Acute, chronic and recurrent candida overgrowth and thrush: restoring balance and addressing root causes

Thrush / candida overgrowth symptoms

Initially, symptoms may be minimal, meaning you can have thrush without discharge, yet this may increase with the amount of overgrowth. Candida overgrowth can present with different symptoms depending on its location, such as:

Gastrointestinal symptoms:

• Diarrhoea
• Constipation
• Sugar & carbohydrate cravings
• Difficulty concentrating, brain fog
• Bloating, gas and distention – particularly after eating sweet or starchy foods

Genital thrush symptoms:

• Itching and irritation to the genital area
• White ‘cottage cheese’ like discharge, from penis or vagina
• Pain and stinging with urination or sex
• Difficulty retracting the foreskin

Oral thrush symptoms:

• White ‘cottage cheese’ like deposits in the mouth
• Redness and thick white coating to the tongue
• Unpleasant taste or odour in the mouth
• Burning sensation in the mouth
• Redness inside the mouth
• Cracks at the corners of the mouth

Chronic candidiasis can contribute to nutrient deficiencies, creating further symptoms and increasing health complications, affecting digestion, skin, nails and hair health, mood and cognitive function.

Candida can also impact the immune system negatively by promoting production of Th2 (T helper 2) cells, therefore suppressing Th1 (T helper 1) cells. The immune system ideally has a balance of Th1 and Th2 cells, with Th1 responsible for killing of viruses, fungi and bacteria, and Th2 directing attacks on pathogens. Th2 dominance, where there is a dominance of Th2 cells, may increase the risk of development of autoimmune conditions in genetically susceptible people, increasing this risk further with chronic infection. For this reason, candidiasis has been linked to onset of autoimmune conditions such as vitiligo, idiopathic thrombocytopenic purpura, and initiating antibodies to a part of the brain called the cerebellum.

What causes thrush?

C. albicans lives in two main forms: as a yeast, a spherical, single celled spore which is not pathogenic, and as a hyphae, which is shaped like a spear and can puncture cell walls, taking zinc and iron from the cells. Candida lives in our gut and on skin as one of our normal (commensal) microbiota species, and will opportunistically overgrow when the conditions allow it. This occurs in immune suppressed individuals, or where the gut microbiome has been disrupted, occurring with these risk factors or conditions:

• Antibiotic use – antibiotics are indiscriminate killers of the gut flora, both beneficial and pathogenic, and allow space for opportunistic species to overgrow, including candida
• Diet high in sugar, and refined carbohydrates – candida’s favourite foods, which stimulates the change from the non-pathogenic yeast form into the proliferating hyphae form
• Stress – which can alter the pH of the gut, and therefore the type and number of gut flora species, and can deplete an immune protein called secretory IgA, which would usually control C. albicans
• Lowered immune resilience – due to other chronic or acute health conditions or medical treatments, such as chemotherapy, HIV, glandular fever, and COVID-19
• Autoimmune conditions such as lupus, thyroid disease, multiple sclerosis
• Diabetes Type 1 or Type 2, and metabolic conditions – if blood glucose is not managed well, it can feed C. albicans and can suppress immunity
• Medications such as immunosuppressants and steroids, and drugs that alter the microbiome pH, and the oral contraceptive pill
• Nutritional deficiencies such as Zinc and Vitamin A – which can contribute to inflammation and suppress immune function
• Heavy metal toxicity
• Intrauterine devices, spermicidal use
• Oral contraceptive pill use, hormone / oestrogen replacement therapy, or high levels of oestrogen, such as the surges occurring in perimenopause and pregnancy
• Gut dysbiosis due to food allergies or intolerances, poor diet, nutritional deficiencies or other factors

In some instances, C. albicans can combine with other microbes to form a biofilm, which is a protective layer that makes it resistant to many conventional antifungal treatments.

Low-grade candida infections can be difficult to detect, as they may be asymptomatic, with recurrent flares associated with the above risk factors. Candidiasis is related to gut flora dysbiosis, and if low grade and chronic, can be a source of inflammation. The following seemingly unrelated dysbiosis symptoms combined with recurrent episodes of candidiasis may indicate a chronic low grade infection:

• Acne, fungal infections of skin or nails, eczema
• Acid reflux / burping
• Anxiety / depression / panic attacks
• Bloating, distension, abdominal pain
• Brain fog
• Diarrhoea / constipation
• Low immune resilience
• Weight loss resistance

Other candida non-albicans species are less common, including; C. glabrata, C. tropicalis, C. krusei and C. parapsilosis, which are often accompanied by milder symptoms than caused by C. albicans. These non-albicans species are more common in women following antibiotic treatments, or in high oestrogen states such as pregnancy, perimenopause, or taking hormone replacement medications.

How to test for candida overgrowth in the gut in Australia

In order to assess the appropriate natural thrush treatment, in Australia, functional medicine candida overgrowth testing might include the following:

• Comprehensive PCR stool testing such as GI 360, or GI Map to determine imbalances of specific microbiota species, detect candida albicans or parasites and check for levels of secretory IgA

Other tests that may indicate or suggest the presence of candida overgrowth. are:

• Food reactivity testing to isolate foods that may be contributing to dysbiosis of the gut flora
• Heavy metal, mould and environmental toxin testing
• Organic acids test (OAT) to assess a range of metabolic markers
• Testing will help to identify all aspects that are causing the imbalance and allowing thrush to thrive, so they can be directly addressed

Thrush treatment – the conventional approach

Conventional antifungal treatments for candida are available by prescription from your doctor, pharmacist, or over the counter. They include a range of pharmaceutical medications as lozenges, creams, pessaries, or tablets.

Most commonly, women with vulvo-vaginal candidiasis present to their GP for diagnosis and treatment when the infection is new or chronic, however, the majority of women self-treat subsequent or recurring infections with over the counter pharmaceutical products.

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

Two main pharmaceutical classes are prescribed:

Polyenes – such as topical nystatin and the azoles:

• Imidazoles, clotriamazole and miconazole (both, topical) and ketoconazole (oral)
• Triazoles, fluconazole (oral)

Other pharmaceuticals, prescribed less often:

• Boric acid intravaginal capsules
• Flucytosine (topical)

Pharmaceutical medicines can provide relief, however, they come with side effects, and many women with recurrent vulvo-vaginal candidiasis relapse after ceasing treatment. Treatment with the oral fungicidal drug fluconazole can be effective short term, however, long-term treatment can result in Candida albicans  becoming resistant, and can contribute to disturbances of bowel flora balance.

Patients taking flucanazole long term are recommended to test liver function after 6 months, and liver toxicity has been reported with long term ketoconazole users recommended to have monthly liver function tests.

If choosing pharmaceuticals to manage thrush is preferred, topical antifungals are the best choice over oral medicines, as they exert their action locally rather than systemically, where problems arise.

Chronic thrush treatment can be more difficult with treatment resistance and concerning drug side effects. These are some of the reasons that many people with chronic thrush / recurrent yeast infections seek natural treatment for candida in the gut and throughout the body.

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