A Naturopathic Doctor’s Approach
Most integrative medicine physicians who have been in clinical practice for a number of years will inevitably encounter a multitude of patients who have had their health negatively impacted by some form of Candida spp. infection. Fungal infections are estimated to occur in several million people each year, and recent evidence suggests those numbers are increasing.,, Fortunately, of all the fungi in the world, only around 600 species are known to be human pathogens., This relatively small group of fungi can cause symptoms ranging from mild infections of the skin to severe cutaneous infections and even potentially life-threatening systemic infections from species such as Aspergillus fumigatus, Cryptococcus neoformans, and Histoplasma capsulatum in addition to Candida spp.,
Fungal infections are estimated to occur in several million people each year, and recent evidence suggests those numbers are increasing.
Candida albicans (CA), the most prevalent fungal species encountered by humans, is a normal commensal microbe colonizing the skin and mucosal surfaces of the mouth, genitals, and intestines in 30 to 70% of healthy people., Most of the time, this colonization is tolerated and usually harmless. However, it is considered an opportunistic pathogen, and can cause problems when a weakened immune system or other factors, such as use of antibiotics and immunosuppressive drugs, allow it to grow unabated.,, It can then affect almost any part of the body including skin, nails, sinuses, and respiratory, gastrointestinal, and urogenital tracts. Although most of these infections are not of an urgent nature and respond readily to treatment, in certain groups of vulnerable patients such as the elderly, critically ill, and those with a compromised immunes system, it can potentially cause severe, life-threatening blood stream infections and subsequent infections of internal organs.,,,
As mentioned above, the use of antibiotics and immunosuppressive drugs such as corticosteroids are major factors contributing to fungal infections. By disrupting normal bacterial colonization and suppressing the immune system, they create an environment within the body which species such as CA can thrive and create a pathological overgrowth situation., There are a variety of mechanisms by which a fungal overgrowth may affect one’s health including: eliciting an immune response, disrupting the balance of healthy intestinal microbiome, and by disrupting the mucosal barrier of the intestines.,
Health conditions associated with candida
CA frequently inhabits the gastrointestinal tract (GI) of humans leading to a condition termed gastrointestinal candidiasis. Recent studies have shown that a high level of candida colonization is associated with several diseases of the gastrointestinal tract. This may have to do with the increased amount of inflammation that occurs when there is a high level of candida present. CA infection has been shown to increase production of interleukin-17 (IL-17) via T helper type 17 (Th-17) cells. These effects on IL-17 may underlie the ability of CA to enhance inflammation in the GI tract. Specific examples of the impact gastrointestinal candidiasis has on health include:
Candida albicans frequently inhabits the gastrointestinal tract (GI) of humans leading to a condition termed gastrointestinal candidiasis. Recent studies have shown that a high level of candida colonization is associated with several diseases of the gastrointestinal tract.
- The presence of CA at high levels has been shown to diminish gastric blood flow and delay healing of gastric ulcers in animal studies, an effect which was partly ameliorated by the use of the probiotic strain Lactobacillus acidophilus.
- The immune response to CA has been proposed to play a role in the development of Crohn’s disease (CD). Mycological investigation of families with a history of CD shows that patients with CD and their healthy relatives are colonized with CA more commonly than control families.,,
- Oropharyngeal candida (commonly known as oral thrush) may also occur with the use of medications such as antibiotics and immunosuppressants. Although oral infection can be caused by other species of candida, CA is the more common agent associated with this condition.
A human study looking at the role candida plays in antibiotic-associated diarrhea was investigated in 24 elderly patients who tested negative for Clostridium difficile toxin and other intestinal pathogens. Seven had intestinal overgrowth of Candida spp. (≥105 CFU/mL). None of the 24 matched, antibiotic-treated controls without diarrhea had candida overgrowth. All five patients with diarrhea and candida overgrowth treated with oral nystatin, a commonly prescribed antifungal medication, responded with resolution of diarrhea and lowering of fecal counts to < 104 CFU/mL within seven days of initiating antifungal therapy despite continuation of antibiotics. In the other two patients with candida overgrowth, the diarrhea spontaneously subsided and fecal candida counts returned to normal (<104 CFU/mL) after antibacterial agents were withdrawn.
Similarly, the incidence of vaginal candida infections, termed vulvovaginal candidiasis (VVC), following antibiotic use is high. In a study done in Australia, a community sample of 223 women without significant vaginal symptoms were recruited and the incidence of genital colonization by various species of candida was documented, along with possible symptoms of VVC, before and after treatment with antibiotics. Baseline candida species colonization was present in 21% of women, rising to 37% after antibiotic treatment. The primary species detected was CA (73%), with C. glabrata detected in around 20%. Self-assessed proneness to VVC after antibiotic treatment and baseline colonization with candida were significantly associated with symptomatic VVC after antibiotic treatment.
In recent years, there has been an emerging interest in the possible role of the gut microbiota as a co-factor in the development of autism spectrum disorder (ASD), as many studies have highlighted the bidirectional communication between the gut and brain (the so-called “gut-brain axis”). Accumulating evidence has shown a link between alterations in the composition of the gut microbiota and both gastrointestinal and neuro-behavioral symptoms in children with ASD., Dysbiosis (a term for a microbial imbalance) in ASD involves not only bacterial species but also yeasts, as reported in recent studies.,, Gastrointestinal CA is two times more abundant in toddlers with ASD than in normal individuals and can increase systemic levels of ammonia and other toxins, which can induce autistic behaviors.,
Gastrointestinal Candida albicans is two times more abundant in toddlers with ASD than in normal individuals and can increase systemic levels of ammonia and other toxins, which can induce autistic behaviors.
Natural remedies to the rescue
In my experience, spanning two decades of clinical practice, candida overgrowth cases have echoed the research, predominantly occurring in patient populations with a diagnosis of ASD VVC, chronic sinusitis, and in those treated with multiple rounds of antibiotics or immunosuppressants. Fortunately, for most patients, these cases responded quite favorably to a combination of select nutrients, particular herbal medicines, and dietary intervention.
- Probiotics – specific strains of beneficial bacteria including Lactobacillus spp., Bifidobacterium, and Saccharomyces boulardii (a beneficial yeast) have been shown to inhibit candida.,,,,, In children, probiotics are an excellent first choice for dysbiosis due to their high safety profile.
- Oil of Oregano (Origanum vulgare) – a wide variety of essential oils possess anti-candida and broad-spectrum antimicrobial activity., In particular, oregano oil has been shown to be highly effective.,
- Caprylic Acid – a medium chain fatty acid, found at high levels in virgin coconut oil, that has been shown to exert antifungal effects against CA and other organisms.,, Virgin coconut oil can also be very useful as a topical agent for CA overgrowth on the skin.
- Colostrum – contains lactoferrin which demonstrates a significant antifungal effect against a variety of pathogenic Candida (CA, C. krusei, C. tropicalis).,, It has also been shown to have a synergistic effect with common antifungal prescription medications. Colostrum also is an excellent intervention for children.
- Pau d’Arco (common name referring to various Tabebuia) – is a canopy tree indigenous to the Amazonian rainforest and other parts of South America. Although limited data exists with human trials, two main bioactive components (lapachol, beta-lapachone) extracted from the inner bark, have demonstrated considerable anti-inflammatory and antifungal effects in vitro.,
- Black Walnut (Juglans nigra)– another excellent herbal medicine, frequently used to treat parasites, has also been shown to exhibit strong antifungal properties.,
- Biotin – a B-complex vitamin, also known as vitamin B7, is not historically thought of as an antifungal agent but may play an interesting role particularly in the resolution of CA that is resistant to treatment. In an article that appeared in Obstetrics &Gynecology, the official publication of the American College of Obstetricians and Gynecologists, authors propose that an appreciable number of women with a history of VVC that is unresponsive to conventional antifungal treatment may respond favorably to pharmacological doses of biotin. This may warrant consideration and further investigation thru human trials given that one in 123 individuals are estimated to be a carrier of biotinidase deficiency (a genetic, inborn error of metabolism resulting in a biotin deficiency).
It has been my clinical experience that using herbal medicines (and nutrients) that have known antifungal activity, especially when combined with a healthy diet, can be quite effective against conditions associated with candida overgrowth.
It has been my clinical experience that using herbal medicines (and nutrients) that have known antifungal activity, especially when combined with a healthy diet, can be quite effective against conditions associated with candida overgrowth. Although there are a variety of “anti-candida” diets one can choose to follow, it has been my experience that the simplest approach is often the best – focus on consuming organic, whole foods including meat, fish, vegetables, nuts, grains, healthy fats, and some fruits while at the same time minimizing sugar, simple carbohydrates, and processed foods.Click here to see References
 Hsu J, et al. Diagnosing invasive fungal disease in critically ill patients. Crit Rev Microbiol. 2011;37(4):277-312.
 Brown G, et al. Tackling human fungal infections. Science. 2012 May 11;336(6082):647.
 Fungal Research Trust. How common are fungal diseases? [Internet]. Macclesfield, Cheshire (UK): Fungal Research Trust; 2017 [cited 2019 Aug 1]. Available from: https://www.fungalinfectiontrust.org/how-common-are-fungal-diseases
 Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microb Rev. 2007;Jan;20(1):133-63.
 Mayer F, et al. Candida albicans pathogenicity mechanisms. Virulence. 2013 Feb 15;4(2):119-28.
 Gow N, et al. Candida albicans morphogenesis and host defense: discriminating invasion from colonization. Nat Rev Microbiol. 2011;10:112-22.
 Perlroth J, et al. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007;45:321-46.
 Cheng, I, et al. Interplay between Candida albicans and the mammalian innate host defense. Infect Immun. 2012;80(4):1304-13.
 Heitman J, et al. Molecular principles of fungal pathogenesis. Emerg Infect Dis. 2006 Oct;12(10):1626–27.
 Douglas L, et al. Sur7 promotes plasma membrane organization and is needed for resistance to stressful conditions and to the invasive growth and virulence of Candida albicans. MBio. 2012 Jan-Feb;3(1):e00254-11.
 Kim J, Sudbery P. Candida albicans, a major human fungal pathogen. J Microbiol. 2011 Apr;49(2):171-7.
 Tani N, et al. Antifungal activities of novel non-azole molecules against S. cerevisiae and C. albicans. Eur J Med Chem. 2012;47(1):270-7.
 Yan L, et al. Disruption of the intestinal mucosal barrier in Candida albicans infections. Microbiol Res. 2013 Aug 25;168(7):389-95.
 Kumamoto C. Inflammation and gastrointestinal Candida colonization. Curr Opin Micobiol. 2011 Aug;14(4):386-91.
 Brzozowski T, et al. Influence of gastric colonization with Candida albicans on ulcer healing in rats: effect of ranitidine, aspirin and probiotic therapy. Scand J Gastroenterol. 2005 Mar;40(3):286-96.
 Poulain D, et al. Yeasts: neglected pathogens. Dig Dis. 2009;27 Suppl 1:104-10.
 Pineton de Chambrun G, et al. Pathogenic agents in inflammatory bowel diseases. Curr Opin Gastroenterol. 2008 Jul;24(4):440-7.
 Standaert-Vitse A, et al. Candida albicans colonization and ASCA in familial Crohn’s disease. Am J Gastroenterol. 2009 Jul;104(7):1745-53.
 Epstein JB, Polsky B. Oropharyngeal candidiasis: a review of its clinical spectrum and current therapies. Clin Ther. 1998 Jan-Feb;20(1):40-57.
 Rautema R, Ramage G. Oral candidosis—clinical challenges of a biofilm disease. Crit Rev Microbiol. 2011;37(4):328-36.
 Danna PL, et al. Role of candida in pathogenesis of antibiotic-associated diarrhoea in elderly inpatients. Lancet. 1991 Mar 2;337(8740):511-4.
 Pirotta M, Garland S. Genital candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J Clin Microbiol. 2006 Sept;44(9):3213-7.
 Fattorusso A, et al. Autism spectrum disorders and the gut microbiota. Nutrients 2019 Mar;11(3):521.
 Horvath K, Perman J. Autistic disorder and gastrointestinal disease. Curr. Opin. Pediatr. 2002;14:583–7.
 Adams J, et al. Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity. Nutr Metab. 2011;8:34.
 Kantarcioglu A, et al. Microbiota-gut-brain axis: yeast species isolated from stool samples of children with suspected or diagnosed autism spectrum disorders and in vitro susceptibility against nystatin and fluconazole. Mycopathologia. 2016;181:1–7.
 Iovene M, et al. Intestinal dysbiosis and yeast isolation in stool of subjects with autism spectrum disorders. Mycopathologia. 2017;182:349–63.
 Strati F, et al. New evidences on the altered gut microbiota in autism spectrum disorders. Microbiome. 2017;5:24.
 Falagas M, et al. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. J Antimicrob Chemother. 2006;58(2):266-72.
 Mailander-Sanchez D, et al. Potential role of probiotic bacteria in the treatment and prevention of localised candidosis. Mycosis. 2012;55(1):17-26.
 Krasowska A, et al. The antagonistic effect of Saccharomyces boulardii on Candida albicans filamentation, adhesion and biofilm formation. FEMS Yeast Res. 2009 Dec;9(8):1312-21.
 Murzyn A, et al. Capric acid secreted by S. boulardii inhibits C. albicans filamentous growth, adhesion and biofilm formation. PLoS One. 2010 Aug 10;5(8):e12050.
 Manzoni P. Use of Lactobacillus casei subspecies Rhamnosus GG and gastrointestinal colonization by Candida species in preterm neonates. J Pediatr Gastroenterol Nutr. 2007 Dec;45 Suppl 3:S190-4.
 Zwolińska-Wcisło M, et al. Are probiotics effective in the treatment of fungal colonization of the gastrointestinal tract? Experimental and clinical studies. J Physiol Pharmacol. 2006 Nov;57 Suppl 9:35-49.
 Azimi H, et al. A comprehensive review of vaginitis phytotherapy. Pak J Biol Sci. 2011;14(21):960-6.
 Hammer K, et al. Antimicrobial activity of essential oils and other plant extracts. J Appl Microbiol. 1999;86:985-90.
 Manohar V, et al. Antifungal activities of origanum oil against Candida albicans. Mol Cell Biochem. 2001 Dec;228(1-2):111-7.
 Pozzatti P, et al. Comparison of the susceptibilities of clinical isolates of Candida albicans and Candida dubliniensis to essential oils. Mycoses. 2010 Jan;53(1):12-5.
 Ogbolu DO, et al. In vitro antimicrobial properties of coconut oil on Candida species in Ibadan, Nigeria. J Med Food. 2007 Jun;10(2):384-7.
 Adams J, et al. Effects of sodium caprylate on Candida albicans. I. Influence of concentration on ultrastructure. J Bacteriol. 1963 Sep;86:548-57.
 Rosenblatt J, et al. Caprylic acid and glyceryl trinitrate combination for eradication of biofilm. Antimicrob Agents Chemother. 2015;59(3):1786-88.
 Jadhav A, et al. The dietary food components capric acid and caprylic acid inhibit virulence factors in Candida albicans through multitargeting. J Medicinal Food. 2017 Nov;20(11):1083-90.
 Herlea V. Antifungal effects of the antimicrobial factors in human milk and colostrum in mixed bacterial and fungal cultures. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol. 1985 Jan-Mar;30(1):43-8.
 Al-Sheikh H. Effect of lactoferrin and iron on the growth of human pathogenic candida species. Pak J Biol Sci. 2009;12(1):91-4.
 Russo R, et al. Randomized clinical trial in women with recurrent vulvovaginal candidiasis: efficacy of probiotics and lactoferrin as maintenance treatment. Mycoses. 2019 Apr;62(4):328-35.
 Kobayashi T, et al. Synergistic antifungal effect of lactoferrin with azole antifungals against Candida albicans and a proposal for a new treatment method for invasive candidiasis. Jpn J Infect Dis. 2011;64(4):292-6.
 Gomez Castellanos J, et al. Red Lapacho (Tabebuia impetiginosa)-a global ethnopharmacological commodity? J Ethnopharmacol. 2009 Jan 12;121(1):1-13.
 Guiraud P, et al. Comparison of antibacterial and antifungal activities of lapachol and B-lapachone. 1994 Aug;60(4):373-4.
 Vikrant P, et al. Plants with anti-candida activity and their mechanism of action: a review. J Environ Res Develop. 2015 Apr;9(4):1189.
 Sytykiewicz H, et al. Antifungal activity of Juglans regia leaf extracts against Candida albicans isolates. Pol J Environ. 2015; 24(3):1339-48.
 Strom CM, Levine EM. Chronic vaginal candidiasis responsive to biotin therapy in a carrier of biotinidase deficiency. Obstet Gynecol 1998 Oct;92(4):644-6.
 Wolf B, Heard GS. Biotinidase deficiency. Adv Pediatr. 1991;38:1-21.