Candida Related Complex

Candida Related Complex is a term coined by my friend and colleague George Kroker, M.D. of La Crosse Wisconsin.  The term appropriately fits the problems caused by Candida because of the diversity and complexity of symptoms it causes.  Candida is a normal inhabitant of our intestinal trac, as well as, mammals including cattle, monkeys, dogs and whales.  Candida is an opportunistic yeast that we normally live in peaceful coexistence with.  However, if Candida gets out of balance and proliferates, it can cause a wide variety of symptoms that are often misdiagnosed.

Antibiotics are by far the major cause of Candida proliferation.  This is followed by cortisone drugs and diets high in refined carbohydrates, especially sugar.  Other causes include toxic chemical exposures, excessive mold exposure, long-term stress and patients with compromised immunity such as in AIDS.  Everyone is susceptible, infants, children, adults and it is more prevalent in women. 

Patients may have had health problems for many years due to Candida and their condition never gets properly diagnosed.  Sometimes the problem starts shortly after taking antibiotics.  At other times the symptoms develop gradually over a number of years, perhaps from taking antibiotics during childhood for ear infections or teenage years for acne.  There is usually a triggering event, when the symptoms become much more acute.  Triggering events include recent infection, toxic exposure, mold exposure, major stress or trauma.Patients with Candida Related Complex often have widespread symptoms affecting multiple organ systems:•Gastrointestinal symptoms are among the most common-gas, bloating, alternating constipation and diarrhea, sometimes reflux symptoms. Typical irritable bowel syndrome symptoms.•Chronic allergies-stuffy nose, congestion, postnasal drip, asthma•Unexplained fatigue, always tired, sleep not refreshing.•Central nervous system-brain fog, mood swings, irritability, depression.•Skin-rashes, itchiness, fungal infections between toes, toenail infections, diaper rash, dandruf•Cravings for sugar, carbohydrates, bread, beer.•Most of these women have had only a few or perhaps no history of vaginal yeast infections.•Infants with early onset of diaper rash and eczema especially after getting antibiotics for ear or sinus infections.

Treatment—Getting Candida under Control

By far the majority of patients with Candida require a three pronged approach to get better:•Anti-yeast medication to reduce the level of Candida•Dietary restrictions to inhibit Candida growth•Probiotics to restore normal bacteria flora in the GI tract.Many effective prescription medications are available-Nystatin, Diflucan (fluconazole), Nizoral(ketoconazole), Sporanox (itraconazole). Less well-known drugs include clotrimazole, miconazole and amphotericin. Caprylic acid is one of the more effective non-pharmaceutical treatments I've used. Others with a good reputation include undecanoic acid (from castor bean oil) medicinal oregano, and grapefruit seed extract.Diet is very important, especially if you've been eating an unhealthy diet, over consuming sugar, refined carbohydrates, soft drinks and junk food. There is no question that these foods have to go, not only do they cause Candida to proliferate, but they weaken your immune response so you are more susceptible to it. The ideal diet is the Caveman Diet-meat, fish, vegetables. Low carbohydrate is the general approach. The more you can stick to this type of diet the quicker you will get better. That being said, some people need a certain amount of carbohydrates to feel okay. If you are one of these people, then be sure to use only whole foods, whole grains. I don't really expect people to stick to such a diet 100%, it's not realistic for most people, but you should do the best you can-shoot for 80% of the time.

Nystatin

Nystatin is a prescription anti-fungal medication which works against a wide variety of yeast and yeast-like organisms.  Nystatin is poorly absorbed from the intestinal tract so it can be safely used by children and even infants.  The medication is virtually non-toxic and is well tolerated by most people even on prolonged administration.  Nystatin is produced by a bacterium called Streptomyces Noursei.

Herxheimer reactions are very common with Nystatin therapy.  Herxheimer or "die off" reactions are related to the release of yeast toxins when the yeast is killed by Nystatin.  Nystatin breaks the cell membrane of yeast, causing it to release it's various antigens which can cause allergic reactions.  Herxheimer reactions may show up as flu-like symptoms and/or an aggravation of the yeast related symptoms that you have had in the past.  If the symptoms are mild, stay on the Nystatin dosage protocol.  Each time you increase the dose, there may be some temporary aggravation of your symptoms.  If the symptoms are too intense, then back the dose down.

Nystatin oral power is preferred rather than capsules because it contacts the esophagus and upper GI tract.  Nystatin oral powder as other advantages such as having more ability to titrate the dose and it doesn't contain the fillers commonly used in tablets.It will be very obvious that nystatin doesn't taste very good. Most compounding pharmacies will not dispense the pure nystatin powder, but will put in capsules. Simply empty the contents of the capsule and mix in at least 3 ounces of water or juice.  If necessary it can be mixed with a small amount of fruit vegetable juice to get it down and it would be okay to mix it with small amounts of food such as applesauce.

Nystatin dosage protocol for adults:Week One: 500,000 units (1/16 teaspoon or one capsule) 3 times a day

Week Two: One million units (1/8 teaspoon or two capsules) 3 times a day

Week Three: 1,500,000 units (3/16 teaspoon or three capsules) 3 times a day

Week Four: 2 million units (1/4 teaspoon or four capsules) 3 times a daySome patients may have to increase their dose of nystatin up to 1/2 teaspoon or higher in order to reduce the level of yeast.  A therapeutic trial of at least three months is recommended before deciding whether or not Nystatin is helpful or not.

Children usually take the same dose as adults, but sometimes only twice daily depending on their size and weight and your ability to get them to take it.

If 1/16 teaspoon is not tolerated, start with a "dot" dose on the end of a toothpick.  If a dot dose causes symptoms, you may have to clean out your bowels with a laxative such as Milk of Magnesia (1 - 2 Tablespoons) or an enema.  If the dot dose is still not tolerated, dilute it in 12 ounces of water and start taking 1 teaspoon, gradually increase every couple of hours to 2 teaspoons, three teaspoons, etc.  Do this for three or four days, or more, before attempting to raise the dose.

Ideally, Nystatin should be taken 20 - 30 minutes before a meal, but it really doesn't matter a great deal when you take it - it can be taken with or without food. If nystatin makes you feel nauseated when you take it on an empty stomach then try taking it with food.

If you have Candida in your mouth or throat (thrush), mix 1/8 teaspoon Nystatin in a cup of water and swish and gargle for 20-30 seconds, then swallow.  This will help eliminate the yeast in your mouth and throat.  You may only need to do this for ten days, then you can just swallow it to help eliminate the intestinal yeast.

Maintaining good bowel function while taking Nystatin is very important. If you tend to be constipated, an herbal laxative or a fiber supplement such as psyllium seed or flax seed may be beneficial.

Some people get less of a Herxheimer reaction with Nizoral (ketoconazole).  Nizoral is a systemic medication and is absorbed throughout the body, but can be potentially toxic to the liver.  If Nizoral is used, a blood test to check liver function has to be done within a month.

Some patients get benefit with over-the-counter products such as caprylic acid or oregano oil which can be helpful at eliminating intestinal yeast.You should read "The Yeast Connection" or other books on yeast by William Crook, M.D. to learn more about Candida.  Not everyone has to follow as strict a diet as recommended in Dr. Crook's book. This depends on your level of sensitivities to yeast and other factors, and should be discussed with Dr. Buscher or one of his medical assistants if you are not sure what to do. The most important thing is to avoid sugar and high levels of refined carbohydrates.  One of the best books on Candida diets is "Allergy and Candida Cooking" by Sondra Lewis. All patients with allergies and Candida should have this book (available at our office).