- Candida can affect many areas of the body with symptoms ranging from innocuous, to mil, to severe
- At greatest risk are those with severe immune dysfunction
- Sugar, ultra-refined foods, and trans-fats are likely to worsen candidiasis
- Medium-chain triglycerides reduce candidiasis
- Omega-3 fats are likely to aid the treatment of candidiasis
- Many herbs exhibit anti-candida activity’
- Mushrooms such as Reishi may also be of benefit to candida treatment
Candida albicans is a pathogenic yeast that is found in the gastrointestinal tract and mouth of at least 25% of healthy adults.1 It is the main Candida species responsible for candidiasis—symptoms caused by an overgrowth of these yeasts.
Candida is present in many people and may cause symptoms and effects that are mild to moderate (yet often very uncomfortable) in most people, through to very severe, and candidiasisis especially dangerous for those with compromised immune systems (those with HIV or cancer in particular) who are unable to adequately launch immune responses to deal with the yeast. In severe cases of immune dysfunction, candidiasis can be fatal. Candidiasis is typically treated with antifungal drugs amphotericin B, echinocandin, or fluconazole but nutrition may play a valuable role in helping to treat candida overgrowth. Candidiasis is known as ‘thrush’ (especially in the mouth) or as vaginal thrush or ‘yeast infection’ when found in the vagina.
- White-to-yellow patches on the tongue or other areas of the mouth and throat
- Mouth or throat soreness and problems swallowing
- Genital itching or ‘burning’ sensation
- White “cottage cheese-like” discharge from the vagina
- Itchy rash
- Itching skin
- Possibly many other symptoms
Candida is also one of the fungi known to be a cause of skin and nail infections known collectively as tinea.
Plausible mechanisms for diet therapy
It has been observed that the dietary sugars maltose and glucose encourage the adhesion of candida to epithelial cells taken from the gut and mouth, while lactose has no effect.2 This adhesion or ‘sticking’ to the cells lining the mouth or other body cavities is considered to be a critical step in the development of candidiasis.
High concentrations of fructose, glucose, maltose, sucrose, and sorbitol significantly promote the adhesion of Candida albicans, tropicalis, glabrata, and parapsilosis.3, 4 While galactose, glucose, and sucrose elicit a maximal adhesion of candida albicans and tropicalis,3, 4 Candida krusei adhesion was enhanced most when cultured in glucose. Maltose and fructose also promoted adherence of Candida albicans and tropicalis, but to a lesser extent than sucrose and glucose. The sweetener xylitol significantly reduced adherence of Candida albicans.3 Lactose and trehalose do not appear to increase adhesion.4
Mice were exposed to candida albicans and allowed free access to water and food, with the drinking water supplemented with either glucose or xylitol or no carbohydrates (control). After 33 days, candida albicans growth on the mucosa of the intestinal wall and faecal cultures of candida were highest in the glucose group. 80% of mice in the glucose group showed extensive, invasive growth of candida in the GI tract compared to only 8% of the control and xylitol supplemented animals.5
Biofilms are defined as an “aggregate of microorganisms in which cells that are frequently embedded within a self-produced matrix of extracellular polymeric substances (EPSs) adhere to each other and/or to a surface.” In other words they comprise of microbes (like yeasts, fungus, bacteria, protozoa) that clump together and adhere to a surface (in this case on tissue in the body) and become encased in a matrix of polysaccharides (long-chain carbohydrates), proteins, and other compounds that they produce, which support the structure of the biofilm and protect them against other microbes and, in the case of pathogenic microbes also protect against the immune system of the body.6 Biofilm of candida albicans showed pronounced growth when its growth surface was pre-treated with sugar,7 and dietary sucrose might reduce the anticandidal activity of salivary lactoferrin.8
On denture surfaces, glucose, sucrose, and starch+glucose solutions increase the metabolic activity associated with biofilm formation and this differs depending on the type of carbohydrate applied. The authors concluded that “dietary carbohydrates can modulate biofilm development on the denture surface by affecting virulence factors and structural features”.9 Candida varieties grown in glucose medium demonstrate more biofilm activity than galactose or control.10
In an evaluation of the diet and health history of 373 women (< 50 years old) increased incidence of candida infection was associated with smoking, oral contraceptive use greater than 6 months, overweight/obesity, metabolic syndrome, and early sexual activity.11 Dietary analysis showed an increasing and significant trend for carbohydrate intake with the lowest carbohydrate intake associated with reduced risk and risk increased as carbohydrate content of the diet increased.11 A strong association was also seen between overall energy intake and incidence of candida infection (OR 2.44; 95% CI 1.36-4.37).
The addition of refined sugar to the diet has also been studied. In a 2-step study of 28 healthy volunteers, the habitual intake of refined carbohydrates was correlated with candida albicans concentration in the mouthwashes and faeces of subjects. Secondly, C. albicans counts were compared before, during, and after a high-sugar diet. No associations were found between candida counts and habitual intake of refined carbohydrate and a high-sugar diet didn’t increase the frequency of candida-positive samples. However, subjects with habitually high candida counts (pre-intervention) did have an increase in faecal candida counts in response to the high-sugar diet.12
In vulvovaginal candidiasis, urinary sugars are associated with infection. Reductions in milk, artificial sweeteners, and sugar resulted in ~90% of patients resolving infection for at least one year.13
Is there evidence for an ‘anti-candida’ diet?
There are many diets that claim to combat candida but at this time there is limited evidence for the effectiveness of them and there are many misinformed claims made about both the severity of the illness and the methods that can be used to combat it. There is however some preliminary evidence that can help us to determine dietary strategies that might be of benefit to candidiasis.
In a pilot study, people with candida infection were treated with either nystatin (an anti-fungal medication) (n = 40) alone or in combination with an ‘anti-candida diet’ (n = 80). The diet consisted of the following food restrictions:
|Honey, jam, candy, ice cream with sugar added and types of fruit with high sugar content such as grapes and watermelon.|
Foods containing a lot of starch, such as products made from white flour (white bread and rolls, cakes, biscuits, pasta), white rice, lentils, white beans and potatoes.
Cured and ‘fatty’ meats; e.g. ham, bacon, salami, sausages, roasts, red meat (pork, beef, mutton, chicken), entrails.
Milk, yellow cheese, cheese spread and mouldy cheese.
Alcohol, alcoholic vinegar.
|Artificial sweeteners (including stevia).|
1-2 fruit servings per day (excluding those with high sugar content).
Food made from whole grain wheat flour (bread and pasta), whole potatoes (cooked), brown rice.
Fish (e.g. mackerel, hake, tuna, salmon, sardines), seafood, low fat-white chicken meat.
Yoghurt and acidophilus drinks (yoghurt with inulin and other probiotics).
Omega-3 fatty acids (alone or with omega-6 and omega-9 fatty acids), linseed oil, evening primrose oil (1 teaspoon or 3 capsules) twice a day, propolis drops, multivitamin with selenium, zinc (one effervescent tablet daily)
Lactobacilli acidophilus or probiotic Bifidus capsules
or any other probiotic, herbal teas traditionally used against fungal diseases.
After ten days there were similar rates of remission (control of the fungal infection) between the drug or diet-drug combination therapy. However, after three months, there was a significantly higher percentage of people classified as ‘cured’ in the diet group (85%) compared to the non-diet group (42.5%).14 While this is promising, it is highly preliminary, and there were some conflicting guidelines (potatoes both allowed and disallowed), and many supplements and herbs also allowed which could have influenced the results.
Other methods that might aid the treatment of candida
A study was carried out to determine the impact of formula or breast milk on candidiasis. In this study, the prevalence and intensity of Candida species were evaluated in 300 healthy Turkish children aged between 0 and 12 years. The prevalence of candida in children who were fed with both breast milk and formula or other fluids was 18.5%, while in children fed only breast milk there were no cases of candida.15
Coconut oil and its constituent fatty acids like lauric acid have demonstrable antifungal activity.16 In mice fed a coconut oil-rich diet, colonisation of the gastrointestinal tract by candida was lower than that for diets rich in either beef tallow or soybean oil. Interestingly, coconut oil reduced colonisation when the diet also contained beef tallow, and dietary coconut oil also altered the metabolic program of colonising C. albicans cells. This finding suggests that coconut oil could be an intervention for humans with candida.17
Lauric acid (the main medium-chain fatty acid in coconut oil) is unlikely to be the only medium-chain triglyceride (MCT) that inhibits yeast and fungal growth. Capric acid (C:10) and caprylic acid (C:8) can also reduce the virulence of candida by reducing activity, adhesion, and biofilm formation of the yeast. Research has shown that capric acid and caprylic acid affect the yeast-to-hyphal (the development of yeast into a more virulent mycelium) signal transduction pathways of candida and reduce expression of key genes (Cdc35, Hwp1, Hst7, Ece1, and Cph1) that regulate the development of these yeasts. Other genes (Nrg1 and Tup1) that reduce hyphae formation are expressed more in the presence of capric or caprylic acid. This research suggests that other (non-lauric) MCTs, like capric and caprylic acid, may be effective interventions for treating Candida yeast infections.18
In human in vivo research, preterm infants supplemented with MCT oil experienced a significant reduction in candida load over a 3-week study (rate ratio, 0.15; P = 0.02) and the candida significantly increase after supplementation was stopped. (rate ratio, 61; P < 0.001). Thus, supplementation with MCT may be an effective method to reduce candida colonisation.20
While research is only emerging, black cumin, garlic, several varieties of ginger, sage, calendula, mint, pomegranate, black pepper-tree, and thyme have reported some positive effects for reducing candida growth,21-23 while turmeric, Eucalyptus, wormwood, and cinnamon, had greater antifungal effects.24 Propolis extract also appears to exhibit greater anti-candida activity than thyme or garlic.25 Antifungal activity against various candida species has also been demonstrated in vitro by goldenseal, guacatonga, calendula, and cranberry, with the exception of cranberry and C. krusei in which cranberry exposure appeared to increase growth.26 Berberine may also be effective against candida by inhibiting its growth and also making it more susceptible to antifungal drugs.27 Henna and common purslane have shown significant anti-Candida activity also inhibiting the growth phase and reducing biofilm formation.28
Clove has also been studied in animal subjects. When clove (Syzygium aromaticum) was administered into the oral cavity of Candida-infected mice, their oral symptoms were improved and the number of viable Candida cells in the cavity was reduced. In contrast, when the clove preparation was administered intragastrically, oral symptoms were not improved, but viable cell numbers of Candida in the stomach and faeces were decreased. These findings demonstrate that oral intake of an herbal food, clove, may suppress the overgrowth of C. albicans in both the mouth and the gastrointestinal tract.29
Oil extraction of oregano has yielded promising results, with greater inhibition of fungal growth from oregano oil compared to the anti-fungal medication fluconazole.30
Carvacrol (a phenol from oregano oil, and also from thyme, pepperwort, and bergamot), epigallocatechin gallate (catechin found in green tea), curcumin and ginger have demonstrated the ability to enhance the activity of antifungals (voriconazole, caspofungin and amphotericin B) against Candida in vitro. This has led to the hypothesis that some herbal medicinal compounds might be used together with antifungals to reduce the dosage required and thereby reduce the potential for adverse effects,31 especially as the candida resistance to antifungal medications appear to be rising.23
Geraniol, a monoterpenoid alcohol (found in rose oil, palmarosa oil, and citronella oil, and in small quantities in geranium, lemon, and other essential oils) reduces the integrity of the fungal cell wall, reduces virulence and hyphal and biofilm formation of candida.32 Other essential oils such as fennel, summer savoury, cumin, and zataria, have also been studied in vitro for their anti-candida potential. While all essential oils exhibited some anti-candida activity, this was strongest for zataria and weakest for cumin. All essential oils performed less effectively than antifungal medications, amphotricin B and ketoconazole.33
Three Thai herbal essential oils used in aromatherapy; lemongrass (Cymbopogon citratus DC), holy basil (Ocimum sanctum L.) and kaffir lime (Citrus hystrix DC), were compared for their action against Candida biofilms. The strongest antifungal action was seen for kaffir lime oil, followed by lemongrass oil and holy basil oil.34
Traditional Chinese medicine
In vitro studies have demonstrated that goldthread (Coptis chinensis/Coptidis Rhizoma) extract exhibits antifungal activity against Candida tropicalis and glabrata.35
Other research has compared the anti-candida effects in vitro of goldthread, cork tree (Phellodendron) bark, giant knotweed (Reynoutria sachalinensis) rhizome, clove, pomegranate rind, Chinese sumac (Rhus chinensis), pulsatilla root, hairy vein agrimony (Agrimonia Pilosa), forsythia root, honey suckle flower, flavescent sophora root (Sophora flavescens), cnidium fruit (Cnidium monnieri), and chebula (Terminalia chebula) fruit. Coptis root was found to have the strongest antifungal action, at a concentration of 6.25 mg/ml, followed by Phellodendron bark and giant knotweed (25 mg/ml), and clove, pomegranate rind, and Chinese sumac (~50 mg/ml).36
A water-based extract from Reishi mushroom (Ganoderma lucidum) has demonstrated significant anti-candida action in vitro.37
Evidence-based Dietary Recommendations for Candida
|Culinary herbs and spices: |
Garlic, ginger, sage, mint, thyme, turmeric, cinnamon, clove, oregano, bergamot, fennel, cumin, lemongrass, kaffir lime
Omega-3 fatty acids (fish oil)
Reishi and other mushrooms
|All added sugars|
Refined and processed carbohydrate foods (made with any refined flour)
Wheat (possible other gluten grains)
Trans-fats (found in refined and processed foods)
The key and overarching consideration for the nutritional treatment of candidiasis is to eliminate or drastically reduce the intake of sugars and limit all processed and refined foods, especially those containing any type of flour.
Eat more herbs and spices
Culinary herbs, while not ‘medicine’ (as they would be if given as concentrated medicinal herbal preparations), could also help, and there is demonstrable evidence that many of these exhibit antifungal activity. Much (but not all) of this research has been performed in vitro (in test tube or petri dish) and so, antifungal compounds in these herbs are not assured to reach target tissue, but some evidence exists that, in vivo, herbs or spices (such as clove) are effective antifungals when in contact with infected tissue (such as in the oral cavity and the gut).
There are other nutritional benefits from increased consumption of herbs and spices, as they are incredibly nutrient-dense foods, and when eaten with variety and as part of mixed meals, they are considered safe and with little chance of reaching toxic levels. For these reasons, increasing herbs and spices in the diet is prudent.
Increased protein might also be of benefit. Increased intake of protein is known to increase satiety, and although the effect of protein on sugar craving shows some conflicting results,38, 39 there is strong evidence that increased protein reduces all cravings, including sugar and ‘sweet’.40, 41
Due to the impact of increased sugar, carbohydrate, and perhaps most importantly, total energy consumed on the growth of candida, increased protein intake, leading to better ‘autoregulation’ of energy intake, is likely to help in the treatment of candidiasis.
Increase omega-3 fats
Omega-3 fatty acids aid immune modulation and reduce inflammation (especially in the gut) and aid the health of the microbiome,42, 43 likely enabling the body to better combat candidiasis.
Use coconut oil and MCT oil
Both coconut oil and MCT oils are demonstrably antifungal and have demonstrated direct inhibitory effects against candida. These can be added as cooking oils or spreads (coconut oil) or added to smoothies, shakes, and other beverages (MCT oil).
A possible role for mushrooms?
The least amount of strong evidence probably exists for medicinal mushrooms such as Reishi (Ganoderma lucidum), also known as Lingzhi. However, the known health benefits of mushrooms of various types, added to the diet, or taken as traditional or modified beverages (such as ‘mushroom coffee’) are clear and so, it also seems prudent to use these as a generally regarded as safe, non-pharma option to aid health and the treatment of candidiasis.
Supplement recommendations for candida
Concentrated herbal medicines and mushroom extracts, and essential oils all show promise for the treatment of candida. However, much of this research has been performance in vitro and so, the transfer to humans cannot be guaranteed and there might be significant safety issues (especially with the use of some essential oils).
Specific supplementation of these should only be prescribed by a qualified and registered health practitioner. This means that you should get nutrition and supplement advice from a registered dietician, nutritionist, or clinical nutritionist, and herbal medicine advice (including the internal use of essential oils) from a registered naturopath/medical herbalist.
Essential oils are highly concentrated medicines that should only ever be prescribed for internal use by a qualified and registered practitioner.
DO NOT use essential oils internally for the treatment of any disease or disorder without proper guidance and certainly do not use them on the advice of promoters of multi-level marketing essential oil brands.
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