Thursday, December 04, 2014

Treating Yeast Overgrowth/Candida

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

(Updated 11/17/22) 


 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!

Note: This post contains affiliate links. Purchases from these links provide a small commission to me (pennies per purchase), to help offset the time I spend writing for this blog, at no extra cost to you.


Sue Jackson said...

Yikes - sorry about the weird font changes - couldn't fix that! Sometimes Blogger has a mind of its own.

Anonymous said...

Don't worry about the font. Great, concise advice, thank you.


Mahendra Trivedi said...

Great post!
Thank you Jason.

Marion S said...

I was on one of the very first LDN yahoo groups when LDN first came out, and when quite a few users started having problems with candida we somewhat determined by patient experience that there is a subset of people who will experience increased candida infection from LDN use. I had to stop using it myself for that very reason and was not real happy about that. You do realize that the azole type of antifungals are very hard on the liver right? I had to decide whether LDN or good liver function was a priority for me. I do find like you that using ketoconazole for a while does make me feel much better.

Sue Jackson said...

That's so interesting, Marion - I have never heard of a connection between yeast overgrowth and LDN. That doesn't change anything for me - LDN benefits me so much that I wouldn't give it up. My yeast overgrowth is now under control with powerful probiotics, restricted diet, and Diflucan daily. My doctors feel comfortable with that & it keeps me feeling good. All of my doctors make sure to keep a close eye on liver function because of all the meds & supplements I take. My son does still take ketoconazole but only every 4 days - he's on a rotation of the different antifungals. Thankfully, liver function is still very good for both of us! We take supplements to help with that, too.

Thank you so much for the info! I really appreciate it.

Anonymous said...

Thank you for a great post. I have yeast overgrowth proven by test from mouth. i just wonder where I can get the ADP – emulsified oil of oregano? Can't find anything using google. Thank you!

Sue Jackson said...

I included a link at the end of the post - we buy ours through Amazon. Here is the link again:


Anonymous said...

Great! Thank you :-)

Anonymous said...

Great information that is clear to understand. Thank you! Have you shared what herbal protocols your son is on? I did not see that blog but would be very interested in the information.

Sue Jackson said...

The herbals/supplements he takes (and me, too) for yeast overgrowth are listed in this blog post. Did you mean his herbal protocol for the tick infections? That's the Byron White protocol, currently taking A-Bart to get at both Lyme and bartonella.

Let me know if you had other questions or I misunderstood what you are asking -


Unknown said...

Can we trust Amazon to store it correctly?

Sue Jackson said...

I'm guessing your question refers specifically to probiotics? I only order them from Amazon (or other mail order) when the weather is cool. Before it gets to about 70 degrees, I stock up my fridge and buy locally from a store that keeps them refrigerated.