Candida and IBS: What you can do about it

three out of four women will suffer from Candida

Research has shown that 75 percent of women develop Candida at least once in their lifetime. More than 6 percent of women suffer recurrent episodes.

Candida is a type of yeast, or fungus, that is a part of your body’s microbiota. Candida can be found on and inside of the human body. While candida plays an important role in educating the immune system’s development and health[1] problems such as irritable bowel syndrome (IBS) may arise when Candida overgrowth occurs, a condition referred to as “candidiasis,” which will be the focus of this article.

What is Candidiasis?

Candidiasis is an infection caused by the overgrowth of Candida species which can occur in people of all ages, from infancy and throughout adulthood. Causes of overgrowth include: diets high in sugar, carbohydrates and saturated fats, use of certain medications such as antibiotics, birth control pills, chemotherapeutics or immunosuppressants, chronically elevated glucose levels as seen in diabetes and obesity, as well as in conditions associated with weakened immune systems such as rheumatoid arthritis or chronic infections.[2]

There are five main species of Candida associated with human fungal infections, including: Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis, and Candida tropicalis.[3] Candida albicans is the most commonly isolated species. Its overgrowth is associated with both superficial (mucosa lining and cutaneous/skin) and systemic, whole-body infections– especially and including those related to the gastrointestinal tract.

What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) “is one of the most common functional gastrointestinal diseases with high prevalence worldwide”.[4] With the aid of the Rome IV diagnostic criteria, clinicians often give patients a diagnosis of IBS when other causative diseases of intestinal distress are ruled out.[5] While the exact mechanism(s) behind IBS remains unclear, researchers continue to explore the pathophysiology of IBS, especially, and including the gut-brain interaction.

In 2019, an article was published in the journal Frontiers in Microbiology that explored the potential role of the gut microbiome in the development of IBS. Researchers observed that individuals with high Candida levels and low gut microbial diversity also had increased levels of certain inflammatory markers. In the presence of increased Candida in the bowels, receptors in the intestinal lining called pattern recognition receptors (PRRs) such as toll-like receptors (TLRs), activated a series of proinflammatory reactions in an attempt to clear the yeast overgrowth. When inflammation goes unchecked, damage to the intestinal wall may occur, resulting in the undesirable passage of proteins, pathogens, yeasts, and other agents into the bloodstream.4

An additional feature observed in patients with IBS is “enhanced visceral perception,” which is associated with “a reduced threshold for pain sense” – essentially proposing that Candidiasis may predispose sufferers to be acutely aware of what is happening in their bodies, in particular the gastrointestinal tract.4

The IBS + Mood Connection

The link between IBS and changes in mood is well established. Dysbiosis and elevations in Candida albicans has been observed in depression, anxiety, anorexia nervosa, autistic spectrum, and schizophrenia, as examples.4

The mechanism behind the interrelationship of the gut and brain is multifaceted, and includes the endocrine system, immune system, and nervous system.[6] As such, individualized biomarkers can serve as an important guide in leveraging targeted therapies.

According to a 2020 study in the journal Psychoneuroendocrinology, TLR signaling can be used as a potential diagnostic biomarker for identification of inflammatory subtypes of depression and hypersensitivity.[7]

Additionally, patients with IBS also exhibit symptoms of hypothalamic-pituitary-adrenal (HPA) axis dysregulation, hormone imbalance, and altered sympathetic/parasympathetic nervous system function.4  These findings are illustrative of the broad ability of the gut microbiome to influence stress response and mood. A simple approach to assessing this impact can be conducted with cortisol testing.

Stool analysis testing may also provide data valuable in the diagnosis and assessment of irritable bowel syndrome. Stool analysis can provide data pertaining to: microbial diversity, the presence of inflammatory markers associated with IBS including fecal calprotectin, Candida levels, and other metabolic markers such as beneficial short chain fatty acids (SCFA) such as n–Butyrate.[8]

Solutions to treat Candida and IBS 

The best solutions for Candida and IBS are individualized. While the standard of care treatment is prescription antifungal therapy such as diflucan, for some, the side-effects (stomach pain, nausea, vomiting, diarrhea, headaches and hair loss) outweigh the benefits. Moreover, antifungal medications may not address other aspects of the condition such as emotional distress, visceral hypersensitivity/pain, or lack of diversity in the gut microbiome.

Holistic remedies fill a much-needed gap in the treatment of IBS related to candidiasis. A typical naturopathic protocol will be three pronged:

Step 1: Support a Healthy Microbiome with Targeted Probiotic Support

In addition to restoring normal microbial health, crowding out Candida species, reducing inflammation, and repairing the cells of the gut, certain probiotic species are capable of relieving symptoms often associated with IBS such as diarrhea, constipation, gas and bloating (Moon, J, 2022).

Consider a probiotic containing active strains of: Lactobacillus acidophilus, Lactobacillus salivarius, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, Bifidobacterium bifidum, Lactobacillus rhamnosus, Bifidobacterium lactis, Enterococcus faecium, and Bifidobacterium longum. In my experience, a highly effective probiotic for IBS is found in Omni-Biotic 10.

Save 15% on Omni-Biotic 10 when you use my practitioner code, DrCain15, at checkout.

Step 2: Employ Antifungal Therapies

Depending on the type of Candida present, certain antifungal agents may be more beneficial than others. Your healthcare practitioner can order stool analysis with culture and sensitivity testing to aid in identification of effective antifungals. Also consider natural antifungal therapies that have the potential to reverse visceral hypersensitivity such as peppermint and caraway oils (Gu, Y., et al, 2019).

Step 3: Support Gut Integrity and Repair

Natural supplements such as L-glutamine have been researched for their efficacy in repairing tight junctions in the gastrointestinal wall (Bertrand, J., et al, 2015) to prevent “leaky gut” and the exaggerated inflammatory response that follows. Typically, L-glutamine is most effective when taken in the powder form, away from food, and before bedtime.

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Summary

The link between Candida, IBS, and mood are multifaceted, but research and treatment into the gut-brain-microbe axis are promising. Emerging data regarding root-cause testing for irritable bowel syndrome, including identification of the presence of yeast and reduced microbial diversity has opened a door to expand therapeutic treatments for IBS with an emphasis on microbial diversity and holistic therapies that target the gut-brain axis.

Dr. Nicole Cain is a licensed Naturopathic Doctor with a masters in clinical psychology She has been interviewed as a mental health expert in Forbes, published in Psychology Today, Well+Good and in journals such as NDNR, and has been a national speaker for PESI. Dr. Nicole’s mission is to introduce a new paradigm for understanding and treating our mental health. As an anxiety warrior herself, she has a special interest in sharing her experiences with anxiety.

[1] Kumamoto CA, Gresnigt MS, Hube B. The gut, the bad and the harmless: Candida albicans as a commensal and opportunistic pathogen in the intestine. Curr Opin Microbiol. 2020 Aug;56:7-15. doi: 10.1016/j.mib.2020.05.006.

[2] Arquilla, E. What is Candida Overgrowth?, Medical News Today, Nov 2020. https://www.medicalnewstoday.com/articles/candida-overgrowth

[3] Turner SA, Butler G. The Candida pathogenic species complex. Cold Spring Harb Perspect Med. 2014 Sep 2;4(9):a019778. doi: 10.1101/cshperspect.a019778.

[4] Gu Y, Zhou G, Qin X, Huang S, Wang B, Cao H. The Potential Role of Gut Mycobiome in Irritable Bowel Syndrome. Front Microbiol. 2019 Aug 21;10:1894. doi: 10.3389/fmicb.2019.01894.

[5] Patel N, Shackelford K. Irritable Bowel Syndrome. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534810/

[6] Cain, N. Mood, Mind, and Microbes: State of the Union. Psychology Today, Apr 2022. https://www.psychologytoday.com/us/blog/mood-mind-and-microbes/202204/mood-mind-microbes-state-the-union

[7] Figueroa-Hall LK, Paulus MP, Savitz J. Toll-Like Receptor Signaling in Depression. Psychoneuroendocrinology. 2020 Nov;121:104843. doi: 10.1016/j.psyneuen.2020.104843.

[8] Chey WD. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. Am J Gastroenterol. 2015 Mar;110(3):444-54. doi: 10.1038/ajg.2015.6.

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