Yeast infections in gut - real or fake?

Factual Questions
1

Disclaimer - I’m not looking for medical advice, just for background info.

A friend of mine was recently told by a doctor that she had some kind of yeast infection in her gut - some form of candidiasis where too much yeast grows in your digestive system. He diagnosed this on the basis that she occasionally had mood swings, felt bloated, and felt that she could not concentrate. As far as I know, the diagnosis involved no tests (ie blood tests etc).

He is sending her to a dietician, with the intent of putting her on a strict diet without bread, alcohol, sugary foods etc. He suggests that this is a widespread problem for women leading to all kinds of depression, and is often linked to antibiotics or birth-control pills.

A quick google suggests that some people think this is a “fringe” or “alternative” view, or even quackery. For eg, the wiki page on the topic links to “Quackwatch” and similar sites. Other sites are in favour and say roughly what the doctor has.

I suppose the diet can’t hurt, but the whole thing has me curious. Is this particular form of internal candiasis real, or fake? As noted above, I’m not looking for medical advice, just facts.

2

It’s no hoax.

From http://www.emedicine.com/med/topic264.htm

GI tract candidiasis:

Oropharyngeal candidiasis

The patient has a history of HIV infection, denture wear, diabetes mellitus, or frequent use of broad-spectrum antibiotics or inhaled steroids. Patients may be asymptomatic, but variable symptoms may include the following:

Sore and painful mouth
Burning mouth or tongue
Dysphagia
Whitish, thick patches on the oral mucosa

Physical examination reveals a diffuse erythema and white patches that appear on the surfaces of the buccal mucosa, throat, tongue, and gums. The following are the 5 types of OPC:

Membranous candidiasis: This is one of the most common types and is characterized by creamy-white curdlike patches on the mucosal surfaces.

Erythematous candidiasis: This is associated with an erythematous patch on the hard and soft palates.

Chronic atrophic candidiasis (denture stomatitis): This type is also thought to be one of the most common forms of the disease. The presenting signs and symptoms include chronic erythema and edema of the portion of the palate that comes into contact with dentures.

Angular cheilitis: An inflammatory reaction, this type is characterized by soreness, erythema, and fissuring at the corners of the mouth.

Mixed: A combination of any of the above types is possible.

Esophageal candidiasis

The patient’s history usually includes chemotherapy, the use of broad-spectrum antibiotics or inhaled steroids, or the presence of HIV infection or hematologic or solid organ malignancy. Patients may be asymptomatic, but variable symptoms may include the following:

No oral disease (>50% of patients)
Dysphagia
Odynophagia
Retrosternal pain
Epigastric pain
Nausea and vomiting

Upon physical examination, oral candidiasis is nearly always present.

Nonesophageal GI candidiasis

Most commonly, the patient’s history includes an association with neoplastic disease of the GI tract. The stomach is found to be the second most commonly infected site after the esophagus. With less frequency, patients may have chronic gastric ulcerations, gastric perforations, or malignant gastric ulcers with concomitant candidal infection. The third most common site of infection (20%) is the small bowel. The frequency of candidal infection in the small bowel is the same as in the large bowel. Approximately 15% of patients develop systemic candidiasis.

Physical examination findings are variable and depend on the site of infection. The diagnosis, however, cannot be made solely on culture results because approximately 20-25% of the population is colonized by Candida. The following symptoms may be present:

Epigastric pain
Nausea and vomiting
Abdominal pain
Fever and chills
Occasionally, abdominal mass

3

I’m not saying there is no such thing as candidiasis, or that it cannot affect the gut, but the symptoms you list from your link seem far more severe - some kind of acute infection, causing vomiting and pain, possibly attacking your organs, for which you may have to be hospitalised.

The one in this case has apparently been inside her for a few years and has just made her feel a little depressed or causing her mood to swing. There is no pain, vomiting etc. The treatment is mostly a diet change rather than a whole lot of drugs.

It’s more like the symptoms described in this Quackwatch link.

4

Is her Doc a real MD? If so, then my WAG is that you aren’t understanding second hand what he is trying to tell her.

Indeed, antibiotics can lead to rather nasty yeast infections. Often, these can be treated by a course of Probiotics, such as live culture yogurt (Activa, etc), or pills.

http://www.blackwell-synergy.com/doi/abs/10.1016/S0928-8244(02)00465-0
"The combination of probiotic L. rhamnosus GR-1 and L. fermentum RC-14 is not only safe for daily use in healthy women, but it can reduce colonization of the vagina by potential pathogenic bacteria and yeast."

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1574-695X.2001.tb01549.x

http://pt.wkhealth.com/pt/re/ajhp/abstract.00043627-200106150-00014.htm;jsessionid=GjRTkK0hrvZkyxLThlWCP2Jqs8fLH9CvRRQVGvcKGh9v3Rw3PVvh!-1547828331!-949856145!8091!-1
Probiotics have demonstrated an ability to prevent and treat some infections. Effective use of probiotics could decrease patients’ exposure to antimicrobials. Additional controlled studies are needed to clearly define the safety and efficacy of these agents.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=12134717&dopt=Citation
Bacterial vaginosis, urinary tract infection, and yeast vaginitis afflict an estimated 1 billion women each year. Once investigation has ruled out complicated underlying causes, the only therapeutic option is antimicrobial agents. In many cases, this is effective at clearing infection. However, recurrences, side effects, and secondary infections are frequent. Coinciding with infection is a disruption of the normal commensal microflora in the vagina, primarily a loss of lactobacilli. The exogenous application of lactobacilli to the host as probiotic agents appears to offer hope as an alternative management regimen to antimicrobial treatment and prophylaxis. Although commercial probiotics specifically selected and proven to be effective for urogenital infections are not yet available, there is growing in vitro and human data to suggest that certain strains could confer health benefits on a large number of women. Given that depleted vaginal lactobacilli and recurrent infection is associated with increased risk of sexually transmitted diseases and preterm labor, multiple antibiotic resistance, and significant reduction in quality of life, the need for probiotic therapeutics has never been greater.
I can give more cites if needed but Google Scholar seems a bit slow tonight.

5

Check out http://www.yeastconnection.com/ for starters. The (in)famous Dr. Crook’s site. I am not making his name up.

God bless practitioners willing to take on cranky, bloated, irritable, depressed, poorly-concentrating chronically-fatigued women. I don’t care what they want to blame it on, or what therapy they want to prescribe as long as it’s benign. I certainly cannot help them. In my personal opinion as a mainstream physician, it’s a crock, but you have lots of believers who will disagree.

The mainstream stance is that candida is very weakly pathogenic and gains a foothold only in the immunocompromised. You can find it almost anywhere in tiny quanitities if you look hard enough, including the gut. Like many putative causes of stuff we are no good at treating it has its ferocious defenders who see it as an obvious cause of multiple problems but feel its role is blown off by mainstream physicians such as I.

6

I don’t want to put words in the venerable Dr_Paprika’s mouth, but when he said “it’s no hoax” I am certain that he wasn’t referring to your friend and her doctor.

As he pointed out, people can develop yeast infections which affect the lining of the esophagus and stomach. This is fairly common in individuals whose immune systems are damaged (as in AIDS).

But, with respect your to friend, it is a complete HOAX. Or at least quackery. The symptoms you describe her as having (mood swings, feeling bloated, and trouble concentrating) are typical for many non-diseases, e.g. hypoglycemia, environmental hypersensitivity, systemic candidiasis, etc.).

Check out Quackwatch and then search therein for terms like “candidiasis”, “candida”, etc.

7

That’s what I get for not reading carefully enough.

GI yeast infections are very real, as the article says. I’ve never heard of a link to diet or birth control pills. Depression by itself usually involves mood swings and inability to concentrate. I was referring to GI candidiasis existing and not your friend and her doctor.