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 health food shops and Lloyds Chemists, or 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 lies between M.E. and Candida a definite but sometimes confusing association. Many of the symptoms of Candida overgrowth are alarmingly 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 stimulates the release of blood sugars. 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 the 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 seen fruit ferment into wine or bread rise, you get the picture of how quickly yeast can grow, given the right environment. Once this happens, the yeast can actually change shape 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
- 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 changed into its aggressive fungal form, it penetrates the gut lining by secreting inflammatory chemicals which weaken the wall and allow the mycelia 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 blood stream. If the immune system doesn't recognise these undigested food particles, it assumes that they are foreign invaders, and immediately sets about forming antibodies to these foods, thus creating symptoms of food intolerance. Because the immune system is so busy fighting these food intolerances, it becomes hyper-reactive and disrupted. This alone can account for fatigue, allergic-type symptoms such as sinusitis or asthma, and brain-fog.
The immune system can also become confused. The large undigested protein molecules from the food are similar to tissues in the body called ‘self-tissues’. Potentially, the immune system starts to confuse the self tissue with food particles and begins to attack its own body – the very body it is trying to protect. The immune system can attack joint tissues – causing tenderness and pain in the joints, and in extreme cases, this mechanism has been hypothesized to go on to develop into auto-immune diseases.
Furthermore, 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. 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.
Candida, being a yeast, thrives on 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 quite logically also crave sugar as a form of 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
There are several methods of testing for Candida overgrowth, but the most accurate is the saliva or blood test. These measure your immune system's antibody response to Candida, and so are able to tell you how badly you have it. The only problem may be if your immune system is so exhausted that it cannot raise the antibodies to the Candida, which will result in a false negative.
A stool analysis can also test for Candida, but is less reliable, as sometimes the Candida is so embedded in the gut wall that it does not come out in the stool and again, 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), 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. Unfortunately, since most NHS doctors are not interested in looking for Candida overgrowth unless you're on immune suppressant medication, have diabetes, HIV or cancer, most people need to pay privately for tests.
- 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, starting to kill it off gradually, and thus lessening the die-off effects.
By raising blood sugar levels, you are feeding the yeast, so you need to starve the yeast by completely avoiding foods with refined carbohydrates and sugar. In addition, people with a Candida overgrowth often become intolerant to foods with yeast in (finding that they provoke brain fog and tiredness), due to the antibody reaction mentioned earlier.
It is well worth doing 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 complex carbohydrates should be increased. It can also help 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 5 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.
- Take 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 frequently alternate them to maximise effectiveness.
There is a novel way of treating Candida that is not very well known. A friendly yeast called Sacchromyces boulardii actually secretes natural chemicals which kills the Candida, and at the same time, it makes it very difficult to stick to the intestinal wall, thus helping to kill and 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. 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.
- Repopulate the Gut with Friendly Bacteria
A healthy intestine contains around 240 trillion friendly bacteria of a wide and unknown range of species. You would be well advised to repopulate your gut with the two major probiotics or 'friendly' gut bacteria which we know about – lactobacillus acidophilus and bifidobacterium, as well as the others such as Bifidobacterium longum, B breve, Lactobacillus rhamnosus, and the friendly yeast Saccharomyces boulardii. Don't be tempted to use cheap probiotic drinks as found on supermarket shelves. These contain the minor gut bacteria and are usually in a very sugary liquid, perfect for encouraging fungal growth. Other cheap probiotic supplements have been shown to be made up of dead or ineffective bacteria. You really do get what you pay for in probiotics.
- Boost the 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 sutherlandia 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?
- Support the Liver
As the Candida dies, their bodies break down, releasing a myriad of toxins into our bodies. These toxins will be carried by the blood stream 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 blood stream – 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
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 blood stream, which can leave you feeling like you have a bad hangover. This die-off period can last between three days and two weeks. 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, 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 3 and 18 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. Once the Candida is under control (this may be confirmed through another Candida test), 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 bed-time 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.