The Effect of Nutritional Therapy for Yeast Infection ...orthomolecular.org/library/jom/2005/pdf/2005-v20n03-p193.pdf · ate the effectiveness of nutritional therapy for yeast infection

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AbstractThe objective of this study was to evalu-

ate the effectiveness of nutritional therapy foryeast infection in cases of medically-diag-nosed Chronic Fatigue Syndrome/ME.

Forty participants, each with medically-diagnosed CFS/ME, received individual nu-tritional advice for treating yeast infection(candidiasis) over the course of one year, fol-lowing an anti-candida protocol which hadbeen used successfully in nutritional practicefor twelve years. Data were generated byquestionnaires from which answers enabledan assessment of nutritional status to be for-mulated as well as allowing scores to be cal-culated for CFS/ME and candidiasis. Con-founding variables included stress, glucosetolerance, use of steroid treatments/ HRT/contraceptive pill and age. The drop-out ratewas high with only eighteen subjects complet-ing the year, the main reported reason beinglack of motivation to adhere to the anti-can-dida diet which was part of the protocol.

Data analysis indicated a relativelystrong positive correlation between candidaand CFS/ME at the start of the study. Theaverage fall in CFS/ME symptom scoresthroughout the year was 30.5%, with oneparticipant achieving a 100% reduction insymptoms. 83% of participants experiencedsome reduction in CFS/ME symptoms scores.Higher than average stress scores and use ofsteroids/HRT/contraceptive pill all negativelyimpacted CFS/ME scores despite following ananti-candida protocol. Subjects aged 36 orover experienced a greater degree of improve-ment than younger subjects, a situationwhich requires further investigation.

The observed study findings support thepremise that nutritional therapy: specifically

in the form of an anti-candida protocol, canbe an effective treatment for some CFS/MEsufferers.

IntroductionOn 16th July 1998, at a scientific brief-

ing to the press at the Royal College of Phy-sicians, the then Chief Medical Officer SirKenneth Calman said, ‘I recognise chronicfatigue syndrome is a real entity. It is dis-tressing, debilitating, and affects a very largenumber of people. It poses a significantchallenge to the medical profession’.1 At thebriefing, he announced the establishment ofa Working Group on Chronic Fatigue Syn-drome, sometimes referred to as Myalgic En-cephalomyelitis. A report was eventuallypublished in January 2002, in which the con-dition was referred to throughout as CFS/ME.2 It suggested a population prevalenceof at least 0.2%-0.4%, the commonest age ofonset being early twenties to mid-forties,and in children the commonest age of on-set being 13–15, although with some casesas young as five years old. CFS/ME wasfound to be twice as common in women asin men and to affect all social classes to asimilar extent, as well as affecting all ethnicgroups.3

The report stated that research hasdemonstrated immune, endocrine, muscu-loskeletal and neurological abnormalities.“Several overarching possibilities, not mu-tually exclusive, have been proposed to ex-plain the occurrence of CFS/ME, including:• CFS/ME is an umbrella term for severaldifferent illnesses:• One (or more) ‘core’ disorder(s) exist.• Several different causative factors triggera common disease process.• The aetiology and/or pathophysiology aremultifactorial.

The Effect of Nutritional Therapy for YeastInfection (Candidiasis) in Cases of Chronic

Fatigue SyndromeErica White, Dip.ION; Caroline Sherlock, B.A.(ss), Lic.ION

1. Nutritionhelp Ltd. 2 Electric Ave. Westcliff-on-Sea, Essex,UK SS0 9NQ

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Journal of Orthomolecular Medicine Vol. 20, No. 3, 2005

• Certain factors are necessary but not suf-ficient to cause CFS/ME.• Certain factors can influence individualmanifestations or duration.• Some features are downstream (second-ary) consequences of the primary diseaseprocess.”4

The report further stated that patientswith CFS/ME experience an individual arrayof symptoms from the overall range seen inthe illness. ‘Some, such as physical and/orcognitive fatigue, are seen in almost all pa-tients, though their extent can vary. Othersare very common, such as pain, disturbedsleep, and gastrointestinal disturbance…Some patients seem to have a dominant lo-cus of symptoms (e.g. flu-like malaise, neu-romuscular symptoms, cognitive impairmentor gastrointestinal disturbance).5

The report included a recommenda-tion that, although research criteria stipu-lates that a diagnosis can only be madeafter the presence for six months of a clus-ter of symptoms, six months should beviewed as an endpoint for the diagnosticprocess, as patients need help to managethe illness much before then.6

The positive nature of much of this2002 Working Group Report does much todispel the controversy which has existedover many years regarding the nature ofCFS/ME. In 1955, two doctors at the RoyalFree Hospital in London decided that anoutbreak of the condition among nearly 300hospital staff and a few patients was causedby mass hysteria.7 This opinion was rein-forced by a report on CFS requested by thethen Chief Medical Officer and publishedin 1996 by the British Royal Colleges ofPhysicians, Psychiatrists and General Prac-titioners.8 The 1996 Working Group’s state-ment of their scope of work was to reviewthe current state of knowledge, adding theirown clinical experience to that of the lit-erature. However, a lead editorial in theBritish medical journal ‘Lancet’ pointed outthat the Royal Colleges’ Working Group washeavily weighted with psychiatric experts

and appeared to make no effort to collectother viewpoints.9 In contrast, the 2002Working Group Report reached the conclu-sion that there should be no doubt thatCFS/ME is a chronic illness which shouldbe recognised as such by health and socialcare professionals, a view endorsed by theDepartment of Health in the Government’sresponse to this Report.10 Although to thisextent the new Report was positive, never-theless the Working Group arrived at thenegative conclusion ‘that there is no curefor CFS/ME’.11 They did however identifythree specific strategies as potentially ben-eficial in modifying the illness: graded ex-ercise, cognitive behavioural therapy andpacing, although members of the WorkingGroup expressed widely differing opinionson the potential benefits and disadvantagesof these approaches.12

In addition, the Working Group foundthat ‘complementary approaches are popu-lar with patients’ and among the complemen-tary practitioners most commonly consultedwere nutritionists. In fact, the WorkingGroup’s recommendations for care includedreferral to multidisciplinary teams or otherservices (e.g. nutritional advice and support).13

The Government’s response to this re-port indicated that the Department ofHealth endorsed the need for more researchon a wide range of aspects of CFS/ME.14

The researchers consider that such aspectsmight include the possible connection be-tween CFS/ME and various biochemicaldisorders, e.g., allergy, hypoglycaemia andgut dysbiosis including yeast infection(candidiasis). Yeast infection is caused bya fungal form of the common intestinalyeast, Candida albicans, which can affecta wide range of body tissues and functionsfor which frequently no obvious explana-tion can be found.15 It is known to releasetoxins into the bloodstream, giving rise toa variety of symptoms which include physi-cal and mental fatigue, muscle ache, bowelproblems and other symptoms not unlikethose of CFS/ME.16-18

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Nutritional Therapy for Candidiasis in Cases of Chronic Fatigue Syndrome

There is a growing body of experien-tial evidence among nutritional therapiststhat many people with diagnosed CFS/MEare found to respond to appropriate nutri-tional therapy which addresses a variety ofbiochemical disorders, even sometimes tothe point of 100% recovery with full andactive lifestyles, a finding which is at oddswith the 2002 Working Group conclusionthat ‘there is no cure for CFS/ME’. Veryoften, as part of their nutritional therapy,these recovered clients will have been ad-vised to follow a specific nutritional proto-col devised to control a suspected intesti-nal overgrowth of yeast.

Although ‘yeast infection’ in its overtforms has been known as far back asHippocrates who described oral thrush indebilitated patients, it was not until 1977that there was any suspicion that ‘this or-ganism is perhaps capable of causing dis-orders much more severe than convention-ally attributed to it’, when Truss (1977)reported his observations of treating gen-eralised candidiasis over the previous six-teen years.19,20 His report was published in‘The Journal of Orthomolecular Psychiatry’in 1978, and by 1984 he had published threemore clinical papers – ‘Restoration ofImmunologic Competence to Candida albi-cans’, ‘The Role of Candida albicans in Hu-man Illness’, and ‘Metabolic Abnormalitiesin Patients with Chronic Candidiasis: TheAcetaldehyde Hypothesis’.21-23 Trowbridge(1986) said that yeast infection was ‘affect-ing approximately one-third of thepopulations of all Western industrialisedcountries’.24 Odds (1988) said that ‘the rateof increase of the infections caused byyeasts in the genus Candida shows no signof abating: clinical and scientific interestin candida remains very high’.25

Yet scepticism in the medical profes-sion was engendered by the AmericanAcademy of Allergy and Immunology whenit questioned the existence of the Candidasyndrome, saying that it was speculativeand unproven.26 A sample medical text

book states that ‘in temperate climates theonly common fungal diseases in previouslyhealthy people are superficial mycoses, es-pecially ringworm and vaginal or oralthrush’, thereby discounting the possibil-ity of systemic health problems caused byyeast infection.27

Despite these opinions, many peoplewith diagnosed CFS/ME have discoveredthat it is possible to regain health if waysare found of bringing under control anovergrowth of Candida albicans, as is fre-quently evidenced in clinical practice bynutritional therapists.

Candida albicans is one of many mi-cro-organisms which colonise the internaland external bodily surfaces of human be-ings soon after birth. Health depends on adelicate balance between two main groupsof micro-organisms, the bifidobacteria andbacteroides. The beneficial bifidobacteriahelp to maintain an acidic pH in the largeintestine, which deters an overgrowth ofinvading pathogens and protects the mu-cosal walls of the gut. It appears that un-der certain circumstances the stability ofthe gut flora can be severely disrupted,leading to overgrowth by opportunisticorganisms, some of which may be patho-genic.28 Others simply decrease functionalefficiency of the gastro-intestinal tract.29

Candida albicans is a yeast, a single-celledorganism which reproduces by budding. Itis a dimorphic organism which can changeits anatomy and physiology from a yeast toa fungal form as it proliferates. Bland (1984)explained that “the yeast-like state is a non-invasive, sugar-fermenting organism,whereas the fungal state produces rhizoids(mycelia), or very long root-like structures,which can penetrate the mucosa, and it isinvasive. Penetration of the gastrointestinalmucosa can break down the boundary be-tween the intestinal tract and the rest ofthe circulation and allow introduction intothe bloodstream of many substances whichmay be antigenic.”30 Both incompletely-di-gested dietary proteins and Candida organ-

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isms are reported to enter the bloodstreamin this way, with specific consequences.31

In addition it is known that Candidaalbicans releases toxins (a minimum of 79known chemical substances) which havebeen shown to affect the brain.32,33 Acetal-dehyde, a breakdown product of alcoholproduced by yeast from sugar, reacts withthe neurotransmitter dopamine to causemental and emotional disturbances and thecommonly-experienced ‘spaced-out’ feel-ing. It also affects the immune system (al-dehydes cause suppression of T-cell func-tion) and other major body systems, caus-ing proliferation of aches and pains injoints and muscles, muscle weakness,numbness, tingling and itching.34-36 Lack ofenergy and fatigue are common. All thesesymptoms are frequently exacerbated byabnormal levels of organic acids producedby yeasts which can be detected in urine.37

At least eight species of Candida havebeen implicated as human pathogens.38

Since each strain is thought to contain upto 35 antigens and any one person may har-bour more than one strain, the sensitizationpotential is enormous, quite apart from theinfectious potential through tissue inva-sion.39,40 The sensitization potential of Can-dida albicans is supported by studies show-ing that histamine release is stimulated byCandida antigens.41-43

Not least to be disturbed by yeastovergrowth is hormone function, and var-ied symptoms of menstrual dysfunction arecommon due to the fact that Candida hasreceptor sites in its cell membranes whichaccept hormones, but also due to the factthat Candida albicans itself exactly fitsreceptor sites waiting for hormones, therebyblocking efficient hormone function.44,45

Causes of yeast overgrowth includeantibiotics, corticosteroid drugs, hormonetreatments, sugar and stimulants in thediet, and stress. Antibiotics cause majorqualitative and quantitative changes in theintestinal flora, encouraging the yeastpopulation to increase.46 Steroid drugs not

only depress the immune system but pro-vide excellent nourishment for fungi.47-50

Sugar is a known promoter of fungalgrowth and the present per capita con-sumption in the United States is 120pounds per year, a figure which is almostcertainly closely echoed in Britain.51,52

Stress, like stimulants in the diet, leads tothe production of adrenaline which in turntriggers the release of the body’s sugarstores into the bloodstream, thereby en-couraging Candida just as much as directsugar consumption.53 Trowbridge (1986)blamed ‘the excessive use of antibiotics,steroids and birth control pills coupledwith a milieu of universal pollution’. Also,‘pregnancy by its hormonal alterations ofa woman’s body, tends to stimulate the re-surgence of yeast overgrowth in her tissues’,so that ‘newborns are eligible to acquireCandida albicans as they come down themother’s birth canal’.54

Determining the involvement of yeast inhealth problems is not necessarily helped bylaboratory tests because their interpretationis not always straightforward and can evensometimes be misleading. Golan (1995), Shaw(1998) and Trowbridge (1986) each discussin some detail the unreliability of laboratorytests based on blood or stool analysis or en-doscopy examination, and Hunnisett (1990)states that a breath test to identify patientswho ferment dietary carbohydrate to etha-nol in their gut might demonstrate the pres-ence of glucose-fermenting organisms in thestomach or small intestine but will not de-tect carbohydrate fermentation in the colon;in addition, any detected fermentation mightbe due to alcohol-producing microflora otherthan yeasts.55-58 An organic acids urine test isprobably more reliable because it will detectelevated organic acids which would only beelevated in the presence of yeasts.59 However,it is an expensive option when an assessmentof symptoms and history can usually provideinformation which is in fact as valuable aslaboratory tests.60

A simple and accessible method for

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determining the possibility and/or sever-ity of candidiasis is to use a questionnairesuch as the one devised by Crook (1984)which indicates symptom pattern and his-tory.61 It is of course possible for symptomsto be the result of causes other than yeastinfection, but a high score relating to a widevariety of symptoms indicates a strongpossibility increasing to probability as thetotal score increases. The surest way ofconfirming the possibility is then to embarkon an anti-candida protocol and await re-sults, which can be clearly seen by compar-ing a newly-completed questionnaire withthe original after a three-month interval.Since it is not dangerous to proceed with atrial yeast treatment protocol, in the finalanalysis this is actually the most reliablediagnostic test of any.62 It was such a pro-tocol that participants in this study wereadvised to follow.

With regard to pharmaceutical treat-ment for yeast overgrowth, there does notyet appear to be a prescribable medicationwhich is both completely effective andcompletely safe, several necessitating regu-lar monitoring of liver function. Odds(1988) states that of the many thousandsof drugs which have been synthesized ordiscovered, only a few are sufficiently non-toxic to justify more extensive testing and,of these, a very tiny number indeed survivethe rigorous requirements for safety andefficacy that justify their introduction intoclinical practice.63 In addition, researchersreport that polyene antibiotics like nysta-tin may actually stimulate yeasts to in-crease the number of their colonies.64 Non-systemic medications intended to destroyyeast overgrowth in the intestines mightwell invade the bloodstream via a leaky gutleading to toxicity, symptoms of which in-clude nausea, muscle aches and brain fog.Conversely, non-systemic medications willnot be able to destroy yeast which has pos-sibly colonised outside the gut. A safe, sys-temic approach is needed and a nutritionalanti-candida protocol had been used in

nutritional practice for twelve years priorto this study. The purpose of this study isto evaluate the extent to which this proto-col (described under Methods) would en-able improvement in symptoms to be ex-perienced over one year by subjects suffer-ing from medically-diagnosed CFS/ME andin this way to assess the possibility of acorrelation between CFS/ME and yeastinfection.

MethodsStudy Design

The study is based on a populationsample of 40 men and women aged 18 andover, suffering from medically-diagnosedCFS/ME. Exclusion factors for participantsincluded those with a medical diagnosis ofdiabetes, multiple sclerosis, cancer, AIDS orother life-threatening illness and pregnantor breast-feeding women. Each participantreceived appropriate advice from qualifiednutritional therapists at a UK-based nutri-tional therapy practice, under the directionof one of the authors who had graduatedin 1990 from the Institute for OptimumNutrition in London and is a registeredmember of the British Association for Nu-tritional Therapy. Each participant was al-located an identification number, andasked to complete a questionnaire (Appen-dix A, see note) from which records weremade of their gender, age, height andweight together with information aboutmajor and minor health problems, healthhistory and current medication prescribedby their doctor. The questionnaire in-cluded a self-assessment score for CFS/ME, comprising lifestyle factors and com-mon symptoms. It also included a self-as-sessment yeast score. Additional informa-tion requested included a stress profile,level of dietary compliance, use of ster-oids/HRT/contraceptive pill, and a glu-cose tolerance profile.

From the list of symptoms reported, ananalysis of nutritional status could bemade, and the level of individual nutritional

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intervention determined to provide an op-timum daily requirement of nutrients. Acomprehensive report was prepared andsupplied to each candidate, providing ad-vice on necessary changes to their diet andalso a personal supplement program whichincluded recommendations for antifungaland probiotic supplements. In addition, anaudiotape was supplied giving informationabout candidiasis and its management.The candidates had a choice of either at-tending for a personal consultation, if able,or alternatively receiving a detailed ex-planatory covering letter with their report.The candidates also had an ongoing facil-ity to telephone their nutritionist for helpor advice as or when needed. Similar ques-tionnaires were completed after 4 months,8 months and 1 year, so that initial, interimand final self-assessment scores for CFS/ME, yeast and other factors could be com-pared. At each re-assessment, a full reportwas provided to the client and there wasagain the opportunity for either a face-to-face consultation or an explanatory cover-ing letter, plus ongoing telephone supportas required.

Treatment ProtocolEach participant was advised to follow

the four-point plan which is outlined below:1. An anti-candida diet (i.e., avoiding

yeast, sugar, refined grains, stimulants andfermented products). Yeasts are able to fer-ment dietary glucose and sugar promotesfungal growth, so all forms of sugar–sucrose,lactose, maltose, fructose and added glu-cose–have to be strictly avoided, as do re-fined carbohydrates which add to the glu-cose load.65,66 Many practitioners, includingTrowbridge (1986) and Lorenzani (1986)agree that all fruit must be avoided untilcandida overgrowths are fully under con-trol.67,68 Foods containing yeast have to beavoided because of the high degree of ap-parent cross-sensitization between candidaand other yeasts.69 Each candidate wassupplied with detailed diet guidelines list-

ing foods to avoid and foods to enjoy. (Ap-pendix B, see note)

2. An individually-prescribed programof vitamins and minerals to improve thebody ’s nutritional status and therebystrengthen immunity. (See specimen list ofoptimum daily requirements, Appendix C,and specimen supplement program formu-lated to meet those requirements Appen-dix D, see note) The individual program ofsupplements for each client was based onan analysis of symptoms as reported in adetailed questionnaire, in line with themethods of symptoms analysis taught bythe Institute for Optimum Nutrition inLondon. Deficiency symptom analysis isarguably the most underestimated methodof assessing nutritional needs, but its ad-vantage is that health is being measureddirectly.70 Biochemical individuality meansthat identical supplement programs wouldnot be effective for each person but, whenan individual program is formulated, goodimprovements in nutritional status (andtherefore in health) can be expected.Through the proper use of optimum nutri-tion, host resistance can be improved to thepoint at which normal healthy bodily proc-esses can fight off infections of all kinds,including yeast infection.71

Research has shown that the followingvitamins and minerals may play a particu-lar part in enhancing resistance to yeastinfection: vitamin C, folic acid, pyridoxal-5-phosphate, riboflavin, vitamin A, zinc,magnesium and selenium.72-75 In addition,supplementation with essential fatty acidsmay be beneficial and pantothenic acidmay reduce the adverse effects of aldehydesby increasing the activity of aldehyde hy-drogenase, the enzyme involved in theirmetabolism.76,77

At each review consultation, clients wereasked to list the supplements they had actu-ally been taking to ensure that they corre-sponded with the supplement program whichhad been formulated for them.

3. Natural antifungals, of which there

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are several. One of the most useful naturalantifungals for inhibiting an overgrowth ofyeast organisms is caprylic acid, a long-chainfatty acid which occurs naturally in coco-nut oil and human breast milk and does notadversely affect beneficial organisms.78-81 Inaddition, caprylates decrease stickiness ofblood platelets, aid digestion by increasingmotility of the stomach and its secretions,reduce cholesterol in blood and liver andincrease the uptake of calcium.82-85

Certain essential oils from herbs suchas oregano have a short-chain fatty acidstructure which is better able to be ab-sorbed through fatty cell wall membranesthan long-chain caprylic acid. Oreganotherefore has greater systemic antimicrobialactivity, being able to reach candida whichhas colonised in tissues of the body beyondthe gastrointestinal tract.86 Once caprylicacid has helped to bring intestinal yeastunder control, plant oils such as oregano areuseful for attacking outlying candidaovergrowths on the skin and nails, and insuch areas as sinuses, ears, eyes and joints.

Each candidate in this study was ad-vised to take caprylic acid as their initialantifungal, and some were later transferredto a different type of antifungal as seemedappropriate for their remaining symptoms.

4. Probiotic supplements to rebalanceintestinal microbes with beneficial flora, inparticular Lactobacillus acidophilus (themajor colonizer of the small intestine) andbifidobacterium bifidum (the majorcolonizer of the large intestine). The Lacto-bacillus bacteria produce the enzyme lactaseto break down lactose and create lactic acidfrom carbohydrates. L. acidophilus has beenshown to inhibit E. coli, salmonella and shig-ella micro-organisms and it has also beenshown to inhibit the formation of myceliain Candida organisms.87-89 Bifidobacteriabifidum produce acetic acid and lactic acidand compete with pathogens for nutrientsand attachment sites. They detoxify theintestinal tract and manufacture B vita-mins and they act as an extension of the

body’s defence mechanism by controllingand destroying pathogenic bacteria, virusesand yeasts.90 Each candidate in this studywas advised to take a supplement provid-ing both L. acidophilus and B. bifidum inencapsulated freeze-dried powder form. Inview of the role of lactose in encouragingCandida, a product was chosen which hasa milk-free base.

These four points form the anti-can-dida strategy which was recommended toeach participant in the study. They werealso warned clearly of one aspect of theanti-candida battle which they would al-most certainly encounter–a syndromeknown as a Herxheimer reaction.91 As yeastis destroyed, the breakdown products andtoxins released can cause extremely un-pleasant symptoms–general malaise, nau-sea, aching limbs, depression, or an appar-ent flare-up of previous symptoms in areaswhere candida had colonized. German der-matologist Herxheimer first described thisresponse when Candida albicans was beingdestroyed by the use of antifungal sub-stances.92 Referred to colloquially as ‘die-off ’,it should be recognized as an encouragingsign that Candida is being destroyed.93,94

However, the symptoms can be far frompleasant and, in some cases, are sufficientto persuade the sufferer to abandon the anti-candida protocol. It is therefore preferableto approach the regime slowly but surely byspending at least one month on just the firsttwo parts of the four-point plan (anti-can-dida diet and immune-boosting vitaminsand minerals) and not introducing points3 and 4 (antifungals and probiotics) untilinitial Herxheimer reaction has subsided.Antifungals are then increased gradually, asdie-off symptoms allow, so that the clientis encouraged to take control of his/herown intake of antifungals. To help mini-mize die-off reaction, liver detoxificationprocesses can be supported by drinkingroasted dandelion coffee (to stimulate theproduction of bile for carrying toxins outof the liver) and taking the herbal supple-

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ment milk thistle (containing silymarin);these recommendations were made to eachparticipant in the study.

Statistical AnalysisThe data were analyzed from a number

of perspectives. Whilst the primary focusof the study was to evaluate the effects of anutritional anti-candida protocol in help-ing to reduce symptoms of CFS/ME, thecollected data also provided the opportu-nity to examine the base relationship be-tween yeast infection and CFS/ME. Assum-ing a normal distribution of CFS/ME andcandida scores, a correlation coefficient (r)was calculated, using data from the samplestart population (40 participants), where thesample correlation coefficient r is assumedto give an unbiased estimate of the totalpopulation coefficient (p). A 95% confidenceinterval around the correlation coefficient rwas additionally calculated. The samplestart population was used for this relation-ship analysis rather than the end population(18 participants) in order to maintain con-fidence levels in what is already a relativelysmall population sample.

The effectiveness of an anti-candidaprotocol in treating CFS/ME was analyzedusing a hypothesis test, where the null hy-pothesis assumed that there would be noeffect on CFS/ME symptoms by adheringto an anti-candida protocol. Assuming a t-distribution and using start and end datafrom the end sample population (18 par-ticipants), a paired, two-tailed t-test (two-tailed to acknowledge the possibility thatsome participants might experience aworsening of symptoms) was used to esti-mate a p value for the study. Start and fin-ish CFS/ME and candida symptom scoresplus simple average percentage reductionsin symptom scores were also calculated.

The additional data collected on stresslevels, use of steroid treatments/HRT/con-traceptive pill, age, dietary compliance andglucose tolerance were also analyzed withregard to acknowledging the presence of

confounding variables. Due to the fact thatboth steroid use and stress are believed tohinder the effectiveness of an anti-candidaprotocol, particular focus was placed on thesymptom scores and percentage reductionsof these population subsets (although it isrecognized that the statistical validity ofsuch observations declines as the samplepopulation size is reduced).

ResultsThe Relationship Between CFS/ME Startand End Symptom Scores

When data from the completing 18participants are analysed according to therelationship between the start and endCFS/ME scores, a moderately strong cor-relation is found (r = 0.64) (Figure 1, p. 199).The graph demonstrates an encouraginglevel of improvement in most cases over thecourse of the study.

The Relationship Between CFS/ME andCandida

Data analysis on the population sam-ple of 40 participants indicated a moder-ately strong positive correlation (r=0.57)between CFS/ME and candida at the startof the study (Figure 2, p. 199).

As a 95% confidence interval gives avalue for r of between 0.31 and 0.74, it isreasonable to assume that reducing candi-diasis may lessen the severity of CFS/MEsymptoms in the majority of sufferers. (Acalculated correlation coefficient on the 18participants remaining at the end of thestudy led to a higher r value of 0.73 but, dueto the reduced population sample size, themore conservative ‘start’ coefficient of r=0.57has been used in this analysis.)

The Effectiveness of an Anti-Candida Pro-tocol on CFS/ME

Table 1, (p. 199) shows the start, end andpercentage reduction symptom scores forCFS/ME and candida for the 18 completingparticipants; Figure 3, (p. 200) represents thesame information in diagrammatic form.

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CFS/ME Scores Candida Scores

Average start Average end % decrease Average start Average end % decrease

30.9 21.5 30.5 51.4 26.1 49.2

Table 1. CFS/ME and Candida scores of 18 completing participants.

Figure 1. Start CFS/ME vs. End CFS/ME Scores r=0.64

Figure 2. CFS/ME vs. Candida – Start of study r=0.57

r=0.57

r=0.64

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One participant achieved a 100% re-duction in CFS/ME symptoms, and anotheran 86% reduction in CFS/ME symptoms.At least 83% of participants experienced atleast some improvement in symptoms. Theaverage percentage fall in CFS/ME symp-tom scores throughout the course of thestudy was 30.5%, and the average reductionin yeast symptom scores was 49.2%.

Using a null hypothesis that an anti-candida protocol would have no effect onsymptoms of CFS/ME, a paired, two tailedt-test on pre- and post-study CFS/MEscores on the 18 completing participantsgave a statistically significant (p=0.024) re-sult at the 97.5 percentile level, thus givingsupport to the alternative hypothesis thatan anti-candida protocol is an effectivetreatment for CFS/ME.

The Impact of Stress on CFS/METhe participants’ stress levels were found

to have a significant impact on symptoms ofCFS/ME over the course of the study. Par-ticipants who experienced a higher than av-erage stress score at the start of the study orat the end of the study, or at both the startand end of the study (where ‘higher than av-erage’ start stress score constitutes a score of

over 12, and ‘higher than average’ end stressscore constitutes a score of over 9) all dem-onstrated a reduced fall in their CFS/MEsymptom scores (23.5%, 26.8%, 20.4% respec-tively vs. 30.5%) compared with the average(Table 2, p.201, Figure 4, p. 202)

A high stress factor (i.e. higher thanaverage start/end/start and end stressscores) also resulted in the sample popula-tion’s absolute end CFS/ME scores remain-ing higher than average, particularly thosewho experienced higher than average stresslevels at both the start and end of the study(CFS/ME scores of 28.8 vs. 21.5).

The Impact of HRT/Contraceptive Pill/Ster-oids on CFS/ME

Of the 18 completing participants, onethird was taking either HRT or the contra-ceptive pill or some other form of steroidtreatment. These participants experienceda higher than average CFS/ME score at thestart of the study (38.7 vs. 30.9); this patternwas also demonstrated when data from theinitial population of 40 were analyzed. By theend of the study, data from the populationof 18 (Table 2, p. 201 Figure 5, p. 202) showedthat CFS/ME symptoms had improved inthis population subset, but by a lower than

Figure 3. Reduction in average CFS/ME and candida symptom scores overthe course of the study.

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average amount (25.4% vs. 30.5%), with theirabsolute CFS/ME scores also remaininghigher than average (28.8 vs. 21.5).

These observations infer that use ofHRT/contraceptive pill/steroids negativelyimpacts the effectiveness of an anti-candidaprotocol in treating CFS/ME. However, animprovement in CFS/ME symptoms wasstill seen in each of these cases, indicatingthat the use of nutritional therapy still re-

mains effective, but to a lesser extent thanin participants who were not using HRT/contraceptive pill/steroids.

The Impact of Duration of Illness on CFS/MEIt has been encouraging to observe

that the participants who have had alonger than average duration of CFS/ME(where a longer than average duration re-fers to over 6 years in this population sam-

All 30.9 21.5 30.5 51.4 26.1 49.2

Those using 38.7 28.8 25.4 64.5 34.2 47.0steroids/HRT/contraceptive pill(6 participants)

Those with higher 31.9 24.4 23.5 58.4 29.9 48.8than average startstress scores(8 participants)

Those with higher 34.9 25.6 26.8 54.7 33.1 39.4than average endstress scores(9 participants)

Those with higher 36.2 28.8 20.4 51.8 35.4 31.7than average startand end stress scores(5 participants)

Those over the 31.7 15.8 50.2 55.0 23.9 56.6average age of 36 (9 participants)

Those with a duration 30.75 18.1 41.1 53.4 27.0 49.4of CFS/ME of 6yrs+(8 participants)

Table 2. Data for sample population of 18 completing participants.

Proportion ofSample

Population

Candida Scores%

decreaseAverage

startAverage

end

CFS/ME Scores%

decreaseAverage

startAverage

end

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ple) were not at a disadvantage in terms ofthe effectiveness of the anti-candida proto-col in reducing symptoms of CFS/ME (Ta-ble 2). In fact, those participants in thissample who had a longer than average du-ration actually experienced a greater dropin CFS/ME symptoms over the study timeperiod (41.1% vs. 30.5%). Longer duration

of illness was therefore found not to impairthe effectiveness of the anti-candida proto-col in relieving symptoms of CFS/ME.

The Impact of Age on CFS/MEOf the study participants, half of the

group had an age of 36 years or more. Theresults indicate that although there ap-

Figure 4. The effect of stress on CFS/ME scores at the start and end of the study

Figure 5. CFS/ME average scores (18 completing participants) for those taking HRT/contraceptive pill/ steroids vs. those not taking them

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peared to be no relationship between ageand CFS/ME start symptom scores, by theend of the study participants over the ageof 36 had achieved a greater reduction insymptoms (50.2% vs. 30.5%), with a lowerabsolute end symptom score than average(15.8 vs. 21.5). (Table 2, Figure 6, below)

DiscussionStudy Design and Results

The issue of testing nutritional strate-gies on sample populations is problematicdue to the difficulty of isolating contrib-uting factors in order to establish causeand effect and to eliminate bias. Duringthis study, it was deemed unethical toform a control group of CFS/ME suffererswho would be asked not to undergo anyform of treatment for their CFS/ME overthe course of the year. With hindsight, acontrol group consisting of CFS/ME suf-ferers who were being treated by conven-tional medicine might have been of inter-est for purposes of comparison with theeffects of the anti-candida protocol. (It isworth noting that the majority of partici-pants were not taking medication for theirCFS/ME symptoms. Of those who did takemedication, anti-depressants were the

drugs which had most commonly beenprescribed by their medical advisors.).However, given that the Working Group in2002 concluded that there is ‘no cure’ forCFS/ME, the assumption was made for thepurposes of this study that, without treat-ment, CFS/ME symptom scores for mostparticipants could be expected to remainunchanged over the course of one year.

Despite the lack of a control, the find-ings are extremely encouraging; the samplepopulation experienced on average a 30.5%reduction in symptoms, 83% of the samplebenefited from some reduction in symp-toms, and a t-test concluded that these re-sults are significant at a level of 97.5%. Onlythree participants experienced a worseningof symptoms, and in each case there was atleast one explanatory factor which is be-lieved to adversely affect candida–use ofnicotine, higher than average stress levels oruse of HRT/contraceptive pill/steroids. Dueto the probable multi-factorial causes ofCFS/ME, these participants might simplyhave had too many causal factors present toenable a reduction in symptoms of CFS/MEover the course of one year, as a result ofwhich their scores for both candida andCFS/ME remained higher than most.

Figure 6. Age vs. Improvement in CFS/ME scores over the course of the study.

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Dropout RateThe presence of bias in this study is

also acknowledged in relation to the lowsample population size (18 completingparticipants) and large dropout rate overthe course of the study (55%). As a resultof this dropout rate, the correlation sta-tistics are based on the larger sample startpopulation (40 participants) whilst the t-tests were paired and based on only those18 participants who started and finishedthe study. The dropout rates might be at-tributed to one of more of the followingfactors:

a) Lack of motivation for strict adher-ence to the anti-candida diet over a lengthytime period, as reported by several of thenon-completing participants.

b) A temporary worsening of symp-toms due to Herxheimer reaction beforeexperiencing encouraging signs of improve-ment, a situation about which participantshad been forewarned and for which theywere encouraged to request specific adviceto help alleviate those symptoms; someparticipants were possibly not prepared togo through this temporary phase.

c) Disappointment that more improve-ment was not being experienced within theone-year time-scale of the study. It is theresearchers’ experience that a one-yeartime period is generally a minimum periodin which to see a marked improvement insymptoms of CFS/ME, and that furtherprogress is usually made after this time (i.e.beyond the end of the study). This medium-to-long term approach to the treatment ofthe illness may have dissuaded some par-ticipants who perhaps were looking for a“quick fix” approach to their illness.

d) Difficulty in keeping to the anti-can-dida diet due to hypoglycemic cravings.Data analysis of the participants who leftthe study early shows that they had an ini-tial score for poor glucose tolerance whichwas on average 12% higher than those whowent on to complete the study. This sug-gests that it was harder for those partici-

pants to control their cravings for certainfoods, and therefore also harder to adhereto a protocol which required 100% compli-ance to the anti-candida diet.

e) Cost of taking part in the study.However, before agreeing to take part, par-ticipants were made aware of the financialcost to them of consultations and foodsupplements. It is therefore unlikely thatfinances played a role in the high dropoutrate for the majority of participants.

In summarizing possible reasons forthe high drop-out rate, it is interesting tonote that, of the 22 subjects who failed tocomplete, some had already shown an en-couraging reduction in their scores forboth CFS/ME and candida. For thesepeople, lack of progress was obviouslytherefore not their reason for failing tocomplete the study.

Confounding VariablesDue to the fact that CFS/ME is thought

to be a multi-factorial condition, it is prob-able that in some participants the anti-can-dida protocol, in addition to reducing can-dida symptoms, also dealt with some otherpossible contributing factors to chronicfatigue, e.g. allergies, hypoglycaemia, lowmagnesium status, poor immune status orlow general nutritional status.

The study has shown that stress, HRT,the contraceptive pill, steroid medicationsand age have all been found to influence areduction in CFS/ME.

Although this study demonstrates anobserved correlation between candida andCFS/ME, this does not imply causation,and infers nothing about the role of othervariables in CFS/ME. However, the impactof these variables should not detract fromthe fact that 83% of completing partici-pants felt that their symptoms had im-proved, indicating that at least one factorin each of their individual nutritional anti-candida programs had produced these en-couraging results.

Whilst the findings regarding the im-

207


pact of stress levels and HRT/contracep-tive pill /steroids are important (that theyencourage candida overgrowth and alsomake it harder to achieve a reduction insymptoms of CFS/ME), further research isrequired specifically in this area, ideallyusing a larger study group. The observationthat certain lifestyle choices (e.g. contracep-tive pill, HRT) and perceived stress levelscan negate some of the benefits of nutri-tional therapy supports the notion that amore holistic treatment plan might be help-ful for some CFS/ME sufferers. In addition,a surprising outcome from this study wasthe higher level of improvement in symp-toms of CFS/ME in participants aged 36and over compared with those aged under36, and this is again an area where furtherinvestigation is warranted.

ConclusionThis study shows promising results in

the future treatment of CFS/ME, using ananti-candida protocol either alone or as anintegral part of a treatment plan which, assuggested by the Working Group in 2002,might include graded exercise, cognitivebehavioural therapy or pacing. Whilst thisis neither a large scale study, nor a double-blind randomized control trial, there areobserved statistically-significant findingsand encouraging percentage reductions inCFS/ME symptoms in 83% of the study par-ticipants using this anti-candida protocol.A correlation between CFS/ME and candidahas been observed, and the effectiveness ofreducing CFS/ME symptoms by following ananti-candida protocol has been shown inthis sample population at a 97.5% signifi-cance level, with an average reduction insymptoms of 30.5%.

It is important to recognize that re-corded improvements are improvementswhich are perceived by the subjects so,whilst it is acknowledged that this study islacking in objective data, its findings maycertainly be considered significant to thosewho are suffering from CFS/ME. Further

study of the impact of the confoundingvariables (e.g., stress, HRT/contraceptivepill/steroids, age) on symptoms of CFS/MEmay also be warranted in light of the find-ings of this research.

The evidence presented here shouldgive hope to sufferers of CFS/ME in that,for some, the power to reduce their symp-toms may lie in their own hands.

Note: Appendices related to this paper(questionnaire, diet sheet and specimenrecommended supplements program) areavailable on request from [email protected] or from Erica White,Nutritionhelp Ltd., 2 Electric Avenue,Westcliff-on-Sea, Essex, SS0 9NQ, UK

References1. Department of Health: A Report of the CFS/ME

Working Group to the Chief Medical Officer.London. 2002: 1.

2. Department of Health: Ibid.3. Department of Health: Ibid: 6.4. Department of Health: Ibid: 21.5. Department of Health: Ibid. 266. Department of Health: Ibid: 39.7. Chaitow L: Postviral Fatigue Syndrome. Lon-

don. Dent. 1989; 3-4.8. Royal College of Physicians, Royal College of

Psychiatrists and Royal College of General Prac-titioners: Chronic Fatigue Syndrome. Salisbury.Great Britain. Royal College of Physicians Pub-lication Unit. 1996.

9. Frustrating survey of chronic fatigue, In. Lan-cet. 1996; October 12.

10. Department of Health: Ibid: Government Re-sponse.

11. Department of Health: Ibid: 45.12. Department of Health: Ibid. 45.13. Department of Health, Ibid: 13, 53, 55.14. Department of Health, Ibid. Government Re-

sponse.15. Golan R : Optimal Wellness. New York.

Ballantine Books. 1995; 214.16. Golan R: Ibid: 208-232.17. Chaitow L: Candida albicans: Could Yeast be

Your Problem?. London. Thorsons. 1985; 9,10.18. Trowbridge JP & Walker M: The Yeast Syn-

drome. New York. Bantam Books. 1986; 98-99.19. Hippocrates circa 460-377 BC: Epidemics. Book

3. trans. by Adams F. Baltimore. Wilkins &Wilkins. 1939.

208


20. Truss C Orian: Tissue injury induced by Can-dida albicans. J Orthomol Psychiat, 1978; 7: 17-21.

21. Truss C Orian: Restoration of ImmunologicCompetence to Candida albicans. J OrthomolPsychiat, 1980; 9: 287-301

22. Truss C Orian: The Role of Candida Albicansin Human Illness. J Orthomol Psychiat, 1981; 10:228-238.

23. Truss C Orian: Metabolic Abnormalities in Pa-tients with Chronic Candidiasis: The Acetal-dehyde Hypothesis. J Orthomol Psychiat, 1983;13: 66 – 93.

24. Trowbridge JP & Walker M: Ibid: xvi.25. Odds FC: Candida and Candidosis 2nd edn.

London. Bailliere Tindall. 1988; 4.26. Trowbridge JP & Walker M Ibid: 83.27. Stokes EJ & Ridgway GI.eds: Clinical Microbi-

ology. Edward Arnold. 1987.28. Bland J: ‘Hidden’ diseases caused by candida.

Preventive Medicine. 1984; 3 (4): 12.29. Plummer N: Lactic Acid Bacteria – Their role

in Human Health. BioMed Publications. 1992;9.

30. Bland J: Ibid.31. Krause W: Fungaemia and funguria after oral

administration of Candida albicans. Lancet.1969; 1: 598-9.

32. Trowbridge JP & Walker M: Ibid: xix.33. Edwards DA: Depression and Candida. JAMA,

1985; 253: 3400.34. Rivas V, Rogers TJ: Studies on the Cellular Na-

ture of Candida albicans-induced Suppression.J Immunol, 1983; Jan, 130: 376.

35. Golan R: Ibid: 219.36. Trowbridge JP & Walker M: Ibid: xvi.37. Shaw W: Biological Treatments for Autism and

PDD. US. Health. 1998; 31-65.38. Odds FC: Ibid: 3.39. Trowbridge JP & Walker M: Ibid: xix.40. Trowbridge JP & Walker M: Ibid: 341.41. Nosal R: Histamine release from isolated rat

mast cells due to glyco-protein from Candidaalbicans in vitro. J Hyg Epidemiol MicrobiolImmunol. 1974; 18: 377-8.

42. Numatra T: The role of mite, house dust andCandida allergens in chronic urticaria. JDermatol. Tokyo. 1980; 7: 197-202.

43. Kashkin PN: Candida complications after an-tibiotic therapy. Mycopathol Mycol Appl, 1961;14: 173-88.

44. Stevens LJ: Endometriosis and Yeast: A NewConnection. Overcoming Endometriosis. 1988.Arlington Books.

45. Feldman D: Steroid Hormone Systems Foundin Yeast. Science Magazine. August 1984.

46.Seelig MS: Role of Antibiotic in the

Pathogenesis of Candida Infections. Am J Med,1966; 40: 887-917.

47. Lipski E: Digestive Wellness. New Canaan, CT,Keats Publ. 1996; 77.

48. Golan R: Ibid: 214.49. Chaitow L: Ibid: 62.50. Brostoff J & Gamlin L: The Complete Guide to

Food Allergy and Intolerance. London,Bloomsbury. 1989; 181.

51. Horowitz BJ: Sugar Chromatography Studiesin Recurrent Candida Vulvovaginitis. J ReproMed. 1984: 7: 441-443.

52. Wunderlich RC Jr: Sugar and Your Health. GoodHealth Publications. St. Petersburg, Florida. 1982.

53. Truss C Orian: The Missing Diagnosis. Birming-ham, Ala. 1983.

54. Trowbridge JP & Walker M: Ibid: 10-11.55. Golan R: Ibid:56 Shaw W: Ibid:57. Trowbridge JP & Walker M: Ibid:58. Hunnisett A:59. Shaw W: Ibid:60. Golan R: Ibid:61. Crook WG: The Yeast Connection: A Medical

Breakthrough. 2nd edn, Jackson, Tenn, 1984;Professional Books.

62. Golan R: Ibid: 200.63. Odds FC: Ibid: 279.64. Braitburg A: Increase in Colony-Forming Units

of Candida Albicans After Treatment with Poly-ene Antibiotics. Antimicrob Agents Chemother.1981 Jan; 19: 199-200.

65. Hunnisett A: Gut Fermentation (or the Auto-brewery Syndrome): A New Clinical Test. J NutrMed, 1990; 1:1.

66. Horowitz BJ: Ibid.67. Trowbridge JP & Walker M: Ibid: 359.68. Lorenzani S: Candida – A Twentieth Century

Disease. CT, Keats Publ. 1986; 27, 61.69. Brostoff J & Gamlin L: Ibid: 184.70. Holford P: The Optimum Nutrition Bible. Lon-

don. Piatkus. 1997; 228.71. Wunderlich RC & Kalita DK: Candida Albicans:

How to Fight an Exploding Epidemic of Yeast-Related Diseases. In. eds. Passwater RA &Mindell E. A Good Health Guide. CT, KeatsPubl. 1984.

72. Am. J. Clin. Nutr. 1981; 34: 1906-11.73. Galland L: Nutrition and Candidiasis. J.

Orthomol.Psychiat. 1985; 14: 50–60.74. Galland L: Nutrition and Candida Albicans. In.

ed. Bland J. A Year in Nutritional Medicine.New Canaan, CT, Keats Publ. 1986.

75. Boyne R & Arthur JR: The response of sele-nium-deficient mice to Candida albicans infec-tion. J Nutr, 1986; 116(5): 816-22.

76. Truss C Orian: Metabolic Abnormalities in Pa-

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tients with Chronic Candidiasis: The Acetal-dehyde Hypothesis. J Orthom. Psychiat, 1984;13: 66-93.

77. Galland L: Ibid.78. Keeney E: Bulletin, John Hopkins Hosp. 1946;

78: 333-39.79. Neuhauser L & Gustus E: Successful treatment

of intestinal moniliasis with fatty acid resincomplex. Arch. Int. Med. 1954; 93: 53-60.

80. Meynell G: Brit J Exp Path, 1963; 44: 209.81. Tsukahara T: Japan J Microb, 1961; 383.82. Tangen O: Scand J Clin Lab Invest, 1975; 35: 19.83. Schmidt-Wickloke HA: Digestion, 1975; 13: 8.84. Caster WO: J Nutr, 1975; 105-676.85. Merril AR: Bioch Biophys Acta, 1986; 855: 337.86. Hoffman D: The Complete Illustrated Holistic

Herbal. London. Element. 1996.

87. Purohit BC: The Formation of Germtubes byCandida Albicans when grown with S pyogenes,E. coli, K. pneumoniae, L. acidophilus and Pro-teus vulgaris. Mycopathologia, 1977; 62, 3: 187-189.

88. Shahani KM: Natural Antibiotic Activity of Lacidophilus and bulgaricus. Cultured DairyProducts J. 1977; 12: 8-11.

89. Collins EB & Hardt P: Inhibition of Candidaalbicans by Lactobacillus acidophilus. J DairySci. 1980; 63: 830-832.

90. Chaitow L & Trenev N: Probiotics. London.Thorsons. 1990; 29.

91. Lipski E: Ibid: 84.92. Trowbridge JP & Walker M: Ibid: 39.93. Golan R: Ibid: 227.94. Lipski E: Ibid: 84.

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