Chronic candidiasis: causes, symptoms, and treatment — complete conference
Cala Cervera
Orthomolecular Nutritionist
I gave this lecture in 2000 at the Hospital de Sant Pau (Barcelona), as part of a congress on cellular nutrition. Today, I still share many of these ideas in my practice, although my approach has evolved in some aspects over the years. Even so, this talk very well reflects the basis of candidiasis treatment and how I understand this process.
Good afternoon. First of all, I want to thank you all for coming; the Hospital de Sant Pau for providing us with such a beautiful venue; and the organizers for creating this "Congress on cellular nutrition." I feel very privileged to be part of a pioneering congress for what will be the medicine of the future.
When I was asked to speak at this congress, I did not hesitate for a moment to choose chronic candidiasis. It is a disease that needs to be better understood, and its treatments require updating. Many people suffer from it and have not been diagnosed because we still do not know how it acts in the body, and I think it is of vital importance that we talk, research, and publish more about it.
I am going to talk about chronic candidiasis from the point of view of orthomolecular nutrition. This therapy is still very unknown in our country, so I think it is best to start by explaining what it is based on: orthomolecular nutrition consists of giving cells the proper nutrients in the proper doses, so that they function as well as possible. It is a therapy that, above all, respects the biochemical individuality of the person. This means that it does not treat the disease, but the diseased individual.
Two people with candidiasis will always be treated while respecting this individuality. For example, one might be treated with a diet rich in protein, cooked foods, and vitamin C and zinc... while another, with the same symptoms, may need more carbohydrates, raw foods, and nutrients like vitamin A and biotin. Because of this biochemical individuality, it is difficult to give talks, because in them we are conditioned to speak in general terms. However, bearing this in mind, I am going to share with you the general guidelines for the treatment of chronic candidiasis.
The two groups of patients
It is of vital importance that we distinguish between two large groups of patients suffering from candidiasis:
The group of diagnosed patients, which mainly includes patients with vaginal and/or oral candida, those suffering from immunosuppressive diseases, those receiving chemotherapy, and diabetics. In these cases, the candidal manifestation is very clear and laboratory tests usually diagnose it.
On the other hand, there is the group of undiagnosed patients, which is usually the majority of people suffering from chronic candidiasis. This group is characterized by presenting a very extensive, very confusing, cyclic, and recurrent symptomatology, but, nevertheless, analytical and laboratory tests are usually normal. Because of this lack of diagnosis, and consequently, the absence of treatment, candidiasis usually becomes chronic. This talk is focused on this type of candidiasis, chronic candidiasis.
The subject of candidiasis has been criticized extensively. It is said to be a fashionable disease and that many therapists are guilty of interpreting any symptom as candidiasis. However, we cannot deny that this disease is an ailment of our time. It is an imbalance resulting from our modern lifestyle: we have never eaten as poorly as we do today, and we have never taken as many antibiotics, synthetic sex hormones, and corticosteroids as we do today. These factors are precisely some of the most important in the development of this disease.
What is candidiasis?
Candidiasis is an infection caused by a yeast of the Candida family. There are about 150 different species of candida, for example, Candida krusei, Candida glabrata, Candida tropicalis, Candida parapsilosis, etc. However, the most common in our body is Candida albicans.
Yeasts are present in all of us shortly after birth and live in harmony with us. They are found on the skin, and in the digestive and genitourinary tracts. Their function is to absorb a certain amount of heavy metals so they do not enter the blood, they help us break down poorly digested carbohydrate residues, and together with bacteria, they maintain our intestinal balance and pH.
The intestinal and vaginal flora, together with the immune system, help us keep these yeasts under control. However, there are a series of factors that can depress the immune system and unbalance the intestinal flora, causing the excessive growth of these yeasts and, consequently, the disease.
Triggering factors
Excess of sugar or refined carbohydrates: these are the main food source for candida. In addition to feeding them directly, they increase blood glucose levels, through which we can also feed them.
Tap water: chlorine destroys the intestinal flora, and the fluoride depresses the immune system.
Antibiotics, cortisone, and synthetic sex hormones: antibiotics destroy the bacterial flora but not the candida, allowing them to grow uncontrollably. Cortisone depresses the immune system, and synthetic hormones destroy vital nutrients such as vitamin B6.
Pregnancy: the increase in progesterone favors the growth of vaginal candida and can cause insulin resistance, also favoring its growth.
Continuous stress: an excess of cortisol depresses the immune system, increases glucose, and destroys the intestinal bacterial flora.
Decrease in digestive secretions: the lack of hydrochloric acid and digestive enzymes prevents proper digestion, causing fermentation and intestinal putrefaction.
Lack of nutrients: malnutrition weakens the immune system, hormonal regulation, and digestion, giving candida more opportunity to grow.
Symptoms
The symptoms of candidiasis are many and can be very varied. It is very important to know why candidiasis can produce these symptoms in order to better understand this imbalance. Many people with candidiasis are treated as hypochondriacal, depressed, and/or anxious patients. Unfortunately, there are many people with candidiasis who have not been diagnosed, and instead, are taking Prozac, Seroxat, or anxiolytics.
A very important point that is usually ignored when diagnosing and treating candidiasis is that its origin is usually intestinal, even when we are looking at vaginal or nail candidiasis.
When candidiasis proliferates in the intestine, it can change its anatomy and physiology. This means it can stop being a yeast and become a fungal mycelium. It is known that candida are dimorphic organisms and can exist in these two forms. In its yeast state, it is not invasive, whereas in the fungal state, it produces highly invasive rhizoids (or very long roots) that can penetrate the mucosa. This can cause excessive permeability of the intestinal mucosa, allowing the introduction into the blood of substances (toxins, poorly digested proteins, etc.) that can act as antigens, severely altering the immune system.
It is known that candida in its fungal state can produce 79 toxic products, for example, ethanol, formaldehyde, etc., but among them, the most abundant is acetaldehyde. This highly toxic substance is produced by candida when converting sugar into alcohol. Some of the effects of acetaldehyde are:
- Formation of vasoactive substances, such as adrenaline, producing symptoms such as nervousness, panic, fear, tachycardia, and hot flashes.
- Interference with acetylcholine receptors, which are important for memory and the nervous system.
- Production of histamine, and therefore, inflammation in any part of the body.
- Blocking of metabolic enzymes, which can lead to blocks in the formation of neurotransmitters.
- Destruction of vitamin B6, important for the protection of mucous membranes, strengthening the immune system, hormonal balance, and the production of hydrochloric acid and digestive enzymes.
- Depression of the immune system.
- Destruction of glutathione and cysteine, necessary to detoxify the body.
- Reaction with dopamine, which can cause depression, insomnia, and an inability to respond to stress.
On the other hand, Candida fit into the hormonal receptors of cells, competing with hormones, but they can also create receptors for our own hormones on their surfaces. This can cause a blockage and imbalance of the hormonal system and endless problems such as premenstrual symptoms, infertility, and endometriosis, among others.
Some yeasts like Candida krusei and Parapsilosis produce thiaminase (an enzyme) that destroys vitamin B1. The lack of this vitamin can produce symptoms such as irritability, muscle pain, lack of concentration, stomach pain, constipation, and tachycardia. It also prevents the conversion of vitamin B6 into its active form, pyridoxal-5-phosphate, which can cause fluid retention, depression, irritability, muscle tremors or cramps, lack of energy, and very dry skin.
Due to the degree of toxicity in which the patient with candidiasis finds themselves, the liver has to filter a large amount of chemicals. For this to happen, the two detoxification phases of this organ require nutrients such as zinc, selenium, copper, magnesium, B and C vitamins, glutathione, sulfur, glycine, and essential fatty acids, which due to poor intestinal absorption, it is very possible are not found in the necessary quantities. This process of autointoxication can aggravate the condition of the patient with chronic candidiasis when in the presence of perfumes, smoke, or other inhalant chemicals.
Once we have seen the way this disease works, these are the most common symptoms in patients with chronic candidiasis, who have usually not been diagnosed:
- Fatigue
- General malaise
- Headaches
- Abdominal bloating
- Diarrhea and/or constipation
- Indigestion
- Heartburn
- Craving for carbohydrates (sweets, pasta, bread, etc.)
- Depression
- Dizziness
- Feeling of a hangover in the mornings
- Joint and muscle pain
- Vaginal discomfort (itching, irritation, sores, etc.)
- Fluid retention
- Insomnia
- Chronic infections
- Allergies
- Anal itching
- Hoarseness
- Nasal congestion
- Shortness of breath
- Nail problems
- Eye and ear discomfort
Related diseases and imbalances
The diseases and imbalances that have been linked to chronic candidiasis are:
- Crohn's disease
- Colitis
- Irritable bowel syndrome
- Rheumatoid arthritis
- Lupus
- Asthma
- Psoriasis and eczema
- Sinusitis
- Multiple sclerosis
- Fibromyalgia
- Chronic fatigue syndrome
- Hypothyroidism
- Hypoglycemia
- Depression and anxiety states
- Anemia
- Acne
- Urticaria
- Allergies
As we can see, the issue of candidiasis is not limited to localized symptomatology.
Diagnosis
This subject is very complex. Laboratory tests do not guarantee the diagnosis of chronic intestinal candidiasis.
In general, the test used to detect intestinal candidiasis is a stool culture. In this test, unless the doctor specifies otherwise, laboratories do not look for candida because the theory is that these yeasts in the intestine are not pathogenic. However, it is rare for a doctor to specify it since there is barely any awareness of this issue. If, on the other hand, the doctor or therapist specifies that yeasts should be looked for, the laboratory analyzes whether there is an excessive growth of them based on the laboratory technician's clinical judgment. This method is not very effective as the problem does not always lie in the quantity, but in the state the candida are in.
On the other hand, most candida cells adhere to the wall of the intestinal mucosa, which makes it difficult for them to appear in stool analyses. And, in some cases, many of these cells die while the specimen is being transported or while waiting for the analysis.
It is important not to rule out the disease just because laboratory tests turn out to be negative. It is better to base the diagnosis on a detailed evaluation of the patient: symptoms, clinical history, analysis of their diet.
In the U.S., many doctors and therapists believe that the clinical protocol for candidiasis presents so little risk and cost (especially the diet) that it should be considered in any chronic disease.
4-phase candidiasis treatment
Candidiasis treatment should encompass two main points: its elimination and its prevention. For this reason, it is important to systematically correct the causes that contribute to the development of this disease. I base my protocol on 4 basic steps:
Preparation
It is vital that we weaken the Candida before attacking it with an antifungal. Otherwise, if they are strong, they will be able to fight it off and eventually become resistant. The best way to weaken them is by making them "go hungry," that is, through diet.
Eliminate
- Sugars and sweeteners (sugar, saccharin, honey, dextrose, stevia, syrups, soft drinks, canned tomatoes, breakfast cereals, pastries, desserts, ice cream, etc.)
- Fruit
- Dairy products, including yogurts
- Alcohol
- Yeast (bread, pizzas, bouillon cubes)
- Potatoes, mushrooms, pumpkin, chestnuts, and sweet potatoes
- Peanuts and pistachios
- Fermented foods (vinegar, tempeh, soy sauce, miso, tea, sauerkraut, kefir, non-alcoholic beer)
- Cereals
- Soy milk and yogurt
- Cereal milks (rice, millet, quinoa, etc.)
- Corn
- Coffee
Allowed
- Meat
- Fish
- Shellfish
- Eggs
- Vegetables
- Legumes
- Nuts and seeds (pumpkin, sesame, sunflower, flax, chia, hemp, etc.)
- Lemon, avocado, and coconut
- Seaweed
- Olive and coconut oil
- Bottled water
During the dietary change period, it is very possible that the patient will temporarily get worse. This is due to detoxification and also because the Candida are "protesting from hunger." If the patient presents digestive difficulties, such as heartburn or stomach heaviness, it is important to help them with digestive enzymes and/or betaine hydrochloride. After a month of starting the diet (and maintaining it), one can move on to the second step.
Elimination
After a month of diet and digestive aids, it is very likely that the enzymes and betaine hydrochloride can be discontinued. Once the Candida are weakened, it is important to introduce an antifungal to destroy them. Today, there are many natural antifungals that do not produce side effects and are truly effective.
Those that have shown the best results in research are caprylic acid, goldenseal, grapefruit seed extract, garlic, Pau d'Arco, oregano oil, undecylenic acid, and many others.
In my experience, the best antifungals are those that contain various antifungal substances together. It is very important to introduce them very carefully, always starting with very small doses and increasing every 4 or 5 days. If the Candida are destroyed all at once, many toxins can form and produce a very strong worsening of symptoms. I like to change the antifungal depending on how the patient reacts; this way, stagnation is avoided during treatment. There are therapists in the U.S. who recommend rotating 3 or 4 different antifungals every four days. In my experience, changing the antifungal every 4 to 6 weeks is sufficient.
In patients who have a lot of detoxification symptoms, it is recommended to give them molybdenum (150 mcg with breakfast, lunch, and dinner). This mineral destroys Candida waste, converting acetaldehyde into acetic acid which, in the Krebs cycle, is converted into energy.
Balance
When the symptoms the patient presented have mostly subsided, it is very important to rebalance the intestinal flora. This step should not be done at the beginning, since when the intestinal wall is inflamed, there may be an intolerance reaction to "friendly" bacteria. This can cause dermatitis, itching, diarrhea, intestinal spasms, and allergies. Furthermore, as long as there is an excess of Candida in the intestine, Lactobacillus cannot grow and repopulate the intestinal tract.
The most abundant bacteria are Lactobacillus acidophilus and Bifidobacterium bifidum. It is recommended to ingest a minimum of 10 billion L. acidophilus and/or bifidum distributed throughout the day, shortly before meals. It is important to choose a good brand because the manufacture of a product with these characteristics requires knowledge of its production and handling.
Many people ask why yogurt is not allowed on the antifungal diet, even though it is known to contain "friendly" bacteria. First, because dairy products contain lactose, and even if they are fermented, whole milk is usually added during the process to make them creamier; and second, because they are usually made with Lactobacillus bulgaricus or Streptococcus thermophilus, which, although they offer certain benefits, are transient visitors to the digestive system and do not colonize the colon.
It is also important to talk about the repopulation of the vaginal flora. Lactobacillus acidophilus inhabits the vaginal flora and is responsible for maintaining the acidic pH by fermenting vaginal glycogen and converting it into lactic acid. There are vaginal ovules and pills to repopulate the vaginal flora. It is advisable to warn that certain spermicides, such as Nonoxynol-9, destroy "friendly" vaginal flora.
Another important aspect is to re-establish cellular nutritional balance. A patient with chronic candidiasis usually suffers from malabsorption and, therefore, cellular malnutrition. A malnourished organism will hardly have a healthy and strong immune system.
In orthomolecular nutrition, we do not use lists of specific nutrients for everyone: we evaluate individual deficiencies and recommend supplements according to each person's particular biochemical needs. However, in my experience, the most commonly deficient nutrients are vitamin C, the B-complex (especially B6, B5, and B3), calcium, magnesium, zinc, chromium, and essential fatty acids of the Omega 3 family. Dosages will also vary depending on the patient, but in general terms, we can talk about:
| Nutrient | Guideline range |
|---|---|
| Vitamin C | 1,000–4,000 mg |
| Vitamin B1, B2, and B3 | 100 mg |
| Vitamin B5 | 500 mg |
| Vitamin B6 | 200 mg |
| Vitamin B12 | 100–300 mcg |
| Folic acid | 400–800 mcg |
| Magnesium | 400 mg |
| Zinc | 15–60 mg |
| Chromium | 200–600 mcg |
| Omega 3 | 800–3,000 mg |
One must be careful that the B-group vitamins and chromium do not contain yeast. I do not usually recommend calcium because its deficiency usually occurs in patients who, curiously, have consumed dairy products for many years, which often causes an excess of extracellular calcium and symptoms of intracellular calcium deficiency. The ideal is to supplement for a while with magnesium and stop consuming dairy products so that calcium levels regulate at the cellular level. If, even after a while, one chooses to add calcium, doses will vary between 500–1,000 mg. In any case, it is the job of each therapist and doctor to evaluate which nutrients are priorities and how to administer them.
At this point in the treatment, it is advisable to start slowly and carefully introducing some foods such as fruit, potatoes, mushrooms, and certain fermented foods, and observe if they are well tolerated. This introduction phase is very important, as the patient will clearly realize which types of food favor their health and which do not. In this period, due to their improvement, the patient usually commits nutritional "infractions," which almost always cause symptoms—not only because they can trigger some candidiasis symptoms, but because there are foods that clearly negatively affect health regardless of whether Candida are present or not. These are usually sugar, dairy, and gluten.
During this period, and thanks to the "infractions," the patient will confirm that there is a very direct relationship between diet and their state of health, which will help them outline their ideal diet for life. This step is fundamental as prevention of a relapse in the future.
Repair
Once the infection has subsided, the intestinal flora is balanced, and the patient's body has a good dose of nutrients, it is convenient to introduce certain nutrients to repair the intestinal wall.
| Nutrient | Guideline range |
|---|---|
| Vitamin A | 7,500–20,000 IU |
| Vitamin E | 100–1,000 IU |
| L-Glutamine | 500–1,500 mg |
| Biotin | 300–1,000 mcg |
These nutrients are responsible for repairing, sealing, and strengthening the intestinal wall (essential fatty acids are usually already being taken from the previous stage). Biotin, in particular, is advised to prevent healthy yeasts present in the intestine from growing and changing from harmless to aggressive.
Duration and support
Treatment for chronic candidiasis can last between 3 and 8 months. There are experts who believe that for every year of chronic candidiasis, one month of recovery is needed. I have observed that this comparison is quite accurate.
The treatment requires patience and a lot of support for the patient. It is important that we, the therapists, know and understand this disease and its healing process well, because our support is fundamental to the patient's recovery. During the time the treatment lasts, it is normal for there to be ups and downs that demotivate the patient. We have to warn them about this and about the symptoms that may possibly worsen in certain phases, so that they neither get scared nor believe that they are regressing. It is quite common for the patient to express emotions that perhaps even they themselves do not know, and to express themselves with anger combined with sadness.
Final reflection
At the end of the treatment, the patient not only feels fabulous (as they say, like they have never felt before), but has also discovered their ideal diet, the one that boosts their health. This will serve as prevention to avoid another candidiasis, and many other imbalances, in the future.
I think it is very positive to make the patient aware that it is important to take advantage of and learn from the disease. Otherwise, the feeling that it leaves them is one of emptiness and fear that it will happen again. I always tell my patients that thanks to their Candida, they have learned three very important things: how to eat, how to listen to themselves, and how to know themselves better. Three key pieces, not only for the prevention of candidiasis, but also for achieving optimal health.
Thank you very much for your attention.
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Cala Cervera
Orthomolecular Nutritionist
