Treating Yeast Overgrowth/Candida

(Updated 2/23/24) 

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 improvement in blood sugar, blood pressure, cholesterol, and other health measures.
• 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.
  

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 this latest terrible flare-up, in 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; also includes explanation of paleo and keto diets). Yes, it is difficult at times, but it is better than feeling so horrible. In fact, I've been on this strict, mostly carnivore diet (I have a few bites of non-yeast-encouraging veggies each day) for almost two months now, and 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 and have not had a single post-exertional crash since I started the diet. That makes it easy to stick with. My doctor suggested sticking with strict carnivore for three months, and after that, I will probably transition to more of a keto diet.

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:

• Caprylic Acid
• Paramicrocidin (grapefruit seed extract)

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

• 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.

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.

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.

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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