Chronic candidiasis, “The Yeast Syndrome,” candida, yeast overgrowth

Overview
The microorganism Candida albicans is a unicellular fungus (i.e. yeast) that is present in all humans. Under normal physiological circumstances, its growth is controlled by the immune system and bacteria that live with humans symbiotically. However, in immunocompromised individuals, such as patients with AIDS or cancer, the immune system is weakened and cannot effectively control the growth of C. albicans. Consequently, yeast infections are often seen in such patients. Oral thrush, for example, is often one of the first signs of HIV infection.

A popular book written by Dr. William Crook in 1975, The Yeast Connection, suggests that this problem does not occur exclusively in immunocompromised individuals. In the book, he proposes that environmental factors such as antibiotics, birth-control pills, poor diet, and stress can all cause C. albicans to grow unabated and cause numerous symptoms. This theory originated in 1986 from a book entitled The Missing Diagnosis written by C. Orian Truss, M.D. Both Crook and Truss claim that C. albicans overgrowth is responsible for a variety of non-specific symptoms that include, but are not limited to:

• Fatigue
• Depression
• Craving for carbohydrates (particularly sweets and foods containing yeast)
• Irritability
• Difficulty thinking or concentrating (“brain fog”)
• Recurrent bladder infections
• Sinus infections
  
• Diarrhea
• Constipation
• Bloating
  

Numerous other books have since been published on the topic, and names given to this theoretical disease entity include candida, chronic candidiasis, yeast syndrome, yeast overgrowth, and others. The proposed treatment for this “syndrome” includes a strict diet devoid of foods that “feed the yeast” (e.g. bread, fruit, juice) and the use of antifungal drugs such as nystatin and fluconazole. Proponents of alternative medicine also suggest a number of supplements and herbs to eradicate the yeast, such as probiotics, caprylic acid, garlic, colloidal silver, and others.

Evidence
There is no experimental evidence that shows that C. albicans can growth uncontrollably in healthy individuals as a result of the environmental factors indicated by Crook. Likewise, there is no evidence that shows such an overgrowth cannot occur because it would be impossible to do so. A few studies have been done to evaluate the effectiveness of anti-fungal drugs in relieving symptoms that patients attributed to chronic candidiasis. A randomized, double-blind study published in the New England Journal of Medicine showed that treatment with nystatin did not provide significant improvement in patients with “candidiasis hypersensitivity syndrome” compared to placebo (Dismukes 1990). A randomized, double-blind, placebo-controlled study in Family Practice, meanwhile, showed that patients who received nystatin or a combination of nystain and a yeast-free diet had significant improvement in symptoms compared to patients who received a placebo or a combination of placebo and a yeast-free diet (Santelmann 2001).

Comment
In the introduction of the Santelmann paper, the authors state, "There are also reports of cures of chronic fatigue, allergic conditions including bronchial asthma, pre-menstrual distress, multiple sclerosis and autism with a regimen of diet free from yeasts, moulds and sugars." In the references list, I discovered that the "reports" are actually Truss's book The Missing Diagnosis, Crook's book The Yeast Connection and the Woman, and a commentary by Truss published in the Journal of Orthomolecular Psychiatry. Obviously, none of these sources are supported by any experiments, and using these sources to claim that a change in diet can cure multiple sclerosis is preposterous. The conclusions seemed to be reached by valid data collection and statistical analysis, but there is a high degree of subjectivity involved since the measure of symptom improvement was based on a questionaire. Also, there is absolutely no demonstration that improvement in symptoms was due to the eradication of C. albicans. One could easily argue that the improvement seen with nystatin resulted from, say, altered pain perception caused by the drug.

A lot of people on the web say that their symptoms improve on the "anti-Candida" diet. In the Santelmann paper, their yeast-free diet did not allow "honey, jam, sweets, ice cream, lemonade, fruit juices (except freshly prepared), alcohol, cheese, and breads and pastries containing yeast." These foods are all devoid of nutrition and high in sugar, so obviously people will feel better by not eating them! Eating these foods causes wild fluctuations in blood-sugar that can certainly leave anyone feeling miserable.

Conclusion
The idea of the "yeast syndrome" is highly speculative and is not supported by any evidence. While severely immunocompromised individuals such as cancer and AIDS patients are often affected by systemic candidiasis, there is nothing that suggests this condition occurs in healthy individuals. The suggestion to eliminate sugars and simple carbohydrates from the diet, however, is certainly prudent.

References
Dismukes, W., Wade, J., Lee, J., Dockery, B. & Hain, J. 1990, "A randomized, double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome", The New England Journal of Medicine, vol. 323, no. 25, pp. 1717-1723.

Santelmann, H., Laerum, E., Roennevig, J. & Fagertun, H.E. 2001, "Effectiveness of nystatin in polysymptomatic patients. A randomized, double-blind trial with nystatin versus placebo in general practice", Family Practice, vol. 18, no. 3, pp. 258-265.

Photo credit: Amazon

No, doctors are not greedy and selfish jerks

On Dr. Mercola's web site, I stumbled across a cartoon dubbed "The Town of Allopath." I must say, the Flash animation was very well done, but everything else about it was quite offensive. This cartoon portrays a physician as an insensitive, deceptive, and greedy individual who fabricates a disease just so that he and pharmaceutical companies can make money. A hermit (representative of a naturopath, I guess) then says that prevention is the best way to maintain good health and suggests that allopathic doctors only treat symptoms of diseases. At the conclusion, the hermit holds up a sign that says, "Don't be fooled anymore," which of course implies that all allopathic doctors are deceiving their patients so that they can make money.

I am by no means someone who rejects alternative medicine. Unfortunately, some alternative medicine practitioners (like Mercola) make such outrageous attacks on allopathic medicine that it is sometimes difficult to take alternative medicine seriously. One common theme on many alternative medicine web sites is the idea that doctors are money-hungry ogres that don't actually care about their patients. Supposedly, doctors purposely prescribe drugs to their patients that don't work so that patients will need to keep going back to the doctor's office. That way, according to the theory, doctors can afford to make their payments on their Mercedes and golf tournaments.

Such false accusations are both facetious and offensive on several levels. First of all, most physicians are not rich. In fact, many are thousands of dollars in debt because the cost of medical school is somewhere in the area of $200,000. Even if they have paid off their debt, doctors are by no means swimming in money. Primary care physicians, especially, have seen their salaries decline dramatically over the past few years largely due to poor reimbursement from insurance companies. Patients often complain that they do not have enough time with their doctors because they are overbooked. This is certainly a problem, but many doctors have no choice. They are not overbooked because they want to maximize profits, but rather because they need to see a certain number of patients to prevent themselves from going bankrupt. Indeed, doctors are well-paid relative to the rest of society, but they deserve it - 4 years of college, 4 years of medical school, and 3+ years of internship/residency certainly isn't a cakewalk. If anyone should be criticized for being grossly overpaid, it should be athletes, singers, actors, and people who work on Wall Street.

Keeping this in mind, one would have to be pretty stupid to go into medicine for the money, especially now. People choose to become doctors because of an earnest desire to help people and a passion for science. Therefore, it is revolting to suggest that doctors don't care about their patients, because frankly, caring about their patients is the only reason why many doctors remain in their demanding and often overhwhelming careers. Despite malpractice suits, daunting paperwork, insurance companies, and annoying drug company reps, physicians still wake up in the middle of the night to take care of their patients.

Of course, there might be a few exceptions, and there is the occasional surgeon who recommends a more invasive procedure so that he or she can receive a higher reimbursement. The vast majority of physicians, however, do not choose treatments with the intent of maximizing profits. Ironically, many alternative medicine sites that accuse physicians of being greedy are blatantly trying to make money themselves. One of the most popular alternative medicine sites, Mercola.com, has its own online store! You can't even read an article without signing up for their newsletter so that they can inundate you with spam. And what will these emails say? Of course, they'll spend a page convincing the reader that drug companies and prescription drugs are evil and out to get everyone's money. They will continue to say that real way to lower cholesterol is not to take statins, but rather to buy some herbal blend from the Mercola store that is not supported by one clinical study.

The vast majority of doctors are compassionate and do their best to provide the best possible treatments for their patients. Unfortunately, the same cannot be said about so-called health "gurus" on the web.

Photo credit: http://www.mercola.com/townofallopath/index.htm