Candida overgrowth

Within the gut live about 1–2kg (2–4lb) of gut flora. These “friendly bacteria” have a variety of roles to play, including assisting in digestion, keeping unhealthy organisms at bay and ensuring that the gut lining remains healthy. The yeast organism Candida albicans can also inhabit the large intestine and does not usually cause health problems.

However, under certain circumstances, it can overgrow in the small intestine, leading to symptoms that include erratic bowel habits (constipation and/or loose bowel movements); wind and flatulence; abdominal bloating; anal itching; recurrent bouts of thrush (vaginal yeast infection); other fungal infections, including athlete’s foot or generalised itching around the groin and/or the inside of the buttocks; recurrent bouts of cystitis and/or problems with vaginal irritation; and cravings for sugar, sugary foods (such as chocolate, biscuits or cakes) or yeasty foods (cheese, bread, alcohol or vinegar). Candida overgrowth may also cause vague, unexplained health problems, such as fatigue, pain and mental distress.

The overlap between symptoms of gut flora disturbance and depression can be confusing for patients as well as practitioners. One of the major causes of yeast overgrowth is antibiotic therapy, which can kill the healthy gut organisms that normally help to keep yeast organisms such as Candida at bay. Other common underlying factors in yeast overgrowth include stress (which can upset the immune system), the consumption of yeast-encouraging foods, such as sugar, bread, cheese and alcohol, and taking the oral contraceptive pill or hormone replacement therapy (HRT).

Tests for Candida

If Candida is suspected, a nutritional therapist may arrange one of the various tests. Yeast analysis of stool samples can be tried, although it can be misleading because Candida is normally present in the large intestine. The blood can be tested for the Candida antigen – if positive, an ongoing yeast infection may be indicated.

Antibodies are substances the immune system produces in response to antigens. Two types of antibody, known as IgG and IgM, are usually measured in the blood. Raised levels of the antibodies specific for Candida may indicate a significant infection. A type of antibody known as secretory IgA is produced by the gut.Measuring the amount of secretory IgA made specifically against Candida can be a good guide to the presence of yeast in the gut.

Another test that examines gut fermentation is based on the principle that yeast tends to metabolise sugar into alcohol. After a blood sample is taken, a person is given a measured dose of sugar. One hour later, another sample of blood is taken. Both blood samples are then analysed for various fermentation products. The presence of these in significant quantity can point to the presence of excess yeast in the gut.

The anti-Candida diet

The cornerstone of the anti-Candida approach is a diet that helps starve yeast out of the system. Foods to be avoided include those that feed yeast directly and those that are yeasty, mouldy or fermented in their own right. Yeast-feeding foods to avoid include: sugar; sweetening agents, such as maple syrup, molasses, honey, malt syrup; sugar-containing foods, such as biscuits, cakes, pastries, confectionery, ice cream, sugared breakfast cereals, soft drinks and fruit juice; white flour products, such as white bread, crackers, pizza and pasta.

Yeasty, mouldy or fermented foods to avoid include: bread and other items made with yeast; alcoholic drinks, particularly beer and wine, which are very yeasty; gravy mixes (most contain brewer’s yeast); vinegar and vinegarcontaining foods, such as ketchup (which also contains sugar), mustard, mayonnaise and many prepared salad dressings; pickles, miso, tempeh and soy sauce (all are

fermented); aged cheeses, such as cheddar, Stilton, Swiss, Brie and Camembert (cheese is inherently mouldy); peanuts, peanut butter, and pistachios (tend to harbour yeast); mushrooms; dried fruits (these are intensely sugary and tend to harbour mould); prepared soups and prepackaged foods, which tend to contain yeast. Foods to eat freely on an anti-Candida diet include meat, fish, eggs, beans, pulses, vegetables, nuts (but not peanuts or pistachios), seeds, oats, brown rice. Views on whether fruit can be eaten on an anti-Candida diet vary. Some experts recommend complete exclusion, while others say you can eat it frequently. In general, one or two pieces of fruit a day will be well tolerated, although grapes are generally best avoided because they are very sugary and usually are covered in a mouldy bloom.

Supplements to overcome Candida

In addition to the anti-Candida diet, it may help to take specific supplements – probiotics, liver-supporting agents and antifungal supplements – to help restore the full functioning of the digestive system.

Probiotics contain gut bacteria. Those that contain both Bifidobacterium bifidus (the predominant bacterium

in the large intestine) and Lactobacillus acidophilus (the predominant bacterium in the small intestine) can help to restore the balance of organisms in the gut and help combat Candida overgrowth.

During the initial phases of an anti-Candida regime, it is quite common for the condition to get worse. Lethargy, fuzzy-headedness and flulike symptoms can start a day or so after the regime starts and generally last from a few days to a couple of weeks. Liver-supporting agents can help reduce these symptoms.

Antifungal supplements can help to combat the Candida fungus directly. Oregano contains two important active ingredients, carvacrol and thymol. Studies have shown that oregano can inhibit the growth of Candida. In natural medicine, garlic is widely used in the control and eradication of Candida. Finally, grapefruit seed extract supplements are also useful as they have the ability to kill Candida in the body.

Improving digestion and food combining

Making sure that foods are fully digested can help reduce food intolerance. Simple steps that can be taken to improve digestion include the following:

Thorough chewing

Chewing mixes food with saliva, which contains an enzyme that starts the digestion of starchy foods, such as bread, potatoes, rice and pasta. It also breaks food up, increasing the surface area available for contact with the digestive juices and enzymes. Each mouthful ideally should be chewed to a cream before swallowing.

Avoid big meals

The larger the meal, the larger the load on the digestive system. Therefore small meals eaten frequently reduce the risk of indigestion.

Avoid drinking with meals

Some people tend to drink fluid with meals in the belief that this helps to “wash food down”. The reality is quite the reverse. Drinking with meals dilutes the acid and enzymes that do the digestive work and does nothing to help the process of digestion. On the whole, drinking should be done between meals, not at mealtimes.

Food combining

Proteins and starches are very different chemically and are digested by different enzymes in the gut. Initially, proteins are digested in acid, starches in alkali (quite the opposite). An inability to cope with protein and starch combinations can lead to impaired digestion. The aim of food combining is to avoid mixing protein and starch at the same meal. This means eating either protein or starch combined with a food that is “neutral” – neither protein nor starch. (For a list of common protein, starch and neutral foods.

Examples of healthy meals include: meat or fish with salad or vegetables other than potatoes; pasta with tomatobased sauce (no meat) and salad; vegetable curry and rice; baked potato, ratatouille and salad; meat stew with vegetables and avocado salad sandwiches. Eating to this pattern can bring tremendous relief to

people with indigestion and increase the chances of complete and rapid food breakdown. It may also help to reduce the risk of food sensitivity, and is often very effective in helping improve digestive symptoms such as bloating, indigestion and acid reflux.

Imbalances and Treatments

The body can be subject to a variety of imbalances that may cause health problems. This section explores the most common ones and explains how to deal with them.

Food intolerance and exclusion diets

Food intolerance occurs when the body has difficulty digesting and using a certain food or group of foods. It is different from food allergy, in which a certain type of food causes an abnormal immune response, such as a rash or swelling. Intolerance, although not usually as dangerous as allergy, can still cause a great deal of discomfort.

Most of what we eat must be broken down by digestion before it can be absorbed via the gut wall into the blood. However, in some circumstances, incompletely digested food can leak through the wall of the digestive tract . This can provoke reactions leading to a range of symptoms and conditions. These include fatigue, abdominal bloating, headaches, migraine, irritable bowel syndrome, Crohn’s disease, colic, eczema and dermatitis, asthma, rheumatoid arthritis, sinusitis, ear infections, nasal congestion and excessive mucus formation. If a nutritional therapist suspects a food intolerance, the following tests can help with the diagnosis.

Prick testing

The prick test checks for an allergic response. It involves breaking the outer layer of the skin and introducing a tiny amount of the food or other substance (e.g. animal hair, pollen) to be tested. If the skin becomes inflamed, it is likely that you have a real allergy to the food.

IgG and IgE blood testing

Antibodies are proteins made by the immune system in response to proteins or other compounds that the body recognises as “foreign”. One type, the IgG antibodies, are thought to be involved in food reactions. IgG antibodies to specific foods can be detected using biochemical techniques, of which there are two basic types – RAST (radioallergosorbent test) and ELISA (enzyme-linked immunoserological assay). An IgE blood test can measure the levels of a specific form of antibody (Immunoglobulin E) in the blood and also check for allergic response.

Neither prick tests nor IG tests are particularly useful for forms of food intolerance, rather than allergy. Allergies involve the immune system, which recognises food molecules as foreign and attempts to label or attack them with IG antibodies. As food intolerances do not tend to involve an immune reaction, different tests are needed.

Cytotoxic and ALCAT tests

The cytotoxic test mixes white blood cells with individual food extracts and then ascertains which foods caused reactions in the cells. The ALCAT test (ALCAT stands for antigen leucocyte cellular antibody) is similar except that assessing the reaction of the white cells requires a sophisticated piece of laboratory equipment.

Electro-dermal testing

Practitioners of Chinese medicine believe that energy flows down channels known as meridians in the body. Electrodermal testing involves measuring the electrical current that flows through an acupuncture point on a meridian, then detecting any changes in the current as the body is challenged with individual foods. Extracts of those foods may be put in the same circuit as the subject being tested – if it changes the current there is a problem with the food.

However, in one reliable study this form of testing failed to identify genuine IgE-type acute food allergy. It has not been fully studied as a way of identifying food intolerance.

The elimination diet

Many practitioners of nutritional medicine regard this as the most accurate way of testing for food sensitivity. Once identified, problem foods can be eliminated for good. Many individuals whose health issues are linked with food intolerance find they experience a sudden improvement in their condition, along with increased energy, enhanced mental clarity and improved digestive function. Foods generally eliminated on such a diet include:

● Wheat (a very common problem food), found in breads, pasta, pastry, pizza, biscuits, cakes, wheat-based breakfast cereals, wheat crackers, breaded food, battered food and anything containing wheat flour.

● Milk, cheese and yoghurt.

● Foods or drinks that are consumed repeatedly, say on four or more days each week (the more often a food is eaten, the more likely it is to be a problem).

● Foods or drinks that are craved (cravings for a particular food can be a sign of intolerance to that food).

● Foods and drinks that are suspected because they seem to induce symptoms.

All likely problem foods are removed from the diet for two to three weeks. If a food sensitivity is at the root of the symptoms, and the problem food has been eliminated, improvement can generally be expected in this time. A good amount of a specific food should be eaten in the morning. Over the next few hours, look out for a return of the original symptoms. Other problems may include headache, itching, depression, fatigue, irritability and foggy thinking. A note should be made of any food that seems to bring on an unwanted reaction and it should be eliminated again from the diet. Foods that do not provoke a reaction

after breakfast should be eaten at lunch and dinner. If by the following morning there are still no symptoms, this food can be provisionally added to a list of “safe” foods.

For the next three days, the food should be eliminated again and a watchful eye kept for any symptoms that

suggest a food reaction. It is possible that the symptoms of a reaction may come on two or three days after a food or drink is consumed. If there are no symptoms after three days, it is likely that the food being tested is safe to eat. This process can be repeated for all the eliminated foods. In normal circumstances, it is wise to exclude problem foods for a month, although two or more months may be better. Abstaining from a food for a period of time can make the body more tolerant to it in the long term.

However, initial food reactions can be worse, not better, than before – a phenomenon that is referred to as

“hypersensitisation”. Care should be taken when reintroducing foods, particularly if the condition being

treated has an allergic component, such as asthma.When a food is re-introduced, it is best not to eat too much of it too frequently, as this can increase the risk of the original problem recurring.

Water

The body is made up of about 70 per cent water.Water is vital in most of the processes that are integral to health. Even mild dehydration (e.g. losing about 70ml of fluid for a 70kg adult) can impair essential body

processes and cause symptoms such as headaches, appetite loss, fatigue, muscle

weakness, light-headedness and dry eyes and dry mouth.

Keeping well hydrated also seems to help reduce the risk of chronic disease. Research indicates, for

instance, that low levels of fluid consumption are associated with increased risk of cancers of the kidney,

bladder, prostate and testes. Other research has found that increasing fluid intake seems to reduce the risk of bladder and colon cancer. Evidence also suggests that drinking water may reduce the risk of heart disease. In one study, women drinking five or more glasses of fluid each day had a 41 per cent reduced risk of dying from a heart attack compared to women drinking two or fewer glasses each day, and for men the risk was reduced by 54 per cent.

As a rough guide, drink about 30ml of water for each kilogram of body weight. For most people, this equates to 1.5–2.5 litres of water a day. However, individual needs can vary with factors such as outside temperature and activity. A good guide to our state of hydration is the colour of the urine. The aim is to drink enough water to keep the urine pale or very pale yellow during the day. The quality of the drinking water is important, too. Tap water contains chlorine. This can induce chemical changes which, at least in theory, should increase cancer risk. It seems sensible to drink filtered tap water or mineral water.

Dietary Fats

Fats provide energy and components for some structures, such as cell membranes and certain hormones. The basic building blocks of dietary fats are fatty acids, which consist of chains of carbon atoms with hydrogen atoms attached.

There are three main natural forms of fatty acid. Saturated fatty acids are so called because they have as many hydrogen atoms as they can hold.Monounsaturated fatty acids lack a pair of hydrogen atoms per molecule. Polyunsaturated fatty acids lack four or more hydrogen atoms per molecule.

Saturated fatty acids

These are found in animal products, such as butter, cheese, whole milk, ice cream and meat, and in some vegetable oils, such as coconut and palm oils. It is often said that eating a diet rich in saturated fatty acids can raise levels of cholesterol in the blood. However, more than one study has found that this may not be the case. Even the belief that such a diet is a major risk factor for coronary artery disease may be overstated, partly as a result of misquoting and misinterpretation of research studies. Saturated fatty acids

may be a factor in weight gain and obesity, although a comprehensive review of the subject concluded that dietary fat is not a major determinant in body weight, and eating less fat is unlikely to bring lasting weight loss.

So, on balance, it appears that saturated fatty acids might be less harmful than is often believed, and that eating them in moderate amounts may not be damaging to health.

Monounsaturated fatty acids

Food rich in monounsaturated fatty acids include olive oil, avocados, nuts and seeds. These fatty acids can lower blood levels of low-density lipoprotein (LDL) cholesterol, the type of cholesterol that is believed to increase the risk of heart disease.

They can also raise blood levels of highdensity lipoprotein (HDL) cholesterol, which is thought to protect against heart disease. A high intake of monounsaturated fatty acids is believed to be one of the reasons

certain populations, such as the southern Italians and the Greeks, have relatively low levels of heart disease.

Polyunsaturated fatty acids (PUFAs)

There are two main groups of PUFAs in the diet: omega-6 and omega-3. The major omega-6 fatty acid is linoleic acid – rich sources include plant oils, such as hemp, pumpkin, sunflower, safflower, sesame, corn, walnut and soya oil. Others are gamma linolenic acid (GLA), dihomogamma linolenic acid (DGLA) and arachidonic acid (AA).

The major omega-3 fatty acids are alpha-linolenic acid (from plants, such as flaxseed), eicosatetraenoic acid (ETA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA and DHA are mainly found in oily varieties of fish.Within the body, these fatty acids can be converted into other substances that may affect health.

The omega-6 and omega-3 balance

The omega-3 and omega-6 fatty acids have important roles in many body systems, including the brain, nerves, immune system, cardiovascular system, eyes and skin. They are converted into hormone-like substances called eicosanoids. Eicosanoids derived from omega-6 fatty acids tend to encourage inflammation, blood-vessel constriction and blood clotting.

Therefore, they increase the risk of coronary artery disease and stroke and inflammatory conditions,

such as arthritis. Eicosanoids derived from arachidonic acid are particularly potent. Those from omega-3 fatty acids, such as EPA, are less likely to encourage inflammation; some are positively anti-inflammatory.

They tend to reduce the risk of clotting and help to relax blood vessels, so helping to reduce the risk of coronary artery disease and stroke as well as inflammatory conditions, such as arthritis. The roughly opposing actions of omega-3 and omega-6 fatty acids mean that it is important to balance their intake.

A ratio of 1:1 is believed to be ideal. Over the past 40 years, however, the proportion of omega-6 to omega-3 in the average diet has increased to roughly six to one. This may be an important factor in the development of many chronic diseases, such as cardiovascular disease and cancer.

To reduce your intake of omega-6 fatty acids and increase your intake of omega-3 fatty acids:

● Limit the intake of vegetable oils, such as sunflower oil, corn oil, rapeseed oil and maize oil, which contain omega-6 fatty acids. Processed foods labelled as containing “vegetable oil” contain these oils.

● Sprinkle flaxseeds on cereals and take flaxseed oil, which is a rich source of omega-3 fatty acids.

● Eat three portions a week of oily fish, such as mackerel, herring, salmon, trout and sardines.

● Take a fish oil supplement each day.

Partially hydrogenated and trans fatty acids

Some margarines and vegetable shortenings (the fats added to many processed foods) are manufactured using a process known as hydrogenation. This can change the structure of fats, creating what are known as trans fatty acids. These are believed to have harmful effects on health, particularly with regard to heart disease.While trans fats do occur naturally in some foods (such as butter), there is evidence that it is only industrially produced, and not naturally occurring, trans fats that have a detrimental effect on heart health.You should consider avoiding margarines and processed foods listing partially hydrogenated oils (or

trans fatty acids) as an ingredient.

Dietary Proteins

Dietary proteins are composed of amino acids and play a role in the manufacture of many structures and tissues, such as bone, muscle, skin and hair. They are essential for normal growth and development in children. In adults, proteins provide the raw materials needed for cell repair.

Cells use amino acids derived from the diet to make DNA and enzymes – molecules with key roles in maintaining healthy structure and function within the body. Of the 21 amino acids, many can be made in the body and therefore do not, strictly speaking, need to be eaten. However, eight cannot be made in the body and so must be provided in the diet. They are the “essential” amino acids.

It is said that adults need about 0.75–1g of protein for each kilogram of body weight per day.Meat, fish, eggs and dairy products are very good sources of protein, as are non-animal foods, such as beans, peas and nuts. Some grains, such as rice, wheat and maize, can also supply significant quantities of protein. In general, animal-derived proteins are more “complete” in terms of their component amino acids than vegetable sources. Vegetarians should eat a broad range of protein-containing foods, including beans,

pulses, nuts, seeds and grains, to ensure amino acid intake.

There is some evidence that too much protein can pose hazards. Excess protein is believed to cause the loss of calcium from bone, predisposing a person to osteoporosis (brittle bones; see p.38) and increased risk of fracture. In one study, women who ate more than 95g of protein a day were found to be 20 per cent more likely to have broken a wrist over a 12-year period when compared to women who ate an average amount of protein (less than 68g a day).

Dietary Carbohydrates

Carbohydrates – sugars, starches and fibre – are made of the elements carbon, hydrogen and oxygen. Their main role is to provide a source of energy for the body.

Sugars

The basic building block of all carbohydrates is a single sugar molecule, such as glucose or fructose, known as a monosaccharide. A disaccharide is two monosaccharides joined together – sucrose, for example, contains glucose and fructose.

Sugars in fruit and vegetables are “intrinsic” as they are incorporated into the structure of foods, often

hidden within cell walls. In some foods, such as biscuits and sweetened cereals, the sugar is not bound into the structure of food and so these are called “extrinsic” sugars. Generally, foods with intrinsic sugars are healthier than those with extrinsic sugars; an apple is healthier to eat than a piece of cake. Foods containing intrinsic sugar tend to release energy more slowly into the bloodstream compared to foods rich in extrinsic sugar.

Starches

Also referred to as complex carbohydrates, dietary starches are made up of chains of sugar molecules. Starch-based foods include vegetables, bread, pasta, rice, potatoes, beans, pulses and breakfast cereals. Starches come in two main forms. Refined starches, as found in white bread, white rice and most commonly available types of pasta, have lost much of their fibre, vitamin and mineral content.

Unrefined starches are richer in fibre and nutrients than their refined counterparts and are therefore considered nutritionally superior. They also tend to give a slower, more sustained release of sugar into the bloodstream, which may be important for health in both the short and long term. Examples of unrefined starches include wholemeal bread, brown rice, wholewheat pasta and rolled oats.

Fibre

Fibre is plant material that is indigestible and is sometimes referred to as non-starch polysaccharide (NSP). Fibre comes in two main forms. Soluble fibre dissolves in the gut to form a thick gel-like substance that slows down the release of some nutrients, particularly sugar, into the bloodstream. It appears to help control the levels of cholesterol in the blood, which may help to reduce the risk of coronary artery disease.

Insoluble fibre does not dissolve in the digestive tract and therefore adds bulk to the faeces. It is useful for

preventing constipation and there is evidence that a highfibre diet is associated with a reduced risk of cancer of the colon. A diet that is rich in insoluble fibre may also reduce the risk of other conditions, including haemorrhoids (piles) and diverticular disease (abnormal pockets on the lining of the colon that can become infected and cause bleeding or perforation of the gut wall).

Good sources of soluble fibre include fruit, vegetables, beans, oats, barley and rye. Good sources of insoluble fibre include wholegrain (unrefined) cereals, such as wholemeal bread, brown rice and wholewheat pasta, as well as beans and pulses, nuts, seeds, and fibrous vegetables, such as

carrots, celery and cabbage.