Superficial Candidiasis Syndrome
Present in all of us, at birth or soon thereafter, is a fungus that lives primarily on the skin, in the gastrointestinal tract, and in women in the vagina. Its name is Candida albicans. It is considered a member of the "normal flora" that live on these body surfaces. A number of familiar conditions occur when this yeast infects these surfaces-diaper rash, oral thrush, "athlete's foot," "jock itch," nail infections, vaginitis, etc. It has not been considered the cause of other "generalized" symptoms-merely the "local" symptoms at the sites of infections, e.g., the vagina, between the toes, etc. These infections of the body surfaces are known as "superficial candidiasis."
Careful attention to the patient's history, however, often reveals the presence of a number of other symptoms that had begun soon after the appearance of the local symptoms. These include loss of energy, inappropriate depression, impairment of short-term memory and concentration, menstrual problems, decreased libido, impotence, premenstrual tension, and other symptoms previously reported. By listening to the patient, it is possible to identify a number of symptoms that began as the local symptoms became chronic, and that disappeared as the local symptoms were brought under control. Listen to the patient! !
It is now 25 years since publication of The Missing Diagnosis, the book that told of the first 22 years of my interest in chronic symptoms related to the yeast "Candida albicans"-a fungus present in all of us, essentially from birth until death, as evidenced by the presence in everyone of bloodstream antibodies to this organism.
In a series of papers that I feel were of great importance, it was reported that in pooled human blood from healthy individuals, 79 antibodies had been found that reacted in the laboratory with Candida albicans, thus identifying this yeast as the source of 79 different substances ("antigens"), each of which had stimulated formation of its own antibody. (Each antibody will react only with the antigen that stimulated its formation. As an example, an antibody formed in response to a "flu shot" reacts only with the influenza virus, the "antigen.")
While these 79 antibodies reacted in a test tube with Candida albicans, thus identifying this fungus as the source of the 79 foreign substances that had stimulated their formation, this does not identify these antigens-only that they came from Candida albicans. The concept that led to this knowledge was, in my opinion, brilliant and points to the probable source of the many generalized symptoms that often accompany chronic superficial yeast infections. The identification of these yeast-derived antigens, and of the mechanism by which they disturb normal physiologic processes, is a promising field for future research.
Yeast had attracted little attention prior to three major developments in the practice of medicine. From 1900 to the mid-1930s the . Index Medicus listed only a dozen or so papers published annually under the heading "Monilia albicans" and later "Candida albicans." This changed abruptly in 1936 with the first of three valuable additions to medical practice-antibacterial therapy. With the availability of penicillin as the war ended, and particularly with the beginning of "broadspectrum" antibiotic availability in 1947 (aureomycin), the incidence of yeast infections continued to rise. Further, the highly dangerous "systemic candidiasis" was reported, wherein yeast spreads through the bloodstream to infect one or more internal organs.
To make matters worse, as far as yeast is concerned, in 1950 cortisone was discovered. This led to a further explosion of reports of yeast vaginitis in the same percentage (35%) of women as had been estimated to have been caused by antibiotics. But most importantly, this also led to immunosuppression as a treatment option in an ever increasing number of conditions.
Soon thereafter the "birth control pill" added its impact to the stimulation of this yeast, now known as Candida albicans, but which had gone through many name changes since its discovery well over a century earlier. During the span of time that encompassed the absorption into medical practice of these three major modalities of treatment,
the increase in incidence of acute yeast vaginitis has been estimated to approach 1500%, with the percentage of cases of acute vaginitis caused by yeast increasing from 25% in 1940 to 90% in 1965.
The advent of broad-spectrum antibiotic therapy also marked the beginning of my interest in Candida albicans. At the time that I was serving as Chief Resident on the Cornell Medical College Division of Bellevue Hospital, I was charged with overseeing the supply of terramycin provided for pre-release testing in the treatment oflobar pneumonia. (The capsules were selling on the "black market" for several dollars each.) We were told to use 1,000 mg every 4 hours "around the clock;" This proved to be two to four times the eventual dose.
I learned very early in my career about the relation of antibiotics to yeast infections. In addition to the familiar vaginal symptoms of itching and discharge, yeast overgrowth often occurs also in the colon, leading to excess gas and bloating, accompanied by constipation or diarrhea, and possibly rectal itching.
Today, after appropriate work-up returns only normal results, these G.I. symptoms are almost always correctly diagnosed as IBS (irritable bowel syndrome) but mistakenly attributed to "stress." Nystatin, an anti-fungal drug, in the proper dose alleviates these symptoms, thus identifying their true cause.
Four years later an event was to occur that demonstrated convincingly how Candida albicans was being ignored as a significant factor in human illness. This case is described in detail later in this report. Briefly, in 1953 a coal miner was given the antibiotic aureomycin when a cut finger became infected. Immediate diarrhea was followed by fever, cough, marked weight loss, and 6 months hospitalization. Treatment with cortisone, antibiotics, and many other drugs failed to slow the progressive downhill course.
Detailed examination of the massive (6 month) hospital chart revealed that two sputum cultures had been positive for Candida albicans. This was ignored by the many consultants who had been involved in the case; .it was considered an "opportunistic" infection of a patient who was dying from an as yet undiagnosed disease. When requestioning revealed how the illness had begun-diarrhea from aureomycin given for an infected finger-treatment of this yeast led to a full recovery.
The final stimulus to my interest in Candida albicans arose when one of my children developed severe asthma, leading eventually to my adding the treatment of allergies to my practice of Internal Medicine. Four years later it became necessary that I limit my practice to allergies. It was at this point that the importance of yeast in human illness could be explored in depth, resulting eventually in the publication of 5 papers and a book detailing my experiences and conclusions regarding the importance of Candida albicans in human health. The first paper, "Tissue Injury Induced by Candida Albicans: Mental and Neurologic Manifestations," was presented after 16 years of investigation. My book- The Missing Diagnosis-was published 6 years later.
The present book-The Missing Diagnosis II-is a sequel to the first; it represents the most recent 25 years of observations in diagnosing and treating chronic yeast infections.
While one purpose of the present book is to update the views expressed in the earlier publications, a primary purpose also is to present for patients an informal discussion as to how they may conduct a "therapeutic trial" to see if this may be the answer to frustrating health problems that have defied the many attempts to elucidate their cause. Patients carrying out such a diagnostic therapeutic trial will find interesting the results of studies of carbohydrate handling in a group of women with symptoms essentially identical to theirs. Published herein as my 6th paper, it is titled, "Membrane Transport in Patients with Chronic Superficial Yeast Infections: Insulin Resistance and Glycosuria-The Metabolic Syndrome."
This 6th paper shows strikingly consistent abnormalities in carbohydrate handling in 52 women with symptoms of the "superficial candidiasis syndrome" (SCS). When the yeast infection is properly treated, the simultaneous disappearance of the generalized symptoms as the local symptoms are brought under control, together with return to normal of the pretreatment laboratory abnormalities in carbohydrate handling (impaired glucose tolerance, insulin resistance, etc.), establishes the relation of these symptoms to these metabolic abnormalities, and of both to the partial, temporary loss of control of Candida albicans.
I emphasize the fact that these publications present my personal experiences and beliefs regarding Candida albicans. "My doctor says that he (she) doesn't believe in chronic candidiasis" is a statement that many patients have relayed to me. The latest textbooks continue to treat yeast as more of a nuisance than as a significant cause of chronic ill health, the principal exception being the instances of deep (formerly "systemic") candidiasis associated primarily with diseases of the cells of the immune system itself (HIV, leukemia, lymphoma, etc.).
When something new is reported in medicine, normally others try to duplicate it. To the best of my knowledge, there have been no such papers published. Many have expressed their disbelief, but not because of a failure to confirm.
Finally, it is important to stress that the "therapeutic trial" is for diagnosis rather than treatment. Patients should consult their physicians regarding long-term dietary changes since other conditions may be affected adversely. Further, since the diet is just one of the components of treatment, it alone cannot be expected to bring this fungus infection under control.
If the three to six weeks trial of a low carbohydrate-low yeast diet results in partial or total relief of a number of the characteristic symptoms of the "superficial candidiasis syndrome" (SCS), treatment should be placed in the hands of the patient's physician or another physician, preferrably one trained in treating allergies.
The diet used to point to this diagnosis may need to be modified to take into consideration other medical problems that may be present. Also, the diet requires adjustment as improvement continues. For these reasons a physician is essential to supervise long-term treatment.
For more information please purchase "Missing Diagnosis I and or Missing Diagnosis II"
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