Fungal Infections (Candida)

Fungal Infections (Candida)

1 Overview

Summary and Quick Facts

  • Fungal infections are estimated to occur in over a billion people each year, and recent evidence suggests the rate is increasing. Although several species of fungi are potentially pathogenic in humans, Candida (esp. Candida albicans) is the organism responsible for most fungal infections.
  • Upon reading this protocol, you will have a better understanding of the various ways fungi can infect a human host, and how conventional medicine treats these infections. In addition, you will discover several natural compounds that have antifungal activity and may complement conventional treatments for fungal infections.
  • Although most cases of Candida infection are treated with some type of antifungal agent, the formulation of the medication (e.g., pills, ointment, suppositories or powder) will largely depend on the location and clinical presentation of the infection. Candidiasis patients should maintain a healthy, well-balanced diet, as poor nutrition is a commonly overlooked risk factor for bacterial and fungal infections.

What are Fungal (Candida) Infections?

Fungal infections can occur in almost any part of the body. Most people have some fungi present in their body, but it often does not become pathogenic unless the person is immunocompromised. Candida is the most common species of fungus present in healthy people, and the one most likely to cause infection.

Fungal infections are usually superficial and/or confined to one area; however, in certain cases the infection can become systemic and even life-threatening. Symptoms will vary depending on where the infection is located, but itching and rashes are common.

Natural interventions such as probiotics and resveratrol may help prevent pathogenic fungal overgrowth.

What Can Increase the Risk of Developing a Fungal Infection?

  • Diabetes (with poor glycemic control)
  • Antibiotics (during and after therapy)
  • High levels of estrogen
  • Weakened immune system (eg, from age, disease, drugs, etc.)
  • Contraceptive devices (eg, vaginal sponges, diaphragms, and IUDs)
  • Allowing skin to stay wet for long periods of time

What are Conventional Medical Treatments for Fungal Infections?

Antifungal agents including:

  • Clotrimazole
  • Nystatin
  • Azoles (eg, bifonazole)
  • Fluconazole
  • Polyenes (eg, liposomal amphotericin B)

Note: The formulation and route of delivery (eg, topical, oral, intravenous, etc.) of antifungals will vary depending on location and clinical presentation of the infection.

What Natural Interventions May Be Beneficial for Fungal Infections?

  • Dietary modifications. Limiting sugar and refined carbohydrates may be helpful. Diets rich in glucose and other simple carbohydrates are associated with fungal infections as well as a weakened immune response.
  • Probiotics. Certain probiotic strains, such as Lactobacillus, can help prevent fungal overgrowth.
  • Resveratrol. Resveratrol is an anti-inflammatory compound shown in laboratory studies to possess potent antifungal properties. Some researchers are hopeful that resveratrol’s structure may be a foundation for a new class of antifungal drugs.
  • Goldenseal. Berberine, an active ingredient in goldenseal, has been shown in laboratory studies to have strong antifungal effects as well as synergistic effects when combined with common antifungal drugs. Life Extension currently recommends only using goldenseal/berberine for a short term.
  • Lactoferrin. Lactoferrin, a protein found in mucosal secretions (eg, breastmilk and saliva), has broad-spectrum antimicrobial activity, as well as synergistic effects when combined with common antifungal drugs.
  • Tea tree oil. Tea tree oil, an essential oil derived from the Australian Melaleuca alternifolia plant, has many medicinal properties and shows promise for fighting candida infections. Tea tree oil should only be used topically.
  • Garlic. Garlic has long been used as an herbal remedy for a variety of conditions. Garlic (and its constituent allicin) can suppress the formation of fungal biofilm, reducing the fungus’ ability to develop drug resistance. Garlic has also been shown in clinical trials to suppress oral and vaginal candida infections.
  • Other natural interventions include certain essential oils (eg, menthol and limonene), active hexose correlated compound (AHCC), caprylic acid, and boric acid.

2 Introduction

Fungal infections are estimated to occur in over a billion people each year, and recent evidence suggests the rate is increasing (Hsu 2011; Di Santo 2010; Brown 2012; Fungal Research Trust 2011). Fungi can infect almost any part of the body including skin, nails, respiratory tract, urogenital tract, alimentary tract, or can be systemic (Long 2009; Baron 1996). Anyone can acquire a fungal infection, but the elderly, critically ill, and individuals with weakened immunity, due to diseases such as HIV/AIDS or use of immunosuppressive medications, have a higher risk (Hsu 2011; Baddley 2011).

Although several species of fungi are potentially pathogenic in humans, candida (esp. Candida albicans) is the organism responsible for most fungal infections. Candida, which is normally present within the human body, is usually harmless. However, it can cause symptoms when a weakened immune system or other factors allow it to grow unabated (Merck Manual 2008; Cheng 2012; Douglas 2011).

Increased use of antibiotics and immunosuppressive drugs such as corticosteroids are major factors contributing to higher frequency of fungal infections. Antibiotics and immunosuppressive drugs, by disrupting normal bacterial colonization and suppressing the immune system, create an environment within the body in which fungi can thrive (Hsu 2011; Tani 2012).

Fungal infections can range in severity from superficial to life-threatening. For example, fungal infections affecting only the top layers of the skin are readily treatable and have a relatively limited impact on quality of life. However, if a fungal infection enters systemic circulation, consequences can be deadly (Badiee 2011; Zuber 2001).

Many integrative medical practitioners believe that chronic, low-level candida infestation can cause a variety of non-specific symptoms that may resemble chronic fatigue syndrome, depression, anxiety, or fibromyalgia. This phenomenon is sometimes referred to as “candida-related complex”. Conventional medical practitioners do not recognize candida-related complex as a disease. However, many innovative healthcare practitioners report improvements in patient quality of life upon treatment (Gaby 2011).

Upon reading this protocol, you will have a better understanding of the various ways that fungi can infect a human host, and how conventional medicine treats these infections. In addition, you will discover several natural compounds that have anti-fungal activity and may complement conventional treatments for fungal infections.

3 Understanding Candida Fungal Infections

Candida albicans is the most common fungal microorganism in healthy individuals, as well as the most common fungal pathogen causing lethal infections (particularly in high-risk groups such as immunocompromised patients) (Cheng 2012; Douglas 2011). It can be found in up to 70% of healthy individuals at any given time (Cheng 2012; Hibino 2009; Schulze 2009).

Candida is considered an opportunistic pathogen because it can harmlessly colonize the human digestive tract, mouth, skin, and genitourinary tract (Kim 2011; Tampakakis 2009). However, when the balance of normal bacteria is upset (e.g., after antibiotic treatment) or the immune system of the host is weakened (e.g. treatment with systemic corticosteroids), candida can proliferate(Murzyn 2010).

Several areas of the body may be affected by fungal infection:

Urogenital tract - Although candida is often found in the lower female urogenital tract in asymptomatic women, proliferation and subsequent infestation of this fungal species accounts for approximately one-third of all infections in the vulva and/or vagina (i.e., vaginitis) (Sobel 2012). Also known as vulvovaginal candidiasis (VVC) or “yeast infection” (Powell 2010), this fungal infection represents the second most common cause of vaginitis in the U.S. (after bacterial vaginosis), and is diagnosed in up to 40% of women who present to their primary care provider with vaginal complaints (Ilkit 2011). Approximately 75% of women report having had at least one episode of VVC, and between 40%-45% will suffer from at least two or more episodes within their lifetime (Workowski 2010).

The most common symptoms of VVC include unrelenting itch, painful intercourse, malodorous vaginal discharge, and painful urination (Workowski 2010). Although the vast majority (up to 92%) of VVC cases are caused by Candida albicans, other candida species can also be responsible (e.g., Candida glabrata and Candida parapsilosis). However, the various candida species tend to produce similar vulvovaginal symptoms. Recently, researchers have reported an increased frequency of VVC caused by non-albicans species (Sobel 2012). This trend may be attributed to selective pressure from the widespread use of over-the-counter and prescription antifungal drugs (Sobel 2012), especially since some non-albicans species are less susceptible to many of these medications (Iavazzo 2011).

Some evidence suggests that hormones influence the infectious process of VVC (Carrara 2010). This conclusion is supported by data indicating that a majority of VVC cases occur during the reproductive years. For example, 75% of women of childbearing age are affected by VVC (Sobel 2012; das Neves 2008; Špaček 2007), while only sporadic episodes of VVC are reported among premenstrual girls and postmenopausal women (Sobel 2012; Špaček 2007). Further research reveals that fluctuating hormone levels resulting from menstruation and pregnancy, as well as the use of oral contraceptives and hormone replacement (i.e., estrogen therapy), may predispose females to VVC (Yano 2011; Relloso 2012).

Researchers have identified several factors that may increase susceptibility to fungal infections including (Sobel 2012):

  • Diabetes (with poor glycemic control)
  • Exposure to antibiotics (both during and after therapy)
  • High levels of estrogen (e.g., oral contraceptives or estrogen therapy)
  • Weakened immune system from drugs (e.g., corticosteroids) or disease (e.g., HIV/AIDS)
  • Contraceptive device utilization (e.g., vaginal sponges, diaphragms, and intrauterine devices)

Although less common, men can get genital fungal infections as well (Aridogan 2011). Therefore, it is important that both members of a relationship receive treatment for fungal infections, even if symptoms are only evident in one person. If antifungal treatment is not initiated in both people in a relationship, the partners may continue to repeatedly infect one another (Brown Univ. 2012).

Skin – Fungal infections of the skin (i.e., cutaneous fungal infections) are a common phenomenon, affecting millions of people worldwide. While cutaneous fungal infection is not normally life threatening, it can be very uncomfortable and associated with a significant decrease in quality of life (Dai 2011; Jayatilake 2011). Candida is just one of a variety of microorganisms commonly found on human skin (NIH 2010). In healthy individuals, the overgrowth of candida is inhibited by resident skin microorganisms (normal bacterial skin flora). However, when there is an imbalance of this normal skin flora, candida can begin to reproduce in sufficient amounts to cause infection (i.e., candidiasis) (Evans 2003). Due to an increase in the number of immunocompromised individuals, the rate of candidiasis of the skin (i.e., cutaneous candidiasis) is currently on the rise (Scheinfeld 2011).

Candidiasis can be broadly classified into two forms based on the degree of fungal invasion: superficial/mucosal candidiasis and deep-seated/systemic candidiasis (Jayatilake 2011). However, superficial candidiasis of the skin and mucous membrane is much more common than deep-seated/systemic infection (Jayatilake 2011). Among the different species of candida that can be found on the skin, Candida albicans is by far the most common (Evans 2003). While cutaneous candidiasis can affect virtually any part of the human body (e.g., finger nails, external ear, in between fingers and toes), it most often occurs in warm, moist, creased areas such as the armpit or groin (NIH 2010; Jayatilake 2011; Kagami 2010; Cydulka 2009; Kauffman 2011). Major symptoms of cutaneous candidiasis include itch (unrelenting and often intense) and an enlarging skin rash. Occasionally, the rash will be surrounded by smaller rashes appearing along the outer edge of the main rash (NIH 2010). These types of fungal rashes may occur on skin that is exposed to feces (e.g., perineal skin), since this area is at a higher risk of becoming infected with candida fungus (Evans 2003).

Individuals whose hands and/or feet remain wet for prolonged periods of time may be prone to fungal infection around or under their finger and toe nails. In these cases, the nail area commonly becomes red and swollen. The nails themselves will become thick and brittle, ultimately becoming destroyed and detached (Cydulka 2009; Kauffman 2011; NIH 2012; NIH 2012). Although anyone’s nails can become infected by fungus, these types of infections are more common among adults older than 60, and among individuals with diabetes or poor circulation (AAFP 2008).

Mouth and throat – Candida infections of the mouth (i.e., oral candidiasis) are widespread among humans (Giannini 2011). In addition to the general factors that predispose an individual to candida infection (e.g., immunosuppressive drugs and antibiotics), oral candidiasis may also be caused by chronic dry mouth and oral prosthesis (dentures)(Junqueira 2012). Although oral infection can be caused by a variety of candida species, Candida albicans is the most common causative agent (Rautemaa 2011).

Oral candidiasis (thrush) is characterized by whitish, velvety sores or patches appearing on the mucous membranes lining the inside of the mouth (e.g., roof of the mouth and inside the lips and cheeks), as well as the throat and tongue (Abe 2004; NIH 2011). These whitish sores may slowly increase in size, quantity, and may bleed easily (NIH 2011). Occasionally, oral candida infections can manifest as subjective feelings of pain or taste abnormalities (Yamamoto 2010).

In addition to infections inside the mouth, candida can also take the form of perlèche (angular cheilitis) (Gonsalves 2007; Sharon 2010), which is commonly identified by reddish lesions and crusting at the corners of the mouth (Park 2011). Perlèche can be associated with long-term use of ill-fitting dentures and incorrect use of dental floss (resulting in cuts at the corners of the mouth) (Sharon 2010).

Systemic infection – Although candida species are normal residents of the gastrointestinal and genitourinary tracts of humans, they occasionally cause a deep-seated or systemic (disseminated) infection (Kauffman 2012b). These serious fungal infections usually indicate the host has a weakened immune system, and can occur as a result of a superficial skin infection that invades deeper tissues, eventually reaching the blood stream (i.e., candidemia). Once the fungus is circulating throughout the body, it has the capacity to reach vital organs such as the brain, heart, and kidneys. While this form of candidiasis is rare, it is the most severe (Jayatilake 2011). These types of fungal infections can be fatal and require prompt diagnosis and aggressive treatment in order to achieve a favorable outcome (Emiroglu 2011).

Since the clinical symptoms of a systemic candida infection can vary, and are often very similar to that of a bacterial infection, the gold standard for its proper diagnosis is a positive blood culture (Kauffman 2012a). Advancements in blood culturing technology now allow for the rapid identification of a variety of candida species in as little as 90 minutes. This reduction in laboratory turnaround time enables clinicians to optimize antifungal drug selection much faster, and ultimately improve care (Advandx 2010; Hall 2012).

Intestinal Candidiasis – Candida organisms are a common part of the normal gastrointestinal flora (Kumamoto 2011), and are present in the gut of approximately 70% of healthy adults (Schulze 2009). However, high levels of candida colonization in the GI tract may be an urgent problem (Zlatkina 2005), especially since it is associated with several gastrointestinal diseases (e.g., irritable bowel syndrome) and certain allergic reactions. (Kumamoto 2011; Schulze 2009). Furthermore, candida colonization in the gut can also promote inflammation, which in turn promotes further fungal colonization in a vicious cycle (Kumamoto 2011).

Intestinal candida colonization can also lead to superficial and systemic candidiasis if the innate host barriers (i.e., mucosa, immune system, intestinal microflora) are not stable (Schulze 2009). Benign strains of intestinal candida can also become more virulent when their gene expression is altered in such a way that they are able to form biofilms, destroy tissues, and escape host immune system defenses (Kumamoto 2011; Schulze 2009). While antimycotics (e.g., nystatin) are available for the treatment of intestinal candida overgrowth, probiotics (having demonstrated positive results in controlled clinical trials) may also be beneficial. Probiotics may exert this affect by rebalancing the normal flora of the gut, thereby suppressing local candida colonization.

Some research questions the clinical significance of yeast infestation of the intestinal mucosa, and suggests that clinical action may not always be necessary (Schulze 2009).

Fungal Sinusitis – Overgrowth of fungus in the nasal cavity (i.e., fungal sinusitis or fungal rhinosinusitis) and the subsequent human immune response (e.g., allergic fungal sinusitis) is currently believed to be responsible for some cases of chronic sinusitis (Ivker 2012). This condition can be classified as either invasive or non-invasive, depending on the extent of fungal infection. Invasive forms of fungal sinusitis are largely limited to immunocompromised populations (Riechelmann 2011), and are characterized by infection of the submucosal tissue, which often causes tissue necrosis and destruction (Montone 2012).

Although optimal treatment options for fungal sinusitis are still debated, (Dabrowska 2011), they typically include systemic antifungal therapy as well as surgical debridement & evacuation of infected tissue (Riechelmann 2011). In addition to these conventional treatment options, some experts believe fungal sinusitis may also respond to probiotics as well as an anti-fungal diet. An anti-fungal diet calls for avoidance of sugar and concentrated sweets, and consists primarily of protein and fresh vegetables, along with a small amount of fruit, complex carbohydrates, and fat-containing foods (Ivker 2012).

Candida-Related Complex (CRC)

While overt candida infection is a well-documented phenomenon, the idea that chronic low-grade candida infestation (primarily in the gut and urogenital tract) can cause various, seemingly unrelated symptoms is viewed with skepticism among conventional infectious disease experts. As a result, the conventional medical community is often at odds with some innovative healthcare practitioners as to the treatment strategy of candida infestation in chronic health conditions.

With his publication of The Yeast Connection in 1986, Dr. William Crook introduced the public to the concept that yeast overgrowth could potentially underlie numerous chronic symptoms (Crook 1986). Seminal scientific research published by Dr. C. Orian Truss in 1977 contributed to the development of Dr. Crook's theory (Truss 1978). The concepts and treatments described in these publications continue to be utilized in the practices of innovative healthcare practitioners worldwide.

The mechanism(s) by which candida overgrowth might cause otherwise unexplainable symptoms are unclear. However, suppression of the immune system, with subsequent reactivation of dormant viruses like Epstein-Barr virus and herpes virus, is one hypothesis (Cater 1995). Other theories posit that candida colonization within the GI tract may contribute to "leaky gut", in which foreign particles "leak" through the intestinal barrier and contribute to systemic reactions (Schulze 2009; Horne 2006; Groschwitz 2009).

Although published, peer-reviewed research on the role of yeast overgrowth in chronic disease is limited, some innovative healthcare practitioners, including Dr. Crook, have detailed reports of improved quality of life upon treatment for suspected yeast overgrowth (Gaby 2011; Crook 1986). Strategies often employed to treat "chronic candida infection" include use of graded doses of antimycotic medications such as nystatin, as well as strict adherence to a sugar- and starch-free diet.

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4 Conventional Treatment

Although most cases of candida infection are treated with some type of antifungal agent, the formulation of the medication (e.g., pills, ointment, suppositories, or powder) will largely depend on the location and clinical presentation of the infection (Pammi 2012; Ferri’s 2012).

Mild oral candidiasis can be treated with either clotrimazole lozenges or a nystatin swish-and-swallow suspension, but may require oral fluconazole for moderate to severe and recurrent cases (Kauffman 2012). An emerging treatment for oral candidiasis involves the use of mouthwash containing silver nanoparticles (SN). Although this approach requires more investigation to include safety and efficacy, it may hold therapeutic potential in the near future (Monteiro 2012).

Candidiasis of the skin is most often managed with topical antifungal agents of the azole class (e.g., bifonazole or ketoconazole) (Katoh 2009). People with candidiasis of the skin should also keep the skin as dry as possible and, if appropriate, use antifungal mouth rinses or shampoos.

Fungal infections of the finger/toe nail plate (e.g., onychomycosis) are typically treated with both topical and systemic antifungals. However, long-term cure and recurrence rates, as well as costs associated with these treatments, are often unsatisfactory. For this reason, researchers have studied the effects of laser therapy for the treatment of onychomycosis; they found that this technology is capable of inhibiting the growth of the fungus on nail samples (Manevitch 2010). In severe cases that do not respond to drug therapy, surgical removal of all or part of the nail plate may be considered (Singal 2011).

Vaginal candida infections can be treated with topical or oral antifungal drugs such as fluconazole or nystatin (Sobel 2012). The species of candida a woman is infected with can influence treatment response. For example, fluconazole and nystatin are both effective for the treatment of Candida albicans, but in women with non-albicans species, only fluconazole is highly effective (Rodrigues Martins 2012).

Treatment for invasive/systemic candidiasis depends on a variety of factors, but will most likely involve intravenous or oral therapy with any one of the following drug classes: polyenes, azoles, and echinocandins (Kauffman 2012d). The polyene drug amphotericin B is a very common treatment, but is hindered by considerable kidney toxicity. Therefore, newer, less toxic derivatives of the drug (e.g., liposomal amphotericin B) are a better option. The high cost of these formulations, however, can be burdensome in some circumstances (Bassetti 2011; Kauffman 2010).

The side effects of most systemic antifungal drugs are comparable and include headache, gastrointestinal symptoms (e.g., nausea and vomiting), hepatitis, kidney toxicity, and lupus-like syndromes, among others (Werth 2011; Kauffman 2011;Khan 2012).

5 Nutritional Therapy for Candida Infections

Given the rise in candida infections (Hsu 2011), and their increasing resistance against commonly used antifungal drugs (Pfaller 2012), novel therapies for the prevention and management of these infections are needed (Mailander-Sanchez 2012).

Dietary modifications such as limiting intake of refined carbohydrates (e.g., pasta, bread, sweets, soft drinks, etc.) may be helpful for people with candida infections. Higher dietary sugar is associated with vulvovaginal candidiasis and abnormal glucose metabolism is associated with recurring vulvovaginal infections (Donders 2010). Diets rich in carbohydrates are also associated with candida overgrowth in the gastrointestinal tract and may contribute to mucosal invasion (Weig 1999; Akpan 2002). Laboratory studies indicate that excess glucose weakens the immune system’s response to candida as well as the azole class of antifungal drugs (Rodaki 2009). Candidiasis patients should maintain a healthy, well-balanced diet, as poor nutrition is a commonly overlooked risk factor for bacterial and fungal infections (Curtis 2010). More information about blood sugar control is available in the Diabetes protocol.

Probiotics – Data suggest that probiotics such as lactobacillus are beneficial against mucosal candida infections (Mailander-Sanchez 2012), and should be especially considered for women who suffer from more than three yeast infections per year (Falagas 2006). Research shows that probiotics exert their beneficial actions by suppressing the growth of candida (in various regions of the body) and inhibiting candida’s ability to adhere to cell surfaces (Balish 1998).

Dietary products containing probiotic bacteria (e.g., certain cheeses and yogurts) can help control candida growth in the human body (Hatakka 2007; Williams 2002). In a study, yogurt containing lactobacillus was associated with a decreased amount of vaginal yeast (detected by culture), as well as a reduced rate of vaginal discharge associated with yeast infections (Martinez 2009).

While yogurt has long been considered a favorite natural remedy for vaginal candidiasis, and has been shown to suppress Candida albicans growth (Williams 2002; Hamad 2006), women must carefully choose yogurt products that are low in sugar. Supplemental probiotics containing lactobacillus, administered either orally or vaginally, can also help resolve urogenital infections (including yeast infections) (Reid 2001; Abdelmonem 2012). In particular, the lactobacillus species rhamnosus and reuteri have been studied for repopulating vaginal flora and reducing yeast populations (Reid 2003; Reid 2009).

Probiotics may also be useful after a course of antibiotics. Antibiotics used to kill pathogenic bacteria also destroy the beneficial bacterial flora of the vagina, putting women at risk to develop yeast infections (Donders 2010). Probiotics also help re-balance gut bacteria, and thus may help avoid symptoms of leaky gut syndrome (Horne 2006).

Resveratrol – Resveratrol, a compound found in the skin of grapes, may contribute to the anti-inflammatory characteristics of red wine. In 2007, researchers investigated (in a laboratory) the fungicidal activity of resveratrol against Candida albicans. They concluded that resveratrol demonstrated potent antifungal properties, and appears to be safer than conventional antifungal drugs such as amphotericin B (Jung 2007). In 2010, further research revealed that resveratrol impairs the ability of Candida albicans to convert into its more infectious form, and thus may be a useful agent against candida infections. In fact, resveratrol’s chemical structure may form the foundation of an entirely new class of antifungal drugs (Okamoto-Shibayama 2010).

Goldenseal – Goldenseal (Hydrastis canadensis L.) is a botanical that has been used to fight inflammation and infection. An active ingredient in goldenseal is berberine (Ettefagh 2011), which has been shown to have strong antifungal effects against candida in a laboratory setting (Liu 2011). Berberine has also demonstrated synergistic effects against Candida albicans when used in combination with commonly used antifungal drugs (e.g., fluconazole) in laboratory studies (Wei 2011; Iwazaki 2010; Xu 2009). Berberine may combat candida growth by interfering with the ability of the fungus to penetrate and adhere to host cells (Yordanov 2008). Study outcomes have been so positive that, similar to the case with resveratrol, synthetic analogs of berberine are being developed that may represent a new class of antifungal medications (Park 2006; Park 2010).

Although berberine has been studied in human clinical trials and shown to have several metabolic benefits, concerns about long-term use of berberine have been raised on the basis of certain preclinical studies (Kysenius 2014; Mikes 1985; Mikes 1983). Some evidence suggests that long-term berberine use, especially at high doses, may impair particular aspects of cellular metabolism in specific types of cells. The implications of this preclinical research are yet to be determined by long-term human clinical trials, therefore Life Extension currently recommends short-term use of berberine.

Lactoferrin – Lactoferrin, a protein found in mucosal secretions (e.g., human colostrum/milk, tears, saliva, and seminal fluid) (Haney 2012; Andrés 2008; Venkatesh 2008), possesses broad-spectrum antimicrobial activity against bacteria, fungi, viruses, and protozoa (Kobayashi 2011). Lactoferrin demonstrates a significant antifungal effect against a variety of pathogenic candida species (i.e., Candida albicans, Candida krusei and Candida tropicalis) (Al-Sheikh 2009). In addition to lactoferrin’s ability to interfere with candida growth on its own, it also displays potent synergism with common antifungal drugs; it has been shown to enhance the antifungal activity of fluconazole against candida (Kobayashi 2011). Although lactoferrin’s antifungal activity against Candida albicans has been well established, the mechanism by which it achieves this effect is not as clear (Andrés 2008). Lactoferrin’s ability to bind to iron may contribute to its antifungal activity (Yen 2011), especially since iron appears to enhance the proliferation of candida species (Al-Sheikh 2009).

Lactoferrin derived from both bovine and human sources inhibits growth of oral candida (Venkatesh 2008). However, bovine derived lactoferrin has been specifically identified as a promising treatment option for oropharyngeal candidiasis (Yamaguchi 2004).

Tea Tree Oil – Tea tree oil is an essential oil derived from leaves of the native Australian plant Melaleuca alternifolia (M. alternifolia). It is well known for its medicinal value and has been used by Australian Aborigines to treat colds, sore throats, skin infections, and insect bites (Larson 2012; Warnke 2009). Tea tree oil has a variety of therapeutic properties (e.g., anti-inflammatory and antiseptic) and is a popular ingredient in a number of natural cosmetic products (e.g., shampoo, massage oil, and skin/nail cream) (Larson 2012; Catalán 2008; Mondello 2006). Tea tree oil, capable of eliminating a large number of microorganisms (Catalán 2008), shows promise as a treatment for candida infections (Willcox 2005). Animal studies indicate that one of the active compounds in tea tree oil, terpinen-4-ol, may be especially promising for treating drug-resistant forms of vaginal candidiasis (Mondello 2006). Furthermore, tea tree oil may have beneficial effects against fluconazole-resistant oropharyngeal candidiasis (Wilcox 2005).

Laboratory research indicates that tea tree oil may exert its yeast-killing effect by inhibiting candida’s ability to replicate. It also appears to interfere with membrane properties/functions of candida (Catalán 2008). In addition, research has demonstrated tea tree oil reduces candida’s ability to adhere to human cell surfaces (Sudjana 2012).

Although tea tree oil is occasionally associated with contact dermatitis (when used topically), it is generally considered to be safe. However, it can be toxic when ingested orally, producing a variety of negative effects (e.g., vomiting, diarrhea, and hallucinations) (Larson 2012). Therefore, it is typically used topically and should be kept out of the reach of young children.

Other Essential Oils – Essential oils (i.e., volatile oils) refer to the compounds found within aromatic plants that give them a particular odor or scent (NIH 2012). Most essential oils are a mixture of various chemicals, which are of clinical interest due to their large spectrum of biological activities (de Araujo 2011).

Although tea tree oil is considered one of the most important essential oils for biological activity against candida (Mondello 2006), a wide variety of essential oils possess anti-candida properties (e.g., carvacrol, 1,8-cineole, geraniol, germacrene-D, limonene, linalool, menthol, and thymol) (Azimi 2011). Experimental models involving geranium oil (or its main component geraniol) show that it suppressed candida cell growth (Maruyama 2008). In addition, clove oil and its major constituent eugenol have shown particularly potent effects against candida (Nozaki 2010), and may be effective against multi-drug resistant forms of Candida albicans alone or in combination with other common antifungal drugs (e.g., fluconazole or amphotericin B) (Khan 2012). A laboratory study demonstrated that essential oil from Moroccan thyme may act synergistically with common antifungal drugs, potentially reducing the need for high doses, which may in turn minimize associated side effects and treatment expenses (Saad 2010). Research has also identified the essential oil of Lemon Verbena (Aloysia triphylla) as a promising alternative for the treatment of candidiasis (Oliva Mde 2011). Compounds isolated from the essential oil of oregano possess antifungal activity as well (Rao 2010).

Garlic – For centuries, the garlic plant Allium sativum has been used as a popular food, spice, and herbal remedy (Aviello 2009; Dini 2011). Garlic has been noted to possess cardiovascular (Ginter 2010), anticancer, antioxidant, and antimicrobial benefits (Dini 2011). Garlic (and its constituent allicin) can cause potent growth inhibition in yeast and be effective against mucosal and systemic/invasive candidiasis (Chung 2007; Low 2008). Research suggests that allicin, due to its effect on reducing the growth of biofilm (a component of candida allowing it to become resistant to certain antifungal agents), may reduce candida’s ability to become resistant to common antifungal drugs. Allicin may also decrease the production of candida by disrupting its membrane (Khodavandi 2011). A clinical trial found that the topical administration of a garlic paste was as effective at suppressing the symptoms of oral candidiasis as clotrimazole solution (the conventional antifungal treatment for this indication) (Sabitha 2005). Likewise, a clinical study of candida vaginitis concluded that there was no difference in treatment response between a vaginal cream containing garlic & thyme, and a vaginal cream containing clotrimazole (Bahadoran 2010).

Additional Alternative Therapies

AHCC – Active Hexose Correlated Compound (AHCC) is an extract derived from fungi of the Basidiomycetes family. AHCC has demonstrated biological activity against a variety of disorders (NIH 2012). Experimental research has shown that AHCC appears to have a protective effect against candida infections, especially among the immunocompromised (Ikeda 2003). Likewise, a 2008 experimental study suggested that supplementation with AHCC may increase the survival of hosts acutely infected with a variety of pathogens such as Candida albicans (Ritz 2008). Additional therapies to support a healthy immune system can be found in the Immune System Strengthening protocol.

Caprylic Acid – Caprylic acid (also called octanoic acid) is a medium-chain fatty acid found in low concentrations in mammalian milk and in relatively higher concentrations in some tropical oils (eg, coconut oil and palm kernel oil) (NCBI 2019). Several in vitro experiments have shown that caprylic acid and related compounds exert antifungal effects against several fungal organisms, including Candida albicans (Adams 1963; Jadhav 2017; Payne 1963; Watt 1962). However, the extent of published, peer-reviewed literature supporting the use of caprylic acid as a treatment for fungal infections in humans is limited (Omura 2011). Nevertheless, integrative health practitioners often recommend caprylic acid, in a wide range of dosages, for gastrointestinal candidiasis (Birdsall 1997). More clinical research is needed to firmly establish the role of caprylic acid in the treatment of fungal infections.

Boric Acid – Boric acid (i.e., boracic acid or orthoboric acid) is the most common form of the mineral boron, which is often used as a supplement for building strong bones and muscles as well as supporting cognitive function and muscle coordination (NIH 2012; Iavazzo 2011). Boric acid has also been shown to inhibit the growth and reproduction of fungi (i.e., fungistatic action) (Iavazzo 2011), and is used intra-vaginally to treat yeast infections (NIH 2012; Spence 2007). In fact, a 2011 review article concluded that boric acid may be recommended as a safe, effective, and relatively cheap treatment for recurrent yeast infections (Iavazzo 2011). Boric acid has also been proven to be efficient for the treatment of most yeast infections that are resistant to conventional therapies (Donders 2010), and thus may be considered a second-line alternative treatment option for this indication (das Neves 2008).

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