By John Parks Trowbridge, MD, FACAM
“There are known knowns. There are things we know we know. We also know there are known unknowns. That is to say, we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know.”
~ Secretary of Defense Donald Rumsfeld
I Haven’t a Clue
I didn’t know about yeast, so I didn’t think of it.
I had heard about yeast, but I forgot to consider it.
I knew about yeast, but I didn’t think it could be causing these problems.
I didn’t know any tests could show yeast problems, so I didn’t order them.
I had heard that yeast maybe could cause illness problems, but I didn’t accept that explanation.
I know that women had yeast problems – but I couldn’t see that recurrent infections for them or for men could be related.
I know that treating a persistent rash is easy, but I never thought that yeast overgrowth could explain why it keeps coming back.
I’ve been treating infections all my life – just learning how to use newer antibiotics is probably what my patients need.
I’ve heard that antibiotics upset gut bacteria, but I can’t see how that could lead to any recurrent health issues, so I’ll just keep treating persisting problems the best ways I know … or refer to specialists as needed.
When the Yeast Syndrome Is Not Treated As Needed
Let’s get one thing perfectly clear: “yeast” is NOT the problem.
Yes, a startlingly wide panoply of discomforts and illnesses relate to toxins produced by yeasts – but yeast is NOT the problem.
So … what is the real answer?
Our patients, quite simply, are sick. Their immune systems are failing, their physiology is twisting all wrong, their nutritional status is compromised, their food selections are abysmal, stresses in their lives are overwhelming – and our “doctoring” often worsens their conditions and addresses none of these root causes.
Root causes? Yes. The Yeast Syndrome is nothing more than the result of our inadequacies, our failures to advise our patients on how to correct their underlying challenges.
In other words, they are sick … and stay sick … and get worse over time for one simple reason – it’s our fault!
“I don’t do anything wrong!”
Actually, you probably don’t do anything right.
But you hold yourself out as a “health professional” – allopathic physician, osteopathic physician, naturopathic physician, chiropractic physician, physician assistant, nurse practitioner, nutritionist, health coach. That means that patients innocently believe that you know what you’re talking about, that you know how to assess their problems, that you know how to propose and manage treatments to help them regain and maintain better health.
But you don’t. Because you simply don’t know what to do. Because you lack the training, the experience, and the perspectives to “see” what’s really happening with regard to yeast.
Remember – it’s not the yeast. It’s the deficiencies in the patient.
For those of you who treasure medical history – this misunderstanding is the classical and predictable result of relying on the discredited views of Pasteur rather than recognizing the more realistic ones of Béchamp and Bernard. Pasteur – a chemist – insisted that his “germ theory” easily explained that a microbe was responsible for every disease. In contradistinction, Béchamp, a physician and pharmacist, and Bernard, a medical physiologist, both endorsed the body’s natural healing mechanisms, maintaining that microorganisms only become pathogenic after environmental factors cause the host’s cellular “terrain” to deteriorate.
History records that Pasteur recanted his conclusions on his death bed, admitting that Bernard was correct, the “terrain” was the best explanation for development of disease. Did Nature consider that his opinion actually mattered? Not at all. Galileo spent the last nine years of his life in house arrest, having been adjudged by the Roman Catholic Church of promoting heresy, namely the proposal by the Polish astronomer Copernicus, that the earth orbited around the sun. Did Nature consider that the judgment of the church mattered? The only thing that ever matters is the Law of Nature because that’s how the real world works.
So, the question must be asked – can you do anything right?
I don’t mean to sound antagonistic. But honestly I’m not here to win friends. I’m here to influence people. Practitioners. So that dozens of millions of patients can – finally – be treated, correctly and well, with their health being restored and preserved for years to come.
Are you now ready to learn how to do “what’s right”?
The real question, of course, is whether you’re ready to admit the prospect that preconceived ideas limit your ability to see what is causing illness in many of your patients…to abandon those that fail to deliver the best results…and then to learn more fundamental principles of disease and health that will enable you to treat your patients well. Finally. For real.
Let’s Start from the Beginning
Descriptions of what sounds like “thrush” (oral yeast colonization) hearken back to the time of Hippocrates circa 460–370 BCE. Vulvovaginal candidiasis was first described in 1849 by Wilkinson; and in 1875, Haussmann demonstrated the causative organism in both vulvovaginal and oral candidiasis is the same. For dozens of years, these persistent, often recurrent, infections were considered and treated in isolation, unrelated to other clinical circumstances. In almost all instances, Candida albicans is the invading organism.
Medical advances come from keen observations and a willingness to learn their explanations. With regard to The Yeast Syndrome, the story is profound in its simplicity. During his training, Alabama internist C. Orian Truss, MD, in 1953 evaluated a coal miner with a cut finger whose organ functions were rapidly deteriorating despite antibiotics and steroids. “When were you last well?” was his question: “Before I cut my finger.” C. albicans growing in sputum cultures had been dismissed by his physicians as opportunistic – but Truss chose to treat him with Lugol’s iodine solution. The antifungal effect was startling … and the patient fully recovered.
Dr. Truss was called to the psychiatry service to treat a young woman with yeast infections of the vagina and intestine, seemingly associated with allergic asthma and hives. Reviewing her chart, he realized the coincident onset of mental confusion and suicidal depression. But then came the surprise…the rapid disappearance of mental and virtually all other symptoms when he aggressively treated her yeast infections. His reluctant conclusion: the apparent capacity of this fungus to cause serious systematic illness.
Not yet fully obligated to his observations, Truss was confronted with more patients suggesting that yeast could be a significant pathogen. After completing studies in female endocrine pharmacology, he found that many women seemed to suffer from a constellation of symptoms that baffled their doctors – leading, as expected, to their diagnosis as hysterical or hypochondriacal. A pattern emerged: many had a long history of repeated vaginal yeast infections. Could the variety and persistence of their symptoms represent an undiagnosed sub-clinical infection with C. albicans? Truss prescribed nystatin (isolated in 1955 from bacteria found in a barnyard in New York state) rather than the usual gentian violet used for comfort with yeast overgrowth. Many patients experienced dramatic recovery.
In 1978, Truss authored a landmark article entitled “Tissue injury induced by Candida albicans: Mental and neurologic manifestations.”1 Several other papers followed, detailing his experiences. Coining the term “The Missing Diagnosis,” Truss later summarized his unique observations in a self-published book of that title in 1983. He expanded the scientific explanations for these unique perspectives in his sequel, The Missing Diagnosis II, self-published in 2009.
Truss’ revolutionary concepts came at a time when rampant antibiotic use, refined carbohydrate consumption, and medical infatuation with steroids unwittingly turned many patients into “yeast factories.” A wide variety of symptoms unexpectedly improved, irritable bowel discomforts, as did skin conditions, allergies, mood problems, including anxiety and depression, as well as inordinate food cravings associated with obesity and pre-diabetes. The brilliance of Truss’ insight is that Candida was more than just a superficial infection of the skin or mucus membranes. Rather, its presence triggered a storm of allergic, metabolic, and immunological reactions that affected many organ systems – including the brain. Dr. Truss recognized the diagnostic confusions, since the manifestations vary greatly from patient to patient, depending in part upon the location and extent of tissue colonization, but principally upon the patient’s immunologic and allergic response to yeast antigens and to possible toxins released by the fungus.
Pediatric allergist William “Billy” G. Crook, MD, pushed these ideas into the public awareness by his easily understandable trade paperback, The Yeast Connection, published privately in 1984 and then by Random House since 1986. He was justifiably excited to share with me sheafs of typewritten pages as he was assembling his book. As I learned from him and others how to “treat yeast,” I knew I had to share more academically supported information, and Bantam Books published The Yeast Syndrome in 1986.
Let’s Get Real
Medical advances are routinely resisted by mainstream practitioners who fail to understand the bases upon which better diagnosis and treatments are evolving. The Yeast Syndrome has been no different – except, perhaps, that such opposition now has a 40-year history…thanks to astonishing ignorance and arrogance.
The formal position of the purported clinical experts, published in 1986, remains virtually unchanged to this day. Their pejorative statements, utterly lacking any serious clinical trials, simply dismiss that The Yeast Syndrome could, in any believable way, explain a great number of conditions with which adults (and children) are suffering, which have been ineffectively treated by such “expert allergists” for years:
Candidiasis Hypersensitivity Syndrome – Approved by the Executive Committee of the American Academy of Allergy, Asthma and Immunology: The alleged basis for the syndrome is described by Crook as follows: Antibiotics, especially broad spectrum antibiotics, kill friendly germs while they’re killing enemies. And when friendly germs are knocked out, yeast germs (Candida Albicans) multiply. Diets rich in carbohydrates and yeasts, birth control pills, cortisone and other drugs also stimulate yeast growth. Large numbers of yeasts weaken your immune system.
Your immune system is also affected adversely by nutritional deficiencies, sugar consumption, and by exposure to environmental molds and chemicals (such as formaldehyde, petrochemicals, perfume, and tobacco). When your immune system is compromised and your resistance is lessened, you may feel bad all over and develop respiratory, digestive, and other symptoms. And you’re apt to develop adverse reactions to additional foods, inhalants, and chemicals. As a part of these reactions, mucous membranes throughout your body swell, and you develop infections caused by bacteria and viruses that a strong immune system would ordinarily conquer.
When you develop an infection, you’re apt to be given broad spectrum antibiotics. Such antibiotics, while at times essential, promote the growth of Candida albicans which depress your immune system. And your health problems continue until the vicious cycle is interrupted by a comprehensive treatment program designed to decrease the growth of Candida albicans and increase your resistance (Crook WG: The yeast connection: a medical breakthrough, ed 2. Jackson, Tenn., 1984, Professional Books, pages 15,16).2
Perhaps someone could have realized that “the science” was clearly confirming the original observations of Truss. Well…that would have been nice.
Steven Novella, MD, an academic clinical neurologist at the Yale University School of Medicine, offered these outright false and fallacious conclusions on his website https://sciencebasedmedicine.org, making the following claims in a post, dated September 25, 2013:
Science-Based Medicine is dedicated to evaluating medical treatments and products of interest to the public in a scientific light, and promoting the highest standards and traditions of science in health care. Online information about alternative medicine is overwhelmingly credulous and uncritical, and even mainstream media and some medical schools have bought into the hype and failed to ask the hard questions.3
The site asserts independent and reliable scientific authority: “SBM is entirely owned and operated by the New England Skeptical Society, a non-profit organization dedicated to promoting science and critical thinking.”
In this light, you should critically review his following unsupported assertions:
Compromised immunity can lead to overgrowth of the fungus Candida albicans, but this doesn’t happen in people with intact immune systems, and it doesn’t lead to the vague, unrelated symptoms described as “systematic candidiasis” by alternative medicine proponents….
One popular fake illness is chronic candidiasis. Candida albicans is a fungus that colonizes about 90% of the population (meaning it is present in the body but not causing an infection or any problems). It can, however, become an infection, usually at times of stress or immunocompromise. The most common manifestations are thrush (a superficial Candida infection in the mouth) and vaginitis, also commonly referred to as a yeast infection….
Over 25 years later Candida hypersensitivity remains an unproven claim, but popular among “alternative” practitioners. The claims have also spread, unhindered by logic and evidence….
Candida hypersensitivity is an implausible syndrome, simply another “one cause of all disease” alternative claim. Such claims are useful only for generating demand for fanciful and worthless treatments.3
At least the American Academy of Allergy and Immunology kindly and correctly listed an incomplete number of prominent symptoms that have, in my clinical experience, been dramatically improved by treatment for The Yeast Syndrome:
The symptoms are described as wide ranging, involving multiple systems, and include fatigue, lethargy, depression, inability to concentrate, hyperactivity, headaches, skin problems, including urticaria, gastrointestinal symptoms such as constipation, abdominal pain, diarrhea, gas and bloating, respiratory tract symptoms, and symptoms involving urinary tract and reproductive organs.2
Sadly, their chronicle of such discomforts blatantly ignores the number of actual chronic diseases that can (and often do) appear as fungal interruptions persist and later impair normal physiologic functions. They missed the boat – the horse is already out of the barn – their false presumptions condemn them to subjecting their innocent and trusting patients to a lifetime of suffering, disability, and even death.
Digging their professional grave even deeper – and condemning their patients to never regaining and maintaining better health by proper treatment – they offered the following, again unsupported assertions:
The Practice Standards Committee finds multiple problems with the candidiasis hypersensitivity syndrome.
1. The concept is speculative and unproven.
2. Elements of the proposed treatment program are potentially dangerous.
On the basis of the evidence so far reviewed and until appropriate published evidence to the contrary is brought to its attention, the Practice Standards Committee recommends that the concept of the candidiasis hypersensitivity syndrome…is unproven.2
Poorly designed and conducted “clinical studies” unfailingly reach the desired conclusion with which they began, namely that The Yeast Syndrome is fallacious and ungrounded in any science: “Given the dearth of controlled data on various aspects of this syndrome — including its pathogenesis, diagnostic criteria, and response to therapy — controversy and skepticism persist.”4
Because Grandma Lives 1500 Miles Away
Did you ever wonder…why are there pediatricians? After all, kids are mostly healthy, and while growing up, they have remarkable resiliency and recover quickly. It all has to do with your cousin Beatrice.
Cousin Beatrice? Yep. In the old days, if you got “sick,” your Grandma would reassure your parents, “When your cousin Beatrice got that, we just did such-and-so, and she got better just fine.”
Sadly, we have lost most of the old-time cures and remedies. Settlers and pioneers, both on farms and in the towns, were literally “off the grid.” They had to rely on herbs and other traditional treatments that exploited your body’s natural ability to heal and repair. Lacking these and other effective ways to help our families, we have learned to turn to pediatricians. And a zillion other specialists as well.
The Yeast Syndrome is the archetypal example of how our modern medical approach has succumbed to the Law of Unintended Consequences. Our almost blind reliance in adopting the claims of “scientific advances” has led us down the path where convenient choices have produced complications both unintended and unforeseen, apart from the desired advantages.
Environmental conditions have set the stage for the overgrowth of yeast, almost unhampered by natural defenses that have protected human beings for millennia.
Remember: yeast is not the problem…our compromised immune system allows us to be inundated by toxins that progressively damage our physiology, nutritional status, and endocrine functions…and we succumb in ways never before seen.
As evidence supporting Bernard and Béchamp, consider the key factors of how we become “sick” with yeast overgrowth:
A = antibiotics, widely used, often abused – and microbiome replenishment
ignored leads to reduction of bacteria antagonistic to yeast growth
B = birth control pills – hormonal disruption favoring yeast growth
C = cortisone – in all its flavors – widely used, even over the counter for topical –
favoring yeast growth
D = deplorable diet – more on this later, but sugars and starches favor yeast
growth and nutritional deficiencies impair immune defenses and other systems
E = environmental toxins – we’re engulfed in more of them every year
F = full of stress lifestyles – surging of stress hormones alerts yeast to an
organism facing challenges, ideal for yeast exploitation
G = genetic predispositions – some people more readily surrender to attack
H = health habits adverse to recovery and repair: reduced sleep, on-the-go hurry-
hurry, and so much more
Human beings can withstand many challenges when healthier and “all systems GO”; but when circumstances alter the situation, always-present yeast (especially C. albicans) are aroused to grow more readily. Each “event” encourages yeast to flourish more, and finally body systems are unable to meet the threat as debilitating yeast metabolites and toxins (“Canditoxins”) flood your cells and organs. Welcome to…The Yeast Syndrome.
The Allergy and Immunology Monkeys Are Mocking You
Hear No Evil, See No Evil, Speak No Evil. This widely recognized Japanese proverb refers to those who deal with problems by refusing to recognize them, ignoring the goodness of the truth literally in front of them and the results that are available to those who live in the truth.
As a classical illustration how today’s “cancel culture” is incredibly effective to bear down on professionals and public alike, to suppress consideration of diagnosis and treatments by having their minions relentlessly parrot the same old stories, the following fake data is promoted by the Rare Disease Database of NORD, the National Organization for Rare Disorders:
Since Candida Albicans is supposed to be present in healthy people, treatment is very rarely needed. The American Academy of Allergy and Immunology has stated that the concept of yeast allergy or Candidiasis hypersensitivity is speculative and unproven. Health foods and vitamins are not effective treatments.5
“Tell a lie loud enough and long enough and people will believe it,” said Adolph Hitler, in his dark declaration, Mein Kampf, and he went on to offer: “It is a quite special secret pleasure how the people around us fail to realize what is really happening to them.“ American humorist Mark Twain observed: “How easy it is to make people believe a lie, and [how] hard it is to undo that work again!”
You Can’t Fix “Perfect”!
Patients and practitioners alike fail to understand one profound operation of biology: your body never makes a mistake. Whatever it is doing, that is absolutely correct, given the circumstances. Our efforts to slap the system around with drugs is but a futile band-aid, flailing against the functions hard-wired into our systems for survival. Simply put, if you want the body to do something different, then you must change the circumstances…in response to which, appropriate changes will appear in body systems. Never a mistake, always the perfect response to the situation presented.
Given this understanding, your body is forever trying to tell us what is “going on.” Sadly, we’re so busy trying to “fix it” that we aren’t listening. Certainly this applies to “taking a complete history.” But this also highlights a fundamental problem obvious not only with conventional medicine but also, on inspection, with “functional” medicine and any “casual” understandings of The Yeast Syndrome. Intensive efforts to test for and determine chemical functional aberrations can get caught up in the briar patch and easily miss “the big picture.” Prescribing medications or supplements aimed at “correcting” each identified issue is the sine qua non of “A-to-B” medical practice: you have “A,” we do “B”; you have “C,” we do “D.” The limits to this approach are endless because failure to know and correct the underlying cause will mean adding more items as ever more issues can be identified – focusing on the trees instead of the forest!
One illustration of how practitioners “get in trouble” (that is, fail to get their patients better) is “3-D chess.” If you’ve played chess, you know that pieces move differently; some go in straight lines on the squares, some go diagonally, and so on. With 3-D chess, pieces can move up or down on 3 levels (each stacked above the other) rather than being confined to just one flat surface. Well, think of your metabolism as having eight boards, each stacked on top of the other. Some pieces can “start here” but end up “over there”! How does this relate to The Yeast Syndrome? A patient might focus on a particular problem – say, a square up on the seventh board and 3 over from each edge – because he has future plans and needs “that” fixed. But the body is busy working in other squares, first on this level then on that and then on another and so on. Remember: your body has a very clear priority: it must survive for the next 10 minutes or nothing else matters. While the patient’s priority is important, it might be way down the list, with many survival items ahead of it. The delay experienced by the patient is frustrating, “I’m doing all these things and I’m still not better with (fill in the blank).” However, the body is attending to priorities in order of critical need, laying the foundation for finally getting all of the biochemical processes more in line. Patience and persistence is the order of the day in order to resolve all the issues related to yeast overgrowth. Remember: no mistakes, just exactly what is needed given the current circumstances.
The real treatment for The Yeast Syndrome must rely on changes in our lifestyle, literally changing the situation in order to alter your body’s responses toward normal. There is no short-cut to better health. It is a biological imperative: “We must follow ‘the Science’”
I need your help designing an airplane – got any good ideas? We’re entitled to our ideas on this – our opinions – our beliefs. But…the physics of aviation is…science. That means, established facts. We can cling to our ideas, our opinions, our beliefs—but we’re not entitled to our own facts. They is what they is, period.
The Wright Brothers showed, in 1903, a whole new realm of science for our investigation and exploitation. Over a hundred years of experiments have revealed physics facts that have allowed us to design and enjoy incredible aviation advances today.
Pasteur, Bernard, and Béchamp in the later 1800s blessed us with new understandings of microbes, first observed by the Dutch microscopist Antonie van Leeuwenhoek who accurately described microorganisms (bacteria and protozoa) that he called ‘animalcules’ (little animals) in 1676. Alabama internist Orian Truss, MD, from 1978 through the 1984 publication of his book, The Missing Diagnosis, gave us deeper insights into the physiologic interruptions possible when yeast toxins are elaborated from pathologic growth in our gut, our lungs, our sinuses. The Yeast Connection (Tennessee pediatrician William Crook, MD) first published in 1984, explained in simple language how many people get sick (and can get well) when Candida albicans “overgrows” unrecognized. The Yeast Syndrome, published 36 years ago by Bantam Books, supported these theses with dozens of citations to the scientific literature. Incidentally, we edited the manuscript twice before submission…then Bantam removed one-third of our definitive document, claiming they could not sell a trade paperback of that length. Patients and practitioners forever lost access to those ideas and treatments.
Despite the many disparaging pronouncements from professional organizations and governmental agencies, the facts established by science are not “consensus” but reality. And therein lies the fundamental fallacy to how most practitioners attempt to “treat yeast”: they have heard or read someone’s impressions “about yeast” and “about yeast treatment.” But sadly they have minimal understanding of the definitive pathophysiology and the corrections that are essential to restore and maintain better health. We could have similar debates regarding the many beneficial effects of vitamin C, well documented since the 1960s by Stanford University chemistry professor Linus Pauling, PhD, and many others – but again, we are obligated to recognize and tightly adhere to the constraints established only by…the facts.
We can agree to disagree—but you’ll be wrong if you dispute settled facts. In the final analysis – which is the health of our patients – we must follow the science!
More recent studies have shown that, despite a psychological bias against “invasion” through the gut and against systemic distribution of the ubiquitous enteric fungus, C. albicans may require less opportunism than had previously been considered. High enteric levels (yeast overgrowth!) have demonstrated the ability to spill-over in significant numbers into the host’s peripheral circulation. Further, it can shed its characteristic cell wall and vary its cell-surface immunogens, allowing it to camouflage its identity from host immune defenses, permitting proliferation into the systemic circulation as non-transients.6
The genome of C. albicans is very flexible and can withstand a wide assortment of variations in a continuously changing environment, challenging our usual concepts of fungal infection. While it exists as a harmless commensal in a healthy individual (vagina, oral, and gastrointestinal mucosa), infections can be established when the local microbiota is disturbed, normal tissue barriers are weakened, or an individual becomes immunocompromised. C. albicans displays unusual genome dynamics and can transition between different cell types. These adaptive mechanisms to the immune defenses of its human host are very subtle and extensive, and by these it evades nearly all efforts directed against it at every level. Interestingly, these elegant adaptive responses display a well-adapted parasitism, occurring only in the especially virulent species but not in the less pathogenic other Candida species.
My Secrets
Since first learning of the disastrous effects of yeast overgrowth in 1983, I have gleaned a few fundamental understandings that have been uniformly effective in helping to restore and maintain better health for people suffering from varied discomforts and disorders. Even where The Yeast Syndrome is not the definitive problem, in many chronic conditions its imprints are often there. Failure to address yeast overgrowth as well will generally limit the results available when treating other pathologies.
MEVY Diet
First and foremost: once you go out your front door, you are in dangerous territory.
Our “food system” has been corrupted in ways never foreseen a hundred years ago. We used to have farms and gardens. Now we have agri-business. We used to have only organic, wholesome crops. But then…experiments started in 1943 to improve yields of American hemp – Cannabis sativa – vital for the war effort. This research blossomed in the late 1940s into sudden and widespread application of fertilizers as ammonium nitrate (no longer needed for explosive weapons), phosphorus, and potassium were used to enhance various harvests. Cardboard-tasting tomatoes are plump and moist but lacking in virtually all the rewards of home-grown fruits.
When populations rely on the “foods of commerce,” consisting largely of white flour products, sugar, polished rice, jams, canned goods and vegetable fats, the result is loss of their immunity to dental caries and loss of freedom from degenerative processes, as shown by Weston A. Price, DDS in his 1939 book, Nutrition and Physical Degeneration, A Comparison of Primitive and Modern Diets and Their Effects. Price was director of research for the American Dental Association and collected extensive research materials, available from Price-Pottenger Foundation: https://price-pottenger.org/.
As of 2001, the Cooperative Extension of the University of California noted that over 1,000 food items came in cans – often with processing chemicals, preservatives, excessive sodium and sugar, and heating/packaging intended to preserve edibility for years. Not necessarily healthy nutritive value but satisfaction for the belly. Only 13 percent of our food dollar is now spent in grocery stores. We consume 31 percent more packaged food than fresh food.
When Americans want to skip the effort of meal preparation, they eat in restaurants. Or, more often, they head for over 200,000 quick-serve or casual serve restaurants…spending, in 2019, some 51 percent of their total food dollar – about 10 percent of their disposable income! In 1955, when Ray Kroc opened the first McDonald’s in Des Plains, Illinois, traditional restaurants claimed only 25 percent. Now about 20 percent of all American meals are…eaten in the car!
The US Department of Agriculture determined in 2015 that American households spent just 6.4 percent of their income on food. Nearly 23 percent of that current total is purchasing processed foods and sweets. Back in 1900, families spent about 40 percent of their income on food. By 1950, the percentage was just under 30. What should become outrageously clear is that our food production, processing, preparation, and selection are “sweeter and saltier and more efficient and convenient” as we become fatter and sicker.
So, my very first step in helping patients recover with The Yeast Syndrome is to have them modify their eating to the MEVY diet: Meats, Eggs, Vegetables, and Yogurt.
In many respects, my program is similar to the low-carbohydrate diet first espoused by my friend, New York cardiologist Robert C. Atkins, MD (Dr. Atkins’ Diet Revolution, New York:Bantam Books, 1981). The MEVY diet is extensively presented in Chapters 13, 14, and 15 of The Yeast Syndrome (“TYS”), coauthored with Morton Walker, DPM. Many patients have survived on surprisingly limited food choices, never having eaten a rainbow selection of vegetables. Others claim a dislike for milk products – but daily yogurt intake often overcomes that aversion. Homemade yogurt is easy and can be more appealing, and “makers” are inexpensive and easy to use. I encourage patients to create appetizing snacks by adding any of over 200 rich flavors (www.bickfordflavors.com); placing cups in the freezer provides a real treat. Alternatively, stirring in spices of choice can create delightful “dips” for carrots, celery, cauliflower, broccoli, other fresh vegetables. Those with professed “milk intolerance” often can mix into the yogurt Lactrase or Lactaid (lactase enzymes) and do quite well.
Food choices, of course, ideally should be as “organic” and “fresh” as readily available and affordable. The emphasis is on wholesome nutrition and supporting a healthier gut microbiome. Those who fear elevating their cholesterol by eating meats and eggs should take comfort from the 70 years of research summarized by Fred A. Kummerow PhD, in his engaging book written at age 100: Cholesterol is Not the Culprit: A Guide to Preventing Heart Disease (Summerfield, Florida:Spacedoc Media, 2014). Those concerned about increasing risks associated with insulin resistance known as cardiometabolic syndrome—first described in 1988 as “Syndrome X” by my friend, Stanford endocrinology professor Gerald Reaven, MD—can find reassurance in his book, Syndrome X: The Silent Killer: The New Heart Disease Risk (New York:Simon & Schuster, 2001). Indeed, for many of my patients, their “pre-diabetes” condition improves dramatically when implementing the MEVY program; and Type 2 diabetics often see reduced symptoms and substantially better control, often with lowered medications.
Nutritional Supplements
While healthier eating is essential, recovery from the ravages of The Yeast Syndrome requires addition of general and specific nutritional factors, such as vitamins, minerals, essential fatty acids, and the like. As we reviewed, the problem is not “the yeast” but rather “the terrain,” the body in which these symptoms are being manifested. In virtually all patients, interruptions to normal physiologic functions have resulted from metabolites and toxic substances produced by overgrowing yeasts. Like dominos, interferences and deficiencies can tumble haphazardly, such that fundamental cellular and endocrine functions are damaged, destroyed, or defeated quickly. Part of the confusion surrounding The Yeast Syndrome is that some patients suffer sudden and dramatic symptoms while others seem to amble along, only gradually developing discomforts over years or even decades. Biochemical individuality is obvious, and each patient must be assessed and treated appropriately.
Some key tenets have stood the test of time. Yeast overgrowth has usually been associated with magnesium deficiency, relative deficit of pyridoxine (Vitamin B6, cofactor for many magnesium-dependent reactions), and frank scarcity of EPA (eicosapentaenoic acid), an omega-3 fatty acid commonly found in cold-water fatty fish. These and other nutritional challenges are reviewed in Chapter 12 of TYS. As you can readily suspect, deficiencies in these and other essential components can result in a broad spectrum of biochemical interferences. In other words, patients can complain of widely diverse symptoms, discomforts, and even diseases while they are suffering with similar degrading functions in virtually all cells and systems. Afflictions will arise first in their “weakest link,” which will differ for everyone, and then progress unwaveringly to the next feeble systems, and so on. When “enough dominos have fallen,” patient distresses will lead them to seek relief. Sadly, conventional medical approaches will uniformly overlook metabolic interferences resulting from toxic products from yeast. To better identify these issues, I have successfully used Micronutrient Testing from SpectraCell Laboratories (www.spectracell.com), Red Blood Cell Elements Analysis from Doctor’s Data (www.doctorsdata.com), and Zone Labs Cellular Inflammation Test Kit (eicosapentaenoic acid and arachidonic acid, www.zonediet.com), among others.
You might have heard of the “Die-Off Reaction,” also known as the Jarisch-Herxheimer Reaction (JHR). This was first described in the late 1880s by Adolph Jarisch, an Austrian dermatologist treating syphilis with mercurials and then, in the early 1900s, was recognized also by Karl Herxheimer, a German dermatologist. JHR is an acute, self-limiting, transient clinical phenomenon induced when antibiotics are used to treat infections of bacterial, fungal, and protozoal origin. The mechanism is thought to result from the breakdown of the targeted microbe, suddenly releasing proteins, toxins, and cytokines that provoke inflammation. Symptoms can include body aches, headache, fever, chills, rashes, nausea and vomiting, flushing, fatigue, malaise, perhaps worsening of skin lesions, although more severe reactions are possible, usually starting within hours of starting antibiotic treatment. The severity of JHR appears related to the organism burden in the body.
When I first began treating The Yeast Syndrome in 1983, fully one-third of my patients refused to return for their second or third office visit. I was perplexed because clinically their problems obviously could be resolved by reducing their yeast overgrowth and correcting the pestering biochemical interferences. Their common complaint: “I only thought I felt bad until I came to see you!” Treating their yeast had triggered a robust JHR that I did not anticipate.
This dreadful situation was preventing patients from restoring their health, enjoying life once again free from many discomforts and distresses. What soon became apparent to me was a different understanding of JHR. Yes, its severity can be related to excessive yeast burden in the body, where a massive amount of proteins, toxins, and cytokines can be released. But additionally – even a minimal body burden of yeast can be provocative of JHR if the treatment administered is notably and quickly effective.
Truss and Crook taught the use of nystatin, the first polyene antibiotic, in treating The Yeast Syndrome. The drug is a “channel-forming ionophore,” having both fungistatic and fungicidal activity, binding preferentially to the dominant yeast membrane sterol, ergosterol. The result is formation of transmembrane channels that lead to rapid leakage of potassium and intracellular contents and death of the fungus. In clinical practice, I describe to patients that nystatin literally “explodes” the yeast cells, flooding the area with yeast toxins. In contrast, ketoconazole (Nizoral) and similar “azoles” inhibit the cytochrome P450 14a-demethylase enzyme, hindering biosynthesis of triglycerides and phospholipids, specifically production of lanosterol, a necessary precursor for ergosterol synthesis. I describe to patients that ketoconazole “punches holes” in the yeast membrane, with gradual deflation of the cells and a more controllable “trickle-release” of noxious proteins and cytokines. In the 1980s, scientists had identified at least 20 yeast toxins that directly interfered with human biochemistry. Today, that number is dramatically higher – a toxicity that is appreciated and addressed only by practitioners who acknowledge the profound interruptions associated with The Yeast Syndrome.
This realization led to my developing of a program to “ease into” treating The Yeast Syndrome, minimizing the expression of JHR symptoms. After a patient has adopted the MEVY diet for a week or more – where reduced intake of sugars and starches is less stimulating for yeast growth in the gut – I introduce a supplement of caprylic acid (derived from coconut oil) or undecylenic acid (undecenoic acid, from castor bean oil), gradually increasing the dosage and frequency. Either of these gently “squeezes” on the yeast, reducing the enzymatic activity that allows them to become pathogenic. At the same time, I prescribe Zymex-II, a proteolytic enzyme formulation (Standard Process) that appears as well to have salutary effects for the gut microbiome. My suspicion is that the proteolytic component is “digesting” released toxins and cytokines before they provoke JHR symptoms, and I have used other proteolytics when needed.
And Finally – Antifungal Medications
Within two or three weeks, I add ketoconazole (Nizoral) or fluconazole (Diflucan) as a once daily dosage for about 6 weeks. This approach is slowly reducing the yeast body burden while minimizing release of toxins and cytokines that can provoke JHR symptoms. After another two or three weeks, most patients are ready for the gradual addition of nystatin, a safe yeast-control medication they will need for many months.
Shouldn’t I have more to say about the medications? Not really. My intention is to have the patient arrive, within weeks, on a stable MEVY diet, on needed nutritional supplements, and on nystatin (or Amphotericin-B, a similar polyene). This program, with enhancements noted below, will continue for many months. How long? For as long as we need to repair and restore the disrupted cellular and endocrine functions while we “hold the yeast in check.” Many months. Sometimes years. Suppressing yeast growth/overgrowth is needed in order to give your body the opportunity to recover…and that is how long we need to treat.
My frustration with many practitioners is that they institute a “yeast treatment program” for just a matter of weeks. Then they advise their patient that “something else must be going on,” since their initial symptoms haven’t shown enough improvement. Often abandoning most of the principles upon which I have based my treatment of The Yeast Syndrome for almost 40 years, they embark upon an exploration involving various expensive tests and curious treatments, often with frustrating (sometimes worsening) results as years go by. In failing to understand the pathophysiology of TYS but holding themselves out as capable of treating it, such practitioners have failed their primary duty to their patient. (Truss offered an excellent review on his evolving approach, including injections of yeast antigens – one that I rarely have used: Truss CO. Restoration of Immunologic Competence to Candida Albicans. Orthomolecular Psychiatry. 9(4):287-301, 1980.)
If yeast toxins and the resulting interferences in biochemical and endocrine functions are the root of the patient’s problems, failure to appropriately treat these impairments sets the stage for continuing symptoms, year after year. Often patients will say they “feel better” when doing other alluring treatments – but they’re never quite well. Percolating yeast toxins continue to antagonize their physiology because their practitioner abandoned the only program that could control the yeast overgrowth and allow for restoration of better health. If yeast producing toxins is their problem, then treatment must be aimed at reducing yeast overgrowth and the continuing damage to their biological environment. Close counts only in horseshoes, hand grenades, and shotguns. Treatment for TYS is specific – and can be very effective to restore normalized cellular terrain.
Hamlet’s Struggle Was Real!
We immediately think of “To be, or not to be: that is the question.” But perhaps he was squaring off against many who failed to see the correctness of his position: “Though this be madness, yet there is method in’t.” Just like treatment for TYS!
But let us pause to consider: “To meat, or not to meat: that is the question.” As more people investigate the challenges presented by the defective Standard American Diet (“SAD”), the pressures of fast-food (“quick-serve”) restaurants, and the increasing use of unpronounceable additives (some literally toxic), preservatives, flavorings, canola oil, and such, a variety of approaches have been proposed. Many of these are espoused for those suffering with chronic diseases, cancer, and other aging conditions. And many focus on reducing dietary intake of meat products. The potential consequences of gradual malnutrition can be deleterious and far-reaching.
“Farm meats” are vastly different now than “free range meats” of many decades past – now we are exposed unwittingly to hormones, antibiotics, and fattening feeds used to bring the greatest poundage (profit) to market. Indeed, everyone gets low level deleterious exposure to those antibiotics and to many bacteria that have been able to develop resistance to them! We used to have farms and ranches, now we have agri-business. When affordable and possible, intake of free range “organic” meats clearly can have benefits for longer and healthier life unless a personal choice intervenes.
But…the definition of “meats” can have many interpretations: beef, buffalo, elk, deer, lamb, pork, rabbit…chicken, turkey, duck, pheasant, dove, emu(?)…fishes – freshwater, saltwater, deep water, lobster, crab, crawfish, shark, squid, eel, turtles, and so on. And each of these categories can have products marketed as free range, farmed, fresh-caught, organic, and so on. Some dietary plans also exclude eggs as meat products, also milk, yogurt, and cheeses. So – the MEVY diet has to be adapted to one where these particular preferences can be accommodated – and adjustments likely will be needed over time.
There are many variations of the vegetarian diet, making for an entertaining challenge: an ovo-lacto vegetarian diet includes both eggs and dairy products (easiest to assist!), an ovo-vegetarian diet includes eggs but not dairy products, and a lacto-vegetarian diet includes dairy products but not eggs. As the strictest of vegetarian diets, a vegan diet excludes all animal products, including eggs and dairy (yes, most difficult to manage!).
Each of these diets that intend limitation of meat-related proteins poses certain risks for nutritional deficiencies: amino acids, minerals, vitamins, even fatty acids. Beyond your professional effort to treat TYS while adjusting for MEVY limitations, you must address basic nutritional maintenance. Lingering deficiencies can create or enhance disease conditions, worsen overall health, and shorten lifespan…and these dietary issues might also represent underlying digestive dysfunctions that must be corrected for your treatments to be successful.
Protein-energy malnutrition/undernutrition is a very real prospect, especially for people who have been limiting intake for years. Symptoms can include or mimic those of TYS as well: muscle loss (even contradictory sarcopenic obesity), weakness, fat loss, edema, fatigue, depression, loss of appetite, immune impairment, osteopenia, aggravation of inflammation (inflammaging), alterations in microbiome, and the body simply “not working” as it usually would. Each of these factors can amplify any of the others and they all join in cumulatively, confirming my assertion that “aging is not a natural calendar process but rather a disease happening one day at a time.”
One major cause of protein and mineral deficiencies is simply not getting enough essential nutrients from food or supplements. Many vegetarian programs rely heavily on beans, peas, lentils, nuts, seeds, and soy products. An overdependence on soy can lead to hormonal imbalances. Various grains and rice often are prominent choices. Reliance on these products – along with fruits – to the exclusion of vegetables can lead to excessive starches and sugars, encouraging the growth of gut yeast. Careful counseling is required, including advising patients that a much longer and more regulated treatment program is needed to resolve TYS.
Adding spices and herbs to meals and snacks can help boost flavor and eating interest. Choosing acceptable high protein drinks can help nutritional replenishment, including shakes, smoothies, and milk (especially unpasteurized/unhomogenized, when that is the patient’s choice), as well as high protein bars. When acceptable, choose seafood options that are higher in beneficial fatty acids (omega-3s) and lower in methylmercury, such as salmon, anchovies, and trout. Remind patients that many (most?) packaged foods (including meal replacement bars) rely on canola (rapeseed) oil rather than more healthy oils.
Are these special challenges? Of course! These patients will require your devoted and continuing attention – and often they will stretch your understanding and your continuing search for more knowledge. Helping these folks will dramatically enhance your care of all patients in the future. You will succeed more often with those who give greatest credence to Hamlet: “You cannot, sir, take from me any thing that I will more willingly part withal: except my life, except my life, except my life.”
References
- Truss CO. Tissue injury induced by Candida albicans: Mental and neurologic manifestations. Journal of Orthomolecular Psychiatry. 7:1, 17-37, 1978.
- http://www.aaaai.org/professional/physicianreference/positionstatements/ps14.stm. Accessed on January 31, 2022; Anderson J et al. Candidiasis hypersensitivity syndrome – Approved by the executive committee of the American academy of allergy and immunology.” Journal of Allergy and Clinical Immunology. 1986;78 (2): 271–273.
- Novella S. Candida and Fake Illnesses. https://sciencebasedmedicine.org/candida-and-fake-illnesses/. September 25, 2013. Accessed on January 31, 2022.
- Dismukes WE, Wade JS, et al. A Randomized, Double-Blind Trial of Nystatin Therapy for the Candidiasis Hypersensitivity Syndrome. N Engl J Med. 1990; 323:1717-1723, referencing Blonz ER. Is there an epidemic of chronic candidiasis in our midst? JAMA 1986; 256:3138–9, Accessed on February 12, 2022.
- https://rarediseases.org/rare-diseases/candidiasis/. Accessed on January 31, 2022.
- Hoekstra III PP. Candidiasis and Candidemia. Journal of Advancement in Medicine. June 1999;12:133-142.
John Parks Trowbridge, MD, recognized for a career of innovative integrative solutions, has been named a Marquis Who’s Who Top Doctor in Advanced Medicine and a recipient of the Alfred Nelson Marquis Lifetime Achievement Award. An Eagle Scout and then a National Merit Scholar educated at Stanford, Case Western Reserve, Mount Zion Hospital (now a U. C. San Francisco campus), the Texas Medical Center, and the Florida Institute of Technology, his exceptional experiences in medicine, surgery, and nutritional technologies encouraged him to ask provocative questions. His persistent curiosity in resolving perplexing issues has enabled him to find effective answers. Serving for years as a senior aviation medical examiner for the FAA, a “company doc” for heavy industry, and medical director for a mold remediation company provided invaluable expertise in toxicology and environmental science. A Fellow of the American College of Advancement in Medicine, he is recipient of the Distinguished Lifetime Achievement Award of the International College for Integrative Medicine. He has served as president, officer, or director of several integrative medical, dental, and lay organizations, has lectured around the world, has produced dozens of hours of CDs and DVDs, and has authored many articles and several books, all sharing his unique perspectives. He and his devoted staff at Life Celebrating Health near Houston, Texas, continue to welcome those who insist on enjoying a healthier future: 1-800-FIX-PAIN, www.healthCHOICESnow.com.
