Candida is a genus of yeast responsible for the majority of fungal infections in humans. Many species of the yeast are normal inhabitants of a healthy human GI tract, acting as commensal organisms. Unfortunately, under the proper conditions, many are opportunistic pathogens.
Typically our immune system keeps Candida in check. It actually exists in 2 forms: a yeast and a fungus. In it’s yeast form, it’s harmless. But when it converts to the fungal form, all hell can break lose. Fortunately, the immune system and other environmental factors keep it in the yeast form.
Candida is normally found in the mouth, gut, respiratory tract, skin, and female genital tract. Therefore, when it overgrows and converts to the fungal form, it causes tissue specific problems. For example, it causes:
- Cavities in the mouth
- Oral thrush in the throat
- Yeast infections/UTI in the female genital tract
- Fungal nail infections
- In serious cases, systemic candidiasis
The assumption has always been that fungal overgrowth is a local event. However, recent evidence suggests that the gut is a significant source of systemic fungal overgrowth from Candida albicans. In this paradigm, the fungal form ventures in to the circulation from the gut and takes up shop elsewhere.
There are multiple ways that Candida can move from the gut to the circulation, only 3 of which damage cells or tight junctions:
People who deal with fungal issues often take to different elimination diets to “cure” their overgrowth. But these diets rarely eliminate the problem, so many deal with recurrent issues for a long time.
Candida diets: The standard paradigm
Nearly all diets that treat fungal overgrowth eliminate simple sugars. Almost all eliminate starches, fruit, and refined carbohydrates. Finally, another common thread is the removal of inflammatory things such as gluten, dairy, and processed foods with artificial preservatives.
Based on the above, you may get the impression that carbs are the enemy. And for some people that may be true. But if that’s the case, why were you able to eat your previous diet without issue for so long? And how is changing your diet for a short period of time going to prevent it from happening again?
To me, one of the biggest culprits is poorly regulated blood glucose. As a result of Type 2 diabetes or regular bouts of hyperglycemia, environmental conditions are perfect for fungal overgrowth. And as we get older, our risk of blood sugar problems skyrockets.
Type 2 diabetes and Candida overgrowth
Type 2 diabetes is a failure of the body to regulate blood glucose levels. As a result, multiple systems that keep fungal overgrowth in check fail. This includes:
- Impaired immune system function
- Chronic inflammation and tissue damage
- Increased “leaky gut”
- High blood glucose promoting “stronger” candida and biofilm formation
Chronically high blood glucose is a major problem, far more than carbohydrate consumption. For example, a study found that the amount of Candida in the mouth correlates to blood glucose levels. They grouped people in to 3 groups and looked at the number of colony forming units of Candida in their mouth. The mean CFUs were :
- 611 CFUs/mL in healthy controls
- 1065 CFUs/mL in controlled diabetics
- 5033 CFUs/mL in uncontrolled diabetics
Furthermore, the amount of glucose in the saliva increased as blood glucose increased. Thus, what’s going on in the blood is probably more important than what you’re putting in your mouth. It’s certainly going to have a greater effect on tissue glucose. Although, they are indirectly related to one another
Candida in Type 2 diabetes
A recent review looked at the relationship between Candida overgrowth and poorly controlled diabetes. In diabetics, Candida is more virulent. That’s because it’s:
- Found in higher quantities
- Adheres better to cell surfaces and the extracellular matrix
- Has greater enzymatic activity to degrade host(aka your) proteins
- More readily forms biofilms
So, maybe diet can be a useful strategy to combat fungal overgrowth, but not for the reason most people think. First of all, the immune system has to falter for fungal overgrowth to happen. Simply consuming sugar isn’t going to do this. In contrast, chronically high blood glucose does.
Having sugar in your gut doesn’t damage cells in the throat, vagina, or teeth. Chronic hyperglycemia does. Finally, having sugar in your gut isn’t going to cause leaky gut. Chronic hyperglycemia does.
Due to the numerous environmental conditions necessary for fungal overgrowth, a simple diet is unlikely to eliminate the problem. Additional measures to control blood glucose are necessary.
Other factors to improve blood glucose
Rather than call diets to fight fungal overgrowth useless, I think a more appropriate term is incomplete. The reason they don’t work is because people think they’ll do a diet for a short period and nothing else. After a few months, they go back to what they were doing.
The flaw in this paradigm is that diet is only one factor that affects blood glucose levels. Even if you stick to the diet, it’s not terribly difficult to experience hyperglycemia. Eat too much, at the wrong time, or when you are inactive and that’s exactly what happens. Not a big deal every once and a while, but do it regularly and you’re in trouble.
Another problem is that you can’t reverse Type 1 diabetes, and Type 2 diabetes takes a long time to correct. Certainly, just altering your diet quality is nowhere near enough. If it was we wouldn’t have a Type 2 diabetes epidemic.
Other important factors for reversing Type 2 diabetes and optimizing blood glucose include:
- Fixing your circadian rhythms
- Food quantity
- Getting adequate physical activity
- Sleep quality and quantity
- Stress management
Even if you don’t have Type 2 diabetes, any combination of these factors will increase blood glucose levels. For example, just a night of poor sleep(<4 hours) impairs your ability to lower blood glucose. And circadian disruption impairs blood glucose regulation both through sleep and other mechanisms.
Furthermore, low physical activity is a known risk factor for Type 2 diabetes. Not only does muscular activity burn blood glucose, long term exercise increases the amount of glucose muscle stores.
Finally, there’s large variability in the way people respond to certain foods. Some people will experience hyperglycemia while eating bread but not oatmeal, while others may be the opposite. Additionally, your blood glucose varies when you eat the same food at different times of the day.
Most people turn to restrictive diets when they experience fungal overgrowth. While cleaning up your diet is always a great thing, it’s unlikely to be effective at controlling Candida in your gut. Simply exposing it to sugar isn’t going to cause fungal overgrowth, but chronic hyperglycemia will.
Yes, a bad diet can play a role in Type 2 diabetes. But there are several other variables that are just as important. Combining two or more of these factors increases your risk of hyperglycemia whether you change your diet or not.
So even if you’re eating the right “types” of foods, eating too much, moving and sleeping too little, and ignoring your circadian rhythms can get you there pretty easily. Paying attention to these factors may be the difference between success and failure in any Candida protocol.
One final note. As with Helicobacter pylori, a knee jerk reaction has been to eradicate C. albicans from the gut. This is not a good idea. There is good evidence you want it there, and there may be substantial drawbacks to doing this.
Having Candida in your gut may protect against systemic fungal infection, may help tune the immune system away from allergy, and can prevent overgrowth of other fungal species. Tune the environment to keep it in check, don’t try to eradicate it with antifungals.