Candida.

Thrush occurs when conditions allow candida albicans, a common fungal species, to overgrow from harmless levels to causing unpleasant symptoms like itching, pain, and white discharge. This fungus naturally lives on and in the body, but only becomes a health issue when it’s allowed to flourish unchecked. While C. albicans causes most candida infections, some rarer species can be harder to detect.

Thrush is a common condition that can affect people of all ages. It often occurs in the mouth, digestive system, armpits, groin, and genital areas, but is particularly prevalent in women of reproductive age. Recurrent vulvo/vaginal thrush infections can be debilitating, impacting up to 75% of women at some point in their lives. Thrush can be a one-time event, recur periodically, or become a chronic issue.

Initially, candida overgrowth may cause minimal symptoms, such as thrush without discharge. However, as the overgrowth increases, the symptoms can become more pronounced. Candida overgrowth can present with a variety of symptoms, depending on where it’s located in the body:

• Diarrhea
• Constipation
• Cravings for sugar and carbohydrates
• Difficulty concentrating, brain fog
• Bloating, gas, and distension – especially after eating sweet or starchy foods

• Itching and irritation in the genital area
• White, “cottage cheese-like” discharge from vagina
• Pain and stinging during urination or sex

• White, “cottage cheese-like” deposits in the mouth
• A red, thick white coating on the tongue
• An unpleasant taste or odor in the mouth
• A burning sensation in the mouth
• Redness inside the mouth
• Cracks at the corners of the mouth

Chronic candidiasis can cause a range of health issues. It may lead to nutrient deficiencies, which can then trigger additional symptoms and complicate your overall wellbeing. Candidiasis can affect your digestion, skin, nails, hair, mood, and cognitive function. In other words, this condition can really take a toll on your body and mind.

Candida can negatively impact your immune system. It promotes the production of Th2 cells, which then suppress Th1 cells. Ideally, your immune system keeps a healthy balance of Th1 and Th2 cells. Th1 cells fight viruses, fungi, and bacteria, while Th2 cells target other pathogens.

However, if Th2 cells become too dominant, it may increase your risk of autoimmune conditions – especially if you have a genetic susceptibility and a chronic Candida infection.

That’s why candidiasis has been linked to the development of autoimmune disorders like vitiligo, idiopathic thrombocytopenic purpura, and the production of antibodies that target the cerebellum region of the brain.

C. albicans has two main forms. As a yeast, it appears as a round, single-celled spore that is not harmful. As a hyphae, it takes on a spear-like shape that can puncture cell walls, allowing it to take zinc and iron from the cells. Candida is one of the normal microbes found in our gut and on our skin. It lives commensally with us. However, it can overgrow opportunistically when conditions allow, such as in people with weakened immune systems or disrupted gut microbiomes.

Factors that can contribute to Candida overgrowth:

• Antibiotic use: Antibiotics kill both beneficial and harmful gut bacteria, allowing opportunistic species like Candida to thrive.
• Diet high in sugar and refined carbs: These are Candida’s favorite foods, fueling its transformation from a harmless yeast into an invasive, proliferating form.
• Stress: Can alter gut pH and deplete secretory IgA, an immune protein that normally keeps Candida in check.
• Lowered immune resilience: Chronic conditions, medical treatments, and infections can weaken the immune system’s ability to control Candida.
• Autoimmune disorders: Conditions like lupus, thyroid disease, and multiple sclerosis may create an environment that allows Candida to overgrow.
• Diabetes: Unmanaged blood sugar can feed Candida and suppress immunity.
• Medications: Immunosuppressants, steroids, and drugs that alter gut pH can disrupt the microbiome, and the oral contraceptive pill.
• Nutritional deficiencies: Lack of nutrients like zinc and vitamin A can contribute to inflammation and impaired immunity.
• Other factors: Heavy metal toxicity, IUDs, hormone imbalances, food intolerances, and gut dysbiosis may also play a role.

The fungus Candida albicans can sometimes team up with other microbes to create a protective biofilm. This biofilm layer makes the fungus resistant to many common antifungal treatments.

Low-grade candida infections can be tricky to detect because they often have no obvious symptoms. However, they may cause recurrent flare-ups, especially in people with the risk factors mentioned above. Candidiasis is linked to an imbalance in gut flora, and if it’s low-grade and chronic, it can be a source of ongoing inflammation.

Some seemingly unrelated symptoms that may indicate a chronic, low-grade candida infection include:

• Acne, fungal skin or nail infections, eczema
• Acid reflux or burping
• Anxiety, depression, panic attacks
• Bloating, abdominal pain, digestive issues like diarrhea or constipation
• Brain fog
• Weakened immune system
• Difficulty losing weight

The other candida species, like C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis, are less common but often cause milder symptoms than the more prevalent C. albicans. These non-albicans candida species are more likely to occur in women after taking antibiotics or during high estrogen states such as pregnancy, perimenopause, or hormone replacement therapy.

To assess the best natural treatment for thrush, functional medicine may recommend the following tests:

Comprehensive PCR stool testing, such as GI 360 or GI Map, to:

• Identify imbalances in specific gut bacteria species
• Detect the presence of Candida albicans or parasites
• Check levels of secretory IgA (a key immune marker)

To help identify the factors contributing to your candida overgrowth, your doctor may recommend several types of testing:

• Food reactivity testing to pinpoint foods that could be disrupting your gut flora
• Heavy metal, mold, and environmental toxin testing
• Organic acids test (OAT) to assess a range of metabolic markers

These tests can provide valuable insights into the imbalances allowing the candida to thrive, so your doctor can develop a targeted treatment plan.

Conventional antifungal treatments for candida are available through your doctor, pharmacist, or over the counter. These include a range of medications like lozenges, creams, pessaries, or tablets.

Most women with vaginal yeast infections first see their doctor when the infection is new or chronic. However, many women then choose to self-treat any subsequent or recurring infections using over-the-counter products.

Your doctor may examine you or take swabs to rule out other conditions, such as vulval dermatitis, genital herpes, bacterial vaginosis, urinary tract infection, vestibulitis or lichen sclerosis.

The two main classes of antifungal medications are:

Polyenes, such as topical nystatin and the Azoles, which include:

• Imidazoles: clotrimazole and miconazole (topical), and ketoconazole (oral)
• Triazoles: fluconazole (oral)

Other antifungal treatments, used less frequently, include:

• Boric acid intravaginal capsules
• Topical flucytosine

Pharmaceutical medicines can provide relief from vaginal yeast infections. However, they often come with unpleasant side effects. Plus, many women with recurring yeast infections find that the infection comes back after they stop taking the medication.

The oral antifungal drug fluconazole can be effective in treating yeast infections in the short term. But long-term use of this medication can lead to the yeast developing resistance. It can also disrupt the natural balance of bacteria in the gut.

Patients taking fluconazole long-term should have their liver function tested every 6 months, as long-term use of ketoconazole has been linked to liver toxicity, requiring monthly liver function tests.

If you prefer to use pharmaceuticals to manage thrush, topical antifungals are a better choice than oral medicines. Topical antifungals work locally rather than throughout the body, which helps avoid the problems that can arise with systemic treatments.

Chronic thrush can be tricky to treat, with the risk of treatment resistance and concerning side effects from medications. For these reasons, many people with chronic or recurring yeast infections choose to use natural treatments to address candida in the gut and throughout the body.

For managing thrush, topical antifungals are the better choice over oral medications. Topical antifungals act locally rather than systemically, which helps avoid the problems that can arise with systemic treatment.

Chronic thrush can be tricky to treat, as it may become resistant to medications and the drugs can have concerning side effects. That’s why many people with recurrent yeast infections turn to natural remedies to address the candida overgrowth in their gut and throughout their body.