Yeast: A Complicating Factor in Rheumatic Disease?

Recognizing a yeast problem

In patients whose immune systems are severely compromised either by disease or by drug therapy or both, a yeast overgrowth of Candida albicans can occur and remain unrecognized. If it spreads into the tissues, it can become devastating, even life-threatening and can compromise response to therapies for existing medical conditions.

Symptoms

Symptoms are varied and may mimic many other medical conditions. They can be gastrointestinal, respiratory, menstrual, neurological, urogenital and musculoskeletal and can involve skin, eyes, ears, arid sinuses. As Shirley Lorenzani, Ph.D. states in her 1986 book, Candida, "Candida and its toxins can go almost anywhere and do almost anything."

Contributing Factors

Candidiasis is seldom the result of any one factor or event, but probably occurs as a result of a combination of factors, past and present.

A diet high in sugar and fat and low in vegetables and protein can be conducive to Candida overgrowth as can a stressful environment. A number of medications can stimulate Candida: oral contraceptives, progesterone therapy, antibiotics, cortisone and other immuno-suppressive drugs, NSAIDs, chemotherapy and radiation. Pregnancy, allergies, chemical exposures and diabetes can also predispose patients to Candida overgrowth.

How Candida Causes Damage

Candida attaches to the walls of the gastrointestinal tract or to other mucous membranes in the body. When the gut is colonized with "friendly" bacteria, it is difficult for yeast to find an entry. When diet drugs, or disease diminish these friendly bacteria, Candida is given the opportunity to proliferate and cause a host of problems.

When yeasts be-in to grow. they send out filament-like roots deep into the mucosa, searching for nourishment. Their by-products cause symptoms of itching, diarrhea, heartburn. gas, bloating, sinus and car problems. Candida toxins circulate throughout the bloodstream, causing disturbances and inflammation of tissues and organs; the symptoms depend on where the Candida settles and can be very misleading, making an accurate diagnosis difficult.

Diagnosis

Diagnosis is through assessment of symptoms. a detailed patient history and laboratory testing. Are the symptoms indicative of a Candida overgrowth, and are there enough symptoms to warrant consideration of and treatment of Candida"

Laboratory Tests

A number of laboratory tests can be helpful in the determination of an overgrowth: several blood tests and a stool culture can provide data which, when added to the patient history and symptomatic data, can help determine it' yeast overgrowth is a factor. For a more complete assessment, these tests can he used in combination.

• Candida Antigen Titer Test: measures Candida antigens in the bloodstream and in what concentration. Any amount is abnormal, but the higher the concentration, the worse the overgrowth.
• Candida Antibody Test: measures the amount of antibodies (IgA, IgE, IgG, IgM) the immune system has generated to fight the yeast. The higher the concentration, the better the likelihood there is a problem with Candida. Results of one test can be easily misinterpreted. For example, a low IgG can mean either no infection or be indicative of immune suppression. High IgE can indicate allergy to Candida rather than overgrowth.
• Stool Sample: The immune system protects the body's mucosa by secreting antibodies (IgA). If those antibodies are elevated, it may indicate yeast is attached to the mucosal walls of the gut triggering an -immune system response. A negative test does not, however, rule out a Candida problem.

Sometimes is is necessary to initiate a treatment regimen to see if the patient responds in order to make a determination of a Candida problem.

Treatment
Simple Infection

Candida overgrowth can be limited to the gastrointestinal tract or it can spread into other tissues of the body. When it is contained in the out, or when it is localized to a specific skin area, treatment is simpler.

11' the patient's diet is high in sugars and carbohydrates which feed the yeast, or if diverticulitis, diarrhea or constipation is a problem, the abnormal transit may be fostering overgrowth conditions and correction of these problems may correct the Candida problem without drug intervention.

A Candida-control diet is an obvious first choice and these diets are readily available elsewhere, They are traditionally low in complex car U)ohy~ rates and sugars and high in low-starch vegetables. moderate proteins with restrictions o n breads, alcohols, and fast food.

Nystatin is effective when the Candida problem is li mited to the lower bowel. It works by coating the walls of the intestine and killing the resident yeast. If it has spread outside this area, Nystatin will probably not do the job.

Miconazol is also helpful for local infections.

This drug is available in powdered form which is helpful if the problem is located in the mouth, throat, or stomach. It is also useful for vaginal infestations

A die-off reaction (like the Herxheimer reaction in RA with antibiotics) can cause an initial worsening of symptoms, and may necessitate smaller doses to start. Vitamin C taken with the drug as well as Advil or other NSAID may relieve die-off symptoms.

Life-style changes to reduce immune system stresses are also in order and can enhance treatment response.

More severe, Systemic Infections

When Improvements do not materialize with initial therapies, it may be time to try more intense pharmaceutical intervention. Nyzoral and Sporanox reach into the tissues and are effective in reaching yeasts that have burrowed too far into the mucosa for Nystatin to be effective.

Diflucan is a more potent systemic antifungal drug which has been shown effective in reaching deep-seated yeast. It is expensive and has more severe side effects than the previously mentioned medications, so it is best to try arid arrest the Candida before it becomes so firmly entrenched that aggressive C7 therapies are needed.

Oral Fungizone is also useful.

Preventives,

When you in have a patient on long-term antibiotics, cortisone, oral contraceptives or inimunosupp ressive drugs, a wise preventive therapy, in the addition to a well-balanced diet. is the addition of acidophilus/bifidus. us. By replacing these "friendly" bacteria which can be destroyed by the antibiotic, etc., you are taking the precaution of keeping the gut healthy and colonized with friendly bacteria.

Strengthening a weakened immune system with vitamins and supplements is also effective in restoring and maintaining a healthy gut.