.
A Closer Look At Vaginal Yeast Infections
About 75% of women will be diagnosed with a vaginal yeast infection at least once in their lives, and Candida is the cause of about 40% of all vaginitis cases. A vaginal yeast infection is probably the most common type of acute Candida overgrowth or candidiasis.
They’re most common in women of reproductive age because they have higher estrogen levels - and estrogen promotes yeast in the vaginal tissues. (Side note: this is also why oral contraceptives increase your risk of yeast infections—they contain synthetic estrogen. More on this to come!)
The symptoms are all too familiar to most women: Itching, redness, burning, white discharge, painful intercourse, yeasty odor, and painful intercourse from tissue irritation. It can also lead to vaginitis and urinary tract infections (UTIs).
The worst part, however, is that yeast infections can become a vicious cycle for women, as the antibiotics used to treat UTIs and vaginitis make women MORE susceptible to yeast infections recurring.
We know that repeat infections can lead to vulvodynia (vaginal pain and tissue irritation) that makes sex painful and everyday activities (like wearing yoga pants and using tampons) uncomfortable. The vulvodynia may very well be caused by the low-grade inflammation of chronic Candida leading to irritated vaginal tissue cells.
But complications from vaginal yeast infections are just one way candida overgrowth can impact your life.
In Part 2 of this series, I’m going to dig into the symptoms chronic candida can cause—and I’m going wayyy beyond just “sugar cravings!” You’ll also learn what the risk factors and predisposing conditions for Candida are.
Recap: Candida Overgrowth
Because this is an intense topic, I want to give a really quick recap before we wrap up this first part of the series.
Here are the main points:
- “Candida” usually refers to Candida albicans
- Candida is a normal, healthy yeast (type of fungus) that lives in about 80% of peoples’ microbiomes
- In certain circumstances, candida can overgrow and change form, causing two types of Candida overgrowth problems:
- #1 Acute Candida Infections - like vaginal yeast infections and oral thrush
- #2 Chronic Candida Overgrowth - low-level, long-lasting candida overgrowth, often a result of incomplete treatment of an acute infection
OK—that’s all for now! I’ll see you back here for Part 2, where we’ll go over the symptoms and root causes of Candida overgrowth in-depth!