Adapted from episode 51 of The Perfect Stool podcast and edited for readability.
Lindsey:
Today on the blog, I’m going in depth on Candida with Dr. Kurt Woeller. Dr. Woeller is a doctor of Osteopathic Medicine, an integrative and functional medicine physician and a biomedical autism treatment specialist. He’s the author of several integrative medicine health books, an international lecturer and educator and medical education director of Integrative Medicine Academy, an online training academy specializing in functional and integrative medicine courses. He’s also the medical director of functional medicine clinical rounds, and autism recovery system, two additional online educational resources. Dr. Woeller teaches the Organic Acids Test training seminar for the Great Plains laboratory and has presented lectures at many other integrative medicine conferences for years. He’s been involved with the Integrative Medicine for Mental Health Conference since its inception as a clinical educator. And through his private practice, he focuses on specialized diagnostic testing and treatments for individuals with complex medical conditions like autism, autoimmune and neurological disorders.
I heard you speaking on a webinar through Bio-Botanical Research or Biocidin, about Candida and that got me thinking that you would be great guest for that purpose.
Dr. Woeller:
Absolutely. I’ve had a lot of experience with it throughout the years with different types of patients and different types of scenarios. So, those videos I actually did for Bio-Botanical Research, really, were fairly in depth, and there’s a lot to talk about when it comes to Candida and chronic candidiasis. So, I’m happy to answer your questions.
Lindsey:
Well, I think it’s something that a lot of my readers and clients struggle with. I look forward to digging more in depth. Let me start off just by asking, are D.O.s more in the traditional allopathic world?
Dr. Woeller:
In today’s world, yes. Many, many years ago, not so much. But things change professionally. In the United States, you have MDs and D.O.s. Both of us are fully licensed physicians, so we go to separate medical schools but get very similar training. And then we do our postgraduate training, whether it’s in pediatrics, family practice, general practitioner, or you have D.O.s who are immunologists, you have D.Os who are neurosurgeons just like you do MDs. Now, traditionally, osteopathy or osteopathic medicine was very much rooted in how the function of the body is dependent on structure and vice versa. And so, a lot of D.O.s early on practiced mostly primary care. But as the years have gone on, that has somewhat changed. So, as a fully licensed physician we could deal with medications, we could deal with traditional lab testing and diagnosis.
Lindsey:
My primary is a D.O., which is a relatively new thing. So, that’s my only experience with a D.O. in any case. What I was going to ask, though, related to that, is that most allopathic doctors dismiss systemic Candida infections as a cause of gastrointestinal issues and other symptoms like brain fog and such, unless you’re immunocompromised. And so, I’m wondering what is the research within the traditional medical literature that supports this diagnosis for people who aren’t immunocompromised, or at least not as far as they know?
Dr. Woeller:
That still occurs very much, and by the way, most traditional osteopath D.O.s who would be more in line with conventional medicine would recognize that same type of thing, that it’s really only an issue if it is invasive. Everybody has some Candida in their body, which is true. So, most of conventional medicine looks at a Candida problem; it recognizes that a newborn might have thrush, where you get oral overgrowth of Candida, or you might get a skin infection of some sort, or it might happen in an elderly patient; they might get thrush as well. But because Candida as a whole as a group of organisms, is a normal inhabitant at some level within our digestive system, it’s often looked at as what’s called commensal: normally there but not problematic. It only becomes a problem if somebody was immune compromised, as you said, so somebody with HIV or some other type of severe disease. And actually, in my early training, I saw a number of people die of invasive candidiasis, which was quite tragic. And it’s terrible. And these people were immune compromised. One of them was actually a young woman who had cancer. And she ended up dying of a systemic fungal infection, not from the cancer so much, but from the chemotherapy that kind of took out her immune system.
The problem with recognizing Candida is only a problem when it’s invasive in the body is that you then don’t understand the chemical influence that these organisms can have, even when they’re primarily residing within the digestive tract. Because most people who have a chronic candidiasis issues don’t have it systemically, they don’t have Candida growing in their bloodstream. By the time you get to Candida growing in your bloodstream, at a very severe level, you are seriously sick. But there’s millions of people throughout the United States and around the world who are still sick from chronic Candida, but it’s in their gut, and it’s producing different chemicals that are affecting them biochemically. And there is a difference, and we can talk about that.
Lindsey:
And so, is there peer reviewed research showing that? Is there something people could plop on their doctor’s desk?
Dr. Woeller:
Oh, absolutely. I mean, this is one of those things. There’s so much research, sometimes it gets confusing where to look. It doesn’t take very long to start looking even just online or on different websites for medical literature that documents this. In fact, I just recently read an article that was talking about autism specifically and autism spectrum disorders. And how these group of individuals are often compromised by the presence of Candida in their body. Yes, from an infectious standpoint, but from certain chemicals that it produces called aldehydes. And these aldehydes end up having a negative biochemical consequence within the liver and within the brain and nervous system, because it acts as a toxin. There’s a lot of literature out there.
Lindsey:
I’ve definitely seen clients who are suffering from those aldehydes. Talk a little bit about what that looks like when those chemicals are present in terms of symptomology.
Dr. Woeller:
Well, it’s interesting because an aldehyde is a functional group. Some aldehydes are normally produced. We get different chemical reactions that might produce an aldehyde. And then we have certain aldehydes that we come in contact with. So for example, most people who consume alcohol and have one too many drinks will get a hangover feeling the next day. Your face gets flushed, you feel headachy, you feel nauseous. Well, the hangover effects of alcohol are really a chemical called acetaldehyde, which is a type of aldehyde. That’s quite toxic to the body. In fact, they figure that many of the severe consequences of alcoholism, yes, the alcohol has problems, but the acetaldehyde that gets produced creates a lot of tissue damage in the gut, which affects the liver, brain and nervous system. People can feel nauseous, get headaches, they can have poor concentration, they can have body aches. The other thing about aldehydes is that they need to be converted actively in the body because they are so toxic, they can generate what are called free radicals. Our body spends a lot of time trying to convert aldehydes into less toxic substances. In fact, much of the first phase of liver detoxification, which is taking chemical compounds that are what are called fat soluble and converting them into water soluble compounds so we could easily get rid of them, most of those enzymes that are part of the first phase of liver detox are geared towards dealing with aldehydes–acetaldehyde being one of them. So, to break it down, Candida is a type of yeast. And all of these yeasts love glucose, so they’ll actually take sugar, glucose, and use it as their primary fuel source. And the end product of glucose metabolism in a yeast cell is ethanol. But the step before that is acetaldehyde. The yeast cell is actually producing acetaldehyde itself before it becomes alcohol. Both compounds are toxic, not only the alcohol, but also the acetaldehyde that the yeast is producing. So, if you have a fungal overgrowth of Candida or other yeast, you’re going to have some aldehyde buildup in your system.
Lindsey:
And so, I’m guessing then if you were having this excess production of free radicals that you probably start to run out of your antioxidants.
Dr. Woeller:
Very much so. In fact, one of the things that this article was addressing was the importance of glutathione as a primary detoxifier in the liver. And as an antioxidant, one of the things they advocated for was to use acetylcysteine, which also called NAC, because it’s the precursor to glutathione. And glutathione is a very important chemical in our body to deal with toxins. And we have a tremendous amount of glutathione in our liver. And it really acts more during the second phase of liver detox as we’re starting to make that final transformation of chemicals into more of a water-soluble form. So, whenever your body is taxed because of too many toxins, whether those are endogenously produced, or we come in contact with things outside of ourselves, we run the potential of depleting our glutathione reserves.
Lindsey:
And I understand they’re right in the process of taking NAC off the market now because it’s considered a drug. Do you know about that?
Dr. Woeller
I know a little bit about it. I’m not sure where it’s all going. From my understanding, at least I had heard that there was some push towards regulating it more, because I guess there was some individuals or whoever was advocating it as a hangover supplement. Which, you know, by the way, might work. I mean, because why do we have the hangover? We have a buildup of these aldehydes. And we know that acetylcysteine helps to detoxify it. I think it’d be a shame if they did that. Because it is such an important compound. I mean, think about here in the United States, how many people have free access to Tylenol? Acetaminophen, and we know how toxic that can be, right?
Lindsey:
And NAC is what you use against it.
Dr. Woeller:
That’s right. And now we’ve got chronic infections, we’ve got immune system issues, you’ve got yeast issues, we have mold problems, chemical toxins, etc. All of that stuff can be aided in the body from a detoxification standpoint with NAC. So, we’ll see what happens.
Lindsey:
If someone isn’t constipated, do you do go ahead and give them NAC when you’re doing candida protocols?
Dr. Woeller:
I think it’s not a bad idea. I like what you just mentioned about not being constipated, because of some of these chemicals like these aldehydes, I think it’s a worthwhile thing to use, if a person can tolerate it. Sometimes people who have a lot of overgrowth in the gut with the gastrointestinal candidiasis, in the early stages NAC might sort of stir the pot symptom-wise, so it might cause a little bit more bloating or gas or just that feeling of being distended. It’s one of those things that’s as tolerated. It’s something I like to use but as tolerated, right.
Lindsey:
I tend to think of it as something that comes a little bit later on in the protocol.
Dr. Woeller:
Right.
Lindsey:
Okay, so you’ve mentioned children with autism. Are there particular symptoms that you see that you believe are related to candidiasis in them, and in children in general?
Dr. Woeller:
Yeah, let’s talk about autism first. What we’ve often recognized over the years is that many of these autistic kids are very sensitive to the presence of yeast and bacterial toxins, including Candida, which is a yeast, and how it manifests a lot of times in them is behavioral, so they can get very goofy, giddy and silly. A lot of inappropriate laughter. I’ve actually had parents describe to me that their kids appeared drunk, like they went and consumed alcohol; poor sleep, poor attention, poor focusing, Now, not all of those I could attribute 100% to just a Candida problem. But oftentimes, when we put them on antifungals, whether it’s something like Nystatin or Diflucan or a combination of botanical remedies, when you go after the yeast, many of those issues either go away completely or decrease. I have seen some hyperactivity, impulsivity type behaviors occur. Certainly, attention focusing can be a problem in some of these cases with underlying fungal problems. With the kids, they tend to get that goofiness, silliness, inappropriate laughter. In adults, I don’t really see that it manifests in that way. For them, they tend to have a lot of brain fog, or headaches or poor focusing, poor attention, maybe body aches and pain, a lot of digestive system issues as well. We know that the autistic kids are having digestive issues, too, it’s just that they can’t really express it because they don’t have language. So, they really can’t tell you how they feel. You’re basically just interpreting things based on their behaviors, right?
Lindsey:
Foot odor, is that related to Candida?
Dr. Woeller:
I don’t know specifically, I mean, unless you had some fungal infection on the skin. So, you asked me that question. Perhaps you know?
Lindsey:
I don’t know. I’m just curious. I just happened to know one particular person who’s got that problem. So how do you test for candidiasis?
Dr. Woeller:
Well, there’s a number of different ways of looking at this. Let’s look at conventional medicine. They’re going to be primarily concerned about an overgrowth scenario that has become invasive, or at least has activated aspects of the immune system that might suggest a deeper-seated problem. They’re going to look at what are called the antibodies, antibodies, like IgG, for example, which would be indicative of some immune activation against the Candida. They might also look at IgE, which would be an allergic type of reaction. That would tell you that your immune system is in a heightened response to an overgrowth scenario, whether it’s in your gut or elsewhere in your body. If there was some concern of it being in the bloodstream, they could always do a blood culture. Or you could do what’s called PCR testing that looks at genetic sequencing within the organism.
Lindsey:
Who does that kind of testing?
Dr. Woeller:
Well, many of the reference labs actually provide that. Like Lab Corp, Quest. It’s not often ordered. But those things are available. And there are some other specialty labs out there that have this kind of technology. So, in the integrative world, what I’ve used is a test called the Organic Acids Test, and it’s called the OAT. We all have organic acids in our bodies. Lactic acid, for example, is an organic acid. But organisms that live in our digestive system also produce their own compounds, their own organic acids, that get absorbed into our body and then concentrate in our urine. So, the organic acid test is a urine test that is a reflection of underlying metabolic imbalances that are occurring in our body or a reflection of overgrowth of different pathogens within our digestive system. And there are certain organic acids that Candida produces. One specific one is called arabinose. We can use the organic acid to evaluate for arabinose levels that is reflective of an overgrowth of Candida in the gut. That is usually my go to, because it gives me an indication of activity in the gut. And it also gives me an idea of invasiveness with at least the lining of the gut that arabinose gets expressed when Candida is becoming invasive.
You can do a stool analysis, and a stool test is another way to culture for Candida. That sort of scenario, a lot of labs have that technology. The downside to depending on a stool test for Candida detection, is Candida is sophisticated. It’s tricky. It’s not always actively shedding in your stools. It’s not uncommon to get a normal Candida culture on a stool test and then do an Organic Acids Test and see organic acid markers elevated. In my experience, to me stool testing for Candida complements the organic acid test. But I don’t I don’t start with the stool. I always start with the Organic Acids Test.
Lindsey:
Right. And now on the Great Plains Organic Acids Test, there’s nine different markers of fungal and yeast overgrowth. And I’m wondering if there’s other markers that are important or that mean different things about Candida or do you look at that arabinose primarily?
Dr. Woeller:
Arabinose primarily for the Candida. There’s a few other markers on there that can be linked to just generalized yeast. But the arabinose is really specific to Candida.
Lindsey:
And where does that marker have to be for you to want to treat someone? Does it need to be marked high? Or is the top quintile good enough? Where would you start treating?
Dr. Woeller:
Well, I always apply every single test to the clinical presentation of the person. I learned long ago, that any given test is a representation of a problem. But the value on the test, not in all testing scenarios, is always going to be reflective of how somebody is feeling, with regards to the condition that they have. A perfect example of that is Candida. You can have somebody who has a lot of symptoms associated with a chronic Candida problem, but their arabinose level might be mildly elevated. It may not necessarily be 234, or 5-600 points high, it might be 75 points in a reference range of 50, for example. But when you take that and put it in the context of the presentation of the individual, it still can be incredibly useful. So, in all circumstances when it’s elevated, I’m going to treat, whether it’s with a medication, whether it’s botanicals, or whether it’s with a combination of things. I’m typically not pursuing treatment if the level is normal, unless, again, I’ve got that clinical suspicion, that presentation of the individual that really suggests that this may be a problem for them. Because the reality is you could have a scenario where you have Candida that is proliferating within the digestive system. But perhaps it’s not necessarily invading the lining of the digestive tract. When Candida is actually growing, or it’s becoming invasive, it’s piercing the lining of the gut. And that’s what’s causing that arabinose to express itself. There’s always that possibility, you might have an overgrowth scenario that isn’t mucosally invasive at the moment.
Lindsey:
And that’s not a dangerous scenario, or that’s not just sort of a predecessor to invasive Candida?
Dr. Woeller:
Well, I think it is a predecessor. I always say, if you actually find a pathogen, like Candida or Clostridium bacteria, for example, do you just leave it alone? Or does it have the potential of getting worse in that given patient? Where they are with regards to their health issues? I’m usually of the mindset that I’m not just going to leave something alone to see what happens.
Lindsey:
Going back to the antibodies test, do you use that test?
Dr. Woeller:
No, I don’t. I mean, there’s a food sensitivity profile that I’ll do that has an IgG marker on it. But I’m not heavily relying on it as a determinant for me of whether to initiate treatment or not.
Lindsey:
Do you use the Fungus Related Disease Questionnaire at all in diagnosing candidiasis?
Dr. Woeller:
Not so much anymore. I used to many years ago, when I was first starting off. I will use it in some cases for people who want some confirmation for themselves. They want to see something on paper. And you know, it’s interesting, my partner had a scenario years ago, where she was consulting with a person who was a nurse, and they were coming from the conventional medical world, and they would have checked every single box on that Fungus Disease Questionnaire. They were so symptomatic to Candida. And what she suggested was, hey, let’s get you started on some anti-fungal botanicals, etc., etc. and this person really fought tooth and nail because they had been to infectious disease, they had been to a gastroenterologist, they had been to others and they just couldn’t figure out why she was so bloated, you know? And she basically said, “Listen, you know, you got a bunch of yeast, right? When you have yeast in bread, the bread expands. That’s what’s happening in your gut.” So, I don’t remember if they did the questionnaire or not, but they eventually went ahead and tried an antifungal. And within three, four days, I mean, they felt remarkably different. So, again, that question is useful, I think in the context of trying to provide people a little bit more insight into whether that’s an issue for them or not. Right.
Lindsey:
Yeah, I think it’s funny because the first question is, “Have you ever taken antibiotics?” So, you can just give the default three to pretty much everybody in this country. Because I don’t know if I’ve met anybody who hasn’t taken antibiotics? Except, perhaps my son. I have son who’s never taken them. But he’s only 17. And then the second question is, have you taken broad spectrum antibiotics for one month or longer? All of a sudden, boom, those two things, you’re already at the probable, which is funny, because it’s so easy to get to that point. It’s virtually everybody who can answer enough questions to get to the probable point. You mentioned invasive candida, so can you talk a little bit about hyphae, and how those impact digestion and how once it’s gotten to that form, the symptoms that would go along with that?
Dr. Woeller:
Candida exists as what’s called a unicellular form. It can exist as independent cells, and it can exist that way in a colony of other organisms. But when we get environmental shifts that occur at that microscopic level, changes in acid-base balance, so the pH changes in oxygen or carbon dioxide levels, changes in temperature, and also changes in food supply. We’re talking about things that are occurring at that microscopic level where these organisms live. That shift, environmental changes, will induce activity change within Candida. Those shifts can actually cause Candida to become invasive. In fact, it’s been shown now that Candida itself can manipulate its environment to cause other Candida organisms to become invasive. And there’s a couple proteins that get produced. One is called invasin, and invasin allows for the Candida to become invasive. As the Candida is changing its form from a unicellular organism, it starts growing hyphae, or what looks like a root or a tail structure. And that root becomes invasive, just like a weed in your lawn, it starts burrowing deeper and deeper with its root structure. The invasin protein allows for that hypha or that root to keep growing deeper into the lining of the gut. And in fact, it can actually grow right through the center of an epithelial cell. Or it can grow between the cells in the area called the tight junction, which is a structure that allows our cells to maintain contact. As we get hyphal invasion at the epithelial level, if it goes deep enough, it can engage the immune system, which is sitting below that surface. And as you start to initiate and engage the immune system, and these macrophages or other immune cells, well, they will start sending signals to other immune cells throughout the body to say, hey, guys, we have a problem, we have an invader. And that starts triggering a broader immune reaction, which can trigger systemic inflammation.
And that might manifest for somebody as joint pain, for somebody else it might mean heightened food sensitivity reactions. The other thing about this invasin protein is it actually allows for certain organisms to get taken in intact into the epithelial cells, called endocytosis. And what they figure is happening is that this is why probably some people over time start to lose some immune capacity against these organisms is because they’re getting embedded into our own cells. And whenever you have cellular components that are embedding, each component has its own DNA, and you could start sharing DNA and that creates a problem of a persistent infection that never gets dealt with. This is even being seen now with mold. Aspergillus mold, for example. And that is the process of invasion, right? It starts invading. When I use the word invasive Candida in conventional medicine, what they’re referring to by invasive is systemic, somehow the organism has broken through the barrier. It’s intact within the bloodstream, and it’s circulating throughout the body. But you can get mucosal invasion that starts breaking down the tight junction causing leaky gut that doesn’t get to the point perhaps where Candida is fully intact in the bloodstream, but it’s just punching holes in the lining of the gut, causing leaky gut, which triggers a much broader immune reaction. And there’s a lot of people in which it exists that way. I think they’ve gotten mucosal invasion of Candida, that could just again, trigger food reactions, trigger inflammation. One of the other problems any time you breach the boundary of the lining of the gut, and you create a leaky gut scenario, it doesn’t even have to be Candida, it could be a chemical that is affecting the lining of the gut, it could be celiac disease, which is breaking down the lining of the small intestine. As you increase the potential for autoimmune reactions, where now the immune system starts getting triggered abnormally against your own tissue. And that can manifest in a lot of ways. It could manifest as arthritis, it could manifest as skin problems, it can manifest as thyroid issues, because those antibodies that can produce what are called auto antibodies, from an autoimmune standpoint, can cross-react with different tissues through our body. I know that’s kind of a long answer to a short question. That is one of the scenarios of how Candida starts to transform itself.
Lindsey:
One of the things that you mentioned was a change in the pH and diet changes, and so I’m thinking some combo of low stomach acid and eating lots of sugar…is that a recipe for Candida?
Dr. Woeller:
It’s an absolute recipe and what happens at the cellular level where these things occur, they’re really surviving within the entire microbiome. And if we have a good healthy, diverse microbiome, there’s a lot of other competing organisms down there that are either competing for food supply, or they themselves are altering the environment. Or then they’re helping to engage immune factors in the gut that keep things in check. So anytime that we shift our body chemistry away from that point of harmony, we’re going to increase the potential of developing opportunistic infections. And so, you have to look at Candida as an organism that is opportunistic. It doesn’t typically become a problem on its own. But it seizes upon an opportunity, if it arises, that, as you mentioned, could just be poor digestion.
Lindsey:
And is there a relationship between Candida and its biofilms and H pylori?
Dr. Woeller:
Well, H. pylori forms its own biofilm. So, Candida can form biofilm, other bacteria can form biofilm. And I first learned about biofilm probably going back 15 or 20 years ago, I was talking to a guy who was a biofilm researcher, and he was specifically working for a company that was looking at biofilms that were associated with burn victims and people with diabetic ulcerations to try to prevent against skin infections. And he mentioned to me at that time, even NIH, I think it was one of those governmental agencies, he says they recognize that most of these organisms live in a state of biofilm, probably 98, 99% of the time. And I actually came across a research article years ago about normal biofilm. Could bacteria, normal bacteria in our digestive tract exist in their own biofilm? And it commented that that looked like it was the case. I think with biofilm there’s more to the story than it just being a problem. Certainly, these organisms can use it for their advantage to try to block access to it from the immune system. So, biofilm in the mouth, for example, is a problem with bacteria, because they know that it can increase the potential for dental disease. Well, the same kind of problems could exist in our digestive system. It just makes it more difficult to get at. But I think the reality is that there’s probably biofilm existing at some level, even in a relatively healthy gut. There’s some information out there on that. I’m not saying that it’s absolutely proven to be that way in all cases.
But I think it makes sense that because these organisms are so dynamic, what we may be dealing with is just opportunistic organisms taking advantage of their own production of biofilm. Even though at some level, it might be normal in how many of these organisms communicate. What’s interesting about biofilm is that it’s so complex. The way I think about biofilm is like you can have organisms that get sequestered in their own biofilm colony. So, it’s almost like it’s its own little community. And they produce chemicals that have what’s called an auto inducing effect on other organisms, even at distant locations within the gut. In fact, they’ve actually shown that a colony of organisms like Candida could send out chemical messages that influence the activity of Candida in another biofilm colony. It’s called quorum sensing. And what’s interesting is certain botanical remedies are known to affect that quorum sensing effect. The more you dig into this information, the more you realize how much there is and how complex it is. And honestly, at some level, how much a lot of medicine and science just hasn’t really understood about how these organisms survive and thrive.
Lindsey:
So, you mentioned the idea that candida overgrowth can lead to food sensitivities. Do you think it can go in the other direction, that a food sensitivity leads to candida overgrowth?
Dr. Woeller:
I think that’s possible. Let’s take for example, gluten. The classic thing would be celiac. You have somebody who has celiac disease, they form immune reactions against the gliaden protein that’s in gluten. And then they also form a corresponding immune reaction against cells lining the small intestine. So, that’s known to occur over time. And what ends up happening is that when the surface lining of the small intestine gets blunted, you start to lose the absorptive surface. The lining along the surface level of the small intestine are different cells, right? You’re going to have some cells that are involved in absorption, you’re going to have some cells that are involved in immune production. So you have a cell that’s producing, let’s say, IgA, or secretory IGA, which is your main immune function, or made an antibody in the digestive tract, and it’s getting taken out because of inflammation, or just destruction. Well, now you’re losing the mucosal barrier, now you’re losing a regulatory aspect of the immune system. And that certainly could change the environment within the digestive tract that allows for an opportunistic organism like Candida to take over.
Lindsey:
Interesting. Okay, so tell me what kind of diet changes do you recommend to patients with candidiasis.
Dr. Woeller:
In most cases, they really just need to really clean up their diet for one. So, it’s kind of the obvious stuff, try to go organic, pure water, clean water, organic, as much as possible, non-GMO. There’s some of the other things that we know can aggravate problems, so alcohol, caffeine. And then a lot of times it gets down to looking at different kinds of food sensitivities. If people have immune reactions, like you just mentioned, to various foods, we’ve got to get those eliminated from the body as well, so that we don’t create so much disharmony in the digestive tract. You know, excess sugar. I think the problem is trying to come up with a defined specific way for every group of individuals based on one diet. It’s a bit challenging because you’ll have some people that can tolerate more things versus others. So as much of a whole food diet as possible. I’ve seen a number of people do well, where they start to convert more towards a whole food or kind of a paleo type of program. I’ve had some other patients who have been able to manage their chronic yeast issues by doing something called a Specific Carbohydrate Diet. And the way this specific carbohydrate diet works is what you’re really trying to do is just get out these complex sugars, things that take a lot of metabolic energy to break down in the digestive tract. I mean, you could talk for hours about different diets for Candida that work for different types of gut problems. But I think in a nutshell, I hope that gives at least some overview.
Lindsey:
That’s great. Do you think that diet changes alone can eradicate Candida or do you pretty much always recommend or prescribe antifungals? Or nutraceuticals or herbals?
Dr. Woeller:
No, I think dietary shifts can make a big change for some people. And so I don’t think every single person will need to do aggressive antifungals. Some of it’s just kind of wait and see how they respond. If they have minor issues, a dietary change is maybe all they need. If it’s more of a long-standing problem, the more symptomatic they are, then usually antifungals are going to be necessary. That doesn’t always mean medication. There’s a lot of great botanicals out there, a lot of great supplements that can work very well. But the more that we can improve the diversity of our microbiome, the greater chance that we have to sort of keep these organisms
in check so that they don’t become a problem. And one of the ways I know that we can do that is just by increasing a lot of the food that we consume as a plant-based diet.
I’m an osteopath, and I was at my annual osteopathic medical conference. This is a couple of years back. And there was a fantastic lecture that was given by a nutritionist. It’s probably one of the best lectures I’ve actually seen at this conference before. And she did a two-hour lecture on the microbiome. And she showed a slide and I can’t remember where the study came from. But they look at everything from exercise to diet, to alcohol consumption, all of these different factors, at what seemed to make the biggest impact on the microbiome. And basically, it was on a consistent basis eating between 12 to 15 plant based foods a day was the largest impact on the microbiome, even more than probiotics, it was doing that consistently. And what that said to me was 12 to 15 plant based foods a day, just make sure they’re non-GMO and organic, because if you just ate a bunch of polluted fruits and vegetables, that’s not going to do much good.
Lindsey:
Now, just in case there’s any confusion as to what a plant-based food is, is this just fruits and vegetables? Does this include legumes and beans and nuts?
Dr. Woeller:
Yep.
Lindsey:
And how about probiotics and fermented foods with Candida?
Dr. Woeller:
They could be helpful. I mean, one of the ways to improve the microbiome diversity is re-implanting good healthy bacteria through a probiotic. Fermented foods are great. We actually use a lot of fermented foods in our home, on my salads and for dinner every night, but it’s as tolerated. Sometimes for people with severe overgrowth scenarios, implementing fermented foods right off the bat might be a bit much for them, they might react to it.
Lindsey:
What kind of reaction would you see?
Dr. Woeller:
Usually bloating, gas, sometimes you can get a histamine reaction if they’ve got any kind of allergic sensitivity happening in the gut, where they feel flushed. Some people might get a rash, they might get headachy.
Lindsey:
And are there specific probiotics that you like that help with Candida?
Dr. Woeller:
Usually, a good broad spectrum I think is worthwhile, something that’s got a number of different Lactobacillus bacteria as well as Bifidobacterium bacteria, Saccharomyces boulardii. It’s actually a yeast, but it actually has anti-candida properties. In fact, I started using it years ago, from a company out of Germany at the time. And we would use it in people when they went on antibiotics, because the antibiotic for bacteria didn’t affect the supplement. And it can help to combat candida overgrowth. So it can be beneficial for some people. That’s one of the probiotics that has some targeting abilities against Candida. You can’t use it with the antifungals – you have to be careful if you’re on Diflucan or taking Nystatin. You can’t take it at the same time because it will get affected by those. But that could be helpful.
Lindsey:
And if you’re giving herbal treatments?
Dr. Woeller:
I would tend to separate them. So, the herbals, the supplement companies will market them for a specific purpose. They’ll put on there Candid-X or something like that. And if you look at the list of things, you know, pau d’arco, berberine, oregano. They go, “okay, we know that that can help with Candida, but many of those herbals also are helpful against bacteria, right?” So, I just make a general rule that if you’re using botanicals, and you’re taking probiotics, separate them out, at least by a couple hours. In fact, what I’ll often do is I’ll just have people take their probiotics at their bedtime, right? Whether they’re taking an antibiotic, whether they’re taking a botanical, whether they’re taking an antifungal, and one of the reasons I actually learned to do probiotics at bedtime was from some of the work we do in people with small intestinal bacterial overgrowth. For people with SIBO, they actually have too much bacteria in the small intestine, in places where it normally shouldn’t be because a lot of the bacteria that get into the small bowel should be in the large intestine. And what ends up happening when you take a probiotic at nighttime, is you have something called the migrating motor complex. And the migrating motor complex is most active when we’re not eating, so it’s most active during the middle of the night, when we’re asleep, and it’s basically sweeping debris through the small intestine into the large intestine. We can use that to our advantage to help sort of sweep the probiotics into our large bowel during the middle of the night, and therefore you’re also taking it away from any antimicrobial remedy you might be using.
Lindsey:
And is there any issue with taking multiple probiotics at the same time at night? Like an S. Boulardii?
Dr. Woeller:
I’ve not had that experience. I mean, you can have any given individual that might have heightened supplement sensitivity, but in general, no.
Lindsey:
Are there specifically nutraceuticals that you like for eliminating Candida?
Dr. Woeller:
Well, you want me to name brands or you just want the ingredients?
Lindsey:
I was getting at the brand.
Dr. Woeller:
Well, I’ve had very good success over the years with Biocidin (find in my Fullscript Dispensary), which is a combination botanical. It comes in capsules; the liquid liposomal form has always tended to work very well and is usually well tolerated. Some people are very sensitive, and so they can get die off with Biocidin. And so, that’s been an effective remedy for me. There are some other brands, GI Microb-X from Designs for Health is as an excellent product. Candid-X (find in my Fullscript Dispensary), which actually comes from a company called BioMatrix Nutrition tends to work well as well. Candida Defense Formula, I think that’s what it’s called, it comes from New Beginnings Nutritionals. When you look at the ingredients of most of these combination botanicals, they generally tend to have similar ingredients. So again, the berberine, the oregano, the pau d’arco, but when I do a write up program for a person with Candida, I am most commonly reaching for the Biocidin products.
Lindsey:
I find that people can be really sensitive to those, that even a drop for some people is way too much.
Dr. Woeller:
They can be powerful, they definitely can. I tend to use a lot of the liquid for the kids. So, a lot of my practice is with autistic kids, and it’s difficult to get them to take capsules. And then we know that a lot of botanical liquids are really strong tasting. Whereas the Biocidin is actually good tasting. So, it’s easy to get kids to take it. There’s a lot of flexibility with the botanical products; those are really my favorite. I use them a lot. But yeah, you will have people that are very sensitive and so doing a drop a Biocidin might ignite a Herxheimer or die-off reaction. Whenever that happens that always tells me I’m dealing with somebody here who’s not only very sensitive, but they’re also pretty compromised by what’s going on with them.
Lindsey:
And will you use the GI Detox then?
Dr. Woeller:
I’m always looking to use a binder. I’m glad you bring that up because the binders are important. And for those who are listening, what a binder does is it acts like a sponge. As we take in things through our food, we’ve taken things through water, it’s going to go into our digestive tract. And there might be toxins in those substances that we want to try to prevent getting absorbed. A binder can help bind up what’s coming into our gut, from the mouth. But we also are pushing things or moving things into our gut from our liver. So, our liver is the main filtering organ of our blood. And it’s going to be dumping a lot of things into our gut so that we can eventually release it through our poop. But anytime you put something in the digestive tract, whether it came from the body through the liver, it has the potential of being reabsorbed. The binders help prevent against reabsorption of toxins. And so, Candida being in the gut, as it starts to die off, is going to release its internal contents. Many of them are toxic to our body. If we have a binder in place, it binds it up and prevents it from being absorbed, and then we poop it out.
Lindsey:
So, I’m always wondering, because I know in these protocols, especially like the practitioner protocols given by Biocidin, they suggest that you use GI Detox between doses of the Biocidin. And I’m wondering, are the toxins just waiting around till that time of day that you do it once? Why aren’t they constantly being generated? How is once a day good enough?
Dr. Woeller:
Well, some of it comes down to tolerance. Some of it comes down to the fact that some of the binders can be constipating for some people. The last thing we want to have happen is for somebody to get constipated because if you’re constipated at the same time you’re trying to kill off organisms, what’s going to happen? The toxins that are getting expressed through the die off are now not getting eliminated from the body, they just get reabsorbed. Some of the binders can cause that kind of problem. You really want to take the binder away from food, otherwise, it’s just getting mixed up with food and it’s not optimal. You also want to take it away from other supplements. So, it’s basically there to try to do its job. For example, certain medications, you wouldn’t want to take it with a binder, like thyroid medication, you absolutely want to separate it. So, I think some of it comes down to the practical aspect and the compliance factor for many people. It’s like, how many supplements can they take in a given day, at different times, like, take these before food, and make sure to take these with food, and then make sure to take these away from food, and by the way, do that three times a day.
Lindsey:
And are fiber supplements as binding as these binders like activated charcoal and GI Detox? Or is that something you can take with food and it’s not as much of a concern for it absorbing nutrients and taking them away or absorbing other supplements?
Dr. Woeller:
There’s a particular fiber called galactomannan and I’m forgetting what plant or tree it comes from, might be the galactomannan tree. I don’t know. That supplement actually is used for weight loss programs, but it does have some binding capacity. I’m blanking right now. I think it might be a pretty good binder for like ochratoxin, which comes from Aspergillus mold. One of the reasons I like the GI Detox from Bio-Botanical Research so much is that it’s a combination of different binders. It’s got some activated charcoal in there. So, it does have that capacity. But it’s not straight activated charcoal, for me straight activated charcoal, over time, tends to be fairly constipating. I don’t get many constipation issues with the GI detox, it tends to be really well tolerated. And so, it’s an all-around good binder. It kind of it throws a wide net; it’s just going to capture a bunch of different stuff; that makes it very appealing from a compliance standpoint when you’re also having people take multiple other supplements. So, the combination of Biocidin plus GI Detox generally tends to work great.
Lindsey:
And how long will you have them stay on a binder like GI Detox?
Dr. Woeller:
Most of the programs when I start off for Candida in my mind, I’m looking at least 60 days, I know it might go longer because most of the people I’m dealing with are dealing with chronic problems. It’s not “Oh, I developed this issue, you know, over the past couple of weeks because I took an antibiotic.” So, at least 60 days, in many cases is between 60 to 90 days. The binder, I will keep in play for that as long as needed. And I like to have that timeframe, because I think it’s a decent timeframe for reassessment. So, I want people obviously to be following up. I usually have them follow up in three to four weeks after starting the supplements to say okay, how you doing? How you feeling? Do we need to make any adjustments? And then again, follow up another four weeks after that. I’ll come back and repeat my testing, typically at about 90 days.
Lindsey:
And they’ll be taking the supplements continuously for 60 or 90 days? No pulsing?
Dr. Woeller:
I’m not pulsing for Candida.
Lindsey:
And are there other fungi that in particular, thinking about the Organic Acids Test, say Fusarium, for example, that are coming from dietary sources that you’re concerned about when you see elevated on that test?
Dr. Woeller:
Yeah, so if you look at page one of the Organic Acids Test, you’ve got a number of markers that could be linked to Aspergillus mold. The one you mentioned linked to Fusarium, it’s called tricarboxylic. And it actually is linked to Fusarium contamination. Now Fusarium is a mold that does tend to contaminate food, particularly grain products like corn, and corn products. It can be an environmental mold, too. But I tend to find that it seems to have a stronger association with food because I’ve seen it actually go away just by people not eating as much corn products.
Lindsey:
And do you think all corn products are equally, potentially carrying Fusarium, or are non-organic or GMO products worse in that respect?
Dr. Woeller:
I’ve wondered about the GMO, you know, that’s going to influence it, it probably would at some level. I mean, if the grains are not stored properly, if they’re wet, they’re moist, if they’re not. Depends on how they’re stored, depends on how they’re dried. All of that can influence mold growth.
Lindsey:
So, it could happen to organic corn.
Dr. Woeller:
Absolutely you could have organic corn and have it stored improperly, it gets wet, gets moldy, it’s just going to be as much of a problem as non-organic.
Lindsey:
And if you see an elevated Fusarium say, but not an elevated arabinose, would you look at the same type of treatment? Or would you just say stop eating so much corn?
Dr. Woeller:
I think it depends on how symptomatic the person is. So, if they’re not real symptomatic, they don’t have the classic symptoms of Candida, there’s nothing there to really pin anything on, it may just be something that they could shift away from corn and they’re fine. If they’re symptomatic at all, then I would move forward with the same or similar treatments to Candida.
Lindsey:
And are there any good herbal treatments for vaginal yeast infections?
Dr. Woeller:
In my practice, I don’t personally deal with that, and haven’t it for quite some time. So I would actually reach out to Bio-Botanical Research and talk to one of the representatives. My thinking is as you could probably do the Biocidin LSF, which is the liposomal. Again, I don’t have any direct experience with that. I know that there’s some probiotics out there that women have used, my partner, who you might want to interview at some point, my partner practice Dr. Tranchitella. She could get much more in depth than I can.
Lindsey:
And one last question. If somebody suspects they have an overgrowth of Candida, they have all the symptoms. Maybe they’ve even gone through SIBO treatment and they’re still symptomatic, and they can’t afford testing like the OAT, which is 300 plus dollars. Is there any danger in treating yourself for it?
Dr. Woeller:
I’ve never seen anybody have a problem who attempted to treat themselves for it. Particularly when they’re using botanicals and changing the diet. My personal feeling is that something like Nystatin, I think it should be over the counter. It’s a very effective medication. It’s a very safe medication, it stays within the digestive tract. I mean, it doesn’t cause liver damage. Most people tolerate it extremely well; it can be extremely effective. You need to think about some of the medications that are allowed over the counter. Again, acetaminophen. Nystatin to me is one of those medications that I would have personally no problem with if it became an over-the-counter that people could have access to.
Lindsey:
Will you use that a lot then rather than the herbals?
Dr. Woeller:
I like Nystatin, and it does a good job. I will tend to use it quite often. But I don’t have a problem using botanicals either. One of the things about botanicals is everybody has access to them.
Lindsey:
And is Nystatin quicker?
Dr. Woeller:
Sometimes, but not always. You’re always going to have those scenarios too where you’ve got Candida plus you maybe have some bacterial dysbiosis. And that’s where a botanical like the Biocidin comes in because it is a combination of different ingredients. It has a broader effect and so Nystatin is going to be very specific. It’s just going to get after the yeast.
Lindsey:
Okay, this has been incredibly informative, and awesome having you on the podcast. Thank you so much for sharing all your knowledge.
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