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Q#1: Yeast Infections
Hello, I am a registered dietitian who is working with a patient with chronic yeast infection. I know that it can be a common problem with patients who have HIV. Do you have any suggestions? I have read many books and find the information conflicting. Do you have any success stories? (August, 1998)
A: Chester Myers, PhD, MS responds:
There are a host of anti-fungal treatments for yeast infections available medically, and a first rule of thumb is to make sure the primary care physician is well aware of any self-help approaches that are considered. Approaches will vary as to where the yeast infection occurs. Included here are a few items to consider in addition to what is available medically. The suggestions offered here have been used effectively by many, but positive results rarely occur in a hurry. We need to keep in mind that one usually relies on help from the immune system even when using medications. If the immune system is deteriorated, the medications may become less likely to work as effectively.
Oral yeast infections should be taken seriously. Oesophageal candidiasis especially, can still lead to very serious complications.
For oral yeast infections, (i) gargles of Te Tre oil (a few drops in a tablespoon of water) are often found effective. This may also be called Tea Tre oil or Tea Tree oil. Use first thing in the morning, after each meal, and last thing at night before going to bed. A swab may be used to directly treat a patch of yeast with the oil diluted 1:1 with water (some even use it full strength). (ii) Grapefruit seed extract may be used in a similar fashion, but be very careful to make sure ONLY the more diluted material(6-10 drops per tablespoon of water) is placed in the mouth since, at full strength, this oil can badly irritate the mouth lining. It goes by different names from different companies - usually available from health food or supplement stores. (iii) Some people use 1% hydrogen peroxide as a gargle. Do NOT swallow this. Usually one can buy 3% from a pharmacy and dilute one part into two parts of water. (iv) Some people use vinegar gargles, but I have less experience with this re feedback information. In general, after eating it should be good practise to brush teeth, and then rinse the mouth out with one of these gargles.
In general, avoidance of high levels of simple sugars is advisable. Some liquid food supplements do not have a balanced carbohydrate profile, insteadrelying only on sugar for this macronutrient source. In some cases, just a bit more than two cans provide about the same amount of sugar as was used in one of the in vivo studies (below) found to cause substantial immune suppression (just over three cans would supply the maximum amount of the other study). In cases where liquid supplements are used frequently (more than a can a day), make sure varieties that contain a good portion of the carbohydrate in a complex form (e.g., starch or maltodextrins with a low DE number - below 20 - you may have to contact the company to find this information).
Well known in the test tube, there are also studies that indicate that high levels of simple sugars may encourage yeast growth in humans. I am not referring to normal moderate levels in a balanced meal. But, be careful of (a lot of) sweet chocolate, soft drinks, etc. However, in humans, this has not been shown in rigid proof-type study. References for the following will be provided on request.
1) From the dental journals there are reports of direct observations of yeast growth in the mouth in response to either sucrose or glucose.
2) A study in monkeys showed that "candida ... reappeared when the animals were fed a high [glucose or sucrose] diet".
3) Two human in vivo studies have noted immune suppression after feeding 100g or 75g of high levels of simple sugars. In one of these, there was 50% impairment in neutrophil fighting activity - neutrophils help fight both bacterial and fungal infections. Starch, as a control did not cause immune suppression. The other study found that lymphocyte activity was also reduced.
4) In both epidemiological study among humans, and in animal intervention studies, high sugar intake is associated with certain types of cancer, possibly a result of immune suppression (when used as a control, starch again did not show this detrimental effect).
5) In an animal model study, it was clearly shown that high sugar levels could also cause exacerbation of yeast growth systemically (within the body).
If gargles of nystatin (the yellow stuff) are used, I have seen this become ineffective as the immune system weakens with disease progression, BUT become again effective when the pharmacist prepared it without the sugar that is normally added to it to improve its taste.
Regarding vaginal infections, I have had anecdotal reports of use of vaginal inserts using acidophilus dispersions, even garlic juice pads. I worry about mucosal membrane burning from garlic, but I have no direct experience on this one!!
Overall in my experience, the use of Te Tre oil gargle and avoidance of excessive sugar intake have had the largest amount of positve feedback. This feedback has been pretty well evenly split between male and female (more females seem to have had these problems; also, smokers seem to have been more frequent in having oral yeast infections).
For skin yeast infections, the 2.5% selenium sulfide form of Sel Sun shampoo may help tineal-type fungal infections (this is lathered on wet skin, and left on overnight, showering off in the morning - do this once a week for four weeks - BUT don't get it in the mouth, eyes, etc., - the selenium sulfide in this shampoos is poisonous). Tolnaftate-containing ointments (sold in the foot care section of pharmacies) may help for some yeast infections. This is used mainly for athletes foot, but may help for other areas of the body. Dequadin oral paint contains 1% of a compound dequalinium chloride that is both antifungal and antibacterial, and may help in some cases. Overall, my experience has been that the medical approaches are generally more effective in dealing with topical yeast infections than for oral yeast.
Q#2: Vaginal Yeast Infections
I keep having recurring yeast infections about 5 to 8 days before my monthly and 5 to 8 days after. I started about the 1st of August. I get the itching, burning and the discharge. I started the Pill in October, so I don't think it was the cause. Although, I really don't know what is. I do all the preventions and I still keep getting it. Please advise!!! (January, 2001)
A: Barbara J. Scott, MPH, RD responds:
Symptoms associated with vaginal “yeast” infections can be caused by Candida albicans or other strains of Candida (commonly thought of as “yeast”), by bacteria or other sexually transmitted organisms, or they can be caused by dermatitis. So probably the first thing to do is see your doctor to find out exactly what is causing your symptoms. (If you use cream that you can buy at the store to treat yourself, you may actually be getting worse because your symptoms are being caused by something else.) Many studies have been done to try to find out why some women have recurrent vaginal yeast (specifically Candida albicans) infections and what is the best way to treat them, but all the answers are not yet in.
Dietary strategies that have been proposed to prevent and/or treat vaginal yeast infections include limiting or avoiding sugar, avoiding foods made with yeast (some fermented foods, beer, many types of bread), and including more yogurt and/or other foods made with active bacterial cultures. Unfortunately, none of these dietary changes have been proven to be widely effective for women who have recurrent vaginal yeast infections (at least 3 times per year). It has been shown that women with uncontrolled diabetes (the levels of glucose in their blood are too high) are much more likely to have recurrent yeast infections than diabetic women who are well controlled (have normal blood glucose levels). Therefore, some people have thought that eating too much sugar (or sweet foods) or too much carbohydrate overall (too many of your calories from starchy or sweet foods) may cause non-diabetic women to have more yeast infections. Another reason why some doctors may recommend limiting sugar (both for HIV+ women and women with recurrent yeast infections) is that one study found a relationship between a diet high in sugar and decreased immune response in mice. The recommendation for yogurt is based on three findings: 1) Candida albicans is often also found in the stool (and therefore in the gut) of women with recurrent vaginal yeast infections; 2) local contamination from the anus to vagina can occur even with excellent hygiene; and 3) the presence of yeast in the gut can lower immune response and therefore increase likelihood of vaginal infection. Yogurt is recommended with the hope that the beneficial bacteria in yogurt will replace (or sort of “fight off”) the yeast and take their place in the gut. Studies have show mixed results related to how many (and which kind) of beneficial bacteria survive the trip through the stomach and intestine and are still viable when they get to the gut. Similarly, the recommendation to avoid foods made with yeast does not help because the yeast in the food is either not active (alive) or it is not the type that is causing the symptoms. (Administrator's Note: For more about this see the discussion on Acidophilus.)
Take home messages for you:
1. Ask your doctor to check your blood glucose and blood insulin levels to see if you have or are at risk for diabetes. If anyone else in your family (a relative) has diabetes or if you are HIV+ and on protease inhibitors, you may be at increased risk for diabetes.
2. Evaluate your current diet to see if it is very high in sugar. If it is, you might try to cut down on these foods since they aren’t that great for you anyway!
3. If you tolerate yogurt and like it, try having it more often. It is a good source of protein and calcium. Try buying plain yogurt (usually non-fat unless you need extra calories) and adding your own fruit (fresh or frozen) to avoid all the extra sweeteners often added to yogurt.
Studies have also shown that there are hormonal influences on yeast infections since women experience more frequent yeast infections who are on the pill or estrogen replacement therapy and in the follicular phase of the menstrual cycle (in the 10-14 days after their period). Use of other methods of contraception (condom, IUD, and cervical sponge) have also been associated with increased risk of yeast infections. Therefore, since it is important to have proper contraception and since you can not change your hormones, the most important thing is to get the appropriate treatment. So be sure to talk with your doctor to determine exactly what is causing your symptoms. Studies have shown that some women who have very frequent vaginal yeast infections need long-term (6 months or more) of treatment that may need to be repeated if symptoms reoccur.
A: Charlie Smigelski, RD responds:
I'll just add one piece to Barbar's wonderfully comprehensive answer to the yeast question, and that is this.... When people are complaining of recurrent yeast problems, or thrush, I wonder about their selenium status. There are mouse studies that talk about inability to handle candida in selenium deficiency. An old Brad Dworkin paper, (Chem Biol Interact 1994 91(2-3):181-6 on Selenium deficiency and AIDS for the academics among you), plus several Mariana Baum papers seem to talk more about candida problems with Selinium deficiency. I ask people who aren't routinely taking Selinium to buy a bottle of 200 mcg pills and take one a day for that bottle at least, just to assure adequate levels and buff up their stored levels.
