Treating Yeast Overgrowth/Candida

Thrush on Tongue (Copyright: adam88x / 123RF Stock Photo)

(Updated 8/22/23) 

Overview:

If you have ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome), long-COVID, or Lyme disease, and 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 to look into the possibility of yeast overgrowth (candida) as an underlying cause. Yeast overgrowth is very common in ME/CFS due to our specific kind of immune dysfunction and in Lyme due to antibiotic use. 

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 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. When I first wrote this blog post, I wasn't 100% back to my normal baseline yet but was 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). Another bad yeast flare-up in summer 2023 led to further discoveries.

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. 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

 

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 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 almost two months in fall 2014 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. Similarly, with a more recent flare-up, in summer 2023, I couldn't figure out why I was so exhausted--much more than is normal for me--all the time, until finally I noticed my tongue was sore, looked in the bathroom mirror, 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 barely 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. I've had similar struggles in summer 2023, even though I was already on Diflucan every day! Sometimes, it takes ALL of the treatments listed below to finally get it 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:

• Take strong probiotics and the right types. 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.
  
• 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, at least temporarily. 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 get even stricter to get yeast overgrowth under control when it gets bad. With this latest flare-up, in 2023, I've been strict no sugar at all, no refined grains (only a few occasional whole grains, like oats or a bit of brown rice), not even a sip of alcohol, and very little fruit. Yes, it is difficult at times, but it is better than feeling so horrible. First thing to eliminate is sugar in almost all forms. Check labels because sugar is added to all kinds of foods. Usually, a small amount of honey or coconut sugar is OK, and we still eat small amounts of fruit, but with this worsening, I've eliminated all 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 ad should be avoided, but erythritol and xylitol have actually been shown to fight yeast. Normally, with the other treatments on this list, I can tolerate fruit, but when it's as bad as it has been recently, then I only eat blueberries (which are actually anti-yeast) and an occasional piece of watermelon (very low sugar). Avocados have almost no sugar, so they're OK, too. Search online for "anti-candida diet" to find lots of information and resources. 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.
  
• Take 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:

• Caprylic Acid
• Paramicrocidin (grapefruit seed extract)

•  Aged Garlic Capsules (we like Kyolic, which also includes ginger)

• Olive Leaf Extract, Oregano (we use ADP brand emulsified oil of oregano as it is easier on the stomach), Monolaurin--these all have natural antibacterial, antiviral, and antifungal properties, so they help ME/CFS in other ways, too.

• 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.

•  Use anti-candida 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. 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).
• 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). 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. 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.
  

Whew. Yup, we are doing all that, and 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 at least feel a whole lot better (no more aches!) even if the thrush is sometimes still visible and I'm still a little more fatigued than normal. I'm definitely improving and on the right track (again). 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, but I’m not out of the woods yet. The yeast overgrowth flares up with the slightest amount of sugar, so my diet is still super-strict. While I was updating this post today, I ordered the anti-candida toothpaste (I had forgotten about that option this time around!), so maybe that will help, too.

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 weekend, 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 more fruit back in), and not see such a big effect. 

 

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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