Effectively diagnosing and treating Candida

Townsend Letter for Doctors and Patients, Oct, 2005 by Jacob Teitelbaum

When stopping sweets, the patient should be prepared to have withdrawal symptoms for about one week. Several excellent books have been written on the yeast controversy and offer additional dietary methods to try. One of the best is The Yeast Connection and the Woman by the late Dr. Crook, a physician who has done a spectacular job of advancing our understanding of yeast overgrowth.

Many people have found that acidophilus--that is, milk bacteria, a healthy type of bacteria for the bowel--helps restore balance in the bowel. Acidophilus is found in yogurt with live and active yogurt cultures. Indeed, eating one cup of yogurt a day can markedly diminish the frequency of recurrent vaginal yeast infections. Unfortunately, many acidophilus products do not have anywhere near the label claim, and the acidophilus is destroyed upon contact with stomach acid. Because of this, I recommend using acidophilus that is in an enteric coated "pearl." This delivery mechanism does not dissolve until it reaches an alkaline environment, protecting the acidophilus from acid as it goes through the stomach. In addition, it eliminates the need to refrigerate the acidophilus. The form that I use in my practice is called Probiotic Pearls by Integrative Therapeutics. I recommend that patients take two pearls twice a day for five months. This supplies over 6 billion bacteria daily (the pearls actually have been a much higher level than the label claim). If patients are on antibiotics (not anti-fungals), I recommend that they take the acidophilus at least three to six hours away from the antibiotic dose.

Natural remedies can also be very helpful as antifungals. Unfortunately, when individual treatments are taken in a high enough dose to be effective, they often cause reflux and indigestion. Because of this, I prefer to use the products that combine a mix of natural antifungals at lower dosing. One excellent one is Phytostan (also by Integrative Therapeutics) which contains Pau D'Arco bark (Tabebuia impetiginosa) 100 mg, Undecylenic acid 100 mg, Caprylic acid 75 mg, Grapefruit fruit extract (Citrus paradisi) 40:1 25 mg, Rosemary aerial parts oil (Rosmarinus officinalis) 4:1 1.5 mg, and Thyme aerial parts oil (Thymus vulgaris) 4:1 1.5 mg. In my own "test tube studies," this combination was almost as effective as the medication Diflucan. Another natural product which did very well was Citricidal (grapefruit seed extract) at higher dose. For the Phytostan I use two tablets twice a day for five months. For the Citricidal (use the tablets not the liquid) I use 200 mg twice a day for five months. They can be used together. If nausea occurs with either of them, I would lower the dose.

Medical Treatments for Yeast Overgrowth

Nystatin, an antifungal medication, has been helpful in the treatment of yeast overgrowth. Unfortunately, some fungi seem to be resistant to nystatin. In addition, nystatin is poorly absorbed, which means that it has little impact on the yeast outside of the bowel.

Other antifungal medications, such as Diflucan and Sporanox, seem to be effective systemically (throughout the body) but they have three main drawbacks. First, they are expensive, costing more than $450 to $900 for a two-month course. Fortunately, however, Diflucan recently went generic and is now available for only $40 for 42 tablets of 200 mg each. For patients without insurance, a mail-order pharmacy called Consumers Pharmacy (323-461-3606) has the lowest prices I have found on prescription medications. Second, any effective antifungal can initially make the symptoms of yeast infection worse. In addition, although it is uncommon, Diflucan and Sporanox can also cause liver inflammation. If patients are taking Diflucan or Sporanox for more than six to twelve weeks, I would consider intermittently doing blood tests to check liver function--specifically, checking blood levels of alanine aminotransferase (ALT) and aspartate transaminase (AST). If they have preexisting active liver disease, you should be cautious about using Diflucan or Sporanox--or not use them at all. I do recommend that patients take 200 milligrams of lipoic acid a day whenever they take Sporanox or Diflucan. This is a natural supplement that helps to protect and heal the liver. For that matter, I also strongly recommend lipoic acid for anyone with active liver disease (for example, hepatitis), at doses up to 1,000 to 3,000 milligrams a day, as it may prevent and/or help treat cirrhosis.