What is Candida Overgrowth Syndrome?
The body plays host to a multitude of microorganisms, and a proper balance among them is one of the keys to good health. While bacteria are by far the most common, the body also supports a very small population of another microorganism, a type of yeast called Candida albicans (popularly known as candida).

Normally present in small amounts along the gastrointestinal tract (in the intestines and the mouth), in the vagina, and on the skin, candida is generally kept in check by the immune system and by the body's "good" bacteria. Problems arise, however, when candida grows out of control and excessively populates one or more locations in the body.

Vaginal candidiasis. The most common form of candida overgrowth is vaginal candidiasis (a yeast infection), which frequently occurs after taking an extended course of antibiotics. Because antibiotics can kill many kinds of bacteria, often the "good" strains that typically keep candida within bounds can be destroyed along with the "bad." Candida, however, is unaffected by antibiotics and, in the absence of its natural bacterial counterbalance, proceeds to reproduce wildly. Intense vaginal itching and other discomforts, along with a white discharge, are characteristic signs of a vaginal yeast infection.

Oral candidiasis. Candida overgrowth in the mouth, also called oral thrush, can occur in people using steroid inhalers for asthma (steroids encourage candida proliferation), and in breast-fed infants whose mothers are taking antibiotics. Oral thrush also develops in people whose immune systems are severely depleted--for example, those who are undergoing cancer chemotherapy or immunosuppressive therapy after an organ transplant, or people with AIDS.

Candida overgrowth syndrome (COS). Vaginal candidiasis, oral thrush, as well as candida overgrowths on the skin such as diaper rash, are common medical conditions, and, when they occur, all physicians agree they should be treated. A third type of candida proliferation within the intestines, however, is a controversial disorder, accepted by some physicians and rejected by others as a "fad" diagnosis. It is known variously as candida overgrowth syndrome (COS), chronic candidiasis, or just simply "a yeast problem."

Often it is nutritionally oriented doctors who believe that COS does indeed exist and treat it as they would any medical condition. They contend that candida overgrowth is a specific disorder, which can be responsible for months or even years of chronic ill health. And they assert that even though candida remains confined to the digestive tract and vagina, the overgrowth has far-reaching effects throughout the body.

They also emphasize that COS is totally different from the potentially fatal candida fungal infection of the bloodstream that spreads the organism rapidly throughout the entire body. This life-threatening situation is usually seen only in people with severely compromised immune systems, and it requires specialized hospital care.

In contrast, symptoms of COS are said to develop from several sources. Overgrowth in the intestines can cause excessive gas, bloating, and bowel movement changes; in women, overgrowth in the vagina can bring on recurrent yeast infections. In addition, the body absorbs particles from candida organisms after they die along with chemical substances produced by the live candida itself. The effect of these compounds is felt systemwide, producing such unpleasant chronic symptoms as fatigue, muscle aches, and brain "fog." Because these substances produce symptoms, they are frequently referred to as candida toxins.

In some cases, while still alive, the proliferating candida yeast burrows deeply into the delicate lining of the gastrointestinal tract, damaging it and creating a syndrome called intestinal hyperpermeability or "leaky gut." When this occurs, a person can develop new sensitivities and intolerances to once harmless foods, such as dairy, eggs, corn, and wheat (gluten).

Key Symptoms

· Bloating, gas, diarrhea, constipation, new sensitivities to commonly eaten foods

· Fatigue, headache, depression, irritability, disorientation, dizziness, inability to concentrate

· Sugar cravings, sensitivities to chemicals and perfumes, alcohol intolerance, increased susceptibility to the side effects of medications

· Muscle and joint aches, sinusitis and recurrent colds, recurrent skin rashes

· (In women), premenstrual syndrome (PMS), decreased libido, recurrent vaginal yeast infection, vulvar itching and pain

· (In men), prostate and bladder infections

What Causes Candida Overgrowth Syndrome (COS)?

According to nutritionally oriented physicians who treat COS, the overuse of broad-spectrum antibiotics is by far the most frequent cause of the ailment. People who have been on antibiotic drugs for long periods of time--to treat acne and recurrent sinus infections, for example--are at particularly high risk for developing the disorder. Because antibiotics so effectively wipe out bacteria (both the beneficial strains and the harmful ones), they dramatically disrupt the body's delicate balance of microorganisms. Candida then takes over.

In addition, medications other than antibiotics can also increase the body's susceptibility to candida overgrowth. These drugs include birth control pills and oral corticosteroids (such as prednisone), which are commonly prescribed to control inflammatory and autoimmune conditions such as lupus.

Other factors that can increase a person's susceptibility to COS include stress, a weakened immune system (due to any cause), a high-sugar diet, hormonal changes from pregnancy, and diabetes.

Conventional Treatments

Doctors routinely treat clinical manifestations of Candida albicans overgrowth in the vagina, mouth, and skin. Vaginal yeast infections are so common that self-treatment using over-the-counter preparations is encouraged by most doctors. Likewise, pediatricians and other physicians regularly treat oral thrush and diaper rash.

Candida overgrowth syndrome (COS) is another issue altogether. During the decades since its original description in the early 1980s, COS has merited few articles in conventional medical journals, and it is not mentioned in medical textbooks. Few studies have been conducted, and most conventional doctors are very skeptical about the existence of the condition at all.

And indeed, COS's elusive set of signs and symptoms can make this problem hard to identify unless the patient and/or physician suspect its presence and believe that candida is a real, diagnosable condition. Confusing matters further is the fact that COS often closely resembles other hard-to-diagnose disorders, such as fibromyalgia, chronic fatigue syndrome, food sensitivities, irritable bowel syndrome, and depression.

Over- and Under-Diagnosis. Unfortunately, misinformation about candida overgrowth syndrome abounds. Most of the popular books on COS incorrectly imply that the candida proliferation can be widespread, occuring within virtually every organ. This is simply not the case. Although chemicals produced by the candida are dispersed by the bloodstream, in COS the candida organism itself is not.

Many people who believe they are suffering from candida overgrowth, in fact, may not have it at all. (This can be a risk of reading a book about a disease and making a self-diagnosis.) Such individuals often spend hundreds of dollars on supplements, which in the end are useless because they never had COS in the first place. Others may confine themselves to extremely restrictive diets, or worry unnecessarily about a condition they do not have.

On the other hand, antibiotics are often prescribed and taken for the wrong conditions (for cold and flu viruses, for instance), or for inappropriately long periods. This sets the stage for candida proliferation. Because most conventional doctors are skeptical that COS exists at all, it is possible that many chronically ill but undiagnosed individuals actually have this easily treatable condition. In these cases, many nutritionally oriented doctors believe that the diagnosis of COS is probably being overlooked by doctors every day.

Medications

Natural therapies available for COS (see below) can be useful for mild cases and are a good first step. The most effective COS treatments, however, are prescription antifungal medications, such as nystatin (Mycostatin, Nilstat, Nystex), itraconazole (Sporanox), and fluconazole (Diflucan). There’s some evidence that nystatin has lost some of its effectiveness in recent years, but the other two are both safe and effective.

Tests and Procedures

Most nutritionally oriented physicians who treat COS do not place absolute reliance on any test, preferring instead to evaluate the whole patient. They will begin immediate treatment if the clinical suspicion of candida is great enough. This includes a history of antibiotic overuse plus recurrent vaginal yeast infections (in women) and symptoms suggestive of COS.

The tests that nutritionally oriented doctors order include cultures of both vaginal secretions and stool, along with a blood test to measure antibodies and antibody complexes to the candida. The blood test measures levels of three separate antibodies (IgM, IgG, IgA) that the immune system creates if candida is present, as well as levels of candida antigen, created when a particle of a candida breakdown product enters the bloodstream and triggers an antibody response.

According to some doctors, repeating these tests at the end of treatment is a good way to determine if it has been successful. If it has, levels of a number of these measurements will show a decline.

Treatment and Prevention

Treatment: Most cases of COS are mild and can be fully cleared up with a combination of supplements and lifestyle changes (see Self-Care suggestions below as well). Because the Candida organism burrows deeply into the intestinal wall, it may take several months to fully treat COS. Recommendations include the following:

• Begin with natural remedies. Many nutritionally oriented physicians recommend starting with anti-candida supplements and adding prescription antifungal medications only if needed. There are good reasons for this.

First, many cases of COS are mild enough to be cleared up by natural remedies. And, while safe, prescription drugs can be extremely expensive if not covered by a health insurance plan.

In addition, if the candida count in the intestine is especially high, a powerful prescription drug will cause a massive die-off effect (called a Herxheimer reaction). This creates uncomfortable flulike symptoms because of the release of toxins from large numbers of candida killed simultaneously. With gentler natural remedies, the candida is killed more gradually, lessening or preventing this reaction.

• Revamp your diet. Some changes in your eating habits are necessary to eliminate a candida overgrowth. Start by increasing your intake of protein and high-fiber vegetables, and by consuming moderate amounts of whole grains and high-carbohydrate vegetables, such as potatoes, beets, and artichokes.

At the same time, try to limit or eliminate sugar from your daily fare because candida thrives on sugar. Fruit, though allowable, is also limited during the treatment phase because of its sugar content.

Some practitioners recommend an even more restrictive diet. Pediatrician William G. Crook, M.D., who first popularized COS in his 1983 book The Yeast Connection, also eliminates baker’s and brewer’s yeast, all packaged and processed foods, cheeses, melons, mushrooms, and a number of other foods. Most nutritionally oriented physicians now consider this diet unnecessary, primarily because of the development of better anti-candida supplements and medications.

Prevention: To reduce your risk of developing COS, take measures to:

• Avoid unnecessary antibiotic use. This is by far the most common reason people develop COS. While everyone agrees that appropriately used antibiotics are lifesaving, it's important not to request or take antibiotics for every little cold, flu, or mild sinus infection. Many of these ailments are caused by viruses (not bacteria) which antibiotics can't affect, and usually they just go away by themselves.

If you have a medical condition that requires long-term antibiotics, ask your doctor if a narrow spectrum antibiotic (one that's specific to your infection) can replace a broad spectrum drug (one that kills all bacteria, good and bad).

If you need to use antibiotics, also take probiotics (Lactobacillus acidophilus, Lactobacillus bifidus, saccharomyces boulardii) for at least two to three weeks after your antibiotic treatment is completed. They will help restore your natural bacterial balance.

Important note: When you do get a prescription for an antibiotic, always finish the bottle. By not doing so, the offending bacteria can become more resilient and cause problems later on.

• Avoid unnecessary steroid use. If you have a medical condition requiring steroids, work with your doctor to reduce your dose to the lowest amount that is effective for your condition. If you use a steroid inhaler, rinse your mouth after each use. Even the nasal steroid sprays can cause candida problems. Since it’s difficult to rinse your nasal passages, try to use nasal steroid sprays only when absolutely necessary.

• Get checked for diabetes, especially if you are middle-aged, obese, or have a positive family history for the condition. People with diabetes are especially susceptible to candida infections.

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