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There are thousands of anti-yeast programmes and supplements to choose from, but the common denominators for beating the stubborn infection are simple, says Celeste McGover
Type ‘candida infection’ into Google and up will pop more than 11 million entries. There are countless websites devoted to combating the yeast organism, which is implicated in a myriad of symptoms, from angry red nappyrashes and jock itch to baffling chronic fatigue, irritable bowel syndrome and even cancer.
You’ll also find scores of how-to-beat-Candida videos, sundry testimonials, numerous Candida books and self-diagnostic questionnaires, anti-Candida diets and programmes galore, hundreds of antifungal colonic cleanses and Candida-crushing supplements, and an array of probiotics to crowd out the pestilential fungus. For something mainstream medical doctors dismiss as a mostly benign and fleeting, treatable condition, millions of people are seeking help to overcome it.
Under healthy conditions, Candida yeast lives in everyone, favouring places like the gastrointestinal and reproductive tracts, where it peacefully helps digest food and fends off bacterial invaders. It is not meant to begin one of its essential tasks until its host is dead, when it moulders and ferments the human corpse from the inside out. Until then, it is kept in check mostly by a suitable pH (acid–alkaline balance) and by competition from other friendly microbes.
Out of control
Given the right living conditions, though, Candida rapidly multiplies, the single cells feasting and fermenting on simple sugars—until they morph into a fungal form with tentacle-like ‘hyphae’, which are filamentous threads, rather like roots that branch and bud, excreting toxins and wreaking havoc.
The idea that pharmaceuticals like antibiotics, birth-control pills and antisteroidal drugs can tip yeast growth into overdrive by wiping out friendly cohabitating bacteria was first suggested by American clinician C. Orian Truss, and popularized by paediatrician William Crook in his 1983 book, The Yeast Connection.
Although popular with the public, the book was met with scepticism on the part of the medical profession. For decades, doctors had dismissed the notion that yeast activities could actually be insidious and behind the plague of modern ailments like irritable bowel syndrome (IBS) and autoimmune diseases, such as multiple sclerosis and arthritis, as a large pseudoscientific cult.
Doctors at the time only recognized yeast overgrowth when it was localized to specific parts of the body: ‘oral thrush’ in tongues visibly coated with a thick creamy-white biofilm; ‘vaginal yeast infections’ where a greyish-white, cheesy discharge is accompanied by burning or itching; and ‘cradle cap’, a condition with yellowish crusty patches on the head, but which can also affect the face, ears, neck, and skinfolds behind the knees and in the armpits.
They believed that cases of systemic infections, called ‘candidiasis’, where Candida entered the bloodstream, were rare. Yet it’s increasingly more common and deadly, killing 40 per cent of the mostly immune-compromised individuals who acquire it—often from surgical equipment.
Now, an emerging and rapidly expanding body of research is providing solid evidence of a yeast connection with modern epidemics. It turns out that our microbiome—the hundred trillion or so bacteria, yeast, protozoa, parasites and viruses that live in and on us—are intricately involved in every aspect of our health, from our ability to fend off disease to our weight, and emotional and mental wellbeing.
Yeasts are a critical subpopulation of these microbes, and several recent studies suggest that Candida overgrowth underlies dysbiosis—the imbalance of our microbiota increasingly linked to a host of chronic diseases.
State-of the-art, next-generation sequencing technology used by researchers at the Center for Medical Mycology at Case Western Reserve University led them to conclude, in a study published this year, that the 184 fungal species in the gastrointestinal (GI) tract—with Candida dominating—“contribute to the aggravation of the inflammatory response, leading to increased disease severity” and that “the fungal community is a critical player in the pathogenesis of [GI] diseases”.1
Another recent study found that infection with Candida albicans may be the triggering factor for the onset of coeliac disease,2 while a recent review has confirmed that the overgrowth of Candida species plays a role in IBS as well as in the psychiatric disorders affecting up to 80 per cent of IBS sufferers.3
The microscopic actions of Candida are beginning to be illuminated too, vindicating the old ideas of Truss and Crook. German researchers recently confirmed that C. albicans uses elaborate tactics to evade the immune system.4 Its twiggy hyphal projections use thigmotrophism—the ability to sense by contact—to identify small grooves and weak points in the host gut membrane, where they then excrete proteins to penetrate the gut wall.5
This creates microscopic leaks in the gut membrane, a condition known as ‘leaky gut’ or ‘intestinal permeability’, a precondition for a wide range of symptoms and diseases.
When the gut–blood barrier is compromised, toxins excreted by Candida and even undigested food particles enter the bloodstream, where they can trigger the full defences of the immune system and induce food allergies and autoimmune diseases, ranging from diabetes to multiple sclerosis (MS).
Yet, despite understanding how Candida behaves, medicine has been confounded by growing numbers of chronically ill patients who have vague and difficult-to-diagnose clusters of symptoms.
Robynne Chutkan, a professor of gastroenterology at Georgetown University Hospital, for example, describes in her book The Microbiome Solution (Avery, 2015) how her medical practice 20 years ago was dominated by readily diagnosed conditions like acid reflux, ulcers and gallstones. Today she is engulfed by an epidemic of people with difficult-to-diagnose syndromes of seemingly unrelated symptoms: skin rashes (acne, rosacea, dermatitis, eczema and ringworm), digestive problems (bloating, diarrhoea and constipation), recurrent infections and miscellaneous complaints, including weight gain, fatigue, food sensitivities, headaches, depression and impaired concentration.
Despite their wide-ranging symptoms, though, Chutkan began to notice one thing in common with most of these patients: a history of lengthy or repeated use of antibiotics.
One patient, Lucia, was typical. She had been a healthy child, but had been treated with the antibiotic tetracycline for a year for moderate acne as an adolescent. During that time, she frequently felt nauseated, and she even developed cradle cap (seborrhoeic dermatitis) on the back of her head.
When Lucia started birth control in her 20s, her nausea worsened; she went to see a gastroenterologist, who detected Helicobacter pylori in a biopsy. H. pylori is another frequently maligned bacteria that, with overgrowth, is associated with ulcers and stomach cancer in later life. Yet, recent research shows that, in childhood, it can keep the ‘hunger hormone’ ghrelin in check,6 and its eradication can affect a number of digestive hormones.7 Also, eliminating H. pylori with antibiotics is followed by oesophageal reflux and disorders like childhood-onset asthma, suggesting that the organism has potentially protective benefits.8
Lucia was prescribed three antibiotics to counter H. pylori, but the nausea worsened and she began to develop reflux symptoms. “That prompted her gastroenterologist to start her on acid-suppression therapy, but not to question why a slim, otherwise healthy 25-year-old who didn’t smoke, drink or eat big dinners late at night was suddenly having reflux,” says Chutkan. And one round of prescriptions quickly led to the next.
It’s not just antibiotics that decimate the gut microbiota, but also a host of other prescription drugs and lifestyle factors. The result has been an exploding epidemic of gut dysbiosis, when strains of good microbes are diminished, so allowing potentially pathogenic strains, including yeasts, to propagate wildly.
“There are a few tests that may provide supporting evidence, but dysbiosis is primarily a clinical diagnosis based on careful history-taking and familiarity with the spectrum of disorders that can result in damage to the microbiome,” says Chutkan.
It’s easy to see why so many people are afflicted, and why so many diets and programmes to reverse yeast overgrowth and dysbiosis have emerged. Sifting through such programmes reveals a pattern of healing common denominators that are relatively simple to follow and, with determination, can produce dramatic responses. Most practitioners say results are usually noticed in less than 90 days.
Doctors suspected Nick Hess, a 35-year-old living in Columbus, Ohio, of being a secret alcoholic. His wife Karen searched their home for stashed bottles after he would slur and rave as if he were drunk. Even his breath sometimes smelled of alcohol, though she’d been with him and knew he hadn’t had anything to drink.
For a year, Hess vomited every morning as though severely hung over, and he was even charged with driving while impaired by alcohol in 2011, when he blew nearly three times the legal limit on a breathalyzer test—despite swearing that he hadn’t been drinking.
Karen spent months trying to get help before she discovered a rare condition—called ‘auto-brewery syndrome’, or ‘gut fermentation syndrome’—in which people have an overgrowth of yeast in their stomach, which causes carbohydrates from starchy and sugary foods to be fermented into alcohol. A bowl of pasta leaves them staggering about.
The Hesses had to find a doctor who took them seriously. They found Anup Kanodia, a Harvard-trained practitioner of functional medicine in Westerville, Ohio, who discovered off-the-charts yeast levels in Hess’s stools. Kanodia put him on a strict no-carb diet and, in just four weeks, Hess’s intoxication symptoms vanished.
The stool tests couldn’t identify the species of yeast overgrowth, but Saccharomyces cerevisiae, the yeast actually used to make beer, is a likely suspect. Candida glabrata, a cousin of C. albicans, is a common non-invasive resident of the GI tract that grows well under anaerobic conditions, and is also known to produce high levels of ethanol and acetaldehyde, compounds found in alcoholic beverages like beer.
Kanodia had never seen patients with levels of yeast as high as Hess’s, he told WDDTY, but a sizable part of his practice is treating people he believes have yeast blooms underlying their symptoms—which range from feeling ‘spaced out’ and fatigued to IBS.
“I was taught in medical school that yeast is very hard to grow and people have to be really sick—like with HIV—to get a yeast overgrowth,” he says. “But we know that yeast is in sinus infections. Babies have fungal cradle cap. It can infect toenails and fingernails. It causes jock itch and diaper rash, and females have vaginal yeast infections. It causes ringworm and other skin infections. Yeast can invade every part of our body, and cause any and all symptoms.”
Kanodia thinks yeast must at least be ruled out when addressing stubborn and mysterious illnesses. He uses a gardening metaphor: “The good bacteria are the soil, and the bad bacteria and yeasts are the weeds. We can’t allow the plants to grow and thrive until we pull up the weeds.”
A 7 point plan to obliterate Candida forever
1 Clear the medicine cabinet
Chutkan’s first step in treating her patients is to get them to agree to never take an antibiotic again unless it’s absolutely necessary. But antibiotics are not the only dysbiosis-inducing drugs. Acid-suppressing drugs and proton-pump inhibitors change the pH of the stomach, weakening the acid that normally protects against pathogens and making it a playground for microbes like the deadly Clostridium difficile as well as yeasts. Birth-control hormones and hormone replacement therapy increase oestrogen levels, which cause fungi to flourish too. Corticosteroids and anti-inflammatory medicines like prednisone destroy good bacteria, allowing fungal species to take over and weaken the immune system.
The obliterating effect of antibiotics
Evidence is mounting at breakneck speed that the microbial communities we develop at birth and during childhood are more responsible for keeping us free of disease than causing it. The microbes in our digestive tract are carrying out vital tasks for us, digesting our food, manufacturing our vitamins, fending off invaders and regulating our immune system, even switching our genes on and off.
Antibiotics, along with many other pharmaceutical-based interventions, act like napalm on the microbiome village. A single five-day course can suppress as much as one-third of the resident gut bacterial species, and it can’t distinguish good from bad. Superbugs resistant to antibiotics then emerge and yeasts, which should be limited, then have the opportunity to bloom.
Yet despite the increasing awareness of these dangers, physicians continue to write prescriptions for antibiotics without considering the long-term health consequences. Global antibiotic use increased by 35 per cent between 2000 and 2010, and Public Health England reported that, from 2010 to 2013, GPs and hospitals increased their total antibiotic use by 6 per cent.1
By the time they’re age 16, the average UK child has already received at least 10 doses of antibiotics—more than one every two years. In the US, antibiotic overuse is even worse, with children having consumed an average of 17 antibiotics by their 18th birthday. As many conventionally farmed animals are fed antibiotics to prevent disease as well as fatten them up, many people are consuming antibiotics through their meat too.
Veterinarians have increased the use of tetracycline more than 10 times since 1969, for example, and the use of penicillin has quintupled within the same time frame.2
2 Ditch the sugars
All yeasts thrive on sugars and refined carbohydrates. They act like microbreweries in your belly, fermenting flour, sugar, potatoes and rice, and releasing toxins, including alcohols and acetaldehydes, directly into your bloodstream. That’s why most Candida diets cut out all fruit and dairy (which contains lactose sugar)—at least for the first 30 days—and then limit fruit to low-sugar berries and green apples.
Virtually every diet excludes gluten from all sources, including wheat, rye, barley and oats, because its role in the development of ‘leaky gut’ has been confirmed by research.9 And trying to repair leaks caused by Candida while gluten is burrowing new holes in the gut lining just makes more work for the body. Cutting out all carbs in the form of grains starves yeast and fungi, and can sometimes make all the difference.
Alcoholic drinks only add to the feeding frenzy. And virtually every Candida diet advises against yeasty foods like aged cheese, mushrooms and vinegar, except for raw apple cider vinegar, which should be kept refrigerated. Even artificial no-calorie sweeteners like aspartame should be avoided: a 2014 study showed they induce glucose intolerance by altering intestinal microbiota.10
3 Drink water
Drinking lots of water is a frequent health recommendation, but American doctor Anup Kanodia, who specializes in the treatment of yeast and dysbiosis-driven diseases, says it’s one of his first recommendations because so many of his patients are dehydrated. With about 60 per cent of the human body being made up of water, it is essential to replenish it to flush away toxins and yeast overgrowth. Kanodia advises his patients to begin by drinking at least 1.5 L (34 fl oz) of water each day.
4- Choose an effective anti-fungal
Although doctors sometimes prescribe antifungal medications like fluconazole and nystatin for yeast overgrowth, the drugs have the same problems as antibiotics, wiping out good microbes along with the bad, leading to long-term risks. They also have dangerous side-effects, including liver damage.
Of all the antifungal, anti-Candida supplements on the market, a few key ingredients are especially effective.
Caprylic acid. This is a fatty acid derived from coconuts and found in coconut oil. It can be taken in pill form, gradually starting at 500 mg/day and working up to 1,000 to 2,000 mg three times a day.
Undecylenic acid. This fatty acid is extracted from castor oil and, before the pharmaceutical revolution, was the main agent for treating fungal infections. For a Candida infection, it is taken in divided doses of up to 1,000 mg/day.
Gymnema sylvestre. A traditional Ayurvedic medicine for diabetes, leaves of the G. sylvestre plant—also known as ‘sugar destroyer’—contain acids that were recently demonstrated to not only inhibit the transition of Candida albicans from yeast to fungus, but also to cause its reversion back to its innocuous single-celled condition.13 This herb is available in 400-mg capsules to take once daily.
Grapefruit seed extract (GSE). GSE as well as grapefruit pulp contain polyphenols that have potent activity against 91 strains of fungus. Both were recently demonstrated to induce yeast cell death by apoptosis (‘cell suicide’). GSE is available as pills (100–200 mg taken three times a day) or in liquid form (diluted with water, usually 10 drops/day). But GSE is contraindicated if you’re taking a number of common pharmaceutical drugs, including calcium-channel blockers and oestrogen, so check with your doctor first if you’re on a prescription.
Oil of oregano. This oil, from the hardy wild oregano bush that grows in the mountains around the Mediterranean, has been used medicinally for millennia, and studies have shown it is particularly effective against drug-resistant Candida species.14 Look for oil derived from the Spanish variety of Origanum vulgare and Thymus capitatus and, if using it orally, take only four to six drops for only seven to 10 days. Oregano oil is contraindicated for pregnant women and children, and for anyone taking blood-thinning drugs like warfarin.
Garlic. The antifungal properties of garlic are well established. It’s an easy addition to an anti-Candida diet, as the cloves can be crushed and added to food or eaten raw.
Berberine is a yellow compound found in several bitter plants, such as goldenseal and Oregon grape, and shown to be active against Candida species. It stimulates glucose uptake by cells and reduces the production of glucose by the liver. The usual dose is 500 mg three times a day before meals. Some people experience a ‘die-off’ reaction, including headaches and flu-like symptoms, because the fungi are dying by the thousands; in this case, it’s best to go slow and rest as much as possible to allow your immune system to do its job.
5 Eat your greens
Research has shown that changing what you eat can radically alter your gut microbes. An Italian study compared the microbiota of children in Europe and in Africa, which were similar at birth. The children in Burkina Faso ate lots of legumes and vegetables, and developed more diverse microbial profiles, with more inflammation-fighting species, whereas the European children, fed a starchy, fatty diet, saw a shift towards microbes associated with diarrhoea, allergy and obesity.11
There is a vast array of anti-Candida diets; some allow grains such as brown rice and quinoa, some nix meat instead, but all radically reduce processed foods and call for a sharp increase in high-fibre foods like lentils, nuts, chia and flaxseeds. Not surprisingly, these have been shown to increase populations of the helpful Lactobacillus bacteria, which then crowd out the fungi.
But one common denominator of Candida diets is eating lots of vegetables, especially dark, leafy greens. “The aim is to get at least 60 per cent of your food in the form of vegetables,” says Ann Boroch, author of The Candida Cure (Quintessential Healing, Inc., 2009). “It may seem hard to do at first, but it is key.”
If it seems difficult to stick to the diet, it’s worth remembering that, at the microscopic level, change can happen fast: Harvard scientists found that switching from a meat-based diet and snacks of pork rinds to a vegan diet induced shifts in microbiota in just one day.12
Chutkan’s patient Lucia went on a strict anti-Candida diet, consuming mostly vegetables, and some lean meats and fish. Her dermatitis disappeared within a week and her other symptoms began to abate, but when she relaxed her diet, she developed a streptococcal throat infection and was given yet another round of antibiotics. All her old symptoms returned with a vengeance and only when she embarked on another round of the strict diet did she get them in check again so that she could gradually expand her diet.
“People often don’t realize that it’s going to take time to conquer Candida,” says Boroch, who was diagnosed with multiple sclerosis 22 years ago and bedridden, but is fully recovered and playing tennis today. Success depends on making lifestyle changes that last, rather than short-term fasts followed by binges, she says. And dietary changes alone do not always conquer Candida.
6 Treat topically
Some of the most effective topically applied treatments for fungal overgrowth are not expensive prescription creams, but the inexpensive remedies your grandmother may have used. Gentian violet (GV) dye was first shown to be effective against many Candida species in 1912, and one recent study found that it significantly inhibits 91 strains of Candida. It can also disrupt Candida biofilms—the thin, slimy, antibiotic-resistant layers of microbes and cell parts that cover mouldy food—swabbed from human immunodeficiency virus (HIV) patients.
Catheters coated with GV are far superior to those coated with silver alloy in preventing microbial colonization, and it’s been reported that GV applied three times a week to fungal nail infections is effective too.15 You can buy GV in dropper or spray bottles of 1 or 2 per cent strength—but be warned, it’s messy and will leave purple stains.
Recent studies have shown that tea tree oil—specifically, its active ingredient terpinen-4-ol—is effective against even drug-resistant Candida.16
Also, raw apple cider vinegar has a long reputation for fighting yeast infections because it alters the body’s pH to one inhospitable to Candida. For toenail yeast, or athlete’s foot, soak the foot in a half-gallon of hot water plus one cup of raw apple cider vinegar for about 20 minutes every day. For yeast-related nappy rashes, do away with baby wipes—they’re harsh and often full of chemicals that damage the delicate microbial balance of the skin.
Opt instead for homemade ones using boiled water, olive or almond oil and a few drops of grapefruit seed extract (GSE) or a drop of tea tree oil.
Stress is one of the most difficult things to avoid, but it’s critical to find ways to control your reaction to what life throws at you, as stress is so closely linked to disease. And little wonder. When stress activates the adrenal glands, they release the stress hormone cortisol which, in turn, tells the body to release stores of glycogen to fuel a fight-or-flight reaction. But because we can’t usually flee or physically fight the things that stress us, this raises our blood sugar and insulin levels dramatically and, of course, feeds systemic candidiasis.
Tried-and-true ways to defuse stress include getting enough sleep, regular exercise, meditation and prayer, forgiving, taking time to be with family and friends, and cultivating your creative side. Consciously choose to free your mind from the whirlwind of thoughts and those pressing to-do lists at least once or twice a day.
Stress is associated with rapid, shallow, upper-chest breathing, sighing and hyperventilating, which you may not even be aware of, so take note of your breathing. Patrick McKeown, who teaches the Buteyko Breathing Method, advises people to slow down, quiet their breathing and reduce their in-breath volume rather than deep-breathe to counteract stress. Breathing gently through the nose increases nitric oxide, a gas that relaxes and opens the airways and blood vessels, and fights bacteria, and is confirmed to help destroy the unhealthy fungal form of Candida.17