For over a decade, countless patients with extensive, chronic gastrointestinal complaints have found their way to my clinical nutrition practice believing that “systemic candida” — or, a pervasive body-wide overgrowth of a particular species of yeast called Candida albicans — is responsible for their misery.
They’ve been led to believe that this condition is responsible for everything from gas, bloating and constipation to fatigue and brain fog to difficulty losing weight, thinning hair and acne. Often, they land on this diagnosis by way of a naturopathic or functional/integrative practitioner — and, more recently, they arrive with results from newly-available stool microbiome tests that seem to confirm it.
Other times, my patients have self-diagnosed based on internet research in which lengthy lists of symptoms associated with systemic candida seem to match their experience exactly.
Despite feeling confident that they’ve identified the reason for these various constellations of symptoms, however, many of these patients have tried all of the recommended remedies that circulate online for treating candida — from the sugar-free/low-carb/yeast-free ” candida diet” to probiotics to bone broth cleanses to extensive herbal supplement regimens to coconut oil and more… and they’re still not feeling any better. And they want to know why.
One reason? “Systemic candida” isn’t what you think it is.
What Is Candida?
“Systemic candida” as it is being marketed to generally healthy people is a pseudoscientific alternative medicine belief. Proponents of this ‘diagnosis’ claim that people with gastrointestinal symptoms suffer from “leaky guts” that allow Candida albicans — a species of yeast that’s an almost ubiquitous and normal member of the human microbiome — to slip out of the gut, enter the bloodstream, travel throughout the body and wreak havoc on systems far and wide, producing symptoms as far ranging as mood disorders and cognitive impairment to digestive disturbances to metabolic sluggishness to immune-driven food allergies or sensitivities.
To be clear: If candida were actually to breach the many physical and immunological barriers in your gut and slip into the bloodstream to infect organs far afield, it would result in an acute, life threatening infection called candidemia, sometimes referred to as systemic candidiasis.
You would develop a high fever, other acute symptoms that vary based on organ systems affected and would likely fall critically ill quite rapidly. (Bloating and brain fog would be the least of your concerns.) Candidemia often occurs in immunocompromised people, such as those on cancer medications, following organ transplantation or who have AIDS.
This isn’t to say that generally healthy, immunocompetent people cannot suffer from various, localized and superficial overgrowth of candida.
Candidiasis can absolutely affect the skin and specific mucous membranes, where the fungus finds a suitable environment to grow:
— The vagina, where it manifests as a yeast infection.
— The mouth and esophagus, known as thrush.
These painful fungal infections are often “opportunistic” in nature, following antibiotic use that wipes out bacterial species that normally keep C. albicans in check. They can also occur in immunocompromised people or those with chronically high blood sugar, such as in poorly controlled diabetes. But these localized infections do not originate in the colon or travel through the blood to arrive at their destination. Nor are they systemic.
Yeast in Your Gut
Newer stool microbiome tests are also misleading people into believing that they have “too much” candida living in their colons by creating arbitrary, proprietary reference ranges that they’ve declared to be “normal,” and labeling anything above that as excessive.
In truth, researchers who study the human microbiome have not established a standard reference range for C. albicans in the colon — or any microbial residents of the gut microbiome, for that matter — which means that any official-looking lab test that flags your levels as excessively high is making up its own standards, which often differ from lab to lab.
Often, these stool microbiome tests — which are not FDA-approved to diagnose any condition — are used to justify selling patients extensive and expensive herbal and probiotic supplement regimens by the practitioners who order them.
For what it’s worth, the yeast species that do live in your gut are not likely to cause excess gas and bloating. Unlike bacteria, yeasts are fungi and do not produce hydrogen or methane gas as a byproduct of metabolizing nutrients in the oxygen-poor environment of the colon. Instead, yeasts produce carbon dioxide, a gas that quickly diffuses into the bloodstream and is exhaled by the lungs. In other words, if you’ve got excessive gas or bloating, blame it on a bacteria, not a yeast!
[Read: What Is Gut Health?]
What Might Cause Symptoms You Thought Were Due to “Systemic Candida”?
All of this is to say: when patients arrive at my doorstep with complaints of chronic bloating, seeming food intolerance, constipation and sluggishness that has not responded to low-carb/sugar-free elimination diets, probiotics, herbal remedies and often even prescription anti-fungals, we have to consider the distinct possibility that maybe — just maybe — there’s something else going on that has nothing to do with candida . So what might that be?
By far, the most common cause of symptoms among my patients who have been misdiagnosed with “systemic candida” is something so banal that they are incredulous it has defied diagnosis for so long: being completely, totally, utterly packed to the gills with stool.
Constipation, chronically incomplete defecation and a high stool burden — which, ironically can often be worsened by low-carb, super-high fiber elimination diets in common circulation within the candida crowd — often presents with many of the same symptoms that the alt med internet attributes to “systemic candida.”
Often, gastroenterologists can miss the diagnosis if their first diagnostic step is to perform a colonoscopy, as the procedure prep eliminates all evidence of the problem.
A simple X-ray or ultrasound is all it takes to confirm the diagnosis of being “FOS” (that’s ‘full of stool’ for those of us in the biz). If this turns out to be the issue, the remedy is to put less fiber into your body until you are able to eliminate more stool, thereby whittling down the backlog that causes so much gas, bloating, pain, sluggishness and occasionally even upper GI symptoms like nausea and loss of appetite.
When my patients don’t respond to simple diet changes and gentle laxative regimens, they often require more specialized evaluation to make sure there is no underlying motility problem or dysfunction of their pelvic floor muscles that’s getting in the way of their being able to move their bowels completely and consistently. Prescription medications, pelvic floor physical therapy, biofeedback or other interventions are often required.
SIBO Is Another Culprit
Another common culprit behind symptoms that are misattributed to “systemic candida” is a condition called SIBO, or small intestinal bacterial overgrowth. I’ve written previously here about this condition, which involves an excess number of your colon’s usual inhabitants taking up residence further upstream in the intestines, where they encounter all manner of delicious undigested carbs, sugars and dietary fibers and reward you with copious amounts of gas, bloating and strange bowel movements in return.
It is not uncommon for people with SIBO to complain of upper GI symptoms (belching, nausea, reflux), brain fog, fatigue and/or new onset food intolerances. These are basically the same set of symptoms that are often attributed to “systemic candida” by functional and naturopathic practitioners.
SIBO is diagnosed with a non-invasive breath test, and is treated with one of several broad spectrum prescription antibiotics — or a cocktail of them, depending on what type of organisms your breath test suggests you are overgrowing. It is not uncommon for patients to require a second, different antibiotic if symptoms do not respond to the first one chosen. Many people with SIBO find that probiotic supplements make them feel worse, not better, which isn’t surprising, as you’re essentially taking pills full of bacteria when having too many bacteria in your gut is the very problem to begin with.
SIBO often recurs if you do not work with your doctor to identify the reason your small intestine became so hospitable to overgrowing bacteria and remedy that predisposing factor. However, with conscientious follow-up diagnostic detective work, a SIBO recurrence is not inevitable.
A diet low in fermentable carbohydrates, called the low FODMAP diet, helps many people with untreated SIBO manage their symptoms, but this diet neither cures active SIBO nor prevents SIBO recurrence in people who have been successfully treated.
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