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Dr David L. J. Freed, MB, MD, MIBiol

Candida albicans is the name of a microscopic fungus of the type called a yeast. This germ lives in the human bowel as a commensal in most of us. The large bowel contains an average of 100,000,000,000,000 germs, of various types (more bacteria than there are cells in the rest of the body), and C albicans is just one species. Normally these germs are harmless and some are actively beneficial. Collectively they are known as the “bowel flora” and human excrement is largely composed of this. And that, in health, is all we need to know.

If however the balance of organisms that comprise the gut flora becomes distorted, by malfunction of the immune system, by antibiotics or (most commonly) just by ingesting too much sugar, more dangerous organisms can flourish and may displace the usual residents. This is usually a short-term imbalance but can sometimes become long-term. Candida albicans, if allowed to multiply beyond normal limits, can be dangerous in its own right and can cause a number of conditions, ranging from the merely unpleasant (thrush), right across the spectrum to the severe (mucocutaneous candidiasis) and even life-threatening (systemic mycosis). Fortunately, nowadays we have several effective drugs that kill fungi including C albicans, besides which several foodstuffs and herbal preparations are thought to be anti fungal, though not perhaps as strongly.

In the 1930’s an obscure illness was noted, mainly in women, consisting of abdominal bloating and vague symptoms such as general malaise, headaches, “brain fog”, aches and pains and fatigue. It was attributed either to carbohydrate intolerance or psychosomatism, depending on the doctor’s prejudice, and was soon forgotten. More recently the syndrome was rediscovered by the American allergists Truss and Crook, who noted the frequent overlap of symptoms with those of food (mainly carbohydrate) intolerance states. Now armed with modern anti fungal drugs, these doctors made the key observation that the illness can often be alleviated by a package of anti fungal measures including low-sugar diet, anti fungal drugs and “probiotics”. These are cultures of living “friendly” bacteria, taken by mouth in the hope that some will reach the large bowel alive and there help restore the balance. From this clinical observation arose the “candida hypothesis”, which proposes that once C albicans multiplies in the bowel beyond a certain stage, it enters a mycelial phase in which fungal extensions (hyphae) burrow between the epithelial cells, making the mucosa excessively permeable (“leaky gut”) and thus encouraging food intolerance.

Undoubtedly the “candida hypothesis” as explained in popular paperbacks is over-simple and inaccurate, and I myself was highly skeptical until recent years, when good scientific evidence began to accumulate that there is in fact abnormal fungal growth in the intestine in this syndrome, that it causes abnormal carbohydrate fermentation (which can be detected by laboratory tests), and that at least some probiotics do in fact work. There is indeed an intimate connection with food intolerance states and the two can aggravate each other. In practice I usually make the assumption that all multi-symptomatic patients are probably harbouring an abnormal bowel flora. I use anti fungal drugs and/or probiotics in about a third of such patients, but most find that a low-sugar diet is all they need if it is sufficiently strict, and combined if necessary with allergy methods – certainly antiquing will not help much without diet.

Recommended reading

Is there an allergic and fermentative gut condition, and does it relate to Candida?
Eaton KK. In Brostoff J, Challacombe S (eds)
'Food Allergy and Intolerance'
Saunders/Elsevier, London, 2002,
ISBN 0702020389, pp 351-363.

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