(Updated 1/24/25)
Overview:
If you have ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome), long-COVID, or Lyme disease, and achiness, extreme fatigue, and/or cognitive dysfunction (brain fog) are prominent symptoms
for you, and/or you’ve noticed some soreness or visible thrush in your
mouth or itchiness in your vaginal area, you should see your
doctor to look into the possibility of yeast overgrowth (candida) as an
underlying
cause. Yeast overgrowth is very common in ME/CFS and long-COVID due to our specific kind of immune dysfunction and in Lyme and other tick infections due to antibiotic use.
It amazes me every time I go through this just how horrible yeast overgrowth
makes me
feel and how it worsens all of my ME/CFS symptoms. When yeast overgrowth is flared up, none of my usual ME/CFS treatments seem to help the way they normally do, and I am exhausted and achy and unable to get off the couch, with even minimal exertion (that I can normally tolerate) causing a worsening. With yeast overgrowth
under control, I
feel pretty good and have mental clarity--I even have energy!--and it’s
the same for my son. Treating
yeast overgrowth makes a huge difference in overall well-being for
people with ME/CFS and Lyme disease (and other bacterial tick
infections).
In fall 2014, my ME/CFS had been worse than usual for months. The source of that
worsening was a flare-up (again) of yeast overgrowth aka candida, after I needed strong
antibiotics for bronchitis/early pneumonia two months earlier. This post describes what treatments work for us (my son also struggles with yeast overgrowth with his ME/CFS and after
several years on antibiotics for Lyme).
Another bad yeast flare-up in summer 2023 led to further discoveries, and I updated this post. It appears I am a slow learner, though! I was horribly crashed in the last three months of 2023 and thought yeast overgrowth was treated effectively, until one of my doctors noticed I still had thrush on my tongue. That resulted in re-learning how critical diet is in controlling yeast, and now in early 2024, with yeast overgrowth under control, I am feeling better than I have in many years!
Why Is Yeast Overgrowth a Common Problem in ME/CFS?
First, some basics. Many, many people with ME/CFS and long-COVID have
yeast overgrowth, even if they don’t realize it. One reason it is common for us
is that it is related to
immune dysfunction. This
study from Pitt found that a particular cytokine, IL-17, helps to suppress yeast overgrowth, as did this
NIH review of studies on IL-17 and yeast. Several studies specific to
immune function in ME/CFS have shown our IL-17 is often low. Many studies and experts have found yeast overgrowth as a factor in many patients with ME/CFS. And this study digs into the
details of immune dysfunction in ME/CFS and a connection to yeast overgrowth.
Yeast or
candida is naturally occurring in our bodies and is not damaging normally.
Problems occur when the yeast takes over (i.e an overgrowth) and crowds out the good bacteria in the GI system. This often happens after a course of
antibiotics because they kill off the good bacteria (aka probiotics) in our
gastrointestinal systems that normally keep yeast/candida in check. Because yeast overgrowth often occurs when you take antibiotics, people being treated for
Lyme disease and other tick infections are at especially high risk. Our Lyme specialist was the first one to prescribe antifungals for yeast overgrowth for both of us. In addition, the immune dysfunction of ME/CFS makes us
more susceptible to bacterial infections than most, so many of us get recurring infections, like bronchitis, sinus infections, and ear infections, that require the use of antibiotics. But even without antibiotics, the immune dysfunction of ME/CFS and long-COVID alone makes yeast overgrowth a common underlying factor.
Symptoms of Yeast Overgrowth
Symptoms of yeast overgrowth can vary widely. Some people
(like my son and I) get thrush in their mouths. Thrush looks like a white or
yellowish coating on the tongue and is caused by yeast overgrowth. When it gets worse,
it can make your mouth and tongue hurt or feel sensitive, especially when you
eat sour or bitter foods. Some women develop vaginal yeast infections--another
obvious sign of yeast overgrowth (interestingly, though I have struggled with
yeast overgrowth for decades and often get thrush, I have never
had a vaginal yeast infection). Many of us with ME/CFS have yeast overgrowth that extends throughout our GI tract, even if we can only see it in the mouth.
However, many of the symptoms of yeast overgrowth in ME/CFS and Lyme are less
obvious and far more debilitating. For my son and I, all of our ME/CFS symptoms
get much worse: flu-like aches, sore throat, cognitive dysfunction,
exhaustion, etc. For me, the worst part is the aches. I spent two months in fall 2014 wracked with flu-like achiness every single day. Amazingly, after experiencing
yeast overgrowth so many times before, I didn’t realize what was going on for
weeks, until I noticed my mouth was sore. I ran to the bathroom mirror and
stuck my tongue out and sure enough, there was obvious thrush in my mouth. Duh. Similarly, with a more recent flare-up, in 2023, I couldn't figure out why I was so exhausted and couldn't get rid of the flu-like aches, until my doctor looked in my mouth, and ... yup, again!
At first, in 2014, I tried all the usual approaches (see list below)
but to no avail – there was still visible thrush in my mouth, and I still felt
absolutely awful and was barely able to function. At that point, I asked my
doctor to prescribe antifungals (yeast is a fungus). At the normal dosage, even
those barely helped. I had to double the dose to finally, finally begin to get the yeast under control. Even that was only partly
effective. When I went to see my doctor after more than a month on Diflucan
(fluconazole, an antifungal), and she looked in my mouth and still saw the thrush there, she
prescribed a stronger antifungal (Ketoconazole), alternating days with the
Difucan. I finally started to feel better. Since then, I have remained on fluconazole daily. I had similar struggles in 2023, even with the anti-fungals! This time, it was my diet that was the key. Sometimes, it takes ALL of the treatments listed below to finally get yeast overgrowth under control.
Treatments for Yeast Overgrowth
Here are the treatments we’ve tried to get yeast/candida
under control, in rough order of what to do first:
Diet:
I just relearned how important diet is in controlling yeast; don't skip this step!
Depending on
how severe the yeast overgrowth is, you may need to severely restrict your
diet, at least temporarily. Yeast feeds on sugar and, to a lesser degree, on grains (especially refined grains). There are three main diet options to help control yeast, from least restrictive to most:
- Paleo: no sugars (except limited natural sugars), no grains, no dairy, no legumes, no alcohol. This diet has been shown to be helpful for those with immune disorders.
- Keto (full name--ketogenic): moderate protein, very low carb, high fat diet, avoiding most sugars, grains, legumes, starchy vegetables, and alcohol. This puts your body into ketosis, where it burns fat for fuel instead of carbs. It generally results in weight loss and improvements in blood sugar, blood pressure, cholesterol, and other health measures. My cholesterol and triglycerides have never been this low before!
- Carnivore: is what it sounds like! Only meats, fish, seafood, eggs, and butter (if you can tolerate it, some high-fat dairy like cheese and cream are OK). A study from Harvard found that 89% of those with autoimmune disease who tried the carnivore diet saw significant improvement in their disease (ME/CFS is not strictly autoimmune but it is an immune disorder). It is also no-carbs, so there is nothing to feed yeast.
I talked about these three diets in detail in my video on Diets for Chronic Illness: Paleo, Keto, Carnivore, with tips on how and what to eat with each one, meal and snack ideas and recipes, and more.
In my blog post about a paleo diet, I explained our own "modifications," but I don't recommend that! I think that's what got me in trouble last year and allowed the yeast to get bad again. Stick to paleo, keto, or carnivore. While I said I was eating paleo, my diet had slipped over the years, gradually becoming less paleo, with exceptions for sugar and grains creeping in more and more often. I was also eating plenty of starchy vegetables that feed yeast.
With that terrible flare-up at the end of 2023, what finally got rid of the yeast overgrowth (after trying everything else in this post) was going to a strict, no carbohydrates, carnivore diet (more info on what I did and how it helped in the video at the link). Yes, it is
difficult at times, but it is better than feeling so horrible. After three months of mostly carnivore, I transitioned to a keto diet and have kept it up for over a year now. It's not hard at all because I am so thrilled to be feeling so good! I am back to walking, going out with friends, and doing all the things I want to do. Last year, I did not had a single post-exertional crash for six months! (until I got COVID) That makes it easy to stick with.
Step one to control yeast is to eliminate sugar in all forms. Check labels because
sugar is added to all kinds of foods. Once yeast is under control, you may be able to tolerate a small amount of honey
or
coconut sugar and small amounts of fruit, but at first, eliminate all sugars and sweeteners except xylitol and stevia (we like Truvia
brand which contains stevia and erythritol). Most sugar alcohols (they
end in -ol on ingredient lists and are present in many products labeled
"sugar-free") also feed yeast (and can upset the stomach) and should be avoided, but erythritol and xylitol
have actually been shown to fight yeast. Use in small amounts, though, to avoid stomach upset. Stevia is a natural, no-calorie sweetener that does not feed yeast and will not upset your stomach. Normally, with the other
treatments on this list, I can tolerate some fruit, but when it's as bad as
it has been recently, I eliminate that, too. Blueberries and other berries are the least likely to feed yeast and watermelon is very low in sugar.
Avocados have almost no sugar, so they're OK, too. I'm even eating a quarter of an avocado occasionally on my mostly carnivore diet.
All grains and especially refined grains (bread, white rice, pasta, anything made with flour) will also feed yeast--your body reacts to these in the same way as sugar. Start with eliminating sugars and grains. If that's not enough, also eliminate starchy vegetables (potatoes and most root vegetables). If that's still not enough, you may have to further restrict carbs of all kinds.
Search online for
"anti-candida diet" to find lots of information and resources. I found this Anti-Candida Diet article helpful. Check out
my delicious recipe for a Paleo Chocolate Smoothie, with great health benefits and options for a yeast-friendly smoothie. And for a treat, try my recipe for Sugar-Free Chocolate Bark.
Probiotics:
Probiotic strength is shown by the
number of billions of active cultures in each capsule. We take probiotics every day, but when yeast
overgrowth flares up, we increase the dose. Renew Life is a good brand that contains 12 different probiotic strains, including those that are important if you are taking (or have taken) antibiotics. When I take antibiotics or have a yeast flare-up, I switch to this stronger variety of Renew Life, with 50 billion units. With this latest yeast flare-up, our functional medicine specialist recommended TruBifido, in addition to the others I usually take. Saccharomyces boulardii
is a specific type of probiotic that works against yeast, so you should
take that (we take 2 twice a day) as well as general probiotics, with a variety of strains in
them, daily.
We take saccharomyces boulardii and regular probiotics every day, all the time. I add the Renew Life (50) and TruBifido when the yeast flares up. Probiotics
must be taken away from (by at least 90 minutes to two hours) any antibiotics or even herbals with antibacterial
properties (like olive leaf, oregano, or monolaurin) and work best on an
empty stomach. We take them before breakfast and before bedtime.
Antifungal Supplements and Herbals:
There are many
natural substances that have antifungal properties that can be taken separately or together. Some combination products include multiple ingredients, but read the labels carefully to be sure you can tolerate all ingredients (for instance, Uva Ursi is a diuretic and not good for those with ME/CFS; some can not tolerate berberine because it lowers blood sugar, etc.) Natural antifungals include:
- MCT Oil - Medium-Chain Triglycerides, a component of coconut--contains caprylic acid.
- Coconut oil or other unsweeetened forms
of coconut (note that coconut contains monolaurin, caprylic acid, and MCT oil)
NOTE: Careful not to take too much caprylic acid, MCT oil, and coconut oil together - they all come from the same source (coconut oil) and too much can cause diarrhea.
Antifungal toothpaste is another option. Thanks
to a blog reader for suggesting it! Our dietician said she uses it, too.
This brand contains probiotics, xylitol, grapefruit seed extract, and silver (note that some recommend swallowing silver solution, but that can have serious health risks). I am still brushing with my regular toothpaste, then
rinsing, then brushing again (tongue and gums especially) with the probiotic toothpaste (you
spit it out but don’t rinse after).
You can also rinse with herbal antifungals. We have used a few drops of
tea tree oil in a small cup
of water as a mouthwash (spit it out!), and our dietician recently recommended rinsing with
Nystatin mouth rinse (requires a prescription). Do NOT use regular mouthwash that contains alcohol, as it will feed yeast.
For both my son and I, ALL of the above still didn’t get our yeast overgrowth under
control. In that case, you need to see your doctor and ask for prescription
antifungals. The three most often prescribed are Diflucan (fluconazole), Nystatin, and less
commonly, ketoconazole. For stubborn cases (like ours!), it can be more
effective to alternate between two or more of them.
Ketoconazole should only be used short-term; I just took it for a month when my yeast flared up badly and wasn't responding to other treatments. Normally, I take Diflucan (fluconazole) every day to keep the yeast in check; my son alternates Diflucan and Nystatin. My doctor said chronic yeast overgrowth is also very common in HIV/AIDS and other immune disorders, and so she feels comfortable keeping me on prescription antifungals long-term, as she does for those other patients.
If you want to avoid prescription medications, then you will have to get extra-strict with diet to get yeast overgrowth under control, possibly going to a carnivore or keto diet and severely limiting all carbs. However, I'm eating mostly carnivore now (no carbs) and still need the prescription antifungals for now; I am hoping to be able to reduce my dose soon.
Whew. Yup, we are doing all that, and until I switched to a carnivore diet, I was still struggling to keep the yeast overgrowth under control! But
since I got more strict with my diet, switched prescription antifungals for a month, and added some extra supplements and probiotics, I feel a whole lot better--no more aches! My energy is great, and I'm able to be quite active without crashing. Our previous dietician
(who is also a biochemist) and our current functional medicine specialist both say the diet is absolutely critical--you have to
starve the yeast to get them under control.
I want to emphasize that this regimen usually keeps both of us feeling quite good: no aches, no thrush in the mouth, no exhaustion (unless we overdo), and excellent mental clarity. When we cheat on the diet, skip probiotics, or reduce the antifungals, our symptoms flare up. In fact, last summer after getting it under control, I splurged on a half cookie Saturday evening with friends and a chocolate croissant Sunday morning (I was craving a treat!), and things got worse again. I doubled up the antifungals, took extra probiotics, and got back to my strict diet, and within 48 hours, I was feeling better again. Hopefully, as I continue to improve, I will be able to relax the diet a little bit (at least add some fruit back in), and not see such a big effect. But I have learned my lesson this time and know I can't go back to regularly eating sweets and grains. Once I get past the initial three months of (mostly) carnivore diet, I will probably transition to more of a keto/paleo approach, but I know now that I can't cheat the way I was before.
It's still amazing to me what a difference it makes in my overall illness to have the yeast overgrowth under control, and it's the same for my son.
Do you have yeast overgrowth/candida?
What has worked for you to help control it? Please share your tips and advice in the comments!
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We started with The Call, a thriller starring Halle Berry as Jordan, a 911 operator working in L.A. Jordan is experienced and very good at her job, until the day she makes a mistake that results in a teen girl being murdered. That incident is so disturbing to her that she loses her confidence and moves into a training position instead. One day, taking a group of 911 operator trainees through the bustling call center, an inexperienced operator gets a call from a terrified teen girl named Casey, played brilliantly by Abigail Breslin, who's been abducted and is in the trunk of a speeding car with a disposable phone that doesn't have a GPS chip. Jordan instinctively takes over the call, as the city's emergency services mobilize to try to find the girl before it's too late. Jordan and Casey bond over the phone, as the situation becomes more and more dangerous. Eventually, Jordan takes things into her own hands and sets out to find the girl before she ends up like her previous caller. This is a taut, edge-of-your-seat thriller with excellent acting that we both loved.
Next, we watched a creepy ghost story we've both been dying to see, The Woman in Black starring Daniel Radcliffe of Harry Potter fame. I've heard rave reviews of both the original book and the movie adaptation. The story takes place in an isolated British town sometime in the past (I'm guessing maybe 1910-20 based on lots of horse-drawn carriages and one rare car in the town). Arthur Kipps, played by Radcliffe, is a lawyer who's been sent to settle the estate of a woman who lived outside town in a house surrounded by a deep marsh that becomes a small island when the tide comes in. Paperwork in the house is a mess, and Arthur decides to spend the night there to sort through it all and finish quickly, so he can spend the weekend with his son and nanny (his wife died in childbirth). Something strange is going on in town, though, and the townspeople don't want him staying at the house - or even staying in town at all. He gradually discovers a ghostly presence bent on revenge. It's a very creepy movie, filled with dark, foggy nights and mysterious, spectral occurrences. We both enjoyed it very much, and my son was excited afterward to show me a trailer for a sequel!
Finally, we watched Prisoners, another thriller we've both been wanting to see that my husband refused to watch because it deals with two little girls being kidnapped (he still wouldn't budge when we explained it's about the investigation, not the girls). Hugh Jackman plays Keller, father of 6-year old Anna, while Terrence Howard plays the father of Anna's best friend, Joy. The two girls disappear on Thanksgiving evening playing outside, while the close family friends enjoy the holiday together. Jake Gyllenhaal plays Detective Loki who investigates their disappearance. Following a lead of an old RV parked in the neighborhood that day, Loki quickly apprehends Alex, a local man with diminished intelligence, but there is not enough evidence to hold him. Crazed with grief and panic, Keller turns vigilante and takes matters into his own hands, while Loki continues to investigate the case. This is a fast-paced and unpredictable thriller, filled with unexpected twists and turns that kept us guessing right up until the final moments - it was our favorite one of the three.
