Candida & M.E.
This article was written by Medical Herbalist Jo Dunbar, who specialises in treating Candida and M.E. It was first published by Theresa Coe in the Action for M.E. magazine InterAction (Issue 53, August 2005). She is also the author of How to cope successfully with Candida (Wellhouse Publishing), available from Botanica Medica herbal clinic and shop, which is owned and run by Jo. She recently wrote a book titled Recovering from Stress, Burnout and Fatigue; you can read a summary of the book here on M.E. Support in Stress & Fatigue. Jo can be contacted at firstname.lastname@example.org, or by telephoning 01372 470990, or 020 8892 9227.
There frequently lies between M.E. and Candida a close but sometimes confusing association. Many of the symptoms of Candida overgrowth are similar to M.E., and may include long-term debilitating fatigue, headaches, food intolerances or an irregular bowel habit, joint and muscle pain, and brain fog.
Other common symptoms which are much more specific to Candida include hormonal symptoms such as severe Premenstrual Syndrome (PMS), mood swings (especially depression), pain behind the breast bone, intolerance to strong odours, dandruff, athlete’s foot, visual disturbances, oral or genital thrush, an itchy anus and a feeling of bloating or flatulence. I do not believe that everyone with M.E. has a Candida problem, but I think it is an issue for a significant proportion of sufferers, particularly people who also have food intolerances, bloating, thrush, or an itchy anus.
Candida is a yeast which naturally lives in the human intestine, but under certain conditions the normally small Candida population can explode with serious consequences to health. From my experience, I would suggest that a Candida overgrowth may result from the immune breakdown in M.E., especially if the sufferer relies on sugar as an energy source (which feeds the yeast) and/or coffee, which raises blood sugar levels. Often the M.E. person has been given several courses of antibiotics, which further encourage the overgrowth of yeast. However, although Candida alone doesn't cause M.E., it mimics the symptoms so closely that distinguishing between the two can sometimes be difficult.
Whereas a definitive underlying cause of M.E. still escapes us, the causes of Candida problems are much clearer, which happily makes it easier to treat. Once it has been established that there is a Candida overgrowth, I usually set about treating the Candida, which then leaves a clearer clinical picture regarding what is needed to treat M.E.
It often surprises people to find out that Candida lives in our gut naturally, alongside other microscopic bowel flora, without causing us any harm. It may even have the beneficial effect of helping to remove excess heavy metal toxins from our bodies. However, there are certain conditions which allow the yeast organisms to explode very quickly from a normally small population group into an enormous domineering fungal overgrowth. If you have ever noticed how mushrooms pop up on a dewy lawn overnight, you get the picture of how quickly yeast can grow, given the right environment. Once this happens, the yeast can actually change form, from a small non-invasive organism into its aggressive and invasive fungal form which develops root-like structures called mycelia, more of which later.
In my experience, the five major causes of Candida overgrowth include:
- Depletion of the gut's friendly bacteria, sometimes caused by long-term antibiotic treatment or gastric infection
- A breakdown in the immune system, as in the case of M.E., chemotherapy or HIV, or burn-out
- Excess female hormones, for example as a result of multiple pregnancies, HRT, the Pill, during a pre-menstruation phase or the menopause
- High blood sugar levels caused either by a high sugar diet, stress or diabetes
- Drug therapy: mainly antibiotics, steroids, hormone therapies, or immuno-suppressive drugs.
Once the yeast has morphed into its aggressive mycelial form, it can penetrate the gut lining by secreting inflammatory chemicals which weaken the wall and allow the root-like structures to pierce it, leading to a leaky gut. The leaky gut is like a hosepipe with large holes in it.
Normally the intestine breaks the food down into tiny particles which are then transported through little gateways in the gut wall into the bloodstream. However, the leaky gut allows larger, undigested food particles to enter the bloodstream. Also, if the person has both Candida and M.E., they can often be too depleted to even digest their food adequately. Compared with correctly digested food particles, which should slip through gateways within the gut wall, in these partially digested food particles are giant molecules which the immune system cannot recognise as food, and thus, it immediately sets about forming antibodies to these ‘invaders’, and in doing so, establishes an intolerance to that food.
Because the immune system is so busy attacking certain foods, it becomes hyper-reactive and disrupted, which alone can account for fatigue, allergic-type symptoms such as sinusitis or asthma, and brain-fog. Imagine being attacked from all angles by a pack of say, hyenas. You would quickly become exhausted and lose your sense of clarity.
The immune system can become confused. To your immune cells, the large undigested protein molecules from the food look similar to the proteins which form the tissues in the body, called ‘self-tissues’. Potentially, the immune system can confuse the self-tissue with food particles and begins to attack its own body. The immune system can attack joint tissues, the mucous membranes surrounding the sinuses, and in extreme cases, this mechanism has been hypothesised to go on to develop into allergic or auto-immune diseases. Once Candida has entered the blood stream, antibodies from the immune system combine with it to form antigen-antibody complexes, which when deposited in the joints, lungs or brain, result in joint pain, asthma, depression and hormonal disruption.
Yeasts are very adept at surviving. Candida is known to secrete toxins called mycotoxins, which can suppress the immune system further, as well as causing liver toxicity, headaches, and muscle pain. The host (that’s you), can feel very ill indeed.
Candida, being a yeast, thrives in dark, warm, wet and sugary environments. People with an overgrowth often have intense sugar cravings – this is the yeast demanding to be fed. People who are chronically fatigued naturally crave sugar and caffeine to give them some energy. In the warm moist gut, the yeast ferments the sugars to produce symptoms such as flatulence and bloating, while the inflammatory chemicals released inflame the gut, leading to poor digestion and absorption, having the knock-on effect of further depleting the body as the sufferer is unable to benefit from nutritional nourishment.
Clearly, gut imbalances leading to Candida overgrowth is a complex problem which requires a multi-faceted approach to treatment, ideally under professional supervision.
- Get the correct diagnosis. Candida mimics so many diseases, it is far better to see a professional medial herbalist, naturopath or nutritionist who is familiar with the condition, and who can help you differentiate one condition from the other.
- A stool analysis can test for Intestinal Candida, but sometimes the Candida is so embedded in the gut wall that it does not come out in the stool and you might get a false negative. However, the advantage of a stool analysis is that it is also able to analyse your levels of beneficial gut flora (the good bacteria), and identify whether you also have a problem with parasites, if you have an inflamed intestine and how effectively you are able to digest and absorb your food. This type of test is not available on the NHS, and you need to pay for a private laboratory test.
- Starve the Candida. One of the best ways to start treating yeast overgrowth is by going onto the Candida diet for one month before you follow the rest of the programme. In this way you starve and weaken the yeast, killing it off gradually, and thus lessening the die-off effects. It is important to realise that this in itself is not enough. The Candida is very resourceful, and it can learn to feed off protein, so you need to actually attack it with herbs and nutritional supplements too.
- It is may be worth considering a food intolerance test, because if you have developed a leaky gut (gut permeability) then you have in all likelihood developed food intolerances. By accurately identifying the foods to which your immune system is reacting, you relieve your immune system of a heavy burden, and reduce the chances of the cross-reaction with self-tissues. If you find that yeast does not show up as a food to which you are intolerant, then you can continue to enjoy your marmite etc., but if it does show up, then you should completely avoid yeast-containing foods until you are better, while your intake of protein, extra virgin olive oil, salads and vegetables, and a few complex carbohydrates should be increased. It is important to avoid non-organic foods, as these often contain high levels of antibiotics, pesticides and hormones, which provide the environment conducive to a Candida overgrowth.
Many people understandably feel that the Candida diet is an awful regime, but investing in a well-illustrated Candida cookbook can make all the difference. We are often stimulated visually, and to see a glossy picture of some mouth-watering meal is enough to send you happily into the supermarket to buy the necessary ingredients for your new healthy diet. I often tell my patients to think of the Candida diet as similar to a Greek type of diet – lots of lovely salads, grilled chicken and fish, barbequed lamb, roasted vegetables, a little feta or haloumi cheese is usually fine. Each person is different, but often, I think a little fruit of the less sweet type, such as five blueberries a day or a few raspberries, can only be helpful. In extreme cases of Candida, then you do need to completely avoid the fruit – but this is for your herbalist or nutritionist to advise you according to your unique needs.
- Antifungal medications. Your doctor may prescribe antifungal drugs such as nystatin, although some may not feel this is justified if you don't have the more obvious symptoms of ongoing thrush etc. However, you can use a wide range of very effective herbal and nutritional remedies such as oregano, pau D'Arco, cinnamon, or caprylic acid. In treating Candida, I usually use two or three natural antifungals at once and always alternate them to maximise effectiveness. It is always worth starting off gently, because if you kill the yeast too quickly, you can actually poison the body and feel worse.
- Boost your gut microbiota. Our bodies are made up of approximately 50 trillion cells, and yet within our guts we host 240 trillion microflora and fauna. We are more of a community than a single organism! The flora and fauna are our first line of defence and of crucial importance to our survival, but antibiotics in foods, chlorine in the water, medicines can severely deplete this population, leaving us vulnerable to unfriendly yeasts and bacteria moving in.
- Use a yeast to fight a yeast. A friendly yeast called Sacchromyces boulardii actually secretes natural chemicals which kill the Candida, and at the same time, it makes it very difficult to stick to the intestinal wall, thus helping to flush the yeast out of the bowel. Then, very elegantly, this yeast dies itself. I find that S bourlardii produces very few of the harsh die-off symptoms that some of the stronger natural medicines do.
- Heal the leaky gut: Herbal teas such as calendula and chamomile can be drunk to stimulate the healing of the intestinal lining, whilst nutritional supplements such as L-glutamine and MSM provide the necessary building blocks for the healing process. Get the hang of making organic bone broths, which are wonderfully nutritional and full of collagen, which help to rebuild the intestinal integrity. The gut lining can take at least three months to repair. Given that food intolerances will slow down healing, a laboratory food intolerance test is also advisable.
- Strengthen your immune system: In Candida, as with M.E., we have one part of the immune system which is overactive, resulting in inflammatory conditions such as muscle and joint pain and food intolerances, and the other side which is depressed, resulting in a poor response to the yeast challenge. Herbs such as Echinacea, Astragalus or Olive leaf are superb at boosting and rebalancing the immune system, and if you are not intolerant to mushrooms, then do consider Coriolus mushroom. There is a lot of argument about ‘mushrooms feeding the yeast’. Mushrooms are higher order fungi and actually have powerful anti-fungal enzymes – consider this: when did you last see a mouldy mushroom?
- Decongest your liver. As the Candida dies, their bodies break down, releasing a myriad of toxins into our bodies. These toxins will be carried by the bloodstream to the liver to be removed, but, if the liver is over-burdened with toxins, then you have a back-up of toxic matter floating around the bloodstream – making you feel much worse. Such symptoms include headaches, joint pain, extreme lethargy, and depression. So, it is of the greatest importance to support your liver with herbs and foods which help to clear it. Lots of lemon juice in your food, chicory and rocket salad, artichokes, beetroot and garlic all help the liver to flush out the toxic matter.
Herbs such as burdock, dandelion root, ginger and lemon juice are very good at encouraging the flow of bile, which flushes toxins out of the liver to be released in the stool. Other foods such as celery, fennel, parsley and watercress encourage toxins to be eliminated via the kidneys. Hot Epsom salt baths also encourage the elimination of toxins via the skin, while therapeutic massage helps to shift toxins into the lymphatic system and the kidneys for elimination. Drinking lots of water is absolutely imperative to facilitating the detoxification process.
- Aid the digestive process for a while. Digestive enzyme supplements support the digestion and absorption of food, and in doing the work for the digestive system, give it the rest it needs for recovery. A sluggish bowel means that any toxins released are able to seep back into the system, thus prolonging the die-off effect as well as contributing to tiredness and headaches. To offset this problem, mix two tablespoons of linseeds (whole or crushed) daily with some live plain yoghurt (providing you are not dairy intolerant), to facilitate regular and easy evacuation of the stools.
A word about die-off:
The bad news is that as the yeast dies, it releases its toxins into the bloodstream, which can leave you feeling like you have a bad hangover. This die-off period can last between three days and two weeks, or possibly even longer. However, if your liver and bowels are working at optimum, you will be able to get rid of the toxins more quickly, and with a careful treatment programme, the die-off may even be avoided. This is one of the reasons why I always recommend seeking professional help if you want to tackle suspected Candida problems.
If you do suffer from both Candida and M.E., treating the Candida can, in my experience, significantly help to reduce many concurrent M.E./Candida symptoms. By clearing the toxic load on the body, relieving the immune system of the Candida and food intolerance burden through anti-fungal medicines and diet, and boosting the immune system with herbs and probiotics, you will have gone quite some way towards helping the body to heal.
Realistically, getting Candida under control takes between three and eighteen months, depending on how severe it is. While you would need to stick to the diet for some time, most people can gradually re-introduce fruit and enjoy the occasional sweet treat as they start to feel better – nowadays, we have stevia and xylitol, which are both perfectly safe to use.
Once the Candida is under control, you can set about tackling the M.E. by continuing to treat the immune, endocrine and nervous systems, and by using adaptogenic herbs to build stamina, although, if you are seeing a professional therapist, she or he will probably be working on both conditions at the same time, because we all want to see you get well again as quickly as possible.
Although there is no quick fix for either condition, people who aren't sure whether Candida is a problem for them and are low in funds might want to try out a sugar and yeast-free diet whilst including live yoghurt and natural anti-fungals in their diet (e.g. raw garlic) for a fortnight. If there is no difference in your symptoms, Candida may not be a factor in your illness, whilst a flare-up would suggest die-off reaction, and an improvement in health would also be a good sign.
Although I strongly recommend professional treatment, both for support as well as access to professional remedies, from a practitioner’s point of view, treating both Candida and M.E. very definitely also requires the patient's input in terms of sticking to the diet and making sure that you get the rest needed to recover – because if these two areas are not adhered to, even the best treatment programme will be sabotaged
Most people on the Candida diet absolutely crave a little sugar. I have a few tips to help you through. First of all – do not allow yourself to become hungry. This is important for M.E. as well as Candida, because when you are hungry, your body starts to panic, which raises cortisol, which depresses the immune system and exhausts your adrenal glands and sends you on a nasty downward spiral.
Try instead to have your three meals a day, with a small snack in between each, and perhaps even a bedtime snack. This way your blood sugars are kept even, you feel much more stable and you won't crave sugar.
If you would just love an afternoon tea biscuit – try this:
3 oat biscuits with some raw cashew nut butter
and a cup of Rooibosch tea.
If you would love a chocolate dessert – try this:
Live plain yoghurt, or Oatley cream.
Add ½ tsp of carob powder and mix well.
Add some hazelnuts for a bit of crunch or a few blueberries if you like.
Pop in the fridge for after dinner.