Systemic Mycoses: An Overview for Modern Natural Health Professionals
By R. Thiel, Ph.D., Nutrition Scientist and Clinical Naturopath

Dr. Thiel runs a clinic in Arroyo Grande, County of San Luis Obispo, California.

He can help you or a loved one.  Call 1-805-489-7188 to schedule an appointment.  


Townsend Letter for Doctors December 2013, # 365: 95-101

ABSTRACT

Systemic mycoses can cause a tremendous variety of health problems including digestive difficulties (diarrhea, bloating, discomfort, flatulence, constipation, colitis, etc.), skin problems (rashes, eczema, psoriasis, dry skin patches, intense itching, hives, open cut-like sores, etc.), bronchopulmonary disorders, asthma, breathing difficulties, fatigue, seasonal allergies, multiple food allergies, weight loss, fever, chronic sinusitis, irritable bowel syndrome, migraine headaches, autoimmune disorders, fibromyalgia, arthritic complaints, chills, malaise, mental cloudiness, inability to lose weight, sweet and other food cravings, and depression.   Although Candida albicans tends to get the most attention, it is only one of 150 fungal species which are known to be pathogenic to humans.  In addition to skin, respiratory, or genital areas, mycotic infections often settle in the digestive system.  Some with suspected gluten-intolerance are really dealing with them.  Understanding the various types of mycotic organisms can be helpful for health practitioners who are interested in natural interventions to help restore their infected patients to health. 

INTRODUCTION

There are over 100,000 different species of fungi, of which approximately 150 are known to be pathogenic to humans [1,2].  Those which are pathogenic have been classified into three broad categories: superficial, cutaneous, and systemic.  Superficial mycoses (systemic (fungal infections) normally are confined to the keratinized layer of the skin and its appendages [3].

Cutaneous/subcutaneous mycoses enter the skin and cutaneous tissue usually in a traumatized area (such as a wound); they usually remain localized, but can spread through the lymphatics to other sites.  Systemic mycoses are medically believed to usually have a pulmonary inception, but can affect most areas of the body [1,4]. 

Amazingly, even though hundreds of peer-reviewed scientific articles, the Merck Manual [5], and Mayo Laboratories [6] all document common problems due to systemic mycoses, many medical practitioners ‘do not believe in them,’ will not test for them, and will not treat them, while some others treat mycotic infections for too short of period of time to be effective [7].  Partially due to this medical disbelief, many natural health professionals see people with a variety of mycotic infections on a regular basis [7]. 

Some people who have these infections them have been told that the symptoms are ‘all in their head’ or something just as useful [7].  Mycotic infections, though not normally fatal, are so underdiagnosed, that an autopsy-based study found that in 22% of cases where the primary diagnosis was incorrect, the deceased had some type of fungal infection [8].  Furthermore this study stated, “autopsy findings revealed a major diagnosis that, if known before death, might have led to a change in therapy and prolonged survival (class I missed major diagnoses).  The most frequent class I missed major diagnoses were fungal infections” [8].  In most “immunocompetent patients, systemic mycoses typically have a chronic course”, instead of being life threatening [5].

Most systemic mycoses are from opportunistic fungi.  They are saprocyctes (organisms which live on decaying matter) that are usually innocuous, but become pathogenic when the host becomes abnormally susceptible to infection [1,5,9,10].   To state it less technically, some yeast are present in the body in small quantities and are considered harmless; it is generally only when they get out of control and multiply excessively that problems are caused.

During the last several decades there have been alarming increases in Aspergillosis, Candidiasis, Cryptococcosis, Nocardiosis, and Zygomycosis; which to some degree appears to be related to medical treatments such as chemotherapeutic agents, irradiation, immunosuppressive agents, broad spectrum antibiotics, and hyperalimentation as well as conditions such as malignancies, AIDS, malnutrition, metabolic diseases, receipt of multiple injections, certain surgeries, burns, intravenous hyperalimentation, and certain malignancies [1,10-12].   The use of antibiotics and certain types of highly processed diets can be a factor even for children to develop them [12a  Florescu DF, Qiu F, Mercer DF, Langnas AN, Shafer LR, Kalil AC.  Risk factors for systemic Candida infections in pediatric small bowel transplant recipients.  Pediatr Infect Dis J. 2012 Feb;31(2):120-3].  Heavy metals, like mercury, may contribute to these infections [13].  Intense periods of stress or incomplete recovery from infection are other causes of yeast overgrowth.  Having gall bladder surgery seems to this investigator to be a factor for some people.  And the gall bladder itself, as well as the kidneys, can also get infected with various fungi [13a Orenstein JM, Dieterich DT, Kotler DP.  Systemic dissemination by a newly recognized intestinal microsporidia species in AIDS.  AIDS. 1992 Oct;6(10):1143-50].

Systemic mycoses can cause a tremendous variety of health problems including digestive difficulties (diarrhea, bloating, discomfort, flatulence, constipation, etc.), skin problems (rashes, eczema, psoriasis, dry skin patches, intense itching, hives, open cut-like sores, etc.), bronchopulmonary disorders, asthma, breathing difficulties, fatigue, allergies, weight loss, fever, chills, malaise, depression, and chronic sinusitis [1,6,9-12,13a 14-15]; some of them may be risk factors in developing autoimmune disorders [7,16].  This investigator has also observed that many with irritable bowel syndrome, migraine headaches, autoimmune disorders, itching, fibromyalgia, alternating constipation and diarrhea, mental cloudiness, certain types of anxiety, inability to lose weight, and even certain forms of arthritis frequently appear to have some type of mycotic overgrowth--another clue is that many report multiple food intolerances (or have been told they have at least a dozen food allergies from an IgG test).  Of course, it needs to be understood that nearly all the symptoms and most of the conditions listed in this paper can be caused by something other than mycotic organisms (and that most people do not have most of the symptoms).

The following conditions have also been reported (by one or more medical doctors) to be at least partially caused by fungi: “malignancies to organs including the esophagus, lung, colon, kidney, breast, uterus, blood, lymph nodes, brain and skin.  Some autoimmune disorders… Scleroderma...diabetes...rheumatoid arthritis...Sjogren’s syndrome...psoriasis...and systemic lupus erythematosis.  Dr. Constantini also listed...Raynaud’s Syndrome... sarcoidosis ...Duchene’s muscular dystrophy...and Cushing’s Disease (excess secretion of adrenal hormone)”; whereas a registered nurse also reported, “Multiple Sclerosis...Fibromyalgia...Chron’s disease ...Endometriosis...Infertility...Migraines” [5].  Many mycoses are polysymptomatic [17] which means they can cause a variety of different types of problems—and of course, not everyone has all or the same symptoms.

It has also been reported that systemic mycoses can predispose one to develop celiac disease [18].  And while this is apparently true, it is also true that many who think that they may have celiac disease actually have some type of systemic mycotic infection.  Many with Down syndrome or autism tend to have wheat sensitivities and may be more susceptible to mycotic infections than the general public.

A major clinical characteristic of virtually all mycotic infections is their chronic course [5,9].  Symptoms often develop slowly; though many are asymptomatic.  Months or years often elapse before medical attention is sought [5;19].  Medical interventions for systemic mycoses include various medications, surgery, and chemotherapy [1,5,9,10,20].  Progress in the diagnosis and medical treatment of many mycoses has been unsatisfactory [5,7,21]: “Immunoserologic tests are available for many systemic mycoses, but few provide definitive diagnoses by themselves” [5].  While localized yeast infections are relatively easy to treat, systemic mycoses, including those referred to as Candida Related Complex (CRC), are much more difficult [5,7]. 

It needs to be emphasized that it is not necessary to have a vaginal yeast infection to be suffering from a systemic mycotic infection.  Based on other research, Jonathan Collins, M.D., wrote, “that the bowel or digestive system is the primary site where yeast settle in the body and produce toxic by-products which bring on the vast array of symptoms throughout the body...an unhealthy lower bowel is the breeding ground for infections and inflammation and will cause illness throughout the body” [7]. 

Although there exists a tremendous amount of natural health literature regarding interventions to be considered for people with an overgrowth of Candida albicans [i.e. 5,21-30], the literature regarding natural interventions for other mycotic organisms is less available.  The purpose of this paper is to discuss selected forms of systemic mycoses and provide some information to help the naturopathic practitioner deal with them. 

SYSTEMIC MYCOSES

Aspergillosis
Aspergillus sp are among the most common environmental molds, found frequently in decaying vegetation (compost heaps), on insulating materials (in walls or ceilings around steel girders), in air conditioning or heating vents, in operating pavilions and patient rooms, on hospital implements, or in airborne dust” [5].  Aspergilli are the second most common systemic mycoses and account for nearly 30% of fungal infections found at autopsy [1].  They often appear after antibiotic or antifungal therapy (to which they are usually resistant) [9]; this is one distressing area of fighting systemic mycoses--sometimes when eliminating one type, another becomes prominent [9].  

“Invasive fungus infections caused by aspergillus spp. occur most frequently in immunocompromised patients. A high infection-associated death rate of up to and over 50% is attributed even today to these fungi. The disease in humans is caused mainly by Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger” [31].

Clinical findings are usually nonspecific and standard sputum cultures are positive only 1/3 of the time aspergilli are present [1].  “Sputum from patients with aspergillomas often does not yield Aspergillus in cultures because cavities are likely to be walled off from airways” [5].  They often are implicated in respiratory conditions [1,14] including sinusitis [32; 32a Kini JR, Shetty SS, Kini H. Spectrum of paranasal sinus mycoses in coastal India.  Ear Nose Throat J. 2012 Jun;91(6):E15-8]; it appears that sometimes, Candida albicans-IgE and IgG subclasses may participate in worsening pulmonary infiltrates when bronchopulmonary Aspergilliosis is present  [33].  Aspergilli are often mistaken for Zygomycetes [1].  As enzymes appear to play a role in the reproduction of various species of Aspergilli [34], it is possible that enzyme inhibitors may play a role in diminishing their reproduction and growth. 

Some have correlated consumption of fatty foods to asthma [35], and it is possible that some of those people actually have an undiagnosed mycotic infection (perhaps from Aspergillus).

Aspergillus fumigatus is the most common form [1,2].  Aspergillus flavus is commonly associated with aflatoxins [2], such as on peanuts [32].  Restrictocin and mitogillon are two other toxins produced by aspergilli--they inhibit host cell protein synthesis by degrading mRNAs [32].  “Molecular epidemiologic studies of Aspergillus isolated from opportunistic infections show many different strains of Aspergillus, suggesting that characteristics of the host are more important than characteristics of the fungi...Aspergillus has a tendency to invade blood vessels” [32]--this is probably true of most situations when a systemic mycotic infection is present.  Invasive Aspergillosis in usually confined to immune suppressed and debilitated hosts [32].  Some with gastrointestinal upset have Aspergillus [1] and some with intense itching may have some version of it (superficial lesions are also a symptom [5]).   Aspergilli “Fungus balls neither require nor respond to systemic antifungal therapy”, though some other Aspergilli forms do [5].  Mayo Clinic researchers found it was one of the most common fungal organisms associated with fungal sinusitis [16].  This investigator’s clinical experience suggest that some people with Aspergillosis seem to improve when dairy is removed from the diet, but whether this improvement is related to a general intolerance or is specific to any Aspergilli is unclear.

In 2010, German researchers concluded, “Recognition of and therapy for fungal infections of the lungs still presents problems even for the experienced clinician. The distinction between invasive mycoses of the lungs and fungal colonisations that do not require therapy is cinically difficult and can often not be made satisfactorily even with advanced microbiological diagnostics” [36].  Hence there is still trouble in the identification and treatment of fungal infections that affect the breathing process.

Blastomycosis
“A disease caused by the inhalation of mold conidia (spores) of Blastomyces dermatitidis, which convert to yeasts and invade the lungs, occasionally spreading hematogenously to the skin or focal sites in other tissues...Blastomyces dermatitidis grows as a mold at room temperature...Inhaled B. dermatitidis conidia convert at...98.6...F...in the lungs into invasive large yeasts ” [5].  It can produce dry hacking and affect the prostate, testis, kidneys, vertebrae, brain, nose, thyroid, lymph nodes, and bone marrow, but skin lesions are probably most common [5].  Men (especially over age 40 [5]) are afflicted with it more than women, with wart-like lesions on the skin and sometime internal organs [37].  There is also a South American form called Paracoccidioidomycosis which mostly effects men aged 20-50 who work as coffee growers [5].

Candidiasis
Candida albicans is the most common cause of Candidiasis [1,2,10].  Candidiasis is an infection involving every part of the body.  It exists in the normal flora of the oral cavity, upper respiratory tract, digestive tract, and vagina.  Severe, invasive Candidiasis involves the kidney in 90% of cases [32]. 

Candida hyphal growth (the more virulent form) requires a pH of 7.4 (slightly alkaline) for optimal growth and can be completely inhibited at a pH of 4.5 (fairly acidic) [38,39] and “is now the fourth most prevalent organism found in bloodstream infections” [5].

It can be a superficial, mucocutaneous, or systemic mycosis.  Infection by any of the species of Candida is nearly always preceded by a compromise of the host defense mechanisms [1,5], such as a selective defect in the functioning of T lymphocytes [40].  It can exist as both yeast forms without hyphae as well with hyphae and the transition from yeast to hyphal forms can increase problems eliminating it as the hyphae can spear their way out of cells which engulf them [32].  Candida has molecules on the surface that mediate its adherence to human tissues which are the main ways it negatively affects health [32].  “Pathologists studying disseminated candidiasis find tiny abscesses throughout the body.  These consist of Candida albicans surrounded by fibrin (a protein able to clot) and a connective tissue shell.  This shell isolates Candida from elimination by the immune system” [7].

“All forms of disseminated candidiasis should be considered serious, progressive, and potentially fatal.  Predisposing conditions such as neutropenia, malnutrition, or uncontrolled diabetes should be reversed or controlled where possible” [5].  All forms of Candida do not respond to the same medical [5] or other interventions.  Candida albicans and C. glabrata tend to respond similarly, whereas C. cruzzi does not [5].

However, many nutritional interventions have been reported to be effective for Candida [i.e. 7,22-30].  Since Candida albicans is often grown in a culture of  various saccharides [2], it is not surprising that reductions in the consumption of refined sugars has been effective [14-16].  Sometimes, this investigator and others [22-25] have had success having subjects also avoiding most fruits.  Interestingly, it appears that Candida albicans cannot grow in human saliva unless it is supplemented with glucose [38].

It was been written that, “CRC is the most dreaded complication of fungal infections, because it is hard to recognize and even harder to treat...This spread of Candida albicans has been described as a domino-effect--one body system after another falls prey to CRC, unless it is stopped or reversed...Another name for CRC is mycotoxins” [11].

There have been substantial increases of candidemias caused by species other than Candida albicans [41].  Candida tropicalis is probably the second most common cause of candidiasis [1,5].  Infections with Candida glabrata and other Candida species are increasing with frequency [5]. C. glabrata can cause fungemia, urinary tract infections, sometimes pneumonia or other focal lesions [5].  Candida paratropicalis is quite similar to Candida tropicalis and is often confused with it [1].   A significant difference is that paratropicalis does not thrive with sucrose, although tropicalis does [2].  Candida krusei (also spelled cruzzi) seems to be less affected by refined sugars (other than dextrose) than most other Candida species [2], thus this investigator rarely encourages reduction of fruit consumption when it is suspected.  Other Candida species such as C. guillermondi, C. parapsilosis, and C. pseudotropicalis can cause infections in humans [1,10], but (other than any differences their shape may account for [2]) this investigator is not aware of adequate reasons to differentiate the dietary restrictions from those of C. albicans.  One of the newest discovered forms, Candida dubliniensis, has a lot in common with C. Albicans, but is still different [42].

In the past, Candida zeylanoides was not considered to be much of a pathogenic yeast for humans [43,44], but can occur in individuals who do not have the “usual risk factors for systemic candidiasis [45].  Case reports have suggested that it can cause arthritis [46], infective endocarditis [45], onychomycosis (nail infection) [41], and gastrointestinal disturbances [40].  It may be implicated in Scleroderma [43].  An animal study suggests that it also can cause tinea cruris (jock itch) [47].  C. zeylanoides is a predominate form of yeast found in poultry [48], raw sausage [49], and some hams [50].

Cryptococcosis
Cryptococcosis is normally due to the fungus Cryptococcus neoformans also called Filobasidiella neoformans or Torula histolytica.  It is an encapsulated yeast and is present in soil and bird (especially pigeon) droppings [32].  Symptomatically it is quite different from the other systemic mycoses in that meningitis with headache is the way it is most commonly presented; blurred vision is also common [9].  Infection tends to occur via the respiratory route by inhalation of Cryptococcus neoformans [1,9].  Consumption of high-dose corticosteroids is a major risk factor for it [32].   Cryptococcosis frequently affects the central nervous system [37].  As Cryptococcus meningitis, it is found in some with AIDS where it tends to increase the mortality rate [51].  The lungs, kidneys, and sometimes skin tend to be affected [5].  It is resistant to killing by alveolar macrophages [32].  It produces the enzyme phenol oxidase which tends to consume the hosts epinephrine [32], thus adrenal support may be helpful for the sufferer. Adrenal support would not help eliminate Cryptococci, but at least may make the sufferer feel better through the process.  Adverse reactions to medical interventions for it include gastrointestinal disturbances [9], thus probiotic intervention possibly should be considered as an adjunct [26,27].

Histoplasmosis and Coccidioidomycosis
Histoplasmosis and Coccidioidomycosis are similar fungal organisms that both produce a disease that resembles tuberculosis [1,32].  Both are caused by fungi that grow as spore producing hyphae at environmental temperatures, but as yeasts (spherules or ellipses) at body temperature within the lungs [32].  Histoplasma capsulatum is acquired by inhaling dust particles which contain bird or bat droppings that contain small spores (microcondia), the infectious form of the fungus [32].  “H. capsulatum grows as a mold in nature or...at room temperature but converts to a small...yeast cell at ...98.6...F...and when invading host cells [5].  AIDS patients are particularly susceptible to disseminated infection with Histoplasma [32].  Histoplasmosis “occurs primarily in the East and Midwest” and primarily affects the lungs [5]--in acute forms it can cause ulcers of the pharynx, spleen enlargement, and liver enlargement [37].  Coccidioides immitis has a high infection rate and usually resides in desert soils, and in the US is mainly confined to the Southwest [1,5].  Similar to Histoplasma, most primary infections with Coccidiodes immites are asymptomatic, but about 10% develop lung lesions, fever, cough, excess sputum, and pleuritic pains along with San Joaquin Valley fever complex [5,32].  “Once inhaled, C. immitis conida (spores) convert at...98.6..F to form large invasive spherules” [5].  Coccidioidomycosis is also called “Valley Fever” [5].   “Untreated disseminated coccidiodomycosis is usually fatal...Treatment for primary coccidioidomycosis is unnecessary in low-risk patients...Treatment for meningeal coccidioidomycosis must be continued for many months, probably lifelong” [5].

Mycobacilli: Nocardiosis and Actinomycosis
Although Actinomycosis and Nocardiosis are often considered together when discussing systemic mycoses, they are filamentous, gram-positive, bacteria in the order of Actinomycetales, and not true fungi [1,2]. These infections are consistently found in the U.S., but the diagnosis is difficult since they resemble other bacterial, mycobacterial, and fungal infections [52].  Nocardiosis and Actinomycosis are symptomatically similar to tuberculosis [2].  Actinomycosis affects males three times as often as females [1].  Nocardiosis, normally in the form of Nocardia asteroides, is increasingly found in patients with systemic lupus erythematosus (SLE) and is probably higher than the reported incidence of 2.8% in the SLE population [53].  “Without treatment, nocardiosis caused by N. asteroides is usually fatal” [5]. When actinomycosis or nocardiosis is present, it is sometimes wise to avoid bovine dairy and/or refined carbohydrates .  Nutritional support such as used by people with “streptococci-type” bacteria can sometimes be helpful for some with some mycobacilli.  

Zygomycosis/Mucomycosis
Zygomycosis (also called Mucomycosis) is a generic term which refers to infections of the class Zygomycetes (also called Phycomycetes); they tend to be both opportunistic and invasive [1].  It is defined as “Infection with tissue invasion by broad, non-separate, irregularly shaped hyphae of diverse fungal species” [5].  “Infection is most common in immunosuppressed persons, in patients with poorly controlled diabetes, and in patients receiving the iron-chelating drug desferrioxamine” (plus people on immunosuppressive therapies or who have chronic renal conditions) [5].  It can cause pulmonary or gastrointestinal lesions [5].  The three most common areas of invasion are the sinuses, lungs, and gastrointestinal tract [32].  Rhizopus species may be the most common; others include Absida corymbifera, Mucor ramosissimus, Rhizomucor pusillus, and more [1,2].  Infection is believed to be less common than some of the other systemic mycoses mentioned in this paper, but is the third most frequent opportunistic mycoses in patients with neoplastic disease [1] as well as for ketoacidotic diabetics [32]. It appears to this investigator that some with Rhizopus often have problems with bile flow; as do some with intense itching.   Rhizopus nigricans produces opportunistic infections and hypersensitivity states [54]; it seems to cause the body to produce additional IgG and IgE [34].  A recently identified strain, Rhizopus azygosporus, was isolated from premature Australian babies, all of which died [55].  Patients with diabetic acidosis or leukemia can be predisposed to rhinocerbral infection caused by Rhizopus oryzae [1]; increased consumption of most fresh fruits and vegetables has been reported to help reduce acidosis [56].   

Mold, Fungus, Yeast, and Interventions

“Mold is caused by fungus which in turn causes disintegration of organic matter.  Whether it is caused by Candida albicans or any of its related species, fungus causes a weakening of the cellular structure in which it lives.  This explains why patients afflicted with this type of infection become very ill and are difficult to treat; many of their cells become weak...Fungus is tenacious” [5] (it should be understood that molds are multi-cellular organisms, whereas true yeasts are single-cell organisms).  These days there are many reports of homes and office buildings having mold problems which require decontamination (such decontamination measures are beyond the scope of this paper).

“Yeast, in its many varieties, is a unicellular fungus that reproduces by budding spores” [7]--it is the budding process that is one of the reasons that elimination is most difficult.  This ability to froth/bud makes it difficult for mycotic infections to be controlled as the quantity of yeast can go from little to overwhelming in a rather short period of time—under optimal conditions one yeast cell can produce multiple millions of offspring in 24 hours; and 24 hours later each of those can produce multiple millions of offspring.  Elimination of yeast is often an up and down process which makes it difficult for the one fighting it.  Actually, one of the problems when mycotic infections are dealt with medically, chiropractically, or naturopathically, is that the sufferer will sometimes feel better before the problem is gone, will skip some interventions (not take supplements, violate dietary restrictions, etc.), do fine, and then ‘suddenly’ notice that symptoms which had left have returned. 

Another reason it is difficult to eliminate yeast is because some are dimorphic [57] and many have pleomorphic hyphae [58].  “The ability to switch between a yeast-like form and filamentous form is an extended characteristic among several fungi.  In pathogenic fungi, this capacity has been correlated with virulence because along the infectious process, dimorphic transitions are often required” [58]--this dimorphic tendency may at least partially explain why changing interventions is often necessary when dealing with mycotic infections.  Pheomorphic hyphae have been found to be affiliated with most types of mycotic yeasts [58].  These abilities to change shapes (dimorphism and pleomorphic hyphae) make it harder to eliminate mycotic organisms (and is one reason why the same intervention does not always work)—pH (both acid or alkaline) is also a factor [39].

It may be of interest to note that according to at least one doctor, “Gas-forming organisms only flourish in an alkaline environment.  We’ve been brainwashed to think that digestive acids produced in the stomach are the root of all digestive problems” [59].

The main virulent mycoses, such as Candida and Aspergillus, do not thrive in an acidic environment [38,39], but some others do.  Thus, the frequent consumption of anti-acids by many with ‘acid reflux’ (GERD) or ‘irritable bowel syndrome’ helps create an environment that the two major mycotic organisms can thrive in (this is not to say that there is no place for antacids, as they can help prevent ulceration and other problems).  Actually, researchers have concluded that many people who think that they have food allergies actually have acid reflux [60] and the reality is that many with acid reflux actually have a mycotic infection as the real cause.  Hence many “food allergies” are likely to be assumed because of how the body reacts to certain foods because of mycotic infections.

“With the continuing increase in clinically important fungal disease...the need for new and improved antifungal agents marches on” [61].  This is partially because the commonly used pharmaceutical antifungal agents are not always effective [62,63]: “Emerging cases of drug resistance to currently available drugs has limited the spectrum of currently available antifungal agents” [64].  “Drugs for systemic antifungal treatments include amphotercin B, various azole derivatives, and flucytosine” [5].

While drugs remain the preferred standard treatment [65] there are concerns about their safety, effectiveness, and cost [66].  “Opportunistic systemic mycoses due to yeasts and yeast-like fungi have become more common than those due to filamentous fungi, occupying fourth position in the list of bloodstream pathogens in some centers in USA. Also, their incidence, pattern of clinical presentations and species spectrum have significantly changed, largely due to more frequent and prolonged therapeutic or prophylactic use of antifungal drugs and subsequent development of resistance. Consequently, infections with resistant yeast-like fungi such as C. lusitaniae, C. krusei, C. tropicalis, C. glabrata and Trichosporon ovoides (T. beigelii) have recently been reported with greater frequency. Since respiratory and systemic mycoses have no pathognomonic clinical or radiologic syndrome and mycological diagnostic facilities are restricted to only some of the major metropolitan centres, these diseases may be frequently confused…Further studies should focus on the development of rapid techniques for selective isolation and identification of systemic pathogenic fungi. The problem of antifungal resistance is likely to become more serious in the future” [67].

“Innate and cell-mediated immunity are considered as the principal defense line against fungal infections in humans” [68].  Thus, natural health professionals tend to focus more on dietary restriction, herbs, naturopathic formulas, heavy metal detoxification, and even electricity to help their clients’ immune systems overcome many of the problems associated with systemic mycotic infections.   Regarding diet, as shown above, there is no single diet that helps all the people who have various types of mycotic infections.  Avoiding refined sugar, as a general rule, is good for most people with systemic mycoses (even some published medical research concurs [17]): many with mycotic infections strongly crave sugar--but to submit to those cravings can make elimination more difficult (or can cause set-backs).  The same can often be said for other refined carbohydrates (white flour, white rice, white pasta, alcohol, etc.).  Although there are some people who need to avoid vinegar, most fruits, or mushrooms, this investigator has found that most can consume them without any apparent adverse affects.  On rare occasions, some people who get severe diarrhea improve when they avoid lettuce as apparently some forms of this vegetable can contain some type of external mold spores.  It should be noted that since some digestive symptoms associated with systemic mycoses are similar to those associated with gluten-intolerance or celiac disease, some who feel they have those disorders never realize that they are fighting a mycotic infection.  The fact that avoiding high-gluten foods improves symptoms is not a guarantee that gluten, for example, is the problem as some chronic mycotic organisms may raise the level of gliadin antibodies [69] and avoiding carbohydrates in general can tend to improve mycotic-related symptoms in some. 

There is a misconception that people with mycotic infections must always avoid yeast-containing foods--while this may be true in some cases, it is most often white flour and not the fact that bread has been leavened with yeast that is the problem.  Saccharomyces cerevisiae (the primary yeast used in baking and brewing)is beneficial to humans and can help combat various infections [68], including according to the German E monograph Candida albicans.In the text, Medical Mycology John Rippon (Ph.D., Mycology, University of Chicago) wrote, “There are over 500 known species of yeast, all distinctly different.  And although the so-called ‘bad yeasts’ do exist, the controversy in the natural foods industry regarding yeast related to health problems which is causing many health-conscious people to eliminate all yeast products from their diet is ridiculous.”  It should also be noted, that W. Crook, M.D., perhaps the nation’s best known expert on Candida albicans, wrote “yeasty foods don’t encourage candida growth...Eating a yeast-containing food does not make candida organisms multiply” [22].  Some people, however, are allergic to the cell-wall of yeast [22] and concerned supplement companies which have nutrient-containing yeast normally have had the cell-wall enzymatically processed to reduce even this unlikely occurrence.

There is no herb or other natural intervention that this investigator has seen which always works.  Basically, most of the substances practitioners recommend help create an environment that hyphal yeast forms do not thrive in or that the body’s own defenses do. 

Some of the more common natural substances this investigator has considered include aloe vera, arginase, astragalus, basil, beet root, bentonite, berberis root/berries, betaine hydrochloride, bile, biotin and other B vitamins, caprylic acid, castor oil, Chinese herbs (various), cinnamon extracts [70],  chlorophyll, citrus seed extract, cinnamon, cloves, colostrum, deer antler velvet, digestive enzymes, echinacea, essential monosaccharides, flowers (various), food multiple vitamins, garlic, goldenseal [71], glandulars, green vegetables, homeopathic & isopathic remedies, horsetail, l-glutamine, l-valine, lactoferrin, licorice, n-acetyl glucosamine, magnesium, manganese, molybdenum, oxygen (in various forms), pau d’ arco (and other South American herbs), probiotics (including non-traditional ones) [72], olive leaf [73], oregano (wild and oil forms) [74], psyllium (seeds and/or hulls), Saccharomyces cerevisiae [71], silver (in various forms), thyme, tillandsia, una de gato (cat’s claw), vitamin C, wheat germ, wheat grass, white fish, and zinc. 

If heavy metals toxins are suspected and/or if recovery takes too long, then some of the additional natural substances this investigator has considered have included acerola cherry, apple pectin, chlorella, cilantro, l-methionine, modified citrus pectin, N-acetyl-l-cysteine, and slippery elm.

Caution about self-treatment needs to be stated:  not everyone tolerates all these substances well, no one probably needs all of them, and perhaps most importantly, inadequate treatment seems to often leave the stronger fungal strains to become dominant [5].   And no matter what “experts” on the internet may claim, the reality is that there is not a single formula that is helpful for everybody struggling with yeast.

Because a compromised immune system or hormonal cycles can be involved (symptoms sometimes worsen near a woman’s menstrual cycle), nutritional support for the thyroid is quite often a useful adjunct (this is true for males and females).  Stress GREATLY affects this condition and this is another reason that thyroid and sometimes adrenal support is helpful.  Someone can be improving, then if faced with one or more stressful events, relapse.  This can be quite frustrating for them and their practitioner.

Also, real food B vitamins (which are not in most vitamin formulas, including ones that say that they are “natural”) can often help as they decrease the overwhelming craving that some with this condition develop towards carbohydrates.  Similarly, chromium in the GTF form can help some with overwhelming sweet cravings.  This investigator has also had some success using other naturopathic interventions, such as bioelectrical stimulation, proper food combining, fasting, and hydrotherapy [75].   Those with dual infections perhaps take the longest amount of time to help get back to normal, and dual-infections (like yeast with a parasite) seem to present relatively frequently in this population.

There are normally ups and downs associated with treatment.  Yet, many “treatments” have “downs” for a long time and never have the “ups” for a significant time.  Hence, it is important that the health professional be highly skilled in making recommendations related to treatment.

‘Die off’ and other adverse reactions sometimes are encountered when interventions are successful [5]--normally these are frustrating as opposed to detrimental.  Some ‘holistic literature’ words it, “When yeast cells are rapidly killed by the immune system, drug treatment, or dietary intervention, a ‘die-off’ or Herxheimer reaction occurs.  This reaction is caused by the massive release of toxins from dying candida cells.  Toxic proteins from the dead yeast cross cell membranes, enter the bloodstream, and trigger an intense immune reaction...Die-off reactions may last from a few days to a few weeks but usually less than a week...A die-off reaction is especially pronounced when using powerful antifungal drugs like Nystatin that literally cause yeast cells to burst apart” [76] ; whereas medical literature has stated, “For the 3 oral antifungal agents the more common adverse reactions (are)...nausea, gastrointestinal distress, diarrhoea, abdominal pain” [77] and “administration of nystatin became impossible in three patients because of vomiting” [78].  Tiredness sometimes accompanies ‘die-off’.

Stressful situations, ‘die-off’, dimorphism, and the tendency of one type of yeast to become dominant while another is being controlled, all make successful interventions complicated (as does use of antibiotics or multiple infections).  But naturopathic interventions are often the most appropriate ones to help the body naturally fight the fungi itself and regain control of health.  Weight-loss is difficult to sustain for overweight people while most are combating a mycotic infection and that much of the progress in this arena does not take place until the infection is controlled.

Mycotic Observations

Into 2010, “Invasive mycoses continue to be a major problem in the growing population of immunosuppressed patients” [79].  Much research in the USA and Germany is being conducted related to them. 

As there are 100,000 known types of fungi [1], there is little doubt that more will be found to be pathogenic to humans.  Additional mycobacilli species are also being found to have clinical importance [80] and even mycoplasma is being investigated [40,81].  Candida, Aspergillus, and Mucor are ubiquitous contaminants which colonize normal skin or gut without causing illness--it is only in immunosuppressed individuals that these opportunistic fungi give rise to life threatening infections [2].  “Malassezi yeast, a type of fungus, inhabits everyone’s scalps, but some people have more of it, and their immune systems react to it” [82] and can cause inflammation and itching.

However, even though most of the symptoms are not life threatening, overgrowths of any of yeast/fungi can make human life miserable.  All yeast produce toxins [32].  It appears to this investigator that these toxins are responsible for symptoms such as itching, mucus, bowel difficulties, and can trigger an autoimmune reaction.  Triggering of autoimmune response then seems to cause arthritic and some other pain-related symptoms.  If one can reduce yeast populations, then the amount of toxins will be reduced and ultimately the body will be able to shut-off (or at least seriously reduce) its autoimmune responses.

Practitioners need to understand that not all pathogenic mycotic organisms are known, few are ever tested for, relatively few are ever detected through the course of most medical appointments, some are not detected when tested for, and perhaps most importantly, all do not respond to the same dietary factors.  Furthermore, there is no single herb, diet, electrical device, or naturopathic formula that this investigator has ever found that will always eliminate it.  Getting systemic mycoses under control is a difficult and frustrating process, but the results are worth the effort; for many who are not leading normal lives now, can live normal (or near normal) lives after control.

About the Author
Dr. Thiel was an Idaho naturopathic physician and an Alabama licensed naturopathic scientist.   He received his M.S. from the University of Southern California, Ph.D. (Nutrition Science) from the Union Institute & University.  He is president of Doctors’ Research, Inc. and runs a natural health clinic in Arroyo Grande, California.

REFERENCES
[1] Chandler F, Watts J.  Mycotic, Actinomycotic, and Algal Infections.  In Kissane J (ed) Anderson’s Pathology, 9th ed. C.V. Mosby, St. Louis, 1996: 391-432
[2] Larone DH.  Medically Important Fungi.  American Society for Microbiology, Washington, DC; 1993
[3] Assaff RR, Weil ML.  The superficial mycoses.  Dermatol Clin 1996 14(1):57-67
[4] Body BA.  Cutaneous manifestations of systemic mycoses.  Dermatol Clin 1996 14(1):125-135
[5] Lane KAG ex. ed.  The Merck Manual of Diagnosis and Therapy.  Merck Research Laboratories, Whitehouse Station (NJ), 1996
[6] Ponikau JU, et al.  The diagnosis and incidence of allergic fungal sinusitis.  Mayo Clinc Proc 1999 74:877-884
[7] Lahoz SC.  Conquering Yeast Infections.  S. Cotel Lahoz, St. Paul (MN), 1996
[8] Roosen J, et al.  Comparison of premortem clinical diagnoses in critically ill patients and subsequent autopsy findings.  Mayo Clin Proc 2000 75:562-567
[9] Berkow R.  The Merck Manual of Diagnosis and Therapy, 14th ed.  Merck & Company, Rahway (NJ); 1982:148-159
[10] Shepherd MG, Poulter RTM, Sullivan PA.  Candida albicans: Biology, genetics, and pathogenicity.  Ann Rev Microbiol 1985 39:579-614
[11] Kawahata N, Yokuchi M, Ohtomo E.  A clinicopathological study of candidemia in the elderly.  Nippon Ronen Igakkai Zasshi 1990 27(2):45-51
[12] Rolston K.  Overview of systemic fungal infections.  Oncology (Huntingt) 2001 15(11 Supp 9):11-14
[13] Fuchs N. The amazing health benefits of modified citrus pectin.  New Living Magazine, October 2003
[14]  Gupta BK.  Study of fungi associated with bronchopulmonary disorders.  Indian J Med Sci 1996 50(9):333-336
[15]  Verhoeff AP, Burge HA.  Health risk assessment of fungi in home environments.  Ann Allergy Asthma Immunol 1997 78 (6):544-554
[16] Vojdani, A. et al.  Immunological cross reactivity between Candida albicans and human tissue.  J Clin Lab Immunol 1996 48:1-15
[17] Santelmann H, Laerum E, Roennevig J, Fagertun HE.  Effectiveness of nystatin in polysymptomatic patients.  Fam Pract 2001 18(3):258-265
[18] Nieuwenhuizen WF, Pieters RH, Knippels LM, Jansen MC, Koppelman SJ.  Is Candida albicans a trigger in the onset of coeliac disease?  Lancet. 2003;361(9375):2152-2154
[19] Hay RJ.  Fungal infections.  Clin Dermatol. 2006;24(3):201-212
[20]  Chin, NX et al.  In vitro activity of fluvastatin, a cholesterol lowering agent, and synergy with flucanozole and itraconazole against Candida species and Cryptococcus neoformans.  Antimicrob Agents Chemother 1997 41(4):850-852
[21] Martino P, Girmenia C.  Are we making progess in antifungal therapy?  Curr Opin Oncol 1997 9(4):314-320
[22] Crook W.  The Yeast Connection: A Medical Breakthrough.  Professional Books, Jackson, TN; 1986
[23] Rochlitz S.  Allergies and Candida with the Physician’s Rapid Solution. Human Ecology Balancing Sciences, New York; 1991
[24]  Carlsen G.  The Candida Yeast Answer.  Healthology Center, Provo; 1997
[25] Rockwell S.  Coping with Candida Cookbook.  Sally J. Rockwell, Seattle; 1984
[26]  Gibson G, Roberfroid MB.  Dietary manipulation of human colonic microbiota:  Introducing the concept of probiotics.  J Nutr 1995 125:1401-1412
[27] Duarte A.  Health Alternatives.  Mega Systems, Morton Grove (Ill); 1995
[28] Citricidal: Grapefruit Seed & Pulp Extract.  bio/chem Research, Lakeport (Cal); 1994
[29]  Ionescu G et al.  Oral citrus seed extract in atopic eczema: In vitro and in vivo studies on intestinal microflora.  J Otho Med 1990 5(3):72-74
[30] Rodriguez R, et al. The Application of Dioxychlor to Clinical Practice.  Bradford Research Institute, Tijuana; 1989
[31] Karthaus M.  [Guideline based treatment of invasive aspergillosis] Mycoses.  2010 May;53 Suppl 1:36-43
[32] Cotran RS, Kumar V, Collins T.  Pathologic Basis of Disease, 6th ed..  WB Saunders, Phil., 1999
[33] Roig E, et al.  Anti-Candida albicans IgE and IgG subclasses in sera of patients with allergic bronchopulmonary aspergilliosis (ABPA).  Allergy 1997 52:394-403
[34] Reichard U.  Expression pattern of aspartic proteinase antigens in aspergilli.  Mycoses 1996 39 (3-4):99-101
[35] Goodhue D.  High-fat foods bad for asthmatics.  ANH. May 17, 2010 http://www.allheadlinenews.com/articles/7018715100
[36] Rupp J, Kramme E, Schultz H, Schaaf B.  [Diagnostics for fungal infections of the lungs] Pneumologie. 2010 May;64(5):300-310
[37] Fungal infections of Humans and Animals.  In Columbia Electronic Encyclopedia, Columbia University Press, 2000
[38] Werbach MR.  Candidiasis.  In Textbook of Nutritional Medicine, 1999.  Third Line Press, Tarzana (CA)  222-228
[39] Konno N, Ishii M, Nagai A, Watanabe T, Ogasawara A, Mikami T, Matsumoto T.  Mechanism of Candida albicans transformation in response to changes of pH.  Biol Pharm Bull. 2006;29(5):923-926
[40] Benjamini E, Sunshine G, Leskowitz S.  Immunology: A Short Course, 3rd ed.  Wiley-Liss, New York, 1996
[41] Horrobin DF.  Essential fatty acids, immunity, and viral infections.  J Nutr Med 1990 1:145-151
[42] Anane S, Kallel K, Kaouech E, Belhaj S, Chaker E.  Candida dubliniensis: a novel emerging specie.  Ann Biol Clin (Paris). 2007;65(1):13-19
[43] Levenson D, Pfaller MA, Smith MA, Hollis R, Gerarden T, Tucci CB, Isenberg HD.  Candida zeylanoides: another opportunistic yeast.  J Clin Microbiol 1991 29(8):1689-1692
[44] Crozier WJ.  Two cases of onychomycosis due to Candida zeylanoides.  Australas J Dermatol 1993 34(1):23-25
[45] Whitby S, Madu EC, Bronze MS.  Case report: Candida zeylanoides infective endocarditis complication infection with the human immunodeficiency virus.  Am J Med Sci 1996 312(3):138-139
[46] Bisbe J, Vilardell J, Valls M, Moreno A, Brancos M, Andreu J.  Transient fungemia and Candida arthritis due to Candida zeylanoides.  Eur J Clin Microbiol 1987 6(6):668-669
[47] Liao WQ, Li ZG, Guo M, Zhang JZ.  Candida zeylanoides causing candidiasis as tinea cruris.  Chin Med J.  1993 106(7):542-545
[48] Deak T.  Identification of yeasts isolated from poultry meat.  Acta Biol Hung 2001 52(2-3):195-200
[49] McCarthy JA, Damoglou AP.  The effect of substrate on the radiation resistance of yeast isolated from sausage meat.  Lett Appl Microbiol 1996 22(1):80-84
[50] Nunez F, Rodriguez MM, Cordoba JJ, Bermudez ME, Asenio MA.  Yeast population during the ripening of dry-cured Iberian ham.  Int J Food Microbiol 1996 29(2-3):271-280
[51] van der Horst CM, et al.  Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome.  National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trails Group.  N Eng J Med 1997 337(1):15-21
[52] Warren NG. Actinomycosis, nocardiosis, and actinomycetoma.  Dermatol Clin 1996 14(1):85-95
[53]  Mok CC, Yuen KY, Lau CS.  Nocardiosis in systemic lupus erythematosus.  Semin Arthritis Rheum 1997 26(4):675-683
[54] Alonso A, et al.  Interstitial pneumonitis induced in guines pigs by the antigens of Rhizopus nigricans.  J Investig Allergol Clin Immunol 1997 7(2):103-109
[55] Schipper MA, Maslen MM, Hogg GG, Chow CW, Samson RA.  Human infection by Rhizopus azygosporus and the occurrence of azygospores in Zygomycetes.  J Med Vet Mycol 1996 34(3):199-203
[56] Airola P.  How to Get Well.  Health Plus Publishers, Sherwood (Ore); 1974:284-285
[57] Sanchez-Martinez C, Perez-Martin L.  Dimorphism in fungal pathogens: Candida albicans and Ustilago maydis--similar inputs, different outputs.  Curr Opin Microbiol 2001 4(2):214-221
[58] Brandwein M. Histopathology of sinonasal fungal disease.  Otolaryngol Clin North Am 1993 26(6):949-981
[59] Williams D. Simply remedies for unpredictable gas.  Alternatives, Special Report, 2007, p. 7
[60] Kolats G. Doubt Is Cast on Many Reports of Food Allergies.  New York Times, May 11, 2011.  http://www.nytimes.com/2010/05/12/health/research/12allergies.html?partner=rss&emc=rss
[61] Muller RJ.  A brief review of antifungal therapy for deep fungal infection.  Oncology (Huntingt) 2001 15 (11 Supp 9):21-25
[62] Hossain MA, Ghannoum MA.  New developments in chemotherapy for non-invasive fungal infections.  Expert Opin Investig Drugs 2001 10(8):1501-1511
[63]  Abuhammour W, Habte-Gabr E.  Systemic antifungal agents.  Indian J Pediatr 2001 68(7):655-668
[64] Pranav Kumar SK, Kulkarni VM.  Insights into the selective inhibition of Candida albicans Secreted Aspartyl Protease: A docking analysis study.  Bioorg Med Chem 2002 10(4):1153-1170
[65] Loo DS.  Systemic antifungal agents: an update of established and new therapies.  Adv Dermatol. 2006;22:101-124
[66] Schedel I.  New medications for treatment of systemic mycoses.  Internist (Berl). 2005;46(6):659-670
[67] Randhawa HS.  Respiratory and systemic mycoses: an overview.  Indian J Chest Dis Allied Sci. 2000;42(4):207-19
[68] Crameri R, Blaser K.  Allergy and immunity to fungal infections and colonization.  Eur Respir J 2002 19(1):151-157
[69] Brinkert F, Sornsakrin M, Krebs-Schmitt D, Ganschow R.  Chronic mucocutaneous candidiasis may cause elevated gliadin antibodies.  Acta Paediatr. 2009 Oct;98(10):1685-8
[70] Ooi LS, Li Y, Kam SL, Wang H, Wong EY, Ooi VE.  Antimicrobial activities of cinnamon oil and cinnamaldehyde from the Chinese medicinal herb Cinnamomum cassia Blume.  Am J Chin Med. 2006;34(3):511-522
[71] Gruenwald et al editors.  PDR for Herbal Medicines, 3rd ed.  Thomson PDR. Montvale (NJ) 2004
[72] Hatakka K, Ahola AJ, Yli-Knuuttila H, Richardson M, Poussa T, Meurman JH, Korpela R.  Probiotics Reduce the Prevalence of Oral Candida in the Elderly--a Randomized Controlled Trial.  J Dent Res. 2007;86(2):125-130
[73] Markin D, Duek L, Berdicevsky I. In vitro antimicrobial activity of olive leaves. Mycoses.2003; 46(3-4): 132-136
[74] Hybrid protocols. Posit Health News. 1998 Fall; (No 17): 18-19
[75] Thiel R.  Combining Old and New: Naturopathy for the 21st Century.  Whitman Publishing, Warsaw (IN), 2000
[76]  Anon.  Candida Yeast Protection Program, Part 2.  http://intelegen.com/nutrients/candida_yeast_protection_program.htm, Intelegem 2002
[77] Gupta AK, Shear NH.  A risk-benefit assessment of the newer oral antifungal agents used to treat onychomycosis.  Drug Saf 2000 22(1):33-52
[78] Van Delden C, Lew DP, Chapuis B, Rohner P, Hirshel B.  Antifungal prophylaxis is severely neutropenic patients.  Clin Microbiol Infect 1995 1(1):24-30
[79] Arnold TM, Dotson E, Sarosi GA, Hage CA.  Traditional and emerging antifungal therapies.  Proc Am Thorac Soc. 2010 May;7(3):222-288
[80] Butler WR, et al.  Mycobacterium celatum sp. nov.  Int J Syst Bacteriol 1993 43(3):539-548
[81] Nicolson GL, Nicolson NL.  Diagnosis and treatment of mycoplasmal infections in Persian Gulf War Illness-CFIDS patients.  Int J Occup Med Immunol Tox 1996 5:69-78
[82] Wang SS.  Itchy scalp offers clues to disease.  Wall Street Journal, July 19, 2011: D1-2

 

 

Although this paper has been reviewed by several doctors, none of these statements have been approved by the USFDA or similar agencies.

The Center for Natural Health Research supplies research and other items for health care professionals interested in natural interventions.

For additional information check out http://www.healthresearch.com. This research is for doctors and other health care professionals. Thiel is not a medical doctor. None of this research is medical advice, nor should it be construed as medical advice; nor is any of this information specific for any individual.

Copyright 2002/2007/2010 by Robert Thiel, Ph.D., Naturopath All rights reserved.