by Emma Holister
candida cartoons: click on image to enlarge
EH: Of all the theories about Candidiasis flying around the Net, I feel that the one explored on your website "Is Candida an Endocrine Disorder?" delves furthest into the heart of this complex issue. Have your experiences over the years given you more conviction about this hypothesis?
CT: I am sure that it is one significant cause of candida. Any hypothesis about the cause(s) of candida has to be able to account for its epidemiology. We know that it is mainly women who suffer from it – estimates are 60% women, 20% men and 20% children. All other explanations for candida such as antibiotics or mercury don’t satisfy that criterion. However, I don’t think it is the sole cause of candida; I never did. The article on our website is one of several that first appeared in our quarterly newsletter, the Candida Digest, exploring possible causes. A recent (2006) edition of the Candida Digest featured another article on causes, so I’d like to quote from that in answering your question:
Candida is multifactorial, which means that there is not one sole cause of candida, but several contributory factors. This does tend to complicate things, because the cause of my candida may not be the same as the cause of yours.
Candida albicans, (and other types such as C. krusei, C. parapsilosis and C. tropicalis) are opportunistic which means that they live in us in small numbers, ready to grow out-of-control, if given half a chance. It is important to understand that Candida albicans is not a pathogen that invades the body from the outside. People often think that their immune system has let them down when they have candida, but this is not so. It is not a failure of defence, but a failure of internal regulation. Physiologists have a name for this internal regulation and the balance it achieves. They call it ‘homoeostasis’. Candida is a sign that homoeostasis is being breached; that the body is struggling in its attempts to maintain the balance of our ‘internal terrain’. The degree of Candida albicans overgrowth indicates the degree of the imbalance. There are three types of imbalance of our internal terrain which could lead to candida:
1. Of the microbes residing in our digestive system. No doubt you are aware that all of us have several pounds of microbes (mainly bacterial) which digest our food for us. It is critical that the microbes are present in the correct ratios. Imbalances here are usually caused by taking broad-spectrum antibiotics or other medication, and are aggravated by poor dietary choices.
2. Of the regulatory system of the body i.e. the endocrine system. In brief, Candida albicans overgrows in the presence of progesterone which is why so many women have thrush when they are pre-menstrual. You can have relatively high progesterone by having relatively low oestrogen, and a number of things block oestrogen receptors e.g. mercury, and steroidal drugs such as the contraceptive pill and HRT.
3. Of the cells and organelles such as:
- sugar imbalance (which is why the symptoms of candida and hypoglycaemia are so similar, and why diabetics regularly succumb to fungal infections);
- acid-alkaline imbalance (see Volume 7 Issue 3 of the Candida Digest);
- insufficient oxygen: evolutionary biologists tell us that fungi first appeared on our planet when there wasn’t much oxygen around, so candida naturally thrives when oxygen levels plummet. Oxygen kills fungus, helping to stop it spreading. Insufficient oxygen is often caused by a lack of iron in the blood (anaemia), making anaemia a prime cause of candida. People who are chronically tired with candida, often think that their tiredness is caused by the candida, but this isn’t necessarily so. In some cases, both the candida and the tiredness are caused by the anaemia. If you are chronically tired and haven’t been tested for anaemia, I would urge you to ask your GP for a test. Ask to be tested for both haemoglobin and ferritin.
It stands to reason that if anaemia is behind your candida problem, you will not get well without increasing your iron levels, and an overly-restrictive diet could do more harm than good.
EH: The natural products recommended for hormonal problems are, amongst others, Black Cohosh, Red Clover, Siberian Ginseng, Dong Quai and Wild Yam. Could these be more effective than the more frequently recommended Evening Primrose Oil?
CT: For menstrual difficulties, I tend to favour GLA over Evening Primrose Oil. The other products you mention are more helpful for menopausal symptoms. The two products that I would NOT recommend for candida sufferers are Agnus Castus and Natural Progesterone Cream. Based on my experience and that of members, those products exacerbate candida symptoms.
EH: Am I right in thinking that on your site you suggest that antibiotics may not necessarily be the worst culprit when it comes to causing Candidiasis? And that hormones such as the pill and HRT could be even worse?
CT: Candida is multifactorial so the prime cause varies from person to person. My impression is that for women, the trigger is often steroidal pills or creams, whilst for children and men, it is more likely to be antibiotics. To give a more complete answer, I shall quote from another Candida Digest that discussed causes:
Candida is part of a cascade of causes and effects, indicating that the body is out-of-balance i.e. that homoeostasis is being breached… I prefer the term ‘contributory factors’ to causes because whilst these factors do cause candida in susceptible people, they do not affect healthy people. The main contributory factors that can result in a loss of homoeostasis leading to candida are:
1. Prolonged use of broad-spectrum or strong antibiotics which destroys the good bacteria in the digestive system. During the course of a long interview with the editor of CAM (a magazine for health professionals), in 2004, Dr Nigel Plummer described a trial undertaken by BioCare that demonstrated Candida albicans overgrowth in the human caecum following the use of antibiotics in 50% of subjects; 33% had mucosal surface colonisation by yeast; 15% of subjects had (what appeared to be) persistent colonisation giving rise to a low-grade inflammatory response. He said that because the inflammation never becomes systemic, the immune system is incapable of resolving it. This means that people end up with a low-level chronic inflammatory condition that gives rise to fatigue, periodic aches and pains, muscle pain, joint pain, intermittent fever, depression, loss of concentration, brain-fog, i.e. symptoms of candida.
2. Use of hormonal products such as HRT, contraceptive pill, or Natural Progesterone Cream. It doesn’t help that these products are usually taken when the body is already undergoing hormonal havoc. The female body is more susceptible to candida at times of puberty, pregnancy, and menopause; and during the post-ovulation stage of the monthly menstrual cycle.
3. Use of steroids such as hydrocortisone, beconase, and prednisolone which block oestrogen receptors.
4. Long-term use of drugs for medical conditions such as immuno-suppressive drugs following organ transplants.
5. Dental mercury amalgam poisoning, or mercury from other sources, e.g. fish. Make sure your Omega 3 is free from mercury. Mercury blocks oestrogen receptors.
6. Chemical poisoning from the home, garden, or workplace. This is particularly relevant for some occupations e.g. hairdressing and farming. Most of our farmer-members cite the handling of sheep-dips and other chemicals as precipitating their candida.
7. Heavy metal poisoning (other than mercury) e.g. lead, cadmium.
8. Stress leading to adrenal exhaustion.
9. As a complication of a medical condition such as diabetes, and/or of the treatment e.g. cancer or AIDS.
10. Vaccinations. There is increasing concern that babies are now given too many vaccinations (25 per year) when their immune systems are underdeveloped. This may predispose them to chronic illness, including candida, later in life. Our adult members who cite vaccinations as the cause of their candida had to have their injections twice because the first one ‘didn’t work’.
11. Poor dietary choices - eating an excessive amount of refined sugar, processed foods, inorganic produce etc.
Some causes indicate specific treatments e.g. detoxification or specific diets. For example if the cause is hormonal then soya and cow’s milk are best avoided, although sheep and goats’ milk may be ok. Conversely, food intolerances of milk and soya should alert a woman to the possibility that her candida has an hormonal cause.
EH: I believe that Candidiasis is the root cause of many modern illnesses. What is your opinion on this?
CT: I don’t think candidiasis is the root cause, because I think that it is a symptom – a sign that homoeostasis is being breached, and whatever is causing that imbalance is the root cause. The reason why I stress that point, is because people need to address the underlying cause in order to make a full recovery from their candidiasis/candida. If they see candida as the root cause then they won’t look beyond that. For many people, that is a crucial mistake. When they fail to recover using a self-help book, they blame themselves for not following the diet religiously, and embark on a dangerously restrictive diet, and fruitless search for the ‘best antifungal’ and the ‘best probiotic’. They run the risk of malnourishment and even more entrenched candida.
I get many telephone calls from people who tell me that they “know all about candida” as they have read the books and surfed the internet, and all they want from us is the definitive diet and the best anti-fungal. I find their self-assurance truly alarming – it takes so much effort to turn them around, to get them heading in the right direction. After 16 years’ involvement with candida, including a decade of intensive research, I certainly don’t feel that I know all there is to know about candida. Sometimes, I think I have barely touched the surface, which is probably what maintains my interest.
I also find that this simplistic view of candida can give rise to misunderstandings between sufferers and therapists. It can lead to a situation where sufferers appreciate the therapists who follow a strategy that they recognise from the self-help books, but are critical of those therapists who have a more fundamental (e.g. integrated medicine) approach, focused on identifying and treating underlying causes, rather than candida per se.
Having said all of that, candida does cause its own symptoms so it must be addressed. What I do think is that candida is implicated in a huge number of illnesses, but as part of a cascade of causes and symptoms, rather than as the root cause.
EH: Do you think that Candidiasis is a 'women's issue'? Do you think that the high incidence of misdiagnosis of Candida and the subsequent prescription of antidepressants has anything to do with this?
CT: Undeniably, it affects far more women than men, and many female members report that their mothers, daughters, and sisters suffer from it too. But we shouldn’t lose sight of the fact that it does affect boys as well as girls, and both sexes of the elderly, and even men in their prime when they are weakened by chemicals or drugs such as steroids or antibiotics. My fear is that it will be more prevalent in the next generation becoming a “children’s issue”, as more women with candida give birth. These mothers pass their abnormal gut flora to their offspring, because a human baby is born with a sterile gut and acquires most of its gut flora from its mother.
I don’t really have a view on the second part of your question, other than to say that it is certainly very depressing to find yourself with an illness that is not medically recognised. I find it hard to imagine that antidepressants can be a solution to a physiological problem; and given their addictive nature, they often serve to compound it.
EH: The moment a person suspects they may have Candida, they are at once bombarded by a tidal wave of sales ploys for this or that miracle cure. Attempting to get better can then become an expensive and fruitless journey for the average Candida sufferer. What would be your advice to someone who thinks they may be suffering from Candidiasis?
CT: They need to understand the cause of their candida. Most of my work is geared towards helping sufferers realise that, and not to assume that because one product or approach worked for someone else, it will work for them too. We have trialled about two dozen supplements. The trials are informal; usually a dozen members try a product for one month. The usual pattern of results is that a couple of people experience significant improvement or even a cure; most report some improvement, and one person says that the product made him, or her, worse. Clearly, there are huge individual differences in reactions to the products. They all seem to work for some people, but they don’t work universally. I don’t find this too surprising, given the range of causes. If we had found a product that worked for everybody we would be shouting it from the hill-tops, but that hasn’t happened.
Similarly, I don’t believe that there is a universal anti-candida diet. I’m not a fan of overly restrictive diets, as I feel that they can do more harm than good. Candida feeds on sugar, so it is important to give up sucrose and glucose. Fructose is more controversial; some sufferers can tolerate it; others cannot. We recommend testing for food intolerances. In theory, sufferers should be able to tolerate yeast, as yeast doesn’t feed on yeast, but in practice, many sufferers find that they are intolerant to it.
EH: I think trying to inform others about Candida is a deeply frustrating process for many reasons. What would you say are the obstacles to progress that you find recurring the most in your line of work?
CT: It appears to me that recognition of candida has languished because of the challenges it makes to the prevailing reductionist medical paradigm. It violates Pasteur’s germ theory. In fact, I would go further and say that candida invalidates it. Pasteur’s germ theory is crude but it is deeply ingrained in our culture, so people have to go through a huge learning curve to really understand candida. It requires a paradigm shift, and that is always painful.
A lack of research evidence for candida. I know that the researchers at Southampton University went all over the place to try to get funding for their research, but were repeatedly turned down. Eventually, after several years of effort, AllergyUK funded the candida research in 2005-2006. I understand that the research went well, although I am still awaiting the detailed results. There is some other research evidence, but on the whole it is sparse. If researchers cannot get funding, this is to be expected.
To the uninitiated, Candida albicans is synonymous with thrush, which has unfortunate connotations. I suspect that is why we have failed to attract a high-profile patron and trustees, despite my endless begging letters.
We can anticipate that some vested interests may not take kindly to exposés about the causes of candida, but that hasn’t been a problem for us yet. This could probably be avoided altogether if we were advocating a narrow pharmaceutical solution, but we are not, as I doubt that the body can be drugged into homoeostasis, would expect toxic side-effects, and know that resistance to anti-fungals e.g. fluconazole, is already an issue.
EH: People suffering from all sorts of immunity diseases including AIDS in particular, have Candidiasis. Do you have many AIDS sufferers coming to your organisation for help?
CT: No we don’t. We do get the most distressing emails from people around the world who have systemic candidiasis (as opposed to chronic candidiasis) and they are obviously terribly ill – often terminal, I would think - but that is usually cancer-related. We have had requests for information from African countries about candida and AIDS. But my only UK involvement with AIDS was to accept an invitation to a major teaching hospital in London, to talk to the nutritionists about the anti-candida diet for their AIDS patients. But I’m not sure that they liked what I said, because yet again, they wanted the definitive diet with no ifs or buts.
I do, however, have strong views about AIDS. I am of the firm opinion that AIDS cannot be caused by any retrovirus, and that the most plausible explanation for AIDS is the one put forward by the Perth Group. This leads me to another point. There are three grades, possibly stages, of candida or candidiasis:
Superficial: thrush, skin and nail infections, nappy rash etc.
Chronic: usually what we mean by ‘candida’.
Systemic: Concomitant with serious illness e.g. cancer and AIDS.
Superficial and systemic are recognised medical conditions – chronic is not. We need to campaign to get chronic candidiasis medically recognised, but in addition I am not totally convinced that the prevailing view of superficial candidiasis and systemic candidiasis is correct. I think that needs revisiting as well. The medical view of superficial candidiasis is that it is a local, somewhat trivial, problem, but there is contradictory evidence, for example vaginal thrush is accompanied by candidiasis in the gut. I consider superficial candidiasis to be an early warning that homoeostasis is being breached.
Systemic candidiasis is viewed as an opportunistic infection that arises when a person’s immune system is shot to pieces. That may happen when someone’s immune system is deliberately suppressed, e.g. with immunosuppressant drugs following a liver transplant, but I’m not so sure about diseases. I think that there is convincing evidence that candidiasis is an integral part of the disease process of cancer, AIDS, and even diabetes. The candidiasis may, of course, progress as a side-effect of the treatment of these serious illnesses, but that’s not the same thing.
EH: The National Candida Society is a pioneer in the field and an inspiration for newer groups appearing world-wide. You have founded an international organisation, how is this coming along?
CT: I am very proud of what we have achieved, but it edges forward ever so slowly. We currently have 700 members. We have had 6,000 members in total; about 85% of them were UK residents, and the rest lived in just about every country in the world, showing that candida is a world-wide problem. These early years have been foundational, and we are ready to use the knowledge gained to start campaigning for candida to be recognised as a medical illness. Achieving that goal will enable us to help many more sufferers, and most importantly to raise awareness into causes and prevention. What is holding us back is lack of resources for staff, premises etc. So far, I have failed to attract trustees and a patron, who will be able to help us draw in the financial resources that we need to expand. If you know of anyone who might be able to help in any capacity, I’d love to hear from them as soon as possible. There’s a huge amount of good rewarding work to be done.
The National Candida Society