Deakin Acupuncture & Oriental Medicine Centre Bringing over 20 years of  Experience  in Acupuncture and Chinese medicine to Canberra Inner South Deakin  ACT

Candida and thrush 

Candida Albicans and Thrush

Thrush is caused by an overgrowth of candida albicans, this yeast normally exists in small amounts within a controlled balance in the vagina, mouth and digestive tract. Candida albicans is an opportunistic pathogen that will take advantage of an imbalance of microorganisms in your gut microbiome. Based on research published in the Journal of the German Society of Dermatology, Candida albicans overgrowth may be responsible for 50 to 90 percent of Candida infection and could be at the root of some chronic disease [1].  

Your gut microbiome plays a crucial role in the health of your digestive system and its balance can easily become disrupted allowing colonies of candida albicans to expand rapidly until they control a large portion of your gut, this causes candidiasis. 

Thrush around the vagina is known as vulvo vaginal candidiasis (VVC), thrush can also occur in the mouth and oesophagus. Candidiasis may infect areas of moist skin such as the base of the fingernails, areas around the groin, the buttock crease and skin folds under large breasts. Invasive Candidiasis can enter the bloodstream and cause a septic infection known as candidemia [2].

In the United States candidemia is one of the most common causes of bloodstream infections in hospitalized patients [3]. 

What causes thrush? Various factors may cause Candida to multiply and become pathogenic and other factors can change the normal vaginal environment, allowing thrush to over colonise the vagina. Candida can be isolated from the genital tract of approximately 20 percent of asymptomatic, healthy women of childbearing age. How this colonisation has occurred is not known, but it is believed that it can exist asymptomatic for years and at some point in their lives 75 percent of women will develop symptoms. 

• Asymptomatic candida colonisation in uncircumcised men is more common than the symptomatic disease. Penile candidiasis is nearly always but not exclusively associated with infection from the female partner [4]. 
• Reproductive Hormones
  Thrush is less common in girls before puberty and post menopausal women. It tends to occur in women of reproductive age between 20–40 years and can be linked to reproductive hormones, in particular estrogen and progesterone [5] which is believed to enhance the proliferation and attachment of candida to the vaginal wall due to the hormonal receptors found on candida [6].
• Pregnancy The incidence of thrush can increase during pregnancy due to the elevated levels of reproductive hormones.
• Sex -. candida is not considered to be a STD as it commonly exists within our bodies but the yeast may get transferred between sexual partners and symptoms can worsened due to the genital irritation that occurs during sex
• Diet - high in sugar, refined foods and simple carbohydrates
• Vaginal products and soap can disrupt the vaginal environment.
• Medications - oral antibiotics, oral contraceptive pill, corticosteroid
• Clothing- synthetic or tight clothing causes poor ventilation of the groin area, this increases moisture and warmth which creates chemotherapy, radiation therapy
• High stress levels - this depresses the immune system
• Poor digestive function such as inadequate levels of healthy gut bacteria, low levels of digestive enzymes, low stomach acid
• Hypothyroid conditions
• Sluggish liver

Symptoms of Thrush are

• vaginal discomfort with burning or itching known as pruritis
• a thick, white discharge which can have a yeast like smell
• redness or swelling of the vagina or vulva
• stinging or burning when urinating or during sexual intercourse
• vulval skin tends to split easily

Diagnosis

Some infections have symptoms similar to thrush are bacterial vaginosis (BV), trichomoniasis, STDs, cervical infections , threadworms [7] . Diagnosis is best done by GP or Gynaecologist via an examination and a vaginal swab.

Recurrent Thrush and Chronic Candidiasis when thrush becomes recurrent systemic candidiasis infection is suspected and this begins to affect immunity and general health. Other types of yeasts which can cause thrush include C. glabrata, C. tropicalis, C. krusei and C. parapsilosis. These yeasts tend to cause recurrent vaginal thrush and are resistant to commonly used antifungal drugs. https://www.healthdirect.gov.au/vaginal-thrush.Topical treatments using antifungals can provide relief to vaginal symptoms but they do not address any underlying systemic candida infection.

Immunosuppressive conditions typically known to be associated with chronic candidiasis infection [8][9]

• Epstein Barr virus ( glandular fever)
• Cytomegalovirus
• Uncontrolled diabetes
• Lupus
• Thyroid disease
• HIV infection

Other symptoms associated with chronic candidiasis

• Bloating and other digestive problems
• Mucous in stools
• Autoimmune disease
• Frequent colds and general low immunity
• Chronic lethargy
• Mood and mental health disorders  
• Mental sluggishness
• Sub fertility
• Hormonal imbalance
• Muscle and joint pains
• Anal itching
• Bad breath
• Extreme sensitivity to tobacco smoke and chemical fumes
• Food intolerances and allergies
• Craving for sweets and yeasted breads
• Recurrent fungal infections such as athlete's foot
• Cancer [1[10][11][12] [13][14]

CAN HAVING THRUSH AFFECT FERTILITY?

Cervical mucous disorders can reduce the chances of conception. Healthy fertile mucous nourishes and facilitates the movement of sperm towards the egg causing fertilisation. The cervix can be dry which may be due to dehydration, low estrogen levels or as a resul from previous clomid cycles. Other causes could be a yeast infection or a pH imbalance, an acidic pH of 5.5 is considered normal [15], any of these can contribute to cervical hostility and prevent spontaneous conception [16].

I have helped many couples conceive, using protocols for lifestyle and diet changes that are based on over 18 years of knowledge, clinical observations and successful pregnancies. Over the decades I have suspected thrush, yeast and genital infections are linked to cervical hostility, when candidiasis and gut dysbiosis are systemically treated there is an increase in spontaneous conception amongst couples.

Low grade thrush infections are often unnoticed, it is believed that 20 percent of thrush is asymptomatic[17]. Many clients are often unaware their symptoms are linked to infection . Symptoms that have persisted for many years, going as far back to childhood become familiar and we become “used to them”, it’s easy for sub-optimal health to be “normalised”. I am committed to helping you increase your fertility and achieving greater health outcomes and to help you reach your best health potential.

Chronic Candidiasis and Fertility vaginal thrush may be symptom of chronic systemic candidiasis. Candidiasis per se may not be totally responsible for all of the infertility problems that we see, underlying health imbalances that predispose the sufferer to chronic candidiasis may also be a contributing factor to it's problematic overgrowth. It can be a vicious cycle, for a yeast infection to persist it is essential that underlying problems be identified, diagnosed, properly treated and then kept under control.

Candidiasis infection according to Dr Alan Beer, who has pioneered research in reproductive failure by investigating correlations between the immune system and reproductive health and has helped many couples with infertility, IVF or implantation failure and recurrent miscarriage .
“ ….candida can produce root-like structures that bore into the intestinal walls, enabling toxins and partially digested proteins to escape into the bloodstream. When this happens the immune response is fierce….....IgA antibodies are rapidly fired out, the macrophages are mobilised and battalions of NK cells are deployed. If this immunological battle is prolonged, all kinds of allergic and autoimmune reactions may eventually take place , including food sensitivities, arthritis, asthma, hives, acne, eczema, hay fever and bronchitis. An intestine that is overrun with candida is more vulnerable to colonization of aggressive bacteria, which may increase the risk of miscarriage and preterm birth” [18].

Sydney Naturopath Peter De Ruyter author of “Coping with Candida” writes
“chronic candidiasis can seriously affect fertility and reproductive health, it can worsen significantly during pregnancy due to hormonal activity, and may cause considerable ill health in the mother and adversely affect the child” [19].

I have observed that systemic candidiasis can occur in women who have been diagnosed with endometriosis. A cross-sectional study published in 2010 correlated the prevalence of endometriosis with other comorbid conditions. In this study 4331 women with surgically diagnosed endometriosis were assessed for cancer, endocrine diseases and infections, researchers found nearly two-thirds of the women reported they also had recurrent upper respiratory tract infections 35% and recurrent vaginal infections 29% The nature of vaginal infections ( bacterial, viral or fungal) is not known and many women with recurrent vaginitis may have had undiagnosed vulvo vaginal candidiasis. The correlation between cancers and endocrine diseases occurred far less commonly among this group than the researchers originally hypothesised[20].

Why IS Chinese Medicine effective at Treating Vaginal Thrush & Candidiasis

In Chinese medicine candidiasis is caused by "dampness", this illustrates the oriental concept that moisture can become pathogenic and manifest in symptoms such as excess mucous, oedema, cysts, tumours. It provides optimal conditions for opportunistic microorganisms such as yeast, viral, bacterial or parasitic infections. Dampness can also be experienced as feelings of heaviness, bloating and mental dullness. Candida affects the digestive system and inhibits assimilation of essential nutrients and amino acids causing a weakening of immunity and general health. Damp diseases in general have a sluggish, stagnant quality and often take a long time to cure [21].Chinese Medicine believes that dampness when left untreated can underlie many chronic inflammatory diseases associated with ageing.

In ancient and modern Chinese medical texts there exists a large body of discussion on dampness and its treatment strategies and entire texts are dedicated to the sole discussion of fluids, dampness, phlegm and mucous [22]. It reflects the serious nature in which the Chinese regard this pathogen, its chronic nature and significant impact on long term health. Treatment may include include acupuncture, diet recommendations, Chinese herbs, naturopathic supplements, probiotics and lifestyle recommendations.

In the Diagnosis of Thrush in Chinese Medicine it is caused dampness invading the pelvic ( Lower Burner) region, it can be due to the following syndromes

• Dampness and Spleen Qi deficiency
• Damp-heat in the Lower Burner affecting the Liver channel
• Liver and Kidney Yin deficiency [23]

CAUSES OF CANDIDA AND THRUSH ACCORDING TO CHINESE MEDICINE

• DIGESTION

Chinese medicine recognises that strengthening digestion and treating gut dysbiosis is essential in chronic candidiasis and this requires patience. I understand that making dietary changes can be confronting and challenging for some people, as food habits can have psychological “pay offs” or can be based around social events. There is no quick fix with treating a damp condition and the commitment and effort you make in your health, will in the end will be an investment in long term good health.

In Chinese dietary therapy the yeast and dampness forming foods are those that are cold in temperature, too sweet or too salty, too oily, mucous producing, stale or rancid. Too much raw food can also weaken digestion. Any of these foods eaten regularly will eventually lead to dampness,   these foods are commonly consumed in abundance by the majority of patients, even by those who are “health” conscious. The ancient Chinese understood how to eat according to the seasons and the modern diet with its many fads has lost this common sense and its connection to seasonal patterns. For example protein or raw smoothies are currently popular and consumed as meal replacements, they commonly use damp ingredients such as bananas or frozen blueberries and other raw fruits and vegetables combined with soy or coconut milk and whey protein, these ingredients were once only available for a limited time over spring or summer, but we now have excess to these throughout the year and they have become a staple for many health conscious clients.

• CONSTITUTION

Chinese medicine recognises that each person is a unique and they have inherited a constitutional type that can predispose them to particular types of digestive and health weaknesses. Recommendations are usually based upon knowledge of Chinese diet therapy and take into consideration each individual’s constitution, I combine this with our anti-candida diet protocol and this combines the best of Chinese medicine and a Western naturopathic approach.

• EMOTIONS

According to Chinese physiology extreme emotions can down-regulate organ function. The states of anxiety and worry are the emotions that affect the Spleen’s digestive function and may contribute to pathogenic dampness. The Spleen and Stomach are primarily responsible for the digestion and distribution of nutrients derived from our food. Frustration and stress affects the Liver and this in turn interferes with the Spleen’s digestive function[24].

The impact of emotions on your health cannot be underrated and I always aim to address these during your treatment. Acupuncture helps to regulate your nervous system bringing about a calmer sense of well being.

• ENVIRONMENT

Our environments can be also an external cause of dampness, this could be living or working in a place with a rising damp, plumbing problems, or living in a home built near or over an underground watercourse or swamp. Also areas of high rainfall and humidity will also predispose one to dampness. While some situations can’t be always be changed but there is often a solution to help minimise how damp environments may impact your health, as part of a holistic approach to healthcare I will advise you on possible solutions. When addressing the environment this includes the local genital environment and how some types of synthetic fibres, clothing and underwear can also increase moisture and sweating in the groin region.

• LOW GRADE INFECTIONS

In 1972 a urologist Barry-Perkins Young observed a condition that occurs in males that presented with comorbid azoospermia, sinusitis and bronchiectasis infections, he named this Young’s syndrome. While this is considered a rare condition, we have noticed over the decades that low grade chronic sinusitis linked to sub fertility in both males and female patients.

In a 2004 study revealed gum disease during pregnancy linked to preterm births[25][26].

Another systematic review and meta-analysis from 2007 examines studies that link periodontitis and cardiovascular disease[27]. An evidence based review of over forty studies shows women with periodontitis took longer to conceive[28]. There is compelling body of evidence that examines how infections can modulate the development of autoimmune diseases[29][30][31]

I believe that low grade chronic infections must be addressed and that a focal infection and its consequences on overall long term health should not be underestimated. Under my care you can be confident that I will inform you about any chronic infection markers that are detected.

References

[1] J Dtsch Dermatol Ges. 2013 May;11(5):381-93; quiz 394. doi: 10.1111/ddg.12097
[2]Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006 Sep;20(3):485-506
[3] https://www.cdc.gov/fungal/diseases/candidiasis/invasive/definition.html#three
[4] West. Z., “ Zita West’s Guide to Getting Pregnant” Harper Thornsons 2005 (pp241-242)
[5] http://www.myvmc.com/diseases/vaginal-thrush-yeast-infection-vulvovaginal-candidiasis-vvt-vvc/
[6] Reed, B., 1992. Risk factors for Candida vulvo vaginitis. Obs. Gynecol. Surv. 47, 551–560
[7] http://www.webmd.boots.com/women/guide/yeast-infection-or-something-else
[8] http://www.myvmc.com/diseases/vaginal-thrush-yeast-infection-vulvovaginal-candidiasis-vvt-vvc/#What_is
[9] Naish,F., Roberts,J “The natural way to better babies: Preconception health care for prospective parents” Random House 2000,(pp. 299)
[10] Pitchford, P. “Healing with Whole Foods- Oriental Traditions and Modern Nutrition” North Atlantic Books 1993 (pp32)
[11] http://www.candidasupport.org/resources/candida-related-diseases/
[12] http://www.alternativementalhealth.com/the-effects-of-candida-on-mental-health-by-william-crook-m-d/
[13] Nørgaard, Mette, Reimar Wernich Thomsen, Dora Körmendiné Farkas, Mads Filtenborg Mogensen, and Henrik Toft Sørensen. "Candida infection and cancer risk: a Danish nationwide cohort study." European journal of internal medicine 24, no. 5 (2013): 451-455.
[14] Ramirez-Garcia, A., Rementeria, A., Aguirre-Urizar, J.M., Moragues, M.D., Antoran, A., Pellon, A., Abad-Diaz-de-Cerio, A. and Hernando, F.L., 2016. Candida albicans and cancer: Can this yeast induce cancer development or progression?. Critical reviews in microbiology, 42(2), pp.181-193.
[15] Naish,F.,Roberts,J “The natural way to better babies: Preconception health care for prospective parents” Random House 2000,(pp. 236)
[16] Rodriguez, R., Hernandez, R., Fuster, F., Torres, A., Prieto, P., & Alberto, J. (2000). [Genital infection and infertility]. Enfermedades infecciosas y microbiologia clinica, 19(6), 261-266.
]17] https://www.healthdirect.gov.au/vaginal-thrush.
[18] Beer,A.E. MD,Kantecki, J., J.Reed “ Is Your Body Baby-Friendly?: “Unexplained” infertility miscarriage & IVF Failure Explained” AJR publishing llc 2006 (pp83-84)
[19] Naish,F.,Roberts,J “The natural way to better babies: Preconception health care for prospective parents” Random House 2000,(pp295)
[20] Gemmill, Julie Anne L. et al. “Cancers, Infections, and Endocrine Diseases in Women with Endometriosis.” Fertility and sterility 94.5 (2010): 1627–1631.
[21] Pitchford, P. “Healing with Whole Foods- Oriental Traditions and Modern Nutrition” North Atlantic Books 1993 (pp31-32)
[22] Clavey, S., “ Fluid Physiology and Pathology in Traditional Chinese Medicine” Churchill Livingstone 1995
[23] Maccioca. G., “ Obstetrics and Gynecology in Chinese Medicine” Churchill Livingstone 1999 (pp835-839)
[24] Pitchford, P. “Healing with Whole Foods- Oriental Traditions and Modern Nutrition” North Atlantic Books 1993 (pp33)
[25]http://journals.lww.com/greenjournal/Fulltext/2004/10000/Periodontal_Disease_and_Upper_Genital_Tract.22.aspx
[26] Goepfert, Alice R. MD; Jeffcoat, Marjorie K. DMD; Andrews, William W. PhD, MD*; Faye-Petersen, Ona MD‡; Cliver, Suzanne P.*; Goldenberg, Robert L. MD*; Hauth, John C. MD* ”Periodontal Disease and Upper Genital Tract Inflammation in Early Spontaneous Preterm Birth” Obstetrics & Gynecology :October 2004 - Volume 104 - Issue 4 - pp 777-783
[27] Mustapha, Indra Z., et al. "Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis." Journal of periodontology 78.12 (2007): 2289-2302.
[28] ]. Fogacci, M. F., et al. "Periodontitis and Infertility: An Evidence Based Review. Glob J Fertil Res 1 (1): 011-015." Global Journal of Fertility and Research 11 (2016)
[29] Bach, Jean-François. "Infections and autoimmune diseases." Journal of autoimmunity 25 (2005): 74-80.
[30] Ercolini, A. M., and S. D. Miller. "The role of infections in autoimmune disease." Clinical & Experimental Immunology 155.1 (2009): 1-15.
[31] Hasni, Sarfaraz Ahmed. "Role of Helicobacter pylori infection in autoimmune diseases." Current opinion in rheumatology 24.4 (2012): 42