(Updated 11/17/22)
Overview:
If achiness or cognitive dysfunction 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 and look into the possibility of yeast overgrowth (candida) as an
underlying
cause. It amazes me every time I go through this just how horrible it
makes me
feel and how it worsens all of my ME/CFS symptoms. With yeast overgrowth
under control, I
feel really 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).
I have mentioned several times since early October that my ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome) has been worse than usual. The source of that
worsening is a flare-up (again) of yeast overgrowth aka candida, after I needed strong
antibiotics for bronchitis/early pneumonia two months ago. I was waiting to
write about it until I could tell you what worked
to get rid of it. I’m not 100% back to my normal baseline yet but have improved enough to tell you more
about what has worked for us (my son also struggles with yeast overgrowth after
several years on antibiotics for Lyme).
First, some basics. Many, many people with ME/CFS 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.
One study from Pitt found that a particular cytokine, IL-17, helps to suppress yeast overgrowth, while several studies specific to immune function in ME/CFS have shown our IL-17 is often low. Many studies and experts have found yeast overgroath 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. 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.
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 years 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 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 almost two months
this fall wracked with 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.
At first, 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 barely
effective – when I went in to see my doctor after more than a month on Diflucan
(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!
Here are the treatments we’ve tried to get yeast/candida
under control, in rough order of what to do first:
- Take strong probiotics. Probiotic strength is shown by the
number of billions of active cultures in each capsule. When yeast
overgrowth flares up, we shoot for at least 100 billion units a day. 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, I take this stronger variety of Renew Life, with 50 billion units. They
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. Saccharomyces boulardii is a specific type of probiotic that works against yeast, so you should take that as well as general probiotics, with a variety of strains in them.
- Eliminate sugar, yeast, alcohol, and grains from your diet. Depending on
how severe the yeast overgrowth is, you may need to severely restrict your
diet. Yeast feeds on sugar and, to a lesser degree, on grains (especially refined grains). We already eat a Paleo diet (no refined sugar, very limited natural sugars like honey, no grains, no dairy), but I got
even stricter to try to get the yeast overgrowth under control. Yes, it is
difficult at times, but it is better than feeling so horrible. First thing
to eliminate is sugar in almost all forms – a small amount of honey or
coconut sugar is OK, and we still eat small amounts of fruit and use Stevia for
sweetening. You also want to avoid alcohol and yeast (so no bread). If
that alone doesn’t work, then also eliminate flour and other grains. I got
so desperate, I even eliminated fruit from my diet entirely for a while.
- Take antifungal supplements and herbals. There are many
natural substances that have antifungal properties. There are many combination products available that 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:
- Use probiotic
toothpaste. This is a new one for us, but it is definitely helping. Thanks
to a blog reader for suggesting it! Our dietician said she uses it, too. The
brand we are using it Designs for Health Periobiotic. 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).
- Rinse
with 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) and Argentyn 23 silver solution. There are
others as well. Most you use as a mouthwash--swish and spit--but she said the
Argentyn 23 is swish and swallow. I just bought some but haven’t tried it yet. Do NOT use regular mouthwash that contains alcohol.
- Take
prescription antifungals. 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. I am currently alternating
days with Diflucan and Ketoconazole. My son has been alternating with all 3 for
a year now.
Whew. Yup, we are doing all that, and still struggling to keep the yeast overgrowth under control! But
since I started the Rx antifungal rotation, I at least feel a whole lot better
(no more aches!) even if the thrush is sometimes still visible. Our dietician
(who is also a biochemist) says the diet is absolutely critical--you have to
starve the yeast to get them under control.
I’ve felt much, much better the last two weeks (good thing
with two very sick people in our household!), but I’m not out of the woods yet.
The yeast overgrowth flares up with the slightest amount of sugar, and I’m
worried about what will happen when I go off the prescription antifungals. I’m
going to try that new Argentyn 23 mouth rinse and just have to wait and see
what happens next week when my prescriptions run out.
UPDATE 5/18/17: About two and a half years have passed since I first wrote this post. Interestingly, what I describe above about my own experiences at that time was a turning point for me. I have stayed on prescription antifungals ever since. Once I got that bad flare-up of yeast overgrowth under control, I gradually backed off the dose, but I found that I still needed to take antifungals. When I tried going off of them completely, the achiness, exhaustion, and brain fog quickly returned. My doctor wasn't thrilled, but she could see the thrush in my mouth and often prescribes long-term antifungals for her HIV/AIDS patients. I am currently taking just Diflucan (fluconazole), and I alternate between 100 mg (1 pill) and 200 mg a day. Sometimes, I can go two days in between the higher doses, but when I try to cut back to just 100 mg a day every day, my symptoms return. My son is still alternating all three types of prescription antifungals, in a 4-day rotation, even though he stopped taking antibiotics for Lyme almost four years ago (he is on an all-herbal protocol now).
In addition, I have stuck to a strict diet, with no sugar, no grains, no alcohol, and no yeast, and my son and I both still take over 100 billion units of probiotics every day, including Saccharomyces boulardii. The reason he still needs all three antifungals (and at a higher dose than me) is that he does not stick to the diet as strictly (he's 22 and in college!).
I want to emphasize that this regimen 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 weekend, I made a cake for my father-in-law's 92nd birthday. I ditched the Paleo stuff and used REAL sugar and white flour, for a change. The cake was delicious, and I allowed myself a treat and had a piece (OK, a piece and a half - it was really good!). By that evening, I was achy and had a mild sore throat. I doubled up the antifungals, took extra probiotics, and got back on the Paleo diet, and within 24 hours, I was feeling better again. 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.
UPDATE 5/22/20:
Things haven't changed much since that last update three years ago! We both still take prescription antifungals daily (though we both dropoped the ketoconazole, which is a much harsher medication and should only be taken for short periods), plus all the herbals listed above and the Paleo diet (even stricter now because my son is now gluten-intolerant, too). My son recently had extensive testing done (he's developed additional GI problems), which
still show severe yeast overgrowth, so he is barely staying ahead of the symptoms with these treatments and diet. His new medical team switched him from the bunches of
probiotics we were taking to just
Mega SporeBiotic twice a day (it's a little cheaper purchased through clinic we go to). One of the specialists explained to me that it's not just numbers with probiotics and that this one is best for him for now based on his test results (and I recently switched, too). We are both keeping up the
saccharomyces boulardii, since it is specific to yeast (2 capsules, twice a day). They are running additional tests on my son to get to the bottom of his GI problems, many of which contribute to yeast overgrowth.
UPDATE 11/17/22:
With the help of testing and treatments through his functional medicine specialist, most of my son's GI problems cleared up. He turned out to be severely intolerant to gluten (some tests indicated celiac disease), so he now avoids it strictly (and feels a lot better). He's still on the same basic regimen for controlling yeast overgrowth.
I am also still doing well with controlling yeast overgrowth. I developed some GI problems last year and began working with the same functional medicine specialist. My tests showed certain probiotic strains were high and others were low, so I now take Core Biotic, which we purchase through the clinic we go to. I am also retrying
Mega SporeBiotic. And during a recent two-week period on antibiotics, I added the
stronger variety of Renew Life. I still take Diflucan every day, alternating 100 mg and 200 mg, as well as
Paramicrocidin,
Aged Garlic Capsules, and
Olive Leaf Extract.
Do you have yeast overgrowth?
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.
