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Systemic mycoses: an overview for natural health professionals.

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, 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. 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 that are pathogenic have been classified into three broad categories: superficial, cutaneous, and systemic. Superficial mycoses 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 (fungal infections) are medically believed usually to 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 a 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 have been told that the symptoms are all in their heads or something just as useful. (7) Mycotic infections 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 saprophytes (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 only when they get out of control and multiply excessively that problems are caused.

During the past 25 years there have been alarming increases in aspergillosis, candidiasis, cryptococcosis, nocardiosis, and zygomycosis, which to some degree appear to be related to medical treatments, such as chemotherapeutic agents, irradiation, immunosuppressive agents, broad spectrum antibiotics, and hyperalimentation. They may also be related to conditions such as malignancies, AIDS, malnutrition, metabolic diseases, receipt of multiple injections, certain surgeries, bums, and intravenous hyperalimentation. (1,10-12) 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.

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. (1,6,9-14) Some of them may even be risk factors in developing autoimmune disorders. (7,15) 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).

Although this investigator is not sure that he can agree with all of the following, these 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 auto-immune disorders were also found to be caused by fungi. These include: Scleroderma ... diabetes ... rheumatoid arthritis ... Sjorgen'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, Crohn's disease, endometriosis, infertility, and migraines. (5) Many mycoses are polysymptomatic, (16) which means they can cause a variety of different types of problems.

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) Medical interventions for systemic mycoses include various medications, surgery, and chemotherapy (1,5,9,10,17) Progress in the diagnosis and medical treatment of many mycoses has been unsatisfactory. (5,7,18) "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, MD, wrote, "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, (5,18-27), 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

Aspergilosis: "Aspergillus spp. 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)

Clinical findings are usually nonspecific, and standard sputum cultures are positive in only one-third of cases in which 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, (1,13) including sinusits. (28) It appears that sometimes, Candida albicans IgE and IgG subclasses may participate in worsening pulmonary infiltrates when bronchopulmonary Aspergilliosis is present. (29) Aspergilli are often mistaken for Zygomycetes. (1) As enzymes appear to play a role in the reproduction of various species of Aspergilli, (30) it is possible that enzyme inhibitors may play a role in diminishing their reproduction and growth.

Aspergillus fumigatus is the most common form. (1,2) Aspergillus flavus is commonly associated with aflatoxins, (2) such as on peanuts. (28) Restrictocin and mitogillon are two other toxins produced by Aspergilli -- they inhibit host cell protein synthesis by degrading mRNAs. (28) "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." (28) This is probably true of most situations when a systemic mycotic infection is present. Invasive Aspergillosis is usually confined to immune suppressed and debilitated hosts. (28) 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 found it was one of the most common fungal organisms associated with fungal sinusitis. (15) This investigator's clinical experience suggests 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 Aspergillus is unclear.

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, testes, 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 sometimes internal organs. (31) There is also a South American form called paracoccidioidomycosis which mostly affects 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. Candida exists in the normal flora of the oral cavity, upper respiratory tract. digestive tract, and vagina. Severe, invasive Candidiasis involves the kidneys in 90% of cases. (28) Candida requires a pH of 7.4 (slightly alkaline) for optimal growth and can be completely inhibited at a pH of 4.5 (fairly acidic) (32) 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. (33) It can exist as both yeast forms, without hyphae or with hyphae. The transition from yeast to hyphae forms can increase problems eliminating it, since the hyphae can spear their way out of cells which engulf them. (28) Candida has molecules on the surface that mediate its adherence to human tissues which are the main ways it negatively affects health. (28) "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. (7,19-27) 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. (13-15) Sometimes, this investigator and (19-22) 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. (32)

It has 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. (34) 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, and 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)) t his investigator is not aware of adequate reasons to differentiate the dietary restrictions from those of C. albicans.

Candida zeylanoides formerly was not considered to be much of a pathogenic yeast for humans, (35, 36) but can occur in individuals who do not have the usual risk factors for systemic candidiasis. (37) Case reports have suggested that it can cause arthritis, (38) infective endocarditis, (37) onychomycosis (nail infection), (36) and gastrointestinal disturbances. (35) It may be implicated in scleroderma. (35) An animal study suggests that it also can cause tinea cruris (jock itch). (39) C. zeylanoides is a predominant form of yeast found in poultry, (40) raw sausage, (41) and some hams. (42)

Cryptococcosis: Cryptococcus neoformans, which is also called Filobasidiella neoformans or Torula histolytica, is the most common cause of Cryptococcosis. It is an encapsulated yeast and is present in soil and bird (especially pigeon) droppings.28 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. (28) Cryptococcosis frequently affects the central nervous system. (31) As Cryptococcus meningitis, it is found in some with AIDS where it tends to increase the mortality rate. (43) The lungs, kidneys, and sometimes skin tend to be affected. (5) It is resistant to killing by alveolar macrophages. (28) It produces the enzyme phenol oxidase which tends to consume the hosts epinephrine, (28) thus adrenal support may be helpfu l for the sufferer (it 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. (23, 24)

Histoplasmosis and Coccidioidomycosis: These similar fungal organisms both produce a disease that resembles tuberculosis. (1, 28) 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. (28) Histoplasma capsulatum is acquired by inhaling dust particles which contain bird or bat droppings that contain small spores (microconidia), the infectious form of the fungus. (28) "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. (28) Histoplasmosis "occurs primarily in the East and Midwest" and primarily affects the lungs. (5) In acute forms, it can cause ulcers of the pharynx, as well as spleen and liver enlargement. (31) Coccidicides immitis has a high infection rate and usually resides in desert soils, and in th e US is mainly confined to the Southwest. (1, 5) Similar to Histoplasma, most primary infections with Coccidiodes immitis are asymptomatic, but about 10% develop lung lesions, fever, cough, excess sputum, and pleuritic pains along with San Joaquin Valley fever complex. (5, 28) "Once inhaled, C. immitis conidia (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 US, but the diagnosis is difficult since they resemble other bacterial, mycobacterial, and fungal infections. (44) 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.45 "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 that used by people w ith "streptococci-type" bacteria can sometimes be helpful 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 an "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. (28) Rhizopus species may be the most common; others include Absida corymbifera, Mucor ramosissimus, Rhizomucor pusilus, 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 o pportunistic mycosis in patients with neoplastic disease, (1) as well as for ketoacidotic diabetics. (28) It appears to this investigator that some with Rhizopus often have problems with bile flow, and some have intense itching. Rhizopus nigricans produces opportunistic infections and hypersensitivity states; (46) it seems to cause the body to produce additional IgG and IgE. (30) A recently identified strain, Rhizopus azygosporus, was isolated from premature Australian babies, all of whom died. (47) Patients with diabetic acidosis or leukemia can be predisposed to rhinocerebral infection caused by Rhizopus oryzae; (1) increased consumption of most fresh fruits and vegetables has been reported to help reduce acidosis. (48)

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. 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 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 dimporphic, (49) and many have pleomorphic hyphae. (50) "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." (49) This dimorphic tendency may at least partially explain why changing interventions is often necessary when dealing with mycotic infections. Pleomorphic hyphae have been found to be affiliated with most types of mycotic yeasts. (50) 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).

The main mycoses, such as Candida and Aspergillus, do not thrive in an acidic environment, (32) but some others do. Thus, the frequent consumption of antacids by many with acid reflux or irritable bowel syndrome helps create an environment in which 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).

"With the continuing increase in clinically important fungal disease ... the need for new and improved antifungal agents marches on." (51) This is partially because the commonly used pharmaceutical antifungal agents are not always effective. (52,53) "Emerging cases of drug resistance to currently available drugs has limited the spectrum of currently available antifungal agents." (54) "Drugs for systemic antifungal treatments include amphotericin B, various azole derivatives, and flucytosine." (5)

"Innate and cell-mediated immunity are considered as the principal defense line against fungal infections in humans." (55) Thus, naturopaths tend to focus more on dietary restriction, herbs, naturopathic formulas, 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 (16)). Many with mycotic infections strongly crave sugar, but to submit to those cravings can make elimination more difficult (or can cause setbacks). The same can often be said for other refined carbohydrates (white flour, white rice, white pasta, alcohol, etc.). Although there are a few people who need to avoid vinegar, most fruits, or mushrooms, this investigator has found that most can consume them without any apparent adverse affects.

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, 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, (56) including Candida albicans according to the German Commission E monograph. In the text Medical Mycology, John Rippon, PhD, 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, MD, perhaps the nation's best known expert on Candida albicans, wrote, "Yeasty foods don't encourage candida growth... Eating a yeast-containing foo d does not make candida organisms multiply." (19) Some people, however, are allergic to the cell wall of yeast (19) 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. Most of the substances practitioners recommend help create an environment that yeast do not like or that the body's own defenses do like. Some of the more common substances this investigator has used include aloe vera, astragalus, basil, beet root, bentonite, berberis root/berries, betaine hydrochloride, bile, biotin and other B vitamins, caprylic acid, castor oil, Chinese herbs (various), chlorophyll, citrus seed extract, cinnamon, cloves, colostrum, deer antler velvet, digestive enzymes, echinacea, essential monosaccharides, flowers (various), food multiple vitamins, garlic, goldenseal, glandulars, homeopathic & isopathic remedies, horsetail, 1-glutamine, 1-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), olive leaf, oregano (wild and oil forms), psyllium (s eeds and/or hulls), Saccharomyces cerevisiae, silver (in various forms), thyme, tillandsia, una de gato (cat's claw), vitamin C, wheat germ, white fish, and zinc. 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 in a dominant position. (5) Because a compromised immune system or hormonal cycles can be involved (symptoms sometimes worsen near a woman's menstrual period), nutritional support for the thyroid is also often a useful adjunct. This investigator has also had some success using other naturopathic interventions, such as bioelectrical stimulation, proper food combining, fasting, and hydrotherapy. (57) Those with dual infections perhaps take the longest amount of time to help get back to normal, and dual-infections seem to present relatively frequently in this population.

"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 explains, "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 in 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." (58) Whereas medical literature has stated, "For the three oral antifungal agents the more common adverse reactions (are)... nausea, gastrointestinal distress, diarrhoea, abdominal pain," (59) and "administration of nystatin became impossib le in three patients because of vomiting." (60) 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 fungus itself and regain control of health. Weight loss is difficult to sustain for overweight people while most are combating a mycotic infection, and much progress in this arena does not take place until the infection is controlled.

Conclusion

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 (61) and even mycoplasma is being investigated. (33,62) Candida, Aspergillus, and Mucor are ubiquitous contaminants that 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)

However, even though most of the symptoms are not life-threatening, overgrowths of any of them can make human life miserable. All yeast produce toxins. (28) It appears to this investigator that these toxins are responsible for symptoms, such as itching, mucus, and 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 shutoff (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 them. Getting systemic mycoses under control is a difficult and frustrating process, but the results are worth the effort. Many who are not leading normal lives now can live normal (or near normal) lives after control.

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About the Author

Dr. Robert Thiel is a naturopathic physician, as well as a licensed naturopathic scientist. He is science editor for the American Naturopathic Medical Association Monitor. He received his MS from the University of Southern California, PhD from the Union Institute & University, and his NMD from First National University of Naturopathy. Dr. Thiel is the author of several books, including Combining Old and New. Naturopathy for the 21st Century. He has written other papers on mycotic infections and sees many people with mycotic infections at the Doctors' Research Clinic in Arroyo Grande, California.
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