Candida overgrowth as a trigger of various common symptoms and conditions is another topic that is controversial in mainstream medicine, but frequently addressed in integrative and functional medicine.
Overview of today's email:
- What is candida overgrowth?
- Can we test for candida overgrowth?
- Practical clinical tips
1. What is candida overgrowth?
Candida is a common commensal yeast found in the GI tract of humans. It is normal to find this in the gut, but when the environment in which candida exists gets out of balance, candida overgrowth in the GI tract can occur.
In mainstream medicine, candida overgrowth is mostly seen in cases of: genital infections and oral thrush.
But in functional medicine, we consider candida as a trigger of various symptoms and conditions, including but not limited to:
- Bloating
- Fatigue
- Brain fog
- Rashes
- Constipation or diarrhea
- Depression
- Joint pain
- Autoimmunity
2. Can we test for candida overgrowth?
The following tests are often cited as useful for identifying suspected candida overgrowth; I've rated these in order in which I tend to prioritize them (when I order them):
- Dr. William Crook's candida questionnaire (symptom-based)
- Serum testing (IgA, IgM, immune complex): In my experience, these mostly indicates a mucosal immune reaction to candida, rather than a continued overgrowth (but I still address with antifungals).
- Organic acid testing
- Stool testing via a functional medicine lab, or a 4 week culture from a commercial lab.
- Biofilm evaluation (e.g. from the company MicroGen Dx)
See this article for more basic explanation on testing.
Note, there are over 200 species of candida so the tests above may only be able to use reagents to isolate candida albicans.
Also, as a reminder, I believe all clinicians need to be responsible and consider the following before testing:
- Does the test have a high sensitivity or specificity?
- Is the cost of the test worth it? Many patients are cost-conscious.
- Will the test outcome change our treatment plan (this is where we need to connect symptoms to lab results)?
- And, if available, is there a recognized "gold standard" test (i.e. if you were in court, what would the medical witnesses use)?
3. Practical Clinical Tips
Some pointers on educating patients with suspected candida overgrowth:
- Candida is naturally occurring in most humans and has a beneficial role in the body
- An abnormal lab finding is worth treating, but a good clinician needs to look for the cause of candida overgrowth
Candida overgrowth is NOT the root cause!
- It is extremely rare for candida to get into the bloodstream, so when running serum labs, educate patients on how the immune system can react to candida and lead to antibody elevation
- During treatment, the goal is to see a symptom response if candida overgrowth is truly a trigger
- Patients will ask about an anti-candida diet (which is commonly recommended per the internet), but it is a stress-inducing diet (which affects the pH of the gut) and can lead to disordered eating. I typically tell patients to do their best to avoid added sugars (but ok to add e.g. 1 tsp maple syrup to coffee), processed foods, and fruit juice, but "starving" candida is not the answer.
I will review this topic in more detail with cases and treatments in the mentorship that is launching at the end of the month, but for today's purposes, I hope this was clinically useful!
Next newsletter topic: Adrenal Fatigue.
Meg
Additional resources that may be helpful
I do my best to share information you find helpful, but if it's not to your standards, please let me know what I can do better by replying directly to this email (it's my personal email). No worries, too, if you need to unsubscribe via the link below.
